[Invited Submission - Special Issue]

Creative Pansori: Methodological Features & Medical Ethnomusicological Aspects of a New Korean Approach to Music Therapy

By Hyunju Kim & Wolfgang Mastnak


Creative Pansori is a music therapeutic method especially designed for people receiving treatment for depression. Developed by the Korean music therapist Hyunju Kim, Creative Pansori was internationally presented at the World Congress for Music Therapy 2014 in Krems / Austria. Based on elements of the Korean UNESCO cultural heritage “Pansori”, Hyunju Kim created a clinical method integrating the patient’s self-expressive narration, the therapist’s drumming, and specific verbal and non-verbal interactivities.

Creative Pansori mirrors the spirit of traditional forms of Pansori which date back to the 17th century and are considered to have their roots in Korean shamanism. This fact raises two crucial questions: How can tradition-based practices be applied in modern clinical, namely psychiatric contexts? And can these methods also be used in a cross-cultural way? As epic biographical practices, therapeutic drumming, and highly nuanced arts-related communication between therapist and patient are important phenomena in various cultures, we assume Creative Pansori to be of possibly cross-cultural music therapeutic value. To verify this hypothesis, however, requires further international and interdisciplinary investigations.

Creative Pansori seems to trigger multifaceted psychological and neurobiological processes which facilitate therapeutic coping and cognitive re-organisation. In order to synchronise somatic micro-structures the therapist’s high empathetic reactivity is required.

Keywords: Pansori; ethno music therapy; Korean shamanism; expressive therapies; therapeutic storytelling; song-writing.


On November 7, 2003, the UNESCO proclaimed the Korean Pansori tradition a masterpiece of the oral and intangible heritage of humanity. On July 11, 2014, Hyunju Kim presented her music therapeutic studies on Creative Pansori at the 14th World Congress of Music Therapy in Krems, Austria. Wolfgang Mastnak found this a convincing approach and a highly valuable contribution to the multifaceted repertoire of music therapy. This involves the question of cross-cultural transferability and touches upon the notion of “independent variables” (Roseman, 2008, p. 19):

Anthropologists and ethnomusicologists insist on the embeddedness of healing practices in individual, social, and historical contexts, but cognitive or biomedical experimentalists find delight in the extraction and isolation of independent variables … Medical ethnomusicology, or the study of music, medicine, and culture, has the challenging task of living at this juncture.

Both Hyunju Kim and Wolfgang Mastnak agreed to further collaboration, Hyunju Kim as music-therapeutic practitioner and founder of Creative Pansori, Wolfgang Mastnak as a clinical and cross-cultural researcher. This collaboration concerns what Koen, Barz and Brummel-Smith (2008, p. 3) call the “burgeoning area of medical ethnomusicology, a new field of integrative research and applied practice the explores holistically the roles of music and sound phenomena and related praxes in any culture and clinical context of health and healing.”

Case Report: A 35 Year Old Korean Woman With Major Depression

The following case report: a) introduces the clinical practice of Creative Pansori and elucidates its typical features, b) defines a clear-cut starting point for our following theoretical analyses, c) encourages cross-cultural discussions on therapeutic epic chants and their underlying cultural-anthropological principles. Although health-related epic chant can be found in many cultures, we should not call this a worldwide phenomenon. Generalisation and the use of terms like “worldwide” is problematic in cross-cultural discussion. In this context Thomas Turino (2003, p. 51) points out that a cultural category “global” is too all-encompassing and vague and too deeply tied to capitalist expansion and the notion of “globalisation”.

Mrs A, Korean, 35 years old, married, no children, since age 32 diagnosed with depression, refuses pharmaceutical treatment which is a main reason for assigning her to music therapy. Her anamnesis includes former temporomandibular and otological symptoms. Suspicious mamma and uterus status leads to gynaecological surgery, however without symptom-reducing effect. This coincides with the onset of anxiety disorders as well as hypochondriac traits. The patient complains about serious conflicts with her mother-in-law and describes dominating inner tensions and devastating anger. According to her words she has given up hope and realises a complete loss of her will to live.

The whole music therapeutic intervention is performed from April to May 2014 and consists of only 12 sessions. The therapeutic contact is characterised by mutual respect and empathetic, patient-centred orientation. In contrast to predefined role definitions that generate a certain patient-therapist-hierarchy, the therapeutic rapport is built through psychological support, dynamic creative processes, and artistic collaboration.

