How Opera Breathing Techniques Help COVID-19 Patients
Singing, as a teacher of mine once disarmingly put it, is simply “an exhaling of sorts.” For most people, the mechanisms of breathing are hardly noticed unless they stop working as intended. That caveat has become more present in the last year, with the nature of COVID-19 leaving us paying more, and more nervous, attention to the breath. We scrutinize unexpected coughs. We protectively shroud ourselves from the exhalations of others. We wonder if our shortness of breath is the first sign of an infection, anxiety, or both.
In April, the English National Opera’s costume department was sewing scrubs and masks for London’s Imperial College Hospital. This autumn, the company has gone further, partnering with the hospital for a therapeutic new project that brings together education, health, and singing. The ultimate hypothesis of ENO Breathe: Can the vocal habits of opera singers help patients recovering from the coronavirus?
While vocal artists often learn breathing for singing, Jenny Mollica, the director of ENO’s educational and outreach work, tells me that participants in this six-week program learn “singing for breathing.” Vocal coach and creative director of ENO Breathe Suzi Zumpe focuses her training on diaphragmatic breathing, the kind of deep, embodied breathing that allows trained voices to sustain, color, and control long musical lines. In other words, imagine that you have a large rubber ring around your waist. Now imagine pushing outwards with your stomach, pelvic floor, and intercostal muscles between your ribs when you breathe in, leaving you with a feeling of power and fullness in your abdomen. When you exhale, imagine squeezing that reserve of air out.
The ENO Breathe program has turned to vocal exercises familiar to many singers in order to help with the symptoms of what is now being called “long COVID.” These include persistent breathlessness and fatigue after physical activity, exacerbated by the mind through heightened levels of anxiety and or even panic.
Over the course of six sessions participants learn myriad warm-ups and routines. Although the program is online-only, it is no less physical than an in-person singing lesson. Exercises include blowing through a straw into a glass of water for as long as one can, and breathing while counting backwards from ten (which help anchor participants in the present if they feel anxious or overwhelmed).
The point of this, and the program altogether, is to use the mind to trick the body into freeing itself, by the strange magic of metaphor and image. One of Zumpe’s warm-up exercises is the aptly-named “spellcasting,” and comprises the following steps:
1. Over one shoulder, sing a series of rapid sh sounds
2. Over the other shoulder, hiss a short set of elongated ss
3. Finally, wave your hands in front of you as if you’re throwing ingredients into an imaginary cauldron while making the fffsschew sound of a whoosh
“The spell has worked,” Zumpe concludes in the video. “You have a delicious cake in front of you.” This exercise can leave participants feeling alert and present. When I tried it, my head and torso seemed to be perched on a cushion of air.
The program includes video tutorials and performances from ENO regulars like Nadine Benjamin and Natalya Romaniw, the latter singing a lullaby from Tchaikovsky’s “Mazeppa.” This piece of programming was deliberate, as Mollica and Zumpe also saw lullabies in opera as moments of heightened calm and reflection: Suzuki and Butterfly’s son drifting off to sleep during Puccini’s “Humming chorus,” Clara’s “Summertime” in “Porgy and Bess,” or Arnalta’s ravishing “Oblivion soave” from “The Coronation of Poppea.” Zumpe wanted the material to be approachable for those without a background in singing or a familiarity with opera. Lullabies, as she points out, exist in every culture, and tap into our most primal feelings of safety and reassurance. In opera, they are often used as a soothing technique by characters under great duress. Participants get to sing some of these tunes as well, along with traditional lullabies from around the world, with karaoke tracks provided by ENO.
In The Spectator, Alexandra Coughlan recently remarked on the collective intake of breath that begins concerts. “Now that our breath is diseased, shrunk from, masked, now that performances are digitally distanced and filtered,” she writes, “there’s something dangerously poignant about that physical swell of inhalation and exhalation that sets the air in motion.”
