31. Allowing Imperfection with Bonnie Robson, MD

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00:00:00 

Jen Milner 

Hello, and welcome to bendy bodies with the Hypermobility MD, where we explore the intersection of health  and hypermobility for dancers and other artistic athletes. This is Jennifer Milner here with co-host Dr. Linda  Bluestein. Before we introduce today's guest, we'd like to first remind you about how you can help us help you  first subscribe to the bendy bodies podcast and leave us a review. This is helpful for raising awareness about  hypermobility and associated disorders. Second, share the bendy bodies podcast with your friends, family, and  providers. We really appreciate you helping us grow our audience in order to make a meaningful difference.  This podcast is for you today. We are so fortunate to be chatting with psychiatrists and performing arts medicine  specialists, Dr. Bonnie Robson. Bonnie has served as a consultant to numerous ballet schools and companies as  performed original arts related research. As a popular invited speaker at national and international conferences  across the globe, her mindfulness approach to performance and psychological skills training programs have been  included in the curriculum of numerous universities and post-graduate arts programs.  

00:01:08 

Jen Milner 

In addition to serving on the editorial board for the journal medical problems of performing artists, Bonnie has served on numerous committees and boards, including the Pamela board of directors, the I Adam's education  committee, healthy dancer, Canada membership committee, and the dance USA task force on dancer health.  Bonnie has received numerous awards for her contribution to arts education, including a lifetime achievement  and the bill Dawson award. We spoke with Bonnie previously on what has been our most played episode to  date, episode 10, Cultivating Psychological Skills. Today we are speaking with Bonnie about perfectionism.  

00:02:00 

Jen Milner 

Hello, Bonnie, and welcome to bendy bodies.  

00:02:03 

Bonnie Robson 

Thank you so much. I'm really pleased to be here. We're thrilled to get to talk to you.  

00:02:08 

Jen Milner 

Yes. So Bonnie, let's start with some definitions. What is perfectionism? Is it a personality trait? Is it a  psychological attitude? What are we talking about?  

00:02:20 

Bonnie Robson 

Yeah, perfectionism is what we're going to address today and hopefully leave with a better understanding. It can  be described as a pursuit of excellence or the search for perfection itself. Dancers tend to be perfectionistic. So  that's why we're talking about it. Do individuals who have perfectionistic traits, select dance training because of  its exacting standards, or do people who study dance learn to set higher and higher goals for themselves or  demand more of themselves? Another way we think of is learning to be self critical often employing self-talk,  and then there's the multi-dimensional model. That can be a combination of three types of perfectionism and it's,  the self-oriented perfectionism, the other oriented and the socially prescribed. That's a lot of confusion, but the,  about the self oriented one, it's the classic one where you, and they're going to get it right. And you make  excessive demands on yourself.  

00:03:33 

Bonnie Robson 

The other oriented, the dancer set standards for those around her. This is interesting. She says they are doing  well enough. That teacher should be clearer. She's not counting, right. How can I possibly meet the standards  when others are not meeting them and the socially prescribed in which the dancer experiences intense pressure  from all those around her to live up to their ideals? I couldn't face my mother if I don't do well. The dancer  believes that those other people hold those, ideals and tries to live up to them.  

00:04:13 

Jen Milner 

I've never heard it broken down into three different, descriptions like that self and then the people around them,  and then trying to live up to other expectations. But that's such a clear image. I know that people with  hypermobility and hyper-mobility disorders tend to suffer. We have higher numbers of, anxiety and  perfectionism and OCD, which is why Linda and I wanted to have this conversation. We are so grateful that you  are having this conversation with us. Because that describes, me at various stages of my life, all three of those  described me at various stages of my life. I think that's something that a lot of people can relate to, but  especially, it seems not just me as a person, but as a dancer. It seems like dancers are definitely tend towards  perfectionism, whether it's perfectionist gravitate towards dance or dance makes us into perfectionism. It's hard  to know which one it is there, or which one came first.  

00:05:12 

Jen Milner 

Are there any gender differences or is it, do you see perfectionism more in men than in women or women than  men? Or is it kind of equal?  

00:05:21 

Bonnie Robson 

Yes, there's that, and I just want to pick up on your idea that, perfectionism in dance, we're going to explore  more of that. You talked about anxiety, think about perfectionism and think how closely linked they are to anxiety. We'll explore that duality and you're right. Female dancers are more perfectionistic than males. More  than other artists, both students and professionals, except for perhaps some musicians who are very in their  individual, pursuit of excellence. Female dancers are even more perfectionistic than athletes, who I think of  gymnast who have to do those turns. So yes, there is a gender difference.  

00:06:14 

Linda Bluestein 

Interesting. I wonder what attracts us to dance. Cause Jen, I was thinking the same thing that, yeah, that can  describe me, as a dancer being drawn to dance because of those exacting standards. That may be making us  expressing that trait even more in that environment. Chicken and egg, but then also like, causing it to be even  more exaggerated because of the environment that we're in.  

00:06:38 

Jen Milner 

That's interesting, there's also something very comforting about those boundaries and about those impossibly  high standards. At least there was for me as a dancer to say, Oh my gosh, I'm going to have to try to achieve this  and this. It was almost comforting just to be able to see that and to know I've got this uphill climb, but I see what  I see those expectations so clearly laid out. While we understand that a lot of times it's negative, there was some  comfort to that for me as well to have that there.  

