Blood-letting
Blood-letting
/ˈblədˌlediNG/
NOUN
the surgical removal of some of a patient's blood for therapeutic purposes.
bitter division and quarreling within an organization or group.
I remember learning about blood-letting in my college microbiology class. My professor chose a unique textbook that chronicled some of the historical strategies employed by medicine to combat the complex mysteries of illness that plagued humans over the centuries. Mercury for syphilis. Maggots to heal wounds. Plombage for TB.
What is fascinating about each of these methods is that there is some tinge of truth to the idea behind their implementation: after all, maggots are great for getting rid of dead flesh. But without a complete picture of mechanism behind the illness, they made due with what they knew at the time. Of course, for each of these cases, a deeper understanding of microbiology and the advent of antibiotics to target specific organisms revolutionized treatments across many diverse diseases. The seemingly bizarre remedies of yore aren’t even a footnote in most people’s minds.
A Roman abracadabra amulet believed to cure Malaria
Ancient treatments went beyond the physical realm as well. in the early third century AD Serenus Sammonicus, the personal physician to the Roman emperor Caracalla, mentioned an unusual cure in his book Liber Medicinalis (=”The Book on Medicine”): he suggested that those who suffered from malaria should wear amulets inscribed with the word “abracadabra” written in the shape of a triangle. There is also a rich history of rituals, chants, and songs to summon healing spirits. This tradition of imagery and ceremony certainly had a positive impact, even if solely for its placebo effect.
Throughout history humans have looked for new ways to cure illness, live longer, and be more successful. We listen to podcasts, read books, look towards experts in an obsessive quest to improve some aspect of our lives. Sometimes an idea gets spread around and becomes a fad, even if there's little evidence for it. Other times, medical professionals believe that something is effective only to later discover that they were wrong. No worries—the field has evolved to take such things in stride. New ideas, new technologies, and re-framing are all part of the culture. It isn’t an affront to anyone to change course based on new data. It is the norm.
(Aside: when I started in science I learned the old-school Sanger method of DNA sequencing—yes, I am THAT OLD. It took months to clone and analyze a short segment of DNA, one base pair at a time. By the time I left the lab, I could clone and sequence an entire gene in two days without radioactivity (nor stress). I did have discard my expert gel pouring and read about the new protocol, but it was worth it. Did I tell my mentor: “I refuse to do the new method. I don’t even want to learn about it. My old method works. Not to mention, I want to honor the wisdom of Sanger, whose historical wisdom made it possible”. That would be crazy! Yet, we do that all the time in singing. We can honor the past and still move forward…).
In our daily lives, It’s a merry-go-round of sorts where we easily cling to a new trend— juice fasting, going “fat-free” (remember how that turned out?), keto— only to move on to another. This isn’t a criticism of humanity: it is a good thing to strive to be better at whatever aspect of our being we choose. The question then becomes, when does an area become so obviously clear, that we don’t need a trick nor a fad nor a guru? When can there be a consensus that we have all of the science and tools already in front of us? Maybe we can learn a little more, but the days of mystery and extremes are truly over? Why do we still look for tricks and secrets and a one-way street when there are many avenues once we understand?
“The idea that we can understand a mechanism and simultaneously think critically to apply a personalized treatment to an individual, is the essence of good medicine.”
Sometimes, like the case of antibiotics, we get lucky. With the exception of overuse and incidence of antibiotic resistance, for the most part it’s cut and dry: you get an infection and there is an acceptable treatment if caught in time. There is a universal acceptance by the experts of mechanism and disease progression. No more blood letting or chanting. However in treatment, variability is the norm. It is understood that every patient is different: some people wish to talk to a therapist or chaplain as part of their treatment; others want to mediate or do yoga. Placebo and psychology are not left out for those who need it: just like in singing, the mind-body continuum is an accepted reality in medicine. But that doesn’t change other critical elements to the course. The strategy then becomes about the individual: what kind of infectious organism is it? Is it local or systemic? What other factors need to be considered? Solutions are targeted accordingly. But the mechanism isn’t questioned. Nor is there hyper-focus on ‘one-way’ or absolutes. In medicine, such singleness of thought can be deadly. The idea that we can understand a mechanism and simultaneously think critically to apply a personalized treatment to an individual, is the essence of good medicine.
I am making a very imperfect analogy here and I admit that. But as singers and voice teachers we need to realize we already know so much and yet there is still a quest for shamans and singular remedies, and methods and secrets in an arena where the marriage of pedagogy and voice science has really given us a wealth of information, akin to the advent of antibiotics. Our community still argues over points which are truly hypothetical and not representative of what case-based instruction should be. Or absolutes about things that cannot possibly be absolutes. Are there still areas to explore? Yes. The neuroscience is exciting for example. But we already have a great deal of information—on both the mechanistic and brain front— to do great things for students. Complex mechanisms are not the realm for dogmas. It is about knowledge, experience, and application.
“In reality, voice teachers are just like the medical doctor faced with an infected individual: we come with expertise, and we need to design a targeted therapeutic plan. Each voice student comes to us with a unique set of abilities and desires. Just like a patient, it is not one size fits all.”
In reality, voice teachers are just like the medical doctor faced with an infected individual: we come with expertise, and we need to design a targeted therapeutic plan. Each voice student comes to us with a unique set of abilities and desires. Just like a patient, it is not one size fits all. We cannot advocate that there is only one way to ‘keep the tongue at rest’ (see “Articulatory Settings” by Honikmann, 1964) or ‘engage certain muscles for breathing’ or ‘the jaw should always be _____ (fill-in the blank) for this note/vowel/whathaveyou’. We shouldn’t even advocate the same exercises for every student! A physical therapist wouldn’t give a hip replacement patient the same exercises for a shoulder injury. Singing uses over 100 muscle groups to coordinate, so we have so many permutations for customization. How the brain signals and coordinates these muscles is an added variable (hint: the decisions happen long before a note is sung and it is rooted in prediction). So order of function comes into play. Not to mention the idea of observation vs action, correlation vs causation, (what I affectionately call “cart before the horse pedagogy”) which so often gets conflated in the absence of critical thinking or a deeper understanding of the science.
However, unlike medical doctors, there is no measure for competence, nor certification for voice teachers. And with that disparity of expertise, comes a greater number of variables. Did some blood-letting make people better? Yes. But does that mean it should be used now? No.
I have been taught by many great teachers who did not have a scientific nor pedagogic foundations. Did they do harm? Not really. But could they have been better in targeting things that we have knowledge of now? Absolutely.
I think the reason I am writing this in my COVID stupor is I desperately wish:
1) to have a consensus on mechanism, which I believe is possible. It may take some Copernican shifts (there tends to be a marriage to historical perspectives for no other reason that they are historical).
2) to have discussions based on case-studies and not abstract ideas nor absolutes.
3) To end the cult of the “master teacher”: cross-pollination, discussion, and yes, even questioning, is what brings progress, not isolation.
Singing is an art and a science. Medicine is as well. The marriage of science and pedagogy in both fields is what made them advance. However, the slow evolution of practice compared to the science, lack of consensus, prevalence of ego, worshiping of gurus, disparity in backgrounds (or misrepresentation of backgrounds), and marriage to hard-held ideas is inhibiting us. We need to do better, but it may take some blood-letting.