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Cosmetic Psycho-pharmacology

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Blair Tindall, in the October 17th New York Times, revealed the “dirty little secret” of classical music: a majority of world-class classical musicians use performance-enhancing drugs.

In this case, it’s beta-blockers, most frequently propanolol.

These drugs slow the heart and calm the mind, quelling anxiety with little in the way of apparent side effects.

The question in the minds of many is, if it’s not OK for athletes, how come musicians can get away with it?

Some experts even believe musicians – classical variety – should undergo mandatory drug tests.

I headed this post “Cosmetic Psychopharmacology” as opposed to “Cosmetic Neurology” because the latter carries a connotation of Botox use or some sort of injected procedure with neurological sequelae.

What we’re dealing with here is, rather, internal rearrangement of the nervous system.

I don’t like either term, to tell you the truth.

“Cosmetic Psychiatry” isn’t any better.

I’m gonna put on my thinking cap and see if I can come up with something more descriptive.

Here’s the Times story.

    Better Playing Through Chemistry

    The growing debate over pharmaceutically enhanced classical music

    Ruth Ann McClain, a flutist from Memphis, used to suffer from debilitating onstage jitters.

    “My hands were so cold and wet, I thought I’d drop my flute,” McClain said, remembering a performance at the National Flute Convention in the late 1980s.

    Her heart thumped loudly in her chest, she added; her mind would not focus, and her head felt as if it were on fire.

    She tried to hide her nervousness, but her quivering lips kept her from performing with sensitivity and nuance.

    However much she tried to relax before a concert, the nerves always stayed with her.

    But in 1995, her doctor provided a cure, a prescription medication called propranolol.

    “After the first time I tried it,” she said, “I never looked back. It’s fabulous to feel normal for a performance.”

    McClain, who was then teaching flute at Rhodes College in Memphis, started recommending beta-blocking drugs like propranolol to adult students afflicted with performance anxiety.

    And last year she lost her job for doing so.

    College officials, who declined to comment for this article, said at the time that recommending drugs fell outside the student-instructor relationship and charged that McClain asked a doctor for medication for her students.

    McClain, who taught at Rhodes for 11 years, says she merely recommended that they consult a physician about obtaining a prescription.

    McClain is hardly the only musician to rely on beta-blockers, which, taken in small dosages, can quell anxiety without apparent side effects. The little secret in the classical music world – dirty or not – is that the drugs have become nearly ubiquitous.

    So ubiquitous, in fact, that their use is starting to become a source of worry.

    Are the drugs a godsend or a crutch?

    Is there something artificial about the music they help produce?

    Isn’t anxiety a natural part of performance?

    And could classical music someday join the Olympics and other athletic organizations in scandals involving performance- enhancing drugs?

    Beta-blockers – which are cardiac medications, not tranquilizers or sedatives – were first marketed in 1967 in the United States for disorders like angina and abnormal heart rhythm.

    One of the commonest is propranolol, made here by Wyeth Pharmaceuticals and sold under the brand name Inderal.

    By blocking the action of adrenaline and other substances, these drugs mute the sympathetic nervous system, which produces fear in response to any perceived danger, be it a saber-toothed tiger or a Lincoln Center audience.

    Even the most skillful and experienced musicians can experience this fear.

    Legendary artists like the pianists Vladimir Horowitz and Glenn Gould curtailed their careers because of anxiety, and the cellist Pablo Casals endured a thumping heart, shortness of breath and shakiness even as he performed into his 90s.

    Musicians quietly began to embrace beta-blockers after their application to stage fright was first recognized in The Lancet, a British medical journal, in 1976.

    By 1987, a survey conducted by the International Conference of Symphony Orchestra Musicians, which represents the 51 largest orchestras in the United States, revealed that 27% of its musicians had used the drugs.

    Psychiatrists estimate that the number is now much higher.

    But use of drugs is still largely secretive.

    “Inderal is like Viagra,” a woodwind player at a major orchestra said.

    “No one admits to using it because of the implication of weakness.”

    Robin McKee, the acting principal flutist of the San Francisco Symphony, agrees, saying, “It’s too bad we’re reluctant to talk about using such a great tool.”

    Indeed, the effect of the drugs does seem magical.

    Beta-blockers don’t merely calm musicians; they actually seem to improve their performances on a technical level.

    For the last two decades, the use of beta-blockers has generally met with approval from the medical establishment.

    “Stage fright is a very specific and time-limited type of problem,” said Michael Craig Miller, the editor of the Harvard Medical Letter.

    Miller, who is also an amateur pianist, noted that beta-blockers are inexpensive and relatively safe, and that they affect only physical, not cognitive, anxiety.

    “There’s very little downside except whatever number you do on yourself about taking the drugs.”

    But now that the drugs have established themselves as a seemingly permanent part of the classical music world, some musicians and physicians are beginning to question the acceptability, safety, efficacy and ethics of using them.

    One concern is that many musicians use beta-blockers without proper medical supervision.

    The 1987 survey of orchestra musicians revealed that 70% of musicians taking beta-blockers got them from friends, not physicians.

    Mirkin, the Philharmonic violist, first obtained Inderal from his father, who took it for angina.

    Others buy it while touring countries where it is sold over the counter.

    “If you look at the logic of why we ban drugs in sport, the same should apply to music auditions,” said Charles Yesalis, a professor at Pennsylvania State University who studies performance-enhancing drugs.

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  • bhw

    There’s a difference between performance and competition. So I don’t know why it would matter if half the Boston Pops took Inderal before a performance. As long as the music is good, who cares?

    But I can see why it might matter if some musicians took it before an audition — a competition — and some didn’t, but only if does improve performance on a technical level. [I’m not sure how you’d measure that, though. Isn’t it arguable that the anxiety was inhibiting the performance and that the drugs just enable the musician to do what s/he is capable of doing when no anxiety is present? Dunno.]

    Do people use beta-blockers for other types of anxieties? Are lots of people walking around with their betas blocked?

  • Other frights soon will be beta-blocked, I predict, even if these beta-blockers aren’t being used for them right now.

    Just think of all the highly lucrative applications this could have! (Lucrative for the pharmaceutical companies, of course. Everybody else will pay and pay and pay.) Better performance in any situation that might make you jittery. No matter what you’re nervous about, the same pill will help you stay calm and smooth.

    Big job interview?

    Crucial presentation to the VP of the whole division you work for?

    Taking a polygraph test to get the SEC off your back about all the insider trading you’ve been doing?

    Asking that really hot co-worker out for a date?

    No problem! Just pop this pill and you’ll be cool as a cucumber!

    I’d be dismayed by all this, if I couldn’t see the long-range implications of it. Eventually, calm cool collectedness all by itself will become a justifiable reason for suspicion. Nobody will trust anybody who isn’t painfully nervous in any public situation.

    And that, dear reader, will be the long-anticipated day in the sun for people like me.