00:07:10 

Bonnie Robson 

Definitely. And, and about anxiety, I heard one teacher say, you always, and you feel good. You always come  back to the studio, it's safe in the studio. That's where you get the comfort, what the next many movement  practices do not have a predictable pattern to the class, but ballet has a predictable pattern, what's coming next  usually. And, that's comforting.  

00:07:40 

Linda Bluestein 

That's interesting. The routine, you always start with, plies and tendus left hand on the bar and yeah, as you're  saying that, I feel like I'm going back to my childhood and I can picture that comfort of returning to home. I  mean, it was really a second home for me. So that's really interesting. The perfectionism trait can be negative of  course, but is it ever a good thing? Is there anything wrong with setting high standards or trying for, the perfect  Arabesque, for example. 

00:08:09 

Bonnie Robson 

As with many things, a little can be a great thing. For example, I was thinking of music on the radio and you  hear a song, Oh, that's the one I like, and you turn the volume up on it feels good and I'm going down the road.  Oh, I'll have some more and I'm really enjoying it now. And then I'll turn it up. Just like, Ooh, that's unpleasant.  More, really uncomfortable, turning it up even more. The ENT specialists tell us, you're going to have tinnitus  and you risk deafness. Certainly the musicians have to be very aware of that. They, that they don't suffer an  early, deafness because of high volume. That happens in dance with perfectionism as well. That's just an  illustration, but you think of an inverted U or a little mountain here. As you start out in dance, you're using the U  principle or the Dobson principle.  

00:09:12 

Bonnie Robson 

We sometimes think, and you're seeking high standards. You said, you get focused and you get concentrating  and you try and do better and you actually feel better and it's progressing and it's better and better until you do  that. Perfect of what you are so pleased. I can try just a little harder. I'll just throw a little more energy into it and  what happens long. You increase to the peak performance and after that there's deterioration and fall off in the  performance.  

00:09:46 

Linda Bluestein 

That's very interesting. There such a thing as good perfectionism then or bad perfectionism and how can we tell  the difference between the two? 

00:09:56 

Bonnie Robson 

So you're absolutely right. There's good perfectionism and we, and those of us in psychology, like to talk about  it as positive normal facilitating, the dancer just as you've described, has pleasure in going to the studio and  trying to maybe today is the day I'll get my splits. I've waited, I've worked at it. The goal of having a tray  encourages a dancer to be organized on time, warmed up and focusing teachers love that. So, but there's also  negative perfectionism as you expected. We call that neurotic, debilitating or maladaptive. It's an all or none  attitude either you're perfect or you're not. The PR person tends to devalue their accomplishment, and focus on  what they have yet to achieve rather than see I'm approaching, getting a perfect PIRO and I'm approach it so  much better. I'm not falling over. I'm actually balancing this is great. Oh, I didn't make it yet.  

00:11:05 

Bonnie Robson 

I'm such a slob. When am I going to get this? Everybody else has got it. Or they have an, I should syndrome. I  should do better. I should have been less tense. I should have been brighter on. I bet you've got some examples  of the, I should person. Can you think of somebody that this has affected negative?  

00:11:29 

Jen Milner 

Absolutely. I was just thinking about that. When I work with dancers, a lot of the times you see them deal with  the shoulds rather than the accomplishments. And, and for me, it's, this is definitely not, like the medical  definition of it, but for me, it's whether or not your perfectionism is personal or, a clinical tool that you use, like  you described, you can have that perfectionism that brings you up to this point, and then you're, it's not personal,  so you can step away from it. Just yesterday, actually I was working with a lovely dancer. Who's at a quite high  level and she was working on some famous pirouettes from the black Swan, variation. It's quite complex going  into the second piece of the pirouettes. She and I were working on it together. She said, I can't get it. I have this  and this. We worked on it together and she got to this point where it was almost quite there.  

00:12:25 

Jen Milner 

We did it again and she did it again and it was beautiful and she just sailed through it and the look of satisfaction  on her face. I said, do you want to do it again? She goes, no, I'm good. And I was like, look at that. It was such a  healthy way. She didn't get frustrated. She didn't get angry when she was working through it. She just tried it  again and she fixed something else. That's, to me is that impersonal perfectionism that you, she could use that as  a tool and then set it aside and for so many dancers that sense of I didn't get it and I'm getting frustrated and I  should do it again until I do get it. And I, it does get perfect. Of course the more that you try to do it, the more  that you push yourself and don't look at your own personal warning signs that you're getting frustrated,  impatient, that you're starting to throw yourself through it, that you're not being careful, physically, it's become  personal and you can't stop until you feel like you've achieved it.  

00:13:21 

Jen Milner 

Even if they achieve that, they say, I should do it again. Right. Or, a whole different I should is I'm exhausted,  but I should go run my variation because everybody says, you should run it three times a day. That you're strong  enough for whatever competition is happening. Right. You should run it three times in a row. So I should do  this. They feel like they're less than, and it gets to the point where they're not even less than as a dancer, but  they're less than as a person, to themselves. And, and I think that's what you're talking about. Yes.  

