Voice Education and Injury Stigmatization (Stigma literature ("The…
Voice Education and Injury Stigmatization
"The Stigma Scale" (J Psychiatry, 2007)
Pilot scale with 42 items - used qual. data from interviews with mental health service users
"Stigma about mental illness may determine how and even whether people seek help for mental health problems, their level of engagement with treatment and the outcome of their problems.
final 28-item stigma scale (Likert format)
aspects assessed include discrimination, disclosure, potential positive aspects of mental illness
Boyd, DeForge (Psychiatric Rehabilitation Journal)
"Brief Version of the Internalized Stigma of Mental Illness Scale"
Subscales: Alienation, Discrimination Experience, Social Withdrawal, Stereotype Endorsement, Stigma Resistance
"Stigma: Notes on the Management of Spoiled Identity"
Origin of term - Greek, sign brandished into slave, criminal, traitor: "a blemished person, ritually polluted, to be avoided, especially in public places"
stigma "used to refer to an attribute that is deeply discrediting"
Inherently social, contextual, a thing of relations
the stigmatized and the normal ("pervasive two-role social process"
The wise: "those whose special situation has made them intimately privy to the secret life of the stigmatized individual and sympathetic with it"
"Where such repair is possible, what often results is not the acquisition of fully normal status, but a transformation of self from someone with a particular blemish into someone with a record of having corrected a particular blemish."
Considering rewards of being normal: "almost all persons who are in a position to pass will do so on some occasion by intent."
Link and Phelan (2001)
"Conceptualizing Stigma" (Annual Review of Sociology"
Necessity of power for stigma to be relevant
"STIGMA: How we treat outsiders"
existential stigma (over which person did not cause or has little control) vs. achieved stigma (earned because of conduct)
Cites Protestant ethic and its connection with capitalism as basis for stigmatization in America - ideology "includes the belief that individual hard work leads to success and that lack of success is caused by moral failings, self-indulgence, and lack of discipline."
Jones et al. (1984)
"Social Stigma: The psychology of marked relationships"
Words "applied to the resulting status of the deviant person. He or she is flawed, blemished, discredited, spoiled, or stigmatized."
stigmatizing process as relational - contextually dependent
Six dimensions of stigma - guided by how much they influence interpersonal interactions: concealability, course (is it reversible?), disruptiveness, aesthetic qualities, origin, peril
Origin: cites Vann (1976) Levine and McBurney (1977)
Vann - obesity explained for two reasons - gland disorder and just loving to eat, then participants shocked him
Levine and McBurney - individual judged more favorably for body odor when explained due to incurable metabolic imbalance
Just world hypothesis
Possibilities for destigmatization?
Major and O'Brien (2005)
"The Social Psychology of Stigma" (Annual Review of Psychology)
Stigma as described in lit: public stigma, structural stigma, self-stigma, felt or perceived stigma, experienced stigma, label avoidance
Attribution theory (Weiner) - social cognitive model, issue of Causal beliefs - assumptions of personal responsibility change perceptions of stigmatized trait
McGinty et al. (2015)
"Portraying mental illness and drug addiction as treatable health conditions: effects of a randomized experiment on stigma and discrimination" (Social Science & Medicine)
suggests that portraying something as treatable lessens stigma
Created vignettes portraying persons with untreated and symptomatic versus successfully treated and asymptomatic mental illness and drug addiction
"Portrayal of persons with successfully treated mental illness and drug addiction is a promising strategy for reducing stigma and discrimination toward persons with these conditions and improving public perceptions of treatment effectiveness."
Journal of Singing
"Health Promotion and Injury Prevention Education for Student Singers"
Refer to WHO "Health Promotion in Schools"/"Health Promotion in Schools of Music Project" begun in 2004
insists education about vocal health should help reduce risk of injury
Haddon Matrix - "based on an epidemiological model that emphasizes interactions across host (an individual who may sustain an injury), agent/vehicle of injury (the mechanism of energy transfer that results in physical injury), and environment (physical and sociocultural context in which an injury occurs) in injury genesis."
Schloneger and Manternach (2020)
"Technology Translated to Teaching: Exploring Vocal Dosimetry"
"Studies of university singing students have shown that these individuals may experience higher vocal doses and more voice disorders than other university students and the broader population
"Unable to say Hello from the Other Side"
For World Voice Day
Addresses stigma, which may "cause the singer to avoid seeking treatment, delaying diagnosis and management, and perhaps creating a less fixable situation."
Shares information about his own injury experience
Non-blaming language: "we all are put in circumstances at one point or another that can present great challenges for the voice."
