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Beta Blockers
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LSOviolinist
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PostPosted: Sun Jan 27, 2013 12:47 am    Post subject: Beta Blockers Reply with quote

I was recently speaking with a colleague before rehearsal and we wandered into conversation about beta blockers and their effects on performance. She told me that a number of professional musicians took beta blockers before performances and auditions to help ease nerves. I was astounded, never hearing this before, to think that in all my years as a professional string player I had never heard of such a thing. I had known a few players to take a swig of hard liquor before a performance to take the edge off, but never a drug. I did research on this topic only to find that it is a source of much controversy and disagreement. For those who do not know what "beta-blockers" are, they function as a blocker to the bodies norepinepherine or what is more commonly known as the fight-or-flight response. This is what makes musicians sweat profusely, shake, and breath rapidly. When the drug is ingested, it keeps the norepinepherine from reaching the beta receptor which in turn prevents the fight-or-flight response. The drug MUST be prescribed by a doctor.

After reading many sides and sources, I have developed a strong opinion on the matter. I think that is unacceptable. I am not arguing against those who actually need the drug. I am saying that for those who take it simply to make their performance a bit less nerve racking, that it is absolutely wrong. Part of being a musician (especially a professional) is possessing the ability to stand up and perform in front of people. Every performer gets nervous, from Itzhak Perlman to someone giving their first performance, but it is the cultivation of that fear that truly MAKES a performer. I always get butterflies before I walk on stage but I know how to work with that. To eliminate that feeling, is to take away from the essence of the job, and nerves do not always detract from a performance, they can actually make it better. I guess what I a getting at it that I think the performer should always try their best to gain control themselves without the help of a substance. When practicing, the musician does not cut out the parts of the score that they have difficulty with or cannot play, they practice slowly. The same technique applies here. If the performer is afraid to play in front of large groups, start with small groups. Here are just a FEW of the interesting articles that I read on the subject

http://www.guardian.co.uk/music/2008/jun/05/classicalmusicandopera.news
http://www.nytimes.com/2004/10/17/arts/music/17tind.html?_r=0
http://www.ethanwiner.com/betablox.html
http://articles.philly.com/2010-08-16/news/24973169_1_beta-blockers-graduate-student-performance-anxiety
http://www.mndaily.com/2010/03/01/better-music-prescription

I would be very interested to read what professionals and amateurs think about this topic.
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Lemuel
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PostPosted: Sun Jan 27, 2013 1:56 pm    Post subject: Reply with quote

I agree with you entirely.

I wouldn't be surprised (but wouldn't bet on it) that many performing musicians, not just violinists, depend
on these things before they go on stage.

Practice unto perfection is only 50% of the solution. In my experience, I made sure every note and passage
was covered during practice, but when it came to performing, everything changed all of a sudden, like you
have a completely different set of hands and fingers.

I believe the root of the problem is the "fear of rejection and criticism". It is human nature to want acceptance.
For others, it is even worse, because they want praise and honor. In short, the problem arises from the
musician's desire to receive (versus give) to the audience. The solution lies in proper mental training and is
basically a shift in one's outlook to love the music and to give to the audience he/she is playing for.

Kato Havas deals extensively with the issue of stage fright in her book "Stage Fright", published by Bosworth
and Co.

(By the way, I'm curious, how many solo musicians do you know go through bouts of depression?).
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LSOviolinist
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PostPosted: Sun Jan 27, 2013 2:50 pm    Post subject: Reply with quote

Lemuel,

I think you are absolutely correct about the "fear of rejection and criticism." Once a performer comes to the realization that they are performing for themselves and not the audience and that they are SHARING this experience, they can begin to harness their nerves. That is not to say that these terms are completely separate, but, mentally there should be this understanding. In regards to your question about solo musicians and bouts of depression, I would have to say all of them (including me.) I think that every musician goes through phases of frustration, depression, anxiety, joy, passion, and everything in between. I cannot think of a single instrumentalist that I know who has not been through bouts of depression. I think it is part of the nature of working in the arts. Creativity is unstable, and as artists we are able to work with this changing force and make beauty. It is a highly emotional field. I once knew a gifted cellist who went to a prestigious conservatory, had a decent solo and orchestral career and seemed to be doing great. One day out of the blue, I received a phone call from a colleague explaining that he had quit the cello. He had fallen into a deep slump of depression and it did not look as though he would play cello again. The upshot of this is that he did not play cello again for six years. Six years! That is a long time to be away from an instrument. He is playing again today, but that serves as an example that surface perception can be deceving. The celebrity examples of this are numerous. Jacqueline DuPre gave up the cello for a time and struggled to come back to it, Nadja Salerno-Sonnenburg gave up the violin then came back to it, after struggling severely with depression and almost committing suicide, in fact, out of the top 10 fields that create the most depressed prone people, musicians ranked at number 5! It all reverts back to feelings of acceptance, love, and appreciation from the audience and colleagues. I still think, despite all of this, that drugs are not the solution. If someone really needs them for a condition or has significant depression, then of course it is the right route but to simply dull the jitters, I cannot approve. I liken it to a gymnast that wants to have calluses surgically implanted on the hands so they are more comfortable on the bars instead of working through the pain and earning the those calluses. Working with nerves is the same. Experience is what creates tolerance.
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Lemuel
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PostPosted: Sun Jan 27, 2013 8:42 pm    Post subject: Reply with quote

