Alford, Szanto - Orpheus Wounded, The Experience of Pain in the Professional Worlds of the Piano

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Orpheus Wounded: The Experience of Pain in the Professional Worlds of the PianoAuthor(s): Robert R. Alford and Andras SzantoReviewed work(s):Source: Theory and Society, Vol. 25, No. 1 (Feb., 1996), pp. 1-44Published by: Springer

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Orpheus wounded: The experience of pain in theprofessional worlds of the piano

ROBERTR. ALFORD andANDRAS SZANTOCUNY Graduate Center; Columbia University

The discovery of widespread physical pain among musicians has

precipitatedagonizedreappraisalsof the impactof competitionuponphysical stress, of the consequences of traditionalways of teachingtechnique,and of the role of medicine in treatingpain amonginjuredmusicians. This article deals with the institutional and individualfactorsthatboth producepain and constrainthe search for solutions,specificallyamongpianists.1

We examinehow the causes and treatmentof pain are eitherdefined,ignored,or mismanagedby the componentsof the institutionalield ofthe piano: the "virtuosoworld,"the "pedagogicalworld,"and the"medicalworld."2Pain is an unintendedconsequenceof the interplayof these multiple nstitutions,whichhave diversegoals, practices,and

ideologies. We explore the internalcoherence of each of the threeworlds and show what institutionalpractices and ideologies shapethem,how theirinterrelationshipsreatetensionswithineachone, and

how each world defines the existence, causes, and remedies of painamongpianists.Since none of the worldshas historicallyhad to copewith the causes of pain (and the medical world only with its con-

sequences),the discoveryand acknowledgmentof its extent has pro-vokeda crisisof responsibility ndresponse.

The argumentof the articleis intended to demonstratethe ultimate"macro-micro"ink: how the internationalpolitical economy of the

concert market,mediated by "meso"processes in the institutionalworlds of the piano, is relatedto the developmentof individualpainfromskilledbody movements.3

Theoryand Society 25: 1-44, 1996

? 1996 KluwerAcademic Publishers. Printed inthe Netherlands.








2

The extent and causes of pain among musicians

Historicallyhere arefew well-knowncases of musicians ufferingpain.

Probablythe best-known s that of Robert Schumann,who destroyedhis ability o playafterhe devised"anapparatusntendedto strengthenandhelp gainindependencefor the fourthfingerof his righthand,"a

physiological impossibilitybecause of the tendons connecting the

fourthandfifthfingers.4

However,a remarkableproportion

of contemporaryperformingmusi-

cians are in considerablephysicalpain.The examplesof the virtuoso

pianistsGaryGraffmanandLeon Fleisher,both of whom lost the use

of theirrighthand,areonly the most well known.5Althoughwe focus

here upon pianists,the extent of pain among all musiciansis extra-

ordinary.A surveyof a largenumberof orchestramembers n theearly1980s found thatalmosttwo thirdsof them had pain associatedwith

playingtheirinstrument.6Another surveydone in 1986 by the Inter-

nationalConferenceof SymphonyandOperaMusiciansof eachplayer

in their 48-memberorchestrasfound that over three-quartershad amedicalproblemthat severelyaffectedtheir performance.Problems

were more prevalentamong women and in the left versus the righthand.There was"relatively ighuse"of beta blockersfor performance

anxiety,connectedto psychologicalstress and possible physicalpain,as we showlater.7

A surveyof 3,000 membersof the Music TeachersNationalAssocia-

tion (MTNA, whose membership s not just pianists)conducted in1989 found that 29 percent had playing-relatednjuries.8Lastly,a

survey we conducted found that over half of performingpianistswhoweremembersof theNew YorkStateMusicTeachersAssociation

in 1990 had suffered "physicalproblems" related to their piano

playing.9

These numbers ndicatethatphysicalstressand naggingpain arepart

of thedailylife of manymusicians.And absentfrom allof thesefiguresare those pain-inflictedmusicianswho have abandonedtheir careers

altogether.

Why does the widespreadextent of pianisticpain merit discussion?

First,andmost simply,we focus on it becauseits extenthas eithernot

been known or ignored.'0As Dr. Alice Brandfonbrener, ne of the

foundersof "performingrtsmedicine,"has said,the discoveryof pain








3

is recent."Ithas only been withinthe last decade... that [thenotable

examplesof

career-ending...

injuries...

among instrumentalists]have

attracted ignificantattention romeithermusiciansor medicalpracti-tioners. With this heightened interest, the great frequencyof other

performance-relatedmpairments,not all of them career-ending,hasbecomeincreasingly pparent."11

Second, we discuss this because,partlyresulting rom this historyof

denial,neitherdoctorsnorpianoteachersappearto knowhow to curethe chronic pain from which many pianistssuffer.12Third, it merits

attentionbecause the ordeals of pianists raise questions about thesocial construction of physicalpain, this most privateemotion. It is

important o trace the social contributions o such intenselypersonalandprofessionaldilemmas.Fourth,we recognizethattheproblemmayindicatesocial pathologiesin the productionof cultureand the devel-

opmentof newmarketplacesorculture.

What are the "risk actors" hatleadto theproductionof painandhow

have these factorschangedhistorically?This is a crucialbut verydif-ficultquestionto answer,preciselybecauseof the fragmentation f therelevantknowledge, ts encapsulationwithinthedifferentworldsof the

piano.Butwe cangivesome suggestionsabouta varietyof interrelatedfactors.

Theconfiguration f thekeyboardandtheweightnecessary o playthe

piano are risk factors that have been essentiallyconstant since the

developmentof the modernpiano.Giventhe physicalrequirements fthepiano,havingsmallhandsor handswithunusual lexibility "hyper-mobility") readditionalriskfactors.

The developmentof a standardvirtuoso repertory(essentiallysince

Liszt) thatplaces greatdemands on the hands and fingersis anotherriskfactor,because it createsintrinsicstrainand requiresmuchmore

practicetime to learnand keep in shape.'3Further, he proportionof

thetotalrepertorywithvirtuosodemandshasexpanded.

Marketcompetition orpianistshasincreased,because of theshrinkingconcert market coupled with the increasing production of concertartists. Increased competition leads to higher standards of perfor-mance,that in turndemandlongerpracticetimes.Performance tand-ards have also increasedbecause of the comparisonof live perfor-mances with recordings that can be perfect because of splicingtechniques.








4

The numberanddemandsof competitionshaveexpanded,as we shall

see, leadingto

greaterdemands to

playthe virtuoso

repertory,n turn

requiringmorepracticetime. The professionalization f pedagogyand

its link to the productionof virtuosi,coupled with the expansionof

market competition,has meant that recitals, auditions, and artistic

competitionshaveextendedto youngerandyoungermusicians, eadingto increasedpracticetime,anxiety,and stressamongyoungmusicians,

enhancing heprobability f pain.

Lastly, hepossibilityof a faultytechnique, ransmittedromteacherto

student, s a key risk factor.If many pianistsareplayingwithunneces-

saryandinefficientmuscular ension,or with excessivemovementand

pressure,the effects of all the other risk factors are intensified.It is

impossibleto assessthe relative mportanceof these factorspotentially

causingpain,but their combination s lethal,as witnessedby the sheer

numbersof pianists inallyacknowledgingheirsuffering.

The secret history of pain

The surprisingrequencyof painis matchedonly by the tenacityof the

silence surrounding he problem.It is highly significant hat no com-

prehensivestudiesabout the incidenceof pain amongmusicianswere

done prior to the 1980s. Before the late 1970s, pain could not be

acknowledgedpublicly,orreasonswe tryto explainhere.

Painamong pianists ooks backon a secrethistory.On the one hand,itis almost celebrated as necessaryfor the developmentof a virtuoso

technique.Accordingto ProfessorJosephRezitsof IndianaUniversity,there is a "prevalentbelief among teachersand students that pain is

necessary."14n the other, t is often deniedby both teachersand stu-

dents. Both sides of this paradoxicalhistoryare importantto under-

stand.

Severalautobiographiesand personal handbooks illustratetheview

that pain is necessary.Ruth Slenczynska,a virtuoso who made her

debutin Berlinat the ageof sixin 1931,wroteMusic at YourFingertips

thirty yearslater.In the firstchapter,entitled "PersonalFactors," he

says that pianists"mustbe stubbornoptimistswho will spend hours,

weeks, even monthsworkingon dull problemsof technique"p. 16).15

Later,she recommends,while discussinghow to learn such virtuoso

pieces as a Liszt HungarianRhapsodyor a Saint-SaensConcerto,that








5

the pianist "repeat he passage four times (without stopping)at each

metronomespeedfrom slow to

fast,in order to build

upthe

necessarypower of endurance."Youwillsufferphysicalpain and learnto endure

it;pain is likea tunneloffirethat orgesmusclesofsteel.Youwillemergeat the other end invigorated,witha tremendousmarginof reserve,and

withtheknowledgeof completemastery,which is well worththeeffort"

(p. 40, italicsadded).16

GeorgeAntheil,a composer andpianist,publishedhis autobiographyin 1945: BadBoy of Music. His imageof how

pianistsmusttraintheir

fingersand theirbody is almostfrightening. Apianist's ingersareboth

his ammunitionand his machineguns. By the timeyou arereadyto be

a concertpianist,theymust have been tempered nto steel.... Practi-

cally any concert pianistwith a real techniquecan [crackplate glasswith his little finger].You practiceslow trills until it almost killsyou,untilyourtwoforearmsare likesorethrobbinghams,twice,three times

theirnormalsize,or so theyseem. Thenyouwaituntil the sorenessgetsout of them. Then you start all over again. Finally,afterweeks, youcommence playingan octave scale.... Up and down, up and down,until,at last,your orearms eem as if theywillburstagain.Moreover, ythistime,thepain creepsup to yourshoulders, preadsoveryourback.Youkeep on. Youmust neverstop. And so techniquecomes to you"(p. 68, italicsadded).17

On the otherhand,pain is denied.A well-knownauthorof worksonthe piano was invited to talkto the facultyat a conservatoryn Man-

hattan severalyears ago. He asked the facultywhetherany of themwere suffering rompain,and if anyof their students were. Vehementdenials wereheard.On the wayout of the room after the meetingtheDean whispered o himthattheywereall lying,about both issues.18nanotherepisode, a pedagoguegivinga talk at a well-knownMidwest

conservatoryaskedthe students o raisetheirhandsif theyhad serious

physical problems.Many hands went up. Afterwards,severalfacultyadmitted privately that they did not know how to deal with the

students'painandthattheytoo werehavingphysicalproblems.19 heserandomexamplesillustratea paradox:pain is seen as necessary ("nopain, no gain")for virtuosity,but then must be overcomeby heroiceffort - and denied.

The denial of pain is strikinglyreflected in written texts on pianoplaying.None of the textbookson pianopedagogythat we have exam-ined deals with pain in any serious way. Sometimes "tension" s








6

acknowledged,but little is saidabout its causes or remedies,exceptto

rest,or

"change our wayof

playing."20his

conspiracyof

silence,that

maybe merelyignorance, s both a symptomof and a stimulus o the

illegitimacy f pain.21

Betweengenetic predispositionsand the actualprevalenceof painis a

set of social mechanisms- the "worlds" hat we have distinguishedabove - that assuage or exacerbate the likelihood of injury among

pianists.

The virtuosoworld

Youngpianistsdeveloptheirtalents n a hot-houseatmosphere,solat-

ed from others,trainedto think of themselves as psychologicallyand

physicallyunique and different.They move throughthe institutional

worlds of the piano, some surviving,some disappearing.22 s theyenter the pedagogicalworld, they find a teacher who nurturestheir

talent andhelpsthemdefine their dentityas a musician.Musiclessonsfor childrenare a "sourceof satisfactionand status for parents."The

child is "passive"n the face of a parentor teacher with considerable

stakein the outcome of music lessons. A "youngmusicianattemptingto overachieves particularly t riskforinjuries."23

The musicteacherhas the "potential.. to exert an inordinateamount

of influenceon themusicaland extra-musicalife anddevelopmentof a

youngstudent,at timesakinto thatof a parent.Onemayturnto almostany musicalbiographyfor confirmationof this tendency"(p. 30). A

well-knownviolin teacherin England,at the 1992 PlayingHurtcon-

ference, describingteacher-studentrelationships n what she called

"establishedschools,"said that "traditions very strong [in] the old

establishment tradition ... many of the problems really are rooted

there,becauseteacher-studentelationships re alsovery strong,which

is good, but when it'sunshakable, hen it becomes veryharmfulvery

often ..."24

The tensionsmount in the course of the attainmentof a professional

identity in the virtuoso world, a cluster of interrelated nstitutions

revolvingaround the pivotal figure of the criticallyacclaimed star

pianist- a uniquefeatureof Westernmusicalculture.Conservatories

trainfuturevirtuosi,who in turnenhancethe conservatories' eputa-

tions,whichhelps recruityoung prodigies.Competitionsoffer a step-








7

ping stone for aspiringperformers o realizetheir dream of reaching

"thetop."Artist management irmsrecruitand promotevirtuosi;con-cert hallsmust book them to fill the house. Recordcompaniessee the

promise of gold and platinumsales. Publicationsoffer stories about

virtuosi to readerseager to find out everythingabout their revered

pianists, romfingeringpatterns o sexual habits.The mass mediadeal

with virtuosi in their celebritycolumns and with talented unknown

pianistsas virtuosohopefuls.Criticslaud and condemnvirtuosi with

languageranging romarcaneto slanderous,whilestayingsilent about

less successfulpianists.

