Memory Slip: Stage Fright and Performing Musicians

Performance Anxiety

Stage fright is more than the sum of its psychological symptoms. It also includes, for musicians, anxieties about physical injury and pain that can negatively affect their self-concept and ability to perform. In addition to physical symptoms such as shaking, sweating, and hyperventiliation, psychological symptoms include feelings of insecurity despite excellent preparation; a dread of ridicule, embarrassment, and shame; worries about structural and/or functional inadequacies (i.e., faulty technique or memory slips); and the perceived stigma that “something must be wrong with me.” The myth that “only crazy people go to therapy” is still prevalent, as is the idea that therapy reduces creativity. Either can feed a performer’s resistance to seeking help. Thus, stage fright has the potential to sabotage the most talented and best prepared musical performers, depriving them of the expression of their talent and undermining their self-confidence and self-esteem, with consequences for personal relationships and careers. With performance-anxious musicians, audience or analyst can become a projection and introjection of the critics and admirers inhabiting the musician’s unconscious as introjected objects, while a search for external approval and quick solutions is typically pursued. Therein lies both a problem and an opportunity for understanding and treatment.

Performance anxiety does not begin on stage, nor is it the exclusive domain of musicians. I have treated some students who chronically underperform on exams or are so anxious that studying becomes impossible. Additionally, high performance anxiety can arise, even for talented and competent people, around gate-keeping exams, such as MCATs, LSATs, or GREs, or around job interviews and career decisions. Some physicians find their careers threatened by their not being able to stand before peers to present research. It is not uncommon for college seniors to suddenly become test-phobic and anxious about life after graduation. Athletes routinely face clutch situations where all eyes are upon them. Many ambitious CEOs and business executives cannot present reports at meetings without self-doubt or give papers at conferences lest they appear incoherent and incompetent. And it is not a long distance emotionally from the boardroom to the bedroom, where some couples struggle with intimacy and performance anxiety.

Although I have described the many settings where symptoms of performance anxiety are manifest, my comments in what follows will focus on classically trained musical performers.

Are Musicians Different from “Other” People With Stage Fright?

What other occupation begins to train people at four years old, or even younger? In what other occupation do aspirants spend thousands of dollars on the tools of the trade and years of private lessons, perform in public from an early age, and intensify their study even more in adolescence and early adulthood, all to pursue a career that is documented to offer substantially fewer jobs than the number of people trained to hold them? Musical chairs indeed! Who would train for an occupation knowing that one’s work opportunities would be so limited, one’s career path so fraught with rejections, low pay, and intense competition? Who would place the value of “psychic income” (e.g., the love of making music and receiving audience approval) above earning “real” dollars? It is in these areas that musicians, particularly those bent on a classical/traditional performance career, differ from people with advanced training in a field who did not need to begin their formal education, much less make a career choice, at such a tender age.

Musical performers begin instrument lessons when very young. My research (Nagel 1987) showed results similar to those of Fishbein, et al. (1988): 90 percent of musical performers begin music lessons before the age of twelve. Nearly half, 46 percent, begin before age seven. In Suzuki musical training, many children begin playing an instrument before age four. These onset of training data raise obvious questions regarding a child’s intrapsychic, interpersonal, physical, and social development during these years of musical training. Yet it is not possible to achieve the extraordinary technical proficiency, musical knowledge, and dexterity required to play a musical instrument at a high level if one begins training at the age when most people choose their life’s work.

Very young music students perform in their teacher’s studio recitals and often in juried local and state competitions. The pressure to perform well and get high scores from judges and audiences at concerts can ignite performance anxiety in novices and experienced performers alike. The social, financial, and occupational demands of a profession in music performance spark intrapsychic dramas around separations, approval, rejection, and intense competition—harking back to the developmental challenges of early childhood, when music lessons and recitals paralleled the hurdles of psychological and physical development.

Career opportunities for individuals who seriously pursue a professional career in the performing arts are extraordinarily difficult both to establish and sustain. Budget cuts to arts organizations often threaten the livelihood of those fortunate enough to have found employment. Many musicians facing unemployment and underemployment hold “day jobs” despite data from the National Endowment for the Arts that show them to be as qualified as their higher-earning peers. The realities of music-as-profession present a range of practical, interpersonal, and intrapsychic challenges.

