Dancers Learn to Get By on Aspirin, Coffee and Grit

NEARLY two decades have passed since the ballerina Gelsey Kirkland blew the stage door open with her drug-laced memoir, “Dancing on My Grave.” Her tale was a warning for an art form veiled in myth and lacking regard for the physical demands on performers, who sometimes sacrificed their health for artistic excellence.

Whether Ms. Kirkland’s book was grand testimony to an era of excess or simply a snapshot of one brilliant but troubled artist’s world, drug abuse has by all accounts become increasingly rare in American dance. The field has shifted from a climate of denial about anorexia, bulimia and substance abuse to one valuing holistic health practices.

When Linda Hamilton, a psychologist and wellness consultant for the New York City Ballet who performed with the company from 1969 to 1988, started writing an advice column in Dance Magazine 15 years ago, questions revolved around losing 10 or 15 pounds by any means necessary. Today, she said, dancers are far more aware of the consequences of unhealthy behavior.

In American dance a new athleticism has joined artistry at center stage. At the same time performing-arts medicine has matured, and its practitioners now recognize dancers as not only creative artists but also as world-class athletes whose art form seems to demand greater challenges each season. But as dancers jump higher, spin faster and try to stay impossibly thin, might they, like baseball stars and Olympic sprinters, be susceptible to new drug regimens? Performance-enhancing drugs, no longer the realm of musclemen, could also have applications for dancers: especially stimulants, diuretics, amphetamines, steroids, hormones and narcotics used for energy, weight control, muscle-building and pain management.

“I know of no current data substantiating the use of steroids and other performance-enhancing drugs by professional dancers,” said Gary Wadler, an expert on those drugs at the New York University School of Medicine and the lead author of “Drugs and the Athlete” (F. A. Davis Company, 1989). “But in the current climate of drug use, you can never be totally dismissive of the possibility, whether with performance-enhancing or social drugs.”

But what defines a performance-enhancing drug? Ibuprofen and beta-blockers, for example, allow users to perform up to their natural potential by removing disabling symptoms. Is there a clear line between performance enablement and performance enhancement?

Both athletes and dancers are driven by a desire for excellence. But they may have different motivations for using substances that improve performance.

For athletes the possibility of lucrative contracts and product endorsements could fuel a willingness to risk health for world records. Even in more obscure sports like curling or kayaking, athletes may pull all the stops to achieve the ultimate prize for their lifelong dedication. Dancers, on the other hand, with few quantitative measures of success, tend to focus on career longevity (if that is the term for careers that are often short) rather than risk all for a moment of glory. They earn modest pay, and endorsement opportunities are rare.

And although ballerinas call on the same power and strength needed for baseball and running, the aesthetic component of their performance requires flexibility, leanness and grace inconsistent with steroid use, which tends to add weight and physical bulk.

Legitimate drugs, used properly, are of course another matter — and a necessity. Professional ballet companies report an annual injury rate of 67 to 95 percent, according to a five-year study published in 2003 in the American Journal of Sports Medicine.

Lower-body injuries are common in both ballet and modern dance, said Shaw Bronner, a physical therapist who works with the Alvin Ailey American Dance Theater. Ballerinas encounter problems related to dancing on point, including stress fractures, ingrown toenails and bloody blisters.

Many hide injuries to protect themselves in a career where union contracts protect jobs but offer no guarantees against adverse artistic or casting decisions. Because dance injuries tend to be chronic, dancers fear being pigeonholed as heading downhill, so some may rely heavily on prescription and over-the-counter drugs.

“Dancers are reinforced for being stoic from an early age, and often continue dancing because they think of injuries as a sign of weakness,” Ms. Hamilton said.

Common medications include nonsteroidal, over-the-counter anti-inflammatory drugs like ibuprofen and aspirin, which allow injured dancers to perform. But these drugs can create a range of gastric side effects and impair performance through dizziness, headache and drowsiness.

Weight control is an issue dancers share with female gymnasts, figure skaters, marathoners and divers, who strive for lean, lithe bodies. Since the New York City Ballet founder George Balanchine prescribed an ideal physique, some not born with a narrow, short torso, long legs and delicate arms have tried to compensate with excessive thinness, using diet pills and diuretics or inducing vomiting to lose weight.

In 1997 Heidi Guenther, a member of the corps de ballet at the Boston Ballet who was then 22 and weighed 93 pounds, died after struggling to slim down. An irregular heartbeat, which can result from anorexia nervosa, was suspected as the cause of death despite an inconclusive autopsy report.

“Guenther’s case was a wake-up call for everyone,” Ms. Hamilton said. Ballet companies, she added, have since treated eating disorders as a top priority and reduced their frequency among dancers through counseling, nutritional guidance and medical intervention.

Preperformance anxiety is another problem dancers share with athletes. Of 960 respondents to a 1997 survey in Dance Magazine, 40 percent said they suffered from stage fright. But some dancers and athletes reported that moderate levels of nervous arousal helped their performances.

Classical musicians and public speakers sometimes use beta-blockers, a type of heart medication that limits the amount of adrenalinelike chemicals in the blood, to combat the physical symptoms of stage fright: shaking, shortness of breath and muscle tension. But dancers avoid them. “In terms of the athletic population, beta-blockers have adverse consequences,” said Donald J. Rose, the founding director of the Harkness Center for Dance Injuries in Manhattan. Chiefly the drugs reduce stamina.

As for recreational drugs like cocaine, studies have shown no athletic performance enhancement from their use, and plenty of risks, including strokes, convulsions and sudden death. Dancers say cocaine has nearly disappeared from their world, although a few may use it on days off. “I’m with the dancers several days each week,” said Dr. Richard Gibbs, the San Francisco Ballet’s physician, “and I never see behavior, hyperactivity, glazed eyes, dilated pupils or other physical signs of drug use.”

Alcohol is also off the menu, since it impairs motor skills, balance and energy, even the next day. Smoking, once popular as an appetite suppressant, is on the wane. But caffeine may hold some benefits; research shows that low doses significantly increase an athlete’s stamina.

“I wish I had racier stories for you,” said Linnette Roe, who said she saw little substance abuse when she danced with the Pacific Northwest Ballet from 1987 to 1999. “But the No. 1 performance-enhancing drug today is coffee.”