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Loss of Function in Musicians

Author: Andy Evans, Director, Arts Psychology Consultants © Andy Evans 1997

The importance of physical function, and in particular the hand and arm, in music making is so absolute that any technical or physical malfunction hits at the heart of the musician’s self-confidence, and is easily exaggerated and dramatised into a more global ‘problem’ which may occupy the forefront of the musician’s worries until both physical and psychological dramas are normalised.

Residual worries may include ‘curses’ acquired from parents or teachers, of hands being ‘naughty’ or ‘disobedient’ (still the word used for distonias), sometimes reinforced in childhood by a sharp crack of the ruler from our more sadistic piano teachers. There is further all the feelings of technical inadequacy associated with self-learned fingerings on guitar and piano, and the constant search for speed, for which the lightening fingered Eric Clapton was ironically nicknamed ‘Slow Hand’, from ‘slow hand clap’(ton). Hand speed is to the instrumentalist what high notes are to the singer - a potentially alarming signal that the maximum possible feats of technique have to be accomplished, and fear of inadequate speed and dexterity are never totally out of mind.

A further psychological dimension is that of how the musician ‘maps’ his musical imagination. Some musicians rely on sound from their first contact with an instrument, and map their musical world - as jazz musicians do - by shifts in chord and melody, so the fingers obey the sound. Classical musicians routinely rely on the printed score for their mapping - the fingers obey the score. Other musicians like guitarists and drummers map their musical thought in terms of finger movements, hand positions and hand movements, and their tablatures reflect this.

While musical technique is all of aural (for sounds), visual (for cues) and kinetic (for movements), it originates in the musical brain, which varies greatly from one musician to another. While one pianist preparing for a major competition may use a high-planning low-risk-low-gain strategy of rehearsing precise movements, another may go for a higher excitement level by spontaneously imagining the flow of the musical argument in each performance and hoping that one’s all-round technique will allow the hand to follow where the brain leads to the ultimate goal of the elusive ‘peak performance experience’ musicians so cherish. Such was Alfred Cortot, who would rehearse twenty ways of playing a passage and then play the twenty first when he went on stage.

So the way the hand is ‘programmed’ by the brain is of vital importance to the final quality of performance. Accepted wisdom is that the imagination rules the hand, not vica-versa. In terms of practise, this ideally means that the musician practises ‘musical thinking’ as conveyed through tone and technique. Overuse-misuse problems may indicate that fingerwork is being pursued in an obsessive or ritualistic way which affords little ‘musical’ pleasure or progress, leading to loss of motivation or actual physical problems. A cautionary tale is that of Schumann, who ritually pursued finger independence to the point of having to abandon being a virtuoso - though this personal blunder thankfully enriched the world of musical composition.

Frequently encountered problems of instrumentalists

(a) String players

The violin is a masterpiece of bad engineering. Not only is it difficult to hold under the chin, but the right hand bowing action is a perfect example of awful human ergonomics. Given the starting premise that performers are prone to hand shake due to the effects of adrenalin induced by confronting a large audience and a further ordeal by fire of their peers, section leaders and conductors, the very last thing they want to hold in a shaking hand is a metre long wooden object which will go through a motion of several centimetres at the opposite end of a minute hand movement of a few millimetres. It is hardly surprising that string players refer to stage fright as ‘the shakes’. In consequence, the performance psychologist makes friends with large quantities of our national violin sections. The same is true of violists to a lesser extent, and so down the descending scale to cellists and bassists, who suffer considerably less as the bow gets shorter, heavier and lower in grip, and so present in increasingly infrequent numbers.

Less often, violinists present with left hand problems involving vibrato. If wrongly applied this can lead to Overuse-Misuse Syndrome, which is dealt with below.

(b) Wind and Brass

Wind players are more rarely seen for hand shake - there is no bow and the hand is conveniently on the keys. Even the embouchure is less shake prone, particularly in the case of the clarinet. Brass players are beset with embouchure problems - particularly the horns - but hand problems are again a relative rarity.

(c) Keyboards

The primary problem of concert pianists is the fear of memory lapses. Having said that, performance nerves do affect hand technique through shaking and sweating, and if this is the case a general reduction in anxiety should be undertaken by the psychologist. Where the problem is Overuse-Misuse Syndrome, this is dealt with below.

(d) Plucked instruments

Both guitarists and banjo players are prone to distonia and Overuse-Misuse Syndrome.

