The Invisible Burden: Psychological Strain and Mental Health Among Musicians
- Dr. Teresa Wenhart
- Nov 18
- 12 min read
Musicians often face substantial pressure: stage fright, the expectation to perform perfectly, and questions about one's identity beyond the instrument. Building on the Vulnerability-Stress Model, I examine biological, psychological, and social factors that foster strain — such as perfectionism, financial insecurity, irregular working hours, and stressful life experiences. I sketch typical patterns of burden and show their effects on performances, relationships, and careers. I also present the prevalence of mental health burdens in the music scene and reference relevant scientific studies. Finally, I offer practical, actionable support and explain which psychological insights we can learn from Harry Potter.
Why is this important? - Consequences of psychological distress
Psychological distress can have far-reaching consequences for the lives and careers of musicians. It affects not only creativity and performance capability but also overall well-being and life satisfaction. In line with the Vulnerability-Stress Model (Lazarus & Folkman, 1994; Folkman et al., 1986), both musculoskeletal complaints (pain, overuse, etc.) and the feared neurological movement disorder “Musician's Dystonia” have been linked, among other things, to psychological factors such as perfectionism, anxiety, and psychosocial stress, as well as to traumatic childhood experiences (Ioannou & Altenmüller, 2014; Schneider et al., 2021; Alpheis et al., 2023; Wenhart & Hildebrandt, 2025), as well as to emotional abuse and bullying by teachers or colleagues (Wenhart & Hildebrandt, 2025; Ramstedt et al., 2023; Özevin, 2022; Elpus et al., 2016).
The Invisible Burden: Bio-Psycho-Social Risk Factors
Overarching factors for psychological distress are often an imbalance between demands and available coping resources, as well as professional and private stressors (Wenhart & Hildebrandt, 2025; Kenny et al., 2014; Middlestadt & Fishbein, 1988; Musgrave, 2023; Cardoso et al., 2025).
In my work as a psychologist for musicians, I repeatedly encounter similar psychological, social, and biological factors that contribute to the development of burdens such as performance anxiety, identity crises, mental health disorders, or social difficulties:
Professional insecurity and financial instability: Many musicians work as freelancers, or part-time in several jobs, and have no fixed income. Financial insecurity leads to chronic stress that can adversely affect mental health in the long term (Vervainioti et al., 2015; Cardoso et al., 2025). The COVID-19 pandemic has worsened the situation, as many musicians faced financial and emotional challenges due to canceled concerts and events (unpublished own research, University of Zurich, https://www.nzz.ch/zuerich/corona-an-der-universitaet-zuerich-werden-die-folgen-erforscht-ld.1584935).
Irregular and long working hours: Unpredictable working hours, short-notice or postponed rehearsals or changing deployment days, additional on-call shifts, and long tours often lead to an imbalance between work and private life and an irregular sleep rhythm. This can lead to physical and mental exhaustion (Middlestadt & Fishbein, 1988) as well as sleep disturbances (Vaag et al., 2016).
Difficulties in family and partnership: The high time pressure and situational demands during important concert phases create social strain, particularly in partnerships and families due to the lack of predictability or compatibility of multiple calendars and emotional dysregulation in stressful phases.
In my practice I usually see one of three variants or a combination of them:
Musician couples or other partnerships without children live as musicians with their own engagements largely side by side, occasionally performing together.
Couples with children try to organize their “chaotic” life circumstances (depending on the other’s profession) in which their own needs are strongly subordinated to the system and/or planned or negotiated anew daily under immense mental effort, or
One partner is clearly behind in their career or gives it up altogether. The latter occurs most often when both partners are musicians. In a heterosexual partnership, this is unfortunately more common for women than in other professions.
Hierarchical structures and pressure in orchestras: Many musicians report hierarchical structures with little autonomy, high competition, authoritarian leaders (section leaders, conductors, etc.), and condescending remarks from colleagues as stressors (Wenhart & Hildebrandt, 2025; Middlestadt & Fishbein, 1988).
High expectations, perfectionism & excessive demands: Musicians are under constant pressure to perform at the highest level and in constant competition with one another. Many talented musicians learn these values from early childhood. This not only fosters anxiety (Alpheis et al., 2024; Wenhart & Hildebrandt, 2025) but also compulsive practicing behavior with the risk of developing focal dystonia ("Musician's Dystonia") (Alpheis et al., 2022; Passarotto et al., 2023).
Isolation and social alienation: Many musicians suffer from social isolation and loneliness (Wenhart & Hildebrandt, 2025; Iorwerth & Knox, 2019; Cardoso et al., 2025). Despite working in a creative and social environment, musicians can often feel isolated. Earlier in childhood and adolescence, important social development phases for many musicians were missed due to absences from school or prolonged practice at the expense of leisure activities with peers. In adulthood, the constant switching between tours and various projects makes it difficult to build stable social relationships.
