A couple weeks back, Slate had a long form article on people using beta-blockers to help with nervousness and stage fright. Just seeing the title, I immediately recalled a piece Drew McManus wrote 15 years ago wondering if the use of beta blockers among orchestra musicians was akin to athletes using performance enhancing drugs.
The Slate article made me wonder about the pressures orchestra musicians face because both performing artists quoted in the article were orchestra musicians. One was a performance psychologist on faculty at Juilliard who was against their use. The other was a cellist who actually founded a company that provides online consultations with doctors to help people access medicines. He is a frequent user of beta-blockers.
A 2015 study the Slate article links to shows that 72% of musicians have tried beta-blockers. 92% of responses indicated beta-blockers were most effective at dealing with nervousness (91% indicated experience was most effective). All those surveyed were orchestra/chamber/opera musicians since the survey was an update of a 1987 survey for International Conference of Symphony and Opera Musicians.
Use of beta-blockers is growing according to the commentary on the 2015 survey,
With regard to beta-blockers, the study shows that 72% of ICSOM musicians have tried using beta blockers for performance anxiety. Out of that group, 90% said they would consider using them for auditions, 74% would consider them for solo or featured performances, and 36% would consider them for orchestra performances. By comparison, in 1987 a reported 27% of ICSOM musicians had tried beta-blockers, representing a significant uptick (45%) over the last 28 years. Also in 1987 of those who’d tried beta-blockers 72% said they would use them for auditions while only 4% would use them for orchestra performances compared to today’s 36%.
While there has been an increase in the number of those who have or intend to use beta blockers, on a positive note, musicians have increased efforts at lead healthy lifestyles and pursue alternatives,
Today’s classical musician also reported better than average health and there was major increase in physical exercise as a method to address performance anxiety. In 1987 61% of musicians reported regular exercise and in 2015, 68% reported regular exercise. As a means for addressing performance anxiety, however, exercise was used by 17% in 1987 and 74% in 2015, a striking increase.
In both Drew’s 2004 piece and the recent Slate piece, there are people who swear beta-blockers are the best thing in the world and pretty much survive day to day by using them.
There are two big issues, however. The first is the obvious point that the pills are just masking the effects so that the root cause of stage fright/anxiety is never addressed so it is no wonder that people feel they need to continue to use them.
The second, and perhaps bigger problem is that the FDA has not approved the use of beta blockers for anxiety. They were created to address chest pain and heart arrhythmias. Taking them incorrectly or if you have a medical condition you are unaware of could result in everything from fainting from low blood pressure to heart attacks.
Going off them abruptly—say, if you took them for a string of presentations, then stopped—is dangerous, too, because blood pressure can spike in response, argues LeRoy.
This is a topic that bubbles up every few years that bears paying some attention. Since there are so many musicians using beta-blockers with apparently no ill-effects, (unless there are unreported incidents at auditions and performances), I imagine people will continue to use and swear by the pills. But this focuses on the symptoms without questioning the causes.
Perhaps the easiest place to start investigating is the training process itself to see if that might be engendering anxiety. The 2015 report asked the age people experienced their first performance anxiety and the largest response was approximately 33% between 11-15 years old. Approximately 25%-28% between 16-20 years old and 15% of respondents between 5-10 years old.
When you say using them doesn’t treat the causes that is a presumption. In some cases, surely, but in others there are uses of this and similar medicines that serve to break either/both a physical or chemical pattern but also psychological patterns. The assumption you are making is that the state of anxiety is a permanent or baseline condition in all cases. Yes, in some that would be true, but occasionally our bodies and minds just need the reminder that there are alternative ways of coping in the world, and that removal of a symptomatic obstacle is itself a condition of flourishing.
Its like taking pain med that relieves the pain but does not specifically or directly treat an underlying cause. The absence of pain afforded by taking the pill allows the surrounding muscles to relax relieving pressure on the causal condition and so indirectly enhances the body’s ability to heal. And the idea that there are psychosomatic illnesses should be a caution that things like anxiety aren’t always the effects of some underlying cause but are themselves the cause of those underlying conditions. Medicine and biology are too complicated to simply assume a one direction causal influence. Symptoms are causes and causes are symptoms at times.
Or so it seems to me…….