00:13:53 

Bonnie Robson 

Yeah. Yeah. Thanks. That's that, it's you go on to say it's so the, I should leads to I'm guilty. I didn't do enough. I  should've done three. I only did two. I let the team down, I'm ashamed. I have trouble making decisions. It's a  negative self-talk or troubling thoughts that are there. I liked, you said they make it personal rather than, that's so  important. We must think about that. These negative thoughts that sneak in and when you're not run out, paying  attention, they can be relieved by mindfulness practice and training. I have to say that mindfulness training,  takes everybody's talking about it, but it takes a long time to learn it. It's another move thought process,  movement thing. It isn't something you can learn overnight. It requires, and it requires group sessions. I, propose  for now a faster temporary solution. It's not that you needed a long-term solution, but let's use thoughts stopping  for these nasty thoughts. 

00:15:13 

Bonnie Robson 

A technique, to get rid of the thoughts is recognize you've got them. Ooh. To wash it out, even using a gesture  like this can help toss it away, have a little shower, whole mini shower, yell out loud. I love being in my car  when the thoughts come, because then I can say really loud and nobody can hear me. The negative thoughts are  gone and that's great, but I've got this space left. If I don't feel it up, the other negative thoughts will come jump  in. Oh, look, space, boom. And, so I need to fill this up with positive thoughts right away. This is a hard skill to  learn, takes practice, to take the negative thought and turn it into a positive, Oh, look, I haven't got that routine  yet. Well, just a minute. If I take it and break it down more, I need to break it down even more.  

00:16:21 

Bonnie Robson 

Maybe I can spend some time. I have some time tonight. Because none of us ever have any time and dancers  have no time at all. Their, their agendas are crushed over and, calendars or things on top of things. If I spend  some time tonight or I focused on how my teacher has been helping me and follow what she's been saying, to do  well, she's rooting for me. I might even write that on a card like this kind of a card and put it up on my mirror.  My teacher is rooting for me. She believes I can do this. Or she wouldn't have asked me on a variation that card  on your mirror can help build self-confidence. She believes in me, she knows I can do it. I could do it. A further  difference has been added by Shannon Norton Bates. In terms of the position, the natives, they talk about  performance, strivings and performance concerns.  

00:17:23 

Bonnie Robson 

Strivings are the pursuit of high standards that we've noticed concerns, worry about performance, fears and  evaluation. You're always thinking, feeling that little camera up here watching you. Oh, look, she did it wrong  again. Oh, look she isn't. She isn't standing at all. Look, her shoulders are hunched. Oh look, it's an observing  ego, but it's a negative one and it reacts a lot to imperfections.  

00:17:56 

Jen Milner 

What struck me about what you said just the, at the beginning of this topic, about being in your car and being  able to say things loudly to combat those negative thoughts. I know this sounds crazy, but a lot of dancers,  especially in the pre-professional and in the younger age, don't realize that they have thoughts. They don't hear  that they're not comfortable or used to hearing their own voices. We as dancers, we feel voiceless, right? We not  supposed to speak up in class. You're not supposed to argue with your director. We don't have that voice. Some  of it is just becoming comfortable with figuring out what you personally are thinking. When you hear those  voices in your head, is that what you think or is that what your director has said or is that what your parents have  said and learning to recognize are those negative thoughts? My negative thoughts, or is that really what I think  and learning to just hear your own voice? It can be revolutionary.  

00:18:59 

Linda Bluestein 

I think that's so true. I remember I was definitely well into adulthood when I realized I am not my thoughts. Like  I can think something, but that doesn't mean that's what I believe. It is kind of an interesting thing that we're not  taught as we're growing up. I'm really glad that you pointed that out, Jen, because right. We can, we can think of  

a very bad thought for example, but that doesn't mean that we believe it to be true or that we actually want that  it's we can separate ourselves from that. So that's super interesting. Bonnie, can you talk more about the  variables that steer a dancer into either adaptive or maladaptive perfection on what the differences are, what we  should be looking for and what the factors are outside the dancer that can affect how they, choose to strive for  success?  

00:19:49 

Bonnie Robson 

Well, Linda, you have already alluded to this. The first variable that differentiates between good and bad  perfectionism is the dance culture itself. The culture demands an ideal body. The culture demands flexibility,  and those are view out there in the bendy bodies group know about this. It demands turnout. Now it's not so  much now, but answers, work to achieve a certain body and aesthetic stamina strength. Gradually this culture is  easing up these standards, but they there's no doubt they were their dance education employs self scrutiny. Just  what you're saying. I have to think of my thoughts. I have to think of this. I have to think what I'm doing. Since the millennium, there's been attention to the motivational climate in dance education, which is wonderful, and  we're all rooting for that. It's and it has had a significant impact on how much perfectionism we're seeing further  it isn't.  

00:20:59 

Bonnie Robson 

It's known that the social environment where mistakes are noted, and outstanding performances valued that sets  the stage for negative perfectionism and the linked anxiety. I talked about anxiety but performance. So they're  very closely aligned there. It's the culture, Jen, what do you think?  

00:21:25 

Jen Milner 

Well, I think yes, to all of that, of course. I was saying something to Linda earlier in a text conversation about,  the culture, just looking back even to when dance was so supremely glorified, and thinking about every little girl  wanted to watch the red shoes and wanted to be in the red shoes and wanted to be the woman in the red shoes,  which is kind of sick. Now you think about that because she is in an abusive relationship, both personally and  professionally with the director of the ballet company. She literally dances herself to death to please him. Right.  Yet were all like, Oh, that's amazing. She's so lucky, dedicated. Right. Just even moving forward, Linda, you  had mentioned, center stage, the movie center stage, which aimed to take a healthier look at it and to kind of try  to shine a little light into it.  