(e) Percussion

Percussionists may suffer Overuse-Misuse Syndrome as their fellow musicians do, and have added technical worries like overhand/underhand choices of grip and the whole question of how and where to practise, and how to avoid boredom when using practise pads rather than the real kit for reasons of noise.

Problems of psychological loss of function

The early literature of Freud contains some classic accounts of ‘hysterical conversions’, notably that of Anna O, where there was a somatisation including some loss of hand function following the traumatic death of her father. Freud’s conclusion that where there is inadequate emotional reaction and working through of a trauma such as death, the outlet for expression might be through the body is equally true to this day.

I had such a case of a guitarist who following the death of his father, which had not been worked through, had a sudden loss of right hand dexterity on stage in the presence of a ‘father figure’ who he had looked up to musically. This loss of dexterity was not present in practise, but continued to occur on stage, and through working through the events of the time he was able to fully recover his hand function.

Treating problems of psychological loss of function

Cases less ‘classic’ than the above can also be usefully treated by the same methods, though in some more paradoxical cases of arm and hand problems the origin remains stubbornly rooted in the unconscious. The patient may not see the utility of pursuing a longer process of sleuthing round the unconscious where the apparent problem is physical, and a frequently heard plea is ‘can’t you sent me to a hypnotist who will root it out and cure me in a few sessions’. The image is closer to the vaudeville stage hypnotist than the clinical hypnotherapist, whose attempts to teach self-hypnosis and professionally examine the root causes appear to be a severe let-down of expectations.

Provided that a good working relationship is established to achieve some psychological benefits, progress does take place and after a while, patients I have seen have recovered most or all of their hand function. The time scale, however, may be over a year - not the quick fix they had in mind at first.

One alternative for the brave psychologist is simply to bluff it out and refuse to collude with the problem. Provided the psychologist acts with extreme authority and directiveness this may work, as it did when Freud treated the conductor Bruno Walter for a difficulty in conducting with the baton. He carefully directed Walter to take a holiday in Sicily for a definite period of time, stating with absolute certainty that the problem would disappear on his return, which it did. While few mere mortals would be so authoritative, the lesson in not colluding with the problem is the foundation of modern pain management and is well learned.

Problems of physical loss of function

(a) Distonia

Because the distonias typically involve no pain or total loss of function, they are less dramatic in presentation than Overuse-Misuse Syndrome. Nonetheless, they are a real problem in that any fault in technique affects a perfect performance, and consequently the livelihood of the sufferer. The performance psychologist may help with alternative techniques designed to bypass or ‘fool’ the problem, because the paradoxical nature of distonias may lend itself to strategic solutions. General reduction in psychological tension and life stressors may help either directly or indirectly, and a programme of ignoring rather than obsessively colluding with the distonia may again help. This is not an easy area to operate in, and advances in research will help considerably with our limited understanding of how to diagnose and treat this problem.

(b) Overuse-Misuse Syndrome (RSI)

What is often referred to as ‘RSI’ seems on the face of it to fit the cases of professions such as keyboard operators, and has thus been seen by the various unions protecting the working conditions of journalists and other frequent keyboard operators as being simply ‘overuse’. This interpretation was originally used for pianists, violinists and guitarists in which it is most often seen. Performing arts specialists dispute this and claim it is better interpreted as not only ‘overuse’ but also ‘misuse’ of the body - particularly resulting from practising long periods in a psychological and physical state of stress and inappropriate posture, for instance before important exams, auditions and competitions.

The difference in emphasis is important not only for diagnosis but for prevention and treatment. The treatment for ‘overuse’ is considered to be complete rest, while that for ‘misuse’ is much more complex, including psychological help with stress reduction, practise attitudes and posture correction.

Whatever the interpretation, the initial treatment plan requires a prompt intervention by a medical specialist, in conjunction with a physical/postural specialist (usually a physiotherapist), which should serve to diagnose the nature and extent of the problem and the overall nature of the treatment plan, which may go on to involve the psychologist and possibly also any of the following, as needed and appropriate:

An Alexander or Feldenkreis technique practitioner
An osteopath
An acupuncturist
A hypnotherapist

A coherent treatment plan is essential not only for the correct treatment of the problem, but crucially to gain the patient’s confidence in the recovery plan that is to be put in place. Without one ‘centralised’ team approach, the patient will show every desire to ‘browse’ around all sorts of plausible practitioners, each of which points out both the ‘perceived’ focus of the problem and a ‘helpful’ intervention. If no attempt is made to co-ordinate the treatments offered, the patient will rapidly end up substantially out of pocket, totally confused and mistrustful of everyone involved in the ‘alleged’ solution of the problem.

