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Rob Ruggiero regularly directs musicals at the Goodspeed and The Muny in St. Louis. Why would he see the need to bring one to the small-staged, low-ceiling, acoustically complicated TheaterWorks, where (as the theater’s producing artistic director) he’s directed mostly straight plays?

His breathtaking production of “Next to Normal” at TheaterWorks shows you why. Ruggiero is familiar with every inch of this small stage, and finds opportunities on it that others would miss. He can turn a step on a short staircase, or an area that’s little more than a shelf, into platforms for grand vocalizing. He utilizes a revolving stage to show the turbulence of family life. When the stage isn’t turning, Ruggiero has the actors spin the furniture, whether it’s a dining table or a hospital gurney.

This metaphorical mental-disorder maelstrom is, in these environs, quite precise. “Next to Normal” is not a wild, mad musical, though there are some jarring rock chords, blinding lights and what-the-heck shocks in the plot to contend with.

The approach is clinical, in the best way. The dialogue is cleanly delivered. The vocal harmonies are carefully aligned. The (onstage, yet unseen) band is tight. To the great credit of sound designer Ed Chapman, every note or word sounds crisp and clear.

The clarity is crucial for such a challenging work of art as “Next to Normal.” The show, which won a Pulitzer in 2010, chronicles the fraught day-to-day existence of Diana, a woman with bipolar disorder. Book writer/lyricist Brian Yorkey and composer Tom Kitt externalize her struggle by showing the effect it has on her family. We follow Diana through a series of treatments, but “Next to Normal” is just as much about the personal tragedy that appears to be the catalyst for her condition.

For what is essentially a family drama studded with piano recitals, first relationships, scrapbook reminiscences and the preparation of school lunches, “Next to Normal” continually surprises the audiences with plot twists, shifts in tone and abrupt changes in tempo. Some of the sweetest tunes in the infectious pop/rock score are staged ironically, with people singing of better times while massive problems are being faced.

Wilson Chin’s clever set design — walls of IKEA-style boxy shelving units — is claustrophobic and airy at the same time, orderly yet random. It’s an appropriate background for the mental gymnastics of Diana and those who are trying to keep up with her.

As Diana, Christiane Noll — a fearless performer whose previous mental-illness musical in Connecticut was “Lizzie Borden” for Goodspeed Musicals in 2001, and who played the long-suffering Mother in the recent Broadway revival of “Ragtime” — can switch from indomitability to vulnerability in a split second. As Diana’s husband Dan, David Harris — so breezy in “Anything Goes” at the Goodspeed last season — can seem shell-shocked and upstanding at the same time. Harris and Noll are an ideal couple for this musical — their singing voices have the same timbre. When they fight, their voices waver on the same wavelength.

J.D. Daw plays two different doctors — one of them a pedantic pill-dispenser, the other a psychiatrist who’s described as (and loudly presented as) a “rock star.”

The other three members of the cast represent various types of troubled youth. Maya Keleher (the pride of Columbia, Connecticut), John Cardoza and Nick Sacks make teen angst a major underscoring factor of the show. They’re natural and convincing, a hard act to pull off in such an up-close atmosphere. Keleher, as Dan and Diana’s daughter Natalie, has work on two levels just as her parents do — in her case petulant and passionate. Natalie is trying harder than anyone to hold herself together, and becomes the heart of the show.

“Next to Normal” is the sort of edgy, bracing, outspoken work that TheaterWorks takes so much pleasure in doing. Being done with such careful thought and expressive detail in such an intimate environment raises this already confrontational musical to a different level of emotional intensity. It’ll blow your mind.

NEXT TO NORMAL runs through May 14 at TheaterWorks, 233 Pearl St., Hartford. Performances are Tuesday through Thursday at 7:30 p.m., Friday at 8 p.m., Saturday at 2:30 and 8 p.m. and Sunday at 2:30 p.m. Tickets are $60 to $75. 860-527-7838, theaterworkshartford.org.

Editor’s note: This story has been updated to reflect that “Next to Normal” has been extended to May 14.