Benjamin D. Koen
Origins and Expressions
To say that the relationship between music, health, and healing is as ancient as music itself, perhaps creates a false dichotomy that, in their origin, music and healing were separate or unrelated entities, and could therefore be combined into a relationship. Rather, perhaps in the earliest human experience the two were one unnamed reality and practice—what we might today call musichealing, musicwellness, or musicmedicine. In one track of contemporary research that explores the dynamics of music, prayer, and meditation in cultural and clinical contexts of health and healing, a similarity exists where, although music, prayer, and meditation can have independent and combined expressions to effect healing, they also very often are one and the same—an indivisible whole.1
Reaching into the past to unearth some semblance of the origins of things, or to answer contemporary questions that relate to the human condition, always brings with it even more questions to fuel our inquiry—the path can be endless, albeit a great adventure. To provide a detailed account of music and healing (musichealing, musichealth, musicmedicine) in the human experience, moving from the mist of speculation about origins and pre-history, into ancient and modern history, and finally the present, and future directions would be an impossible task in the space provided here. Indeed, the ethnomusicologists, anthropologists, musicians, healers, researchers, practitioners, therapists (e.g. music, dance, drama, and expressive arts therapists), physicians, social and health scientists, among others that have in various degrees contributed to laying the foundations, the creation, establishment, and development of medical ethnomusicology are far too numerous to mention here.
Moreover, medical ethnomusicology is certainly not the only discipline concerned with the subject of music and healing. There are multiple areas and disciplines within and without academia, research, and applied practice that often share goals and approaches with medical ethnomusicology—indeed, at times there is such a common ground between disciplines or people involved in this work at the levels of research, application, and practice, that differences become secondary, if not irrelevant. This is often, but not always best seen in people who have significant experience, have studied, or hold degrees or certifications in more than one area, or who have in-depth study and practical experience apprenticing or learning from culture-bearers and traditional teachers. At the same time, many programs are increasingly approaching their discipline-specific education and training from an integrative or holistic knowledge perspective—that is, significantly drawing from any and all areas of knowledge that directly inform any given subject within their discipline.
In addition to medical ethnomusicology, the areas that are concerned with music, sound, health, wellness, prevention, and healing are increasing and include medical anthropology, the medical humanities, cognitive ethnomusicology, applied ethnomusicology, applied anthropology, music performance, social medicine, medical sociology, global health studies, music therapy, dance therapy, expressive arts therapy, art therapy, arts in medicine, drama therapy, poetry therapy, sound therapy, sound studies, sound healing, the arts, and several disciplines across the research, scholarly, and professional areas in medicine, including holistic, integrative, complementary, and alternative medicine (HICAM), psychology, psychotherapy, neuroscience, cognition, the social and health sciences and allied fields. Additionally, new tracks within music studies are increasingly including similar concerns in their endeavors—this can be seen for instance in the new tracks of music and community engagement and music and wellness.
Notably, as this list expands and becomes more diverse, there is a corresponding increase in unity of thought with respect to an awareness and acceptance among scholars, researchers, and practitioners that music and related practices can play a significant role in human health, wellbeing, prevention, and cure. Now, the time is propitious for this journal’s readership to significantly advance endeavors within and across disciplines, within and without academia, in research, applied practice, and treatment with respect to music’s multiple and diverse beneficial, functional, therapeutic, medical, preventive, wellness engendering, and healing roles for human beings.
One Path of Many
I am often asked how I came to be involved in the area of music and healing and how was medical ethnomusicology formed? Sharing a few thoughts and reflections from this experience will be instructive as we move from past, to present, and into the future. From my earliest memories of playing music, I distinctly recall experiencing what I can now perhaps best describe as a categorical existential shift in my state of being—a kind of liminality wherein passing through the threshold into music, with its mystical, laden, and limitless dimension, brought with it an experience of the ineffable that renewed, revitalized, protected, and healed me in ways both great and small.
The experience of this transition from a present state to this personal music state enchanted and entranced me in a way that made the music state of being the one that was most natural for me—the state of being wherein I felt most at home. While each person who crosses the threshold of music can have a deeply personal and distinct experience, I have learned through my travels in over forty countries and across many more cultures that many musicians also have similar experiences as what I describe here. Indeed, the music state of being is one that often captures a person from the first time a one sets foot into its domain; at times it grows more slowly in a person’s life, though ultimately, what often happens is that the music state becomes the way one lives, views, and experiences the world at all times, with or without instrument (or voice) in hand as it were.