Thepublic

flocks to virtuosiperformances,leavingpianistsof lesser standing o playto audiences ured to recitals

by complimentaryickets.

How and why does the operationof the virtuosoworld cause pain?Theconstituentsof the virtuosoworldtrain,recruit,publicize,criticize,

manage, promote, and lionize the virtuosi. The rigorous physicaldemands and the relentlesspracticingneeded to succeed in the cut-

throatrivalry or the few positionson top expose pianiststo a higherriskof pain.

However, hevirtuosoworldalso penalizestheopen admissionof painand a public searchfor treatment,as pain-ridden pianists stain the

pristine mageof the virtuoso,whose almost sacred talentis expectedto be unencumberedby profane biological impediments.Pianistsin

paindo not symbolicallyqualify or virtuosostanding,nor can theybe

confidentlybookedforperformances.

Assuminga certaindegreeof geneticvulnerabilityo pain fromlong,repetitive muscle use, the requirementsof virtuosic standing thus

expose individualsto a high degreeof risk accompaniedby negativeincentives to pursue remedies. The additionalpenalty is having toabandon a career to which they have devoted their lives. Potentialvirtuosiare thusin a triplebind:they areexposedto highrisk;theydonot wish to abandon a life commitment;but theycannotacknowledge

theirpainand seekhelpwithoutnegativeconsequences.

The prestige of virtuosityis bestowed only on a select number of

pianists.Whilemusic schools continue to producean everlargercadreof young prodigies,decliningpublic attendanceconfrontsperformerswith a shrinkingconcert market that is only partly compensatedbyexpandingmediamarkets.25 hus,there is moreemphasison competi-tions to screen out allbut a few and a focus uponnote-perfect,power-








8

ful performances, which adds even more emotional and physical stress.

Winning a competition has become more necessary as the cornerstoneof an important pianistic career, and adds considerably to the emo-

tional and physical pressure to perform the most demanding literature,

extend practice time, and to compete at even earlier ages.26

The sheer number of competitions has expanded greatly (see Figure 1).There were about 10 international competitions in Europe in the

1950s. The number has increased geometrically since then, to 20 in

1960, 40 in 1980, 58 in 1988, 104 in 1993. Since not all competitionsare held every year, there are even more organizations planning an

international piano competition in Europe. In 1992, for example, there

existed approximately 135 international piano competition organiza-tions in Europe. If one counts the "numerous national, local and inter-

nal competitions (especially in the U.S.A.)... the amount of piano

competitions worldwide might well total some 500" (p. 29).27

The career significance of piano competitionsis

indicated bythe wide-

spread extent that young pianists "pad" their vitae. Alink comments

that "itis amazing to see how many times facts about prizes are distort-

ed in the curriculum vitae of pianists" (p. 19). "Unfortunately, a few

110

100........... ........ ..............................

90-.

80..

70-

60-'

1 f

40q

30 ............. ..............................

20 . . .. . . .. . . . . ... . .

10 ..IA"" I I

0 ,,,,'_'......,... al_..........'1900 1910 1920 1.0 1940 1950 1460 1970 1980 1990 2.o)0

Fig.1. The number of (semi-)international iano competitions being organized in

Europe,for eachyear.(Courtesyof GustavA. Alink,Piano Competitions, rdedition,

Den Haag: PCPublications,1993,p. 28. 1st edition1988.)








9

pianistsgo quitefarin this.Theytend to 'invent'good results,knowingthat

nowadays,hereare so

many competitionsthatit is

quitedifficult

to check the informationreceived."Because of this inflation, andbecause "many concert agencies and impresarios"only have the

competitionresults,as reportedby the pianist,as the basis for a book-

ingdecision,it is "moreand moredifficult oryoung pianiststo startaninternational areerandto find a good manager...."The result is that

pianistsare"evenstimulated o makeup and embellish theircompeti-tion results. Another consequence of all this is that competitionsareconsideredeven more important!"p. 18).28 The increased mportanceof competitions eads to considerableadditionalemotional and physi-cal stressupontheseyoungmusicians.

Competitionshavepenetratedall the waydown to the earlier evels of

training,in the form of Music TeacherAssociation "auditions" nd"Piano Olympics"(see our discussion of piano pedagogy below).

Accordingto Helen Epstein,authorof a book basedon conversationswith musicians,"winninga competitionhad, in the opinion of many,

become almost indispensable.... A prize also was tangible proof ofaccomplishment, standardof undisputedexcellencein a field riddledwith ambiguities.Although music competitionswere disparaged bymusiciansas encouragingmechanicalplayingand politics, by teachersas causingneedless demoralization,and by critics as producingtech-nical wizards producing soulless notes,29they were nonetheless a

phenomenon that few could afford to ignore.... The contests hadcreated a new breed, the competition artist ..."30

The competitionartistis under tremendousstress to produce note-

perfectmusic- a skill that for all but the most talentedprodigiescan

onlybe attainedby incessantpracticing.Accordingto one competitionartistinterviewedby Epstein. "Ina concert, if you miss a note, youdon't worry...." Here, you immediately feel that it's fifty points against

you."31 naddition o exposingpianists o the risk of pain by submittingthem to gruelingpracticeschedules,competitions,by theirverynature,

createsituationsof extremestress in whichthe musician's ndurance sstretchedto its limits. "Ihave never had to go throughpressurelike

this," aid one contestantat therenownedLeventritt ompetition,"Theworstpart s theexhaustion.Youpracticeallday;you'reunderstress allthe time.My neck andbackfeel like a solid knot."32Quitepossibly,atmoments like these, when the capacityof the body and the nervous

system is tested to the extreme and beyond, the potential for paincreatedbyarduouspreparationdevelopsinto full-blown ymptoms.








10

Competitionsare not the only pressuretowardnote-perfect playing,and

hence,increased

exposureo the riskof

pain,in the virtuosoworld.

The exactingstandardsof modem music recording,the preeminentvehicle of music appreciation oday,likewiseproduce intolerance-to

even minor digressionsfrom the musical score. The standards ash-

ioned in the recordingstudio are reflected, n turn,in the concert hall

and competitioncircuit as well, where live performancesare increas-

inglyexpectedto match the clinicalprecisionof studio-crafted ecord-

ings. "Throughthe recordingindustry, people have become highlyconscious of technicalexcellence," aid conductorMax Rudolf while

judging heLeventrittCompetition,"Therearesimplyno mistakeson a

recordingand theyhave become the new standard. n the old dayswe

didn'tminda wrongnote here and there.Now, youngpianistshave to

playperfectlybecause a wrongnote sticksoutlikea sore thumb."33

It is notjustthequality tandards f the newrecordings hatcreatenew

demands on pianists,but also their increasing pervasiveness.Beingrecorded s no longera privilegeof theHorowitzsandthe Schnabels;a

vast populationof pianiststodaymake routine visits to the recordingstudio andits standards pplyto them all.

Audio recordingsandtheirpromotionthusencouragethe ardentpur-suit of virtuosity n both an estheticand a market-oriented ense. By

indirectlyraising he standardsof live performance,whether nside or

outside the studio,they contribute o the existingpressures or brutal

practiceregimens.By presupposinga mass market or the recordings,

they help stimulatethe need for virtuosi,and hence for heated com-petition.Bothfactorsexposepianists o anincreasing iskof injury.

So integral s the collective nvestmentn virtuosityn allaspectsof the

virtuosoworld that its elimination, n the hope of reducingpain, is

entirelyunrealisticand improbable.Virtuositysignifiesa standardof

expertise,both technicaland interpretive,aroundwhich musicaldis-

course revolves.It promisesand secures social status for musicians,

partly by providinga legitimateclaim for high incomes. As such,virtuosityis the orienting principle and the chief product of social

mobility ntheinstitutionalieldof thepiano.

The selection process constitutesthe definable social structuresur-

rounding hepiano; herewardof virtuosostatusobjectifies herulesof

the game,knowableto all, to whicheveryactormust adhere.For the

musician,the consecutivestages that must be passed throughin the








11

quest for virtuoso status provide a series of challengesthat conti-

nuously demand superhumanefforts.But, the hierarchycrownedbythevirtuoso s not simplya negativeside-effectof virtuosoproduction.It is a structural oundation that instills interpretableorder into the

field of professionalpiano playing.By means of this hierarchymusi-ciansdefineandnavigate n this world and locate theirpersonal denti-

ties as performingartistsof varied calibers.Virtuosity s not an "end n

itself,"normerelya principle hat egitimatesan aristocratic ianofield,nor is it primarily nideology excluding hemight-have-beensromthe

select sphereof privilegedperformers.Virtuosity s the centralaspectof collectiveorderandmeaning n thisarrayof interrelatednstitutions.

Maintenanceof the actionsand valuessupportingvirtuositys to some

degree passive: people do not consciously conspire to maintain the

hegemony of the virtuoso.The social structureand culturalcontext

definedthroughvirtuosityconfrontparticipantsas a practicalgiven,a

result of an ongoing historicalprocess toward which this world has

been steadilygeared.Moreover, hisprocesshas been transformednto

a set of primarily conomicrelationships,hatprescriberoutineagen-das for a career as well as salient financialrewards.The critical andaesthetic formulationsthat characterizevirtuosos and their perfor-mances are similarly emanticexpressionsof the structural rdergen-erated andmaintainedby the virtuoso element.A world structuredbyvirtuosityplacesprofoundemphasison minutedetailsof executionand

interpretation; t articulates historical comparisons, traditions,and

contexts; t developsa fine-grained cale of distinctionamong players.

Technicalperfection,attainedonly by an heroic exertionof mind,body,and will, becomes the key measure. The greater the emphasis on

virtuosity, he more demandingand detailed the evaluativecode. Theconstitutivelogic of virtuosity has enormous rhetorical effects onmusicians.

Virtuositythus defines the social structureand the entirelanguageofthe field of professionalplaying.The consequencesof this as regards

the productionof painin thismusicalworld areenormous,for hiddeninside theromanticmageof virtuositys an ideologyofpain.Virtuositycommandsandforgives he superhuman xertionrequired o liveup toits culturallydefinednorm,embedded as it is in social, economic,andestheticimperatives.For all membersof the virtuosoworld,includingperformers,virtuosityofferssufficientrewards o makepaina second-

aryconcern.Butmorethanthat,theidealof virtuositys alienandhos-tile to the acceptance of pain, because pain impedes musical per-








12

fection and professionalendurance.For this reason,pianistscannotconfess

theyare in

pain. Theyremainsilent to their

teachers,to theirmanagers,sometimes even to themselves.They dare not seek helpbecausetheyfearit might endangertheircareers,and becausepain isnot yet publiclyrecognizedas a legitimateproblem.They arelikelytothinkit is a personalaberrationand areoften reduced to dealingwiththeafflictionentirelyon theirown,in perfect solation.

While thevirtuosoworldgeneratespainandpenalizes ndividual olu-

tions, it is difficult or its institutions o respondto, or even recognize,the problemof pain. Some of the institutions, ike the recording n-

dustry,do not recognizethe problemsimplybecause they are neverconfrontedwithpianists n pain.Ironically,t is thepain-riddenpianiststhemselves,for the now apparentreasons,who do the most to guardthe secretof painfromtheiraudiences,concertmanagement irms,andthe media. Conservatories the institutionsthat bridge the virtuosoandpedagogicalworlds- arebetterpositionedto respondto theprob-lem of pain,but they are riddled with internalconflicts of goals: they

must simultaneouslyprovide pedagogy and produce virtuosity.Thefacultymembers of the leading conservatories- frequentlyvirtuosithemselves- principally eachrepertoireand careermanagement,not

techniqueor the healthyuse of the body.34The stakes for admittingpainintothecurriculum,webelieve,arehigh.

In the routine,standardpracticesof the virtuosoworld,pain is pro-duced while it is simultaneouslydenied, seen as necessaryand some-

times even as beneficial. But while providingmutuallyreinforcingreasons for the productionand perpetuationof pain among pianists,the virtuoso world offers no remedies. The hope for solutions to the

problem s left eitheror both to thepedagogicalor the medicalworlds,to whichwe now turn.