Developmental Antecedents, Ego Defenses, and the Body

Given how ubiquitous performance anxiety is, the psychoanalytic literature on the topic is remarkably sparse; it is even more meager where music performance anxiety is concerned. Among those who have written on the topic, Gabbard (1979, 1983, 1997) addresses issues of narcissism, emphasizing that some musical performers feel validated only by audience acclaim, to compensate for diminished self-regard. This leads to “an unending search, so that the individual is consigned to a life of dependency on certain external objects in an effort to satiate his intense object hunger. . . . the audience’s applause and admiration is almost a matter of survival” (1983, pp. 428-429). The narcissistic needs that arise around performance are often accompanied by the fear of rejection and abandonment by the audience/ critic, who symbolically represents residues of the performer’s earliest audience, his caregivers and significant others. Feeling unloved, unwanted, or abandoned can become internalized in the performer’s mind, generating maladaptive ego defenses and a punitive superego, typical of shame reactions (Gabbard 1997; Lansky 2008; Lansky and Morrison).

The inability to realistically assess one’s talent and accept one’s limitations and strengths is unappreciated (or underappreciated) by the music performer who overemphasizes the need for “perfect” technique and musicianship to solidify (or establish) self-esteem. This magical emphasis neglects actual ability only to focus on perceived defects, deficits, and losses. An implicit underlying fantasy is that by being the “perfect” child-patient-student-performer, the parent-therapist-teacher-audience can be coerced to gratify all wishes.

David Freundlich (1968), a psychiatrist whose father, Irwin Freundlich, was a renowned piano teacher at Juilliard when I was a student there, creatively but hypothetically addresses narcissism in famous classical music performers by commenting on the photographs on their record jackets. According to Freundlich, some performers fantasize that they will be punished (or castrated) for their wish to exhibit superiority (e.g., technical facility and brilliant musical insights) or—even worse—that they will be exposed and found lacking. Gabbard (1979, 1983, 1997) and I (Nagel 1987, 1988, 1990, 1993, 2017) suggest that a fear of failure of not being “good enough” camouflages unconscious fear and guilt about being good enough. Because being good enough is unconsciously prohibited, under-par performances can serve a defensive function. By occupying the spotlight on stage, the performer who is good enough can arouse envy in other performers, thereby inducing guilt and shame in response. Because the quest for love, coupled with anxiety about winning (and losing), unconsciously evokes preoedipal narcissistic disappointments as well as oedipal strivings, stage fright fueled by guilt and shame can sabotage a performance, ensuring that a forbidden on-stage “victory” does not occur.

Since the young child is sexually and generationally excluded from the parental dyad, resentment and anger can resonate with earlier infantile disillusionments around relinquishing the throne of “His Majesty the Baby” (Freud 1914, p. 91), now compounded by unrequited oedipal love (Novick and Novick 1996). For the anxious performing musician, envy and greed associated with competitive strivings may become redirected to the need to eliminate and overpower other professional musicians—their “rivals.” Musical and technical brilliance—driven perhaps by a resurgence of infantile omnipotence now coupled with desire—may become a symbolic tool for the consummation of a performer’s affair with the desired audience / opposite-sex parent, leading to intense anxiety.

Feder (1992; Feder, Karmel, and Pollock 1990), Gabbard (1979, 1983, 1997), and Lombardi (2008, 2011) address the significance of the body and its defects as perceived by performers. Gabbard illustrates how the experience of spoiling (soiling) a performance (i.e., making mistakes) is experienced by the performer as loss of control, igniting the affect of humiliation.

Discussing the composer Charles Ives, Feder (1992) comments on a specific body part that is experienced as injured or painful, noting that for Ives a “fantasy of the ear” became “the mode of symbolization for early objects and experiences; specifically, Ives viewed the ear as the “organ of creativity” (p. 154). According to Feder, the ear was highly sexualized for Ives, who regarded it as an organ that could “both give and receive, incorporating both male and female fantasies” (p. 154). For Ives, “disuse atrophy” of the ear (p. 156) suggested that castration fears were displaced upward from the genitals to the ear. Awareness of the meanings inherent in bodily displacements can be observed for a variety of physical symptoms, including pain and injury, that trigger performance anxiety, inadequacy, and anxiety exposure before an audience.