"Medical Privacy and the Professional Singer: Injury Stigma, Disclosure, and Professional Ramifications on Broadway"
gap in protections in equity union
survey of 30 Broadway singers in 2015
Found harsh professional ramifications for vocal injury
Performer hesitation to disclose - using sick days for vocal issues
Gaskill Dosimetry (2013)
"Comparing the Vocal Dose of University Students from Vocal Performance, Music Education, and Music Theater"
can provide real-time measurement of actual phonation time, fundamental frequency, and vocal intensity
Ambulatory Phonation Monitor developed by KayPentax
cycle dose and distance dose - sensitive not only to pitch but also to loudness
"There have been occupational health standards suggested for the upper limit of tissue vibration in other parts of the body...it is clear both from theoretical calculations and vocal dosimetry data that the vocal folds routinely exceed the reported upper safety limit for tissue vibration"
"Ten Good Ways to Abuse Your Voice: A Singer's Guide to a Short Career"
List of "abuses" includes not warming up, not exercising, singing the wrong music, singing in noise, speaking in noise, teaching voice
Sataloff, Jaworek (2015)
"Medical Evaluation Prior to Voice Lessons"
Lack of clear statement in NATS Code of Ethics related to teacher as gatekeeper for otolaryngologists
No mention of stigma as barrier to care - instead cites lack of heath insurance, financial concerns, and "fear of the unknown"
Journal of Voice
"Health Information-seeking Behaviors Among Classically Trained Singers"
first study to consider how classically trained singers search for health information or access specialized voice care
50 male singers, 101 female singers, control group of 27 males and 22 females
Singers more than eight times more likely to make use of home remedies for vocal problems than controls
-Singers 12 times more likely to have encountered incomplete or incorrect info about voice-related issues than controls
Gilman et al. (2009)
"Performers' Attitudes Toward Seeking Health Care for Voice Issues: Understanding the Barriers"
n=78, randomly selected participants of professional CCM conference
10-item Linkert-based response questionnaire
39% do not seek medical attention for voice problem due to insurance coverage
"Knowledge, Experience, and Anxieties of Young Classical Signers in Training"
50 undergrads, 35 masters, 25 DMA/young artist (n=110) (drawn from Rice, Juilliard, HGO, Lindemann)
Found no statistically significant difference in test scores for vocal knowledge across three levels of training, mean scores just above 50%
All expressed interest in knowing more about anatomy, physiology, speech pathology, care of voice, voice disorders
Nearly 1/3 of singers had been diagnosed in the past with a vocal fold disorder - addresses stigma
Anxiety about visiting otolaryngologist increased with level of training
Broaddus-Larence et al. (2000)
"The Effects of Preventative Vocal Hygiene Education on the Vocal Hygiene Habits and Perceptual Vocal Characteristics of Training Singers"
11 adult singers with no more than 2 years of formal training
attended four 1 hour classes on vocal hygiene, anatomy, and physiology
"Results revealed minimal changes in vocal hygiene behaviors and perceptual voice changes."
Abuse language: "abuses" identified include verbal arguing, coughing, talking in noise, talking in smoke, throat clearing, coaching, waiting tables
Braun-Janzen and Zeine (2009)
"Singers' Interest and Knowledge Levels of Vocal Function and Dysfunction: Survey Findings"
129 singers, limited primarily to singers with exposure to classical training and rep
comparing professional and amateur singers knowledge regarding vocal function and dysfunction
Perceived knowledge levels higher for professional singers than amateurs, but substantial number in both groups reported limited or no knowledge in area of role of SLP and the voice
Other Voice Resources
Sataloff, Hawkshaw, Moore, and Rutt (2014)
Title: "50 Ways to Abuse Your Voice: A Singer's Guide to a Short Career"
Manual of Singing Voice Rehabilitation: A Practical Approach to Vocal Health and Wellness"
Tackles concept of "vocal abuse"
"This concept and terminology is not found in any other area of performing arts, in the world of athletics, or any other type of movement-related injury...By referring to traumatic vocal injuries as vocal abuse, an element of blame is introduced into the conversation. The term suggests that singers are responsible for causing their own injuries, creating a stigma that surrounds the whole issue. The singer is viewed as being at fault, and there is an implication that if he or she only had better technique or was otherwise more accomplished, the injury wouldn't have happened. The integrity of the singer's voice is called into question, and this may persist even after the physical injury has healed. This stigma is particularly notable in the classical singing realm and is so powerful and pervasive that many singers hide their injuries, use pseudonyms when seeking medical care, and never reveal the voice problem to the public, thus perpetuating the idea that 'good singers don't get voice injuries.' The stigma may also make singers reluctant to seek help when they are having voice problems for fear that they will be diagnosed with the dreaded nodules, labeled as a 'vocal abuser,' and be forever regarded as 'damaged goods.'"
Gillespie and Abbott (2010)
"The influence of clinical terminology on self-efficacy for voice" (Logopedics Phoniatrics Vocology)
Exposed teachers with voice problems to terms 'abuse/misuse' or 'phonotrauma/muscle tension' to describe origin of common voice problems
Factors that can impact adherence to treatment protocol: patient perception of disease severity, patient-clinician rapport, cultural norms, family support, patient perception of treatment efficacy, self-efficacy
This study measures self-efficacy: "state (behavior or situation) rather than trait (personality)-specific"
Voice therapy dropout rates estimated at one urban center as high as 65%
post-exposures, completed Voice Self-Efficacy Questionnaire designed for study
"Results provide preliminary support for the hypothesis that clinical exposure to 'abuse/misuse' terminology may harm normal increases in self-efficacy for voice that are generally expected following education about medical conditions."
Does greater knowledge of vocal anatomy and physiology correlate with reduced stigmatization of vocal injury?
Does a previous personal experience of vocal injury effect stigmatization? To what extent is "self-stigma" internalized following an injury?
Does level of injury stigmatization vary across singing style (classical vs. jazz vs. CI)?
Does internalization of the Protestant ethic and just world hypothesis correlate with increased stigmatization of vocal injury (victim blaming)?