00:22:23 

Jen Milner 

I thought that black Swan, the movie with Natalie Portman did a good job of showing some of the reality of it,  but also that the reality of it is not healthy, right. That they were saying, Hey, this is not healthy. This is not  normal. They weren't trying to glorify it. At least they weren't trying to glorify where she was emotionally and  mentally. But just so much of our culture. Many of the TV shows the reality TV shows with the follow different  studios. Even if they don't intend to, kids sit down and watch that. They see if you're watching a TV show about  a big dance studio and they're consistently casting the kids who have the most flexibility or who are the most  assertive and dominant in the dressing room or, who stay after every day and come early every day, even when  they shouldn't, when they should be going home and resting, who pushed through the pain.  

00:23:20 

Jen Milner 

If those are the ones that are getting cast the most and getting all the plum roles and getting pushed up front,  then the little girls and boys who were watching those TV shows at home were going to go, Oh, that's what I  have to do. That's, that's what I should be doing. Even if their own studio isn't like that their own studio could be  lovely, but they see so much of it in that culture. They see so much of it on social media that it's really hard to  avoid getting those messages these days, even if your, a personal studio.  

00:23:46 

Linda Bluestein 

Is, is trying its best to approach it in a healthy way. I think that's a really good point. I think reality, I like to use  air quotes for reality because reality TV, but it blurs the, especially for the young, super young impressionable to  answer or, any other type of reality TV show, it kind of blurs the line between reality and entertainment and  with social media and everything can definitely increase those challenges.  

00:24:15 

Bonnie Robson 

There's some other factors, Linda, they're extrinsic factors to outside the self, wonder, artistic director said to  me, it's all about casting. From the very first Nutcracker, everybody wants to be Clara. Some people hold onto  for years that they never got to be Clara. And so they're not quite good enough. In Clara is often chosen simply  because she has long hair and fits the costume. Students don't know that as students grow older, they're likely to  experience more competition, however, in their own school, because they're getting better and they're staying  then, in the summer intensive more competition at larger competitive competitions or conventions such as  YAGP. Students again, on you're watching on line to see how these people live and they even do backstage.  What they're feeling unhealthy competition can promote perfectionistic attitudes. Interestingly enough, in turn  that decreases creativity, teachers report the groups that used to have fun and really enjoyed traveling to the  competition can instantly turn and become self-critical faced with a superior competitors. 

00:25:44 

Bonnie Robson 

Their teachers say they just fall apart. The teachers are looking to us in terms of psychological skills that these  students can take, and learn from so that they can get rid of this, unhealthy rivalry. Sanford Bates looked at two  types of learning environment, the task oriented in, a kind of climate that promotes individual learning. And  everybody is of equal value. It's cooperative and collaborative and students are encouraged to set their own  intentions. I love that Jennifer, when your students said, that's enough, I've done it. That's much my goal for  today. And, long-term goals, how they're going to get to the gala, the exams, the audition. We'll talk a bit about  that later, but to stay with this type of learning, the second type of learning is ego involving a climate that in  that's often in elite conservatories, it promotes negative comparisons. The teacher may ask for somebody to  demonstrate and show how to do it, or worse.  

00:26:55 

Bonnie Robson 

The teacher may ask somebody to demonstrate, to point out the negatives and equally demeaning. I've seen this  happening in some, particularly Irish dancing lately. Everybody gets a trophy, no matter what they get some  award. And, that's very demeaning. In many elite conservatives competition is just accepted. Apprentices are  competing to get into the company. This culture, may extend as far as rivalry between teachers, to have more  winning students and in that kind of environment, it's easy for students to shift from task focused to, outcome  focused. I wonder if you've seen this in a studio Jen or, in your experience, people have reported this and move  from one studio to another because of this kind of,  

00:27:52 

Jen Milner 

Absolutely. I mean, I see a lot of it, most of which I won't talk about in public, but I think that it's there even in  the best schools, there's that little bit of ego, and it's so hard to let go of that. The healthiest schools that I see are  the ones that say, if a dancer is injured, I've seen some schools say, well, can you just get through Nutcracker?  And I've seen other schools say, Hey, there's going to be other nutcrackers and you get healthy and not realizing  the ones who are asking them to just push through Nutcracker, not realizing the implications of what they're  saying. Right. Putting that burden unintentionally on the child to make their Nutcracker look better or to help  them get through what they're trying to get through. Or, if you see, I know a school, not one that I work with  regularly, but, a school that had several years ago, a dancer with a very clear eating disorder and several of the  dancers had said, we're concerned, we're worried about it.  

00:29:00 

Jen Milner 

And the school said, Oh yes. Yet turned around and had her be their face of their company at their competition  was a competition studio space, their company at their competitions, that kind of thing. They would say one  thing, but then clearly something else was happening because they thought, well, sure, that's unhealthy, but also  she looks so good. Let's put her forward and let's put it out there. The dancer that was 10 years ago, the dancer is  healthy now and it was a healthy outcome for it, but it's so hard for those studios to not say, Oh, but I mean, I  know, but, and to put our egos on that back self, I I'm just as guilty of it. I want to see my dancers do well and I  want to have them get out there and be successful and amazing. The ego driven studios, the ego-driven  companies, the places where you can see that the director is starting to get that of a God complex and, casting  capriciously and making clear examples of bringing up a 16 year old through the ranks and then casting her in  principal roles, to say, I can do whatever I want.  