The body/mind relationship is deeply emphasized by Lombardi (2008, 2011), who examines how some patients struggle with the “relationship between the body and the repressed unconscious as well as the relationship between the body and the dimensionless abyss of the unrepressed unconscious . . .” (2011, p. 5). Lombardi maintains that the effectiveness of psychoanalysis involves working through conscious—or unrepressed unconscious—bodily sensations and awakening awareness of “an authentic form of subjective experience” (p. 5). As these underlying dynamics are analyzed, the patient is better able to “think in the presence of emotion” (p. 3), something that performance-anxious musicians frequently find themselves unable to do. Music performers use their bodies to play their instrument, and for singers the body is their instrument. To have the body fail—or to fear that it will fail (due perhaps to memoery slips or defects in musical technique) becomes a hallmark of anxiety around mental and physical collapse on stage. For some anxious musicians, this can be experienced as psychic annihilation anxiety.

Exploring creativity from a developmental perspective, Kaplan (1969, 1995) examines stage fright as a disturbance in “poise” in performers in general. Kaplan maintains there is an unavailability of maternal nourishment and tactile holding (i.e., narcissistic supplies) when the performer appears alone on stage. In other words, the act of performing may itself be experienced as expressing deprivation, as the performer seeks nourishing approval from the audience. According to Kaplan, public performance for creative individuals is a counterphobic action and represents, in part, the “repression of historical trials in our lives that are compressed and retained in an affect like stage fright” (1995, p. 421).

For performers, according to Kaplan (1995), “stage fright is no disease of the psyche, unless all powerful apprehensions about significant and worthwhile enterprises are likewise pathologic” (p. 422). Seeking audience approval as displaced parental (and analyst) love cannot be underestimated for musicians who require approval and applause, like oxygen, to shore up loving object representations that are lacking. Yet at the very time a performer requires the soothing parent, the parental imago is not available. Indeed, the performer feels abjectly alone on stage, and comforting mental representations do not come to the rescue. At such moments, performance anxiety can be a terrifying and psychically disorganizing experience.

Shame

Shame is a powerful affect and an ego defense against narcissistic injury, but it is also a reaction formation to the wish for genital exhibitionism (Morrison 1989; Lansky and Morrison 1997b). This points to a painfully conflicted dilemma for anxious musical performers who crave love and approval from viewers and listeners but also unconsciously fear exposure of their perceived deficits, which would result in ridicule and rejection by the audience (or internalized object). Musicians’ dreams often convey the fear of walking onto the stage and finding themselves naked, small, unprepared, exposed, and demeaned by others (and the self). The prototype of exuberant, age-appropriate childhood narcissism—an exhibitionistic showing off and hamming it up, typically associated with displaying the body—can become tangled in an affective and defensive web of shame for the older anxious musician who fears being viewed as an inadequate sham and feeling humiliated and small on stage. Repressed affects about genital exposure may be defensively displaced onto other body parts that produce sound on an instrument (e.g., fingers and hands, lips, arms—note Feder’s comments above regarding Charles Ives’s displacement of sexualized fantasies from genitals upward to his ear). Similar examples of repressed and displaced feelings emerge in treatment when exploring musicians’ fantasies. In other words, there is a wish to be loved through performance but, at the same time, a fear of rejection that accompanies anxious musicians onto the stage, leading to conflictual dilemmas and often maladaptive compromises.

Morrison and Stolorow (1997) note that when probing the “subjective experience of the self” one typically discovers oedipal issues that reveal entrenched layers of preoedipal trauma fueling the performer’s defenses (p. 82). Further, according to Morrison (1989), Freud’s emphasis on affects, defenses, and the vicissitudes of guilt (as related to psychic conflict and the ego ideal) evolved into the structural concept of the superego, although Freud did not explicitly explore shame in his study of narcissism (1914). Piers maintains that shame reflects a perceived deficit and/or defect in the self, while guilt is an affective or defensive response to a real or perceived superego transgression (Piers and Singer 1953). Avoiding the compartmentalization of shame and guilt or the idea that guilt replaces shame, Piers, to quote Morrison (1989), believed that “guilt and shame interact and can be interchanged” (p. 11), thus emphasizing the fluidity of mental life. Wurmser (1981) underscores the idea that the “complex affect of shame . . . always involves the superego” (p. 73). In my experience working with performance-anxious musicians, a strong punitive superego is a prominent feature which is expressed in the insistence for perfection at all times while on stage.

