Is it all in the head?

Some practioners, such as prof Joaquin Fabra in Spain, think treating the symptoms of focal dystonia with botox and splints is the wrong approach.  Instead, he thinks you should go staight to the heart, or in this case the head, of the matter and change the way you think about dystonia.

I have read a few different accounts of his approach, and each patient has varying success.  After speaking directly with some one who had a very positive experience with Fabra, I felt I understood a little better how his approach claims to work.  Before I outline these ideas, I must stress that Fabra, like many similar practitioners of FD, claim that every individual is different and the approaches must be modifed to suit each case.  What I outline here is only what I have gathered from his interviews, or from speaking to others who have met him, and not from my own first hand experience.

Focal dystonia is a type of phobia, or defence system, that the mind has created in reaction to heightened anxiety, or stress.


The musician is no longer thinking about the sound he wants to create, but more worried about attaining a specific technique by a specific time.


Rather than let the body move in its natural way, the musician tries to overtly control the movements.


The spasms of focal dystonia are a direct consequence of the body rebelling against the control.


If the musician can learn to stop fighting the dystonia, and relinquish control to the body, allowing the dystonia to happen, he will begin to make progress towards rehabilitation.

These ideas are of course not unique to Fabra's approach, but they set him and others like him apart from the wider medical community.  Despite advances in neuroscience , where imaging  techniques claim to show abnormal changes in the motor-cortex of musicians with FD,  there still seems to be room for practitioners whose treatment focuses on the psychological, rather than physiological aspects of the condition.

 For more background into the changing views of dystonia, download this article.  It gives an outline of the psychogenic history of dystonias, to the neurological and genetic approaches of the modern day. It concludes that perhaps there is no room for such  distinctions, and these categories should be abolished.


 The PYSCHOLOGICAL ASPECTS of focal dystonia are put in context in an article on




It gives examples of the kind of pychological problems that need to be addressed as part of an intergrated approach to FD therapy.

Musicians' Focal Dystonia

Eckkart Altenmuller Alice Brandfonbrener Institute del Arte David Leisner Barbara Conable Joaquin Farias Joaquin Fabra Katherine Butler

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