Since the psychologist will rarely be the first practitioner involved in a case of physical pain, it is crucial that those involved in the initial assessment present a realistic picture of what the psychologist can and can’t do, so that the patient comes to therapy sessions with the right attitude.

An example of the ‘wrong’ attitude is a referral to a psychologist which goes along the lines of ‘I’ll send you to Mr X, who is very good with musicians and will surely help sort out the problem’. The patient is quite likely to infer that Mr X is, like the medical model just experienced, a person who will give a clear and helpful diagnosis followed by an equally clear recovery plan.

The reality of the psychologist’s work is that even assessment is complex - the mind is by far our most complex organ and is not easily examined. Time is required to assemble the jumble of psychological factors potentially involved, and even more time is required to see those factors that stand out as priorities. Yet more time is required for the patient to comprehend and accept his own problem - for the blindingly obvious reason that any material in the ‘unconscious’ is by definition not yet in the ‘conscious’ mind. More time again is required for the patient to accept and accommodate changes in perception, attitude and actual behaviour that might eventually help solve a problem or avoid its recurrence. A cherished medical colleague of mine once wryly observed that ‘the difference between doctors and psychologists is that with psychologists nobody dies and nobody gets better’. Humour aside, this could well be borne in mind as an initial approach to the ‘softly softly catchy monkey’ nature of the psychologist’s approach.

In the past I have seen a number of patients who present with less than helpful or realistic attitudes to the work of the psychologist. These are primarily the ideas that:

Pain is felt ‘in the body’ so the problem should be in the body
Physical practitioners therefore seem to offer more of ‘a cure’
‘Talking about’ pain is not on the face of it relevant or productive

Given the high levels of desperation and frustration that musicians feel when contemplating the loss of their life’s work and ambitions, this is not surprising, but nor is it helpful. What is helpful is the attitude that mind and body are closely related in a constant feedback loop, and that any gain anywhere in that loop has knock-on gains on the total performance system. Such a holistic attitude may be anathema for the impatient sufferer seeking a clear solution, but it is particularly appropriate in these cases.

Having moved on from some initial ‘cautionary advice’ on referrals, which has already become second nature to the new corpus of enlightened medical specialists involved in regularly dealing with musicians’ problems, we can now look at some of the useful work the psychologist can do with the full co-operation of the correctly referred patient.

Treating Overuse-Misuse Syndrome

The first difficulty both the client and the therapist has to grapple with is ‘how much of the pain is physical and how much psychological in origin’. Typically the medical specialist will find some initial problem, e.g. inflammation, and there will be an accompanying diagnosis from a physical practitioner of ‘misalignment’, ‘bad posture’ etc. No indication is usually given of what percentage of the problem is manufactured in the mind, and indeed such a calculation would be very difficult to achieve. Typically the inflammation improves to the point where nothing shows up on scans, and the postural issues have been dealt with in a number of sessions, with advice for how to use the body better in future. At this point the pain should go away, but in a significant number of cases it doesn’t.

Since the psychologist’s initial problem is not knowing exactly what percentage of the problem is physical, the opening premise is that there is no guarantee that he will achieve actual pain reduction. It cannot be too strongly stated that the first task of the psychologist is to get the clients trust that talking will be of some use. This trust may be given and then withdrawn according to whether ‘results’ occur, i.e. the perception of pain lessons.

The psychologist is therefore well advised to start with an overview of how talking might prove useful. He may outline some of the following possible areas of help:

Desensitising the mind to pain. One enlightened GP described (to a patient of mine) the main function of the brain as ‘ignoring things’. This useful advice - that the brain would cease to function if it were not able to prioritise what needed to be attended to - goes a long way towards describing the necessity of persuading the brain to ignore pain rather than ‘noticing it’ constantly. Even where organic function is restored, the image of pain can linger, because it obeys the laws of classical conditioning laid down by Pavlov - rapid onset, followed by slow desensitisation. Pain is no longer actual but a dramatically over-sensitised perception, which the brain is unable to let go of. The psychologist’s role here is in facilitating this process of desensitisation.
Loss of function, and the emotional stages of loss.
Careers advice if and where the medical advice is complete rest
Tendency to hypochondria, which musicians are particularly prone to because of their hightened imagination, sense of drama, self-involvement and non-verbal focus.
Dealing with sabotage. Performers ‘pushed’ into a career on stage, e.g. by parents, may physically break down as a defensible way of opting out and preserving their identities and alternative career goals.
Dealing with perfectionism. This is a personality type that seems prone to physical breakdown. Since high stress is invested in being perfect, there may be a tendency to over-practise or practise obsessively and unproductively. The standards for such perfection may be set by parents, or siblings and peers for whom there is a high degree of envy and obsessive competition, or by artistic role models (Heifetz and the equivalent) one strives to emulate. The most imaginative artists can even create a nearly-believed-in perfect fantasy version of themselves, incorporating envied physical and mental features of others, which becomes more and more dissociated from their real values and attributes. I have found by examining my database of personality profiles that the most successful performers I have seen are normal or even low on perfectionism, while those who have dropped out or had psychosomatic problems score extremely high. There is a crucial difference between performing a task perfectly, which is the kind of technical mastery successful performers have, and trying to live up to an ‘image’ of being perfect, which is where the problems start.

(c) Personal Injury

Personal injury is something I dealt with regularly for two years as an Occupational Psychologist in rehabilitation centres, and then later on occasions in my ordinary practise. The overwhelming lesson I learned was that of totally separating the roles of the forensic psychologist, whose job is to fight the corner of the injured party in court as an expert witness, and that of the confidential counsellor who must on no account get involved in the legal proceedings.

I developed a lot of sympathy for the inner ‘double life’ of the victim who is forced during a delay of several years to simultaneously maintain a state of injury deserving of compensation and at the same time attempt to recover enough function to carry on with one’s career as best as possible. This unenviable double life takes an enormous toll on the inner mental state of someone who is grappling with all sorts of stages of loss, with their attendant angers, depressions and utter frustrations.

The services of the best possible forensic psychologist - preferrably one who does PI cases day in and day out and knows all the legal angles and the most effective lawyers to use - frees the personal counsellor to explore the real personal issues without having to get politically involved and wear two antagonistic hats.

General Problems of Performance Anxiety

Besides the particular psychological factors directly affecting the hand, as outlined above, there is the fact that anything that puts the mind/body continuum of the musician into a state of anxiety is likely to adversely effect various parts of that continuum, including shaking of the hand, potential for errors and body and limb stress. Added to this, the psychologist is frequently called in where a hand problem is accompanied by general anxiety about performing, since the incidence of performance anxiety is shown by surveys to be as high as 60% to 70% in orchestral and freelance musicians.

A full account of techniques for conquering this are outlined in detail in ‘The Secrets of Musical Confidence’, referred to at the end of the chapter. A brief overview is given below. In my view, the origins of generalised performing anxiety in the musician break down into particular problems, each with different treatments:

a) Performing anxiety

The classic ‘stage fright’ is often the result of a sequence of bad experiences. These are frequently ‘first time’ experiences, such as the first day in school, the first time you had to stand up and recite something to the class from memory, or your first time in the local youth orchestra. Such experiences can ‘condition’ our behaviour to associate fear and the prospect of failure with performing in public. This is known as a ‘learned response’. Such conditioning can either be general, as in feeling a generalised anxiety, or can be a repetitive fear of a particular problem, such as dropping the bow, dropping one’s instrument, not being able to pick fast enough on the guitar, or playing wrong notes.

Treating this is done by a cognitive re-evaluation of the musician’s beliefs regarding performance, starting with an explanation of the peak in adrenalin response that occurs in all performers (not just those who get anxious) just before until just after going on stage. Persuading the musician that this peak is entirely normal allows him to accept an initial sweating, heartbeat and dry mouth as no more than a temporary annoyance that regularly settles down once performance starts. It also soon becomes clear to the musician that he has played through such nerves time and time again, so that the melodramatic feeling of ‘panic leading to humiliating failure’ can be replaced by a more rational analysis of ‘temporary nerves that may slightly compromise but don’t prevent performance’.