At the beginning of the therapeutic process, Dangas, short songs which are usually offered before a Pansori performance, about the four seasons are used to create an atmosphere facilitating a positive approach to life as well as her readiness to break negative cognitive patterns. The consequent process should deepen the patient’s awareness of depressive conditions as well as of still existing positive vital energies. In the end Mrs A becomes able to track down resources to cope with the hardships of life and to reorganise her existence.

During the first therapeutic phase traditional Pansori triggers associations and links the artistic contents with biographical moments, step by step the patient begins to create her own Creative Pansori narration. Emotions get expressed through poetic images: in the authors’ opinion the poetic image of the autumn wind becomes a symbol of isolation and the dreamless winter nights create an icon of hidden anxieties. The whole music therapeutic process leads to:

  • the ability of highly nuanced emotional expression and symbolisation;
  • the discovery of positive sensations and biographical memories;
  • the patient’s readiness to actively overcome hardships and to seek creative solutions;
  • the re-discovery of self-responsibility for the joys and sorrows of life.

In addition to a significant decrease of depressive symptoms the therapeutic process strengthens the patient’s self and encourages her to actively shape her life.

Creative Inspiration & Creative Reinforcement

With regards to creativity, the case of “Mrs A” suggests four hypotheses:

  • listening to Dangas facilitates biographical associations and triggers creative reactions in Korean depressive patients;
  • artistically accentuated, empathetic, and patient-centred approaches help to activate creative potentials;
  • text-writing and Pansori-oriented performance work as creative reinforcements. Inter-depending experience of artistic identity and the vital availability of creativity form therapeutically effective circuitries;
  • in therapeutic contexts creativity has to be seen both as a psychological and an artistic entity that play crucial roles for the genesis of new self-images as well as for re-gaining adequate self-efficacy.

Referring to her new music therapeutic concept Hyunju Kim emphasises the term “creative” and points implicitly to three issues: What role does creativity play in therapeutic contexts? Has clinical work with Pansori a certain power to enhance creativity? Are these findings cross-culturally transferable or do they necessarily depend on Korean enculturation?

From an anthropological perspective creativity is deeply intertwined with the human evolution (Simonoton, 2003) and involves issues of evolutionary adaptability and social adjustment. Phylogenetic aspects of creativity (Byrne, 1998) let us assume analogous ontogenetic mechanisms. Though there is strong evidence of creativity as a therapeutic agent as well as of meaningful interplays between creativity, brain functions, and the arts (Zaidel, 2014) underlying neurobiological mechanisms are still mostly unknown and the essence of creativity regarded a mystery (Boden, 2013).

Both in therapeutic practice and in clinical theories creativity has considerably gained in importance. Creativity seems to have decisively contributed to the development of the human brain and its neurofunctional configurations (Dunbar & Schultz, 2007). Under psychosocial strain creativity may decide between pathological developments and personal growth (Provine & Lemberger, 2014). In the context of psychological health promotion creativity is considered a crucial factor of resilience (Metzl & Morrell, 2008) and may essentially contribute to therapeutically important cognitive alterations (Finkelstein, Vardi, & Hod, 1991).

These considerations are obviously of eminent importance for Creative Pansori. The setting not only stimulates the patient’s innate creativity for poetic purposes, but also initiates curative moments. Overlapping processes of self-oriented and authentic narration seem to trigger creative potentials and promote a neuro-cognitive reorganisation of the psyche. There is no doubt that Pansori belongs invariably to Korean culture. With regard to the interdisciplinary considerations above, however, we advocate the possibility of its cultural adaptability and consequently cross-cultural clinical applicability.

Therapeutic Storytelling, Song-writing & Creative Pansori Narration

Mrs A showed a baffling progress of artistic expression. Though at the beginning of the therapeutic sequence she just uttered trivialities such as “In summer it was hot and so I felt hot”, step by step she used a more poetic language to express feelings and reminiscences. For instance, inspired by the four-seasons-Dangas she wrote and performed [original text in Korean language, see appendix A]:

As the pain grows in my mind
I begin to see things that had not been seen before.

Sometimes, when I see beautiful things, I seem to live.
As I look around on a shiny day, I can see people who suffer more than I do.

I cannot forget the colour of the sky,
I could fall into the blue sea of Jeju,
It is suffocating that I cannot enjoy the summer day.

Endless suffering and waiting.
As time goes by I fall into my mind. Nobody to meet and to talk to.
I must talk to somebody.