While breath is life—crudely, mechanically vital—it is as much attached to metaphysical concerns as it is to physical ones. In the Gospel of John, Jesus Christ “breathes” the Holy Spirit (spirit itself deriving from the Latin for “breath”) into his disciples, who are quite literally “inspired.” For Saint Augustine, it was through his breath that God imparted the soul into human beings. Breathing is inextricable from the nourishing of the soul or inventions of the creative mind. The Oxford English Dictionary gives one of inspiration’s figurative senses as “the suggestion, awakening, or creation of some feeling or impulse, esp. of an exalted kind.” In Middle English, inspiracioun implied a “supernatural communication from an angel or a departed philosopher.” Several centuries later, Paul Celan would describe poetry as “an Atemwende, a turning of our breath.”
Samuel Beckett grasped breathing’s potency as an existential and dramatic synecdoche in his 1969 piece “Breath.” The 45-second tableau is so brief that Beckett wrote its entire text on the back of a postcard:
1. Faint light on stage littered with miscellaneous rubbish. Hold for about five seconds.
2. Faint brief cry and immediately inspiration and slow increase of light together reaching maximum together in about ten seconds. Silence and hold about five seconds.
3. Expiration and slow decrease of light together reaching minimum together (light as in I) in about ten seconds and immediately cry as before. Silence and hold for about five seconds.
Rubbish. No verticals, all scattered and lying. Cry. Instant of recorded vagitus. Important that two cries be identical, switching on and off strictly synchronized light and breath. Breath. Amplified recording.
Maximum light. Not bright. If 0 = dark and 10 = bright, light should move from about 3 to 6 and back.
A filmed version of “Breath,” designed and produced by Damian Hirst in 2000, strew the stage with the medical equipment and waste that populates Hirst’s other work. This additional bit of synchronicity makes the piece eerily prescient 20 years later, in a year defined by the frightening isolation of hospital wards and piles of discarded PPE.
“Breath” is an allegory of life itself. Its single eponymous breath is also a uniquely compact description of drama’s most minimal structural components: A rising of tension, an inhalation, and consequences—exhalation—in its release.
That opera is sung, and therefore works through the intensified control and release of air pressure in the body—“Breath” writ huge—is what makes it such a powerful and distinctive form of expression. Powered by the muscles that encase our innermost vital organs, it is both metaphorically and physically visceral. Breathing and drama are most essentially intertwined.
Ken Querns-Langley, director of the London Bel Canto Festival and an experienced voice teacher, tells me that audiences will unwittingly begin to breathe with singers on stage as they become engrossed in the drama. A truly rapt audience is a communion of exhalation. This may go some way to explaining the extraordinary intensity of Ermonela Jaho’s acclaimed performance of “Addio del Passato” at the Royal Opera House, where her sharp intakes of breaths are given a terrible percussive force as she gasps out “tutto…finì.” It calls to mind the memory of a “Saint Matthew Passion” directed by Mark Padmore, who also sang the role of the Evangelist. As the chorus and orchestra gathered on stage the concert began not with a conductor’s back to us and peremptory upbeat, but with a single intake of breath from Padmore, to which the musicians miraculously conjoined themselves in a moment of spellbinding intimacy.
How can singing reduce anxiety? “We associate singing with deep breathing,” Querns-Langley tells me, as it works through the diaphragm. This is what singers and their teachers refer to as “the support.” Breathing in this way stimulates the vagus nerve, a thread of sensory fibers that is the longest nerve in the body and connects the brainstem to the heart, lungs, and stomach. It activates the digestive system as well as the parasympathetic nervous system, which regulates our “rest and digest” mode (the opposite with our sympathetic nervous system, which is associated with the more anxious state of “fight or flight”). “It tells you that you’re safe,” says Querns-Langley. To help encourage these nurturing senses of relaxation and release, participants in the ENO Breathe program received a care package which included a mug, tea, and biscuits.
ENO is not the first organization to use singing as a form of therapy for chronic illness. For over ten years, London’s Wigmore Hall has run Singing with Friends, a choir for patients with dementia and their families. These represent a relatively new healthcare phenomenon called “social prescribing,” which encourages non-clinical interventions in recovery. Dr. Sarah Elkin, the ENO Breathe project lead at Imperial College Hospital, describes it as “an intervention that is not a medication, though it does come from a healthcare professional.” These kinds of projects are often rooted in the community, drawing on volunteers, cultural organizations, and social enterprises; in Elkin’s words, “a collection of people that together can help an individual.” Even my own singing teacher, Norwegian soprano Malmfrid Sand, runs a choir based in a West London health center for people with Parkinson’s and multiple sclerosis (as well as the carers and volunteers who work with them).