In addition to this personal and often shared sensibility and relationship with or beingness of music (i.e. the music state of being), another aspect of my life experience is worth mentioning. Since all of my immediate family was or still is in the field of medicine—my father was a general surgeon, my mother a nurse and director of nursing at a skilled nursing facility with some 200 beds, and my brother is a neurosurgeon—and since my parents came from diverse cultural and religious backgrounds and had a deep love for and interest in cultural diversity, including openness to diverse ways of knowing and being in the world, my framework of understanding music and healing was one that included the power to heal as a given in music. Hence, the notion of musical healing, or music as medicine, or in treatment was a very normal concept and reality for me, wherein music for healing could function alone or as one whole with other practices, such as prayer and meditation. Moreover, I was fortunate to have years of hands-on learning where I could experience the power of music not only in my own life, but also with others over different periods of time. From a young age, when my brother and I took care of the lawn, flowers, and trees at the nursing home where my mother worked, there were limitless opportunities for me to visit the residents there. With some I became close friends for a number of years, and with many others, the time was shorter, but nevertheless all the experiences had a profound effect on my life. I would spend hours in the nursing home, playing music for and with residents, in groups and often one-to-one in the privacy of their rooms. Tears would often flow, and laughter, and smiles too were part of the daily experience as the music brought out memories and emotions for residents.
Intertwined with the music was the experience of simply being present with the residents—often in silence, sitting together, and also at times sharing prayers, poems, stories, and meditations together. This first-hand experience with a culturally diverse group of people who were in the midst of different kinds of disease and healing processes in the context of an institutionalized healthcare facility, and building upon my sense of musichealing that emerged in my life prior, gave me an orientation toward music and healing that was very matter of fact or natural—that is, music and healing to me was as natural as the wind blowing or the sun shining—it was part of life.
Names, Traditions, and Social Power
The motivation for the name Medical Ethnomusicology came from the desire to create a borderless discipline within a system that has limited itself by disciplinary borders—that is, to create a field of research, applied practice, performance, and treatment that included music, medicine, health, healing, and culture that could draw from any field of the past or present and move in any direction in the future—a kind of new beginning as it were, free from the circumscription of academic conventions. Of paramount importance is that like the term music, the terms “medicine” and “medical” have a diversity of meanings across disciplines, cultures, and historical periods. Hence, medical ethnomusicology draws upon the core meaning of the terms medical and medicine to mean: that which brings benefit, health, wellness, balance, healing, cure, and wholeness. This definition is meant to be broad and inclusive and clearly not limited to a conventional biomedical understanding of medicine.
A common question is how is medical ethnomusicology related to or different from music therapy? When considering the relationship between two or more areas with shared concerns, as mentioned above, at times there is such an overlap between what a researcher or practitioner does, that there might not be much difference, if any. However, there are also clear differences as well, not so much to do with the motivations and aspirations of researchers or practitioners who simply want to serve and benefit people, but rather to do with epistemological and ontological orientations relative to the anthropological, ethnographic, social science, and performance dimensions of ethnomusicology. Additionally, the general concerns, requirements, and organization of the discipline of music therapy, as well as the institutional and administrative structures of the music academy have also helped to create an environment ripe for the beginning of a new field. While there is often a great overlap between these two and other areas mentioned above, there are also distinctions with respect to theory, methods, and practice.
Why name the new field Medical Ethnomusicology? Why not one of the terms from the list above or some combination thereof? First, if we consider the roots of ethnomusicology as being long before the formation of the society in the mid 1900’s, then look into the early history of ethnomusicology and anthropology, tracing it up to today, we find that one of the recurrent themes in ethnomusicological discourse is music and healing. Second, over the past two decades, the importance of culture and interest in culturally diverse approaches to and practices of music, medicine, health, and healing has increased in biomedicine, the health and social sciences, and in music therapy. From this vantage point, the terms medical (as defined above) and ethnomusicology could best indicate a field that includes the research and application of music, sound and related practices in diverse cultural and clinical contexts of health and healing. Equally important was to consider the long-standing fields in the social sciences and medicine where related terms were employed to indicate similar concerns, most importantly is the field of medical anthropology. Likewise it was important to consider the numerous and diverse traditional practices where local terms for medical or medicine are used in conjunction with music to indicate a concept, practice, treatment, or approach.