The pedagogical world

Therecentdiscoveryandacknowledgment f the extentof painhasputsome responsibility n pianoteachersto ask whethersomethingabout

pedagogicaltechniques s causingtension and stress.But, the combi-

nation of commercialand professionalcommitmentsof most pianoteachersmakeit difficult or the institutions, ither alone or collective-

ly,to recognizethepervasivenessof painand to respond n anykindof

coordinatedor integratedway.A brief descriptionof the pedagogicalworldwillillustrateheiractivitiesand commitments.35








13

The pedagogicalworld includes a varietyof institutionscommitted,

partiallyor

totallyto the

productionof

pianistswith

competenttech-

nical and interpretive abilities, but not necessarily virtuosi. The

pedagogy programswithin conservatorieshave developed curricula

primarily or pianistswho will become teachers. Consistentwith the

primacyof virtuosity,hese programsaregenerally owerin statusthan

the "performance" pecialty.General music schools and liberal-arts

programsand majorswithinuniversityand college arts and sciences

programshave courses and majors n piano pedagogythatemphasize

teachingrather hanperforming.

The differentiation f "performance"nd"pedagogy"majors nAmeri-

can schools of music reflectsthe institutionaldisjuncturebetween vir-

tuoso andpedagogicalworlds.How muchcapacity o play,and at whattechnical or interpretive evel of proficiency,one should expect of a

pianoteacher s a contestedissue,as is the converse,whether o expecta potentialconcertartist,who mayhappento teach,to takepedagogycourses.36 pecialpedagogicalassociationshavedeveloped,suchas the

National Conference of Piano Pedagogy (NCPP), founded in 1979.The isolation of the virtuoso world from the pedagogicalworld isindicatedby the fact that very few concert pianistsof internationalstaturehavebeen on theprogramsof theNCPP,veryfewhave attendedthe meetings, and few faculty of three of the major conservatories

(Juilliard,Peabody,Curtis)have eitherattended the meetingsor been

participantson panels. And, professionalassociationscomposed ofdifferent subgroups of teachers exist, such as the Music Teachers

NationalAssociation,orientedlargelytowardprivate-studio eachers(manyof whom now call themselves"independentpianoteachers").Anumberof journalsandmagazinesdirectedtowardpianoteachersarenow published, such as Keyboard Companion.37

New piano students are drawninto the cycle of small student recitalsfor theirparentsandfriends,and if they show any promiseat all, theystartto playfor auditions,then competitions.Auditions and competi-

tions are increasinglyembedded in the institutionalpracticesof theMusic TeachersNational Association and other pedagogicalassocia-

tions, that adds to competitivepressures,and thus the productionof

pain.Each of the sevengeographicdivisions of theMTNA hasa "Divi-sionChair" or competitions.The stateassociationseachsponsorcom-

petitions that select winners to be judged at the division and then

national-meetingsf theMTNA.At thenational evel,competitionsare

sponsored (with larger money prizes) by major instrumentmakers








15

written iterature.42 ntil veryrecently,pedagogical raditionshavenot

had to deal withpain.We haveno wayof knowingthe extent of painexperiencedby pianistsin generationspast.No one knows how manystudents came to their teachers asking for help with pain. Teachers

could avoidthe problemby dealingwithtechnical,esthetic,and inter-

pretive ssues.Whetheror not theproblemhas existedas it does today,theheritageof piano pedagogyoffers littlehelp.

The currentstateof knowledgeaboutpiano pedagogy s probablywell

summarizedn a recent volumeby threeleadingscholars in the field.

We rely upon it as primaryevidence for our claim that there is no

single,coherent,and widely accepted body of pedagogicalknowledgeabout the causes of and remedies for pain.43What the widely read

pedagogues,the few that thereare,do have to offer are some generaltheories of pain. Arnold Schultz,for example, in The Riddle of the

Pianist'sFinger,disagreesthat techniqueproduces pain. He argued,

sixty years ago, that "physical injuries, unless they are caused by

organicdisease,arealmostalwaysdue to persistentuse of muscles after

extreme fatigue has set in, or to inordinatelyhigh degrees of con-traction.The notion that they are due to generallymistakentechnical

methods, as theorists are wont to declare,is not groundedin physio-

logical fact. The kind of movement that a muscle produces has no

effect on its well-being.The bad effects of bad techniquearemusical,not physiological."44his argumentof Schultz's s controversial,and

probablynot accepted by most pedagogues currentlygrapplingwith

pain.

Well-known oncertartistGyorgySandor,whowrote what is essential-

ly a textbook "onpiano playing,"ook preciselythe opposite positionover four decades later. "Thespectacularlyhighincidence of ailments

among pianists (fatigue,muscle pain, tendonitis, bursitis,and other

temporaryand chronic afflictions)is primarilythe result of faulty

practicehabits,of excessivetensions,andof muscle-building xercises.

These undesirable and troublesomesymptoms result from the con-

tinuous abuse of the muscularsystem; heycan andmust be avoided.Imustdisagreewith the many pianistswho believe that muscular atigueis inevitable[andis due] to the weaknessof their muscles, that, theycontend,mustbe builtup. Nothingcouldbe further romthe truth!...Ourtask is to know how to coordinatethe strongermuscleswithintheentireapparatusandto acquire he habit of doingso wheneverwe playthe piano.... Techniquemust be based not on the strengthandenduranceof our muscles but ratheron theiroptimalcoordination."45








16

These two contrastingpositions illustratethe contradictorydiversitywithin he

pedagogicalworld on some

absolutelyundamental ssues.

Some of the classic andorthodoxwaysof teaching echniquemayhave

been basedon an erroneous heoryof the physiologyof the hand. One

of the majorcontroversiescenters on a particularkind of exercise,describedin detail in Malvine Bree's 1902 work on Leschetizkyand

also found in numerous books of exercises, includingCzemy and

Hanon.46nthisexercise, ntendedto strengthen hefingers, hepianistholds downone or more noteswith the fingersof one hand,andplaysother notes with otherfingersof the same hand.By thus isolatingthe

fingers rom eachother and from the hand,thatexercise,whenrepeat-ed constantly,produces extremetension and strainin the hand.This

exercise, despite its dangers, is alive and well. A picture of it was

reproduced n the magazineKeyboardClassics n 1987 by the com-

poser and pianistRobert Starer.He learned themfrom Victor Eben-

stein as a studentin Vienna. Starernotes that "ifthe hand got stiffor

tired[Ebenstein]permittedyouto let it hangdownloosely,andshake t

lightly.After a few weeksof goingthrough he exercisesdailythe needto recuperatediminished."Then Starergives an example of the five

fingersholding down widely dispersednotes. "The third and fourth

fingerswere no longer adjoiningand thus stretchedmore.You went

throughthe entire sequence given above and then repeatedit once

more in the final, most painfully stretched position."47 Recent neuro-

physiologicaltheories of muscular tension hold that such painfulstretches,while enduredby thebodyfor perhapsa long time,ultimate-

ly cause a rebellionof the body in the form of pain or stiffnessthatinhibit playing.Some have used the analog of metal fatigue;a steel

springcan move thousandsof times,thensuddenlybreak.

It is quite ikelythatsome of the orthodoxwaysof teaching hepianoin

fact cause pain, but because of the way in which pain has been

individualized, ationalized,and denied, that possibilityhas not been

recognized generally within the pedagogicalprofession. And, as a

corollary,here is no consensusin the pedagogicalworld on thecauses

of and treatment or pain.Relatedto this is anotherwidespreadargu-ment thattherecan be no commonbasis for techniquethatcan serve

for musicians.The conductor/composerLukas Foss takes this posi-tion: "There s not one perfecttechnique.... Each musicianneeds a

differentone, he has to find his technique,the techniquethat will

enablehimto expresswhathe has to say."48








17

A consensus does existamongmany pianoteachers(butnot all,as weshall

see)and

amongphysiciansand

neurophysiologistsboutthe

handand armposition least likelyto lead to physicalstrain.Dr. Brandfon-

brener,althoughgenerallycautious n herdiscussionof pedagogy,doestake a stand on, for example, the issue of posture:"The ideal (i.e.,physiologically ndmechanically)s for the lowerarms and wriststo belevel with or slightly above the keyboard... The upper arms should

hang naturally and relaxed from the shoulders...." For "most"pianists,she argues,this position "allows or optimalintegrated unctioningofthehands,wrists,arms,shouldersandback" p. 39).

Variationsn the impactof the riskfactorssummarizedabove on theactual incidence of pain may depend on a particularpedagogicalschool andwhetheror not its physiologicalrequirements remechani-

cally efficient.This would seem to be an importantarea for research,but we havefoundnothingsystematic hatwould indicatewhich, f any,of the Russian,French,or German(or any other)schools of pianistictechniqueare"safest"o use.

Dr.Brandfonbreneraysthat"many chools of pianotechniqueregardthe position over the keys and posturingof the fingersas singularlyimportant."How curvedthefingersshould be is debated,as well as the

position of the wrist,views of which are also "partially functionofone'spedagogical chool..." (p. 39). Shesaysthat "wegenerallyrecom-mend that the wrist be maintainedas closely as possible to a neutral

position - in a relativelystraight ine with the forearm,neither bent

toward he thumb .. nortoward he smallfinger" p. 39). Eitherwrongpositionis usuallycalled"twisting."

This view is diametricallyopposed to that of the virtuoso Ruth

Slenczynska, n her book writtento provide"advice or the artistandamateuron playing he piano."The content of herideas is inconsistentwith much currentpedagogicaland medicalthinkingabout hand andwristposition.She recommendsplayingoctaveswithfourth and third

fingersas a "developer"f "endurance"n thehands.49

But the terrifyingposition she advocates is what she calls the "stiffoctavemold"(see Figure2). The wrist is higherthanthe arm,and the"middle ingers[are]curledunderso thattheywillbe out of theway."50If you put yourown hand andarm in thatpositionyou will feel strain.As already ndicatedSlencyznska aysthatplayingoctavesthiswaywill"buildup the necessary power of endurance.You will sufferphysical








18

Fig.2. How painis produced; he stiff octavemold.(FromRuthSlenczynska withthe

collaboration f AnnM.Lingg),MusicatyourFingertips.GardenCity,N.Y.:Doubleday,1961,p. 56.)

painandlearnto endure t"(p. 39). A recognitionof these differencesin fundamental pproachess barelyrecognized, et aloneopenlycon-

fronted.

In conclusion,pedagogyhas been a low-statusprofessionalspecialtywithin the institutional ield of the piano,but to the extenta body of

knowledgeis developingthat pinpoints the causes of pain in faulty

technique,pedagogycan challengethe ideologicalassumptionsaboutindividual ausesof pain,whether alentor overuse.Manypedagoguesare openly questioning he usefulnessand harmlessnessof traditional

teachingmethods, and in the course of these debates pedagogyhasbeen opening up towardthe medicalworldthroughconferences suchas the one we have described.Debates, sometimesintense,over the

causes of pain and what to do about it, are reflectedin these pro-grams.51








19

The medical world

Once painhas been producedby the normaloperationsof thevirtuoso

world, and once pain is acknowledged, he medicalworld must dealwith it. Withthediscoveryof thewidespreadextent of pain amongpro-fessionalmusicians,a new specialtycalled "musicmedicine"or "per-

formingarts medicine"has developed. The doctors concerned with

treatingpianistsand other musicians n pain are seekingto developa

legitimatemedical specialtywithinestablishedtrainingand treatmentinstitutions.

Themedicalworld is a compositeof institutions hat have considerable

legitimacyandpower:medicalschools,hospitals, nsurancecompanies,clinics andphysicianpartnerships,olo practices,clinics.The powerofthis professionallows professionalswho see a new medical need to

penetratequickly heworld of musicians.

The cognitiveand organizational equirementsor developmentof a

medical specialtycan be summarizedbriefly.The cognitive require-ments nclude:- a languageof diagnosis ("overusesyndrome," ocal dystonia,ten-

donitis), hatmaybe oversimplifiedandis acknowledgedas suchbyspecialists)butserves to identify hefieldpublicly;

- a catalogof treatments rest,surgery,physicaltherapy,psychother-apy,drugs,etc.)that arerationally onnectedto thediagnoses;

- a specialtyname ("performing rts medicine")that establishesits

distinctiveniche in thepantheonof medicalspecialties;- accumulating linicalexperiencethatcan be described n a special-

ized language;- anaccumulating odyof research eporting linicalstudiesthathave

academicandprofessionalcredibility.

Theorganizationalequirementsnclude:- a minimumnumberof doctorspotentiallycommitted o the special-

ty.They must come from other establishedspecialties, n ordertolegitimate henewsubfield;

- a flow of patientsdemandingmedicalservicesfora set of symptomsthat can be plausiblydefinedby the diagnostic anguageand treat-mentcatalogas appropriateorthe newspecialty;

- the establishmentof a visible set of institutionalized xpressionsofthe specialty:a professional association, a journal, a textbook,researchconferenceson thespecialty;








20

- coursesin medical schools thatarerecognizedas specialtytraining,use the

textbook,and teachthe

languageof

diagnosesand the cata-

log of treatments;- clinicswherethespecialtycan be advertised,earned,andpracticed.

