There is a particular grief that comes when a performer loses their ability to perform. It is not like losing a job. It is closer to losing a language — the primary way you have communicated with the world, made sense of yourself, and found joy.
I know this grief personally. As a musician, I developed focal embouchure dystonia. The movements I had trained and trusted for years simply stopped being available to me. I felt terrified, ashamed, and completely alone. And no one could tell me what was happening inside my body, let alone what to do about it.
What I eventually came to understand — through my own long recovery and through nearly 30 years of clinical work since — is that the nervous system is at the centre of this story. Whatever form the loss takes, whether it is focal dystonia or the yips or stage fright so severe it becomes avoidance, the body is not breaking down. It is adapting. And what has been learned, no matter how deeply embedded, can be unlearned — because the brain remains structurally plastic throughout life (Draganski et al., 2004).
The spectrum: from stage fright to focal dystonia
Performance difficulties exist along a spectrum. At one end are the experiences almost every performer recognises: the elevated heart rate before a big performance, the mind going blank, the sudden awareness of your own body in a way that disrupts fluidity. These are normal nervous system responses to a situation that feels like it matters.
Further along the spectrum are performance blocks that have become more persistent and intrusive. The yips — the sudden, involuntary loss of fine motor control under pressure — are well documented in golf and increasingly recognised across sport and music; researchers describe them as a continuum, with some cases closer to performance anxiety and others closer to task-specific focal dystonia (Smith et al., 2003). Chronic performance anxiety can narrow a performer’s world gradually, until the spaces in which they feel safe to perform have shrunk to almost nothing.
At the far end of the spectrum are the focal dystonias: neurological conditions that cause involuntary muscle contractions interfering with highly specific, highly practised movements. Embouchure dystonia in wind and brass players. Focal hand dystonia in pianists, guitarists, and string players. Writer’s cramp. Cervical dystonia. Blepharospasm. These are not psychological conditions (Altenmüller & Jabusch, 2009) — but the nervous system, and what it has been through, is deeply involved in their development and in their resolution.
The apparent differences between these conditions are real. But the underlying logic is the same: the nervous system has organised a protective response, and that response is now getting in the way.
What the nervous system is actually doing
The nervous system is not malfunctioning. This is one of the most important things I say to the people I work with, and it takes time to land. When the body tightens, when movement goes wrong, when access to flow is cut off — the nervous system is doing what it has learned to do. It is adapting to what it perceives as a threatening environment. It is protecting, as best it knows how.
Those protective adaptations have often been laid down long before the current difficulty began. Research on elite performers has long noted the extraordinary early dedication and pressure that shape their development (Bloom, 1985), and large-scale epidemiology shows that adverse experiences in early life have measurable, lasting effects on adult physiology and health (Felitti et al., 1998). The same intensity that can drive remarkable mastery can also leave the nervous system with a latent vulnerability. Under sufficient pressure, that vulnerability becomes visible.
This is why purely technical approaches so often fail. The problem is not in the technique. It is in the patterns of nervous system activation that are running beneath and through the technique. Trying to correct the movement without addressing the nervous system state from which the movement emerges is like trying to fix the expression on someone’s face without attending to what they are feeling.
The way back: listening rather than fighting
The turning point in my own recovery — and in the recovery of most of the people I have worked with over the years — was not effort. It was curiosity. It was the shift from fighting the symptoms to becoming interested in them. What is the body actually trying to protect? What does safety feel like, at the level of the nervous system (Porges, 1995)? What happens to movement when that safety is present?
This is the work of somatic performance therapy: helping the nervous system find its way back to a state of genuine regulation, in which flow is not something you have to reach for or trick yourself into, but the natural expression of a body and mind that are no longer in conflict.
The dimensions of flow that researchers have identified — clear goals, complete absorption, a balance between challenge and skill, the merging of action and awareness, the loss of self-consciousness (Jackson & Csikszentmihalyi, 1999) — are not things you can manufacture by trying. They emerge when the conditions are right. And the conditions are, at their deepest level, neurological.
The work is different for each person. For someone with stage fright, it might begin with interoceptive awareness — learning to feel what is happening in the body with curiosity rather than alarm (Craig, 2009). For someone with the yips, it might involve exploring the patterns that have built up around the problematic movement, and the feelings those patterns are carrying. For someone with focal dystonia, it is a longer journey — but the direction of travel is the same.
You do not have to grieve forever
If you are reading this because you have lost something that mattered to you — the ability to play, to compete, to perform at the level you know you are capable of — I want to say something plainly: you do not have to grieve forever.
The nervous system is extraordinarily plastic. What has been learned can be unlearned (Draganski et al., 2004). Not by force, but by understanding. Not overnight, but progressively — with the right support and the right approach.
If focal dystonia is part of your experience, focaldystoniamethod.com is where I would direct you first. The Focal Dystonia Method Online Programme is the most complete resource I have created for people working with focal dystonia directly.
If your experience sits elsewhere on the spectrum — performance anxiety, the yips, a sense of blocks without a specific neurological diagnosis — the Free to Perform approach, which I am bringing into a dedicated programme in 2027, is designed for you.
If you are a performer dealing with a performance block, or would like to understand the Free to Perform approach more fully, you can explore Ruth’s work at ruthslchiles.com/free-to-perform — or, if focal dystonia is part of your experience, at focaldystoniamethod.com.
References
Altenmüller, E., & Jabusch, H.-C. (2009). Focal hand dystonia in musicians: Phenomenology, etiology, and psychological trigger factors. Journal of Hand Therapy, 22(2), 144–155. https://doi.org/10.1016/j.jht.2008.11.007
Bloom, B. S. (1985). Developing talent in young people. Ballantine Books.
Craig, A. D. (2009). How do you feel — now? The anterior insula and human awareness. Nature Reviews Neuroscience, 10(1), 59–70. https://doi.org/10.1038/nrn2555
Draganski, B., Gaser, C., Busch, V., Schuierer, G., Bogdahn, U., & May, A. (2004). Neuroplasticity: Changes in grey matter induced by training. Nature, 427(6972), 311–312. https://doi.org/10.1038/427311a
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/S0749-3797(98)00017-8
Jackson, S. A., & Csikszentmihalyi, M. (1999). Flow in sports: The keys to optimal experiences and performances. Human Kinetics.
Porges, S. W. (1995). Orienting in a defensive world: Mammalian modifications of our evolutionary heritage. A polyvagal theory. Psychophysiology, 32(4), 301–318. https://doi.org/10.1111/j.1469-8986.1995.tb01213.x
Smith, A. M., Adler, C. H., Crews, D., Wharen, R. E., Laskowski, E. R., Barnes, K., Valone Bell, C., Pelz, D., Brennan, R. D., Smith, J., Sorenson, M. C., & Kaufman, K. R. (2003). The ‘yips’ in golf: A continuum between a focal dystonia and choking. Sports Medicine, 33(1), 13–31. https://doi.org/10.2165/00007256-200333010-00002