REACHING BEYOND TRADITIONAL BOUNDARIES: THE LIBRARIAN AND MUSICIANS' HEALTH






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Publication: Music Library Association. Notes
Author: Pierce, Deborah L
Date published: September 1, 2010

Two roads diverged in a wood, and I,

I took the one less traveled by,

And that has made all the difference

-Robert Frost, The Road Not Taken

Music history is full of evidence that musicians have serious health concerns that affect their profession. Traditionally, these stories have been told in the context of describing the eccentricities of great creative geniuses: Beethoven lost his hearing; Chopin's tenuous health affected his playing; Schumann had a self-inflicted hand injury, attempted suicide, and committed himself to a mental institution. More often, the many musicians who struggled throughout the centuries as well as those who struggle today with injuries and other physical and mental-health concerns have relegated their problems to the shadows in secrecy. This began to change when the playing-related injuries of Gary Graffman and Leon Fleisher, both renowned pianists, were made public in a New York Times article in 1981.1 Since that time, information about the many health issues that are faced by musicians in their profession has gradually come into the light.

Within the decade following the publication of the Times article, medical practitioners hosted their first Symposium on the Medical Problems of Musicians, the first issue of the journal Medical Problems of Performing Artists was published, results of a major research survey on the medical issues of orchestral musicians among the forty-eight professional orchestras belonging to the International Conference of Symphony and Opera Musicians was published,2 and the Performing Arts Medical Association (PAMA) was established. Research and information dissemination continued to expand in the 1990s as an online musician-health survey sponsored by the University of North Texas was undertaken; the Textbook of Performing Arts Medicine was published; and an ever growing body of programs and literature documenting the research, study, and experiences of medical practitioners, musicians, and educators emerged.3 These three distinct groups share similar interests in and concerns about musician wellness, yet they each have a very different focus.

The group with the largest output and earliest publications is the medical professionals. Although most of their publications are clinical in nature, some of their later writings have an educational focus. Their educational programs and materials can be divided into two categories: one goal is to train other medical practitioners, and the other more recent goal is to educate musicians. Musicians were the next group to actively come onto the scene. Much of their output can also be divided into two categories: one for the purpose of gathering and sharing information in the form of bibliographies, written primarily as theses and dissertations, and the other by injured musicians who struggled through a maze of insufficient knowledge and uneducated medical practitioners to bring their personal messages to fellow musicians. The injured musicians' contributions are often very passionate, with a strong desire to share their hard-won knowledge with other musicians.4 As more information became available, music educators added their voices to the conversation. Although the Music Educators National Conference's (MENC) Handbook of Research on Music Teaching and Learning was first published in 1992, it was not until the second edition in 2002 that information on wellness was included.5 As educators began their own research and started writing from a pedagogical viewpoint, they also added arguments for the need to include wellness education in the music curriculum.

An important milestone was reached in 2001 when the National Association of Schools of Music (NASM) included the first language acknowledging the need for attention to these issues in its handbook.6 In later editions the association expanded on earlier language, which had merely encouraged programs to connect students with qualified medical professionals, to encourage schools of music to provide access to education about physical and mental health issues as well as providing prevention information.7

THE MUSICIAN-MUSICOLOGIST-LIBRARIAN AND MUSICIANS' WELLNESS

From the beginning of my career as a music reference librarian in 1981, I observed music student and faculty needs for health information and resources relating to their profession. These needs were not only obvious from their requests for research assistance, but also from my interactions with them while performing and socializing.8 As students got to know and trust me, they often would ask wellness questions, and would seek me out to find a neutral sounding board to discuss their issues. As a performing musician, educator, musicologist, and librarian, I have always looked for practical applications of my research and study, and have easily combined these worlds by focusing on performance practice and information literacy. With a practical and service orientation to life, and my information specialist hat firmly in hand, I began searching for both informational and human resources that could help these students answer their questions. I found interesting information about publishing and research trends as well as implications for the traditional activities of a librarian: collection development, circulation, and reference.

Publishing and Research Trends

As one might expect, publishing patterns followed the development and historic events in the field. To get a better sense of the history of the field and to confirm what I had learned from over twenty years of observation, I compiled a list of books and theses from searches in OCLC using the main subject headings that relate to musician wellness (for a list of subject headings used, see appendix A). I added important titles to the list that did not show up in these searches. This gave me a detailed picture of research and publishing trends in the field. As the "Mono - graphic Publishing and Research Trends" chart shows, few works were written in the first half of the twentieth century. The number of books and theses increased slowly from the 1950s to 1980 with a tremendous growth rate from the 1980s to 2010. While there were a few more theses than books written in the 1980s, the number of published books grew at a much faster rate starting in the 1990s, more than doubling the number of theses in the first decade of the twenty-first century.