See also: Schemata in Musicians: Reflecting Psychological Patterns and Strengthening Self-Competence
Predisposition to high sensitivity and neurodivergence (ADHD, autistic traits): In my work as a psychologist for musicians I observe that neurodivergent traits, such as autistic traits, ADHD, and features described in the concept of high sensitivity, occur quite frequently among musicians. While the prevalence of ADHD and high sensitivity and their consequences among musicians, to my knowledge, has not yet been studied, there are indications of more autistic traits and neurophysiological differences in a subgroup of musicians (Wenhart, Bethlehem, Baron-Cohen & Altenmüller, 2019).
Physical or psychological violence in the parental home: Physical and psychological violence in the parental home is a risk factor for the development of musician disorders such as musician's dystonia (Schneider et al., 2021; Alpheis et al., 2023) or psychological distress (Wenhart & Hildebrandt, 2025). These experiences unfortunately often strongly shape how individuals perceive the world and other people today, as well as their resilience on stage and in social situations by reactivating difficult memories.
See also: Schemata in Musicians: Reflecting Psychological Patterns and Strengthening Self-Competence
Emotional violence and bullying by teachers or colleagues: Unfortunately, music students or musicians repeatedly report experiences with teachers that point to non-pedagogical remarks or even emotionally intrusive behavior and bullying (Wenhart & Hildebrandt, 2025; Ramstedt et al., 2023; Özevin, 2022; Elpus et al., 2016). These experiences, even if they occur later in life, shape one’s self-concept and the inner dialogue during practice and on stage.
See also: The Greatest Hits of Inner Critics in Musicians – and How to Quiet Them, and: Schemata in Musicians: Reflecting Psychological Patterns and Strengthening Self- Competence
Common topics in my counseling for musicians
(Note: The order of the listed topics does not necessarily reflect their frequency.)
Stage fright and performance anxiety
Panic attacks and nervous breakdowns
Loneliness, social isolation
Identity crises (What do I want? Who am I besides the instrument?)
Entanglement with or detachment from the parental home and loyalty conflicts
Reactivation of old memories and stage experiences under stress
Difficulties in sensing, describing, or expressing one’s own emotions
Emotion regulation & self-care
Dealing with personal expectations & self-doubt
Dealing with inner critics & negative self-talk
Psychological and physical violence in the parental home or by a teacher
Feelings of shame and guilt regarding unattained career goals
Psychosomatics
Difficulties in communication and interaction with teachers, colleagues, and conductors
Bullying
Distrust in social relationships
Resignation from the profession as a musician and the music world
Techniques of social communication & interaction
Improving empathy and perspective-taking
Difficulties in self-organization
Women Musicians' Health
With female clients, additional issues often arise that are not addressed by, or are only marginally addressed by, institutional offerings. These include, for example, cycle-related resilience to stress, emotional regulation, and performance anxiety, as well as specific experiences of sexist behavior by instructors (Wenhart & Hildebrandt, 2025; Ramstedt et al., 2023) or by musical authorities ("you play like a schoolgirl," or inappropriate comments about movements at the instrument). Also topics include perceived disadvantages in orchestral auditions or lack of visibility in the freelance music scene due to gender.
Prevalence of Mental Health Problems Among Musicians
Research findings show that musicians are more frequently affected by mental health issues than the general population. In particular, soloists, section principals, and internationally touring musicians show the highest risk for mental health problems (Loveday & Musgrave, 2023; Newman et al., 2022).
Anxiety disorders and depression
Kenny et al. (2014) found among Australian professional orchestral musicians a high prevalence of affective disorders, including social phobia (33%), post-traumatic stress disorder (PTSD) (22%), and depression (32%). Research by Vaag, Bjørngaard, and Bjerkeset yielded prevalence rates of 20.1% for depressive symptoms and 14.7% for anxiety symptoms (Vaag et al., 2016). A study by Westminster University and Help Musicians UK found that 71.1% of musicians suffer from anxiety, while 68.5% are affected by depression (Gross & Musgrave, 2016). These figures are alarmingly high compared with the general population, where about 20% have a similar diagnosis (Wittchen & Jacobi, 2005).
Burnout
A survey by the German Orchestra Association (DOV) in 2020 showed that almost half of the surveyed orchestra musicians reported symptoms of burnout (DOV, 2020).
Substance use
Many musicians drink regularly and in excess, not infrequently before rehearsals or concerts. A further factor is the use of prescription sedatives and beta-blockers (Vaag et al., 2016). Both medications are frequently passed around among colleagues without medical consultation, risking health hazards from unsupervised use.