Treatment then goes on ‘deconstruct’ the original fright. The essential steps in this are:

Identify how the panic response became associated with performing in the first place. Take a detailed history including other non-performing panic situations if relevant
Begin to dissociate the ‘conditioned’ panic from the essential process of making music. Monitor performances to identify and deal with the particular ‘triggers’ the musician is sensitive to.
Acquire a conscious strategy of mental reactions to respond immediately to recurring triggers.
Acquire a sense of history and reality: the original ‘catastrophe(s)’ that caused the panic happened through a freak combination of factors that will not be exactly repeated in normal music making.
Acquire a sense of scale: nerves - however unpleasant - are not the same as utter panic. You can play through them and survive them.

b) Social anxiety

A distinct type of stage fright comes from bad feelings about fellow performers. It is not unknown for orchestral musicians to have nightmares about desk partners or section leaders or to walk off stage in disgust. Some performers are always criticising others, some feel constantly criticised. Many do both - they feel critical about their own ability and then ‘project’ this on to others by criticising them instead. They then feel really bad when they suspect others criticise them. The criticism goes round and round - we dish it out, we take it in.

The world of performance - and classical music in particular - is a critical place, and contains its fair share of criticism (constructive and destructive) from parents, teachers, critics and competitions/audition panels. It has the worst effect of all on the shy personality types who lack the social skills to deal with humiliating put-downs, and such shy people may be in particular danger of systematic mental bullying. A decent assertiveness course is a highly advisable first step for anyone particularly lacking social skills.

Beside this, however, good results in general can be got from treating attitude problems in the musical world as ‘attributions’. An attribution describes any cause of apparant behaviour that you 'attribute' to somebody or something. Behaviour can be attributed to a set of circumstances - "he's angry because his car was towed away this morning" or to a person's feelings and inner motives - "he's angry because he thinks I can't play the music right". The problem is where situational reasons are confused with people's motives. We then interpret people's anger as displeasure with us, their tired looks as boredom with us, their failure to make contact as rejection of us. This is known as the 'fundamental' attribution error’ - that of blaming ourselves for what we assume is our fault, rather than looking for causes outside ourselves, as the following true story illustrates:

A New York singer/actor came on stage just before lunchtime on Friday, the last day of a week of auditioning for a musical. As soon as he reached the front of the stage the producer groaned and said "Oh No! Not again!" very audibly. The actor fled the stage on the spot, and remained distressed until he happened to meet the producer a few days later. "How could you humiliate me like that in front of everybody" he said angrily, recounting what he thought he had witnessed. The producer looked blank for a while, then his face suddenly lit up. "Oh my God - I know what that was! We'd sent the messanger boy out for some take-away lunch and told him on no account to bring back the tasteless junk food we'd had all week. I turned round as you came on and saw him coming towards us with yet another pile of junk food take-aways. I must have said 'Oh No! Not again!' pretty loudly - I guess you thought I meant you. Now you mention it, you auditioned very well a few months ago, and we had our eye on you for the part".

Dealing with attribution errors

Other people’s ‘vibes’, ‘attitude problems’ or unpredictable behaviour are better dealt with than left in our minds to fester. We have an instinctive feeling that we do not want do deal with ‘their stuff’, but we may need to really train ourselves to disconnect our own feelings from the moods of others. As little children we will have blamed mummy’s bad moods on our ‘naughty’ behaviour, and we have a lot of unlearning to do to be free of this almost unconscious self-blaming tendency. Steps towards doing this are:

Remind oneself constantly that there are all sorts of possible reasons for the moods or actions of others. Had the New York actor done that he might have got the part. So don't start with the assumption you are in the wrong.
Actively try to find out what other people's motivations actually are. Ask them, interpret their actions, look for reasons. Find alternative attributions for your feelings.
Create 'boundaries' between the moods of others and yourself. See fellow performers as 'inside their skins'. Visualise their whole personality as 'contained' inside their skin, so they stop at the boundary of their skins. They will then seem life size, and won't 'spill over' towards you. When other people seem negative or critical, this may be a function of their own inability to cope with their problems. People in the grip of inner problems are naturally inflexible, unsociable, defensive or aggressive. By not responding to their bad moods you help them too.
Be generous to fellow musicians - generosity of spirit is the complete antidote to criticism. As saxist Cannonball Adderley said: ‘fun is what happens when everything is mellow’

c) Intra-psychic anxiety

"Performers are egomaniacs with inferiority complexes" is a succinct way of putting it. Musicians, as performers, have two secret fantasies - that they are ‘really marvellous’ and that they are ‘really not that good at all’. How can the musician allow two such irreconcilable fantasies to exist alongside each other? Well, in a variety of clever ways:

By somehow contriving to never put his talent to the test, by making excuses for instruments, not auditioning for jobs, developing strange physical pains, giving up performing etc.
By carrying on playing with some ‘excuse’ for not doing well, like being drunk, always arriving late etc.
By becoming a rebel and maintaining that nobody really understands.
By convincing himself he is ‘a fraud’, and suffering constant guilt and anxiety that one day he’ll be found out.