Endless border of waiting.
When can I be happy?
Can I overcome the hard times? Let’s find a way.
Till spring comes, till spring comes in my mind, just wait.

The word “waiting” plays a crucial role in Mrs A’s poem. This was a very subjective decision and we have to be careful not to overinterpret this term which is of no extraordinarily important meaning in Korean culture. For Mrs A, however, “waiting” meant to regain desire and happiness in life.

From a neuroscientific perspective the question about the role of neurotransmitters (Flaherty, 2005) and prefrontal activities (Gonen-Yaacovi et al., 2013) in creative processes and their therapeutic impacts arises. Such neuropsychological considerations involve neuro-psychiatric issues, e.g. concerning depression and schizophrenia, and suggest the possibility of cross-cultural transferability of expressive arts-therapeutic means. Appropriate investigation of such issues requires interdisciplinary and cross-cultural research and goes beyond the possibilities of a phenomenological case study. From aesthetic and cultural anthropologic perspectives, however, we have to carefully respect specific cultural features and codes. In traditional Pansori, for instance, the term “Imyeon” means the ability and mode of a singer to express the deep essence of a text. To understand the singer when he “draws the Imyeon”, however, requires specific Korean acculturation (Kim, Kim, Kim, Kim, & Park, 2009). Nuances are important, as Tara McAllister-Viel (2001) shows in her cross-cultural treatise about breath and sound production in Pansori.

Pansori is a highly complex and aesthetically demanding cultural phenomenon (cf. Lee, 2008). Virginia Gorlinski (2013) gives a concise introduction:

P’ansori, sometimes called Korean folk opera,  a genre of narrative song of Korea, typically performed dramatically by a vocalist, accompanied by a puk (double-headed barrel drum). Built from the word p’an, meaning “open space,” and sori, meaning “singing” or “sound,” the term p’ansori itself is a reference to the markets, public squares, and other such open venues where performances originally took place. <br />
With a fan in hand, a p’ansori singer uses a combination of ch’ang (song), sasŏl (narration), and pallim (dramatic gesture) to tell a story. Meanwhile, the drummer provides the appropriate rhythmic setting for each song. A considerable amount of improvised interaction occurs between the drummer and the vocalist throughout the performance.

With regard to clinical practice we finally have to emphasise the long tradition of storytelling in psychotherapy. In receptive settings the therapist takes the role of the storyteller (De La Torre, 1972), typically offering tales in order to trigger curative processes (Bergner, 2007). In contrast to these practices, creative storytelling refers to the patient’s activities. Writing, improvising, or performing stories the protagonist uses literary techniques to processes biographic images, traumatic experiences, desires and hopes (Rennie, 1994). In music therapy this approach is rather known as therapeutic songwriting (Baker, Wigram, Stott, & McFerran, 2008).

Integrating aesthetic experiences with traditional Pansori and “songwriting” in Korean Pansori styles Creative Pansori involves elements of both approaches: arts-related inspiration and aesthetic free association on the one side, creative production and artistic expression on the other. Improvisation makes therapeutic use of the power of the creative moment, expressive singing contains more self-representing information.

Contemporary clinical application of Pansori touches upon the issue of Pansori and making of tradition in modernity (Um, 2013). Further scientific discussion which involves particularly a Korean and cross-cultural perspective is needed. Addressing the authors, Jane Edwards, University of Limerick, particularly highlights that morality tales related to Confucianism are featured strongly throughout Pansori repertoire and that Buddhism, beyond mystic shamanism, is part of the syncretic blend being performed in Pansori.

Expression, Transformation, & Catharsis

Expression, namely self-expression, is considered one of the most powerful means of psychotherapy and arts-related therapies. In the West the idea of healing expression goes back to the Ancient Greek notion of “catharsis”, meaning in a sense purification or cleansing. Originally indicating psychological effects of a tragedy on the spectator, contemporary notions of catharsis point to purgation from emotions through the arts. Thus contemporary expressive therapies emphasise the healing power of artistic self-expression, authentic imagination, active participation and the entirety of body and mind (Malchiodi, 2005). These aspects are especially mirrored by various modes of psychological, artistic (Knill, Barba, & Fuchs, 2004; Knill, Levine, & Levine, 2005) and spiritual (Koss-Chioino & Hefner, 2006) transformations.