Other mental health conditions
In addition to these common disorders, newer studies indicate that musicians also have an increased risk of obsessive-compulsive symptoms and personality disorders (Kaufman et al., 2018). These difficulties can be amplified by rigid self-discipline, perfectionism, and dependence on external validation and evaluation by others, which are typical in the music industry.
Counseling and Prevention Strategies
Given the alarming situation, there is growing interest in targeted intervention measures tailored to the specific needs of musicians.
Psychological coaching: goes beyond mental training and coaching by non-psychologists and is simultaneously more specific than traditional psychotherapy, which is bound to psychiatric diagnoses and disorder-specific treatment plans. In a confidential setting (duty of confidentiality), musicians learn to strengthen their mental resources, build resilience, develop their personality, and achieve their professional goals despite high stress and biographical difficulties. It fosters a better understanding of one’s own psyche and offers strategies for coping with stress, perfectionism, and social challenges.
Mental training & sport psychology: Many counseling offerings and mental training workshops draw on approaches from sport psychology and performance coaching. They often speak of a "performance mindset" and teach cognitive and physical strategies for handling performance situations and for effective practice with and without the instrument.
Psychological workshops for students and teachers: Psychoeducation, exchange, and experiential learning with other students in groups; workshops for the psychological education and experiential learning of teachers (e.g., Wenhart, 2024).
Mindfulness and stress management: Training in mindfulness, meditation, and other stress management techniques has proven effective in strengthening mental resilience.
Specialized counseling services: Organizations such as Help Musicians UK offer targeted support for musicians, including crisis intervention and long-term care.
Peer-support networks: Interacting with other musicians who have had similar experiences can be a valuable resource. Platforms and networks that offer peer support help overcome isolation.
Awareness campaigns: Initiatives that inform musicians about mental health and reduce stigma are crucial to enable musicians to talk openly about their problems and to promote early interventions. Many student organizations at music conservatories have launched awareness events in recent years.
Take Home & Conclusion
In J.K. Rowling’s well-known Harry Potter series, in the later books where Harry and his friends have grown into teenagers and then adults, they confront the Dark Lord Voldemort. They also insist on speaking the name of the Dark Lord aloud. Previously, adults had modeled that one should only refer to him as “the one who must not be named.”
With psychological burdens and individually difficult life experiences or mental patterns (schemas), it is similar: they lose their power when we give them a name, when we label them. What we cannot name, in the truest sense, is not tangible and thus not controllable. Unlike Voldemort, the aim in psychological counseling and in research on these topics is not to determine who is to blame, but at most which circumstances led to the situations. Taking responsibility for one’s own behavior, accepting situations and experiences that happened in the past or lie beyond our control, integrating them into ourselves, and making the world a little better each day, is the task of every musician and every other person.
Here, a figure from Harry Potter helps as well: the Mirror of Erised (Desire spelled backward). Looking into that mirror shows not only our greatest wishes, often unattainable dreams. For example, Harry sees how he would meet his deceased parents. Even if one can do much for certain dreams, such as a specific career goal, it is not entirely within our power to achieve it. Therefore, we must not lose ourselves in our dreams. For this reason, the headmaster ultimately moves the mirror to another place, so that Harry and his friends can engage more with reality and with what they actually have: their resources, achievements, personal strengths and weaknesses, and their social connections—friendships and family.
Sources:
Own Research:
Wenhart, T. (2024, February 25). Mental Stark, Psychisch Gesund - Konzeption von Schema-Workshops für Musiker:innen und Musiklehrkräfte. (Conference Poster) 22. Symposium der Deutschen Gesellschaft für Musikphysiologie und Musikermedizin
Wenhart, T. & Hildebrandt, H. (2025). Music Students' Psychological Profiles: Unveiling Three Coping Clusters Using Schema Mode Inventory. (submitted, in review)
Wenhart, T., Bethlehem, R. A., Baron-Cohen, S., & Altenmueller, E. (2019). Autistic traits, resting-state connectivity, and absolute pitch in professional musicians: shared and distinct neural features. Molecular autism, 10(1), 20.
https://www.nzz.ch/zuerich/corona-an-der-universitaet-zuerich-werden-die-folgen-erforscht-ld.1584935
Research of Others
DOV (Deutsche Orchestervereinigung). (2020). Umfrage zur psychischen Gesundheit von Orchestermusikern.
Alpheis, S., Altenmüller, E., & Scholz, D. S. (2023). Focal Dystonia and the stress network: The role of stress vulnerability and adverse childhood experiences in the development of musician’s dystonia. In Basic and translational applications of the network theory for Dystonia (pp. 23-44). Cham: Springer International Publishing.
