Landing a job as a professional singer requires a melodious, clear and captivating voice. On the other hand, damaged vocal cords can lead to vocal stigma that can in turn result in a loss of income. The condition itself thus inhibits the search for medical and psychological treatment because the performer fears their reputation will be tarnished.  

Those are the findings of a recent study authored by McGill School of Communication Sciences and Disorders (SCSD) Associate Professor, Nicole Li-Jessen, PhD, and her SCSD colleague, James McGill Professor Marc Pell, PhD. Their study, titled “An integrated empirical and computational study to decipher help-seeking behaviours and vocal stigma,” was published in Nature Portfolio’s Communications Medicine 

 

Professor, Nicole Li-Jessen.

 

Prof. Li-Jessen’s study builds on research on health stigma and discrimination by Anne L. Stangl, a professor at Johns Hopkins University. Prof. Strangl’s team proposed that stigma is “a barrier to health seeking behaviour, engagement in care and adherence to treatment across a range of health conditions globally.” The paper also discussed how stigma related to race, gender, sexual orientation, class and occupation intersects with health-related stigmas, and examined how the framework can be used to enhance research, programming, and policy efforts. This framework has been widely used for studying stigma against a range health conditions, including leprosy, epilepsy, mental health, cancer, HIV and obesity/overweight. 

In contrast, the stigmatization process of communication disorders is under-studied even though the vast majority of people with communication disorders, for example, hearing loss and stuttering, encounter discrimination, based on 2024 statistics from the American Speech–Language–Hearing Association. 

 “Our lab has been using computer simulations to answer biomedical questions,  so I’m taking a new direction to apply our computing technology to understand vocal stigma in addition to the traditional survey approach,” explains Prof. Li-Jessen, who is also Canada Research Chair in Personalized Medicine of Upper Airway Health and Diseases and Director of Voice and Upper Airway Research Laboratory. “In this study, we wanted to understand how social networks, for example, when you interact with someone, will have the same stigma effect outside your social circle, with those who have not known anything about or do not have experience of vocal stigma.” 

Prof. Li-Jessen’s simulation data showed that vocal stigma could be worsened and polarized with larger social circles. That is, large social networks may exacerbate the stigmatization process, i.e., negativity spreads faster than positivity. She thanks the collaboration of the Alliance of Canadian Cinema, Television and Radio Artists (ACTRA) and National Association of Teachers of Singing (NATS), as well as the funding sponsor, Social Sciences and Humanities Research Council for being able to complete the study. 

Among professional singers, about 46% reported having a history with voice disorders, compared to 18% of the general population. For those in their early training, almost 60% of students in drama acting showed clinical signs of vocal dysfunctions. “They just try to keep pushing, using their voice, giving them no time for recovery. They don’t want to lose their shows and, as you know, the show must go on,” Prof. Li-Jessen says. 

To correct vocal cord damage, a hierarchy of treatments can be applied. “If it’s a benign lesion, we usually try to do behavioural voice therapy first to see if the lesion will go away, or correct some of their behaviour,” Prof. Li-Jessen says. “If that doesn’t work, usually the patient will be sent to surgery. However, not all singers will opt for surgery because there is a risk of scarring. Sometimes scarring can lead to a partial loss of the voice. So, it means they will lose their income.” 

McGill’s SCSD has been holding annual public seminars, panel discussions and free voice screenings for World Voice Day. “We hope to expand this program to reach more artists across the country.” 

Improving performers’ access to services could also play a role, for example, by including the coverage of employment and medical insurance for performers requiring vocal health care. Upholding medical privacy is also important in ensuring that performers’ careers are not unfairly damaged by past health issues. 

“The first step, though, is to increase awareness of vocal stigma within the performance industry,” Prof. Li-Jessen says. 

Related: 

To learn more about Prof. Li-Jessen’s research, please visit https://voice.lab.mcgill.ca/ 

Glick, A.R., Jones, C., Martignetti, L. et al. An integrated empirical and computational study to decipher help-seeking behaviors and vocal stigma. Commun Med 4, 228 (2024). https://doi.org/10.1038/s43856-024-00651-3 

Anne L. Stangl, et al. The Health Stigma and Discrimination Framework: a global, crosscutting framework to inform research, intervention development, and policy on health-related stigmas. BMC Medicine 17, 31 (2019). https://doi.org/10.1186/s12916-019-1271-3