Illustrations by Sirichai Tachoprasert
In 1999, musician Jana McCall was set to play the biggest show of her life. She was on right before the headline band at Bumbershoot, the Seattle festival that has become a modern-day Woodstock for West Coast rock ’n rollers. The place was packed with thousands of fans, it was hot, and the crowd was rowdy.
Looking out at the audience, McCall should have been amazed at how far she’d come. Just a decade earlier she had followed her friends out to Seattle, leaving Arizona and a rough upbringing. A child of teenage parents who were hooked on drugs, McCall had been hospitalized for anxiety and depression at the age of 18. She spent most of her teen years feeling painfully shy and anxious and sought solace in Phoenix’s punk rock scene.
In Seattle, McCall hit her stride. It was the early ’90s and the grunge music scene was exploding. She played bass for a punk band being pushed by Sub Pop Records, and partied with artists like Kurt Cobain. By 1999 she released an album of her own songs. Bumbershoot was like the exclamation point at the end of a decade that had changed rock history.
“In the face of the unattainable, people who suffer from anxiety often don’t see reality, but only the catastrophic,” says Dr. Sullivan.
But McCall was neither excited nor nostalgic, nor running through the set list before the show. She felt only one thing: fear. Sweating profusely, she locked herself in a bathroom and on the side of the sink she cut up Lorazepam, a tranquilizer, into tiny pieces so it might last her through the night. Minutes before what she’d later recall as an embarrassing performance, all she could wonder is what possessed her to be a musician.
This is the almost unanswerable question surrounding performance anxiety: what compels people who are deathly afraid of getting onstage to try to make a career of it?
Performance anxiety, a type of social anxiety, has received increasing attention in the last 30 years as discussions about the “common colds” of mental illnesses—anxiety and depression—reached mainstream ears. Social anxiety affects nearly five million Americans and typically begins in childhood but can strike anytime before the age of 25.
At root is the drive towards an unattainable perfection, which often makes getting up in front of a crowd crippling. Most sufferers try to conceal their angst, but they’re often betrayed by their bodies—stuttering, sweating, blushing, even blacking out. The symptoms become part of the problem: knowing the audience can see their fear makes them even more nervous.
A certain type of anxiety labeled “anticipatory” is common in performers. It typically runs parallel with obsessive thinking about what might go wrong, how one could fail or be harshly judged, before an event has even happened.
“I would just get sick—incredibly nauseous or throwing up, diarrhea,” McCall remembers. “Not only could I not function in regular life, I couldn’t get onstage.”
At her Bumbershoot show, submerged in adrenaline, she hit wrong notes, mumbled awkward things to the crowd, and even insulted a British music writer in the audience. McCall abandoned dreams of touring soon after. Now 39, she currently lives a quiet life in Bozeman, Montana with her boyfriend and 10-year-old son.
Psychiatrists and psychologists have developed two highly effective treatments for anxiety: medication and cognitive behavioral therapy. Research suggests that both are equally effective. But in our fast-paced, goal-oriented society, a pill that guarantees results and works immediately is very alluring. “Many patients come to me and say ‘Just give me a pill, doc,’” says Dr. Gregory Sullivan, assistant professor of psychiatry at Columbia Medical School in New York.
Medications commonly used for depression, like selective serotonin reuptake inhibitors (Zoloft, Paxil, and Prozac) are the first line of defense. “They are some of the most powerful medications for dampening the fear system,” says Dr. Sullivan.
Others include monoamine oxidase inhibitors (MAOIs) and benzodiazepines (sedatives like Valium and Xanax). And then there are the best-known stage fright drugs, the beta blockers propranolol and atenolol. Beta blockers are typically used for high blood pressure—but were found to block the nervous system’s response during anxiety. They can ease the pounding heart, tremors, and clammy hands associated with panic. (Stories abound about how the New York Philharmonic has an established network of underground sources for these drugs.)
People who suffer from anticipatory or performance anxiety are terrified of being “ordinary,” researchers say. They tend to have extremely high, if not impossible, expectations for themselves. And the surfacing of a flaw, such as a tendency to forget one’s lines, could send them spiraling into a slump, pushing them to stop performing altogether.
At the height of her career, Barbra Streisand stopped doing live performances for 27 years. After a Central Park concert where she forgot the words to a few songs, she simply refused until her famous 1994 comeback show at Madison Square Garden.
Carly Simon only discovered her voice because she stuttered so badly as a nervous child that her mother would tell her, “Just sing it.” Then she could express herself. But when too much fame and attention came her way, the fears came back ten-fold. “Sometimes I can love myself and sometimes I just really, I can’t bear myself,” Simon told CNN in 2004.
Perhaps the most striking example is Cat Power, the indie rock singer who cancelled an entire U.S. tour earlier this year because of anxiety. She routinely hides her face in her hair, performs covers rather than original songs (for fear no one really wants to hear her work), and sometimes sings with her back turned to the audience, because it’s the only way to keep herself from walking off. “She is so painful to watch, I almost wonder why she even bothers playing live,” wrote a Cat Power fan on a web bulletin board.
There is no one confirmed cause for social anxiety. But there is substantial evidence that, like most human behavior, a combination of genes and environment are to blame.
Anais Koivisto, a 22-year-old actress and the daughter of a known playwright and actor, grew up in the world of theater. At the age of seven she fell in love with the spell actors cast over audiences. She later discovered her father had always struggled with a paralyzing fear of performing.