Descriptions of musical insecurities often are metaphors for bodily insecurities about dreaded structural and functional defects represented by malfunctions of memory and technique when playing a musical instrument. Residues of childhood fascination with how bodies work—or don’t—are heard in performers’ childhood expressions such as making “boo boos,” “having accidents,” “making a mess,” and “dropping notes.” A familiar expression, “break a leg,” proffered by friends and family to performers, is manifestly intended to allay anxiety. It also evokes the image of broken body parts, perhaps a reaction-formation to envy and ill will toward the performer. This overdetermined cliché that encompasses well-being, ill will, and success reminds one of the complex magic wishes typically uttered by children. The performer’s apprehension around emotional and musical incontinence in public becomes unconsciously associated with fears of being exposed as broken and losing bodily control. Shame on you! to performers who soil and spoil their performance and make a mess on stage!

Music Performance Anxiety and Developmental Stages

While my theoretical approach to understanding stage fright is based on classical and ego psychological perspectives (Nagel 1987, 1989, 1990, 1993, 1998, 2004, 2017), I also draw on Erikson’s biopsychosocial schema (1950), which includes and extends Freud’s psychosexual developmental stages throughout the life span. Erikson’s epigenetic schema, “The Eight Stages of Man” in Childhood and Society, significantly condensed below, is pertinent to underlying developmental challenges with the potential to fuel performance anxiety. Both biological endowment and significant relationships during one’s earliest months and years begin to create a platform for the emergence of performance anxiety. For example, the newborn is completely dependent on parents and caregivers, who can become the prototype of the internalized audience/critic. With loving responses to the melodic coos and gurgles of the newborn, Erikson maintains, a sense of trust (or mistrust) begins to emerge in the baby. Pertinent to the music performer, a sense of trust in oneself to elicit reactions from others can help create a foundation for security later in life when a performer is on stage making music before an audience/parent.

Toddlerhood adds additional challenges for the developing child, including seeing the world from a vertical/standing (vs. horizontal/supine) position, acquiring language, and emerging from total dependency on the objects of infancy. The body begins to come into the child’s awareness, and this is gradually accompanied by the wish to feel competent by gaining control over bodily functions through either pleasing or defying parents. The outcome of this stage in Erikson’s schema can foster an adaptive sense of autonomy but also result in shame and self-doubt, the latter being hallmarks of performance anxiety. Subsequently, as the child traverses the next two stages of life, the toddler turned preschooler and then elementary-school age obtains pleasure from learning new ideas and behaviors and developing a sense of right and wrong. Importantly, when thinking of young musical performers, it is during this developmental period that many children begin instrument lessons and perform in their first recitals. Mental development has long preceded that debut recital, impacting this life stage as well as later appearances on a musical stage.

Subsequent developmental tasks as detailed by Erikson will not be highlighted here. Rather, my emphasis has been on the child’s earliest years, when musical, physical, interpersonal, and mental growth occur simultaneously. Experiences that have been internalized with meaningful objects, such as parents or chosen musical instrument (the latter perhaps used as a transitional object [see McDonald 1970]), social influences, and biological endowments affect the performer’s capacity to cope with love, rejection, shame, competition, and guilt; all underlie performance anxiety reactions in the young child, preadolescent, teenager, young adult, middle-aged adult, and elderly person in every musical performance.

Clinical Example: Ms. A.

Physical injury and pain are common in musical performers and have a profound effect emotionally; they may end professional aspirations altogether. It cannot be overstated that not being able to play one’s instrument due to psychological and/or physical impediments is experienced as a terminal illness for many performing musicians, potentially leading to a sense of having lost one’s identity. Physical injury and pain should invite psychological exploration and treatment, contrary to Lockwood’s claim regarding musical performers that “complaints of purely psychic origin are very unusual” (1989, p. 225). ¹

Ms. A., a violinist, requested an appointment after what she described as a “disastrous performance” which, according to her description, involved “losing technical control in difficult passages” in a recent concert. While she noted a frequent pattern of technical difficulties occurring, she said her stage fright had been lifelong and was unresponsive to self-help measures that included reading books, exercise, medication, cognitive-behavioral strategies, and diet.