LSOviolinist wrote:
It all reverts back to feelings of acceptance, love, and appreciation from the audience and colleagues.


Thanks for answering my question. Yes, this is the root.

It's a paradox really. Those who are constantly worrying about feeling accepted and appreciated, never
truly experience acceptance, and those who are not worrying or looking for it, experience it.

I think stage fright applies to anyone going on stage, not just musicians. Unlike calluses though, when a
person experiences stage fright, the memory of the experience creates an ongoing fear of future re-occurrences.
It is even worse if people in the audience openly criticize or tear down the performer for his failure.
Have you ever seen this happen?

I once attended a student audition session, where Yehudi Menuhin was there to provide constructive feedback
as needed. One advanced student made a few minor mistakes during her performance. I fully expected Menuhin to
provide some positive feedback, but to also critique those areas where she could improve. Instead, Menuhin told
her to start all over with her bowing (i.e. beginner). There's nothing wrong with this, but I saw her becoming
disoriented from a few negative responses that came from the audience.

Unfortunately, we live in performance-based society (versus relationship based) where acceptance and love,
and feelings of being valued (self-worth/esteem) are conditional upon one's performance, and it shouldn't be.
Rather, a performer should settle and know his/her true inner worth before performing. In this way if
people happen to openly criticize or reject the performer, the performer would not be affected.
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Maggini
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PostPosted: Mon Jan 28, 2013 2:58 pm    Post subject: Beta blockers Reply with quote

For years, I agreed with LSO Violinist and fought hard to control my shakes. Sometimes I did well and sometimes I fell apart. Not long after my 50th birthday, I had what I thought was a panic attack while performing with a pianist at a wedding. I shook so badly I couldn't keep the bow on the string.

I called my doc and went straight to his office. He ran some tests, including observing me doing some acitivities- reading a magazine, drinking from a cup, etc. He concluded that I have "Essential Tremors." Akin to Parkinson's disease, ET sufferers find that the shaking is not constant, but triggered by motion.

I began taking a beta blocker. It doesn't stop the ET, but it makes it manageable and I am able to perform well.

SO, I would agree that one should attempt to control it on one's own, without drugs. But some of these people with mild symptoms may not be able to control it without help.
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LSOviolinist
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PostPosted: Tue Jan 29, 2013 12:23 am    Post subject: Reply with quote

Maggini,

I of course support you and others like you that suffer from similar conditions. I guess what I am getting at is that to use beta blockers simply as a means to "calm nerves", outside of medical conditions and necessity, is (in my humble opinion) wrong. A performer should not shy away from these feelings but cultivate them. I understand that these drugs are prescribed by doctors, however I cannot help but wonder how easily they are prescribed. I wonder what tests are administered and even with the tests, I would think that similar traits that would normally qualify an individual for a beta blocker would arise with all performers; elevated heart-rates, quick breaths, increased blood-pressures, nervousness, sweaty palms, and tremors. Are not these traits common to most performers, some more than others? It seems, at least from the outside, that prescribing a beta blocker to a performer would be a simple task if the performer met these "basic" symptoms, regardless of whether they have a true "medical" need for the drug. The articles that I read made it seem that the majority of those performers prescribed do not have a significant medical need for the drug other than helping to take the edge off a performance. Food for thought.
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LSOviolinist
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PostPosted: Tue Jan 29, 2013 12:37 am    Post subject: Reply with quote

Lemuel,

I have seen players completely demoralized by seemingly insignificant comments on their playing. These comments can tarnish and bruise a developing ego. When you wrote