Therapeutic moments of Creative Pansori refer to these psychological as well as cultural-ethnological aspects. Epic chant expression together with rhythmic percussive accompaniment are characterising constituents of Pansori (Jang, 2013), which originated in south-west Korea in the middle of the Joseon period (1392-1910). The term pansori comprises two parts: the Korean word pan, meaning a place where many people gather, and sori, which can be translated as “sound”. Early therapeutic aspects point to narrative songs of Korean shamans which may have influenced the genesis of Pansori.

Describing a way of culturally accentuated expression, Pansori differs from emotional reactions such as weeping, crying or laughing where artistic, aesthetic, and psychological transformations play a crucial role. In terms of psychoanalysis this can be interpreted as a form of cultural sublimation, though not necessarily in the sense of a defence mechanism. Traditional Pansori uses stylized speech and respects a certain scenic design, moments that characterise also Creative Pansori: on the one side the patient is encouraged to express deep feelings, on the other side the cultural frame gives security and prevents the patient from getting mentally lost. This very subtle balance between psycho-artistic freedom and cultural boundaries seems to be not only a main feature of Creative Pansori but also a possible sense-making guideline for various arts-therapeutic settings: Frequently arts-related cathartic transformation processes require both creative freedom and guided feelings of safeness. Although Creative Pansori derives from traditional Korean music drama, we have to be aware of the fact that presentational forms and shaman roots of both are not necessarily the same.

Creative Pansori & The Power of Shamanic Self-healing?

Shamanism, humanity’s most ancient spiritual practice (Winkelman, 2000), has achieved a dramatic modern resurgence. We do not advocate esoteric trends and dodgy practices of neo-shamanism. Still we hypothesise that shamanism is not a singularity of archaic cultures, but rather an anthropological phenomenon: There are features of shamanism (Eliade, 1951) which seem to touch the sources of the human nature. This phenomenon coined the term of “the shaman within” (Poncelet, 2014) which refers essentially to innate self-healing mechanisms. Broadly speaking, in the realm of medical ethnomusicology, Shamanism is regarded as a phenomenon of major importance (cf. Olsen, 2008)

Korean shamanism, which is not well known in the West, plays an important role for spiritual practices in Korea which involve a wide variety of religious elements (cf. Buswell, 2007; Baker 2008; Grayson, 2013) as well as for understanding Korea’s cultural heritage. This refers especially to Muism and Sinism, which are deeply associated with the ethnic religion of Korea (Lee, 1981; Kim, 1998). In addition to these core characteristics Korean shamanism is also found in the context of clinical indications (Kim & Ko, 2011).

Though we have to respect anthropological distances between archaic shamanistic rituals and modern clinical practices, modern interdisciplinary research tries to track down the common truth of archaic and medical explanations of healing principles. Though shamanic tales, psychological theories, and neuroscientific studies are of extremely different nature, together they may contribute to the scientific revelation of the essence of human nature and health (Krippner, 2002; Hyman, 2007; Hutch, 2013).

In this context we suppose that Creative Pansori contains moments of incantation of life energies, modes of creative life-symbolisation, trans-spiritual communication, and self-healing potential of music-associated trance phenomena. It is obvious that these hypotheses require more ethnomedical as well as clinical research. Though warning about dangerous charlatanism we have to take serious reports that elucidate how to integrate shamanistic and contemporary medical approaches (De Schweinitz, 2010).

As with healing traditions of Siberia (Walker, 2003), shamanism is deeply connected with music, there may be a tendency to hypothesise a certain healing power of rhythm and sound which, from a Western perspective, might be called “mystical.” This refers also to shamanic music rituals in Korea (Lee & Yi, 2004). For further discussions non-hierarchical epistemological paradigms that accept the equal right of truths from various disciplines seem to be mandatory.

Creative Pansori in Cross-cultural Clinical Application?

Hyunju Kim and Wolfgang Mastnak met for the first time at the World Congress for Music Therapy 2014 in Krems. The congress focussed on “Cultural Diversity in Music Therapy – Practice, Research and Education”, though the original idea for the congress topic was cultural sensitivity. This much more delicate expression, however, points to the often inseparable connection of enculturation and arts-related methods in therapy as well as to what extent music therapeutic models can be cross-culturally applied.

In music therapeutic domains such problems have to be seriously discussed: On the one side because of the risk of misinterpretation and/or simplification of ethnic elements in Western artistic and therapeutic practices. On the other side because of trends to implant western cultural practices in Eastern Asia which might be – in clinical domains – inadequate for patients with Eastern Asian enculturation. In this context, however, we have to take recent socio-cultural developments into account. Novel cross-cultural “blends” arise which contradict a binary view of East and West.

