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Beyond the Roof
of the World
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Beyond the Roof
of the World
Music, Prayer, and Healing
in the Pamir Mountains
benjamin d. koen
New York
2009
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Copyright © 2009 by Benjamin D. Koen
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Pamir, Samandar Pulodov for his brotherhood, mystical insight and
calm communication, expertise and tireless assistance in the fi eld;
Davlatnazar for his masterful driving through treacherous moun-
tain passes and over raging rivers, his sense of humor and positive
nature; nurse Lailo and Dr. Shirinbek, both of whom helped to fl esh
out aspects of the medical dimension of the project in Badakhshan;
Rafi que Keshavjee and all the friends at the Aga Khan Humanities
Project for their hospitality and assistance in welcoming my wife and
me to Tajikistan and facilitating our work; and Margaret Mills for
introducing me to new friends and colleagues in Dushanbe.
I also extend my gratitude to numerous colleagues across the
fi elds of music, medicine, the humanities, and sciences, who have
encouraged this work, especially Margarita Mazo, Ted Levin, Daniel
Avorgbedor, William Malarkey, Marina Roseman, Kay Kaufman-
Shelemay, Gregory Barz, Ken Brummel-Smith, Karen Brummel-
Smith, and Michael Rohrbacher. I also offer my heartfelt thanks to
the following people: to all my Persian-speaking family, friends, and
viii acknowledgments
colleagues who continually share their knowledge of Persian with me, and
many of whom assisted in translating some of the Tajik-Persian language texts
that underlie much of this study, especially my mother-in-law, Mahin Vojdani,
Dick Davis, and Parvaneh Pourshariati; to Shiling Ruan for assistance with the
statistics; and Suzanne Ryan for her intellectual courage and excellence in her
work. I am also honored to acknowledge and thank my brother, Joseph Koen,
for his loving encouragement, advice and consultation regarding the medical
and neurological aspects and implications of my research; and to my parents
Thelma and Leon Koen for their unfailing and unconditional love, strength,
and encouragement, and their example of sincerity, integrity, and trustworthi-
ness. Most of all I thank my beloved wife and best friend, Saba Koen, who
shared in these and so many other experiences of music, prayer, meditation,

Vowel Sound
a lab
â law
e bed
i machine
u tutu
o go
xii language, pronunciation, and transliteration
Consonant Sound
kh Bach (German) or José (Spanish)
zh vision
The “â” sound in Tajik lies in between the sound found in “law” and that
of “go,” whereas in the standard Persian spoken in Iran, it is most often pro-
nounced as the sound of “law.” The “gh” and “q” represent sounds not found in
English, a hard velarized “g” pronounced higher up in the mouth” (Lewis, 2000,
xvii). Many authors often use the French “r” as a reference, which serves as a
good starting point, however, the intended sound is quite distinctive and unlike
the French “r.” To pronounce the Tajik-Persian (or Persian) “gh” or “q,” a helpful
comparison can be made with the pronunciation of the English “g.” To pro-
nounce “g” (as in “gap”), one makes contact with the middle of the tongue to the
point where it meets the soft palette; the tongue disallows airfl ow until the point
of contact is released, thus producing the sound “g.” With the same process in
mind, rather than using the middle of the tongue, one should use the area that
produces the French “r,” the back of the middle velar region, which must make
contact with the palette so that there is no possible airfl ow. When this point of
contact is released, the proper sound is produced. One must have the “gh” or “q”
sound in mind, or a hard “k” sound might be produced. Other consonants are
basically consistent with their English equivalents. Plurals in Persian are gener-
ally created by the addition of ân, ât, or hâ on the end of a word. For simplicity
and clarity, I have opted to use “-s” to indicate plural forms.

4 beyond the roof of the world
While it is still overwhelmingly true that “in the West, music simply is not part
of the biomedically driven clinical reality encountered in doctors ’ offi ces, clin-
ics, and hospitals” (Friedson 1996, xi), the last decade has seen a new degree of
interest and openness on the part of physicians, scientists, and funding institu-
tions to support and conduct research that considers music, prayer, meditation,
and related practices as potentially effi cacious medical and psychological inter-
ventions for use in clinical and public health settings. This broad-based interest
includes a deeper awareness that spirituality and belief are essential to include
in the outmoded mind-body description of a human being.
Across diverse cultures, musical healing is practiced within the context of
broader belief systems and religions, which often function as holistic entities.
Friedson observes, for instance, that “in traditional African societies, religion
and healing form an amalgam that is often functionally irreducible into constit-
uent parts” (Friedson 1998, 274). Throughout traditional cultures of the world,
music is almost always central to healing, and is viewed as being essentially
spiritual or “other worldly.” Additionally, a common etiological view among
practitioners in traditional healing systems is that “any illness is . . . ascribed
to a disturbance of the balance between man and spiritual or mystical forces,
and the aim of health seeking is to restore the equilibrium” (Oosthuizen 1989,
30). Music is often described as the bridge by which the physical and spiritual
are connected and can be the most vital component of a healing ceremony
or practice. Moreover, the physical and spiritual dimensions are often viewed
not as separate dimensions that must be connected but, rather, as aspects of
one reality, where music functions as a balancer of these aspects, facilitating
and contextualizing the ritual performance of healing that occurs through the
interaction of physical, spiritual, and musical forces.
Establishing a balance of the physical and spiritual, however, is not only a
central concern in cultures where traditional or indigenous knowledge is in-
tegral to life; it is of profound importance to countless individuals in the most