Ms. A. feared that her bow arm would shake, which she maintained revealed a “flaw.” Her physical symptoms were embarrassing, and she worried she would be publicly exposed were her technique “to fail” on stage. She said she would feel humiliated if seen as “inadequate” by audiences. She admitted that she had contacted me with mixed feelings, as she had been told by her parents that “therapy is for crazy people” and that “intelligent people solve their own problems.” She also revealed that she was pursuing a music career over the objections of her parents, who warned her that if she became a professional musician she “probably would end up eating cat food in New York City.” Realizing that she had gone as far as she could on her own, Ms. A. was willing to reach out for help.

Early in our work, it became evident Ms. A. wanted, indeed demanded, “answers” from me, just as she demanded the “right notes and perfect technique” from herself. My questions and requests for clarifications and elaborations were interpreted as “criticisms,” to which she would vehemently respond that I did “not like her “ or was “withholding information” (i.e., answers and solutions) from her.

I experienced most sessions as a battle between us rather than a collaboration. Treatment felt at odds with her stated wish to “keep the peace.” Increasingly annoyed, I felt blocked and impotent when I was continually rebuffed. I often felt helpless as I gradually came to understand that I was identifying with her sense of incompetence when I found myself tempted to argue back. I realized that these interactions were re-creating an earlier relationship in her life that involved “power and submission,” something she complained about when describing interactions with her parents (Novick and Novick 1996, p. 47). I recognized that I had started to collude, ineffectively, with her insistence on a perfect performance, and with her disappointment that I could not provide what she wanted. I found myself thinking that I needed to find a better way of working with her, a way to curtail her unrelenting criticisms of me (I, too, was feeling increasingly ineffective). Reflecting further on my discomfort and the pressure I felt to perform better with her helped me understand that I was feelimg she was not my appreciative audience. This was a reprise of an old theme for me.

Ms. A.’s interaction with me replayed an earlier time in her life when she was a dependent child. From her accounts it was clear she had experienced parental bullying and emotional neglect. She felt no control in relation to her abusive, demanding, and temperamental father or her depressed, unavailable mother. Gradually we started to understand that her belief about having no effect on her parents was recapitulated in her feelings toward me and in her bouts of stage fright when she feared losing control of her bow and losing the audience. She experienced both guilt and delight in going against her parents’ wishes and pursuing a music career (and psychological treatment). What she failed to rcognize was that if successful in her musical pursuits, she would essentially invalidate her parents’ wishes that she not pursue a career in music. The fear that her “rebellion” would possibly evoke their rejection and abandonment (a fear projected onto the audience) coexisted with satisfaction with her increased independence from her parents.

Ms. A.’s shame over feeling exposed and humiliated by her faulty “technique” and her rage at not being appreciated or understood emerged as a leitmotif in our interaction. I began to realize that her early experiences and affects resonated with some of my own early dynamics, including feeling unappreciated and abandoned. This realization allowed me increasingly to steady my reactions toward her and to continue our work with greater awareness of my countertransference. As I revisited the origins of my feelings about performance competence, I no longer needed to try so hard to “get it right.”

Despite her complaints and occasional threats to leave, Ms. A. remained in treatment and began to speak about experiencing greater security on stage. While I did not feel she had gained much insight, I believed that since I had showed her I could withstand her provocations without collapsing or retaliating, she could now better tolerate the explosive emotions that seemed to threaten both our relationship and her musical technique, neither of which in fact collapsed.

Around the time Ms. A. reported her greater comfort in performance, her complaints of pain in her bow arm escalated to a fear that was career-threatening. She had not experienced the pain before we began working together. Once again, she leveled unrelenting accusations that I was not helping her. Ms. A. began a pilgrimage to a series of physicians in search of a diagnosis and treatment (“answers and solutions”). None found an underlying biological cause of her arm pain. Only one doctor suggested she examine her emotional life. Several suggested physical therapy. One offered the option of exploratory surgery.

Using a beta blocker in a self-prescribed dose that, according to the literature, was not a therapeutic level for treating performance anxiety, Ms. A. continued to tremble on stage. She had obtained the medicine from a friend. (Many musicians have turned to beta blocking drugs to control physical symptoms and often share their medicine with colleagues.) Ms. A. emphatically maintained that the drug helped her, even as she continued to worry about her physical sensations. It did nothing for her arm pain or to significantly reduce her performance anxiety.

