It is simply not good enough to tell a performer to relax. Many of us have simply no concept of what it is to relax or be relaxed. There are few wn0 are fortunate enough to feel totally relaxed despite the long hours of practice necessary to become a better than competent performer.

The tension projected by the teacher will often find its end expression in the rigid posture and performance of the student. It is thus vitally important that both student and teacher be aware of what they can do to contribute to a relaxed atmosphere conducive to the best efforts of each one.

The self-imaSe 01 tne musician is vitally important, as all of us carry within us an image of how we see ourselves, and an image (often incorrect) of how others perceive us. If a musician cannot visualise him or her self as competent or confident he or she will always be battling that negative self-image.

As a corollary, given a certain amount of natural ability, the confident musician who has a degree of control over anxiety will perform at optimum levels. If they then perform with the body in a relaxed state there will be less tendency for injury to occur.

In addition, simple thought-blocking exercises where the performer is told to block all negative or unwanted thoughts by imagining they are wearing a magic helmet which only allows positive or creative thoughts to pass through have also been effective.

In the book, Mirrors of The Mind^ the many uses of self-hypnosis, relaxation and imagery are explored. Many of the simpler approaches to be described in the book will have major application to musicians and their teachers.

These processes, as outlined above, may also be brought to bear on the musician who develops pain or altered sensory awareness. The fear of injury in itself is a powerful factor in the production of the vicious cycle of pain — fear — muscle tension — pain — fear etc.

The ability of the musician to dissociate him or herself from the discomfort or to actively engage in the process of muscular and emotional relaxation is of advantage in preventing the end-stage pain and stress problems that present to therapists.

Simple hands-on measures such as basic massage techniques may be of great value when the relationship of student musician and teacher is a secure one, and where there is no implied sexual threat.

Such simple techniques should always be carried out with the explicit permission of the student involved. This is particularly important where relaxation and imagery exercises are carried out together with the gentle massage or reassuring touch.

*84\37\8*

Preliminary trials of the drug known as Sumatriptan appear very promising whether the drug is injected or taken by mouth. It is claimed that up to 80% of those given the drug by a variety of methods gained relief of their headache. Sumatriptan is due for commercial release some time in 1990.

In the treatment of migraine there has been an increase of studies showing the efficacy of intravenous use of a moderately potent local anaesthetic, Xylocaine. In some casualty departments this has become the treatment of choice for acute migraine, rather than the automatic administration of narcotics such as Pethidine or Morphine.

*62\37\8*

A large proportion of chronic pain patients do demonstrate physical pathology ranging from slight to questionable, such as minor degrees of arthritis and degeneration of areas such as the cervical spine, and to a great degree in conditions such as terminal cancer. Adequate, assessment includes the scientific assessment of these processes, such as physical findings, X-rays, electromyograms or EMGs, and CAT scans which may all be important depending on the type of pain.

Psychological pain

Psychological pain is just as keenly felt with or without a physical cause. We are just as disabled if the pain is partly, or wholly, from psychological causes and may require just as much help. In the final analysis, when all the fancy definitions are stripped aside, ‘pain is what hurts!;

Acute pain is associated with anxiety and chronic pain with depression and the resultants alterations in mood, self-concept and thinking. It has also been shown that 50 per cent of depressed hospital patients have pain as a major symptom. Almost all published reports on the psychological and psychiatric evaluation of chronic pain patients report depression as a major component. This is often marked although patients themselves may deny being depressed.

Another important concept has been described that replaces the older concepts of functional or psychogenic illness. This is called sornatisation. This refers to the physical expression of emotions such as sweaty palms, rapid pulse, gastric hyperacidity, increased blood pressure, slowing down of movement, and early morning waking and depression. Sornatisation also refers to, and includes, the concept of psychogenic disorders, or mind-caused disorders also known as ‘conversion disorders’. For example, blindness, hysterical paralysis, deafness and finally pain caused by emotional factors. Briefly, sornatisation is a physical expression of an emotional or psychological disorder such as anxiety, gross stress and, occasionally, severe depression. Thus, one of the difficulties in diagnosing, and treating, chronic pain patients is that it is often difficult to decide what are the physical and/or psychological components of the pain symptoms.

*40\37\8*

Pain also involves one component of the autonomic (automatic) nervous system called the sympathetic system. This controls the involuntary muscles of the body — the ones that function automatically — including the heart muscles, which control the pumping of the blood around the body, and the arteries, which have muscles in their walls allowing them to open and close. Other examples are the muscles that control the iris of the eyes and the muscles that control breathing. The sympathetic nerves also control the small arteries that control the flow of blood to the muscles.