A related concern when naming a new field is to consider how the term resonates in the broader academic and professional world and the social power it conveys. With this in mind, employing the term medical in a holistic way that emphasizes its core meaning, and with the link to music and culture (i.e. ethnomusicology), also positions the new field within the growing discourse in holistic, integrative, complementary, and alternative medicine (or HICAM), as well as those areas of social science that have a more established history of securing major external funding. All these bode well for the future of the music academy as we reflect, discover, create, and apply new ways of researching, teaching, performing, and practicing music and healing for the benefit of the human condition.
Brief Overview of the Research and Scholarship
At the outset, it should be mentioned that the research and scholarship that informs and indeed are part of medical ethnomusicology could come from any field, cultural place, or historic period. That is, as a field that builds from an integrative and holistic knowledge base, it is not limited to one disciplinary canon of knowledge. Although the purpose of this essay is not to provide a detailed history of medical ethnomusicology, some foundational works in music scholarship should be mentioned, foremost being Marina Roseman’s Healing Sounds from the Malaysian Rainforest: Temiar Music and Medicine (1991) and the subsequent collection of articles in The Performance of Healing, edited by Carol Laderman and Marina Roseman (1996). In 1992, John Janzen’s Ngoma: Discourses of Healing in Central and Southern Africa was published, and in 1996 Steven Friedson published Dancing Prophets: Musical Experience in Tumbuka Healing. In 1997, a special issue of The World of Music, volume 39(1) titled “Music and Healing in Transcultural Perspectives,” brought further diversity to a growing body of ethnomusicological work on music, medicine, and traditional healing practices; and a subsequent issue of the same journal in 2000, volume 42(2), “Spirit Practices in a Global Ecumene” provided a continuation of research into ritual and ceremonial practices of diverse cultures. Also in 2000, two important edited volumes were added to this growing body of research: Musical Healing in Cultural Contexts, edited by Penelope Gouk, and Indigenous Religious Musics, edited by Karen Ralls-MacLeod and Graham Harvey. Another key work that must be mentioned here is Devon Hinton’s dissertation “Musical Healing and Cultural Syndromes in Isan: Landscape, Conceptual Metaphor, and Embodiment.”
The first dissertation to propose medical ethnomusicology as a new area of research and applied practice was “Devotional Music and Healing in Badakhshan, Tajikistan: Preventive and Curative Practices” (Koen, 2003). In addition, the beginnings of medical ethnomusicology had important works exploring the role of music and the arts in the lives of people with HIV/AIDS in Africa. The first book in this area was Gregory Barz’s Singing for Life: Music and HIV/AIDS in Uganda (2005), and a subsequent collection of articles, edited by Barz and Judah Cohen in 2011, The Culture of AIDS in Africa: Hope and Healing Through Music and the Arts.
Other subjects should be mentioned that have formed part of the first decade of work in medical ethnomusicology. These include applied programs for children associated with the autism spectrum,2 music and Alzheimer’s and dementia treatment and care; traditional music and dance practices as medicine for social healing; integrative research on music and medicine; music, religion, and spirituality in institutionalized medical care; cultural and clinical contexts of music, prayer and meditation in healing; music’s role in priming psychological flexibility to effect healing transformations; diverse cultural practices of music and healing; shamanism; improvisation, creativity, songwriting, and community healthcare; community, music, art, and technology in pediatric oncology care; physiological measurement of music’s effect on health and wellness; pediatric mental and behavioral health; music, public and global health; music, culture, and holistic, integrative, complementary, and alternative medicine.3
In addition, two books were central in firmly establishing the new field—the monograph Beyond the Roof of the World: Music, Prayer, and Healing in the Pamir Mountains, (Koen, 2009); and its partner edited volume The Oxford Handbook of Medical Ethnomusicology (Koen, 2008), which emerged from and expanded on the first ever conference on medical ethnomusicology, “Music, Medicine, & Culture: Medical Ethnomusicology and Global Perspectives on Health and Healing”—held at Florida State University and jointly sponsored by the College of Music and College of Medicine.4 This conference, along with the monograph and edited volume encourage three key points worth mentioning here that have formed a key foundation in the new field and set a strong framework for future engagement within and across disciplines and professional areas.
