Health & Body

Why Are We Still So Bad At Addressing Dancers' Mental Health?

Jim Lafferty

"So why did you quit?"

It's a question I've been asked hundreds of times since I stopped dancing over a decade ago. My answer has changed over the years as my own understanding of what lead me to walk away from greatest love of my life has become clearer.

"I had some injures," I would mutter nervously for the first few years. This seemed like the answer people understood most. Then it became, "I was just not very happy." Finally, as I passed into my 30s, I began telling the uncomfortable truth: "I quit dancing because of untreated depression."


It makes sense that people ask me "why?" I was a promising student. I left my family in upstate New York at 14 to train in the highest levels of Pittsburgh Ballet Theatre, and then San Francisco Ballet School. I spent my summers at the School of American Ballet and the Chautauqua festival program. I can say now what I was incapable of seeing then—I was a good dancer.

But I was never a confident dancer. I relied heavily on the praise of my teachers and casting to feel my self-worth. And over time, the micro-failures that dancers must overcome each day started to chip away at me. In my last year at SFBS, I would routinely cry in the studio. A missed pirouette or a class where I felt invisible to the teacher would completely dismantle me. Concerned teachers would stop me in the hallway with words of support, but my grit was too far gone.

Matthew Murphy for Pointe

While dealing with back-to-back stress fractures, I was forced to sit in every single class that I missed for eight weeks and watch my peers surpass me. Sage dance therapist Dr. Bonnie Robson recently told me that despite the fact that injury is the most common reason for onset for depression in dancers, most injured dancers will see doctors, physical therapists and Pilates instructors while never seeing a mental health professional.

Three thousand miles from my parents and without a mentor, I learned my coping mechanisms from my peers. I thought being skinny would make me happy, so I tried all the ill-advised dieting techniques and then-still-legal ephedrine pills. I started self-medicating and at 18 I had developed a party resume that you would read about in a Rolling Stone profile. I remember sobbing to my mother on the phone, "I love dance, but it doesn't love me." On the worst days I considered that I would be less of a burden to the people that I loved if I were gone. It would be better than not dancing.

In the years since, I have had the privilege of conducting hundreds of interviews for articles I have written in Dance Magazine and other Dance Media publications. I have the handful of great dance therapists in the country piled up in my recent call list. My conversations with them and other dancers and dance-support professionals, combined with my own experience, has lead me to an unavoidable truth: I believe that dance institutions are failing their dancers with a lack of support for mental health.

Quinn Wharton

In a recent interview, Dr. Brian Goonan, who works with dancers at Houston Ballet Academy, told me that the same drive to succeed that make so many ballet students great may also predispose them to depression. And yet, as a dance writer, when I call up so many of the great training institutions in this country to ask for an interview with the psychologist they refer their dancers to, they can't produce one. Houston Ballet Academy is the only school that I know of that makes regular office hours with a mental health professional available to their students in the studio. I hope that there are others I simply haven't found.

But I believe that small steps can move this industry in the right direction. Based upon the countless interviews I've done with professionals on the mental health of dancers, I have a few steps I'd like dancers, parents and directors to consider:

Advice For Dancers

Jim Lafferty for Pointe

  • Periods of darkness will come with this challenging pursuit, and that is normal. It does not make you weak to seek help for your mental well-being the same way that it does not make you weak to go to physical therapy or a nutritionist.
  • If a friend or teacher tells you that they are worried about your mental state, listen. And know that this confrontation is hard for them. It is an act of love, not a criticism of your character.
  • Ask for help when you need it. It is not normal to feel sad every day for two weeks or more.
  • Understand that the most difficult time in your training is also the time that you are most statistically likely to experience depression. Dr. Robson told me that people are most likely to experience their first depression in their late teens and early twenties.
  • If/when you leave dance, consider a career in mental health if it interests you. Reach out to local studios and companies and offer your services.
  • Feeling like you want to quit is a common symptom of depression, according to Dr. Goonan. It does not necessarily mean that you will, or should stop dancing.