There were few dissertations and theses about musician wellness written before the 1980s. Those that appeared in the middle decades of the twentieth century focused primarily on vocal production and the performance behavior of musicians. A few titles from the 1970s reported research on the physiological workings of the musician's body, and a few looked at performance anxiety. By the early 1980s, there were some studies that generally described what musicians were experiencing, with some also including information about coping strategies. By the end of the 1980s most of the studies were on performance anxiety. Those that did focus on the physical body became more refined. Physiological research still focused more on production-for example videofluorographs of tongue positions in brass playing-than on any physical problems or on the impact of playing on the musician's body. There was more research on a broader range of topics during the 1990s, including more specific studies on the various aspects affecting the physical and emotional well-being of musicians. These expanded further during the first decade of the twenty-first century to include more alternative healing methods and the impact of the actual music on musicians. Theses came from a variety of institutions. Although there were noticeable numbers of theses produced at Texas institutions during the 1990s, there was no single institution that could claim a significant proportion of the output.

Book publishing took a slightly different path. Prior to 1950 most of the titles were not in English; during the 1960s and 1970s they focused mostly on technique and were predominantly written for vocalists. The first titles to focus on instrumentalists came into the literature toward the end of the 1970s, but vocal topics were still dominant into the 1980s. Some of the first books written by musicians were published around this time along with a couple of alternative wellness topics such as yoga for body conditioning. Some works that have become classics were also written in this time frame. The first edition of Tensions in the Performance of Music, edited by Carola Grindea with foreword by Yehudi Menuhin, was published in 1978, Eloise Ristad's Soprano on Her Head appeared in 1982, and Barry Green and Timothy Gallwey's first edition of The Inner Game of Music came out in 1986.9 Publications in the 1990s presented a wider range of topics and included a more balanced collection of materials for both vocalists and instrumentalists. Some of the first books on hearingrelated issues and alternative solutions like the Alexander Technique also appeared during this time. By the first decade of the twenty-first century an ever-widening range of wellness materials for musicians was being published along with new editions of old favorites. Scientists and neuroscientists were adding to the research, titles on specific instruments were being written, educational and philosophical topics appeared, and prevention was a common theme.

In addition to a rich and deep monographic presence, there is an even larger body of journal literature available. The journal literature can also be divided by the three distinctive groups of writers-medical practitioners, musicians, and music educators-and follows historic patterns similar to the monographic literature. The critical journal which every collection should own is Medical Problems of Performing Artists. While this journal's focus has primarily been on clinical issues, it also includes articles of an educational nature.

Collection Development

In 1987 I started actively developing a collection of musician wellness materials at the University of Washington Music Library, and continued developing that collection for twenty years. Since there were few items published during the early years, finding materials to purchase was challenging. Many good resources that were available were being published by small presses that were not part of our approval plans or regular vendor catalogs, and were available only through diligent research. Like - wise, several were self-published, which made them difficult to identify and obtain. Although most of the recently published wellness mate rials are available from mainstream sources, there are still important mate - rials that are not appearing in the traditional resources music librarians use to develop collections.

In preparation for my MLA presentation, I wanted to create a comprehensive list of monographic materials for participants, but quickly realized that the literature had grown to the point where extensive bibliographies were probably no longer helpful, and there would be no way to capture the picture quickly or easily. I decided to focus instead on creating a small, well-balanced, "desert island" core collection of materials for small music schools that would not likely have access to these resources in their own institutions. To do this, I decided my best motivator would be to purchase these materials and donate them to my undergraduate music alma mater, Pittsburg State University. They were happy to be the recipients of the results of my project.

My focus for this project was on in-print materials spanning a wide range of musician wellness topics while representing all three groups of writers-medical practitioners, musicians, and music educators. I also kept the collection to a size that would be affordable for me as well as for potential donors to other institutions, and, of course, I included some of my favorite titles (for the resulting "Desert Island List of Musician Wellness Resources," see appendix B). This project brought me personally up-to-date with the publishing and literature in the field, and also provided materials to music faculty and students in an institution that did not then have such a collection.

I was able to purchase the majority of these materials easily from two primary vendors, but also needed to do some sleuthing to find sources for a few of the items.10 Most were listed as available in our primary library vendor's database. However, many of the entries in the vendor database had outdated publishers or distributors, and some titles were only available directly from the authors.11

Circulation and Replacement Patterns

One of the reasons I was interested in providing this material to a small school is that, during the twenty years I spent developing the collection at the University of Washington, I noticed that musicians were hungry for wellness information. As soon as one of the items appeared on our new-books shelf, it was almost immediately checked out. Theft and mutilation of these materials was surprisingly high, higher than in the general music collection. I remember one title I had purchased from MMB Music which disappeared and had to be replaced three times during its first year in the collection. The item was not expensive, less than fifteen dollars, so I surmised that its value was in its contents, and that its disappearance was probably due to patrons not being able to find it to purchase themselves. I was tempted to put bookplates in some of the titles to give pricing and purchasing information so that perhaps the items would not have to be replaced so often. I also noticed an increase in markings, highlights, and marginal notations in many of the items.12

While looking back on the years I attended to the collection, I was curious whether actual circulation statistics would match the usage patterns I had observed for these materials. I ran several lists using our local circulation database. The exercise was fraught with difficulties. There was a lack of circulation statistics before online circulation was implemented, data collection was not consistent, and there was no circulation information available for items that had been replaced since circulation statistics were deleted before the replacement items arrived. In spite of these difficulties, the picture I gathered was still interesting. There were wellness titles among the items with the highest circulation and renewals. Most of the wellness titles in this top group were focused on topics relating to vocalists or were general in nature. With the exception of two titles, all of the items in my "Desert Island List" had circulated in the past two years, and about half of the titles on the list were in circulation at the time I checked our online system.