"a performer should settle and know his/her true inner worth before performing. In this way if
people happen to openly criticize or reject the performer, the performer would not be affected."

it reminded me of Eastern schools of music, particularly classical sitar schools. The student performers are not allowed to perform publicly until they have reached a certain maturity and prowess on their instrument. When they do perform, they drone for the teacher on stage, nothing flashy or overdone but still essential to the music. In this way it seems that the students (by developing personally before professionally) are much more confident and stable performs, not only trusting in their skill but in themselves.
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mokumoku
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PostPosted: Tue Apr 16, 2013 5:06 pm    Post subject: Reply with quote

You have never heard of a musician taking drugs to enhance their abilities? That is a common reason that people use drugs, to enhance certain abilities.
Now as far as needing the drugs, in order for there to be a need, there must be a desire. In the case of needing the drug for health reasons, the desire is to have good health. So where to draw the line between "need" or not?. One use for the drug is anxiety, and anxiety is basically what people are suffering from when experiencing stage fright. Who are you to judge whether someone "needs" a drug or not? The only way that another person's drug use can effect you is mentally. Is it that you are jealous that a person is using a drug to overcome their stage fright, and jealous of how well they are able to perform? Do you think it unfair? Who could possibly know better than the individual if their use of a drug is "justified"? Who knows an individual better than than the individual knows themselves? Who can understand the effects a drug has on an individual better than the individual?
I cannot understand why you would judge someone else's use of a drug to overcome their stage fright as "wrong", for any reason other than jealousy of their performance.
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Lemuel
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PostPosted: Tue Apr 16, 2013 6:09 pm    Post subject: Reply with quote

If it was simply jealousy of performance, then not only would it have been wrong to judge, but jealousy in
itself would be just as wrong, for a person is jealous because he/she doesn't want to be seen as inferior, which
is really the same problem as the one having stage fright.

However...

You are probably referring to the morality of taking drugs. We are not (at least I'm not, LSOviolinist can
speak for himself) dealing with this, but rather the approach or technique to overcoming stage fright.

As in everything, there is right approach and wrong approach, even in playing the violin. To use drugs to overcome
stage fright is no different than using a stake to hold the violin up. Both are band-aid solutions. The root problems
remain, and only get covered up.
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mokumoku
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PostPosted: Tue Apr 16, 2013 7:59 pm    Post subject: Reply with quote

So I hope I interpreted your post accurately, some of it was not completely clear to me.
While jealousy and stage fright may share motivating factors, they are very different responses.
My response was mainly directed at the first post in this subject, by LSOViolinist. As far as morality, LSOViolinist did say that it was absolutely wrong to use a drug to calm nerves before a performance, to paraphrase.
Now about taking a drug being a "band-aid solution", while I am not too fond of the phrase, I understand the definition, and this can definitely be the case, especially when a person must take it again and again, and cannot have the effects without it.
But think about this; by taking the drug and experiencing a performance free of stage fright, the person now knows what it feels like. They now know it is possible. They can learn from this experience, and may learn to overcome the stage fright without the drug. What do you think of that? In that sense, the drug is more like "training wheels".
Even if a person does become dependent on the drug, at least it is highly effective! That is partly why I don't really like the "band-aid" phrase. That is one effective "band-aid"! Of course it is still sad to have to depend on a drug, and most would much rather not have to.
From the first post in this subject, I just got the feeling that LSOViolinist felt maybe that using beta blockers is "cheating", and a possible hint of jealousy, because I can't see why else someone would disapprove of another person's drug use, if it is not damaging that person's health. I don't see how one person can determine whether another's stage fright qualifies as anxiety or not. Even if the person's stage fright is "normal", and they don't suffer from severe anxiety, I think it is up to them if they choose to use a drug for it, legally of course. Again I do not think it is best to be dependent on a drug, but who's to say if it is "right" or "wrong" for a person, other than the person themselves? I guess this sort of a discussion about the line between use and abuse.
Drugs certainly are a controversial subject.
Just thought I should say that I am only stating my thoughts on the subject, which might change as the discussion progresses. I worry sometimes that the lack of tone in writing or typing can cause things to be misinterpreted, possibly as offensive.
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PostPosted: Tue Apr 16, 2013 8:22 pm    Post subject: Reply with quote

I also must say that I do not think you are necessarily jealous, just that this is the one of the few motives I can think of in saying that someone else's drug use is wrong if they don't need it for health reasons. I do not mean any offense by this. If I said I have never suffered jealousy it would be an obvious lie. The reason I am having this discussion is to learn, and maybe to teach.
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Lemuel
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PostPosted: Wed Apr 17, 2013 12:04 am    Post subject: Reply with quote

Yes...misinterpretation is always possible, no matter how one writes, especially with those who are apt to
take things personally. To settle your doubts, I wasn't offended nor jealous (But, you must of course realize
that just like LSOviolinist, someone else reading this forum could also question your motive for posting, and
can think of no other reason than you supporting drugs for overcoming stage fright and perhaps using it yourself).