First, building from multiple traditional and scientific models, I have proposed a holistic epistemology for considering research in medical ethnomusicology that I call “the five factors of music, health, and healing”5—namely, the physical, psychological, social, emotional, and spiritual dimensions and factors of life shared among music, health and healing wherein healing transformations can be engendered. Second, the field has a health orientation rather than a disease orientation. That is, although culturally diverse illness and disease etiologies (including biomedical and health science perspectives) form part of medical ethnomusicology’s epistemological frame, an emphasis is placed on culturally diverse health, wellness, and healing etiologies, which, in addition to accounting for the five factors model, is unapologetically focused on that which creates health, wellness, healing, cure, balance and wholeness. Third, there is an emphasis on applying new knowledge in the service and benefit of the people within the contexts one has conducted research, learned, or worked, as well as to consider the underlying principles and processes of musical healing that are culture-transcendent, and to employ these for the wellness, health and healing of others in diverse cultural and clinical contexts when appropriate. Hence, although not all medical ethnomusicologists will do all aspects of the new field, we can concisely say that medical ethnomusicology is a field of holistic research, application, performance, and treatment.
In a recent article by Rebecca Dirksen, “Reconsidering Theory and Practice in Ethnomusicology: Applying, Advocating, and Engaging Beyond Academia,” she touches on several factors that are contributing to a rise in the area of applied ethnomusicology. This is relevant in considering future directions inasmuch as medical ethnomusicology is one form of applied ethnomusicology. Although not all researchers will directly move into applied research or treatment, nevertheless, as mentioned above, application forms a key component of the medical ethnomusicology.
Dirksen makes an important observation with respect to extreme imbalance between people receiving doctoral degrees and the jobs available that is worth repeating here:
…exponentially more Ph.D.s have been awarded than there are academic positions available. Several years ago, Susan Wright reported that the United Kingdom graduates roughly one hundred anthropologists from doctoral programs per year who must compete over one or two academic openings—a phenomenon that has only become more exaggerated. In the United States, a similarly extreme imbalance exists between holders of humanities PhDs and the number of university positions vacated or created in any given year. At the most fundamental level, graduates must seek out jobs anywhere they are available, which includes the public sector, the development sector, the commercial sector, and the like.6
She further asks challenging questions about how we are preparing our students for the job market within and without academia and how are we at present engaging our contemporary world. A related question is how is what we do meaningful and valuable to the world, and to what degree? Building on the importance of being relevant and of value to the world, I suggest that the work we do:
...can be relevant to one’s own life, and our contemporary world. I should emphasize that while some may view this to be a bold or challenging statement, it is not intended to be so. Rather, I view this as an unfolding expression of an outward-looking orientation that is growing in ethnomusicology and academia as a whole. This outward-looking orientation results from an aspiration to do work of value, import, and of benefit to others, which, while a central concern to many in the discipline, is especially strong among the new generation of young scholars, who are keenly focused on and passionate in their concern for making contributions in three core areas. First, they hope to serve and benefit the people in the cultures where they conduct their research; second, they endeavor to advance ethnomusicological knowledge and that of related disciplines; and third, free from the circumscription of disciplinary borders, social constructs, or conventions, through their research and practice, they aspire to contribute to the lives of people beyond their immediate cultural area of research.7
Medical ethnomusicology is among the most promising developments in music in recent times. Its foundational concepts are such that all engaged in the music academy can benefit from its growth and flourishing at the personal, professional, administrative, and institutional levels. Beyond this, in the public, private, political, governmental, and non-governmental spheres of society, medical ethnomusicology also serves as a clear and strong voice supporting and expanding on the ancient notion and belief that music is vital for human existence. Music is vital for the health and wellbeing of our bodies, minds, emotions, social and spiritual realities. Here, a reflection on our roles within the academy is apropos:
Considering that there are multiple fields and numerous disciplines that have a direct interest in music, health, and healing, and that each discipline brings a unique and valuable perspective to bear, and further considering that there is a need for a greater appreciation and sophisticated understanding of the roles of culture in musical meaning, as well as its healing power in traditional and clinical contexts the world over, medical ethnomusicology is perhaps best viewed as having emerged at the nexus of current developments in the interdiscipline. Ensuring that all our disciplines, and the interdiscipline, develop in healthy ways and serve to benefit more people more effectively and efficiently, is in part, dependent on our willingness as researchers, practitioners, performers, healers, students, scholars, and administrators, to think beyond the conventions of our particular disciplines, areas, and established administrative structures—in one sense, to let our greater loyalty be to the broader pursuit of knowledge and wisdom of which we are all a part, and allow that to inform, indeed, transform our individual disciplines as the requirements of our current time period demand. What these requirements are, and how they might influence our work at the disciplinary and interdisciplinary levels of academic discourse, research, and applied practice can perhaps only be revealed through a borderless and frank consultative process that includes a broad diversity of voices within a shared vision oriented toward benefiting humanity.8
Music, specialized sound, and related practices form a dimension of human reality that virtually all recognize as having the profound potential to effect positive and negative changes in one’s state of being. Most often, people also readily acknowledge music’s power to effect positive health or healing transformations in one or more areas of the five factors mentioned above. How do the potentialities of music relative to health, wellness, or healing relate to your particular area of music? What has your experience been with respect to these potentialities and affective powers? How can you build from your personal experience and extend that through your research, performance, teaching, or practice? What do these potentialities mean for researchers, administrators, performers, and practitioners with respect to community engagement, securing external funding, and the expansion or transformation of our programs? These and many more questions will, in part shape our future directions. I suggest that we move in these and more directions with swiftness, an outward-looking orientation, mutual support across all areas of music and related disciplines, and with a keen focus on service through music to our fellow human beings.
