Medicine and Music: Health and Harmony

Written by Allen Chang, violinist and medical student, as part of the Breaking the Silence series.

CW: mental illness, musicians’ injuries, discussion of beta-blockers.

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“Since rest is often not an option, many musicians choose to simply bear the pain, which inevitably results in further injury,” remarks Allen on the difficulties of current ‘rest’ treatments for musicians by healthcare professionals. Photo: Hossein Taheri. [Allen holding stethoscope up to his violin.]
Have you ever experienced the difficulty of balancing the doctor’s suggestions with the necessity to practice?

This tension defines my life. Having to balance the simultaneous roles of being a medical student and violinist, I’ve struggled with shaping both into a single identity. Though the priorities of physicians and musicians are different, I do believe it’s possible to find a healthy balance.

On the outside, I may appear to be “the medical student who plays the violin,” but those who know me might suggest that a better description is: “the violinist who happens to be in medical school.” The reason why I make this distinction is that I, too, have experienced many of the same obstacles other musicians go through.

Prior to university, violin was my life—something I’m sure many of you can relate to regarding your own instruments. I certainly was no stranger to the mental stress and physical injuries which were correlated to a musician’s lifestyle. It wasn’t until I stepped foot into the medical field that I began to realize much of what I had to endure was not healthy, nor should it be taboo to discuss the health issues of musicians.

I’m quite certain I went through periods of depression due to the constant stress to perform well. I also have no doubt that the endless hours of practice are the cause of my tendonitis and lower back pain, problems which still trouble me to this day. I am not a professional musician, nor am I a fully licensed doctor, but having to straddle the two lifestyles has shown me it is possible to reconcile the differences.

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“It wasn’t until I stepped foot into the medical field that I began to realize much of what I had to endure was not healthy, nor should it be taboo to discuss the health issues of musicians,” confides Allen. Photo: Hossein Taheri. [Two Allens in same photo looking at each other, one in a lab coat and stethoscope, one of him playing violin.]
Keeping a Healthy Mind

It’s often said that to be a good musician, we have to wear our hearts on our sleeves. Although this is beneficial for musicality during performances, it also makes us more susceptible to mental illnesses. In fact, research done in the UK found that 69% of musicians self-reported depression symptoms, and 71% reported anxiety [1]. Emphasis is often placed on the prevention of physical injuries, which often neglects musicians’ mental health. Academic institutions foster an environment where students are encouraged to practice diligently, but the same atmosphere is also responsible for stress and anxiety.

Despite the many initiatives to circumvent this, there are many ways for every musician to take charge of their own mental and physical wellbeing. Though this may be achieved through various means (and I am by no means yet a licensed healthcare professional), I will list a few here which have worked well for me.

Since my first year at McGill, I made sure I always had someone to talk to during times of need. Though this person could essentially be anyone you trust, for me she happened to be a friend, professor, and mentor.

Many mental illnesses can also precipitate due to extended periods of isolation [2]. Unfortunately for us, isolation is part of our everyday practice routine. I recall times in my life where I was practicing more than 12 hours a day prior to a competition, but where I still felt sad because I was experiencing minimal improvement. I choose to overcome this by prioritizing time to socialize and relax. Now, I frequently hang out with friends and grab dinner on Friday nights, forgetting about all the stress and worries for the evening.

I’ve also learned to say “no.” Over the years, I’ve often taken on more than I can manage,  causing me needless stress as I tried to follow through on all my commitments. We tend to all have a good sense of how much we can handle, and I believe we can trust that. Also, these are suggestions that have worked for me, but they may not work for everyone; additional research and a bit of trial and error may be required to find what works for you.

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Allen playing in a Christmas concert at age 5.

Rest vs Reduce

Physical health is just as essential to the career of a musician as to an athlete. Regrettably, many doctors don’t understand the demands placed on a musician due to daily practice, and the stress of performance or competitions. Hence, when musicians approach doctors with their physical ailments, they are either treated with regimens for athletes or instructed to rest. While these suggestions aren’t inherently wrong, they disregard the specific needs of musicians, and the mental stress resulting from a lack of practice. Since rest is often not an option, many musicians choose to simply bear the pain, which inevitably results in further injury.