Most of these cognitive and organizationalprerequisites or a newmedical specialty alreadyexist. A journal,Medical Problemsof Per-

formingArtists,was establishedin 1986, followed by a new profes-sional association,that enjoyeda membershipof seventydoctors bythe fall of 1991, and A Textbook of Performing Arts Medicine was

publishedin 1991. Some twentyclinics specializing n arts medicinewere established by 1991.52

A leading figurein all of these efforts has been Dr. Brandfonbrener,Director of the Medical Problems of PerformingArts Institute at

NorthwesternUniversity,editor of the journal and co-editor of the

textbook. Doctors specializingin the new practicehave engaged in

seminars, nstitutes,and conferences such as several held under the

titlePlaying Hurt.53

It is striking hatthe creationof the new medicalspecialtyof "perform-

ing arts medicine"hasbeen accomplishedwithoutthe knowledgebase

to justifyit. Dr. Brandfonbrener, iscussingthe journalshe edits, said

that the number of high-quality ubmissionsshe receivedin the first

few yearswas "thin," ndthat it was encouraging hat the numberhad

improved,as researchers ncreasinglysaw the journalas a legitimate

and prestigiouspublicationoutlet.In her chapter n the textbook,sheemphasizesthatthis is a "first ext," hat is a "response o the rapidly

increasingdemand orknowledgeandtraining"p. 25). She admits hat

only a few "preliminary"tudies havebeen done, but these "appear o

more thanjustifythe current evel of interestin performance-related

injuriesof musicians" p. 27). In effect, the leading physicians(fre-

quentlyalso musicians), tarting rom a powerful egalandprofessionalbase, arecreatingorganizationaltructures an association,a journal,

a textbook,clinics- in anattempt o legitimate he field. The necessaryknowledgebase canthenbe soughtthroughresearchandaccumulatingclinicalexperience.The doctors thus have a stake in publicizingthe

widest extentof painandinjury.

Because these doctors must deal with the competingclaims of both

pedagogyand of nontraditionalmedicine,they are vulnerableto the

criticism rom mainstreammedicinethatthey are eitherquacksor not








21

based on scientificmedicine.Theymustguard heirprofessional lanks.

To maintainlegitimacy they

arelikely

toemphasize physiologicalcauses andtraditional olutions,suchas surgery.

The medical explanationfor pain among pianists is "overusesyn-drome,"a labelfor a complexof symptomsabout whichlittle is knownof the causes.54The most common diagnosesof the consequencesof

overuse arecarpaltunnelsyndrome, endonitis,and focal dystonia.Dr.Brandfonbrenersaid in an interview that "the overall incidence of

injury s probablyhigherthanit used to be, because of the highdegreeof competitiveness,hatcontributes o both physicalandpsychologicalstress."In the chapteron epidemiologyin the textbook, she wrote:

"Manyof the currentsuspicions regardingetiology of these perfor-mance-related ailments are based on anecdotal experiences and

calculated guesses ... many of the current assumptions on which diag-noses are made and treatmentsare prescribedawaitscientific verifi-

cation."55

The doctors are makingan honest attemptto deal with the problem,but theirapproach s necessarilywithin a medical definitionof how totreat symptoms.Little attention is paid to the possibilitythat faultyways of moving,of usingmuscles, cause the pain, and that retrainingwould solve the problemwithoutsurgery.Dr. Brandfonbrener,ne ofthe leadersin the musicmedicinemovement,has said that"input rommusic teachers s crucial .. [because] o much of the evidencepointsto

faulty techniqueas a cause of injury."56 nce the damagehas been

done, of course,surgerymayseem to be a benignattempt o repair hedamage.

The Textbookof PerformingArts Medicine is an example of how

"physical"nd "psychological"isabilitiesare treatedseparately, ven

thoughtheirmutualinterrelationshipsrerecognized.Existingmedical

specialties (neurophysiology,psychiatry,clinical surgery,rheumatol-

ogy) must be acknowledgedand built into the structure of a new

specialty,evenat the cost of not beingable to analyzethe multipleandinterrelatedaspectsof the problems.Pain is an excellentexampleof achronicphenomenonthataffectstheentireorganism,hascomplexandlittle-knowncauses, and thus cannot be comprehended within theboundariesof existingmedicalspecialties.

Doctors are not accustomed to preventivesolutions,but even if theyhad a strategyfor prevention,their legitimate jurisdictiondoes not








22

extend into the pedagogicalor virtuosoworlds,so that it is impossiblefor them to

challengeother

institutions,particularlybecause of theabsence of a secureknowledgebase aboutmusicians'njuries or diag-nosis andtreatment.57

The weakness of the medicalanalysisof causes and treatment s indi-catedby the highproportionof personswho seek nontraditional olu-tions. The causes identifiedby nontraditionalreatmentsnclude lackof physicalcoordination,ack of awarenessof pain, ack of sensitivityo

movement,posture, breathing,tensions in the body. Treatments n-

clude: various bodywork therapies:the Alexander Technique(thatfocuses upon alignmentof the spine), the Feldenkraismethod (thatstressesbody awareness),acupuncture, hiropractic,physicaltherapy,etc. Not only arepeople forced to seek nontraditional emedies,they

go beyondthe medical realmaltogether o psychologyor religion.58A

numberof pianistsand teachershavedevelopedtheir owntheories and

solutions orpain,and areoffering heirservicesto others.59

"Chronicpain syndrome," rom which many pianistssuffer,is a very

ambiguousmedicalcategory,verymuchlike "overuse yndrome." The

conceptis so poorlydefinedthat chronicpain syndromes ack official

status within the standardbiomedical taxonomy.... [It]is a widelyused clinicalcategorywithoutofficialsanction,an anomalouscategory,

onlypartially egitimizedas disease."60

Pain also challenges he individualistic ssumptionsof the cultureand

of biomedicine,precisely because it cannot be treated solely as aphysiologicalexperience,and there are broad cultural and historical

variationsn the definitionandexperiencingof pain:"... processesthat

inscribehistoryand socialrelationsonto the body... simplycannotbe

reduced to biologicalterminologywithoutdistorting n the most fun-

damentalwaywhatpain,or forthatmatter,experienceperse is about"

(p. 9).61

The resultof the impossibilityof reducingpainto a conventionalcat-egoryof diagnosis,disease,andtreatments that it remainson themar-

gins of the dominantideology and thus institutionsof biomedicine.

"Painclinics,alongwith alternative herapies or pain,have evolvedin

themarginsof medical nstitutions" s a result.62








23

Relationsamongworldsof the piano

Each "world"has its core focus and institutionalgoals, commitments,and competence.Each world "exports" he problems that it cannotdefineas partof its domainand thenincorporatento its zone of com-

petence.

The medical worldcannot deal with the pedagogicalcausesof pain; t

recognizespsychologicaland physiologicalsymptoms,that may have

pedagogicalcauses.And, evenwithinthemedicalworld thefragmenta-tion of cognitivecategoriesand institutional ubfieldsforces a defini-tion of someproblemsas"psychological"nd others as"physical."

The pedagogicalworld has exported musicians with physical symp-toms out to the medicalworld to diagnoseand dealwith,becausepainwas not defined as a consequence of pedagogy.Few of the majortextbooks or handbooks or monographs on piano technique and

teachingmentioned,deal withpainor tension,exceptin the most cur-

sory way."Rest,""relax,"nd "becomfortable," re injunctions o thepianist,notknowledge hatconnectstheoryandpractice npedagogy.

The virtuosoworld,comprisingconservatories, ompetitions,concert-artistmanagers,concertproducersand organizers, akes the existenceof a body of availableperformersas given.Young or older concertartistswithphysicalproblemsare eithernot acceptedin or are elimi-nated from conservatories,cannot win competitions,cannot reliably

appearfor concerts, and thus - unless their problems are solved insome way - ultimatelysimply disappearfrom the virtuoso world.Whateverhappens,thevirtuosoworldtakes no responsibilityor deal-

ingwiththeproblems.

But the hegemonyof the virtuosoprinciplehas been accompaniedbyfermentingdebate on pain. Given the increasingacknowledgmentofthe problem,which mightbe a direct result of professionalizationof

both artsmedicineandpianopedagogy,n theentirefield of thepiano,relationshipsamongthe institutionscomprising he virtuoso,medical,andpedagogicalworldspose the possibilityof criticalchanges.As weshow repeatedly n the course of this article,the relative solation ofthese worlds has significantlyhindered a concertedresponse to pain.Perhapsmost damaging n this respecthas been the isolation of peda-gogyand medicine.Medicinehas traditionallybeen able to enter the

processonlyat its criticalstage,afterthe symptomshavealreadydevel-








24

oped. The exclusion of medicinefrom the institutionalboundariesof

musicpedagogyhas thwarted he possibilityof prevention(assuming,of course,that medicinecouldprovideadequatepreventivemeasures),therebygivingfree reinto "overuse"hroughphysiologicallynsensitive

pedagogicalregimens.Therearesigns,however, hat therelationship f

pedagogyandmedicinemaybe changing.

Some of the problematicrelationsbetweenthe pedagogicaland medi-cal worlds are summarized n an answer (at the PlayingHurt con-

ference)by Dr.Ledermanto aquestion

fromthe floor aboutwhetherdoctorsever work with teachers to deal with studentsin pain.Leder-mansaid that he did,but that"obviouslyhis is a veryticklishsituation.One can'tbegin with a student who is studyingwith one teacher and

say, I've identifiedyour problem;I'm going to take you to anotherteacherwho'sgoingto fix it. That'sone quickwayto get yourselftarredand feathered,or worse yet, cut off from patientaccess."That frank,informal off-the-cufflanguageundoubtedlyreflects a general reluc-tanceby doctors to challengepedagogicalpracticesandtechniques hat

theybelieve arecausingpain, partlybecause of anunwillingnesso riskconflict withno pay-off, partlyout of self-interest:maintainingaccessto patients.

What is the relation between the virtuoso world and the medical world?

The virtuosoworldprovidesa steadystreamof patientsto the medical

world,that takes them as presented,and treats the symptomsand the

proximatecauses of pain: tension, "overuse," tiffness, through the

standardparaphernaliaf medicaltreatment:ortisone,surgery,physi-cal therapy.Even as the field of performingarts medicine develops,with its own attemptsto establisha niche within the medical estab-

lishmentby providingpossible preventivemeasuresagainstpain, it is

unable to promulgate hose preventivemeasures n the virtuoso world

becauseof the institutional oundaries similar o thoseseparatinghe

medical and pedagogicalworlds - that keep it outside.Moreover,by

identifying pain as caused by the "overusesyndrome," he medical

worldhelps to individualize he causes of pain, thereby blockinganycriticism of the institutionsof the virtuoso world. Solutions to pain

gained thoughthe interactionof the virtuosoworld and the medical

world areunlikelyanytimesoon, and no concretecooperationhas so

farappeared.

The difficulties n the mutual nteractionof the virtuosoworldandthe

pedagogicalworldare remarkeduponin variousearliersectionsof this








25

article.Here too, the social isolationof largeareasof the two worldsinvolved s the

culpritn the low

degreeof communication hatstands

in the way of prevention.By far the largest groupamong pedagoguesare privateteacherswho teach pre-college students.Their exposureand interactionwith the virtuoso world is for the most partminimal.

Many piano teachers who are responsiblefor the developmentof the

earliestand thus most deeplyembeddedtechniqueshavelittleexposu-re to the problem of pain, because most of their students are not

prodigies.The talented ones are passed on to "higher-level"eachers,and preciselytheir enthusiasmand drive will get some of them into

trouble ater,as the stressesand tensionsof faultyplayingaccumulate.63

Another aspectof the difficultyof findingsolutions to the problemof

pain thoughthe interactionof various worlds of the piano was raisedearlier n thecase of conservatories.Herethe double and often contra-

dictingagendasof teachingand virtuosoproduction nhibit the clear-headedconfrontationwithphysicalproblems.The conservatorys too

enmeshed n the valuestructureof the virtuoso world to confrontpain

publicly n the compositionof its facultyand curriculum.And, virtuosiwho serveas part-time eachersareboth most likelyto teach the mosttalentedprodigiesand be the most incompetentor unwillingto dealwithincipientproblemsof pain.As thepedagogueTobiasMatthayputthe issue over threedecadesago:"Those few giftedones [the virtuosi]who instinctivelystumble upon Right Doing, physically,are usuallypreciselythe ones least fitted to help us by self-analysis.The greatertheir temperamental,emotional and musically-imaginative ifts, the

more likely they are to be disinclined,opposed, and even resentfultowards any exercise of self-analysis,mechanicallyand physically.Hence we find that these usually proveto be quitebad teachers,tech-

nically... "64

However,as in the relationof pedagogy and the virtuosoworld, the

increasingawareness of pain is stimulatingefforts at cooperation.65Which rhetoric of explanationand remedieswill come to dominate,

medicalorpedagogical,s notyetclear.