00:30:14 

Jen Milner 

That poor girl has to live with the social pain that comes with that when the rest of the company has to deal with  it. So you definitely see that. I do think that especially over the past year, with all of the mental health issues that  are coming to the forefront and dance, I do think that starting to be addressed, I think dancers are starting to get  that voice and to start to see just because the director wants to make me do this, or just because my teachers are  pushing me to do this, maybe that's not the best. I do see that the task-driven is starting to become more  prevalent, Hopefully as dancers find their voices, it will continue to be that way. As dance studios and dance  teachers let go, there's another one of my soap boxes. If they let go of saying, well, this is the way it's always  been, or this is how it was done to me. 

00:31:07 

Jen Milner 

They should have to go through this too. Right. I didn't get to use gel pads and my Pointe shoes. Neither should  they, I suffered with Lamb's wool. Well, great. They didn't have gel pads then. Right. Learning to let go of that  and see what's important for the kids, I think is so important and so valuable.  

00:31:27 

Bonnie Robson 

I was waiting to see if Linda had an example she was burning to share, but if not, I'd like to share one. I, this  year I met a wonderful teacher named Kim Maketto, of elevated dance project in Idaho. I have to share her  name because of the wonderful innovation she and her co-director Melissa Larson have brought, they're looking  at teaching life lessons through dance, rather than the other way around, such as a healthy lifestyle, community  awareness, self compassion, these are all things that we'd want to share with children of nine, 10, 11, 12, respect  for others. They focus on these themes throughout the whole year. They work on building confidence, learning  responsibility, compassionate, and kindness, and respect. I love this. They actively encourage everyone around  them, including their competitors. Their dancers will often line up when the competitors come off stage and high  five them, as they go by.  

00:32:31 

Bonnie Robson 

This kind of attitude, they also learn task analysis and goal setting. Just like you said, that's enough for today. I  just thought that's the we're beginning to see studios like that are saying, we're not here to turn, we're here to  learn. Yes, absolutely.  

00:32:52 

Linda Bluestein 

It reminds me of a saying that I heard the other day and I might not get it exactly correct, but it's easier to raise  healthy children than to fix broken adults. And, so many of these, dance educators, studio owners, do have this  opportunity to really, have a huge impression on young people. I think that's so fabulous, Bonnie, that example  that you shared, that's really.  

00:33:17 

Bonnie Robson 

Great. Wonderful what they're doing.  

00:33:21 

Jen Milner 

So, so we've talked about perfectionism. We've talked about the stress that comes with that. What is the  relationship between perfectionism and stress and anxiety and how those all fit together?  

00:33:34 

Bonnie Robson 

Yup. You've brought it just where we're going. Stress is related to anxiety. The pursuit of perfection can be a  crucial part of stress developing that stress, bubble, stress puts a dancer at risk for injury, mental disorder,  including depression and even suicide, anxiety and anxiety, around, dance leads to eating disorders or reduced  energy availability. Further perfectionism is related to social anxiety, not anxiety and social anxiety. W in  psychiatry, we think of as stage fright, as performance anxiety, that people actually cannot go to what they, to  the place where they're going to perform. They can't concentrate, they're distracted. Naturally they, if they do  go, they have a poor performance than they could give.  

00:34:42 

Linda Bluestein 

That's really important because we know that people who have hypermobility are at a greatly increased risk of  anxiety. At least most of the studies show that like some eight to 16 times increased risk of anxiety. And, there  was even a study back in 2012 and the British journal of psychiatry that showed differences in, key emotion  processing brain regions, including increased volume of the amygdala. There's a lot of really interesting research  out there on hypermobility and different, conditions like, even obsessive compulsive disorder and, ADHD,  attention problems and things like that. This is a super important topic for the hypermobile population. 

00:35:29 

Bonnie Robson 

Yeah. As you say, the amygdala way down in the bottom in here, and it's the emotional center, but set fires off  information up to this prefrontal region, which is your judgment, your planning, your organization. Well, they  all go out the window if you get to rot down.  

00:35:49 

Linda Bluestein 

That's where the thought stopping is probably really important to do sooner rather than later, because once you,  I, I'm so glad that you're talking about the stress, because stress is also a huge activator of mast cells and causes  degranulation of mast cells. You get the release of cortisol and all the other physiologic, things that happen in  the body, once we're under stress, it's harder to stop it. Right? So if we learn to stop those thoughts earlier, rather  than later, when there's all these physiologic things happening in the body that are, is biology, it's not, judging  ourselves harshly that, Oh, we should be able to stop this, but if we can recognize those thoughts earlier, I think  that's probably a really key, strategy that people can use.  

00:36:35 

Bonnie Robson 

Linda, is there a podcast that tells us more about that? So we can hear more about that at another time.  

00:36:43 

Linda Bluestein 

About which aspect of it,  

00:36:46 

Bonnie Robson 

About the mast cells and the physiology of the anxiety and the stress.  

00:36:53 

Linda Bluestein 

There's a fantastic journal article that talks about that I can put a link to in the show notes. I happened to know  the author quite well. Maybe Jen, and I can see if we can get an interview with that person. Also, maybe there  will be a press. Yes. Yeah. It's a really challenging thing because these conditions are often not recognized for  so long people go to these appointments and they're told, they're basically told that they're crazy. Well, what  

does that do? That just increases your stress level, which is part of the problem in the first place. So it really  creates this vicious cycle. And, and we also know that people that are hyper mobile have increased  interoception. We have increased awareness of what's going on inside of our body. As these things are happening, we're more and more aware, whereas people who are not hyper mobile are they're kind of oblivious.  