This collision of inner fantasies is the reason why the highest stressor in musicians (see ‘Pressure Sensitive’, Wills and Cooper) is ‘feeling you must reach or maintain the standards of musicianship that you set for yourself’. Clearly musicians worry obsessively about their internal standards but carry on performing regardless. The real solution lies in the fact that both these fantasies are some way off reality. Worst fantasies in particular are typically built on things parents or teachers said at some point, such as ‘you’re too nervous to play in front of audiences’ or ‘you’ll never make it to the big time’, which stay in the brain like curses. Such predictors may be totally wrong, and in particular may not allow for the musician’s progress over time. A generally more accurate indication of real ability is how other performers value a fellow professional who is getting a reasonable share of work. This reality is a more stable option than the constant roller-coaster of internal fantasies. Who needs fantasies of being ‘the best’, and who is the ‘best’ anyway? If the musician is valued by fellow professionals, audiences and pupils enough to stay in the business, then this says a lot.

By ‘owning up’ to this realistic self image as others typically see it, the musician can get on with the process of making real gains in his career, rather than forever putting off that wonderful day when ‘his talent will be fully revealed to an unsuspecting world’. Fantasy is important to creative artists, such as filmaker Roman Polanski who said one of the secrets of his art was not knowing where reality ended and fantasy started. In the world of Virtual Reality imagination has replaced money as a unit of currency. But for the classical musician in particular, reality is a consistent ability to deliver the goods. And the musician is not ‘only as good as his last performance’ as some would have us believe - he is as good as a lifetime of study and dedication gives him every right to be.

d) Burnout

I believe that most performers start their love affair with their art form - often at an early age - with somewhere near 100% passion. They then progressively develop from 0% knowledge and disillusionment with the profession to the critical mass of 51% disillusionment. After that the passion for performing goes into negative equity and progressive burnout ensues - performing becomes more disagreeable than agreeable. This is ‘spiritual and emotional burnout’.

Without knowing it, the musician has hit a career plateau where the typical work schedule is fairly similar day in day out, and this applies equally to international artists as to rank and file performers. Energy of youth burns out revealing any number of underlying tensions from performing nerves to worry about the future. Ambition gives place to apathy and low performing buzz as careers becomes more predictable and less varied and challenging.

When burnout is combined with performing anxiety the result is a feeling that ‘I can’t stand it any more - either I reduce the anxiety or I’m giving my career up just to keep me sane’. Loss of motivation may have caused a fall in professional standards which is bringing the performer down close to the minimum acceptable level. This may have been noticed by others before it really hits the performer. To the performer it may be a sudden awareness that denial no longer is an adequate defence - technical elements are suddenly much harder than they seemed, and there is a realisation that one is only just coping. This sudden ‘peak’ in anxiety may be dramatically worse in performers who have become well known and have heavy schedules in the public eye, sometimes stretching ahead for months and years of advance bookings. Fear may become alarm and the performer fights against a desire to ‘call for help’ such as getting permission from a doctor or other specialist to have a short, long or complete break. Typical symptoms of burnout are:

Don’t practise or rehearse enough
Don’t warm up before performances
Don’t listen to other musicians - just try to get own part right
Arrive minutes before performance
Tempted to or actually read papers/books in rehearsals
Have stopped doing solo recitals or chamber music.
May feel consuming guilt at falling technical standards which turns into stage fright
May turn up for work drunk or drugged as a way of dealing with nerves
May use alcohol or cannabis daily and lose track of pressing career needs or reality in general.

Burnout may mirror apathy in other areas (marriage, sex, lapsed hobbies, lapsed sport due to overweight). There may be several common depressive features, such as a sense of ‘not looking back to birth but on to death’ - fantasies one wanted to accomplish in one’s lifetime may no longer be possible - particularly in career terms. When spirits are low and a career is perceived as hitting a trough, it can share depression’s sense of anguish and ‘futilitarianism’.