Reference Assistance

Even with all of the available literature and programs in the field, there are still many music students who have not been exposed to wellness information, and often ask for guidance either for their own information or for research they are doing in their coursework. A good place for these students to get some background information is with the two articles on "Performing Arts Medicine" and "Musican's Health" in MENC's New Handbook of Research on Teaching and Learning. They provide a good overview of the issues of the field, and are a good starting place for anyone at the beginning of their research. There are copious bibliographies and Web pages that have sprung up over the last three decades which are also good starting places for research. I especially recommend the bibliographies produced by PAMA and the Music Teachers National Association (MTNA), because of their coverage and PAMA's attention to updating its site. (See the list of "Essential Reference Resources for Musician Wellness Information" in appendix A.)

Since the field overlaps many disciplines, a multidisciplinary approach to research is a must to obtain a discerning picture. For example, in order to find a balanced and comprehensive view of the journal literature, a researcher must search not only music databases like Music Index and RILM, but also databases like PsychINFO, PubMed, the CAIRSS database developed by the Institute for Music Research, and the Cumulative Index to Nursing and Allied Health Literature (CINAHL).

NON-TRADITIONAL ROLES

Many who have worked for an extended time in music librarianship find the need to serve and to teach through sharing information and information resources on all levels and in all circumstances. No matter what my activities or encounters might be, they filter through the lens of an information specialist; it seems to have taken up residence at the cellular level.13 When I am asked to introduce myself in various contexts, I often describe myself as someone who helps others connect their dots, to help connect them to resources, both human and informational which will assist them on their life's journey. A major part of my own journey is a heartfelt passion for music. I have the need to understand its healing powers and the musician's role in this healing. Steeping myself in a lifelong exploration and contemplation of music's role in healing has brought me to the arena of musicians' wellness and has developed my desire to assist other musicians to heal their problems and issues related to our profession. During my years as a music librarian I was provided with opportunities to use my skills in these endeavors. Some of these opportunities took me into roles that are not traditional for an information specialist, yet I found my participation to be heavily influenced by philosophies coming from the library and information science profession.

My early experiences as a performer, especially while I was a music student, were very positive, so I never really contemplated musician wellness issues during those years. I was blessed with supportive instructors who provided me with a balance of challenges and nurturing. While I had a few minor physical issues as I spent more time practicing, they were remedied intuitively by changing my practice habits and by resting. I had mild performance anxiety as an undergraduate, which fortunately vanished with the addition of more skills and experience. In 1990, however, I was in a serious automobile wreck that affected all aspects of my life including my abilities as a musician. For the next six years or so I personally navigated those murky and often tumultuous waters I had read about in the passionate books by injured musicians, searching for healing and the return of my ability to perform again. When most of my injuries were healed and I was well on the road to a full recovery, I started viewing the world of musicians, musician wellness, and music education a little differently. Since I knew that information on various aspects of musician wellness was becoming more readily available, I wondered why this information was not included in the education of musicians, why we were left in the dark to fend for ourselves, why medical practitioners were ignorant of these issues, and why there was reluctance to include this information in the curriculum.14

I spent the next decade researching, reading, collecting, and experimenting on myself with various healing paths including the healing powers of music itself. Beginning in 2000, I spent a couple of years training as a neurolinguistic programming (NLP) practitioner. During the portion of my program where we were required to do sessions with clients, and for the seven years following while I was a registered counselor in the state of Washington, I spent time addressing wellness issues with both professional and amateur musicians, using NLP techniques and talking about the issues these musician friends and acquaintances faced in the profession. Around this same time, I did some work with Dr. Jean Houston researching the arena of human potentials, and I continue to work with Jean today. I decided to leave counseling to the professionals, but gained many useful skills and learned a lot about the field of musician wellness during this process.

Around the turn of the twenty-first century, I began talking in earnest with faculty and colleagues about my desire to teach a course in musician wellness from the perspective of the musician and music information specialist. I wanted to share what I had learned through my own experiences, training, and knowledge of the literature. My intent was to complement and add value to my own expertise by bringing in a variety of medical professionals as guest speakers. I had support from many individuals who knew of my experience and knowledge in the area, including one faulty member who told me he thought it was past time this was taught in academia, and I was the perfect person to do it. In 2003, the Music Education Department at the University of Washington School of Music offered my course in a summer session: Mind and Body Health for Musicians.

Musician Wellness Course

I based the overarching theme of the course on information literacy concepts along with the idea that there are different solutions for different people.15 I wanted to provide the most neutral environment possible in which students could learn critical information about musician wellness research along with a variety of ideas and techniques. The course was constructed to allow students to explore a related area that most interested them, to have the freedom to discuss issues, and to come away with plans for their futures. Students were asked to do a variety of assigned readings, to keep a journal of their experiences throughout the course, and to research a topic of interest and present their results to the class. Their final project was to write an outline of their life-wellness plan, including any of the techniques and ideas they learned during the course that they planned to include as a regular part of their daily practice.