00:37:44 

Linda Bluestein 

Sometimes I feel like I can feel every single cell as it's moving through my body and my husband, he'll be  bleeding from something and he has no clue, honey, you're bleeding. Oh, am I, so I think that, yeah, we'll have  to make sure that we have an episode specifically about that because it is an important,  

00:38:05 

Bonnie Robson 

Important to remember that our bodies can sometimes be enemies. They can fight back. I was going to go on to  talk about, something you can do, in terms of, preventing this perfectionism, getting in the way of a poor  performance. That is the task analysis that the people at the McCotter studio, where were doing, training as little  as 10 minutes or half an hour, a month, not every day, 10 minutes a month, can get, can help you set reasonable  goals, task analysis, and we've done the research significantly improve the performance. Once the goals are set,  a dancer can plan can use time management. If a dancer has a featured role or is to perform a solo, in the spring  and the earlier she has cast the better she needs to plan. If she's nervous, she may procrastinate very risky, but  very tempting. Well, I'll do it later.  

00:39:19 

Bonnie Robson 

No, no. If she breaks it down now and is able to accomplish the elements, then she can work on the feelings and emotions. She didn't, doesn't have to add in all those other spend time with the worry spending time with the  negative thoughts. Now we're talking about outcome goals and process goals. Process goals are the ones she's  going to set up. They're much more effective than outcome goals. Outcome goals are I'm going to dance a  perfect performance, but protests goals help to maximize performance and they're possible. And they're within  the dancers control. We use, a little anacronym called SMART. So they're specific, they're manageable, they're  achievable. They're not unrealistic. I can't do 32, a French rotates tomorrow night. That's not never going to  happen. They're relevant, to what you want and you have a target date to finish. So, that's the smart way to  proceed with task analysis.  

00:40:31 

Linda Bluestein 

That's great. And, and what about, parents? How can they recognize that their child is stressed and anxious and  what can they do about that?  

00:40:41 

Bonnie Robson 

Yes. Okay. Ballet parents, I have good parents and bad ballet parents. And, not all parents who are concerned  about their kids or come to ask about things, from the staff are negative. Parents are pushy parents. Sometimes  they're genuinely concerned that this dance culture is bringing out something substrates in their children that  they're not sure are healthy. For the parents, if you're looking at your dancer who seems to be over worried, is  that, are they constantly seeking reassurance? Are they so over worried that you can't, help them calm down?  They can't say, Oh, yes, I remember I'm going to be okay. Yes. Are they really afraid of the performance?  Would they rather give up the chest? Most dancers? I know, even though they're very nervous, maybe nervous  about the performance, they still want it. They realize that this is an opportunity they want to be out there.  

00:41:42 

Bonnie Robson 

That's what they're working for, that they want to be on stage right now. We're talking at a time of the COVID  pandemic and, the many dancers are, do not have the opportunity to be on the stage. Well, I've had, I've been  talking to some of the dancers as they go back and have performed again. The euphoria they feel in returning is  so wonderful. A dancer who doesn't want to perform is unusual, a dancer who would give up an opportunity to  perform that's unusual, for parents, are they so tense that when they walk into a room, other people recognize it,  their aunt or uncle says, what's wrong with Martha today. She seems very tense. They also have difficulty  sleeping. Now, all athletes have trouble sleeping before an event. That's been documented, but we're talking  about real trouble. So they can't get to sleep. Then they get to sleep.  

00:42:43 

Bonnie Robson 

They have early waking, they can't get back to sleep. A performance psychologist or counselor can often help  sort this out for you. Parents may want to ask about that from the studio. Some studios have a counselor on their  wellness team and what the counselor can also help the parents with is recommending if a more intensive,  management, the anxiety needs to be sought rather than working through and psychological skills training. Do  you need a medical referral as you said, Linda, and I want to call you Dr. Linda at this point. We mustn't forget  the physiology, and it, as much as we might be trying, there may be something that physiologically, might need  to be done. There's another variable, that I'd like to talk about and that's about individual child development, or,  what we call ontology the growing up, a man named Dienelski, notes that much early reinforcement for  outstanding performance, leads to performance, anxiety, to perfectionism, and to performance becoming the  basis of your self-esteem applause is love.  

00:44:03 

Bonnie Robson 

The little dancer does the first recital and gets flowers and grandma comes and everybody's excited and it's  wonderful. And, and so on. And, and, as the dancer progresses, she's better and she gets better roles and public  came and she goes to a competition and gets a scholarship. And, but then one day there's some critical notes and  the whole thing falls apart. Why? Because she had based her whole self on her ability to dance. She didn't have  other things. It's very important that dancers and parents acknowledges the dancers, not be just uniformly  dancers. I think about a chorus line and the, main dancer saying, I am a dancer. All I need is the music. That was  her life. That was it. A dancer, like that only feels accepted if she's doing well. If she has a down part, her self esteem falls off, it's dependent on other people's view of her, not her own view of what she's enjoying. 

00:45:14 

Bonnie Robson 

Did you have a good time? Did you enjoy it? I don't know Linda, but do you have any examples of that where,  the dancer, that's what she is. She has, if she has to think of a future career, there's nothing else.  