Recovering from burnout

Life on the ‘mid-life plateau’ can be successfully managed so as to give variety and enjoyment, but not in the same hectic all-consuming way of the ambitious performer straight out of college, and not either in the apathetic and jaded way where actual standards become progressively worse. Increasing passion means reviving interest and commitment, while decreasing disillusionment means managing your life to prioritise pleasure, creativity and variety and decrease all sources of stress. New priorities are:

Sleep and relaxation: pace work, and make periods of calm around important gigs
Take regular holidays. Synchronise holidays with your partner where possible. Get help with children so you can get away - e.g. an au-pair.
Say no. Eliminate the drudge of your bottom level of work. Alert the diary service to your particular needs.
Take exercise. Be fit for tours which take you into overdrive. Work out or swim.
Don’t let teaching schedules overwhelm you. Organise teaching so it fits you, not the whims and exigencies of your pupils/parents - your own comfort is essential for good teaching.
Communicate more, with other performers and your wider social circle. Keep in touch. Visit friends and vica-versa. Have dinner parties.
Have at least one other passion - hobby, reading, sport etc. The more interactive the better.
Increase the variety of work, e.g. conduct, compose, arrange, broadcast, write articles etc.. Also increase creativity - create your own work rather than relying on others.
Do regular solo gigs and play chamber music with friends
Practise for pleasure - take out old pieces as well as your regular exercises

The Team Approach to treatment

We have already mentioned some key team members who get involved in all the medical, postural and psychological issues of hand problems. Whether the problem is one of assessment, treatment, or rehabilitation - or that of simultaneously treating a physical problem and a general case of performance anxiety - there is an obvious need to compare notes on a shared patient simply to optimise the treatment and share in any extra insights that one or other has obtained.

Probably even more important than this is to offer the patient a coherent, believable and co-ordinated treatment plan. It is the patient who is by far the most confused, frustrated and not least out of pocket in being passed around willy nilly from one specialist to the next, and the suffering of the patient should be alleviated as much as possible by clear advice as to who is involved, why they are involved, what can and can’t be done, what time scale to expect, and simply how to convert free-floating anxiety and medico-speak overload into a credible recovery plan. If this can include actual practise plans, examinations at regular periods, ongoing psychological support and explanations of what is happening in plain language, so much the better.

I have been very impressed by the work of Dr. Richard Norris in the USA in exhaustively analysing the ergonomics of performance and designing recovery programmes that are optimised down to the smallest significant detail. His thoroughness and care is a model for us all, and his book is included in the references.

The concept of the Performance Psychologist

I have referred to myself throughout as a psychologist rather than a therapist or counsellor for a number of deliberate reasons beyond the fact that I happen to be one by training. In the sense that I have weekly sessions where I sit in a chair and work with musicians I am no different from any other therapist, but the content and approach of such sessions is sometimes radically different from the general therapist, particularly those of the classical psychodynamic model who reveal no personal details and work strictly with transference. For a start, I spend hours talking in great detail about the musician’s work, career, instrument, practise plans, performance strategies and inner musical life with an added knowledge that I posess in my other function of being myself a professional musician. I also allow the patient to play their instrument, I listen patiently to CDs and tapes and I try to go to live performances where it helps.

By using the term psychologist I have an added agenda of trying to intruduce musicians to the idea that they have at their disposal just the sort of resource that sportspeople call a ‘Sport Psychologist’. If this serves to enlighten them to the realisation that a psychologist is not a socially unmentionable bogeyman who dwells on ‘ineffeciency’ but a friendly, accessible and expert resource that promotes added ‘efficiency’, then hopefully more of our musicians will take advantage of all the progress in expert teatment that has been steadily growing over the last decade into a whole new area of professional help that they can be proud of using.

References:

‘The Secrets of Musical Confidence’ Andrew Evans, HarperCollins UK, 1994. Please note that this book is presently only available from Arts Psychology Consultants, price £8 including postage and packing.

‘Secrets of Performing Confidence’ Andrew Evans, A&C Black UK 2003. Please note that this book is available from Arts Psychology Consultants, price £10 including postage and packing.

‘The Musician's Hand, A Clinical Guide’, Ian Winspur and B Wynn Parry Martin Dunitz, London 1998

‘Studies on Hysteria’, Freud and Breuer, Penguin Freud Library Volume 3.

‘Pressure Sensitive’, Wills and Cooper, Sage Books UK

‘The Musician’s Survival Manual; a Guide to Preventing and Treating Injuries in Instrumentalists’, Dr. Richard Norris MD, The International Conference of Symphony and Opera Musicians (ICSOM)