Advice For Parents

Nathan Sayers

  • When your child registers with a new school, ask who they will be referred to if they need mental health support. Ask for that person's name and number in case the dancer doesn't want to go through the school to see them. They may not be able to give it to you, and this doesn't mean you should forbid your child from going, but if enough parents start asking, it will be heard.
  • Help your child establish reasonable goals.
  • Avoid the "my girl is going to be a principal dancer" cocktail talk; your child will feel that. And remember that criticism of their dancing should only come from their teachers.
  • Check in with your kids about more than just what is going on in the studio. Ask them how they are feeling, and if they are enjoying anything outside of dance.

Advice For Teachers and Directors

Matthew Murphy for Pointe

  • Teach your dancers to treat their mental wellness with the same care that they do their physical wellness. Break the stigma. Share your own experiences and give them permission through your acceptance to seek help when they need it.
  • Do not reserve calling in mental health professionals for cases that involve eating disorders. There are a litany of issues that a dancer may face that are just as devastating to their health.
  • If you are an institution for which dancers move away from home to train, you are responsible for their well-being. Build a close relationship with a psychologist who has spent time in the studio. The dancers should know who that person is, have met them multiple times, and know how to reach them directly.
  • Even if you are a small school, do some research on the mental health offerings in your area. Meet the psychologists and explain the specific challenges that dancers face.
  • If a once-driven student seems like they are trying less hard, skipping classes or acting lazy in class these are signals that something is wrong. Don't give up on them.


When I quit dancing, it felt like an eventuality, something that was completely out of my control. In retrospect, I see that with proper attention to the mental health challenges I was facing, I could have potentially made it much further. I was fortunate to share the studio with many great dancers in my training years—many of whom have since been on the cover of this magazine. The constant trait that I see among the dancers who have "made it" is resilience. It isn't always that girl with all the perfect feet who ends up with a dream career. Talent will take you far, but emotional strength will take you farther.

I have been amazed and thrilled to see how much the dance world has changed since I left it. Nutrition discussions are moving from low-fat to eating whole foods. Cross training is the norm and new styles of movement and body types are slowly finding their place. But this taboo remains, and it is too important to ignore.

The Conversation
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Sin #2: Misaligning the spine. Photo by Erin Baiano

Throughout your dancing life, you've heard the same corrections over and over. The reason for the repetition? Dancers tend to make the same errors, sometimes with catastrophic results. Dance Magazine spoke to eight teachers about what they perceive to be the worst habits—the ones that will destroy a dancer's technique—and what can be done to reverse the damage.


Rolling In

To get a 180-degree first position, dancers will sometimes let their arches roll forward. But turnout is not about forcing your feet open; it's about opening up in the hips. “Turning out is an activity, not a position," says Irene Dowd, who teaches anatomy at the Juilliard School. “If we stop sustaining that movement, our feet will passively roll in." Rolling in places stress on the tendons of the feet and leads to injury because the rest of the body compensates for the imbalance when your knees can't line up over your toes.

Dowd warns against using only the arch to combat rolling in. “Dancers will try to lift up their arches and pull up on the inside of the ankle," she says. This can result in the inflammation of the tendons in the ankle and lead to tendinitis, a painful overuse injury that's common in dancers. What she feels are “Victorian furniture feet—feet that aren't fully in contact with the ground" should be solid in three areas: the heel, the ball of the big toe, and the ball of the little toe. Imagine how your weight is being transferred from above, through the body and down the legs, rather than gripping the foot and lifting from the arch.

Misaligning the Spine

Distorting the back, either by crunching the lumbar vertebrae and splaying the rib cage open or by hunching the shoulders forward and tucking the pelvis under, affects every other part of the body. Since the proper placement of the torso is the foundation of any movement, a dancer with a misaligned spine will develop other deadly technique sins. Problems can ripple all the way down to the extremities and upward to the neck and head. The core will be loose, unable to provide essential support. A pelvis that either tips back or tucks under will limit the range of motion in the hips.

