The Stigma of Vocal Injury

When I heard Adele was cancelling the last two performances of her tour, I felt true sadness for her.

I know how hard she has worked to endure injury, get through surgery and recovery, and take the stage again. Despite this battle, she is again in an unwanted position – in the middle of yet another conversation about vocal injury.

The usual cacophony of responses from the voice community rang out: a split between empathy and judgment. I can’t help but feel these reaction cause a problem for the artist community. Every day, I a singer or actor who has delayed that visit because they were afraid of being diagnosed with an injury.

They fear so much. First, their voices are their identity, their music their life. Singing is not something they do. It is who they are. Their entire sense of self is threatened when they find out they are injured.

The second layer is the fear of judgment. That judgment is crippling. They fear the diagnosis that will put them in the crosshairs of the singing world. Sentencing comes fast in this world. “This wouldn’t have happened if…” If she practiced more. If she studied with me. If she didn’t write such difficult music. If she used backing tracks… it’s endless.

I’ve struggled to understand this because I know that if singers didn’t do this to each other, the outside world wouldn’t either. When singers criticize each other, they create permission for the world to see an injured singer as weak, instead of hurt. Singing is a sport but not in any other sport does this judgement within the ranks occur. When Tom Brady tore his ACL and MCL (ligaments in his knee), no one, least of all his teammates, lay into him about bad technique, pushing too hard, or playing wrong. They didn’t wag their fingers in judgement and call that injury inevitable. The community bands together and acknowledges that these are the perils of pushing your body to an extreme. They rally around him and encourage him on the path to recovery.

It’s worth noting that periods of rest are built into a football player’s schedule… perhaps this is a simple reflection of the fact that the body needs a break? Singers, take heed. The body needs a break when it is pushed athletically. But somehow singers are denied this allowance. They push a more delicate part, their vocal folds, even harder. This delicate system can be devastated by something as simple as a cold. But when a singer needs to cancel, take a break, or go on voice rest, they are called into question about their technique, stamina, lifestyle and ability.

The touring singer often does 3-4 nights in a row, with barely a day off in between. Their “rest days” are usually spent traveling, not in restorative sleep. The musical theater singer belts 8 shows a week. And yet there is no forgiveness to be found from their peers. No one rallies behind Adele, admitting they also had an injury. They too needed to cancel. They too feel the demands are too high. They are afraid to stand up for each other because they do not want to bear what Adele has had to. But if all singers did give each other this grace, the judgment would stop.

When I talk to an injured artist, I find I must focus on taking the self-blame off their shoulders. I see their devastation when there is a bump on their vocal folds and know my role is not just as physician and surgeon but as healer of their fearful heart. It is hard for me to undo years of programming that they are to blame for this but I try because the weight of self-recrimination is suffocating. But I know that when they leave my office, they must swallow their fear. They won’t talk to their peers because they fear the judgement or that they won’t be cast or that they will be seen as “high risk.”

I don’t believe this all comes from a bad place. Singers hear about injury and it preys on a vulnerable and scared place. What if that happens to me? The rationalization defense mechanism is launched and the singer comes up with reasons why this happened to Adele but would never happen to them. By saying that Adele did it wrong, and by not doing those “wrong” things, the singer can feel control. If they continue to do everything right, they won’t be injured like she was. They tell themselves that injury does not happen as a necessary byproduct of working a delicate instrument to an extreme. It’s a mistake. One they are not making.

But the damage it does to singers as an industry is profound. It means singers “push through” when they are sick, telling themselves they are “working around” an illness. It means they do not cancel a gig when it is recommended by a laryngologist.

Injury happens in the most talented singers on the planet. The sooner we stop blaming the victim and start allowing singers to cancel, to rest when they need it, and to have an injury that requires surgery, the safer the entire singing community will be. We will catch injury early, we will prevent injury, and we will advocate for a reasonable performance schedule.

I applaud Adele for speaking out. She could have hidden the truth. But instead, she admitted she is a human who is engaged in an extreme sport and now she is hurt. Her confession is a balm to the singing community that they should welcome, rather than refute with claims of “better technique.” I hope that Adele has started a conversation that leads us to a place where we can protect singers, allowing them to continue to gift us with the music that we treasure.