History and Background
The Concept of Performing Arts Medicine
Where and when did the term 鈥減erforming arts medicine鈥� first enter the lexicon? It is, of course, likely that this terminology had been utilized many times in the past and was a part of the name of the British organization founded by Ian James in 1984. Discussions regarding the need to establish a clear scope in the burgeoning field of health care for perfomers first began at informal get-togethers at the Aspen meetings as early as 1984. There were two rather divergent approaches to the subject. One, championed particularly by Dr. Richard Lippin, 鈥渁rts medicine鈥� that included all performing and visual arts. Others were involved primarily in the healthcare of instrumentalists and, used the term 鈥渕usic medicine.鈥� The closely-related term 鈥渕usical medicine鈥� had been used in describing a variety of maladies affecting instrumentalists and submitted as brief case reports or letters to medical journals. Some in the group, who were primarily clinicians seeing 鈥渋njured鈥� performers as patients preferred the inclusion of performers in instrumental music, singing, (our ENT colleagues often referred to 鈥渧ocal instrumentalists鈥�), and dance but did not feel a strong clinical connection to the visual and literary arts. Hence, the group eventually settled on promoting use of the term performing arts medicine for this 鈥渘ew鈥� specialty.
Along with adopting a name for the type of practice, physicians who were primarily engaged in this part-time subspecialty, the members in the group also began, as early as 1984, discussing the need for some type of organizational structure with several goals: 1) to promote quality care for performers, 2) to expand and perpetuate the meeting at which topics of mutual interest would be presented and discussed, 3) to support and conduct programs for education and research in this developing field, 4) to establish some form of communication and coordination among the clinical centers already in place and those being planned, and 5) to foster dialogue and cooperation among performing arts organizations, educational institutions in the performing arts, and health care associations and schools. By 1986, the organization was blessed with a vehicle for facilitating communication and education, the journal Medical Problems of Performing Artists (MPPA). By 1988, the Performing Arts Medicine Association (PAMA) had been established, had a mission statement and bylaws, a set of officers and a board of directors, an official journal (MPPA), at least one annual meeting planned in Aspen, Colorado, and an annual dues structure of $100 for physician members. By the following year, PAMA was officially incorporated as a non-profit organization with a Federal Employer Tax I.D number and 16 members.
The Last 30 Years
To say that a lot has happened over the last 30 years would obviously be an understatement and something no one participating in those early meetings would have predicted or believed possible. Literature in the field of performing arts medicine has increased exponentially. Whereas finding studies regarding medical problems producing impairment in musicians and particularly relating playing an instrument to specific ailments was extremely difficult in the late 1970s and early 1980s, case studies and reviews began to appear in the late 1980s, not only in the journal MPPA but in many general and specialty publications. PAMA began to keep track of relevant literature in a bibliography which has, at the present time, reached some 15,000 citations! MPPA has roughly doubled in size from 142 pages published in 1986 to close to 290 pages in 2018. A number of books began to appear on this subject, notably, The Musician鈥檚 Hand: A Clinical Guide by Winspur and Wynn Parry, pioneer clinicians from UK [1], Medical Problems of Instrumentalist Musician by Raoul Tubiana and Peter C Amadio [2] and the first Textbook of Performing Arts Medicine by Sataloff, Brandfonbrener, and Lederman in 1991 [3]. Performing arts, music and its connection with medicine, especially related to brain function, became a subject of increasing interest and research. Perhaps no individual was more responsible for highlighting this relationship than the late Oliver Sacks, MD, a neurologist and prolific writer who provided fascinating insights into the brain鈥檚 function and dysfunction as it relates to the arts, culminating in his Musicophilia in 2007 [4]. How music and the arts can influence brain development and function has also been the subject of increased scrutiny and investigation. There is now abundant evidence that the brains of musicians can differ significantly from those of non-musicians as the result of musical training and playing an instrument [5].
As the field of performing arts medicine became recognized, performing artists began seeking the expertise of practitioners with knowledge in this area, leading to the establishment of specialized clinics and groups throughout the U.S. and worldwide. Unfortunately, many of these subsequently folded or simply disappeared, often for lack of support from parent institutions and inability to sustain the necessary energy and financial resources to keep them going. Educating healthcare practitioners in dealing with problems of performing artists has been an ongoing concern of PAMA and other professional organizations. The meeting held in Aspen each summer, and more recently in other venues, and now having evolved into an annual international symposium, has served this function admirably, and the excitement generated among attendees at this meeting and workshops is palpable by the closing day. A number of regional meetings and courses have supplemented the annual event, now expanded to include not only lectures, workshops, and open communications but a pre-symposium certification course dedicated to educational objectives. Attendance at these symposia has more than doubled since the early meetings.
PAMA itself has grown dramatically from the original 16 members to the current 342,
representing 19 countries. Most encouraging is the inclusion of 87 students and resident
trainees and 67 representatives from the performing arts community. Membership was
initially limited to medical professionals, trainees, and students, purposefully and
after sometimes heated debate among the founders. The reasoning, viewed as possibly
elitist by some, was that the concept of such an organization was sufficiently unusual
that it was necessary to establish its scientific legitimacy and peer respect in the
medical community before opening membership to performing artists and therapists of
all types. This was finally accomplished in 1993, four years after its establishment.
While PAMA remains truly international, similar organizations have been established
in other countries, including, the U.K., France, Germany, Holland, and Australia.
Performing arts medicine has achieved a substantial degree of name recognition. There
are still many in the performing arts community and, indeed, many healthcare professionals
who remain unaware that such services exist or, if aware, how to access knowledgeable
healthcare practitioners. There is work to be done to increase the knowledge base
of performing arts medicine through clinical and basic research, disseminate that
information to healthcare professionals who can incorporate it into their practices,
expand the number and availability of knowledgeable practitioners, and educate the
entire performing arts community that their particular and, at times, special needs
can and should be adequately met. We are not there yet. The research journal, Medical
Problems of Performing Artists, has produced four volumes each year since 1985 and
is the official journal of the Performing Arts Medical Association (PAMA), the Dutch
Performing Arts Medicine Association (NVDMG), and the Australian Society for Performing
Arts Healthcare (ASPAH).
References
1. Winspur, Ian and Christopher B. Wynn Parry, Editors. The Musician鈥檚 Hand: A Clinical Guide. London: Martin Dunitz Ltd. Distributed in the United States by Blackwell Science, Inc. 1998.
2. Tubiana, R. and Amadio, Peter, C. Editors. Medical Problems of the Instrumentalist Musician. London: Martin Dunitz, 2000. ISBN 1-85317-612-5.99.50.
3. Sataloff RT, Brandfonbrener AG, Lederman RJ, editors. Textbook of performing arts medicine. New York: Raven Press 1991.
4. Sacks O. Musicophilia: tales of music and the brain. New York: Alfred A Knopf; 2007.
5. J盲ncke L. The motor representation in pianists and string players. In: Altenm眉ller E, Wiesendanger M, Kesselring J, editors. Music, motor control and the brain. Oxford: Oxford University Press; 2007.p.153-172.