I was surprised by the high level of interest among the students. Many who were unable to take a summer course wanted to talk with me, had many questions, and expressed their hope that the course would be taught in the regular academic year. I was also surprised by the intensity of the students who did take the course. I had students who had stressful physical issues and others who faced debilitating performance anxiety. The biggest surprise to me was the frequently-expressed belief that the students could not talk with their studio teachers about these issues. This confirmed my original belief that students need a neutral environment in which to explore and learn about health information in their field.

It was gratifying to see my students settle into a relaxed and inquisitive mode during the course of the quarter as they explored the issues, talked with a variety of professionals, and were exposed to some alternatives. I was fortunate that the health professionals and faculty I asked to speak to the students were very good and very caring. One student commented that he had not been so intellectually challenged during his entire program-he was a junior at the time-and he found it not only stimulating, but decided to explore the possibility of a career in the medical field. I continued to field questions from students who took the course as well as from those who wanted to take the course but could not that quarter. Since teaching the course I continue to work with music teachers, students and fellow musicians, suggest resources when asked, continue compiling my own list of local resources, and speak on the topic whenever I find an opportunity.

While I was developing my own expertise and opinions and teaching my course, other prominent medical practitioners and educators were working on health promotion for musicians in higher education.16 In August 2003, the University of North Texas system in collaboration with PAMA secured funding from a variety of sources to organize national task groups comprising top scholars in their fields to create core content for a musicians' health initiative. These groups worked for a year and presented their findings at a 2004 conference comprised of medical professionals, representatives from many major music and medical organizations, and music educators. The working conference, Health Promotion in Schools of Music (HPSM), culminated in a series of recommendations and actions that continue today. Their actions have influenced health recommendations by NASM, and NASM has formally endorsed HPSM's recommendations.17 Publication patterns show an influence from the conference as well. In addition to publications that came directly out of the conference, many participants have also published works in the five years since that pertain to the content of the conference.

I was fortunate to be a participant in the HPSM conference. The panel presentations confirmed my beliefs and added to my knowledge of the field. I was able to make personal contacts with a variety of people who have concerns and passions similar to my own. One of the highlights for me was an informal meeting of educators who had taught wellness courses. I found that representatives from all of the three interest groups-musicians, medical practitioners, and educators-were teaching courses. We shared syllabi and discussed our experiences with teaching wellness information to musicians. Some of my ideas were of interest to instructors who asked permission to incorporate them into their own coursework, and I gained new ideas that I would like to incorporate if I have the opportunity to teach my course again. As the only information specialist among the group, I was able to lend a unique perspective to many of the conversations throughout the conference. My attendance at HPSM has also enhanced my ability to help make connections between music students, faculty, and experts in the field. For example, at one point when one of the specialists I met at the conference came to Seattle for another conference, I was able to put together a program that brought them to the University of Washington to work with music students.

In the winter quarter of 2009, I taught a freshman seminar at the Uni - versity of Washington-Inspiration from Contemporary Thinkers: Ex ploring Your Place in the Universe-based upon my work with Dr. Houston. It was during my preparation for this course that I came full circle to the link with my work in human potentials, information science, and musician wellness. This realization came while reading The Art of Possibility by Benjamin Zander-conductor of the Boston Philharmonic and teacher at the New England Conservatory of Music-and his wife Rosamund.18 In the winter quarter of 2010 I developed and taught another freshman seminar, The Power of Music, which led my work back to music, teaching about its joys and healing value. My hope in teaching this course was to help create or deepen the students' passion for music, both for the musicians as well as for possible future patrons of the arts. I wanted to provide a healthy view of our field and show the positive influences and healing power we can bring to the world through our music.

THE FUTURE

Research and publishing continues to grow with major proponents of the field like Alice Brandfonbrener, Robert Sataloff, Kris Chesky, William Dawson, Gail Berenson, Louise Montello, and many others actively working toward providing information to musicians about their health and well-being. Some educators continue to teach courses and include wellness information in their studios.19 Conferences, workshops, and other presentations continue to help educate musicians across the field. I continually see more music teachers at all instruction levels with interest in keeping their students healthy. The most promising programs are coming out of work with young musicians, educating them about wellness topics well before they study music in conservatories or academia.20 It is to be hoped that NASM will continue to advocate for institutions of higher learning to incorporate more wellness into their curricula and possibly enforce their recommendations in the accreditation process.

I will continue to look for ways to share the knowledge I have accumulated and will collaborate with others of like mind to help make positive changes in the education of musicians. I am currently writing a regular musician wellness column that focuses on resources in Glissando, the newsletter of the Pacific Harp Institute.21 I am also hopeful that I can influence other music librarians to spread the word from their own circles of influence, to collect important materials, and to educate themselves as musicians and as information specialists to help guide musicians to quality resources in the field.

1. Jennifer Dunning, "When a Pianist's Fingers Fail to Obey," New York Times, 14 June 1981.

2. Martin Fishbein, et al., "Medical Problems among ICSOM Musicians: Overview of a National Survey," Medical Problems of Performing Artists 3, no. 1 (March 1988): 1-8; based on "The ICSOM Medical Questionnaire," Senza Sordino: Official Publication of the International Conference of Symphony and Opera Musicians 25, no. 6 (August 1987).