I began to question Ms. A.’s reluctance to examine her emotional life for the source of her pain. I said I felt she was running away from emotional pain inside herself and asked if she could consider the idea that she was fleeing me, perhaps viewing me as her criticizing father and/or absent mother who did not approve of her career choice and did not help her with answers. I suggested that she might need to use medication to avoid strong feelings and memories too painful to reexperience. Not unexpectedly, she said I was wrong.

Not long after, Ms. A. reported a dream in which her boyfriend had left town on businesss. Fearing he would never return, she was surprised when he came back. She said she felt “disarmed” in the dream. Analysis of the dream did not seem to go anywhere at the time, but I mentally recorded her somber affect as she spoke of feeling “disarmed.”

Several months later, Ms. A. suddenly told me that she had found a good job that meant moving out of state and ending our work. I felt sidelined, surprised, and left out of her decision, although in retrospect I believe there had been a displaced reference about her boyfriend going away (but returning) in her dream that had not been sufficiently understood. I, too, felt disarmed to hear her unexpected announcement about ending treatment and moving away. Her words resonated for me as they evoked my father’s abrupt abandonment of his family when I was four and the lifelong secrets my family maintained around his disappearance.

I also associated to her word disarmed as a reference to her fear of losing not only physical control at her violin but also emotional control regarding what her arm could do should she use it to express her anger at me. It seemed like her arm pain and the disuse it occasioned protected her from lashing out, even as it punished her through her stage fright for the wish to do so. Her most dreaded punishment for lashing out physically was the emotional pain of being unable to play her violin, dropping her bow, and losing her musical sense of self.

I asked about her having kept her job search secret. She told me she had avoided talking about it for fear of displeasing me, claiming, “I feel guilty to feel so good and happy.” I said I wondered why she would feel guilty about happiness. She said she was surprised she could feel good and not worry about hurting anyone. She rationalized that she would hurt me if she talked about the job search. There was insufficient time to work through her defenses and actions before she left.

Could I have anticipated Ms. A.’s departure and responded differently in our sessions? Would some acknowledgment or clarification have preserved our work together? In retrospect, I believe I was more tuned in to her dream in which someone she cared about (the boyfriend) left but also returned, as my father had not. Yet a reference to her fear of parental abandonment should she pursue music, and some recently expressed anxiety that I would become disgusted and leave her, left a leitmotif of departure in the air.

Simultaneously, I started to believe that she felt increasingly that I was a steady rock, and would not vanish because of her arguments with me. I cared. Did she care about me? Instead of considering more carefully that her dream involved her leaving me (I recalled her previous travels to various physicians for pain management, even though she always returned), I thought she was beginning to feel more stability, trust, and connection with me in our relationship. My guarded feelings for her were softening.

Ms. A.’s voice was shaky when she told me about moving. I noted how upset she appeared. I recalled her earlier dream about her boyfriend going away—offering the idea that perhaps she felt she needed to leave me before I left her—as she feared her boyfriend had done in her recent dream. I added that she feared her parents too would leave her if she pursued a career in music. Ms. A. said she always feared attacks from others. I offered the idea that she might fear that she literally would attack me with her bow arm if she were pain-free and that, indeed, I would then leave her. I said I believed her fears/wishes regarding her aggression made her feel ashamed and guilty, rendering her arm “disarmed” with pain—pain that offered both protection of others should she lash out and punishment toward herself for her rage and shame (i.e., the debilitating and shameful stage fright). But this pain, I went on, also prevented her from playing her beloved violin, having a successful career, or establishing a close relationship. Ms. A. spoke with palpable affect as she told me, “I fear I will hurt people, and that they will either hit me or hate me.”

This interaction opened some brief collaborative space between us. We could speak for the first time about how she re-created with me the painful relationship she had experienced with her father and her fear of his temper (and her own). She fantasized she would use her bow arm to hit me in a fit of rage. The pain in Ms. A.’s bow arm protected her from demonstrating her talent (confirming her father’s disapproved of her pursuit of music as a profession), her longing for closeness, her rage, and her shame as her pain destroyed her career aspirations.

