The whole life force, on and off stage

I welcome the BPS response to the growing mental health crisis in the performing arts [as part of the Psychology Matters campaign]. This aligns to the British Association for Performing Arts Medicine's core mission as the largest provider of clinical services to the UK's performing arts sector. BAPAM celebrated its 40th anniversary last year; about 3,000 performing arts professionals and students seek consultations with BAPAM annually. Whilst the clinical consultations we provided increased by 86 per cent from 2019 to 2023, consultations relating to mental health increased by about 400 per cent. 

Performing artists present high degrees of mental health challenges, with a growing body of research setting this at three to five times the general population. Psychosocial dimensions are also central in the aetiology of common physical health problems and pain that performers report, and systemic factors such as performance ideologies and a culture of individualism, competition and perfectionism that favours skills and abilities but does not give enough attention to the person, to the human and relational side of performance. 

These structural issues underlie the persistent problem of stigma and prejudice in the industry, making it very challenging for performers to acknowledge vulnerabilities and difficulties – and leading to a tendency to somatise distress, to interoceptive mistranslation, alexithymia and low emotional literacy. This is attended by loss of agency and self-efficacy, loneliness, shame, performance anxiety, chronicisation, comorbidity, often resulting in trauma, burnout, injuries and premature career transitions. 

Psychology is at the centre of BAPAM's clinical and educational work through a holistic and multidisciplinary model with wellbeing and psychological literacy at the centre. As a Chartered Counselling Psychologist at BAPAM and specialist advisor in the Music and Mental Health Group committee of the Royal Music Association I strive to advance parity of esteem between mental and physical health and the provision of integrated and anti-oppressive practice. It is important that we work together to support the full spectrum of performing artists – musicians, singers, actors, dancers, circus artists and others that may or may not operate within the radar of media recognition. 

Working with Professor of Music Performance Studies at the University of Cambridge Mine Doğantan-Dack and Professor of Violin at Trinity Laban Conservatorire John Crawford has enabled me to deepen my understanding of specialist issues before they present in the consulting room, and learn firsthand how fundamental it is that educators and clinicians work together to develop pedagogical and medical practices that integrate and unify mind-body and technique-expression in order to achieve a living alignment between inner emotional movement and bodily gestures which is the key to presence and healthy performance, in the arts and in life. 

At the 42nd Annual Performing Arts Medicine Association (PAMA) International Symposium held last summer at UCL, Dame Evelyn Glennie in dialogue with BAPAM Medical Director Dr Finola Ryan emphasised the value of complementing measurement and diagnosis with a broader experiential focus on the whole experience of the performer, rather than only on deficit. This message encapsulates the importance of attending to the whole person, rather than isolated symptoms, and to the body as lived in all its uniqueness and complexity, rather than only as a performance machine or medical object. Psychological and phenomenological awareness is crucial to move beyond simple deficit correction in order to understand and effectively treat underlying causes. 

This is necessarily a cross-disciplinary, collaborative and pluralistic effort. The emphasis is on sensorial, affective, cognitive, motor and socio-cultural elements, as well as on the relationships and interactions between them. Focusing upon these as unified parts of a wider whole changes how we operate, just like the sound of a musical instrument played on its own or as a part of an orchestra is not the same sound. 

In my experience of assisting performers during career transitions, I found that a common reason that leads them to retrain as healthcare practitioners is to finally be able to acknowledge their own lived, subjective, embodied experience and assist others in doing the same. The neoliberal emphasis on individualism, self-control and success in the performing arts has created a 'dangerous distancing and suppressing, a culture of silence' (Stanhope & Weinstein, 2021) around sufferance and ill health in order to optimise productivity. Psychology helps us to be mindful of forces with oppressive potential and reminds us that it is not realistic 'to be non-discriminatory without questioning embedded political and cultural assumptions' (Biggs, 2010). 

Performance ideologies, individualism, competition, perfectionism and a culture of excellence create strong barriers to the experience and expression of difficulties and disturbance. Symptoms are often the only way that performers have found to communicate what had to be suppressed or denied for fear that it would destroy everything and prevent them from being professional performers. But if symptoms are cut-off from meaningful connections to the whole person they are experienced as depersonalised, a split entity that possesses them like an external alien being for which they have no conceptions or names, no language to express a part of them that they regard as faulty, foreign and as such to conceived only in the realm of abstraction and generalisation, to be expelled – an internalised othering and prejudice that seeks to escape pathologisation but actually ends up reinforcing it. And how can they perform with their whole selves or have an authentic voice when there is something shameful and unaccessible that they feel has to be hidden else they won't appear to be healthy, resilient or excellent enough? This erects a barrier that stops the deep emotional connection required for artistic performance and expertise, and creates a taboo and silence that can make it terrifying for the barrier to come down else they may be overcome, rejected and unable to perform professionally. We can most constructively recognise and work with these dynamics from a systems standpoint that acknowledges symptoms as normative and protective life issues, and embraces complexity and the whole person rather than only dysfunctions. 

This is, I believe, where psychology comes in most effectively and can deliver the most transformative results: widening the focus beyond mechanical or technical issues and putting the (inter)subjectivity of the performer at the forefront of performing arts practice and research, with all their unique embodied meanings, feelings, dispositions, values and sociocultural situations. Psychology assists performers in working creatively with their relation to personal, relational and cultural issues that ground or unground them in their performance, helping them embrace a personal artistic voice and a long-lasting career. Psychology helps the performing arts to extend and depolarise notions of resilience to include, rather than exclude, the experience of vulnerability and failure beyond binaries. This involves opening up the narrative around failure and the individualisation of issues so that resilience may no longer be 'weaponised' against performers to avoid addressing systemic issues in the industry, as Northern School of Contemporary Arts Principal Sharon Watson put forward in her powerful keynote address at the PAMA conference in London. 

Psychology is key to challenging the pathologisation of performers and promote performer centred - rather than condition or illness centred – approaches from teaching to clinical treatment, provide truly personalised, preventative care, and safeguard inclusivity and diversity. It is now common knowledge that engagement in the arts is conductive to positive health and wellbeing as illustrated, for example, by the social prescribing program in the NHS, and yet this is not the case when it comes to professional performing artists. In the process of professionalisation it is not only their performance that becomes instrumentalised, but also their creativity, i.e., what matters to them the most, what is most at stake in their lives, that which is most deeply felt, their innermost meanings, emotions, identities, dreams, energies – their whole being and life force, on and off stage. 

More info: BAPAM Mental Health and Wellbeing Services for Performing Artists - Guidance for the Performing Arts Sector

References

Biggs, S. (2010). Assessed Unit 4: An academic paper which examines the meaning and implications of anti-discriminatory practice in counselling psychology. Counselling Psychology Review, 25 (3): 25-31. British Psychological Society. 

Stanhope, J., Weinstein, P. (2021). Should musicians play in pain? British Journal of Pain, 15 (1): 82-90.