Christine Spizzo's students at the North Carolina School of the Arts constantly work on their placement. “The one directive I give in class more than any other," she says, “is tailbone down, navel muscles lifted." She emphasizes that the tailbone lengthens downward without tucking under, and the navel muscles lift upward, not inward. This opposition allows the external rotator muscles to be actively engaged at the top of the thigh. Spizzo uses the expression the Four Ts—“no tucking, tipping, tilting, or twisting of the pelvis"—as a reminder for students.

Clenching the Toes

Clenching, curling, knuckling—no matter what it's called, this condition hampers a dancer's ability to articulate the feet. Clenched toes also make the feet an unstable platform to stand on, creating problems for the rest of the body. The muscles and tendons of the foot, knee, and ankle must work together to perform a relevé or jump, says Edward Ellison, director of Ellison Ballet Professional Training Program in New York. Clenched toes will place unwanted stress on the joints of the legs, leading to imbalance and overuse injuries. On pointe, knuckling over can damage the bones and tendons of the feet.

Master ballet teacher Sara Neece of Ballet Arts in New York says that when the first joint of the toe presses down into the floor too hard, the second joint of the toe jams into the metatarsal. For Neece, the key to remedying clenched toes lies in “bringing sensation to those unused tendons" beneath the second joint, and teaching the toes how to work in a careful and deliberate manner. While seated, a dancer should prick the back of each clenched toe with a fingernail about 20 times. Sitting on a chair with the foot on the ground, she should drag it back toward the body, slowly raising it to demi-pointe with a forced arch. Teachers must pay attention to the response of the feet to this localized work, since overstressing the tendons can damage them. Another way to teach the toes to stretch out is to weave a strip of cloth over the second toe and alternate below and above successive toes, leaving it there during barrework and nondance activities.

Giving In to Extreme Hyperextension

Hyperextended legs, in which the straightened knee naturally curves behind the thigh and calf muscles, are prized in the world of extreme ballet bodies. Christine Spizzo sings the praise of a moderately hyperextended leg line, as the leg fits snugly in fifth position, and the arabesque looks gorgeous, with that slight curve offsetting the arch of the foot. However, dancers with extreme hyperextension must take special care. “The hyperextended dancer tends to have weak external rotator muscles," she says, so the legs are more prone to collapse in on themselves when landing from a jump, letting the body weight fall on the knees. This can result in damage to the joints that maintain the alignment of the leg, including twisted knees and sprained ankles. Even if the dancer understands how to avoid giving in to her hyperextension, she has to learn how to express herself fully while restraining her legs.

But Spizzo points to dancers such as international star Sylvie Guillem, who has used her extreme hyperextension to her advantage. The dancer must think of lengthening rather than straightening or locking the knee, even if it feels slightly bent. She must develop a heightened awareness of the turnout muscles from the top of the thigh down to the calf. “The muscles must be activated to not allow the dancer to give in to the hyperextension," says Spizzo. She uses the image of the barbershop pole to encourage dancers to apply that feeling of an infinite spiral to their legs. Somatic practices such as Pilates can help to strengthen those stabilizing turnout muscles. Spizzo insists that dancers stand with the heels together in first position and never be allowed to press back into that knee joint. To do this, “the quadriceps must remain soft. As soon as you grip, it pulls that kneecap back dangerously."

Using Unnecessary Tension

“Tension," says Daniel Lewis, dean of dance at the New World School of the Arts, “pulls you off balance. It tightens the muscles and causes injury." Stiff muscles are injury-prone muscles, which make free and confident movement impossible.

Unwanted stiffness can also limit your versatility as a dancer. “Modern dance is concerned with trying to go into space off-center and off-balance," says Mary Cochran, chair of the dance department at Barnard College. “If you spend too much time holding your body stiffly, it's hard to make the transition from working in-balance to working off-balance."

Rhythmic breathing helps dissipate tension. Think of the lungs as another limb and pace the breath with the dynamics of the music. Sustain a sense of motion in the body, even when you are still, advises Cochran. Doing so will help reverse the muscle memory of using tension as a form of stability.

