Recovering From Vocal Illness

Very little has been written about helping singers recover their singing after various types of illness. There is a great deal of research about helping people come back to vocal health in relationship to speech, but little information about how to help people recover their ability to sing or, barring that, restructure their ability to sing in a compromised but still musically acceptable manner.

I shudder to think about the skilled vocalists who have developed vocal fold issues from various causes not directly related to singing such as: side effects of systemic medication for chronic conditions, injury from intubation for surgery of other areas of the body, injury to the chest, the lungs, the abdominal muscles or other areas such as the neck or face, or from viruses, growths (not cancerous) or paralysis (part of one fold or an entire fold). Many of these singers have been told “you will never sing again” by well-meaning doctors or speech pathologists. I have written about this here before. I understand they are required by law to give the “worst case scenario” in order that they not be sued for malpractice later. I understand they do not want to give someone “false hope” (an oxymoron if ever there was one). I know that they say this because very often they believe it is true and based on solid facts.

It is sad to think that singers can be helped, sometimes back to a very high level of function or even to a complete recovery, through exercises, but that few people know what those exercises are or how they work. They do not know which exercises to use, or how long to use them. They do not know what to do to balance the re-training so that it isn’t overwhelming to the vocal folds or the physical system. They do not know how to counsel a person to practice — how long in terms of minutes and how long in terms of times between sessions with the teacher is needed. They do not know how to recognize the symptoms in the singing that indicate the exercises need to be adjusted in order to address each level of recovery as it arises. What’s scariest to me is that the people who do not know this, in addition to the singers and the teachers of singing, are the throat specialists and the speech language pathologists who do not, themselves, sing. Further, if you are a “classically trained singer” (something that is not defined, quantified or codified in any way by any organization or body and therefore means pretty much anything), and you get a degree in speech language pathology, you might think that these two things, combined, automatically gives someone the ability to teach singers in CCM styles how to recover those sounds. If you think that, in my opinion, you are wrong.

Time and time again I have worked with people who were “classically trained”, sometimes with a degree in voice from a university and, if they stick with the process, have them tell me, “Gee, I’ve never made this sound before. I didn’t even know I could make a sound like this. It’s really different.” It cannot be that all kinds of people, from all kinds of places and with who knows what kind of “classical training” say the same thing. They can’t all be having the same kind of “coincidence”. It feels different because it is different.

There are too many people with classical training and experience (only) who have never tried to sing in a truly free, truly useful CCM sound, who actually teach the exact sounds necessary in a lesson. Rather, they teach what they know and let the singer work out any gaps between whatever that is and what the singer actually uses. This gap is either ignored (typically) or diminished, making the responsibility for success strictly the singer’s. That’s not fair.

Here, then, are my thoughts, based on my experiences, to help those who need assistance in recovering their singing, or to guide those experts from other disciplines who are open to hearing about 40 years of “front lines” experience working with singers of all levels, and regarding the information given as being valid.

It is quite possible to teach yourself to belt and belt well. Belting, however, involves constriction. It is not possible to belt well with all the muscles in the throat in a relaxed position. Typically, a belter who sings well, has reasonably strong breathing muscles (maybe from a sport or dance) and good posture, and is singing from an expressive rather than “ego-driven” place, can sing well for years without issue. If, however, such a person encounters a prolonged illness or accident that prevents them from singing or performing for some number of months, and such a person is also on medication, and is “of a certain age”(typically in their 40s or older), the constrictors can begin to lose their very “taut” muscle condition and become lax. Then, slowly, the system upon which the vocalist has been relying for decades begins to self-destruct. If the singer goes to an SLP for rehab, the typical instruction is to take the pressure off the vocal folds by teaching the person to “relax” and “lighten up”. That’s fine, and if it was so that the vocalist had poor speech (many do) prior to the onset of the problem there’s no harm in working to improve it. If, however, the sessions conclude with the singer having regained “normalized” speech but not the same vigorous singing vocal production, she is still caught between a rock and hard place.

The singing teacher needs to put the “constriction” back into the system, so that the singer can return to the sound he or she was used to making and recognizes as being “their sound”. Done recklessly, done too quickly, done without skill, such instruction risks ruining the voice entirely. Done with an idea that the sound should be “classicalized” in order to make it “more resonant”, the singer can be encouraged to sound louder and stronger but with the wrong vocal quality for the music that she wants to sing. Done with the idea that all it takes is “singing in the nose” and/or some form of yelling, the sound could be strong but unmarketable. Again, this leaves the vocalist caught between a rock and a hard place.

And, typically, a singer is traumatized by this time. She may be afraid of re-injuring her voice. She may be afraid to face that the singing may return but not for a long time and not without considerable work. She may be afraid to start over, learning first in baby steps something that she had done easily, with no thought, for most of her professional life. The psychological situation of a singer in this circumstance matters and it matters a lot. The teacher has to take that into consideration in the re-training process.

The larynx has to be coaxed to rise (indirectly) through vocal exercises. The vocal folds have to be coaxed to close very firmly, but without locking (such as what occurs with stutterers). The muscles of the tongue and the swallowing muscles (the constrictors) must work without pulling in anything extra, such as the back of the tongue, the neck muscles, or the jaw. The entire vocal system has to be brought to a high level of strength, stamina and stability, without sacrificing flexibility, because both are needed in equal measure in order to allow the voice to be expressive. Sound made for its own sake is useless. Sound has to be made to express something. Seems obvious, but listen to some individuals who have been “classically taught” and ask yourself, “what does this have to do with musicality or expressiveness?”and then draw your own conclusions.

There are no “instruction bulletins” about how to do this work. There are no pamphlets, no published papers. There is no one saying, “Yes, do this. No, don’t do that. Yes, this much. No, not that much,” so that younger or less experienced teachers can learn. At the conferences, there are no experts presenting on this topic. There are no guests at the various teacher gatherings. The only place I’ve ever seen anyone do this kind of session in public is at the Symposium: Care of the Professional Voice (www.voicefoundation.org) and those are brief, and only one time a year in one place. Once, I presented something on this topic for NYSTA. Once. This should be an on-going course.

In the next twenty years, there will be people who were rock singers who got DMAs and PhDs because they wanted to learn but who understand, too, how to work with injured CCM singers and not try to “operacize” them in an effort to restore their ability to sing. There will be discrimination about what kinds of training are for what kinds of reconstruction of singing. There will be tiered knowledge about what to do first, second and third, and what to do in this kind of singer versus that kind. There will be graded applications of how to work with a youngster or a senior and how to understand the differences between a rock singer and a jazz vocalist in terms of style, regardless of what kind of voice the person has. Right now, unfortunately, you have to be really lucky to find such a person. You have to bump into someone with this experience.

If you think this is important, as I do, perhaps you will join your voice with others to raise this issue in your area. If no one knows that this kind of expertise exists, let alone that it is available, the blindness will just continue. If you care about this as an issue, even if it does not personally touch your own life, and you can talk about it to others, please do so.

Those of us who are senior teachers with this kind of experience should be called upon by all the teaching organizations (singing, SLP, ENT, research) to share what we know. We shouldn’t have to go out begging to share our knowledge, to be given a forum where the information is on a platform that makes it available to others. Right now, sadly, that is exactly what we have to do and it is daunting and sad to be rejected from participating in these conferences. If you can help change this, please do.

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