Nerves — the pain conduits

The nerves are the most important piece of the pain puzzle. Their endings pick up pain signals which are started by a stimulus such as a pinprick. These nerve endings are found in all body tissues except the hair and nails. The nerves transmit the pain message, or signal, to its final destination — like a conveyor belt, taking messages to the brain and away from it. Tens of thousands of different nerves exist in the human body and there are about ten billion nerve cells in the brain. The nerve fibres vary in thickness and length. The nerves are either thick or thin. The thick ones have a coating of fatty material — the myelin, which acts like an electrical conductor to carry messages, or signals, along the nerves.

*17\37\8*

In order for gas to burn properly, a good supply of oxygen is needed. If there’s not enough oxygen the gas burns incompletely. When methane burns in a good supply of air it forms waste products of water (as steam) and carbon dioxide. However, if burning takes place in a poor air supply carbon monoxide will be formed.

Carbon monoxide is very poisonous; it poisons the system by interfering with the way oxygen is transported from the lungs to the tissues. Therefore you must ensure that your gas fire has an adequate supply of air, and a good, clean vent. The importance of not blocking up the ventilation bricks in a room with a gas fire is obvious. In small quantities it merely reduces the oxygen-carrying capacity of the blood, but in larger amounts it can kill. Continual exposure even to low levels of carbon monoxide can quickly poison a very large percentage of the oxygen-carrying capacity of the blood.

Carbon monoxide poisoning is not a permanent thing, and in small quantities it debilitates rather than kills. However, it is a potentially vicious killer, and the more carbon monoxide to which you are exposed at any one time, the greater your likelihood of dying. The symptoms of carbon monoxide poisoning are principally headache, drowsiness and befuddlement.

Carbon monoxide is also present in cigarette smoke. The amounts are too small to kill, but it definitely impairs the ability of the body to supply the tissues with oxygen.

Orthodox treatment

Carbon monoxide poisoning is potentially fatal. If there is any question about the health of the patient – and especially where a young child or an older person is involved – you should call a doctor immediately. The patient may need to go to the hospital. In hospital, treatment is simple – giving high concentrations of oxygen increases the amount of oxygen carried by the blood (although the red blood cells which normally carry oxygen have teen poisoned by the carbon monoxide, some oxygen goes along dissolved in the blood serum) and after a while the carbon monoxide dissociates from the red blood cells, which can then go about their oxygen-carrying work normally again. After a minor degree of exposure, the patient is usually back to full health in a couple of days. However, lack of oxygen quickly and often permanently damages the brain, and death or severe brain damage can follow in severe cases of carbon monoxide poisoning, as well as damage to other tissues due to lack of oxygen.

Self help

Don’t close off ventilation holes in rooms with gas fires. Do get your gas fires serviced regularly. Do check the chimney flue for birds’ nests and anything else that can cause pressure, which would force waste gases back into the room.

Don t use old-style open-Hue water heaters (the type that get their supply of air from within the room) in bathrooms and other enclosed spaces. A sudden, massive build-up of carbon monoxide like this can kill the occupant in the bath. Closed-system burners are much safer. These are the so-called ‘balanced flue’ systems, where incoming air is drawn exclusively from the outside, and the exhaust gases are vented exclusively to the outside.

*130\20\2*

The transmitter chemicals are stored in tiny bags inside the ends of the nerve cells. However, sometimes these transmitter substances don’t seem to work as well as they should. Perhaps the nerve cell isn’t producing as much transmitter chemical as it should; or else The receiving nerve isn’t as sensitive as it could be; or alternatively, the first nerve cell has been stimulated so much that it has partially run out of transmitter chemicals and can no longer pass on the messages.

In depression it seems that there isn’t enough transmitter substance to go round, so messages can’t pass freely round the brain as they once did; as a result, thinking becomes an effort, and the emotions are dulled. This neatly explains how and why we may get depressed.

Some types of depression (particularly manic depression in which episodes of depression alternate with periods of excessive activity) undoubtedly occur for genetic (hereditary) reasons, and there has been some interesting work among the Amish community in America to show how this genetic predisposition to depression is passed on. But there is a second group of people who get depressed; and at first sight this appears to have nothing to do with transmitter chemicals.

People in this category become depressed for psychological reasons: they worry about things, perhaps becoming obsessed with a problem that they can’t solve, and have ideas, thoughts and anxieties racing round their head. You might think that depression which was entirely related to an outside event – such as bereavement -would have little or no effect on the transmitter chemicals. Not so! This is a good example of how transmitter chemicals can be used up by excess brain activity. In fact, the brain isn’t inactive – it’s simply having all its energy short-circuited in an attempt to deal with an insoluble problem. It’s exactly the situation that happens in your house when someone switches on the washing machine: for a moment all the lights may dim, because most of the energy in the electricity supply is being diverted to making that huge motor start up, so there’s much less left for the lights.

