When I was a piano major at The Juilliard School, I struggled with stage fright. Always fearful of memory or technical lapses when performing, I practiced harder to offset my fears. No one talked about “it,” and my fantasy convinced me that I was the only student in the school with such frightening feelings. At times, I would complain to my piano teacher, hoping for some magic advice, but his words, intending to reassure me (“Don't worry. I'm not worried about you.”) did not provide relief and actually reinforced my wish to please him. I graduated knowing a great deal about how to play the piano, but very little about my anxiety. The dynamics, vicissitudes, and treatment of performance anxiety have continued to interest me as a psychoanalyst.
Although performance anxiety affects many individuals besides musicians (e.g., test takers, public speakers, and athletes as well as individuals who are not specifically in the public eye but must assert themselves in front of others), professional musicians are unique in two specific ways. First, musicians begin training in childhood on an instrument that becomes the focus of their life's work. While career decisions typically are made in late adolescence or young adulthood, the musician spends critical formative years focusing on lessons and socially isolating intense practicing while at the same time interacting with important caregivers, teachers, and audiences who are transference objects. Stage fright has sabotaged many recitals and auditions.
Second, the job market for classical performing musicians is much more problematic than it is for other highly skilled professionals. Unemployment in the arts is notoriously high, pay often inadequate (musicians are famous for accepting “psychic income,” a term borrowed from economists H. Baumol and W. Bowen), and many musicians work at jobs considerably below the level for which they were trained, if they work in music at all. Exquisitely sensitive to preoedipal and oedipal issues of rejection, shame, loss, exhibitionism, envy, and competition (I only mention a few underlying dynamics), musicians are internally primed for the external conditions of the competitive performance profession, where a career may be an adaptive attempt to find approval, love, and applause. Pleasure in music making can be severely compromised and careers abandoned altogether due to the intrapsychic conflicts that present as performance anxiety.
Pleasure in music making can be severely compromised and careers abandoned altogether due to the intrapsychic conflicts that present as performance anxiety.
From a psychoanalytic perspective, it is not unusual to see emotional concerns communicated through physical complaints when the body “speaks.” The body and mind work in concert but not always in harmony. A recent article in my local newspaper quoted a 16-year-old violist as saying he was “terrified” when told he had a “repetitive stress injury.” He found that “talking about it really helped.” A former patient of mine developed arm pain for which there was no organic diagnosis from numerous physicians. It disappeared after we analyzed her repressed anger. Clearly in our time, as Freud discovered years ago, threats to bodily integrity have significant and idiosyncratic meanings as intrapsychic and interpersonal factors potentially confound the presentation and/or treatment of medical conditions.
Yet, anxious performers are not rushing for psychoanalytic consultations and treatment. In fact, research and anecdotal accounts indicate that many performers seek medical treatment for physical complaints including tendonitis, carpal tunnel syndrome, and other pain disorders. Nor has stage fright gone unnoticed by the drug companies. Beta blocking drugs are routinely prescribed for performance anxiety and are often shared among performers without prescriptions. The symptoms that threaten competence and excellence in performance often can be reduced or eliminated.
Arts medicine clinics (emphasis on “medicine”) have been established at major medical centers, including Northwestern University and The Cleveland Clinic. A review of arts medicine by Alan Lockwood was published in the New England Journal of Medicine in 1989. Citing the impressive large scale International Conference of Symphony and Opera Musicians (ICSOM) survey of major symphony orchestra members and numerous other independent studies, Lockwood found that physical problems could seriously challenge or end careers. Suggested treatments included rest, splints, physical therapy, postural changes, biofeedback, drugs, and sometimes surgery.
He concluded that “in spite of many emotional factors associated with musicianship and the sensitive nature of the personality of many musicians, somatic complaints of purely psychic origin are very unusual.” My disagreement with his conclusion was published in a subsequent issue of the NEJM. While not doubting the presence of physical pain and injury and the necessity for medical treatment, I maintain that the symptoms of performance anxiety and the dynamics of the formative years were linked to stage fright and could be related to somatic complaints.
Julie Jaffee Nagel, Ph.D., is a member of the APsaA Program Committee, University Forum Committee, co-chair of the Music Subcommittee of the Ad Hoc Arts and Psychoanalysis Committee, adjunct assistant clinical professor, Department of Psychiatry, at the University of Michigan, and in private practice in Ann Arbor.
The intrapsychic implications of physical pain for the performing musician are as career threatening as are physical conditions. One cannot dismiss emotional pain from someone who has a lifelong ego investment in playing a musical instrument.
Psychoanalysts and musicians have much in common. Musicians, like psychoanalysts, are deeply involved affectively in a working-through process as they interpret musical/nonverbal (and verbal for psychoanalysts) themes, which can be conceptualized as manifest melodies with overdetermined latent meanings. Musical meanings become interpreted through performance and affect both performer and listener, who form a special type of “musical object relationship” replete with transference and countertransference implications. Should intrapsychic conflict block the creative and performing process, psychoanalysts can offer their unique talents to our cultural ambassadors who have the potential to enrich our lives so deeply.