00:45:30 

Linda Bluestein 

Oh my gosh. Do I ever, so when I was dancing and started having getting injured, my entire identity was  wrapped up in dance. I was 16, 17, and, wasn't able to dance. I remember going to, I would still go to class  because at that time, you're supposed to still go and watch. I would just sit there and cry through the entire thing.  I would just cry at home and I didn't know what I was if I couldn't dance. So, that was a difficult phase to go  through and figuring out if I can't be a dancer, then what am I going to do with my life? So, yeah, I definitely  personally can completely relate to that. I think as much as we can have different parts of our identity, that, I  also love to learn new things and I love animals. Now I'm a mom and a wife and all these different aspects of  myself besides dance.  

00:46:31 

Linda Bluestein 

So I think that's really helpful.  

00:46:33 

Bonnie Robson 

Those of us in dance medicine are so grateful that you didn't continue dancing or teaching that you're here to  help us understand some of the aspects of medicine. It's wonderful.  

00:46:45 

Linda Bluestein 

Well, I think that's one of the funny lessons in life is that sometimes some of the worst things that happen to us,  can later be things that we grow from that we can really, they talk about post-traumatic stress disorder, of  course, but post traumatic growth. Both then, and when I wasn't able to work anymore as anesthesiologist, that  was pretty devastating to my self esteem. I went through a really difficult phase. Also, and little did I know then  that I would be doing this and able to reach so many more people. So, yeah, it's sometimes things in life turn out  very differently than what we expect, but that's where keeping an open mind is super.  

00:47:30 

Jen Milner 

Broadening our horizons. Absolutely. A lot of times when I work with my pre-professional dancers, you chat  while you're working out and I will always ask them maybe our second or third session, if you weren't dancing,  what would you be doing? Or what do you think you would want to do when you're finished with your dance  career? Not saying if you don't make it, or if you get injured, but saying, what do you, what would you, and  there's always the dancers. You go, what I really love architecture, or I think I would want to, and they've  already thought about that. They have a whole personality outside of dance, even though they may be pursuing  it quite passionately. They're the ones who get that deer in the headlights look like, why did you just say that  freaks me out. I can't even think about that. I don't want to think about that.  

00:48:14 

Jen Milner 

Those are the ones that we're going to have some long conversations, but you see that those very distinct  personalities there. I think that the perspective, some can be in both of them, but as we said, it's either personal  or it's impersonal. And you see that distinct difference. What, what if though, Bonnie, what if the perfectionism is in the parents? So we've talked about parents helping their kids with stress and anxiety, but what if the parents  are the perfectionist and how does that rub off on the pre-professional dancer?  

00:48:47 

Bonnie Robson 

Very dangerous. It can actually embed the perfectionism in the child. Who's, got some perfectionistic traits in  the parents as, Oh, that's good. That's good. That's good. Right? Why don't you take notes, from what your  teacher says? So I'll get your pad and pencil. While that might be in many things, I'm recommending journaling  and taking notes in this instance where it's an example where the parent is pushing and concern. Of course we want parents who are concerned, who are going to make sure that their children don't end up with a problem,  because they're pushing too much. I think psychoanalytic theory comes in here where the dancer becomes, has  used his perfectionism as a defense against feeling, defective or inadequate. In both of those instances where the  parent is pushing too much where the child is saying, I'm not okay, I've got to be more perfectionistic. Otherwise  I'm useless.  

00:49:53 

Bonnie Robson 

I'm nothing, I'm no good. They set unrealistic goals and they prove their own point. You can't make that goal.  So, yes, you are inadequate at that. Because you set an unrealistic goal. So, helping the parents to see that too,  often in situations where I see a child who's anxious, the, I will ask, I say, are you the most anxious, worrywart,  the family? Are you the worrywart? And no, I'm not the worry wart my mom is the worry wart. Well, my  brother is the worry wart. We have a little talk in the family about where did all this worry come from and it can  be generational right back. That usually requires some, work with an expert around family therapy and helping  the family readjust their goals.  

00:50:56 

Linda Bluestein 

That's really interesting because being around anxious people makes us more anxious, right? It, that energy, and  since there's a hereditary component to both anxiety and hypermobility, it's, it makes sense that would be  something that would be present more on family.  

00:51:13 

Bonnie Robson 

There's, one of the thing that has come out in the research that I might want to just tuck away, for teachers that,  perfectionists tend to get discouraged quite some more, some group of them, when they don't meet the standards  they've set and they tend to drop out very talented. Young people will say, I'm so awful. I just quit. And they're  just gone. Rather than I'm saying, I'm useless and they say, I'm not going to have any more to do with that. I'm  done. I'm done with, I'm done with soccer, I'm done with hockey, I'm done with dance. So, one has to be aware  of that. If, if a particularly a studio teachers, if you don't want to see dropouts of the people that you thought  were had good potential.  

00:52:01 

Jen Milner 

Yep. Well, I remember very clearly myself. I hated working on fouette turns because I wasn't good at them. I  would rather not do them than to do them and not be good at them. I, I remember being 14 and, my best friend  would say, Hey, let's stay after in the studio and work on forte turns. I'm like, no, you can go ahead. You can  stay in work. She would go in there and she'd look terrible and she'd fall. She didn't care and she'd get up. And  she just kept practicing and practicing. I just, I didn't want people to see me less than perfect. I didn't want to  work through that sloppy messy phase. I was never amazing at forte turns. I mean, I could knock them out  barely, but it was never something fantastic. That's, those are the things that I look back and regret.  