A better suggestion would be to limit the number of hours spent on practicing. This summer, I had the privilege of studying with Dr. Rictor Noren, a professor at The Boston Conservatory at Berklee and The New England Conservatory. According to him, any practicing beyond 4 hours is futile, simply inefficient, and “a waste of time.” Moreover, spreading the hours throughout the day instead of playing for a whole afternoon can also increase productivity. Not only is this helpful in recovering from injuries, but it also decreases the chance of incurring new ones.

I understand this is all easier said than done and I am definitely guilty of over-playing while injured, having spent hours upon hours trying to perfect the Bach Loure while having tendonitis. But ultimately, don’t forget to listen to your body; pain is your body’s way of telling you that pushing any further will result in injury. Instead, perhaps take an hour to grab a coffee before coming back to practice. Not only will you be less prone to injury, but your efficiency will be greater as well!

Also, remember that physical health also encompasses minor and seemingly irrelevant ailments such as bleeding callouses and violin hickeys. Diligent care of these wounds can prevent further exacerbation or infections.

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Allen performing at a Youth Rally with his worship band. Photo: Hanna Donato.

“So doc, what about beta-blockers to calm my nerves?”

I’ve had countless friends ask me about using various drugs to aid their performance career, some even being pressured by their instructors to do so. Though the science behind the medications are sound, they aren’t without certain risks, some of which may be life-threatening. Beta-blockers act by inhibiting your stress response, but they also impair your ability to react on the spot. It’s also important to be aware that many of these drugs may interact with alcohol or other recreational drugs.

Alternatively, there are many exercises which may be used to help rein in anxiety—controlled breathing being one I’ve found particularly useful. Noa Kageyama, a performance psychology specialist and staff member at Julliard, wrote a wonderful article entitled How to Make Performance Anxiety an Asset Instead of a Liability. Anxiety is a natural response elicited by the body to better prepare you for stressful conditions, so harnessing it can allow you to take your performance to the next level.

At the end of the day, it’s unfortunate that musicians’ health is still not recognized by many healthcare professionals as a priority. Nevertheless, we’re responsible for advocating on behalf of our own health. In an industry which is extremely demanding, it’s indeed challenging to put health before career and success. Therefore, I humbly suggest keeping your well-being in the back of your mind, because prioritizing your health can increase not only the efficiency of your everyday practice, but also the longevity of your career.

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“It’s unfortunate that musicians’ health is still not recognized by many healthcare professionals as a priority,” admits Allen. Photo: Hossein Taheri. [Photo of Allen playing violin.]

Over the next few months, Allen will be working at the Royal Victoria Hospital as a third year McGill medical student. Musically speaking, he continues to arrange and record covers on his YouTube Channel, and plays in McGill’s Beethoven Orchestra. He’s also an active worship leader and coordinator at his church. To contact or find out more about Allen and his upcoming projects, you can find his website here and contact him via email at allenchangmusic@outlook.com.

C Natural’s Breaking the Silence series is a collection of musicians’ health experiences from musicians, music educators and researchers that features one story each week. With over 80% of professional musicians facing health issues related to their career throughout their lifetime, this series aims to provide strength in numbers and to initiate transparent dialogue surrounding musician’s health issues in our community. If you are interested in contributing your story, anonymously or publicly, contact Claire Motyer here.

A note to readers: Keep in mind that those who are sharing their stories on this series are doing so from a place of vulnerability and trust that their audience will be respectful and receptive. Please comment with respect and avoid negative or harmful comments directed towards the contributor.

References:

[1] Help Musicians UK. (n.d.). Mental Health. Retrieved July 05, 2017, from https://www.helpmusicians.org.uk/working-retired-musicians/mental-health.

[2] Abad, C., Fearday, A., & Safdar, N. (2010). Adverse effects of isolation in hospitalised patients: a systematic review. Journal of Hospital Infection, 76(2), 97-102. doi:10.1016/j.jhin.2010.04.027.

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