Ms. A. and I explored her fantasy that being “perfect” on stage would modify or reverse paternal disapproval and her father’s verbal abuse. She feared “making boo-boos, having accidents, dropping notes,” and feeling ashamed—emotionally incontinent—about technical mistakes and memory lapses, understood as involuntary soiling in public when her technical boo-boos would not permit a clean performance. Ms. A.’s notion of her imperfect body and her belief about her flawed technique became a painful hallmark of her mental pain.

Only during our termination work, which was condensed but fruitful in many ways, could Ms. A. begin to understand how pleasure and guilt commingled for her. She also started to recognize that emotional and physical pain and feeling close to me (versus a defensive anger) were aligned for her psychologically and related to her stage fright. Nevertheless, she insisted she had to move for a job opportunity.

Despite my wish to continue our work and my feelings about her abrupt departure, I felt some satisfaction that Ms. A. had begun to appreciate that exploring the pain in her mental life could help her better manage her performance anxiety. I recommended that she continue treatment in her new location. While Ms. A. had become increasingly secure in performing (the ostensible symptomatic reason she had entered treatment), our work unearthed aspects of herself that were deeper than musical technique. When she moved, I reflected on our time together, even as I further processed my abandonment by my father.

Discussion

A confluence of narcissistic sensitivities, ego/superego development, shame dynamics, physical injury and pain, and terrors pertaining to psychic and bodily disintegration can fuel anxiety reactions in many people. In this respect, Ms. A. was not unlike highly anxious nonmusical performers. Yet these dynamics hold particular resonance for the performing musician who has spent formative years while simultaneously preparing for a musical career.

Ms. A.’s challenging stance toward me led her to identify with her demeaning father (and to turn me, through her transference, into herself while imitating her father). This allowed her to experience a sense of omnipotence and power she believed she lacked. For my part, I realized that when at times I tentatively asked for clarifications, I was trying to avoid confrontation. At other times, I became more verbal than typically is comfortable for me. I tried to dodge the bullets of Ms. A.’s unceasing assaults. As I better understood my countertransference reactions toward her, I grasped how her decision to withdraw from treatment was her solution to protecting both of us from what she imagined would be mutually expressed rage, which would provoke my abandonment of her. Beneath these feelings, I sensed her longing for closeness and love.

Ms. A.’s pain concealed her pleasure in triumph. On occasion, she suggested that she enjoyed “stirring me up” because it gave her a sense of power. After one of her concerts she said she feared she had made others in her quartet look bad, adding that she feared she had injured them. Her arm pain had protected her from dangerous omnipotent power even as it disempowered her.

For Ms. A., who expressed her fears of becoming “disarmed,” Lombardi (2011) offers the idea that bodily complaints can be experienced viscerally as a terror of bodily disintegration altogether, “a sense of nothingness” (p. 5). Psychic pain, experienced as physical pain, can be excruciating and incapacitating. The psychological implications of injury and pain for performing musicians can be experienced as life-threatening, as much as the physical consequences of a terminal disease.

Coda

I knew nothing about psychoanalysis when I experienced stage fright at Juilliard. Like all music students, I had weekly private lessons and performed in recitals but also learned about theoretical concepts such as consonance, dissonance, ambiguity, conflict, resolution (musicians analyze these elements as harmonic and formal structures in the score), and multiple function (musicians call this counterpoint and harmonic modulations). I learned how to analyze a score from various theoretical perspectives, listen carefully, and be acutely aware of nonverbal musical interpretations. I did not learn about managing my anxiety. I practiced the piano for long hours every day, as performers do.

Stage fright was a topic not openly acknowledged at Juilliard when I was a student there. I believed that if you were talented enough you would not suffer with this demon. I held the fantasy that I was the only one there who experienced performance anxiety. Stage fright was a stigma one suffered alone in silence. My piano teacher reassured me, when I complained, that he believed in me and that I should too. His well-intentioned, supportive comment resulted in increased pressure not to let him down. Only many years later did music analysis resonate for me with psychoanalysis.

I did not enter psychoanalysis overtly because of my stage fright. Yet through my analysis I came to better understand my first memory slip and its significance regarding my “forever recording.” I filled some gaps with my childhood ideas about why my little white toy piano, the beloved gift from both my parents when they were married, held powerful meaning for me. This tiny, twenty-four-key piano was fun for me. I discovered I could play tunes and compose music on it. My piano was associated with happy feelings.