3. The Texas Center for Music and Medicine program is a collaborative effort between the Health Science Center and College of Music at the University of North Texas in Denton, and is directed by Dr. John Hipple and Dr. Kris Chesky. Many publications appeared during the 1990s and 2000s as a result of this study. The participants in the program continue to do research and regularly present their results at conferences and in print. For more information about the program and its corresponding publications, see the Center's Web site: http://www.hsc.unt.edu/research/ifd/music_medicine/index.html. The Textbook of Performing Arts Medicine, edited by Robert Thayer Sataloff, Alice G. Brandfonbrener, and Richard J. Lederman, was first published in 1991 (New York: Raven Press). The work was updated in a second edition as Performing Arts Medicine (San Diego: Singular Pub. Group, 1998). The third edition has been announced as forthcoming on the Medical Problems of Performing Artists Web site at: http://www.sciandmed.com/mppa/.

4. I have read many of the publications from all three categories of authors and find that those written by injured musicians have played an important role. They filled a gap in the literature in the early years before medical practitioners began writing educational materials for musicians, and before music educators started writing about musician wellness. Musicians have often found important solutions to their own issues, and present their material with the kind of passion and experience that has the ability to influence and educate other musicians about the importance of prevention techniques and other health information. Many good publications written by musicians are still in print, and should be included in a well-balanced collection.

5. Handbook of Research on Music Teaching and Learning, ed. Richard Colwell (New York: Schirmer Books; Maxwell Macmillan International, 1992); The New Handbook of Research on Music Teaching and Learning, ed. Richard Colwell and Carol Richardson (Oxford; New York: Oxford University Press, 2002).

6. NASM's original language in its general standards for graduation in both the baccalaureate and graduate degrees was in a section entitled "Professional Health": "Institutions should assist students to acquire knowledge from qualified professionals regarding the prevention of performance injuries." National Association of Schools of Music, 2001-2002 Handbook (Reston, VA: NASM, 2001), 79, 100.

7. By 2009, NASM had added a section on "Facilities, Equipment, Heath, and Safety" which slightly expanded its earlier language to: "Institutions should assist students to acquire knowledge from qualified professionals and authoritative medical sources regarding the maintenance of professional health and the prevention of performance injuries" (p. 57); and added more language in a section on "Student Services" to address more clearly the health education of musicians, "The institution shall provide and/ or facilitate access to education, counseling, and professional care associated with the maintenance of physical and mental health" (p. 125). See the NASM Handbook 2009-10 (December 2009), http://nasm .arts-accredit.org/site/docs/Handbook/NASM_HANDBOOK_2009-10_DEC2009.pdf.

8. I was often amazed at how many students, especially in the 1980s, were compiling bibliographies of musician wellness materials. The main interest at that time was performance anxiety.

9. Tensions in the Performance of Music: A Symposium, ed. Carola Grindea, foreword by Yehudi Menuhin, pref. by Allen Percival (London: Kahn & Averill, 1978); Eloise Ristad, A Soprano on Her Head: Right-side-up Reflections on Life and Other Performances (Moab, UT: Real People Press, 1982); Barry Green and W. Timothy Gallwey, The Inner Game of Music (Garden City, NY: Anchor Press/Doubleday, 1986).

10. Since I was spending my own money, I did a little more research on vendor prices than we normally do in our library jobs. I discovered that by carefully selecting vendors, I could purchase more materials. The majority of the materials were available from amazon.com and its associate sellers; many were also available from abebooks.com. The collection cost a little less than one thousand dollars. The same collection would have cost about fourteen hundred dollars if purchased through my library's main vendor.

11. As I was contacting authors who were distributing their own out-of-print titles, I suggested they might try working with www.backinprint.com or a similar service. Through this company, one of my scientist friends was able to make her own popular out-of-print book easily available through amazon.com.

12. When I was gathering materials in preparation for teaching a wellness course in 2003, I replaced some items that were so heavily marked they were almost unreadable. I took note of the marginal notations, which helped confirm my strong beliefs that musicians had a passion and hunger for wellness information as well as a need to discuss the issues.

13. Examples of this work include volunteer roles as librarians in community music ensembles, historical societies, museums, and the like, as well as writing program notes for concerts, preconcert lectures, and historical and literature research for musicians outside of our normal work routines.

14. Our profession has its pedagogical roots in a maestro-led social structure, often imbalanced in terms of competition versus nurturing, as well as having a history heavily steeped in narcissism. There are whole conferences where medical professionals come together to research creativity and madness (see http://aimed.com/). Some factions in educational institutions fear litigation and the potential of high costs of remedy if music students are apprised of the realities of the health risks of the profession. Suffice it to say that these are complex, often controversial, and complicated issues that I only discovered with years of research, observation, and experience.

15. For information about how information literacy concepts were integrated into the course, see Deborah L. Pierce, "Incorporating Information Literacy into the Curriculum: A Look at ACRL's Best Practices Initiative and Successful Music Programs," Music Reference Services Quarterly 8, no. 4 (2004): 57-76.