1Koen, Beyond the Roof.
2Koen, Personhood Consciousness; Bakan and Koen et al. Saying Something; Bakan and Koen et al. Following Frank.
3Koen, Oxford Handbook.
4This conference was funded by the Florida State University Council on Research and Creativity Interdisciplinary Support Program Grant and co-directed by myself and eminent physician-scientist, Kenneth Brummel-Smith, M.D. Subsequently, flute Professor Eva Amsler and I held a related symposium titled “Flute Summit: Health and Healing Traditions from the Americas” in 2006.
5Koen, Beyond the Roof, 25-58.
6Dirksen, Reconsidering Theory and Practice, online.
7Koen, Beyond the Roof, 6-7.
Bakan, Michael, Benjamin D. Koen, Fred Kobylarz, Lindee Morgan, Rachel Goff, Sally Kahn, and Megan Bakan. “Saying Something Else: Improvisation and Facilitative Music-Play in a Medical Ethnomusicology Program for Children on the Autism Spectrum.” College Music Symposium 48 (2008a): 1-31.
---. “Following Frank: Response-Ability and the Co-Creation of Culture in a Medical Ethnomusicology Program for Children on the Autism Spectrum.” Ethnomusicology 52(2), (2008b): 162-202.
Barz, Gregory and Judah M. Cohen (eds.). The Culture of AIDS in Africa: Hope and Healing Through Music and the Arts. New York: Oxford Unversity Press, (2011).
Barz, Gregory. Singing for Life: Music and HIV/AIDS in Uganda, New York: Routledge (2005),
Dirksen, Rebecca. “Reconsidering Theory and Practice in Ethnomusicology: Applying, Advocating, and Engaging Beyond Academia.” Ethnomusicology Review 17 (2012): online.
Hinton, Devon Emerson. “Musical Healing and Cultural Syndromes in Isan: Landscape, Conceptual Metaphor, and Embodiment.” Ph.D. dissertation, Harvard University, 1999.
Janzen, John. Ngoma: Discourses of Healing in Central and Southern Africa. Berkeley, University of California Press, 1992.
Koen, Benjamin D. “My Heart Opens and My Spirit Flies: Musical Exemplars of Psychological Flexibility in Health and Healing.” Ethos 41(2) (2013): 174-198.
---. “Music Primes Psychological Flexibility In Counseling: A Cognitive-Behavioral Healing Model.” International Journal of Business, Tourism, and Applied Sciences (2013): 299-308.
---. Beyond the Roof of the World: Music, Prayer, and Healing in the Pamir Mountains. New York: Oxford University Press, (2009).
---. The Oxford Handbook of Medical Ethnomusicology. New York: Oxford University Press, (2008).
---. “Musical Healing in Eastern Tajikistan: Transforming Stress and Depression Through Falak Performance.” Asian Music 37(2) (2006): 58-83.
---. “Medical Ethnomusicology in the Pamir Mountains: Music and Prayer in Healing.” Ethnomusicology 49(2) (2005): 287-311.
---. “Devotional Music And Healing In Badakhshan, Tajikistan: Preventive and Curative Practices,” Ph.D. dissertation, The Ohio State University, 2003.
Koen, Benjamin D., Michael Bakan, Fred Kobylarz, Lindee Morgan, Rachel Goff, Sally Kahn, Megan Bakan. “Personhood Consciousness: A Child-Ability Centered Approach to Socio-Musical Healing and Autism Spectrum ‘Disorders.’” In The Oxford Handbook of Medical Ethnomusicology, edited by Benjamin D. Koen, 461-481. New York: Oxford University Press, 2008.
This article is edited by Matthew Shevitz, Editor of CMS Forums. The Editor of Scholarship and Research expresses appreciation for the contributions of Benjamin Koen and Matthew Shevitz in this special issue.