The psychological milieu

The psychologicalmilieuof the giftedyoung performermaylead to adenial of pain, whatever its causes. If pain is not recognized or

acknowledged by young prodigies or by their parents and teachers








26

encouraging heir talent, then no action will be taken to correct the

problems eadingo the

pain.Here we shift

perspectivesromthe social

worlds of painto the experienceof thoseworldsby individualsmovingthroughtheir musical career,confrontingparents, teachers, schools,audiences, n theirdevelopingsense of competenceand authorityas amusician.All of the processesto which we refer are risk factors:not

everymusicianwill be subject o them.

The denial of painbecause of the impactof ego demands and career

contingenciesis intensified because of the inaccessibilityof pain to

conventionalmedical treatmentand its ineluctablyprivatecharacter.As Elaine Scarry puts it, the "resistance of pain]to languageis not

simplyone of its incidentalor accidentalattributesbut is essential to

it."66 he invisibilityof painto otherscreateswhat Good et al. describe

as a "double bind" for the sufferer, citing Scarry: "...pain comes

unsharablynto our midst as at once that which cannot be denied and

thatwhichcannotbe confirmed."67

What are the factors that can lead to psychologicaldenial of pain?PsychiatristKylePruett'sanalysisof the "psychological spectsof the

developmentof exceptionalyoung performersand prodigies"givessome clues. CitingAlice Miller's The Dramaof the GiftedChild,he

asserts that a child's talent can be a "mechanism o guaranteean

existential,securerelationshipwith a psychologicallydisablednurtur-

ing object [motheror teacher]who can provideit in no otherway."68The "conscience,derivedas it is from early parent-child nteraction,

can assistin the developmentof talentthrough ts impositionof disci-pline and expectations ... but ... extracts a heavy toll on the emotional

life of the performer..."(p. 340). Pruettemphasizesthat thereis little

evidence about how widespreadthis emotional dependence is. The

point is that if the teacheror parentsare fulfillingtheir own needs

through he developmentof a talentedchild,they have a stakein not

recognizingphysicalproblemsthat might disruptthe child'sprogress,

particularlyf there s no publicrecognitionof painas a risk.

Even worse, if the teacherof a young prodigyhad to drop out of a

promisingconcertcareerbecauseof pain,he or she maybe passingon

dangerous echnicalhabits to the young student.In cases such as this,teachersmay have a specialemotional investmentboth in the child's

progressandin not recognizingwhataspectsof theirownteachingare

contributingo a potential or futurepain.








27

Exceptionally gifted performersare vulnerable to post-performance

depression, marked by "sadness, crying bouts, anxiety and panicattacks ... lethargy, fatigue..." and even in some cases suicide

attempts.69 he factors that lead to such depressionare "the stressof

repeatedauditionsandcompetitionwith hundredsof othersfor one or

two positions, leadingto insidious erosionof self-esteem"and the so-

cial "isolationof travelingand touring."Also, "manyperformers...also report that no one 'warned' them of the tremendous physicaldemandsor fatigue"(p. 342). Under these stressfulcircumstances,t

maybe easy to deny pain.The youngartist s rewarded or successful

performances,and acknowledgingpotentiallycripplingphysicalprob-lems is ego-threatening,o saythe least.

The ego requirements f talentcan lead to a feelingof being"saddled

with a sense of pressure,an almostobligatoryqualityto expandtheir

talent from their own inner drive, not exteriorly imposed"(p. 344).And, "afteradolescence, what was previouslya pleasuresometimes

beginsto feel more like an obligation o delightpeople"(p. 344, italics

added).

The requirements f stage presencealso distancethe young performerfrombody awareness."Privately, e maybe feelingverymuchin love

withhis music in a veryintimate,oftenvulnerableway.On the outside,

however, he must appear cool and totally in control, invincible"

(p. 345).

The public recognition of success may underminethe young per-former's inner sense of self, under some conditions. "The youngmusician who chooses an anxiety-bindingpatternof grandiosityand

omnipotenceriskshis self-esteem.Thatself-esteemcanbe anchored n

the possession of certainqualities,such as musical talentand success,instead of the more sustainingauthenticityof one's own perceptions.He can become increasinglydependentupon adulationand admira-tion. Thispathis not chosenconsciously,butcanbe a resultof a deeply

troubled entanglement of poor early nurturing experiences" (p. 345).

Pruettemphasizesthat even in the absence of suchpathologicalearlyexperiences,significantanxietyis an endemicproblem.As he puts it,"when the peckingorder of the most importantrealm of your life isdeterminedalmostexclusivelyby demonstrable kill,regardlessof age,the pressureseems never to end"(p. 346). It does not seem unlikelythat a potentiallydisablingtension or pain will be endured,and not








28

acknowledged,given the enormous costs not only to one's precious

career,but alsoego identity.

Pruett ends his chapter n the medicaltextbook with well-intentioned

advice."Thisoverallrespectfor one's whole self can also takethe form

of encouragingchildrenearlynot to push themselvesthrough njuriesor pain.... The guildingprincipleshould be the preservationof self-

esteem,not the layeringof armor"p. 347-348). We can teach children

thatcriticalreviews are of "complete rrelevance o theirinnate worth

as humanbeings"(p.

348).By focussing only upon

thepsychologicalaspectsof thedevelopmentof talent,Pruettneglectsthewaysthe social

worlds of the piano interactwith the psychologicalmilieu to create

emotionalbarrierso therecognitionandacknowledgment f pain.

Social theory, social worlds, and the body in pain

As sociologistBryanTurnerrecentlyargued,"wedo not have a sociol-

ogy of pain, although ... the complex and ambiguous relationshipbetween the mind,the nervoussystem,thebody and the experienceof

painis nowwell established."70

It is interestingo note that a moregeneral"sociologyof thebody"does

not exist either,althougha varietyof core concepts of classicaland

contemporarysocial theorists presuppose a body on which and

throughwhich social action must be enacted.The "rationalizationf

thebody"(Weber) hrough cientificpractices medical, echnological),the "disciplining f the body"(Foucault)via variousinstitutionsof so-

cial control (prisons,schools, mentalhospitals),and the "productive

body"(Marx's onceptof laborpower)areallexamples.71 ut thebodyin these theoriesis mostlyactedupon, is sociallycontrolled,andis not

an agent, complete with deep-rooted motives, feelings, and desires:

eroticimpulses,angerandhostility,shameandguilt,exaltation n per-

forming, oyin learning.72

The living, experiencing,activebody can be theoreticallyrecognizedmoreeasily f a "society"s conceivedof as composedof multiple evels

of analysis("vertically"onstructed)and multipleinstitutional ogics

("horizontally"onstructed)with each level and each logic not well

integratedandcoherent,andlongitudinally"historically"onstructed).Ratherthan a "system" r a "structure" "society"maybe best under-

stoodas a bricolageof diverseelements:materialandsymbolic,ration-








29

al and irrational,cognitiveand emotional.73Each individualbody is

cross-cutby myriad memberships("social

circles" nSimmel'smeta-

phor),and the emotionalandphysical ensionsexperiencedbyindivid-

uals cannot be understoodoutside of the social context in whichtheyare exposed to multipleand contradictorypressures, ncentives,andsanctions.But, conversely,reifyingand isolatingthe analyticelementsof the social context into different "institutions""worlds,""roles,"

"organizations"almostanycollectivenoun could be inserted),perhaps

paradoxically eflectsunderstanding f justhowthose socialprocesses

reallyoperateon the bodiesof concrete, ivinghumanbeings.

Pierre Bourdieu has stressedhow throughembodimentone acquiresthe appropriateclassificationsof identity (prodigy,teacher, virtuoso,

physician)underlyingsocial and class position.74Throughembodi-

ment,culturebecomes a secondnature,appearsas natureas its condi-tions of acquisitionare forgotten or repressed, and thus becomes

"doxa" thetakenforgrantedsense of reality.Bourdieu,however,doesnot considertheorganizationof pleasureandpain,their"economy,"n

thisprocessof embodiment. ndeed,he seems to arguethat the levelof

painexperienced ninitiationbinds theinitiate o thegroupto whichheis admitted.75

However, Bourdieu does specify two conditions under which the

arbitraryqualitiesof practicesare "denaturalized" made to appeararbitrary. irst,wherethe conditions of the operationsof habitus are

incongruentwiththe conditionsof its acquisition.Second,wherethere

is a crisisso thathabitus does not producethe results withwhichit ishistoricallyassociated.In this study,we have analyzedthe practiceof

pianoplayingas a particularhabitus,anembodiedknowledge,showingthe ways in which certainpracticesare being challengedas arbitraryandperhapsunnecessary o the productionof music at the standardof

virtuosity.The "economy" f pleasureandpain probablyoperatesas a

quite generalpotentialbasis for thepoliticizationof practices,and thustheirpotential ransformation.

What is fascinatingand unusualaboutour case studyof the discoveryof painandfinally ts confrontationby the socialworlds of thepianoisthatwhat Bourdieucallsin some contexts the "doxa" ndin others the"habitus" f both virtuosityandpedagogy s beingchallengedanddis-

rupted.How far and how deep the establishedpracticesof teaching,learning,and performingwill be transformed s an open questionatthismoment.76








30

Conclusions

None of the three worldswithinthe field of professionalpianoplayinghas adequatelyconfronted the problem of pain, partly because itscauses and treatmentcould be easily assignedto anotherworld. Themedical world could blame pain on "misuse";he virtuosoworld onlack of "genius"or "hardwork";the pedagogical world on "bad

teaching"or "lack of talent."Each world, for its own reasons, has

managedeither to skirt the problemof pain outrightor to develop

techniquesand

languageshatfail to offer

generalremedies,or worse,

exacerbate the amount of pain pianists endure. In the meantime,market competition in a shrinking concert market has increased,

togetherwith audience dependence upon charismaticvirtuosity.Themore compactvirtuosoworld, populatedby ever largernumbers of

hopefulpianists,creates ntensecompetition n whichthe causes stimu-

latingpain multiply.

A number of factors have inhibited both the private and publicacknowledgment f pain.First,there are the demandsof maintaining

professionalcareer as a pianist.It has been difficult f not impossiblefor concert artiststo admitthey arein pain,because it would threaten

their careers.Second, there is the romantic mage of pain:the belief

that pain is necessaryand inevitablein order to be a virtuoso. This

factoris relatedto a cultureof mastery(or masculinity):he idealof a

stoicalmaster n control of his body,able to surmountsuch mundane

obstacles as pain.77

Third, the emotional identificationof the young prodigy with their

teacher; he belief that the teacher s givingtheyoungpianista preciousskill, potentialcareeras an artist,and would not allow unnecessary

pain. Psychologically t is difficult to challenge teachingmaxims that

lead to discomfort. nstead,musiciansn painblamethemselves.

Complementaryactorsareleadingto a growingability o acknowledge

pain.First,whatmightbe calleda "cultureof femininity" mphasizingawarenessof the body maybe increasing. t is interesting o speculatewhether women teachers are more likely than male teachers to

emphasizethat playingshould be "comfortable." re women pianistsless likelyto sufferpainthanmalepianistsbecauseof less commitmentto the ideal of control,power,andmasteringpain?








31

Second, the rise of the world of performing-artsmedicineitself pro-

videsa

refuge,a safe

placewhere

paincan be

legitimatelyacknowl-edged.Medicalizationakespainoutof the virtuosoworldand"neutra-lizes" its emotional and professionallychargedcharacter,whetheror

notthedoctors have solutions.

Third, he diffusionof awareness hatpainis not one's individualprob-lem, as such examples as Gary Graffmanand Leon Fleisher havebecome publicly acknowledged.However,once acknowledged, here

maybe a contagioneffect.Is it possible thatthe reported ncidenceof

pain is a result of a kind of "masshysteria"?This possibilityraisesa

knottymethodologicalssue:How muchcan we trustsubjective eportsof pain? Once people are asked if they have physical problems,they

may become aware of them. Or, the individual may "discover"or

"remember"nanalogto parentalor teacherabuse. Suchanattempt o

explainawaythediscoveryof widespreadpainas hysteria eemshighlyunlikely.

If injuries o hand and armcan be shownto be causedby keyboards,not just pianos, but computers too, then legal institutionsmay getinvolvedin this complexstory.Here we aredealingwitha futurepos-sibility,but an ominous one. Repetitivestress injury(RSI) has been

charged by persons sufferingpain afterlong hours on the computer,and more than2,000 suits have been filed againstmakersof computerequipment.78 he U.S.OccupationalSafetyand Health Administrationin October, 1994, announced a plan for rules that would "make t

harder or employers o claimthey didn'tknowabout the problem....For the delicatemuscles andtendons in the fingersandwrists,rapidlypushingbuttons[or pianokeys]thousandsof times an hour canbe justas stressful[asdrivingscrews or slicingcarcasses n a meat-processingplant]."The Timemagazinearticleblithelyexplainsthe consequencesof these stresses as creating"tinytears in the muscles and tendons,whichbecomeinflamed. f thetissues aren'tgiventime to healproperly,scarring anoccur."78

Thatthehandmotionsrequired or thepianoandcomputerkeyboardsareessentiallythe same,in termsof body physiology,has been finallyrealized.A book givingconcrete instructionson how to "play"both

types of keyboardssafely and efficientlywas publishedin 1995, al-

thoughthe author,a concertpianist, ocusses upon computers,with anaccurateeyeon a farbiggermarket or thebook.80








32

It is curious n a societylikeours thattechnicalsolutionshavenot been

exploredat all as a cure for

pain.Interviewswithmembersof manu-facturing ompaniesat the NationalConferenceon PianoPedagogy n

October,1994 indicated hatthere is practicallyno workbeingdone inthis area. Even thoughcertaintechnologicalsolutionsreadilypresentthemselves(as they do in the computer ndustry, or example),havingto withchanginghephysicalarrangementf thekeyboard,nothinghasbeen seriouslyconsidered.81Neither have pedagogicallearningrou-tines in electronickeyboardsreached the sophisticationthat is now

technicallypossible.This lack is fortunate andperhapsnot accidental)because Steinway and Baldwin might become subject to suits on

exactly hesamegroundsas IBMhas becomeliable.