00:52:45 

Jen Milner 

I regret not allowing myself to fail and not allowing myself to try things that I knew I wouldn't be good. Not  giving myself that grace, that those are the things that I think my perfectionism kept me from and kept me from  developing entirely different skill sets, maybe in dance.  

00:53:02 

Bonnie Robson 

You do, you, aren't talking about mastery, you've mastered the turns enough so that you are confident enough  that you can stay in the profession and do them. If needed, I mean, mastery is so related to getting yourself up to  the point where you say, I can do this. I have energy. I feel I can do this. That's what you're doing, but I wish I'd  had more energy to say, take a chance, try it. Nobody's going to see me, I'm going to fall over, but there's me in  the mirror, so take a chance, see if this would work, see if that was work. Getting yourself aroused enough for  the performance for the audition for the exam is very important. And that takes practice. That might be a whole  other session that we talk about arousal and energy, and how to build enough energy. It is a body sensation is  crucial to practice. 

00:54:07 

Bonnie Robson 

So, while dancers are, it's not enough to just plan and organize and you have to try, you have to give yourself a  chance. I love this. There is a new kind of thought coming out through self-compassion and many teachers are  saying before class, give yourself, this class with self-compassion, allow yourself to make mistakes, to try things  to be good enough. I love the good enough. If you walk away from today saying I was good enough, I stayed  through that whole thing. I was a little bored and I wanted to leave, but I stayed and I got to the end to where she  said I was good enough, your good enough. I have just one little thing, that I I'd like to, and I thank you so much  for letting me talk on like this, but I like to share one little, anonymous saying that I came across lately.  

00:55:05 

Bonnie Robson 

Like the one lender came across on, it was the voice she'd heard. Mine is on a dream. A dream written down  with a date, becomes a goal. A goal broken down into steps becomes a plan and a plan backed by action. Taking  a chance makes dreams come true. You will master that task and move on to the next one. I love that when I  found it,  

00:55:37 

Jen Milner 

But it's so great. I'll have to have, get you to email that to me. I love that. Well, Bonnie, it sounds like if I'm  going to do a really crude summary of all of this, it sounds like we are acknowledging that there is perfectionism  out there. Right? And that the, one of the first things we have to do as artists does, is acknowledge that if that's  something that we are wrestling with and, maybe being able to start and recognize, and form our own thoughts  and choose what thoughts we have and try to take control, of not having the negative thoughts and filling it with  positive thoughts instead. Being able to say, are those, my thoughts are those someone else's thoughts, and then  trying to train our brain to help alleviate stress as you talk about doing the training, and learning to not take  failure personally, that, if we fail on that turn, that's okay.  

00:56:37 

Jen Milner 

As you said, it's okay to be good enough. It's okay to say that was good enough. I tried and failed and that's  okay. That is that a fair summary later. I think we'll all take the image of your dancer saying, that's enough. I did  what I came to do today. I don't have to take on a whole new set. That's enough being able to walk away. That's  so hard.  

00:57:03 

Linda Bluestein 

And as parents, because there'll be different ages of people listening to this. For anyone that's a parent, I think  it's so important, Bonnie, what you were saying about if we have that perfectionistic attitude as a parent, how  that can impact the child, because, we all love our children and we want them to be, we want to raise them well,  but sometimes we don't realize the things that we're doing that are detrimental until later when they're a lot  older. I think that's really helpful for parents, especially parents of young children.  

00:57:34 

Jen Milner 

Yeah, absolutely. Okay.  

00:57:36 

Linda Bluestein 

Well, well, this has been so great to chat with you today, Bonnie, and we would just so appreciate you coming  on again and chatting with us about this super important topic. Perfectionism.  

00:57:48 

Jen Milner 

Yes. Thank you, Bonnie so much again, you're welcoming. And that's what it was. It was a chat of our sharing,  our thoughts. So that's why it was so great. Thank you for having me.

00:57:59 

Linda Bluestein 

Of course, anytime, and you all have been listening to bendy bodies with the hypermobility MD today. We have  been speaking with Dr. Bonnie Robson psychiatrist and performing arts medicine specialist, Bonnie, thank you  again. Very much for taking the time to come on the bendy bodies podcast today and sharing your expertise  with us. Thank you for joining us for this episode of bendy bodies with hypermobility MD, where we explore  the intersection of health and hypermobility for dancers and other artistic athletes. Please leave us a review on  your favorite podcast player. Remember to subscribe so you won't miss future episodes. Be sure to subscribe to  the bendy bodies, YouTube channel as well. Thank you for helping us spread the word about hypermobility and  associated conditions. Visit our website, www.bendybodies.org. For more information, for a limited time, you  could win autographed copy of the popular textbook disjointed navigating the diagnosis and management of  hypermobile Ehlers-Danlos syndrome and hypermobility spectrum disorders just by sharing what you love  about the bendy bodies podcast on Instagram, tag us at bendy underscore bodies and on Facebook at bendy  bodies podcast.  

00:59:15 

Linda Bluestein 

The thoughts and opinions expressed on this podcast are solely of the co-hosts and their guests. They do not  necessarily represent the views and opinions of any organization. The thoughts and opinions do not constitute  medical advice and should not be used in any legal capacity whatsoever. This podcast is intended for general  education only and does not constitute medical advice. Your own individual situation may vary, do not make  any changes without first seeking your own individual care from your physician. We'll catch you next time on  the bendy bodies podcast.