My body betrayed me a few years ago during lessons with two piano teachers.
One was my third teacher since taking up piano lessons after retirement in 2020. This teacher was mid-60s and a well-known classical pianist with whom I studied for nine months.
I've analyzed my emotional challenges during that period, but not my physical challenges. The latter included visible, intractable hand shaking, invisible tummy trembling and anxiety, and sometimes quick trips to the powder room just before lessons. Occasionally my symptoms continued after lessons.
About nine months after I moved on from this teacher I found a young, kind, and personable piano teacher. However, during the first few lessons I experienced the same symptoms - but this time I was not nervous at all!
It was both puzzling and exasperating, especially because during the next-to-last month of lessons with the first teacher, I had completed Julliard Prof Noa Kageyama's amazingly effective five-session zoom "Psych Essentials of Performance Class." What I learned helped me develop new practice and performance strategies to tamp down my nerves when I played for my teacher or for a few friends. I thought I had my problems licked - but no. Something else was going on. My distress over these seemingly intractable problems mounted substantially.
When my partner suggested that my continuing distress might be due to subconscious PTSD from the former experience, that struck me as correct. I had a trusted, well-experienced talk therapist at the time with whom I had worked for a few years, so we thoroughly examined the problem. Yet together we could not solve it quickly enough; I wanted to continue piano lessons and keep progressing!
Laurie Niles,* a violinist, explained her story on a website she hosts. Her issue did not deal with not enough practice time or with an advance feeling of dread. Even when she started out just fine on stage, completely ready and relaxed, anxiety just sometimes showed up and diminished her well-rehearsed performance. Just like Niles, I simply could not put my finger on what the problem was, so how could I possibly, by myself or even with my therapist, solve it?
A POSITIVE POSSIBILITY
Then I remembered a group chat in Noa's class where another student (a long-time senior piano teacher) mentioned in passing that just before a performance they took a medically-prescribed beta blocker to calm physical tremors and anxiety. Later they told me that, like me, strategies learned in Noa's class had helped but did not entirely solve their problem, so they consulted their doctor who checked their health status then prescribed the beta blocker propranalol. The student takes it 30 or so minutes before performance with the amazing absence of tremors, anxiety, and negative side effects.
More fascinating to me, this student would realize that on multiple occasions they had taken the medication, but it was only after the performance when they remembered how calm and focused they had felt on stage and how well their performance had gone!
I immediately researched the medication and learned that beta blockers block the action of adrenaline on beta receptors in the body. This results in a decrease in heart rate, blood pressure, and the force of heart contractions. By reducing these physiological responses (of the sympathetic nervous system), beta blockers help to alleviate symptoms of anxiety and reduce the workload on the heart. They take from one to three hours to take effect and they clear out of the body in about eight hours.
Next, highly valuing my health and knowing that any medication or herb has side effects (even as does food we eat - try raw sauerkraut sometime to see!), I asked my doctor about the efficacy and specific side effects of taking a beta blocker to solve my continuing problems. She told me that for a number of years she had prescribed it for public speakers, with good results. She reviewed my current health record and since I had no blood pressure problems or other contraindications like hypertension, she prescribed propranalol. (Before refills she periodically asks me to check my blood pressure.)
THE CURIOSITY OF STIGMA
There is a notable amount of online stigma and flamboyant opposition toward beta blockers expressed by some musicians, but not by doctors. Yet I read estimates that up to 80% of orchestra members might take them before performances - so I wondered why the stigma?
The medication is not addictive.
If the medication were addictive, you might have heard stories of, or at the symphony seen, some very amusing roller-coaster-like auditory and visual interpretations of any gorgeous, lyrical classical piece on the program. (Of course, you might not have noticed these during performance of pieces such as Liszt's intense Ballade No. 2 where the pianist's gyrations would likely be overlooked!).