If pain is still slipping throughthe cracksamong the various worlds

constitutinghe field of professionalpianoplaying, t is becausein each

of these worlds there are forces at work either producingpain or

explainingt in individualistic erms.The pervasiveexperienceof painis an unintendedconsequenceof the mutualactionsof the institutions

involved in creating and propagating piano music in our culture.Unintended consequences put stubborn difficulties in the path of

change preciselybecausethere are no concrete intentionsor interests

at stake that areproducing he problem.As the examplesaboveshow,

however, he mererecognitionof painas a realitypushesfor a mutual

opening up and interactionamong these only partially overlappingworlds.If the issue of pain among pianistsbecomes forciblyraised-

wellbeyondacademicdiscourseandprofessional"interest roups" in

the broadcommunityof piano playingand the even broader realmofthe media,each of these institutionalworldsfaces deep challenges.At

thismomentit is impossibleto knowwhatmighthappenif the issue of

pain is finallyconfrontedas a joint problemfor these social worlds.

Withinphysiological imits, the issue is whetherknowledgeexists or

canbe acquiredabouthow to playthepianoin awaythatwill minimize

the occurrenceof pain.82

Wehavebeen concernedwith the institutional nd individualprocessesthatboth causepain and standin the wayof obtaininga suitablecure

for injuredpianists.As we haveshown,the institutionwith whichpainis traditionally associated in our culture - medicine - plays only an

accompanyingpart n thisstory.As DavidB. Morrisnotes in his recent

work on the culturalembeddedness of pain. "Certainlywe can take

comfort in assuming that pain obeys the general laws of human

anatomy and physiology that govern our bodies ... however, the cul-








33

ture we live in and our deepest personal beliefs subtly or massivelyrecastour

experienceof

pain.The

storyof how ourmindsand our

cul-turescontinuouslyreconstruct he experienceof paindemandsthatwelookbeyondthemedicinecabinet."83

For the sociologist,what is most theoreticallyand substantively om-

pelling about the relativelyesoteric tribulationsof pain-riddenper-

formingartists s preciselyhow,withintheexperienceof emotionaland

physicaldistress,deeplyindividualphysicalstates andemotionscannotbe separated rominstitutionalpressuresand constraints.And not onlydoes the scourge of pain among pianists shatter the dichotomy ofindividualversus nstitution,t alsoprovidesa palpableexampleof how

painin our cultureexists in the shadowof multiplesocialworlds.84

Acknowledgments

The authors are indebted to the Editors of Theoryand Societyfor

incisivesuggestions.Wehavereceived so manyhelpfulcomments romfriends andcolleaguesthat it would be invidiousto mentiononly a few

names;their help is acknowledgedand deeply appreciated.Previousversions of the article were presented at meetings of the AmericanLiszt Society,the AmericanSociologicalAssociation, and at the Uni-

versity of California at Santa Barbara.The argument, despite its

groundingn evidence,is basicallya theoreticalone:manyof the claimsare tentativeand subjectto furtherverificationn the largerprojectof

whichthis article is only a part.The ResearchFoundation of CUNYprovided ndispensable upport.

Notes

1. The factors that produce pain among pianists as compared to violinists or other

instrumentalists may or may not be the same, and it is beyond our scope to

speculate on the possible similarities or differences.

2. The concept of "field"is, of course, derived from the work of Pierre Bourdieu. See

his The Field of Cultural Production (New York: Columbia University Press, 1993).As we use the term, a "field" is broader than a "social world." A "field"comprisesall of the organizations, institutions, and social roles involved in the production,distribution, and consumption of piano teaching, learning, and performing. In

Bourdieu's language, as formulated by Loic Wacquant, "a field consists of a set of

objective, historical relations between positions anchored in certain forms of power

(or capital)...." See Loic Wacquant, "Toward a Social Praxeology: The Structure

and Logic of Bourdieu's Sociology," in Pierre Bourdieu and Loic J. D. Wacquant,An Invitation to Reflexive Sociology (Chicago: University of Chicago Press, 1992),








34

16. The term "social world" is derived from the work of G. H. Mead, and we relyhere upon one of his disciples: Anselm Strauss. According to Strauss, "Mead

directs us ... to look at modern society as if it were a congeries of social worlds,"

rather than either as composed of "anonymous, alienated individuals" or as "highlybureaucratized and/or rationalized." "Some - possibly most - organizations can

also be viewed as arenas wherein members from various sub-worlds or other

worlds stake differential claims, seek differential ends, engage in contests, and

make necessary alliances in order to do the things they wish to do." See Anselm

Strauss, "Introduction" to Anselm Strauss, editor, George Herbert Mead, on Social

Psychology: Selected Papers (Chicago: University of Chicago Press, 1977) (first

published 1956), xviii-xix.

3. Ourapproach

thusdistinguishes among individual, organizational,

and societal

levels of analysis. See, for an example of this mode of inquiry applied to theories of

the state, Robert R. Alford and Roger Friedland, Powers of Theory: Capitalism, the

State, and Democracy (Cambridge: Cambridge University Press, 1985).4. Reginald Gerig, Famous Pianists and their Technique (Washington-New York:

Robert B. Luce, Inc, 1974), 203.

5. It is interesting to speculate about whether Vladimir Horowitz's periodic retire-

ments and Glenn Gould's early departure from the concert stage were due in some

measure to physical ailments. Both pianists employed an extremely low posture,

which almost certainly produces physical strain. And Otto Friedrich, in his biogra-

phy of Gould, describes Gould's almost life-long complaints about physical ail-ments. See his Glenn Gould: Life and Variations (New York: Vintage Books, 1989),

which has dozens of references to Gould's "health problems." The pianist Byron

Janis, acclaimed in the 1960s, also had to leave the concert stage because of pain,

specifically arthritis. Janis, in a recent interview, dismissed the explanation of his

pain as due to his "fondness for marathon evenings or his brilliant style of per-

formance ..." He said: "Playing the piano, of course, exacerbated [the arthritis. But]

I'm convinced that the exercise of those fingers, constantly using them, is what kept

me from having totally deformed hands" (New York Times, Section 2, 11 Decem-

ber 1994, 44).

6. See the citations to the work of Dr. Hunter J. H. Fry, in Susan E. Harman, "Theevolution of performing arts medicine as seen through the literature," in Textbook

of Performing Arts Medicine, ed. R. T. Sataloff, A. Brandfonbrener, and R. Leder-

man (New York: Raven Press, Ltd. 1991), 22.

7. See Harman, Textbook, 15.

8. Alice G. Brandfonbrener, "Preliminary findings from the MTNA music medicine

survey," American Music Teacher, 39/1 (August/September 1989): 14. The article

does not give the proportions of persons playing different instruments suffering

injuries, but 81 percent of the respondents were pianists. It is difficult to interpret

these raw percentages, since we do not know the wording of the questions asked. In

our own survey, which had questions about how serious the injury was, answersvaried considerably.

9. The survey was a mail questionnaire, and 268 members of the NYSMTA respond-

ed, with over a 50 percent response rate. A few persons who had never played or

taught the piano were excluded. Ninety percent of those who responded had a

degree in music. Forty-four percent said they had played "many" solo recitals.

Twenty-five percent defined themselves as either a "virtuoso" or a "concert pia-

nist." Of those who answered "Yes, I have had physical problems" (52 percent of

the total sample), 40 percent said that it had been a "nuisance," 23 percent an








36

formingvirtuosoherself somehowqualifiesher to teach and write about how to

practice.A typical practicefor piano teachers is to list their teachers;the more

famous their teacher,the more credible they are as piano teachers. The gift of

charismatic race- virtuosity is transmitted s if by a layingon of hands(so to

speak)."Music s poetry,"Cortot(12); "Play t how Beethoven wroteit,"Wilhelm

Backhaus 62).16. Ina commenton an earlierversionof thisarticle,ProfessorGailBerenson,chairof

the National Conference on Piano Pedagogy'sCommittee on the Preventionof

MedicalProblems,said that"teaching hilosophieshavechangedsince then. Most

pianistsno longerpractice ike this."

17. GeorgeAntheil,BadBoyofMusic(GardenCity:Doubleday,Doran andCompany,

1945).That these beliefs still exist is shown

bya somewhat ess dramatic etter

(al-thoughhe also uses the militarymetaphor) o Claviermagazineby JoaquinAchu-

carro,a piano facultymemberat SouthernMethodistUniversity,commentingon a

previousarticleby Greg Dempster: Iwantto]"... make thefinger-infantrys com-

fortableas possible on the keyboardbattlefield!I don't fear pain as Dempsterseems to. The profession of concert pianist demands a great deal of devo-

tion ... and hard practice, with an emphasis on hard.... The price of playing is

high, and we should be ready to pay it... [William]Kapell had calluses on his

fingertips ... [Rudolf Serkin] ... a bleeding finger ... only through painful effort has

this small (4?10??)woman [Alicia de Larrocha]managed to stretch a tenth."

(November1992,4).18. Interviewwith theauthor,who must remainnameless.

19. Interviewwith thepedagogue,who must remainnameless.

20. For a recent review of the literatureon piano technique,see MarienneUszler,Stewart Gordon, and Elyse Mach, The Well-Tempered Keyboard Teacher (New

York: SchirmerBooks, 1991). Other books examined include ReginaldGerig,Famous Pianists.The only reference that comes close to mentioning pain in

Gerig'sbriefconcludingchapter,"ThePerspectivesof anEnlightenedPiano Tech-

nique," is "poor coordination and unnecessary fatigue will ... be avoided ... by a

rudimentaryunderstanding f the musculatureand the skeletaljoints associated

withpiano playing..." (510). Anotheroften citedwork,JozsefGat, TheTechniqueof PianoPlaying(Londonand Wellingborough:Collet's,1980) does not mention

pain.The onlyreference o physicalproblemsoccurs n a footnotein a chapter"On

the Role of the VariousJoints":"Themost frequentcause of the inflammation f

the tendonsheaths s the work carriedout underexcessive strain"117).21. Stewart Gordon in Etudes for Piano Teachers: Reflections on the Teachers's Art

(New York:Oxford UniversityPress, 1995) emphasizesboth the "unbelievable

physicalstamina oryears"which a professionalpianocareerdemandsbutalso the

denialof the physicaldangers.He arguesthat most pianists"oftensportit-could-

never-happen-to-me ttitude"aboutpossible dangersto theirbody. "Even n the

face of a virtualepidemicof thatbete noire of all keyboardplayers,tendinitis,we[pianists]persistin dailyhabitswhichby and large ignorethe most basic rules of

caring or the physicalorganism"118), such as warmingup. "Wedo not takethe

time to stretchandprepareourplayingmechanism,nor do we sensitizeouraware-

ness to its well-being.Quitethe contrary,when an occasionaltwingeof an acheor

pain forces its way into our conscious consideration,we are very prone to pushahead by calling up an extra measure of effort"(119). Gordon contraststhese

dangeroushabitsof pianistswith athletesand dancers,where there is conscious

andsystematicattention o the demands heymakeon theirbodies.








37

22. In HaroldSchonberg's urveyof The GreatPianists:FromMozart o the Present

(New York: Simon and Schuster, 1987) [Revisededition. The first edition was

publishedin 1963]), Gary Graffmanand Leon Fleisherbarelymake a mention

(490) andByronJanisdoes not appearatall.

23. Brandfonbrener, Textbook, 28-29. The exaltation of the teacher is deeplyembedded in culturalassumptions,extending to such subtle practices as howobituariesarewritten.WhenJuilliardpedagogueAdele Marcusdiedin May,1995,one of the first sentencesin her obituary bothin the New York Times- 5 May-

and as releasedby Associated Press - 4 May)was that she had startedstudyingwith Josef Lhevinneat theageof 15.