16. While I was preparing this presentation I observed that events in my own history had often paralleled events in the field. For example, at the same time the 1981 New York Times article was published, I completed my masters in music and began a career as a music librarian in academia; about the time NASM was including its first language advocating for musician wellness education, I was trying to convince my institution to allow me to teach a course in musician wellness; I taught my wellness course during the year that experts in the field were putting together teams and bringing them together to discuss details of educating musicians in higher education.

17. For more information about the HPSM conference, including videos of conference sessions and text of the recommendations that were written as a result, see the conference Web site at: http://www .unt.edu/hpsm/. The recommendations were also published in Kris S. Chesky, William J. Dawson, and Ralph Manchester, "Health Promotion in Schools of Music: Initial Recommendations for Schools of Music," Medical Problems of Performing Artists 21, no. 3 (September 2006): 142-44.

18. Rosamund Stone Zander and Benjamin Zander, The Art of Possibility, rev. ed. (New York: Penguin Books, 2002). The Zanders's book was originally published by Harvard Business School Press in 2000, and was not written specifically for an audience of musicians. There are numerous examples in the book that are specific to musicians, however, making it an important title for musician wellness collections.

19. See the list of "Musician Wellness Courses or Programs in Institutions of Higher Education in the U.S." in appendix C. One noteworthy series of articles which provides descriptions of some of the courses was published in 2007: "Health Promotion Courses for Music Students," parts 1-3, Medical Problems of Performing Artists 22, no. 1 (March 2007): 26-9; 22, no. 2 ( June 2007): 80-1; 22, no. 3 (September 2007): 116-19.

20. As an example, in the summer of 2009, the Pacific Harp Institute in Seattle, Washington, directed by Alison Austin, focused its summer camps for young harp players on recital preparation that included many aspects of musician wellness. MTNA is another group that has provided a variety of programs for its teachers and students over the past several years. Gerald Klickstein's The Musician's Way: A Guide to Practice, Performance, and Wellness (Oxford; New York: Oxford University Press, 2009), and his corresponding programs available at http://www.musiciansway.com/, also have some interesting prospects for creating a grass-roots movement that might make health programs in higher education less critical if musicians already have the skills and information needed before they enter conservatories or universities.

21. For access to Glissando, see the Pacific Harp Institute's Web site at: http://www.pacificharpinstitute .org/. The archive of newsletter issues is available through the "Press" link.

Author affiliation:

Deborah L. Pierce is a reference and instruction librarian at the University of Washington, Seattle. This article is a revision of a presentation given at the Music Library Association annual meeting in San Diego, California, 24 March 2010.

All cited Web sites accessed 26 May 2010.

Appendix A:

ESSENTIAL REFERENCE RESOURCES FOR MUSICIAN WELLNESS INFORMATION

General Overviews of the Field

Brandfonbrener, Alice G., and Richard J. Lederman. "Performing Arts Medicine." In The New Handbook of Research on Music Teaching and Learning, edited by Richard Colwell and Carol P. Richardson, 1009-22. Oxford; New York: Oxford University Press, 2002.

Chesky, Kris, George Kondraske, Miriam Henoch, John Hipple, and Bernard Rubin. "Musicians' Health." In The New Handbook of Research on Music Teaching and Learning, edited by Richard Colwell and Carol P. Richardson, 1023-39. Oxford; New York: Oxford University Press, 2002.

Journal

Medical Problems of Performing Artists (MPPA). Narberth, PA: Science & Medicine, Inc., 1986-. Quarterly.

Indexing Databases

Music Index

RILM Abstracts

PsychINFO

PubMed.gov: http://www.ncbi.nlm.nih.gov/pubmed/

CAIRSS for Music (Computer-Assisted Information Retrieval Service System): http://imr.utsa.edu/CAIRSS.html

CINAHL (Cumulative Index to Nursing and Allied Health Literature)

Bibliographies

Marxhausen, Paul. Musicians and Injuries, http://rsi.unl.edu/music.html (accessed 26 May 2010). This Web site, hosted by the University of Nebraska- Lincoln, focuses on instrumentalists. It has a good list of preventive to-dos, along with an extensive list of resources.

Music Teachers National Association. "Annotated Bibliography on Musician Wellness," http://mtna.org/Resources/AnnotatedBibliographyonMusicianWellness/ tabid/313/Default.aspx (accessed 26 May 2010). This is a searchable database that includes not only books and articles, but also pamphlets and useful Web sites.

Performing Arts Medicine Association. "Bibliography," http://www.artsmed .org/bibliography.html (accessed 26 May 2010). As noted on their Web site: "This bibliography focuses on the health problems of instrumental and vocal musicians, dancers and actors. It consists of citations from the medical, musical, and popular literature, with emphasis on clinical problems and relevant basic science in performing arts medicine. There are some references on alternative therapies, such as Alexander, Feldenkreis, etc. The list is mostly confined to the English language, although numerous articles in French and German are included as well."

Other Web Resources

Health Promotion in Schools of Music: Initial Recommendations for Schools of Music, http://www.unt.edu/hpsm/index.htm (accessed 26 May 2010). This site includes NASM and HPSM recommendations and a general strategic framework for health promotion in schools of music. It also provides access to the final report from the Music Education Liaison group and online access to videos of the 2004 conference sessions.