Or you might have noted musicians falling off the stage in a stuporous heap, or a conductor reeling as she walked along stage-front to reach the podium. She might even miss the step up - but no such reports were unearthed in all of my research (lol!).
Research shows possible mild side effects of headaches, sleep disruption, cold hands and feet, and sometimes breathing issues (and ED if that is a concern). Further, you do not have to take the medication regularly to build up its effectiveness, and absent heart or other serious ailments, one could engage in a medically-prescribed trial but quit anytime without withdrawal symptoms.
Despite these benign facts, on some piano teachers' and musicians' blogs I've read that beta blockers are called "fake" and "dishonest," and that struck me as odd. One piano teacher said a number of musicians or students consulted her to try to get off beta blockers. But why? Beta blockers are not addictive.
Further, there is no evidence of harm if properly prescribed on an individual basis to those without contraindications. It's not as if there is black market with shadowy figures trafficking beta blockers on dark street corners of distressed neighborhoods. It's not as if we don't know what the ingredients are in propranalol and in our ignorance we risk imbibing a grain of included fentanyl that will kill us.
When I wrote to the aforementioned piano teacher to ask about the efficacy and safety of beta blockers, she sent a short, friendly reply. I followed up by asking - if beta blockers are legal and not addictive - why do some of her students tell her they want off and can't just stop? (Of course, dependent or obsessive personalities can easily get stuck on most anything - including chocolate!) I also asked about the demographics of these students but she said she was now "too busy" to answer further. In the abruptness of her reply I sensed antipathy to the medication, but I could have been wrong.
Kayleigh Miller, another violinist, in 2014 wrote a thoughtful, balanced article on beta blockers published on Nile's music website. After the blog one reader expressed concern that "Although beta-blockers may not be part of the 'monstrous trade world wide,' the pharmaceutical industry nevertheless has a vested interest in pushing these products -- even when they may not be medically necessary."
Although I've seen no evidence that the pharmaceutical industry has been pushing beta blockers in particular, in general I agree with this industry's inordinate profit motive. Even supplement and herbal remedy manufacturers love to claim that they "work" without clear scientific evidence that they do, and thus, push sales to ill-informed purchasers. (The Sunday, July 14 New York Times Opinion section reports that in 2016 the global supplement market amounted to $135 billion, in 2024 ballooned to $150 billion, and is projected to reach nearly $310 billion within four more years. I doubt that an equivalent level of excess reliance on beta blockers exists in the global community of musicians.)
So, do we avoid every single possibly helpful legally-prescribed medication or supplement or herb just because of ubiquitous kleptocorporate capitalistic motives
in the health and wellness industry?
Commenters also included Gregory Lawrence, leader of San Diego's chamber orchestra. Contrary to fact, he inaccurately equated the medication with taking steroids, but
...beta blockers are not steroids.
Lawrence also deemed them to be "performance enhancing drugs," and said:
"Such drugs should NOT be allowed for auditions, and I think the AFM should make mandatory that symphony orchestras have musicians tested 2 hours before an audition...and if found, that person should not be allowed to audition at all, auto disqualified.
I in fact run a pro orchestra, and I do not want musicians in my orchestra who cannot control their nerves naturally..."
I in fact would never work for such a misinformed, judgmental, and unhelpful orchestra leader.
Why take such a punitive perspective if he believed some musicians had anxiety? Why not approach them and say "how can I help reduce anxiety in the face of our shared great love of music and our desire to express ourselves more easily"?**
To be fair, when Lawrence made his 2014 comment, he did not say that he actually did test applicants or orchestra musicians for beta blockers. Indeed, by now ten years later he may have changed his opinion. Nonetheless, I wonder if he also employed or would employ a drug test for being under the influence of freely available and legal alcohol, or for that matter 420, before hiring or putting on stage any musician - or is he only concerned about legally-prescribed beta blockers?