Exactly the same thing happens within the brain: so much mental energy is being used up trying to solve this unsolvable problem that there isn’t much left for anything else. AH this excess internal activity in the nerves is merely going round and round in circles, depleting the transmitter chemicals and making them unavailable for use in other situations.

There are therefore two main ways we can help people with depression. The first is to put back some of these transmitter chemicals (or else make the existing transmitter chemicals work more effectively); the second is, where appropriate, by counselling or psychotherapy to try to solve some of the problems that are rocketing around the subconscious. If successful, it will leave the brain cells free once again to pass messages on in the normal way.

Many anti-depressive drugs improve the brain’s supply of 5-HT (one of the transmitter chemicals). This fits in neatly with the idea that the increased sensitivity to headaches in depression is due to a lack of 5-HT, making you both more depressed, and more sensitive to pain. Medicines to help restore some of the transmitter chemicals improve depression of both origins – biochemical, and related to external events. There are many non-brain causes of anxiety/depression, too. General physical problems such as lack of thyroid hormone (causing depression) or excess (causing agitation); kidney or liver disease; alcoholism; drug dependency; pre-menstrual syndrome (PMS); food allergies; lack of natural light during the winter in certain susceptible people, also called SAD – Seasonal Affective Disorder; and peculiar reactions to medicines, chemicals and food additives can all cause anxiety/depression. The treatment here is to remove or treat the cause wherever possible.

In many ways, depression is not a disease of the logic as much as disease of the emotions; it is often the inability to express those intense emotions that cause problems in the first place. Paradoxically, it is not the inability to experience joy that’s the problem, but anger; and a fear of sadness.

Whatever the exact trigger, there is often a fear of the intensity of the emotions it engenders. For example, maybe you’ve just been bereaved – but you don’t cry, perhaps through fear of making a scene, or because you are scared of the intensity all your emotions. When you do this, you put a clamp on your emotions, so your emotions are unable to change or move; the result is that although you’re protected against the intensity of the sadness or anger that you feel, this emotional 11,imp also prevents you from becoming happy. Letting out these emotions, taking the clamp off so that you can first go down emotionally – by crying or expressing means that ultimately you’ll be able to come up again.

There are two ways to face your problems. Firstly, if you know what they are |and can verbalise them, then concentrate on them and think them through. But be warned, facing your problems in this way is frightening: don’t try it on your own, unsupported, especially if your depression seems severe.

Often these fears and emotions are too deep-seated to verbalise, and all that you ,due aware of is the emotion you feel, emotion that can’t be put into words or reduced to logic. This is where things like art therapy can come in: by using music, .lit and dance, skilled therapists can help you express those inner feelings and let suit those hidden emotions that have troubled you for so long.

*88\20\2*

The tensor tympani is a muscle like any other muscle, and after a time it too can go into spasm and get tired in the presence of constant loud noises. In addition, reflex contraction of the muscles around the neck, head and face also occur where there is constant loud noise. This muscle tension serves to cause headaches.

Noise is also wearing just because it is noise – it stops us concentrating and makes it difficult to make out what other people are saying. This acts as a further source of stress, and where there is stress there is increased muscle tension. Yet more headaches result. (This is even more the case when the noise is an irritant, such as a baby’s cry, where in addition to the noise there may be feelings of anxiety, stress or guilt at being unable to do anything about it.)

For most types of noise-induced stress the cure is simple: reduce excess noise wherever possible. If you’re working in a noisy environment, then by law your employer will be required to supply you with ear defenders. Wear them! If you don’t you may permanently damage your hearing.

Of late, excess noise has found a place in the office, with the arrival of the computer printer. The daisy-wheel printer, which gives high-quality characters, is like a manic version of a golf-ball electric typewriter; a dot-matrix printer gives off less of a clatter, more of a constant whine. Both these printers can be extremely annoying in the office environment. The cure is simple: buy a printer hood. This is an acoustic shield, which fits over the printer, yet allows you to see what is being printed. Alternatively, buy a bubble-jet or a laser printer, which are virtually silent.

*123\20\2*

After the early part of childhood, tumours generally reduce in frequency and the incidence of cancer only rises again in later life. This too is understandable because in later life the immune mechanisms of the body start to break down and cancer cells may no longer be as easily recognised and dealt with.

*110\20\2*