Performance enhancement?

A blog post by Matthew Guerrieri today (4/18) reminded me of a conversation I had recently regarding musicians and meds, specifically Inderal, the beta blocker most often used for performance anxiety.

It’s safe to say that performance anxiety is an inescapable fact of life for any professional musician - regardless of preparation or experience, everyone feels some surge of adrenaline, some sharpening of the nerves every time they walk onstage. There are those who find a way to channel this energy in a positive and productive way, while others are beset by what can sometimes be crippling stage fright. I’m always surprised by the number of well-known performers who have battled nerves all of their lives – Vladimir Horowitz left the concert stage for a decade because of stage fright; Glenn Gould took Valium; Barbara Streisand stopped giving live performances because of it; the list goes on and on.

Musicians, creative creatures that we are, have found a variety of ways to cope with performance jitters, running the gamut from deep breathing and visualization to a pre-concert cocktail (or two). The irony of it all is that nerves are part of what creates excitement in a performance and gives live music it’s “edge” – and it’s part of what makes it thrilling for those of us on stage as well. The problem lies in when the personal edginess becomes so overwhelming as to become debilitating, or when it prevents you from approaching optimal execution.

The use of Inderal, which is intended for angina, hypertension and migraines, as a musician’s performance aid started quietly in the late ‘70’s and has become fairly commonplace in the business. Studies from as early as the late 80’s show that nearly 22% of musicians polled took beta blockers in one capacity or another; I would venture to guess that this percentage is far higher now, particularly in audition situations.

By blocking adrenaline receptors in various organs, beta blockers slow one’s resting heart rate, lowering both blood pressure and cardiac output. What it can do is allow one to focus on music making by minimizing the physical effects of anxiety; what it cannot do is help you play well if you haven’t adequately prepared or are unable to control your psychological state. There’s a lot of back and forth about it out there on the internet/blogosphere, with passionate opinions in both directions.

I’ve never been able to figure out why this is such a terribly controversial topic and one which musicians are often reticent to discuss (I’ve always been of the “do what you need to do” school of life). Maybe it’s our general societal sensitivity to what might be considered to be a performance enhancing drug. I certainly know colleagues who have found great success in Inderal use for high-pressure situations. By the same token, I’ve had friends who found it to be emotionally detaching and terribly unhelpful. As with anything in life, it's up to each individual to figure out for themselves what works best for them, or, as the French say, chacun a son gout.

Beta blockers are a regular feature of my life; I hate (HATE) flying, and it’s something I have to subject myself to at least 3-4 times a month, if not more. I was initially prescribed Valium for air travel (there was a period of time when simply walking onto a plane was panic-inducing), but Valium's not really a viable option if I have to get off a flight and conduct a rehearsal 2 hours later (which is not so infrequent a situation) – it just make me terribly sleepy and apathetic, neither of which are acceptable to an orchestra. Inderal at least keeps my heart rate from going out of control every time we hit an air pocket and lets my brain calmly reason with itself (“Flying is statistically safer than driving”, etc.). I still have to deal with what’s going on internally, but at least the physical manifestations are suppressed, and that makes it infinitely easier. I don’t think I could really make a living as a conductor if I couldn’t cope with air travel, so in a way beta blockers really do help me career-wise!