Classical Music’s Dirty Little Secret
Beta-blockers help arts students beat stage fright
Laura Usiskin, CC ’05, still shudders when she recalls how she once felt when playing her cello for audiences. “My bow would shake so hard I could hardly control it,” she says. “My fingers felt like they were moving through mud.” Teachers assured her that she’d become less scared with repeated performances and auditions, but she proved them wrong. “I tried for six years, but it just wasn’t working.”
Everything changed her first year at Columbia. Before her audition for the joint degree program with Juilliard, her teacher suggested she take beta-blockers, a class of drugs usually prescribed to treat heart conditions that blocks the brain’s adrenaline receptors. The drugs, which are popular among professional musicians, worked miracles.
“It’s amazing, because mentally, you’re just the same, but physically, your body isn’t completely run over by adrenaline. Your heart’s not pounding, your hands aren’t clamming up, and your body’s calm. It’s very cool,” she remembers.
Since that audition, Usiskin has earned a Masters of Music from Juilliard and acceptance into Yale’s ultra-competitive music graduate program. Some musicians would argue, however, that beta-blockers have played an unfair role in her success. The drugs carry a stigma in the classical music world because some consider their calming effects to be performance-enhancing, making the music created under their influence less authentic.
“Most professional musicians use them, but they don’t talk about it with each other,” says Karen Smith, a private lesson instructor in Columbia’s Music Performance Program, who uses beta-blockers. Karen Smith isn’t her actual name—she prefers to have her real name omitted from this article, for the same reason that keeps musicians from discussing the drugs with each other.
“It’s not that I’m embarrassed,” explains Usiskin, who also avoids talking about her beta-blocker usage, especially with people who don’t experience severe performance anxiety. “People who don’t take them feel like it’s a crutch ... If I didn’t get nervous, I could see myself feeling that way.”
How prevalent are the drugs in the classical music world? The secrecy that surrounds their usage makes it hard to come up with concrete numbers. Most agree, however, that they’re almost ubiquitous in professional settings. Cellist Taylor Cowdery, CC ’09, says that his former teacher, a member of the Orpheus Orchestra, estimates that close to 80 percent of Orpheus members use them. The drugs are also popular in conservatories, like Manhattan School of Music. “They’re everywhere—tons of the students here use them,” says Alicia Kravitz, CC ’06, and current Manhattan School of Music student.
Beta-blockers aren’t medically sanctioned to treat stage fright—the drugs are used to affect the heart and circulatory system for use in reducing blood pressure or treating chest pain, migraines, tremors, and even frequent heart attacks. Usiskin asserts that the medication is “innocuous,” so there’s no harm in taking them for an off-label purpose. She says that Health Services at Columbia prescribed beta-blockers to her in her first year, back in 2001. She claims they knew she was using them to treat performance anxiety, not the heart problems for which the medication is intended. Still, “they didn’t flinch,” Usiskin says. “Beta-blockers are so innocuous, Health Services passes them out like water.”
Although Health Services is unable to comment on Usiskin’s specific prescription because of confidentiality policies, Associate Medical Director Marcy Fernschneider offered this statement: “Beta-blockers are sometimes prescribed by doctors to treat the physical effects of performance anxiety—if, for example, a musician were experiencing stage fright. This common practice is known as ‘off-label’ use, which is the prescribing of a medication for purposes outside of the indications on its label. Health Services at Columbia infrequently prescribes beta-blockers for this purpose.”
While heart patients tend to take 20 to 100 mg dosages of beta-blockers, musicians get by with much smaller amounts, usually hovering around 10 mg. Musicians experiment to determine a dosage that calms them without dulling the energy of their playing. There are no definitive studies on the side effects of taking too much of the medication for the treatment of performance anxiety. Still, musicians seem unfazed by the risk they may be taking. “10 mg has always worked for me, so I was just lucky, I guess,” Usiskin says.
Musicians are often psychologically dependent on beta-blockers, convinced they need them to perform well in front of audiences. Mark Seto, assistant conductor of the Columbia University Orchestra, cites an extreme case of a girl he knew who was so intimidated by her conductor that she took beta-blockers before every rehearsal. Smith has a similarly dependent colleague, who takes about 70 mg of the medication before rehearsals. This is compared to Smith’s 5 to 7 mg dosages, which she takes only for high-stress performances.
Though Smith uses beta-blockers more sparingly than her colleague, she admits that she takes them mostly for their psychological effect—the sense of empowerment they provide.
The debate rages on about whether teachers should offer the medication to their students. In 2004, a Rhodes College music instructor was fired for giving the pills to her students. Despite this widely publicized crackdown, the instructors of some Columbia students have offered them the medication. Gwen Dipert, BC ’09, says that her high school flute teacher recommended she use beta-blockers, but she turned them down. “I felt like my nervousness was something I should work through, and beta-blockers should be a last resort,” she explains.
Some believe that extra adrenaline can even be useful in performances. Violinist Patrick O’Donnell, CC ’09, says he knows musicians who “turn their anxiety into positive performance energy.” He explains, “It adds a bit of spontaneity and extra musicality to their playing.” Cowdery agrees, saying that without extra adrenaline pumping during a performance, you’ll lose “a good deal of spontaneous energy.”
Still, Dipert sympathizes with musicians whose intense performance anxiety makes the medication almost a necessity. “I don’t consider it cheating. It’s like taking antidepressants—the people who take them need them.”
Smith also uses the antidepressant analogy. “If a medication can help a severely depressed person get through the day, why not take it?” Regarding beta-blockers, she explains, “There’s enough stress in the world already. Why have more when there’s a way to get rid of it?”
For Usiskin, there was no turning back after her first audition with beta-blockers. “I feel like I tried for so long to perform without them that now, I’m worthy. I passed the test.”