Facing The Music

When the viola player charged off the stage, his colleagues assumed he’d broken a string. The violist knew differently. This was the end of his career.

It had started earlier during the performance – a nagging voice in his head telling him he was ‘a fraud’ and ‘not good enough’ to be there. ‘My bow hand started to tremble. I doubt the person next to me even noticed, but it felt like an earthquake. My hand started to freeze so the vibrato sounded like a nanny goat.’ It was a three-hour performance and it would be a torment to survive. ‘My heart was going 19 to the dozen. I felt sheer terror – claustrophobia. I was playing in a sea of strings and had to swim with everyone else. It was like being in a straitjacket.

I felt cold and tingly, even my vision was affected, I could barely see the music. Stage fright is exhausting. I thought I would collapse.’

The performance was a success and, to prolong the violist’s agony, the audience cried for more. The encore would be just four minutes long and the music was technically unchallenging, but it was still too much. ‘As I rushed out, a brass player was coming on to the stage. I handed him my instrument then slid down the wall on to the floor. The man asked me my name but I couldn’t remember it. I was so relieved to be off stage, but also very ashamed.’ Today, relaxed and happy, the man still refuses to reveal his name. The professional stigma of stage fright in the performing world is too shaming – the taboo too insurmountable.

In the trade, a bad case of the shakes is known as ‘the pearlies’ as in ‘Pearly Gates’, says Julian Maunder, who teaches strings and offers shiatsu to stressed musicians. He says these people would rather suffer in silence than risk their careers. ‘It’s like people calling cancer “the Big C”. They think if they say it they will catch it. Stage fright is the same.’

Strangely, performers are not just hush-hush about stage fright and stress but also illnesses and injuries generally. ‘Within all of the performing arts, the pervading attitude is that the show must go on. Performers are expected to overcome injuries and illness. If you fail to overcome this, there will always be 30 to 50 people wanting to step into your shoes. There is no incentive to put your hand up and say, “I need time out,”‘ explains Eileen Quilter Williams, general administrator of the British Performing Arts Medicine Trust (BPAMT).

The Trust, a registered charity whose patrons include Richard Baker, Simon Rattle and Cliff Richard, among others, is now in its 16th year. It offers a designated health service to performers, including musicians (popular and classical), actors and dancers. It views these professionals as special cases not dissimilar to sports stars. Here is a group for whom even minor medical problems can impact on their very livelihoods. A sore throat, for example – a mere inconvenience for most of us – could be momentous for an opera singer.

In addition, punishing schedules bring a whole raft of occupational hazards into play. Musicians are at risk of muscular problems and hearing difficulties. Actors and dancers risk injury. Irregular hours and long rehearsals allow little time for healthy living and the competitive nature of showbiz raises stress levels into the stratosphere. It is either ironic or a classic example of self-protective denial that the performing world thrives on a culture of repression. It’s a case of put up or shut up.

Angelina Spurrier, a classical ballerina who works at the BPAMT, remembers one director telling any dancer who complained: ‘I have a top hat full of names of girls who will dance for me for nothing.’ During her career touring in Germany, she says she never dared show any weaknesses. ‘You had to appear to be 100 per cent focused at all times. Any anxiety and even injuries had to be buried. So many of the girls I worked with had eating disorders or drinking problems and everybody smoked.’

But the culture is changing. Increasing numbers of performers are learning of the BPAMT’s existence and turning to it for help, while health and safety legislation means employers can no longer afford to be complacent.

Typically, a performer’s first contact with the BPAMT is made via the charity’s helpline. Around 20 to 30 people call each day and most are invited to attend one of its clinics or are put in touch with an appropriate consultant, doctor or therapist. At the BPAMT’s headquarters in London’s Covent Garden, Louise Miller, a GP working part time in a city practice, is holding her monthly clinic. Like so many of the Trust’s doctors, she has a strong interest in the performing arts, singing in a choir and playing the cello. She gives her time for free, offering each patient a 30-minute consultation – a luxury compared to the seven to 10 minutes most of us get when we visit our doctor.