It was not until a decade into her acting career that she started to notice her own anxiety—and realized she may have inherited more than her father’s talent.
When she was 17 she attended a performing arts high school in San Francisco, and in her senior year she competed in a Shakespeare contest. The grand prize was a trip to perform at Lincoln Center in New York City.
“I had been really nervous in the hour before [taking the stage],” she recalls. She reviewed her character, motivation, setting—all things she was taught in acting school—but still her mind raced in circles.
“I felt physically petrified. I got up onstage and I blacked out,” she said. Instead of delivering her well-trained monologue, she started reciting the text of a sonnet.
“My brain just totally misfired,” she recalls. “I realized halfway through the first line and I just stopped dead in my tracks.” The judges told her to start again. For a second she felt terrified, but her worst fear coming true actually liberated her. Moving through the horror, Anais calmed down and was able to focus on her character, who, coincidentally, was suffering in an anxious moment. Things just clicked, all the preparation worked, and she was able to give a top-notch performance.
“That’s the one thing I can’t explain,” she said. “Whatever that switch is, I don’t know why it occurred. When the nerves release, I think it’s letting myself feel what I need to feel in order to act.” She won top prize.
Curiously, this moment echoed the first time she’d seen her father perform. Days before the opening of a production of Shakespeare’s The Tempest, Peter was still struggling to memorize his lines. As opening night came closer, the fear of getting onstage loomed larger. He tried psychotherapy and all kinds of meds—anything to help him focus. But nothing stopped the negative thoughts and body shakes.
On opening night, however, he gave what critics and he himself said was one of the best performances of his life. It was always that way with her dad, Anais said. “The more anxiety he felt leading up to the performance, the better the actual performance,” she explained. Of course, this sort of positive feedback may have encouraged future occurrences of fear. The notion of equating struggle with success appears to be a keystone of ambitious performers.
This cycle of physical fear and creative breakthroughs is one that follows Anais to this day. “It’s not that I want to be perfect or give a perfect performance, it’s that I feel like I have to be,” she explains.
Anxiety is, after all, an obsession with perfection. “In the face of the unattainable, people who suffer from anxiety often don’t see reality, but only the catastrophic,” says Dr. Sullivan. The body, accordingly, overreacts.
Anais experienced the brain’s most extreme response to fear: blacking out. It’s a strategy the brain evolved to cope with situations when stopping to think could actually cost a person their life, for example, when coming face-to-face with a bear in the woods or waking up to realize the house is on fire. The blood rushes from the higher level processes to the amygdala, a small region in the brain that houses the “fright or flight” fear response.
Cognitive behavioral therapy is remarkably successful at helping people deconstruct the negative and automatic thought processes that keep them in the grips of fear. Whether it’s a feeling of not being worthy to be an artist, a fear that people won’t accept you as you are, or misgivings over the sacrifices you’ve made, most anxiety starts at the subconscious level. “A lot of that stuff doesn’t even come up until you’re about to go on,” explains Martin Knowles, an actor turned psychotherapist whose downtown Manhattan practice has catered to performers for 20 years. The solution, he says, is to bring one’s self into sync.
People who suffer from anticipatory or performance anxiety are terrified of being “ordinary,” researchers say. They tend to have extremely high, if not impossible, expectations for themselves.
Therapy usually requires between eight and 20 sessions but gives the patient a learned technique to use in any nerve-filled situation, without the fear of losing themselves to meds. If a person thinks an audience “will think I’m stupid,” then the therapist will ask them to give solid evidence for this thought. Then they find a way to discount the hopeless and negative scripts that ruminate in the anxious mind.
Cognitive behavioral therapy can be used either on its own or in combination with drugs and boasts a 70 to 80 percent success rate. “It’s about getting them to take a step back,” says Dr. Sullivan. “Their thoughts are negative. We try and help them reframe it to include positive possibilities.”
Many performers also create their own coping strategies. Some take on a character other than themselves. Rumor has it this is what compelled Peter Gabriel to start donning the futuristic costumes of his Genesis days, and Tom Waits to assume the slurred, growly-voiced persona that didn’t appear until his third album.
Then there’s that habit rock stars have of wearing sunglasses, no matter what time of day or night. Case in point: Bono’s purple shades or Andre 3000’s aviators. Andre says direct eye contact often makes him too scared to get onstage. The shades, he says, create just enough of a shield between him and the audience to give him the courage to get up there.
Little does he know there is striking scientific evidence for this tactic. Recent brain imaging studies of the visual cortex revealed that when people with social anxiety are shown pictures of faces, they focus on all features of the face but conspicuously steer clear of the eyes.
When we spoke, Anais was on her way to rehearsal. She’s just moved to New York and already scored a lead role in an upcoming comedy at the Times Square Arts Centre. But she confided she’s been going through a rough time.
“I don’t know how much longer I can go on like this,” she said. “Everything feels physically hard.” She described moving in a jerky and uncontrolled way, and of having her muscles freeze during rehearsals. She says it’s hard to smile. Worst of all for an actor, her voice goes into her chest, silencing her.
“But acting is not always like this for me,” she continued. “Sometimes, it is lovely, sublime, wonderful, easy—like surfing when you hit the barrel of a wave and suddenly you are gliding over glassy water.”
This, it would seem, is exactly what keeps performers like Anais hanging on. The promise of the perfect wave; the perfect performance. The possibility that just on the other side of these frightful, disorienting feelings, we might discover the most perfect version of ourselves.