Alpheis, S., & Altenmüller, E. (2024). Comparison of Perfectionism Between Music and Medical Students and its Association with Anxiety. Medical Problems of Performing Artists, 39(2), 82-92.
Alpheis, S., & Altenmüller, E. (2022). Influence of adverse childhood experiences and perfectionism on musician’s dystonia: a case control study. Tremor and Other Hyperkinetic Movements, 12, 8.
Cardoso, M., Leonido, L., Pereira, A., & Morgado, E. (2025). Mental health challenges in professional musicians: A systematic review of stress, anxiety, and depression. International Journal of Innovative Research and Scientific Studies, 8(2), 3611-3621.
Elpus, K., & Carter, B. A. (2016). Bullying victimization among music ensemble and theatre students in the United States. Journal of Research in Music Education, 64(3), 322-343.
Gross, S. A., & Musgrave, G. (2016). Can music make you sick? Music and depression. University of Westminster.
Ioannou, C. I., & Altenmüller, E. (2014). Psychological characteristics in musician׳ s dystonia: a new diagnostic classification. Neuropsychologia, 61, 80-88.
Iorwerth, M. A., & Knox, D. (2019, December). The application of networked music performance to access ensemble activity for socially isolated musicians. In Proceedings of the web audio conference 2019–diversity in web audio.
Kaufman, S. B., Bromley, M. L., & Korn, E. (2018). The Dark Side of Creativity: Original Thinkers Can Be More Dishonest. Academy of Management Journal, 61(5), 1802-1825.
Kenny, D., Driscoll, T., & Ackermann, B. (2014). Psychological well-being in professional orchestral musicians in Australia: A descriptive population study. Psychology of Music
Lazarus, R. S. (1984). Stress, appraisal, and coping (Vol. 445). Springer.
Folkman S, Lazarus RS, Gruen RJ, DeLongis A. Appraisal, coping, health status, and psychological symptoms. J Pers Soc Psychol. 1986;50(3):571.
Loveday, C., Musgrave, G., & Gross, S. A. (2023). Predicting anxiety, depression, and wellbeing in professional and nonprofessional musicians. Psychology of Music, 51(2), 508-522.
Musgrave, G. (2023). Musicians, their relationships, and their wellbeing: Creative labour, relational work. Poetics, 96, 101762.
Middlestadt, S. E., & Fishbein, M. (1988). Health and occupational correlates of perceived occupational stress in symphony orchestra musicians. Journal of occupational medicine, 687-692.
Newman, C., George, R. P., Beitz, T., Bergson, Z., & Zemon, V. (2022). Mental health issues among international touring professionals in the music industry. Journal of psychiatric research, 145, 243-249.
Özevin, B. (2022). Music Class and Abuse. Athens Journal of Education, 9(4), 575-591.
Passarotto, E., Doll-Lee, J., Altenmüller, E., & Lee, A. (2023). Practice behaviors as trigger factor for the onset of Musicians’ Dystonia. Journal of Neural Transmission, 130(12), 1561-1569.
Ramstedt, A. M. (2023). Emotional abuse in classical music education in Finland: A study of Finnish women musicians’ experiences. Action, Criticism & Theory for Music Education, 22(3), 198-226.
Raeburn, S. D. (1987). Occupational stress and coping in a sample of professional rock musicians (second of two parts). Medical Problems of Performing Artists, 2(3), 77-82.
Schneider, J., Scholz, D. S., & Altenmüller, E. (2021). Impact of psychic traumatization on the development of musicians’ dystonia: six exploratory case studies. Medical Problems of Performing Artists, 36(1), 1-9.
Vervainioti, A., & Alexopoulos, E. C. (2015). Job-related stressors of classical instrumental musicians: a systematic qualitative review. Medical problems of performing artists, 30(4), 197-202.
Vaag, J., Bjørngaard, J. H., & Bjerkeset, O. (2016). Symptoms of anxiety and depression among Norwegian musicians compared to the general workforce. Psychology of music, 44(2), 234-248.
Vaag, J., Bjørngaard, J. H., & Bjerkeset, O. (2016). Use of psychotherapy and psychotropic medication among Norwegian musicians compared to the general workforce. Psychology of Music, 44(6), 1439-1453.
Vaag, J., Saksvik-Lehouillier, I., Bjørngaard, J. H., & Bjerkeset, O. (2016). Sleep difficulties and insomnia symptoms in Norwegian musicians compared to the general population and workforce. Behavioral sleep medicine, 14(3), 325-342.
Wittchen, H. U., & Jacobi, F. (2005). Size and burden of mental disorders in Europe—a critical review and appraisal of 27 studies. European Neuropsychopharmacology, 15(4), 357-376.