24. All of the quotesfrom the PlayingHurtconferenceat the Universityof Minnesotaare taken from

transcriptsof the

taped speechesand comments

bythe

speakers.The conferences, sponsored by the Minneapolis SymphonyOrchestra,brought

togetherprofessionalmusicians, eachers,andphysiciansconcernedwiththegrow-

ingincidenceof physical njuries.25. RobertJ. Silverman, ditor of The Piano Quarterly, rgued n 1991 that the "con-

cert hall, as a mediumof communication,s slowly dying."His reasons were that

"audiences retired of conventionalprogramming.. competition romrecordings,radio,and television tends to keep people confined to their homes ... highticket

prices ... and a steadyerosion of support rom ourcountry'seaderswhen it comesto artseducation"ThePianoQuarterly9/156 (winter1991-1992): 28-29).

26.Joseph Horowitz,

in his bookon the CliburnCompetition,remarks hat "Musicbusinessmen ind it safer andeasier to exploittheyounggladiatorwho comes trail-

ing loud publicityand applause.As neverbefore, they aim for the instantcareer,

quickly begun, quickly expended"(reprintedin The American Music Teacher

(December/January, 990-1991): 21.

27. Drs. GustavA. Alink. PianoCompetitionspublishedbytheauthor,1993).28. Unfortunately,we do not knowthe totalnumberof pianistseligibleto enter com-

petitionsnorwhether hatnumberhaschangedas the numberof competitionshasincreased.Nor do we know the averagenumberof competitionseach pianisthasentered.

29. HaroldSchonberg,n his classic andextremelyreadable urvey,The GreatPianists,perhaps nadvertentlymakes an analogybetweencontemporarypianistsproducedin the competitioncircuitandaccountantsor executives:"Pianists f today's nter-national school are eclectic in approach, clear in outline, metrically rather

inflexible, onallyhard .. theymakea positivefetishof theprintednote,observingthevalues the wayaccountants tudya balancesheet. This theydo verywell.What

theydo not do is readbetween henotes.Ina way, theyarejuniorexecutives,com-

pany men, well-trained,serious, confident and efficient, and ratherlacking in

personality"496, italicin original).Schonbergarguesthat"theday of the super-virtuososhowman s gone ... the emphasis odayis on 'musicianship':larity,pro-

portionand the othercontemporary irtues.The conceptof the Artist-as-Herohasbeen abandoned.Accuracyis more important han temperament"499). Schon-

berg may or may not be rightabout contemporary tandardsof judgmentof vir-

tuosity.Ourargument oncernsthenetworkof institutions hat areoriented owardthe recruitment nd trainingof virtuosiwithalmostsuperhumanechnicalcapac-ities,andthephysicalstrain hatresults.

30. Helen Epstein, Music Talks: Conversations with Musicians (New York: McGraw &

Hill, 1987), 188 (italics by author).Joseph Horowitz has described the VanCliburn nternational ianoCompetitionas "epitomizinghe cult of the performer.








38

Its cashprizescommodifyartists. t mainlyendorsesthe contractionof the reper-toire to masterworksof the past, each

comparedto itself in a dozen

barelydistinguishable ecordings."The Ivory Trade(New York: Simon and Schuster,1990), excerpt reprintedin The AmericanMusic Teacher(December/January,1990-1991): 18.

31. Epstein, Music Talks, 193.

32. Epstein, bid.,193-194.

33. Epstein, bid.,189.

34. Gail Berenson,Professor of Music in the School of Music, Ohio Universityat

Athens,commentedon thispointthat"It's ime to change his!"35. The diversityof professionalrolesamongpianopedagogues s striking,withmany

differentwordsused to characterize hem n the MusicTeachers'NationalAssocia-tion 1992 program:ecture-recitalist, linician(and"workshop linician"), djudi-

cator (and "judge"), oach (and "masterclass coach"),performer,accompanist,recordingartist,chambermusician, ecturer and"speaker"),musicologist, eacher

(and"nationallyertified eacher"), ditor,pedagogyworkshop eader,consultant,churchmusician,chairman of faculty),orchestral oloist, recitalist,author,musicdirector. Frequent couplings were: "performer,clinician and adjudicator.""Independentpiano teachers"also had "privatestudios" or engaged in "studio

pianoteaching."36. StewartGordon (Etudes) acknowledges(and bemoans) the status hierarchyof

"performers"nd mere "teachers"r pedagogues."'Performers'...bythe natureoftheiractivitygarneran admiringpublicwhile 'teachers'mustremain, f not totally

unappreciated, t least unheraldedand long suffering"4). And he notes that the

paralleldivision n musicschools between"performance"eachersand"pedagogy"teachers s characterized y a "feelingof divisionbetweenthe two areas,one whichcanrange rom mereestrangement t best to open animosityatworst" 6).Gordon,who is both a pianistand an educator,discusses the tensions that individuals eel

who bridge the virtuoso and pedagogical worlds: "... most of us have had to learn

how to balancethe delicaterelationshipbetween ourprofessionalactivitiesas per-formersand as teachers"7).

37. We mustemphasizethat these "worlds" o not exist in watertight ompartments.Dr. Alice Brandfonbrener nd Dr. RichardLedermanwere on the 1989-91 and

1991-93, respectively,Editorial Committeeof the AmericanMusicTeacher,the

Official Journalof the MTNA. FernandoLaires,a virtuoso Liszt specialist,was

also on the 1991-93 EditorialCommittee.Ten other persons solidly within the

pedagogical world included Frances Larimer (head of piano pedagogy at

NorthwesternUniversity),MarvinBlickenstaff a teacherat GoshenCollegeanda

frequentpresenterand "clinician" n pedagogical opics at professionalmeetings),Richard Chronister(editor of the KeyboardCompanionand founder of the

NationalConferenceon PianoPedagogy),and seven others served from 1991-93.

We expect that the persons crossingthe boundariesbetween these worldswill bemostopento institutionalnnovation.

38. James Bastien lists 45 of the "betterknown and newer method book authors,"summarizeshe contents of 26 of the method books forbeginners,putout by over

twentypublishers.See the second edition of his How to TeachPianoSuccessfully

(ParkRidgeand SanDiego:Neil A. Kjos,Jr.,1977), 71.

39. See, for anexample,JamesBastien, bid. Inkeepingwith the "small-business"thic

andideology,a constantconcern of the professionalassociation s to mediatecon-

flictsbetweenmembers. n the MTNAcode of ethics,members"agreenot to solicit








39

studentsof other teachers.""Members hall not make misleadingstatements n

theirprintedmatteror publicityreleases,"and"anyadvertising hallbe dignified."A grievancecommitteewas established o "helpresolveproblems nvolvingmem-bers and students or parents."Such codes of ethics are one of the mechanisms

necessary o manage he difficultcombinationof professionalism ndcommercial-ism- sellinga serviceandcompetingwithother teachers orstudents.

40. Professor Gail Berenson of the Ohio UniversitySchool of Music commentedon

this point that "Lotsof youngstudentssufferinjuries" nd that "Early raining s

importantor all students n buildinga healthy oundation."41. Of some 45 sessionsinvolvingpresentersof papersat the 1992 MTNA meetings,

onlyone mentioned"pain" r anysynonym n the title:"PianoLessons:Gain with-

out Pain."Three othersdealt withsomeaspect

ofpedagogy.42. The great majorityof piano teachersand pianistshave workedout an individual

synthesisof conceptsand principles hatwe call private ore. Our surveyof NewYork Statepianoteachers has documented he lack of anybody of literature hatserves piano teachers as a framework or their work.There is no work used in

actual eachingby more thanone out of 10 Americanpianoteachers.The classics,suchasMatthayandLeschetizky,are knownbutnot used.Moremodernworks,bysuch pedagoguesas Abby Whiteside,GyorgySandor,WilliamNewman,GeorgeKochevitsky,ArnoldSchultz,and JozsefGat,areneitherknownnor used. From40to 64 percentof eventhishighlyselectedpopulationof professionalpianoteachersare"not amiliar"withthesemodern

pedagogues,and fewerthan one of 10 useanyof them (the highest percentages are; Joan Last 12%, Tobias Matthay 10%,

SeymourBernstein10%).43. Uszler, Gordon, and Mach, Well-Tempered.he flyleaf blurb says that this is a

"texton pianopedagogy,"designed"specificallyor piano pedagogycourses."The

prefacebythe authorsmakesclearthatthe book is intendedas a "resource"orthe

buddingprofessionalpianoteacher.

44. Arnold Schultz,TheRiddleof the Pianist'sFinger(New York:CarlFischer,Inc,1936), 212. This is a rarereference o pain.

45. GyorgySandor, On Piano Playing:Motion, Sound and Expression(New York:

SchirmerBooks, 1981),x. Sandorgoes on to saythat"When hetechniqueof pianoplaying s reduced o its fundamentals,t turnsout to be a skillthat s ratheruncom-

plicatedand unproblematical, ut it is neverthelessa compositeone, that is, theindividualmotions of the fingers,hand,armandshoulderareverysimplein scopeandinfunction,buttheyallmustbe coordinatedandsynchronized"xi).

46. Malvine Bree, The Groundworkof the LeschetizkyMethod (New York: G.Schirmer,1902). Leschetizkyhimselfclaimed to have no "method."His studentsandbiographerswroteabouthismethod.

47. Robert Starer,"VictorEbenstein'sExercises,"KeyboardClassics7/4 (June/July1987):11.All italicsareadded.

48. LukasFoss, "Thestate of pianoplaying n the twentiethcentury,"AmericanPianoTeacher39/1 (August/September1989): 25. Foss originallypublishedthe articlein 1948, butin his introduction o the re-publication e saysthat "Istillagreewiththecontentsof thisarticle."

49. That position, or somethingsimilar- playingoctaves with the third and fourth

fingers creates he severe strain hatmayhavecrippledGaryGraffman.50. Slenczynska,Music,40. Thepicture s takenfromtheendpaper llustration.51. Some pedagogues,such as Dorothy Taubman,are beginning o specializein the

problemsof pianists'painandinjury.Mrs.Taubmanhas attractedover a hundred








40

pianistsand piano teachersto the TaubmanSchool of Piano at AmherstCollegeeach yearfor 15 years.She arguesthat"pianistsare able to play unlimitedhours

without any fatigue or strain,providing they are playing correctly,"a position

directlyopposed to the medicaltheory leadingto the label "overusesyndrome."See herbriefessay"Ateacher'sperspectiveon musicians'njuries,"TheCaliforniaMusic Teacher15/3 (Spring,1992): 12. References to Taubmanprinciplesare

creeping nto thepedagogy iterature.Ruth C. Friedberg's ecent book summarizes

them as follows: "a natural hand position (ust as the arm hangs, fingers not

artificially urled); he eliminationof hand stretchingand twisting,and of fingerisolation; heuse of fingersand armtogetherwith extensiveemploymentof forearm

rotation;and the adaptationof fingeringand notation to promote the pianist'shealth and comfort"TheCompletePianist:Body,Mind,Synthesis Metuchen:The

ScarecrowPress, Inc, 1993), 26. Friedbergbelieves that the Taubman ystem maybe "onepossible answer to the epidemic of pianists being diagnosedby musical

medicine as victims of 'overuse"' 26). An interestingandimportantquestionout-

side the scope of this articleis whetherknowledgeabout appropriateuse of the

body to enable most people to playwith a virtuosotechniquewithoutriskingpain

actuallyexists,buthas not becomepublic knowledgebecauseof the fragmentationof the institutionalworldsof thepiano.

52. Harman,Textbook,13.

53. A corollary organizationalprinciplemust be a militantrejectionof interlopers,

quacks,charlatans,who either claimthe same

bodilyterritoryor claimto treatthe

same diseasesor injuries,but withtechniquesand conceptsthatcan be dismissed

asunprofessional ndincompetent.54. Dr. RichardLederman,a leaderin the new specialtyof performingartsmedicine,

also says that the terms "cumulativerauma" r "repetitive train"are used. In a

review of the currentstateof the field, he says that he prefersthe plural("overuse

syndromes")because "thisclearly is not a single entity, a common mechanism

appearsto underliethese disorders."See his article,"Anoverviewof performingartsmedicine,"n TheAmericanMusic Teacher 0/4 (February/March 991):70.

Dr. Lederman s Directorof the Cleveland Clinic Centerfor PerformingArtists,

Co-Directorof the Annual Symposiumon Medical Problems of MusiciansandDancers at Aspen, Colorado,andfoundingVice Presidentof the PerformingArts

MedicineAssociation,aswellasco-editorof the firsttextbook nthefield.

55. Brandfonbrener,Textbook, 5.

56. Ibid.,14.Sheadds that"pianists sagroup... appear o be frequentvictims ..."

57. It is widely acceptedas legitimate,of course, for the medicalprofessionto inter-

vene whereunsafe healthconditionsor behaviorshavebeen firmlyestablishedby

credible research,as in the case of smoking.Nothing yet wouldjustifya poster

warningpianists hat"TheBarberSonata s dangerous o yourhealth."