“Many of them say it is the most important thing in their lives,” Sand tells me, adding that these rehearsals may represent for many their only social outing. She also identifies a special social lift with group singing: “When we sing with other people it makes us sound better than we are on our own. The best, and strongest, singers in the group blend with and raise up voices that are weaker or less focused.” This is particularly important, she says, for those who physically struggle to produce sound.
Merging with a collective body empowers and transfigures the experience of our own. As an amateur singer in a symphony chorus, I understand exactly what Sand means. There is a uniquely thrilling sensation in becoming part of a sound unimaginable from your own meager resources.
Elkin notes that she saw that some patients continue to get breathless even though they’d begun to recover from the coronavirus. In offering the unique skillset of singing coaching, ENO seemed like the complement to Imperial College Hospital’s treatment. Together, the two organizations could make a complete educational package. Social prescribing will be particularly important in the aftermath of the pandemic, as it offers a way of addressing the social and environmental needs that shape patients’ mental and physical wellbeing in a way that goes beyond medicine.
Sheeba is a woman in her early 40s who loves music, painting, and poetry. She is also a survivor of COVID-19, currently taking part in ENO Breathe, and candid about both experiences. In March, as her condition worsened, she was hospitalized and separated from her partner and children. Moving into her isolation room was “like walking into my grave.” Though she is now out of the hospital, since contracting the virus she has felt more tired, and her breathing has been labored. At night she sometimes wakes up feeling breathless and anxious.
At first, Sheeba felt a degree of trepidation about joining the program. “I’m not a singer, and English isn’t my first language,” she says. But she soon felt welcomed in the “vibrant community” of participants. She likens Suzi Zumpe to sunshine, and after the first week Sheeba could already “feel the air in my lungs.” Singing, she adds, “has quite literally been a breath of fresh air.”
The social aspect of the program was also vital for Sheeba, who was allowed only her phone and the music on it while in the hospital. For many like Sheeba, including her fellow program participants, this experience of isolation is one of the other defining long-term effects of COVID.
Meeting the other participants, even if only online, allowed Sheeba to recognize her experience of illness in others and talk through its long-term difficulties. The group’s diverse range of ages, backgrounds, and ethnicities created an inclusive and welcoming space to engage with an artform that was also new for Sheeba. And the breathing and vocal exercises have enabled her to build a sense of agency when it comes to her own health. Instead of calling her doctor if she feels anxious or breathless, she can reach her own state of equilibrium. This, she notes, also helps with the enormous pressure currently placed on the UK’s National Health Service.
Sheeba speaks with the zeal of the convert about singing and strengthening her vocal folds, adding that exploring opera has been like “imagining another world.” It even allowed her, as she jokes, to access her inner diva: “Suzi has inflated my ego! I want to be an opera singer!”
There is a reigning modernist tendency in critical discourse to see the arts, particularly music, as mattering most when they are disjunctive and abrupt interventions in our lives and senses. It is less fashionable, perhaps even a little embarrassing or sentimental, to see them as consolatory, reassuring, or reparative.
Matisse once said that his paintings should be like a comfortable armchair into which we can settle after a hard day. This is generally at odds with the rhetoric of criticism which celebrates urgency and valorizes confrontation. To cast the arts as consoling or reparative can be taken as naive—we are stringent in our critiques of institutions and canons—or complacently optimistic, even implying the arts are simply nice luxuries, far from essential in times of huge economic and social turmoil. Interventions like ENO Breathe, though, are powerful testimonials for just how vital and straightforwardly life-affirming the arts can be right now: They calm, restore, and renew. Medicine and music twine together souls and bodies in the care they offer.
At time of writing the UK is caught in the second wave of infections. Concert halls have shut their doors to audiences again, and lockdown is back. There exists the real possibility of thousands more deaths. But it also means there will be many more like Sheeba who need long-term therapies and care that can help them to breathe—and live—again. ¶