Pinching Your Shoulder Blades

Although used as a strategy to open the chest in front, pinching your shoulder blades together immobilizes the back. The serratus anterior on the sides of your rib cage is so overstretched that it can't work. Edward Ellison says that pinched shoulder blades impede the freedom of the arms and the support of the upper spine. He feels that they “cause your weight to fall behind your axis, and strain the trapezius and rhomboid muscles of the back."

Irene Dowd suggests thinking about widening the tips of the shoulders to the side, to allow plenty of room for the chest. “It helps to think about the chest—full of your lungs, your heart, all those organs—as a sphere," says Dowd. “We need to have enough room for all those precious organs to breathe." To relax shoulder blades, sometimes she will tell students to focus on the movement of the hands. “Is the hand really a lively part of my being?" Dowd has her students ask. “The shoulder blade should support that hand."

Getting Stuck in a Rut

While physical habits impede progress, the deadliest sin is losing the drive to improve technique at all. Franco De Vita, principal of American Ballet Theatre's Jacqueline Kennedy Onassis School, says good technique begins with a dancer's approach to class. Being present and focused enables the dancer to learn combinations quickly—and correctly. “Not listening and changing the exercise is unacceptable," says De Vita.

Michael Vernon, chair of the ballet department at Indiana University, feels the worst thing a dancer can do “is to get fixed into doing something a certain way, being safe. I love young dancers who understand that you have to dance for tomorrow, and not yesterday." Keeping an open mind means more than just trying a different preparation for a pirouette. “Being open to new styles of dance and new ways of moving the body is vital to keeping the art relevant."

Cover Story
Portner's embrace of the unexpected has led to unexpected opportunities. Photo by Quinn Wharton for Dance Magazine

Clad in her signature loose black T-shirt and baggy gym shorts, Emma Portner is standing in a cavernous industrial space in downtown Los Angeles. A glass box—big enough to fit five dancers with only a little room to maneuver inside—sits in the middle. The five performers, Portner included, are standing inside it, side by side, palms on the glass.

"Question," Portner asks. "Are we looking at our hands?"

She steps out to watch the others try the phrase, and adds a few more steps. Quick, staccato movement, legs kicking out, torsos swiveling around, fists hitting glass. "This is a puzzle," she says, almost to herself. "I'm not sure I'll like it." The statement, like so many, is punctured with a sweet, nervous laugh.

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"When I started out, I wanted to be a Fred Astaire," he told us, "and after that a Jerome Robbins. But then I realized there was always somebody a dancer or choreographer had to take orders from. So I decided I wanted to become a director, namely a George Abbott. But as I got older I dropped the hero-worship thing. I didn't want to emulate anyone. Just wanted to do the things I was capable of doing—and have some fun doing them. By this time I'm glad I didn't turn out to be an Astaire, a Robbins or an Abbott." He would go on to become an Academy Award–winning director, indelibly changing musical theater in the process.

The Creative Process
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Health & Body
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Let's say that today you're having a terrible time following your class's choreography and are feeling ashamed—you're always stumbling a few beats behind. Do you:

1. Admit it's your fault because you didn't study the steps last night? Tonight you'll nail them down.
2. Feel worthless and alone? You slump your shoulders, avoid eye contact with your teacher and fellow dancers, and wish to disappear.

Shame is a natural emotion that everyone occasionally feels. If you answered #1, it may be appropriate—you earned it by not studying—and positive if it motivates you to do better in the future.

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My hypermobility used to cause me a lot of trouble, but I've gained confidence and strength after reading about it in one of your columns. I now have a Pilates instructor who's retraining my body and helping me dance in a consistent way. Thank you!

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She had grown up training in the recreational division at the Royal Winnipeg Ballet School, then went on to perform on Broadway and in musical theater productions around the country. She eventually left the stage to find more stable work, running a mortgage company and later getting a nursing degree because, she says, "I knew that I could do that for a long time."

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