58. Of those persons reportingsome physicalproblemsconnected with playingthe

pianoin ourNew York StateMusicTeachersAssociationsurvey,the following sthe rank orderof the frequenciesof differentkinds of solutionssought:physician

44%,pianoteacher39%,painrelievingmedicine32%,physical herapy21%,cor-

tisone shots 18%,the AlexanderTechnique 18%, chiropractic17%, ice packs

15%,ultra-sound herapy13%,massage12%,practicemore 12%,sportsmedicine

clinic9%,surgery7%,acupuncture %.Forty-sevenpercentreported hattheydid

something lse in addition:"other."

59. One exampleis JacquelineSchmitt,who holds a Master'sdegree in Piano Per-

formance romIndiana,a studentof MenahemPressler.Ms. Schmitt s Director of








41

PianisticRetraining t the Instituteof MyofascialPain and Musculo-SkeletalMedi-

cine in Ann Arbor,Michigan.At the age of 24, Ms. Schmitt'smuscles contracted

intoa "spasmwhenevershereached or anoctave,"and she underwent urgery wo

years aterto removethe "gangliaormed on the flexor and extensorsheaths n the

righthand."Later she beganworkingwith Dr. Ellen Ward on "musculo-skeletal

manipulation," "compositeof techniqueswhich reach deep into the fascia to

releaseconstrictionsand to realignthe bones and muscles."Ms. Schmittoffered

lectureson "identifying nd correcting .. causes of pain and dysfunction"o the

Illinois State Music Teachers Association in 1988. (Quotes drawn from Ms.

Schmitt'spublicitybrochureofferingconcerts,clinics,andpedagogy eminars.)60. It is alsoimportanto note that chronicpaincannotbe medicallyclassifiedas either

"psychological"r

"physical,"hich

complicatests definitionand treatmentwithin

conventionalbiomedicalcategoriesand professionalspecializations."TheAmeri-

canPsychiatricAssociation DSM-IIIcategoryof 'PsychogenicPain' subsequently

dropped in DSM-III-R-was unacceptablebecause physiciansand psychologistsfind relatively ew cases of painin whichthe etiologyis clearlyandsolely psycho-

logical."See ArthurKleinman,Paul E. Brodwin,ByronJ.Good, andMary-JoDel-

Vecchio Good, "Introduction,"o Mary-JoDelVecchio Good, Paul E. Brodwin,

Byron J. Good, and Arthur Kleinman, Pain as Human Experience: An Anthropo-

logicalPerspectiveBerkeley:Universityof CaliforniaPress,1992),4.

61. As Kleinman t al.,ibid.,putit,"chronicpainnotonly exposesbasic contradictions

of medical deologyand care to analysisbut also suggeststhe importanceof moresystematiccriticism of efforts to contain and manage fundamentalaspects of

humansuffering hrough echnicalmasteryand instrumentalationality"7).62. Mary-JoDelVecchio Good et al., ibid., 203. The authorsgo on to say that "In

standardmedical settings, the bodily and experientialorder of chronic pain is

framedby ideologiesand practicesthat divide the sufferer nto partsand reorder

the 'pain patient'by practice specialtyand clinic schedules.... The resistanceof

the body of the treatmentof painis therebyamplified n experienceby the contra-

dictionsof the Americanhealth-care ystem" 203).63. StewartGordon notes the tension in the young prodigybetween the "passionate

drive... needed for musicalsuccess,"but the "inherentdanger" hat the drivewillbe accompaniedby an unrealisticdream of "stardom." Anything ess becomes

linked with failure at worst or compromiseat best"(Etudes,21). And, once the

young prodigyhas felt the intoxicationof earlyadulation, he incentivesof tacklingthe "highly irtuosic cons of the literaturearegreat" 24). "Ifstudentcompetitionsenter the picture,the display piece is often seen as a vehicle with which to win.

Even parentalpressure s often strongto indulge n continueduse of showyreper-toire"and disdain for "lesser"works(such as Haydnsonatas)."Thiscavalieratti-

tude toward more subtle musicalchallenges s insidiousin that it often resultsin

burnout"24).

64. Tobias Matthay, The Visible and Invisible in Pianoforte Technique (Oxford: OxfordUniversityPress,1932), 16. Thislittlevolume,whichMatthayhimselfdescribedas

a "digestof the author's echnicalteachingsup to date,"contains no references o

pain or injury.Matthaymentions"limb-stresses"nd "stiffness"an antagonisticoppositionof muscles) 15-17) butnot in relationshipo pain.

65. The need for the mutualopening up of the differentworlds of the pianois clearly

expressedin a 1991 article in TheAmerican Music Teacher February/March),entitled "An Overview Of PerformingArts Medicine,"by RichardLederman,M.D.:"Clearlyhe healthprofessional s often,if not usually,goingto requiresome








42

help. The physician or health-care worker cannot be expected to understand the

nuances of performance on any, let alone all, instruments, and input from teacher

and performer-consultants may be extremely helpful. The health-care professional

can, however, be expected to understand the language of the performer as it relates

to his art and can be expected to look for and recognize aspects of playing tech-

nique that may be biomechanically unsound or inefficient.... I am often confront-

ed with the challenge that somehow all of this should be unnecessary if proper tech-

nique is taught and if sensible practice and performance is carried out. I believe that

the playing-related problems of the instrumentalist are the result of a complexinteraction involving the anatomical and physiological equipment of the instru-

mentalist, the technical skills acquired through the process of teaching and learn-

ing, the time andintensity

committed topracticing

andplaying,

and someintangibleand in some cases, unpredictable factors, such as emotional stress, trauma and

systemic illness. I further believe that while prevention of all those playing-related

problems is the ultimate goal (as it is in all medicine), we have the responsibility

currently to learn how to manage the problems that do continue to arise.... I

would like to see a collaborative effort among the teacher, performer, and health-

care professional to achieve common goals. This can be realized by the mutual

education of the parties involved and by investigation of the many factors that con-

tribute to playing related problems and of methods to prevent or alleviate them"

(italics by the author).

66. See Elaine Scarry, The Body in Pain (New York: Oxford University Press, 1985), 5.67. Good et al., ibid., 5; Scarry, ibid. 4.

68. See Kyle D. Pruett, "Psychological aspects of the development of exceptional young

performers and prodigies," Textbook, 340.

69. The quote is from Robson, in Medical Problems of PerformingArtists, (1987), 342.

Because of the paucity of empirical research, the incidence of various degrees of

psychiatric disorders is not known.

70. Bryan S. Turner, Regulating Bodies: Essays in Medical Sociology (London and New

York: Routledge, 1992), 168.

71. Turner, Regulating, argues more generally that there is no sociology of the body in

classical and contemporary social theory, discussing Weber, Parsons, Giddens, andBourdieu. The body tends to be treated as a conscious and cognitive actor: "a

thinking and choosing agent, not a feeling and being agent" (87, referring primarily

to Giddens). Turner reviews the recent literature on "the body and society," as part

of his effort to establish a new sociological specialty (complete with a new journal).

But Turner's own arguments are still in a highly abstract vein, and he does not offer

any substantive theories about, for example, how the body as "lived experience"

interacts with the body as an "objective presence" in specific kinds of social rela-

tions and structures.

72. For an important exposition of the importance of repressed shame in social life,

and some unusual empirical data, see Thomas J. Scheff and Suzanne M. Retzinger,Emotions and Violence: Shame and Rage in Destructive Conflicts (Lexington:

Lexington Books, 1991). The quote from Leon Fleischer earlier (note 10) suggests

the power of this emotion. If the incidence of pianists in pain was significant thirty

years ago (and it is impossible to know), but repressed, it would account for signifi-

cant emotional and additional physical trauma.

73. For an argument that there are multiple institutional logics, see Roger Friedland

and Robert R. Alford, "Bringing society back in: symbols, practices and institu-

tional contradictions," in Walter W. Powell and Paul J. DiMaggio, editors, The New








43

Institutionalism in Organizational Analysis (Chicago: University of Chicago Press,

1991). There we defended the relative autonomy of the societal level of analysis,and the institutional logics were those of the family, the state, the capitalist econo-

my, religion, and democracy. Our argument here is at the organizational level of

analysis, by contrast. Each "social world" is a congeries of interorganizational rela-

tionships, but, as we already suggested, an individual may be a member of several.

74. We have not really dealt with what Bourdieu calls "classification struggles," where-

in groups seek to promote the value of the types of symbolic or cultural capital to

which they have greatest access or potentially the greatest power. All three of the

social worlds have their own internal hierarchies of status and power, contested

both at the boundaries and at the center.

75. See Roger Friedland and Richard Widick,"Mapping

thespace

of Pierre Bourdieu,"

unpublished paper, University of California at Santa Barbara, for the argumentfrom which this summary of some of Bourdieu's relevant points is drawn.

76. Bourdieu, in Distinction (Cambridge: Harvard University Press, 1984), 571.

"Doxa" comprises the ways that the "primary experience of the social world"

defines "relations of order as self-evident." A "habitus" is a set of deep-rooted pre-

dispositions to behave and think in certain ways. See also Bourdieu, The Field, and

Loic Wacquant, in An Invitation, 2-59, for a lucid exposition of Bourdieu's central

concepts. In more Bourdieuian language, "habitus consists of a set of historical

relations 'deposited' within individual bodies in the form of mental and corporealschemata of

perception, appreciation,and action"

(ibid., 16).77. Byron Janis "recounted instances in which the pain was so intense as he started to

warm up that he could not imagine enduring the performance. But after a few

minutes it went away. 'You just play through it,' he said, "and this is what kept hap-

pening" (New York Times, ibid.).

78. This issue is so new there is no scholarly literature on the topic. Our information is

derived from Time Magazine, 24 October 1994, 61. A few months later, plaintiffslost a suit against IBM and Apple Computers claiming that "computer keyboardmakers should be held liable for repetitive stress injuries such as carpal tunnel syn-

drome, which most experts agree have no single cause." Attorneys for the plaintiffs

intended to appeal (San Francisco Examiner and Chronicle, 12 March 1995).79. It is relevant to note that a leading medical expert, Dr. Richard Lederman, com-

pletely rejects this pseudo-scientific explanation, confessing that very little is known

about the causes of repetitive stress injury:"... unfortunately there are few reliable,if any reliable studies of actual pathology of overuse. One reads glibly, I'm afraid,about tissue tears, and scars, and all this sort of stuff ... the pathologic basis for this

is in a few animal studies that have questionable relevance to what we're dealingwith in everyday practice of seeing instrumentalists ... we have to plead a certain

amount of inability to prove what we're talking about" (from Lederman's comments

at the Playing Hurt conference cited above, from the transcripts).

80. The author, concert pianist Stephanie Brown, describes the "dangerous angle"(which piano pedagogue Dorothy Taubman labels "twisting"), and several other

fundamental mistakes in holding and moving the hands ("clawing," "scratching,""curling"). Brown has codified a number of principles about hand position andmovement which are beginning to be regarded as "common sense" among piano

pedagogues. The book received enthusiastic blurbs on the cover from several

neurologists and hand therapists, including Dr. Frank Wilson (cited earlier). See

Stephanie Brown, The Hand Book (New York: Ergonome Publishers, 1995).81. Several alternative keyboards have been invented, but none has been adopted.








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Dr. Otto Goldhammer, for example, invented exchangeable keyboards, with five

different widths of keys, to be used in music schools so that "every pupil plays on a

keyboard fitted to his hands" (Gat, Technique, 272).82. In response to the discovery of widespread pain, some actions are indeed being

taken. Professor Gail Berenson, Ohio University, in a private communication

(January 3, 1995) says that "several universities [are] incorporating new courses

into the music curriculum that teach musician wellness strategies in a preventativeeffort." She directed a workshop on "Comfort in the Performance Spotlight" in

June, 1995, with faculty members Dr. Thomas Mastroianni of Catholic Universityof America (a teacher of a "wide range of courses dealing with musician wellness")

and Dr. Richard Norris, Medical Director of the National Arts Medicine Center.

Wemight

note that a recent addition to the repertoire of interest groups on the

internet is one called "sorehand," headquartered at the University of California at

San Francisco, which is accessible by the following command: listserv@ucsfvm.

ucsf.edu. In the message area one writes: subscribe sorehand [enter your name, no

brackets].83. David B. Morris, The Culture of Pain (Berkeley: University of California Press,

1991), 2.

84. An interesting and important topic for study would be a comparison of the condi-

tions under which pianists suffer pain with similar or different conditions for other

occupations that require repetitive and stressful motions of the body: dancers,

skiers, swimmers, and boxers,to name a few. Some of the same

problemsof

linkingpedagogical techniques with the incidence and causes of injury exist for sports:

"... a direct link between injury and training methods is seldom made." See William

A. Sands, et al., "Women's gymnastic injuries: a 5-year study," American Journal of

Sports Medicine 21/2 (March, 1993): 271. For a study of boxers with a similar

theoretical framework to ours, see, for example, Loic Wacquant, "The pugilistic

point of view," Theoryand Society 24/4 (August 1995).

Alford, Szanto - Orpheus Wounded, The Experience of Pain in the Professional Worlds of the Piano

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