Performers vs. Anxiety
Brobson Lutz, M.d.
In local music circles, Domino is considered a “famously reluctant performer” and has cancelled many appearances through the years for vague illness-related excuses.
“Instead of closing out the first post-Katrina New Orleans Jazz and Heritage Festival with homegrown rock ‘n’ roll legend Fats Domino, tens of thousands of fans were left to puzzle over Domino’s last-minute cancellation and brief, apologetic appearance,” wrote music writer Keith Spera in The Times-Picayune May 8, 2006. According to Spera’s account, several long term friends including WWL-TV news anchor Eric Paulsen and musician Haydee Ellis went to Domino’s home several hours before his scheduled performance to provide moral support.
Domino insisted he wasn’t feeling well and wanted to go to the hospital. Doctors at Ochsner checked his heart, ran some tests and found nothing wrong. Still Domino insisted he felt too bad to perform according to the newspaper account. “He wasn’t feeling well, so we took him to the doctor. He’s OK, but he doesn’t feel up to performing,” said longtime friend Haydee Ellis to The Associated Press in an article that ran at the time.
“Fats said it best. He said ‘no one knows how you feel except you,’” Paulsen told Spera who also quoted a fellow musician: “You can never tell with Fats. He can bounce back in a minute.”
Haydee Ellis has known Domino for years as a fellow musician and friend of the family. She played a few songs with him once but they’ve never played together professionally. “I would agree that Fats Domino is the city’s best know musician with performance anxiety,” Ellis said recently when contacted on her cell phone one Sunday on her way to Snug Harbor. “Everyone knows he practices up to the last minute. He really sweats to sound like he has always sounded. The best protection against performance anxiety onstage is to forget about being scared,” said Ellis. “I had a guy in my band have a panic attack on stage during a Jazz Fest performance. The next song on the set list had him playing lead and singing. Just before the song he mumbled to me that he couldn’t pull it off. We switched to another song. He had been playing music for years on stage when it happened.”
While Ellis believes Domino does have performance anxiety, she’s adamant that his inability to play the last day of Jazz Fest in May 2006 was related to other factors. “He was still in Katrina stress. He had lost everything. He was living in Harvey. It was so different from his community. It was definitely not just performance anxiety. There were other elements and just too much pressure. He was even on the Jazz Fest poster that year,” added Ellis.
Performance anxiety is a grab-all term encompassing onstage jitters, stage or camera fright, fear of public speaking or performing in anything from an interview to a major performance. It doesn’t occur in just music and acting; performance anxiety can play havoc with any career where speaking before a group is obligatory. It even strikes mimes and jugglers who never speak.
Symptoms include a pounding heart, butterflies in the tummy, sweaty palms and a dry mouth. Muscle tremors, quivering lips and a breaking voice are more visible manifestations of performance anxiety. All these signs and symptoms are caused by a surge of adrenaline-like chemicals related to an important animal survival trait – the fight or flight response. These evolutionary responses primed our ancestors to run from bears and to stay and fight if an exchange of blows seemed advisable. Muscles contract to protect vital organs. Blood shunts from gastrointestinal organs to muscles. Blood pressure rises and the heart rate races. Pupils dilate to improve distant vision. If humans had hair like dogs, it would stand on end. All these physiological responses are geared to handle unexpected stress or excitement but this same release of stimulants can cause anticipatory havoc when a planned performance is the goal.
For centuries musicians around the world blunted the symptoms of performance disorder with a drink or two before performances often followed by many more after the gig. Alcoholism became an occupational hazard. The well-publicized marijuana use by jazz musicians and other performers is probably related to the relaxing effect of cannabinoids. Musicians and others took tranquilizers and sedatives such as Equanil, Valium and Librium to blunt the neurohormonal releases common to excessive anxiety. But these drugs dull the sensorium; tolerance and dependency problems can follow.
Inderal was a therapeutic breakthrough on the cardiac front when the FDA first approved it 1967. It helped regulate irregular and rapid heart rhythms and cardiologists quickly discovered other cardiac indications. It is a beta-blocker as it blocks the action of adrenaline and other nervous system substances responsible for the fight or flight responses. Alpha-blockers block something else. Other specialists took note.
“Inderal is an important drug in neurology. It is useful to treat essential tremor and some migraine conditions in addition to performance anxiety,” says Dr. Frank Oser, a neurologist at Ochsner Medical Center.
“Dr. Richard Spector and I took care of an opera singer a few years ago who was certain he had some kind of lung, heart or throat problem,” says Dr. Josh Lowentritt, an Uptown internist and nephrologist. “He canceled several events. Dr. Spector and I worked him up and down – laryngoscopy, pulmonary function tests, EKG, stress test, labs, x-rays and a swallowing study. Once he was convinced he wasn’t going to die of a horrible illness, he started taking a low dose of Inderal before performing and we never heard from him again.”
According to Dr. Wallace K. Tomlinson, performance anxiety among college students is very common. It is often precipitated by a student who has to present or speak before a class. “A second year law student had a little problem in high school. By her second year in law school her fear of speaking to the class was crippling her. She experienced flushing, stammering and tremulous voice when asked to speak,” says Tomlinson, Professor Emeritus in Tulane’s Department of Psychiatry and Neurology. “She responded to propanolol (Inderal) given about 45 minutes before any presentation. It worked like a charm,” said Tomlinson.
“Over the years, several of my residents utilized beta-blockers when presenting cases to the Louisiana Dermatologic Society. They reported it was beneficial for the sweaty palms syndrome,” emails Dr. Larry Millikan from Atlanta.
“I know of sub-specialists and residents who used beta-blockers before delicate microscopic ear surgery to steady their hands while operating under high powered surgical microscopes,” says Dr. Knight Worley, an ENT specialist and past-president of the Touro Infirmary medical staff.
One physician who makes no qualms about taking a dose of Inderal before potentially stressful situations is Dr. Mary Lupo, Lupo Center for Aesthetic and General Dermatology. “For years, I’ve been on the national lecture circuit as a filler and Botox expert. I demonstrated these techniques on jumbo screens in front of hundreds of dermatologists and plastic surgeons. Since the camera is up close, I want not even the least unsteadiness to my hands so I take Inderal 10mg,” says Lupo “It gives me the steady hands of a mohel,” she adds, using the Jewish term for the religious person who performs male circumcisions. (Supposedly a mohel performs his first circumcision on his own son making this select group a candidate for mass Inderal use.)
An occasional beta-blocker isn’t for everyone. For example, it might aggravate asthma and cardiac patients taking it on a daily basis may not achieve the desired response when faced with performance anxiety.
My suggestion: If you have performance anxiety or shutter at the though of public speaking, check with your physician to see if 10 to 20 milligrams of Inderal 30 minutes to an hour before some feared public activity is something you can try.