Noa has a July 2009 blog on beta blockers entitled "Three Reasons How Beta Blockers Could Ultimately Hold You Back." He recently told me that he is aware that many musicians today choose beta blockers much more responsibly (i.e., obtaining a prescription) and discuss them more openly. He explained to me that at the time he intended the blog for music students whom he felt might overlook an effective and much cheaper "fix", namely that of learning how to more effectively practice with the result that they might never learn it. He wanted them to know all the options, and that makes sense to me, but I would have liked him to add this explanation as the intended readership of that blog.
Examining how one frames a matter in the psat or present, can shed light on someone's perspective, so I wondered why he did not title the article "The Pros and Cons Regarding Beta Blockers" or "How Beta Blockers Could Ultimately Help You Focus and Perform More Easily"? At the end of the blog is a section entitled "Why Do Some People Swear by Beta Blockers?" Instead of "swear" I wondered why he did not use the neutral, less emotional words, "some people say"?
I join with Noa in that I am not necessarily against their use (nor do I necessarily encourage their use). However, I limit my endorsement to those who pursue advance discussion with their doctor and factual assurance against possible substantial risks with periodic monitoring over time, not just one doctor's visit in order to obtain a prescription. That is far too dangerous to my mind.
Further, in support of my position is the fact that the same medication can have different results in different people, making a limited trial quite sensible. But also to be clear, I do not think that one must exhaust every possible non-medical solution before trying beta blockers.
I wonder how Noa reached his early opinion (that may or may not persist until today) most musicians do not need them? Was it based on a credible survey with numbers demonstrating that most musicians (out of how many surveyed?) do not need them? Anyway, how does one determine when one needs a medication? That seems to be a matter of individual circumstance in consultation with one's doctor.
Even if beta blockers aren't needed, for some and for me beta blockers in general parlance do "enhance performance". Yes they are banned by the World Anti-Doping Association for athletic competition, and in archery and shooting because they are considered possibly life threatening. I don't know of one case of a musician shooting another musician or audience member plus, is it a fair equivalence to compare musical auditions (and then playing in an orchestra) to competition for Gold Medals at the Olympics where officials want to "level the field"?
In any case, I'm not a "performer" and more to my point: aren't psychological and practical practice and performance strategies that Noa teaches also "performance enhancers?"
Of course they are! So are those strategies also "fake" and "dishonest"? Are those strategies "performance enhancers" of the type for which the San Diego orchestra leader would fire a musician? Do those also evidence a weakness to be avoided? Should everyone just "cowboy up" or "put on their big girl panties" and suffer anxiety the old fashioned way by going it alone?
Further, does choosing a medical solution justify actions by others to stigmatize the medication and shame the musician?
In any case, how is shaming anyone - for any reason - justified or justifiable?
WHY DOES STIGMA REMAIN?
I have a theory.
Although I don't know whether a larger percentage of women among female musicians or men among male musicians take beta blockers, I suspect that the major resistance to and stigmatization of them come from men.
In our patriarchal society, men are supposed to be self sufficient and "strong," not reveal weaknesses, solve problems directly, and take care of the "weaker sex." Hetero men don't often talk about or complain of physical matters that might elicit derision from their buddies or show weakness to a woman. They must "man up." It certainly makes sense that male musicians who generally predominate numerically over female musicians in any role, might shy away from taking or publicly admitting that they opt to "rely on" something outside of themselves and take beta blockers.
WHAT DOES PROPRANALOL SPECIFICALLY DO FOR ME?
(1) It works 100% of the time and within 30 minutes to completely disappear hand tremors, stomach-clutching, anxiety, and precipitous visits to the powder room just before piano lessons. More importantly, it does not interfere with my mentation or driving safety and ability. I have no side effects other than calm.
(2) The result is that during lessons I don't make atypical mistakes which do not accurately reflect my actual progress at home between lessons. I can now play straight through a piece and get the feedback that I seek. Thus, I don't waste my time -- and my money - or my teacher's time.