well as the miraculous cures and spontaneous healings that are documented
throughout the history of medicine have overwhelmingly shown, there can be
an effi cacious relationship between the tangible and intangible—between be-
lief, consciousness, the metaphysical, and the body.
1
An important institutional
response to this expanded awareness has been the formation of the National
Center for Complementary and Alternative Medicine (part of the NIH) in 1998.
This center funds research in various areas, which have parallels in diverse cul-
tural contexts of music and healing, including prayer, dance, psychotherapy, im-
agery, hypnosis, and meditation.
A critical addition to the discourse, which has yet to be brought to the
forefront, even though it shapes all healing experiences, is the laden frame
of cultural context— the dynamic, multidimensional spaces and places where
music and related praxes are empowered with cultural and personal meaning
to promote health and facilitate healing. This is but one area in which medi-
cal ethnomusicology strengthens the course of integrative medicine. In addi-
tion, medical ethnomusicology brings a wealth of diverse healing practices and
in-depth knowledge of music and sound phenomena to bear within the ever-
present and ever-changing frame of culture.
The inclusion and utilization of both the physical and spiritual re-
alms in healing has been described as a “sacred clinical reality” (Kleinman
1980, 241), which builds on the socially and culturally informed concept of
“ clinical reality”—or a complex of interrelated features including “the beliefs,
6 beyond the roof of the world
expectations, norms, behavior, and communicative transactions associated with
sickness, health care seeking, practitioner-patient relationships, therapeutic ac-
tivities, and evaluation of outcomes” (Kleinman 1980, 42). Building from this
framework, healing systems or clinical realities oriented toward that which is
spiritual, religious, or metaphysical “emphasize sacred reality, illness orienta-

people in the cultures where they conduct their research; second, they endeavor
to advance ethnomusicological knowledge and that of related disciplines; and
medical ethnomusicology and the ontology of oneness 7
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.
These aspirations are, in part, what initially drew me to ethnomusicology,
and what have compelled several scholars to pursue applied research in the
medical ethnomusicology realm. Certainly, it cannot be said that these three
points are new and only of interest to the younger generations of ethnomu-
sicologists and colleagues in related fi elds of study and applied practice. On
the contrary, these motivations, along with an inherent love for people and
music, have oft been the direct or underlying impetus that has inspired many
a heart and mind throughout the history of ethnomusicology. I highlight these
three points here because they form a sense of primacy that compels many in
our disciplines to conduct research that is not only meaningful and relevant to
one ’s self and the culture from which it emerges, but also to people beyond that
particular cultural milieu.
In hand with these concerns is an ontological sensibility that uniquely
shapes how many younger generation ethnomusicologists view themselves and
those with whom they work in the fi eld. Fortunately, like their predecessors, this
generation is by no means uniform. Nevertheless, the sociocultural changes of
the last quarter century have not only created a unique global awareness and
opportunity for engagement among the peoples of the world that was not as
typical or possible previously but also have shaped the processes of accultura-
tion and academic training of these scholars, making them keenly aware that
they are intimately linked to and part of the whole of humanity, which, for
those who engage cultural domains as central to their research, comprises the
broadest sociocultural frame of life on the planet. Simultaneously, there is a
growing awareness that each individual comprises a unique cultural landscape