H.E.A.R. (Hearing Education Awareness for Rockers), http://www.hearnet.com/ index.shtml (accessed 26 May 2010). This Web site is from the first advocate group in the U.S. for prevention of hearing loss in musicians. Information about hearing loss risks is included.

Main Library of Congress Subject Headings

Instrumentalists-Health and hygiene.*

Music-Performance-Health and hygiene.

Music-Performance-Physiological aspects.

Music-Performance-Psychological aspects.

Musicians-Health and hygiene.

Musicians-Heath aspects.

Musicians-Mental health.

Musicians-Wounds and injuries. *

Singers-Health and hygiene.

Singing-Physiological aspects.

Singing-Psychological aspects.

Voice disorders-Prevention and control.

* These categories have similar subject subdivisions under specific instrumentalists, for example, "Pianists-Health and hygiene," as well as instrumentalist genres, for example, "Stringed Instrument players-Health and hygiene."

Appendix B:

DESERT ISLAND LIST OF MUSICIAN WELLNESS RESOURCES

Adolphe, Bruce. The Mind's Ear: Exercises for Improving the Musical Imagination for Performers, Listeners, and Composers. St. Louis: MMB Music, 1991. Available from the author at http://www.pollyrhythm.com/projects_page.html.

Alcantara, Pedro de. Indirect Procedures: A Musician's Guide to the Alexander Technique. Oxford; New York: Clarendon Press, 1997.

Bruckner, Susan. The Whole Musician: A Multi-sensory Guide to Practice, Per formance, and Pedagogy. Santa Cruz, CA: Effey Street Press, 1998. Available from the author ($25), susan.bruckner@cabrillo.edu.

Bruser, Madeline. The Art of Practicing: A Guide to Making Music from the Heart. New York: Bell Tower Books, 1997.

Chasin, Marshall. Hearing Loss in Musicians: Prevention & Management. San Diego: Plural Publishing, 2009.

Cheng, Stephen Chun-Tao. The Tao of Voice: A New East-West Approach to Trans - forming the Singing and Speaking Voice. Rochester, VT: Destiny Books, 1991.

Colgrass, Michael. My Lessons with Kumi: How I Learned to Perform with Confidence in Life and Work. Moab, UT: Real People Press, 2000.

Conable, Barbara. What Every Musician Needs to Know about the Body: The Practical Application of Body Mapping to Making Music. Rev. ed. Portland, OR: Andover Press, 2000.

Dawson, William J. Fit as a Fiddle: The Musician's Guide to Playing Healthy. Lanham, MD: Rowman and Littlefield Education; Reston, VA: Published in partnership with MENC, the National Association for Music Education, 2008.

Dayme, Meribeth Bunch. Dynamics of the Singing Voice. New York: Springer, 1993; 5th ed., 2009.

Dunkel, Stuart Edward. The Audition Process: Anxiety Management and Coping Strategies. Juilliard Performance Guides, 3. Stuyvesant, NY: Pendragon Press, 1989.

Freymuth, Malva. Mental Practice and Imagery for Musicians: A Practical Guide for Optimizing Practice Time, Enhancing Performance, and Preventing Injury. Boulder, CO: Integrated Musicians Press, 1999; St. Louis, MO: MMB Music, 2004. Available from the author, Malva Freymuth, malvas@comcast.net.

Green, Barry, and W. Timothy Gallwey. The Inner Game of Music. New York: Anchor Press/Doubleday, 1986.

Green, Barry. The Mastery of Music: Ten Pathways to True Artistry. New York: Broadway Books, 2003.

Grindea, Carola, ed. Tensions in the Performance of Music: A Symposium. London: Kahn and Averill, 1978; new ed. enl., 1995.

Havas, Kató. Stage Fright: Its Causes and Cures, with Special Reference to Violin Playing. London: Bosworth, 1973.

Horvath, Janet. Playing (Less) Hurt: An Injury Prevention Guide for Musicians. Minneapolis: J. Horvath, 2002; rev. ed., 2004, etc.; New York: Hal Leonard Books, 2010.

Jordan, James. The Musician's Soul: A Journey Examining Spirituality for Performers, Teachers, Composers, Conductors, and Music Educators. Chicago: GIA Publi - cations, 1999.

Klickstein, Gerald. The Musicians' Way: A Guide to Practice, Performance, and Wellness. Oxford; New York: Oxford University Press, 2009.

Kropff, Kris, ed. A Symposium for Pianists and Teachers: Strategies to Develop the Mind and Body for Optimal Performance. Dayton, OH: Heritage Music Press, 2002.

Lehmann, Andreas, John A. Sloboda, and Robert H. Woody. Psychology for Musicians: Understanding and Acquiring the Skills. Oxford; New York: Oxford University Press, 2007.

Lieberman, Julie Lyonn. You are Your Instrument: The Definitive Musician's Guide to Practice and Performance. New York: Huiksi Music, 1991.

Montello, Louise. Essential Musical Intelligence: Using Music as Your Path to Healing, Creativity, and Radiant Wholeness. Wheaton, IL: Quest Books, 2002.