Of course it is up to the person if he wants to use drugs or not. Just because we think the approach is wrong
doesn't mean the person is not free to go ahead and use it. If I teach you a way to hold the violin and you
don't agree with me, you're free to follow your way and I my way, even if my way is clearly a much better way
(and vice versa).

As for using drugs for training, I think that was covered in part by the original post of LSOviolinist - that there
are much better ways to train than to use drugs. Quite frankly, I really feel bad for those who wind up addicted
to them, to the point that they start taking it not only before a performance but for any sign of tension. If a
student of mine was afraid of performing, I could not with clear conscience introduce him/her to "beta blocker"
drugs to solve the problem, let alone of young child.
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mokumoku
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PostPosted: Wed Apr 17, 2013 4:33 pm    Post subject: Reply with quote

I have never used Beta Blockers, and I am not a performing musician, but if I did, how would anyone reading this know if I they had been prescribed to me by a doctor or not? My motive for posting is obvious, it is that I do not consider myself fit to judge someone else's drug use unless it is clearly harming them significantly, or if it is illegal. I would consider dependence on a drug to be significant harm, though in some medical cases it is a necessary sacrifice, which you both seem to agree with. I still want to know what you think of someone gaining experience from a drug use, and not needing to use it again to have benefited from the experience, because it was covered only in part by LSOViolinist's first post. I am saying that in this case, it is not just a "band-aid", because it had a lasting effect on the person. Do you consider this possible? I fully agree that addiction to a drug is no good, but people do have self control, and intelligence to avoid this. I also agree that you should not introduce someone to Beta Blockers, as that is a qualified Doctor's job, to determine if they are appropriate.
LSOViolinist, you said that you had only recently realized that musician's use drugs to help with stage fright, so I wonder why you have formed such a strong opinion on something you have such little experience with, other than recent research. If a drug use is legal, than that is not an issue either. Just stating my thoughts.
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PostPosted: Wed Apr 17, 2013 4:42 pm    Post subject: Reply with quote

I want to say that I mean no offense by my post, and that I am not judging anyone for their opinions, I am open to their opinions and want to learn more about them. I have a tendency to turn off my emotions, so sometimes things I say seem to come across as insensitive or offensive to others, though maybe I am worrying about it too much, or maybe not because you did seem to agree with me about that, Lemuel. Honestly I just want to know more about your beliefs.
I know that words and phrases can have certain connotation with some people, for instance the phrase "what makes you think..." could likely be read with a feeling of strong disagreement and anger behind it. I realize now that it would have been better to phrase it as "why do you think...", but I don't always think about things like that, I tend to be frank and literal with my words. I would prefer my writings to be read as those of an emotionless, innocent, curious robot.
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Lemuel
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PostPosted: Thu Apr 18, 2013 11:22 am    Post subject: Reply with quote

I appreciate your frankness actually, and so far I've not felt a single tinge of offense. So just relax Smile.

My beliefs? Sigh Confused.

I've never used "beta blockers", so you might as well say that I have no experience also. However, I've seen
the destructive effects of drug abuse and other addictive behaviors on the nervous system and emotional
well being. So my views would be too biased for you.

Self-control isn't as simple as it looks. Our human nature tends to migrate towards short-term pleasure and
immediate rewards at the expense of long-term negative consequences, especially if one is seeking a relief from
some type of pain. Honestly, how many of us can say no to something that gives pleasure, but is not good for
our body and mind? I've seen more who can't say no.

Once in a while, I'll take a tylenol to get rid of a bad headache, if I happen to be working. If I'm not working,
I'll go to bed or take a warm shower. On the other hand, if my headaches continue, there is more than likely
a deeper problem. Even the fine print on the bottles of pain killers recommend seeking a physician if the
headaches persist.

As far as motives are concerned....have you ever asked what are the motives of those seeking better
performance through the use of drugs, especially during competitions? I think anyone can answer that question.
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