‘I love coming here. I never know who is going to walk through the door next. I have seen everything: actors with acne, singers who think their voices change when they go on the pill, tumblers with back problems, dancers with eating disorders, keyboard players with neck problems,’ explains Dr Miller. The list goes on. Musicians arrive with their instruments. Dr Miller likes to watch how they play, as their posture or the way they move or hold their instrument can provide diagnostic clues. If an instrument is too big to carry, she will have them simulate the movement by using her desk as, say, a mock keyboard or drum kit.

Simon Hallett, a double-bass player with the Royal Opera House Orchestra, consults Dr Miller with an archetypal musician’s complaint. He has hearing problems. ‘The pit is so enclosed that it is like a resonating box. Over the last 12 to 18 months, I have experienced a loss of high frequency sounds and I also have mild tinnitus,’ he explains. He has already seen a doctor but wants a second opinion from the BPAMT’s empathetic and knowledgeable medical team.

‘An ordinary GP may not recognise that the problem takes on a new importance because you are a musician. They will treat you the same as if you are a bricklayer,’ says Hallett. He is delighted that the Trust also helps raise awareness. When he first joined his orchestra, musicians were not offered hearing tests and nobody wore earplugs. Now this is standard practice. Dr Miller is familiar with the issue – the use of earplugs is one of her hobbyhorses. As well as running clinics at the Trust, she is the medical advisor to the London Philharmonic Orchestra (LPO) and insists that all its musicians wear earplugs.

Placing doctors with orchestras is another service overseen by the Trust. Dr Miller was assigned to the LPO in April last year and remembers being invited to stand on the conductor’s rostrum to introduce herself to the ‘band’. As a perk, she gets to see her patients perform for free. ‘As they come on stage, I wonder how they are feeling. It is very nice going to a concert where you know the performers.’ Dr Miller visits the orchestra every three to four weeks, whenever it is resident in London. Her sessions take the form of an open house. Any LPO performer with a medical issue can consult her.

Typical problems include string players with muscular-skeletal problems, musicians with hearing problems or complaints about stress, exhaustion or performance anxiety. For the latter, she may suggest relaxation techniques or, if a performance is imminent, prescribe beta-blockers. However, if the problem is more severe, she might refer the patient on to one of the BPAMT’s specialists, such as psychotherapist Tony Yates. The frightened viola player (not a member of the LPO) who dashed from the stage found help via the Trust. Tony describes the man’s ‘critical inner voice’ as ‘a severe superego’. It is a phenomenon he sees commonly. He says the problem normally stems from childhood, where the critical voice was that of a pushy parent.

‘This inner voice may be partly aspirational (it tells you how to perform better) but is also partly judgmental,’ says Yates. As part of his therapy, he teaches the patient to ‘separate their self-esteem from the performance’. In other words, the person is taught to have an identity outside their work.

‘Interestingly, the minute you take the focus off the performance and look at the person’s whole life, the performance problem starts to diminish,’ he says.

He likens the process to marital therapy, which may bring a couple closer or help them to separate. And so it is with performers. Therapy helped make the viola player ‘psychologically healthier’, but he has stopped performing professionally. ‘Now I just play for the hell of it. I play better now than before because I no longer carry that burden.’

What is the BPAMT?

The British Performing Arts Medicine Trust (BPAMT) is a charity that puts performing artists in touch with a network of doctors, associated professionals and alternative practitioners experienced in performing artists’ problems.

Regular clinics are held at the BPAMT’s headquarters in London and Manchester. Practitioners running these sessions include, among others, GPs, an ear, nose and throat consultant and two hand specialists. Therapists working with the Trust range from psychologists to chiropractors. Most services are offered to performers free of charge, or at reduced rates. If you are a professional performing artist or ‘serious’ amateur (such as a member of a colliery band or choir) in need of medical support call the BPAMT’s helpline on: 020 7240 4500 (London) or 0845 602 0235 (outside London).

The BPAMT also runs the Association of Medical Advisors to British Orchestras, which is currently seeking to recruit medical professionals who can donate their time free of charge. Contact the administration department on (020 7240 3331) for more details.

Anyone who would like to support the Trust financially can subscribe to the BPAMT supporters’ organisation, Take a Bow. Annual subscriptions cost £35. More details from the administration department or on the BPAMT website, at www.bpamt.dial.pipex.com.

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