Norris, Richard. The Musician's Survival Manual: A Guide to Preventing and Treating Injuries in Instrumentalists. Ed. by Deborah Torch. N.p.: International Conference of Symphony and Opera Musicians, 1993; St. Louis, MO: MMB Music, 1997.

_____. Therapeutic Exercise for Musicians. Videorecording (VHS). Cambridge, MA: N.p., 1990. (The Norris book and video are currently out of print.)

Parncutt, Richard, and Gary E. McPherson, eds. The Science and Psychology of Music Performance: Creative Strategies for Teaching and Learning. Oxford; New York: Oxford University Press, 2002.

Paull, Barbara, and Christine Harrison. The Athletic Musician: A Guide to Playing Without Pain. Lanham, MD: Scarecrow, 1997.

Ristad, Eloise. A Soprano on Her Head: Right-side-up Reflections on Life and Other Performances. Moab, UT: Real People Press, 1982.

Rosset i Llobet, Jaume, and George Odom; illus. by Axel Oliveres i Gili. The Musician's Body: A Maintenance Manual for Peak Performance. Burlington, VT: Ashgate; London: Guildhall School of Music and Drama, 2007.

Salmon, Paul G., and Robert G. Meyer. Notes from the Green Room: Coping with Stress and Anxiety in Musical Performance. New York: Lexington Books; Maxwell Macmillan International, 1992.

Sataloff, Robert Thayer, Alice G. Brandfonbrener, and Richard J. Lederman, eds. Performing Arts Medicine. 2d ed. San Diego: Singular Publishing Group, 1998.

Schneiderman, Barbara. Confident Music Performance: The Art of Preparing. St. Louis, MO: MMB Music, 1991; Bloomington, IN: IUniverse, 2008.

Tillman, June Boyce. Constructing Musical Healing: The Wounds That Heal. London; Philadelphia: Jessica Kingsley Publications, 2000.

Watson, Alan H. D. The Biology of Musical Performance and Performance-related Injury. Lanham, MD: Scarecrow Press, 2009.

Werner, Kenny. Effortless Mastery: Liberating the Master Musician Within. New Albany, IN: Jamey Aebersold Jazz, 1996.

Appendix C:

MUSICIAN WELLNESS COURSES OR PROGRAMS IN INSTITUTIONS OF HIGHER EDUCATION IN THE U.S.

The programs marked with an asterisk are described in a series of articles about "Health Promotion Courses for Music Students," parts 1-3, Medical Problems of Performing Artists 22, no. 1 (March 2007): 26-29; 22, no. 2 ( June 2007): 80-81; and 22, no. 3 (September 2007): 116-19. Web sites cited below accessed 26 May 2010.

*Eastman School Of Music: Wellness Initiative for Students at Eastman (WISE): http://www.esm.rochester.edu/studentlife/wellness/.

*George Mason University.

Ithaca College: sponsors regular Healthy Musician workshops: http://www .ithaca.edu/gps/healthy_musician/.

*Michigan State University: has a Musician's Wellness Team: http://www .music.msu.edu/common/wellness.php.

Moorehead State University: offers a 300 level class titled The Art of Performing (which focuses on performance anxiety) as well as some special-topics classes dealing with wellness issues.

New England Conservatory: offers a variety of online Health & Wellness Resources as well as classes on wellness issues: http://www.campusdish.com/ en-US/CSNE/NECMusic/FreshHealthy/HealthandWellnessResources.htm.

*Northwestern University: The Medical Program for Performing Artists run by Alice Brandfonbrener at the Rehabilitation Institute of Chicago regularly sponsors education for musicians as well as providing comprehensive performance oriented medical evaluation and treatment of medical problems: http://www.ric.org/conditions/pcs-specialized/PerformingArtsMedicine.aspx.

*Ohio University, Athens, Ohio: Gail Berenson teaches a wellness course at the university in addition to giving workshops nationwide: http://gailberenson .com/.

Portland State University and Marylhurst University: concurrently offer a Mu - sician's Wellness course: http://www.coordinatemovement.com/musicians_ wellness.php.

*Shepherd University, Shepherdstown, West Virginia.

*University of Indianapolis: The Music Department and School of Occupational Therapy have collaborated to bring training to students.

*University of North Texas: Many opportunities for wellness education are available through the Texas Center for Music and Medicine: http://www.hsc.unt .edu/research/ifd/music_medicine/.

*University of Southern Maine.

Louise Montello of Performance Wellness, Inc., lists several universities and professional orchestras that have employed performance wellness trainers in their programs on her Web site: http://www.performancewellness .org/pwexperience.html.

Other institutions present at the HPSM conference that have offered coursework or programs on wellness include: Berkeley College; Boston Conservatory; Francis Clark Center for Keyboard Pedagogy; Hardin Simmons University; Oberlin; Rutgers; University of California, San Francisco; University of Washington; and Western Michigan University. According to a survey of participants during the HPSM conference, forty-six percent of the institutions represented offered some kind of course or wellness program. Since there were a little over one hundred attendees, it is likely there are more schools that include wellness information in their programs.

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