The Biopsychosocial Model in Singing
Dear students & friends,
I was reading back through my blogposts and noticed that I have never actually sat down and written a post about my biopsychosocial singer theory. Biopsychosocial is a term that I came across while writing my doctoral dissertation, and it quite literally changed the way I think about singing and voice teaching.
The term was first described by psychiatrist George Engel in his 1977 paper “The Need For a New Medical Model: A Challenge for Biomedicine”. Engel argued that the biomedical model, which viewed disease and health from a purely physical and easily observed lens, neglected the multidimensional human experience and, in doing so, failed both the physician and the patient. In his work, Engel encountered two opposing philosophies; namely, that the physical and the psychological should be siloed, the responsibility of entirely separate disciplines, or that any domain outside of the physical was a myth. He argued both positions were wrong, and proposed a model that “would account for the reality of (diseases)... as human experiences as well as disease abstractions… (Engel, 1977, pg. 131).” He noticed that biomedical markers could only predict potential for disease, not the actual experience of disease, and also noticed the presence of disease absent of biomedical markers. This led him to conclude that “the boundaries between health and disease, between well and sick, are far from clear and never will be clear, for they are diffused by cultural, social, and psychological considerations (pg. 132). In response, he proposed a biopsychosocial model of medicine, health, and wellbeing:
Bio- encompassing biological factors
-psycho - encompassing psychological factors
-social- encompassing social and cultural factors
This attitude is certainly more mainstream today, echoed by terms like “holistic health” or even within the World Health Organization’s definition of health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" (2).
What are the implications for a singer? Just as the wellbeing of any system of the body might be viewed through this triple lens, the voice system is no different. Biological, psychological, and social factors impact the voice (and each other), resulting in a non-linear, dynamic system of vocal wellbeing and function.
It’s easy enough to picture a scenario to illustrate this point. Take a young singer, who has been cast as the lead in his school musical. He has been practicing the role as much as possible, but has numerous academic obligations limiting his time and increasing his stress. He’s got midterms coming up, and he really wants to do well, so he stays up late for several nights in a row studying. Unfortunately, the lack of sleep takes a toll, and he starts to feel a tickle in his throat. Being the high achiever that he is (and unwilling to disappoint his fellow cast members), he decides to push through and sing opening night as planned. He throws himself into the final few rehearsals of tech week, and masters the role, despite noticing his voice does feel a little “off”. The day of the show, he gets decent sleep, but knows he probably should have been hydrating a little more than he did. However, as his big number approaches, he gets more and more nervous about the high note - can he hit the note? Will he remember the lyrics? He begins to doubt his own ability. And, sure enough, while he sings most of the song pretty well, his voice cracks dramatically on the high note, and he’s so shaken he forgets the lyrics in the next scene. The next day, discouraged, he wonders what went wrong and starts to feel like maybe he doesn’t have what it takes to be a singer.
What happened? You can use the chart below to pick out the various biopsychosocial limitations that show up in this narrative.
Biopsychosocial Limitations to Performance
As a singer and a voice teacher, I often have to ask myself the question, what is going on here? I also use the above chart as a kind of mental checklist to look deeper. The voice is a complex enough system that any one of these factors might throw a singer off; yet resilient enough where they don’t necessarily have to. My job as a voice teacher is to guide singers (including myself) through the necessary steps to achieve vocal wellbeing - to make sure we are optimizing every point on the list. But it's easy for singers and teachers to fall into the trap of gatekeeping wellbeing - the idea that if every factor is not perfectly managed, the voice will fail, I will fail. This, ironically enough, is a belief based limitation.
In 1988, researcher Albert Bandura wrote “Knowledge, transformational operations, and component skills are necessary but insufficient for accomplished performances. Indeed, people often do not behave optimally, even though they know full well what to do. This is because self-referent thought also mediates the relationship between knowledge and action.” (3) He goes on to describe the importance of self-efficacy, or the belief in one's ability to effect change in successful performance of an action. In my experience, while certain factors may overwhelm the voice’s resilience (I don’t know of anyone who can sing through laryngitis!), it is this belief which is the single most important factor to make or break a performance. Similarly, it is not the most naturally talented singers who are the most successful, but the ones who hold most stubbornly to their beliefs and dreams.
I think the biggest takeaway for me from my research was that as exciting as it is to get lost in the science and technique of singing, we have to remember and acknowledge our humanity as singers. We are creatures of flesh, intellect, and spirit, and our voices, for better or worse, reflect that! Our voices simply will not allow us to ignore the person behind the voice. It is our voices’ greatest vulnerability, but also our voices’ greatest strength. As a voice teacher, this realization was game changing, forcing me to connect more authentically with myself and with my students. It also ended up being a very important part of my dissertation, A Voice Teacher’s Guide to Temporomandibular Disorders (you can read it on my website here: https://www.drjaneclukeyvoicestudio.com/about ). And (how it could it not), the model also helped me understand people better, so that’s fun.
Recently, a friend of mine attended The Shenandoah Conservatory CCM Vocal Pedagogy Institute. As a graduate of Shenandoah Conservatory’s DMA program in Voice Pedagogy, I also attended the Institute back in the day. I was very gratified to hear from my friend that the biopsychosocial model is now being taught at the CCM Institute, credited as being brought to the attention of the faculty because of my research! I am forever grateful to my dissertation committee and all the faculty at Shenandoah for believing in my research.
Do you see parallels in your own life as a musician? Has there been a time where your voice has forced you to look more holistically at your own life? Shoot me an email, I’d love to hear from you.
Warmly,
Dr. Jane
References:
Engel, George L. "The need for a new medical model: a challenge for biomedicine." Science 196, no. 4286 (1977): 129-136.
World Health Organization. (1948). Constitution of the World Health Organization. Retrieved March 26, 2022, from 126 https://www.who.int/about/governance/constitution#:~:text=Health%20is%20a%20state%2 0of,belief%2C%20economic%20or%20social%20condition
Bandura, Albert. "Self-efficacy mechanism in human agency." American psychologist 37, no. 2 (1982): 122.
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