We have to find some way of making the health of the performer more important than the show.
—DAVID HINKAMP, MD, MPH
Performing arts psychophysiology is the second specialty to grow out of the awareness that musicians and artists may have needs that are somewhat different from those of other patients. As a specialty, performing arts medicine was developed in the early 1980s to address the issues created by participation in a particular performing art itself (Brandfonbrener, 2000). Simply stated, it became very obvious that artists appeared to have both unique presentations of common ailments, and more specific ailments that were unique in etiology because of participation in the arts. A performing arts psychologist wrote that "psychology's role in the care of performers has lagged behind that of athletes, where special attention is given to performance enhancement, the promotion of well-being, and clinical issues in sports" (quoted in Hamilton, 1997, p. 67). Attention to such issues for performing artists is coming of age.
There are three main points of emphasis for all performing arts health care. First, performers depend heavily on the physical condition of their bodies (Harding, Brandt, & Hilberry, 1993; Hoppman & Patrone, 1989; Leijnse, 1996; Parr, 1988). The parts of the body used during performance of a musical instrument, in fact, function like an instrument; the body (the primary instrument) is just as involved in the music-making process as the chosen (secondary) instrument. Anyone can depress a piano key or pluck a violin string, but it takes a professional to turn these events into music. Performing arts medicine openly and aggressively addresses the physiology of this issue.
Second, musicians have been found to have a high prevalence and incidence of psychiatric disorders (Nagel, 1998; Ostwald, Avery, & Ostwald, 1998), including mood, anxiety, personality, somatoform, substance use, sleep, psychotic, and eating disorders (Cohen & Kupersmith, 1986; Fishbein, Middlestadt, Ottai, Straus, & Ellis, 1988; Ostwald et al., 1998). The field of applied psychophysiology and biofeedback is a profession dedicated to the research and development of clinical applications for mind–body, stress-related phenomena.