Performance anxiety - a diagnosis?

Edited: September 8, 2022, 3:27 PM · The extended and controversial discussion thread on performance anxiety has, to me, raised a significant issue, that of the definition of "diagnosis."

My late colleague (Dr. Harvey Mandel) and I wrote a book - "The Psychology of Underachievement" (1988, Wiley, currently out of print). One chapter has our theory of diagnosis, which I think is relevant here. It it spelled out in more detail in our book, but here goes....

We posited 4 separate mental operations in making any diagnostic judgment for the purpose of treatment (medical, psychological, or anything else). Experienced professionals typically make these 4 mental steps in a matter of seconds, but they do represent 4 different ways of thinking.

1. Observational Diagnosis: This is what we can all agree on, because we all observe, hear, read, and otherwise experience the same things. In this case, it is the observation and experience of anxiety when performing, which is something we all seem to experience and describe pretty much the same way.

2. Dynamic Diagnosis: This is the assumed underlying cause (be it physical, behavioral, assumed, or whatever). This is NOT actually observed, but is the assumed "underlying cause" that we believe is the reality. It typically is not "proven" in any individual case, but is assumed. And it is where we typically have disagreements, because everyone assumes a different underlying theoretical cause of the problem.

3. Treatment Diagnosis: This is prescribed not by the observational problem, but by the assumed underlying cause. Therefore, it is another place for potential and actual disagreement. If Dynamic Diagnosis "A" is assumed, then treatment "X" is appropriate. If Dynamic Diagnosis "B" is assumed, then treatment "Y" is appropriate.

4. Practical Diagnosis: This diagnosis is where we modify the diagnosis and treatment based on the uniqueness of the individual, his or her history, the particulars of the situation, and so forth.

It is no surprise to me that the performance anxiety discussion thread resulted in such heated debate and differences of opinion. I would hope that taking a step back (and using the refined logic that I believe professional musicians develop) will help resolve significant issues such as performance anxiety.

Replies (2)

September 7, 2022, 3:30 PM · How did you manage to lose the thread title?
September 8, 2022, 3:27 PM · Gordon:
I don't know. I put this thread up yesterday, but I got a message that it was too soon after another one, but it's nice to see it up at last.

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