(3) I don't get distracted during lessons but can now concentrate on learning more advanced piano techniques for which I'm ready, such as improving the shaping and voicing of a piece. I no longer sense that old feeling of dread creeping up when my teacher gives me feedback, and I don't see it as "critical", but helpful.
(4) Best of all? I always return home after lessons without a speck of dread, always hopeful and ready to get started on my homework to better express my deep love of music.
In a wider sense, I do not find that beta blockers deprive me of the thrill of a peak performance and prevent "everything coming together" mentioned as a possibility in Noa's article. Things now "come together" for me in lessons or when playing occasionally for a few friends in relative calm without the distraction of physical symptoms.
Anyway, why would any professional or amateur be well-advised to play on the "outer limits of performance" which Noa thinks might be missed if taking a beta blocker? Why - unless one is an iron-clad virtuosa with 20 years experience - or unless in safety at home practicing to stretch one's boundaries from time to time? Even when I was a practicing senior attorney I never felt it wise in a complex trial to go to the "outer limits of performance."
In my case, physical and emotional calm results in the opposite, namely, I'm always pleasurably excited (but not anxious) in anticipation of my next piano lesson and I note considerable progress since I've been taking beta blockers. Not long ago during a visit, I asked a retired piano teacher friend if I could demonstrate my progress in playing Part A of Schumann's "Widmung" (an advanced piece for sure!). I did so based upon only four weeks' practice and a beta blocker. Brave lass, indeed I thought to myself - and I did it easily without hesitation. Besides, my friend was not an audience "fan to thrill" on stage and my goal is not to entertain theatrically, but to become a better pianist by and by and share my love of music.
THE RIGHT TO SELF-DETERMINATION (CONTROL OF ONE'S BODY) AND FAIRNESS (and why I chose Lady Justice as the image above).
As a long time radical feminist, humanist, and retired lawyer, I'm all about self-determination and fairness. Those are key values I hold for myself and ones that guide me in how to treat others.
Miller, the violinist mentioned above, sums up a perspective that I share:
I'd love for everyone to eat bananas and meditate and breathe their stress response away, but I honestly know that everyone is different and that every body responds differently to stress.
She says she is neither for nor against the taking of beta blockers by professionals but she does not address us amateurs or students.
Regarding professional or amateur, performer or student, if someone cannot whole-heartedly support a medical option a musician chooses to quell anxiety - that's well and good. But at least one can respect the other person and leave it up to them to decide how to proceed.
At least one can avoid commenting negatively when not based on science and the facts, and thereby avoid perpetuating irrational, unfair prejudice.
Above all, one can refuse to heap more stigma flame on the fire of music love that we all feel and lovingly seek to express.
I'm sorry that stigma remains and justice is not served regarding beta blockers, in part because more folk don't refuse to be shamed and do speak up publicly and objectively about situations where medically-prescribed beta blockers have benefitted them without detriment.
I hope that day comes quickly!
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*Thanks to Niles for linking to my blog!
**For a heartening example from the fictional medical community, watch the Netflix series "New Amsterdam". The hero is Medical Director Max Goodwin who has a special greeting for almost every complaining, needy, and deserving medical or support staff (including janitors, even addressing them in their Spanish language. Later in the show he learns a doctor's American Sign Language!). He typically responds to each professional or personal request with the words: "How can I help?" Then to the extent of his ability he does just that! AMAZING!! A leader who wants to help and not ignore or worse, punish anxiety!
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Lending (for a future volume of poetry)
Lend me your ear and I’ll wax poetic,
try to control me and you can’t,
show me you care and I’ll hear youl,
ignore me and I’ll definitely rant.
Suffer my optimism willingly,
offer help when my spirits get down,
encourage but don’t ever pity me
for then I’ll for sure hold my ground.
Don’t tell me what to do or to think
but ask me for my honest opinion,
then share yours as your time will permit
and I'll remain your delighted mignon!
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