After my parents’ divorce, my mother bought a full-size upright piano for me when I began formal lessons. I remember coming home from kindergarten the day it was taken off a big truck and wheeled down the sidewalk to my home. I was so excited. My upright piano, which was exchanged for a baby grand when I was eleven, became a source of comfort, and it expanded, with its full keyboard and bigger sound, the ways I could express the unnamed feelings inside me.

I remember a year-end program in kindergarten in which I was asked to play the piano to accompany a group of elves singing “Wind Your Thread and Unwind Your Thread.” I learned the song by ear. Friends began to ask me to play the piano at my home or at theirs. At school assemblies, teachers would invite me to perform. I was in every talent show. However, at home, when my mother asked me to “play something,” I would reply, “I don’t know anything” (an unconvincing excuse because she always heard me practicing). In my mind, there developed a difference between practicing and “performing” for someone else. Playing the piano brought me considerable attention. Yet I started to feel pressure and shyness about performing in public.

I grew up in a house full of love and care from my mother and my grandparents. My piano was special throughout my life, and playing it brought deep comfort to me after my mother’s untimely death when I was at Juilliard. Among other meanings that I have come to understand about playing the piano is that it became associated with painful losses.

In my analysis, I came to realize that the one important person from whom I could not receive loving attention was my father. As a child, I was only told about his professional life, which revolved around his being a three-time Olympic gold medal winner in speed skating years before I was born. He accomplished these impressive feats against long odds and great obstacles. If I could not know my father, perhaps I imagined (though not consciously) that I could “be” like him. Perhaps my musical accomplishments would win his attention.

These themes emerged early in my analysis as I initially spoke rather intellectually about my career choice and change more than about how I felt about my family. My attachment to my analyst was warm and affectionate, and while our work was rigorous and at times painful, I did not doubt his steadfastness and integrity. His reliability and interest in my feelings, as much or more than any interpretation, were mutative for me. Not long after beginning analytic training I unexpectedly found tremendous pleasure blending my musical and psychoanalytic backgrounds through combining them in my writing.

Playing a musical instrument has had a lifelong impact on me. Was the goal I was seeking through my performances my gold medal father? A brilliant performance could not undo the loss I had sustained. Nor would a less than stellar performance cause my father to leave. This is the disillusion of my omnipotence. A related question arises in my retrospective look at Ms. A.’s analysis: Could I have heard or said something differently to have saved our work together? Did I “miss” something or “cause” something to happen, as I had fantasized doing as a child to cause my parents’ breakup?

Playing the piano in public, like skating on ice, can be slippery. One falls off the notes when musical technique slips. Memorization also can be slippery in performance when the performer forgets the score. My father slipped out of my life, although he obviously did not fall down on Olympic ice. Often, when on the couch, a piece of music would come into my mind, which I would then explore in my associations. One such occurrence was the emergence of the nursery song, “Twinkle Twinkle Little Star.” In a session one day I heard this familiar tune inside me. I softly repeated the words aloud:

Twinkle twinkle little star

How I wonder what you are

Up above the world so high

Like a diamond in the sky

Twinkle twinkle little star

How I wonder what you are.

Did my father, the Olympic star, wonder about me as I must have wondered what he was like and where he was? That mystery and wonderment will be unknown forever to me, just as my memory slip is imprinted in my “forever recording.”

During my analysis, I began to mourn some of the contrapuntal melodies and fantasies in my mind. I did not cause my father to leave and my parents to divorce, a fantasy that had haunted me into adulthood until I understood myself better. I cannot recall that anyone ever tried to explain my father’s disappearance to me. I filled the void with my own “explanations.”

When I was six years old, my “forever recording” evoked my father’s “for always” absence. My fantasies and shame around forgetting my music during my recording session had become transformed into anxiety around loss, feeling forgotten, never remembered, and not feeling secure when I attempted to express myself at the piano in public. I have grown to appreciate that, for me, combining my music and my psychoanalytic training has been deeply satisfying and has allowed me to bring together two disciplines and many feelings that, at first glance, appear unrelated—like my parents after their divorce.