In spite of critical positions considering cultural identity an illusion (Bayart, 2005) and revealing the fragility of cultural authenticity (Lindholm, 2008) we suggest to consider a dualistic music therapeutic model: curative susceptibility to music is ontologically determined and represents an anthropological entity. Variations are genetically and epigenetically determined and generate a huge heterogeneity. The responsiveness in concrete musical situations, however, depends on three main interdependent factors: enculturation, self-concept, and momentary psychosomatic conditions. This position seems to go along with Koen et al. (2008) and involves both culture independent variables and cultural imprints, i.e. anthropological constants and the heterogeneity of enculturation.

Cultural transferability and cross-cultural applicability of Creative Pansori has to be seen from the perspective of this dualistic model. While it is very unlikely that typical Korean Creative Pansori triggers similar therapeutic effects in patients with different enculturation, we strongly hypothesise the clinical effectiveness of its determinants: biographical epic chant, rhythmic support, empathetic rapport, artistic expression and symbolic aesthetic experience.

Interaction, Synchronisation, & Empathy

In contrast to many functional medical applications of music such as in hypertensive patients, psychiatric music therapy is intertwined with modes of communication and therapeutic rapport. This feature even gave a music therapeutic concept its name: “Interactive music therapy” (Oldfield, 2006). Through analysis of Creative Pansori sessions the following essential aspects could be identified. The empirical data are derived from the case study of Mrs. A as well as from other clinical and non-clinical experiences with Creative Pansori.

  • Empathetic reactivity. The therapist shows high awareness for the client and extremely precise micro-reactivity. The therapist’s percussive play and body-movements tally with the dynamic expression of the client. This kind of reactivity is not only based on objective observation (which would cause micro-delays) but seems to depend crucially on the therapist’s ability of deep empathetic sensation: the patient’s psychosomatic “here and now” is exactly mirrored by the therapist’s performance.
  • Percussive frames. The therapist, however, does not just double the client’s activities but provides a therapeutically meaningful percussive frame. Micro adjustments, which the therapist is responsible for, guarantee an artistically perfect co-ordination of the patient’s speech-rhythms and the supportive percussive accompaniment. According to the theory of Creative Pansori this rhythmical harmonisation creates a balanced state of empathetic connection and a subjective feeling of safeness. In this context the term “frame” concerns both the therapeutic structure and “changdan”, the various metric frameworks of Pansori.
  • Artistic synchronisation. In terms of musical performance both therapist and client get synchronised. Also with regard to other expressive artistic experiences such as Free Jazz improvisation, for instance, we highlight this quality as a strong agent to trigger feelings of identity in artistic practice.
  • Psychosomatic synchronisation. The therapeutic process leads to a precise body-oriented synchronisation between patient and therapist. Features refers, e.g., to micro-movements, muscular tensions, and respiratory rhythms. From body-oriented therapeutic models and experiences we know about the power of such modes of synchronisation. In the context of Creative Pansori we also discuss their psychosomatically regulatory impacts.
  • Being one in performance. In-depth-analysis suggests the hypothesis that this process of synchronisation is not only based on cognitive reactivity. There is, according to the self-perception of patients, a sort of mystical “becoming one”[1] in the symbolic sphere of sound and rhythm. Anthropologically, such forms of transient unification play an important role in mystical and religious practices as well as for a deep feeling of safety in life. This feeling is opposite to emotional isolation and one’s feeling of being incomplete.

Perspectives for the future

The presentation of Creative Pansori at the World Congress for Music Therapy 2014 was a starting point for cross-cultural clinical considerations. From a medical ethno-musicological perspective we suggest to focus discussions, clinical experiences and investigations particularly on the following topics:

  • psychological and neuro-physiological mechanisms underlying Creative Pansori.
  • clinical indications for Creative Pansori, not only narrowed down to depression.
  • adequate adaptation of Creative Pansori for cross-cultural clinical use.


[1] Finally, analysis of relational dynamics in Creative Pansori processes leads to the question about referring states of consciousness. We do, of course, not call Creative Pansori a music hypnotherapeutic method. Nonetheless, we have to take the possibility of certain music-induced trance levels into account: alterations which entail issues of psychotherapeutic relevance (Rüegg, 2007), hypnotic suggestibility (Kelly, 1993), and trance-related cognitive and cortical reorganisation as well as re-programming of the mind (Robertson, 2013).


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