s The Phantom of the Opera simply a supernatural love story—or a case study of someone experiencing major depression with psychotic features? During the grand rounds showcase, Dr. Tobia set out to convince the audience of the latter. The theater-like production took place onstage in the hospital’s Arline and Henry Schwartzman Courtyard. Through breathtaking operatic numbers, it featured Udine, in character as Christine, offering the patient’s perspective, while Dr. Tobia informed the audience at every step “what is really going on with Christine.” Shawen M. Ilaria, MD, chief psychiatry resident and an accomplished musician, accompanied Udine on the piano. As Udine sang, Dr. Tobia provided lyrical examples of how the show’s trajectory follows Elisabeth Kübler-Ross’s five stages of grief—denial, anger, bargaining, depression, and acceptance— which Christine deals with as a character. “Phantom is not only the most inspiring musical I’ve ever seen, it is also a perfect clinical study for teaching about mood disorders,” Dr. Tobia says. “In Christine, we find a character who is dealing with complicated bereavement—she is still mourning her father, who died when she was 13—along with significant stress in her life. It allows us to talk about what is known in the DSM [Diagnostic and Statistical Manual of Mental Disorders] as persistent complex bereavement disorder and its potential evolution, which includes full-blown clinical depression, psychosis, and suicidality.” Dr. Tobia admits his views may be unorthodox. “The first time I saw Phantom in 1995, as soon as Christine steps through the mirror in the dressing room (act 1, scene 3), I was mesmerized. I viewed everything that followed in the musical as a product of Christine’s imagination.” He also contends that even though Phantom ends with lovers united, it is likely that the Christine character, sometime after the play’s conclusion, commits suicide. “There are clues in the show,” he says—such as the tone in which the viscount tells the story at the outset—“that suggest that they don’t spend their lives together.” All this speculation (Andrew Lloyd Webber has not weighed in), Dr. Tobia points out, is in the name of teaching, which is always the goal. “Every didactic I teach has stated objectives that I have to reach,” he says. “We take care to keep the narrative 10 Robert Wood Johnson I MEDICINE n fall 2016, Anthony Tobia, MD, associate professor of psychiatry (above, right) and Broadway actress Julia Udine (left) came together to give the Rutgers community a glimpse into the psychiatric underpinnings of The Phantom of the Opera for a special grand rounds. evidence-based and not promote the stigma of mental illness.” Udine, 23, first learned of Dr. Tobia’s use of Phantom through her sister, Michelle Udine, MD ’14, now a resident in pediatrics at the University of Alabama at Birmingham School of Medicine. Four years later, working with him on this project, she’s found herself delving into Christine in a deeper way. Much of what Dr. Tobia has to say about what’s happening in Christine’s mind, she says, rings true. “As an actor, you try to connect with the role you are playing, find the subtext, so you can make sense of what’s happening on the page,“ says Udine. “If