that he was a thinking thing was the product of his question, and that question
was a product of specifi c practices—those of disembodied, unmindful refl ec-
tion” (Varela et al. 1991, 28). Their thesis, which is, on many points, expressive
of Bohm ’s technical and philosophical argument, and that encourages a balance
between what they call “two planetary forces, science and Buddhism” (Varela
et al. 1991, 254), intersects with the present book in many ways.
This book is also concerned with a harmony between multiple domains of
knowledge—science, religion, spirituality, belief, culture, music, and experience—
and approaches ways of knowing and ways of healing as being centrally connected to
transformative experiences in which multiple types of music, prayer, and medita-
tion are key for embodying a state of being that is expressive of wholeness and
health. Another shared aspect is that Varela, Thompson, and Rosch are also con-
cerned with making a positive difference in the world that is not confi ned to con-
tributing knowledge to “their” area of cognitive science alone, but seeks to appeal
to a readership that might engage mindfulness awareness as a way of enacting a
better world.
These formulations in physics (Bohm 1980) and cognitive science (Varela
et al. 1991) are mentioned here to give a broader purview of the ontological
sensibility that is growing within academia, which informs the younger
generation of ethnomusicologists ’ lifeworlds, and that categorically shifts
former presumptions based on separateness and otherness to connectedness
and wholeness.
This ontological shift also has important implications for ethics in the fi eld.
While this ontology engenders an increased respect for the diversity of another
medical ethnomusicology and the ontology of oneness 9
human being or culture, there is a corollary increased sense of belonging or
shared existence on the planet that allows for a more intimate and transparent
engagement and discourse between all participants in fi eld research about ethi-
cal issues that previously might have been viewed as taboo for participants to
broach, or nonessential to critical ethnographic or scientifi c research. Indeed,

of the reader of Barz ’s sensitive and thought-provoking ethnography. Rather,
a reader from the new paradigm would encourage him and others engaged
in this work to stretch as far as they are able, bringing as many people into
the process as possible to effect a positive change through musical affect and
performance sooner than later, not only across the continent of Africa, but any
10 beyond the roof of the world
place in the world where music and the expressive arts can educate people to
transform not only the persistent misunderstandings about HIV/AIDS but also
behaviors, relationships, health practices, perceptions, and health outcomes.
Barz ’s Singing for Life is an example of a work that is not only concerned with
the multivocal singing of a particular story with sensitivity and transparency
but, quite simply, it is concerned with making a difference in human life.
Serving others or making a positive difference in human life through one ’s
work is the hallmark of the new ontological paradigm from which medical
ethnomusicology emerges. It is interesting to note that the recurrent and central
theme voiced within the Association for Medical Ethnomusicology
2
is that what
we do benefi t people through music ’s potential to promote health and facilitate
healing. Moreover, among the diverse membership of the association and the
multiplicity of interests and approaches to research, applied practice, and per-
formance, many are involved in some aspect of collaborative research, and
are also active musicians in a wide array of settings where music is central to
effecting positive changes in health.
3
Ontology of Oneness
The core value on which my research rests is a particular sense of being that
I have called ontology of oneness. In the fi eld, ontology and epistemology can
be viewed as two aspects or frames that characterize and guide fi eld research.
Ontologically, contrary to the dominant, binary and often divisive perspectives

are born. Perhaps the fi eld simply is not.
Refl exivity, Transparency, and Accuracy
Along with these movements and ontological sensibilities, is an increased in-
fl uence that refl exive anthropology is having across academia, which is fully
present in, but certainly not limited to, ethnomusicology and anthropology.
For instance, within the health science literature, this infl uence is most notably
present in the establishment and expansion of the medical humanities and
ICAM, as well as the growing awareness of the importance of narrative medi-
cine, where the voices, thoughts, and beliefs of all participants, including pa-
tients, family, researchers, and practitioners, are becoming further integrated
into a multivocal expression of human experiences that traverse domains of
illness, disease, grief, pain, suffering, health, healing, birth, and death. Addi-
tionally, over the last decade, the dramatic increase in the range and scope of
research in medical anthropology can be seen as fueling a unique balance be-
tween refl exive and objective approaches to research, which has also shaped
the present book.
Such a balance is particularly important to this book in that it proposes a
new model of research that integrates physiological experiments, which require
a certain type of methodological rigor for meaningful data to emerge; and it
can be seen as a refl exive and phenomenological ethnography, which requires a
different type of methodological rigor, and which conveys indigenous and cross-
cultural epistemologies of healing from Tajik Badakhshan, including threads of
indigenous knowledge that exist in that region; other knowledge that is Pamiri,
but that might not be considered necessarily “indigenous” (e.g., views from
12 beyond the roof of the world
certain Pamiris who have been trained as medical doctors outside of Pamir, and
who might also practice other indigenous modalities of healing); the views
and dynamics that a researcher brings to the fi eld; and the thoughts, theories, and
new knowledge that can be generated through the interaction of all of these.
Balancing and integrating multiple threads of knowledge in ethnography,

integrity and honesty, is more than a “bit player”? One cannot rightfully claim
to be a bit player if one was not, anymore than one can claim to be a full partici-
pant if one was a bit player or a hands-off observer. Refl exivity then, becomes a
vehicle of ethics in ethnography, a way to balance one ’s writing with the actual
experiences from which the ethnography emerges.