Bali Healing Ritual in Sri Lanka from a Medical Ethnomusicology Perspective

Medical ethnomusicology, a new growing sub-field of ethnomusicology takes into consideration on an equal basis music, medicine/healing and culture. This article focuses on a complex of cultural beliefs intertwined with the arts and crafts, in a multileyered bali healing ritual, which aims to restore wellbeing of individuals and communities in the South Asian country Sri Lanka. MZ_2016_2_FINAL.indd 121 8.12.2016 12:28:58 122 M U Z I K O L O Š K I Z B O R N I K • M U S I C O L O G I C A L A N N U A L L I I / 2 music and sound across the biological, psychological, emotional, social and spiritual domains of human life, spanning the world of traditional cultural practices of music, spirituality and medicine”.1 “Inherently integrative, often collaborative, and purposefully transinstitutional”, medical ethnomusicology takes into account “localized understandings of medicine, spirituality, healing, and general health care. Music is often a bridge that connects the physical with the spiritual, two interconnected aspects that suggest to anthropologist Arthur Kleinman a ‘sacred clinical reality’”.2 It is not necessarily linked to nonWestern cultural contexts and research paradigms, but it implies their usefulness for better comprehension of the triangle composed of music, healing and culture. For me, it implies both the new sets of knowledge and understandings on how to prevent and cure diseases in various cultures and their application for the sake of socially motivated causes. Healing, Curative, and Therapeutic Aspects of the Rituals Healing, cure and therapy are the three mutually related notions, which are the most important constituents of all known medical systems. Complete Medical Encyclopedia of the American Medical Association defines healing as “the act or process through which a person regains the normal structural and functional charactistics of health and wellbeing after an illness or injury”.3 Cure is explained as “the restoration of health of a person who has a disease or disorder”.4 Merriam-Webster’s Medical Desk Dictionary defines therapy as remedial treatment of mental or bodily disorder.5 These definitions of healing, cure and therapy seem broad enough to encompass the predominant western medical notion of the removal of symptoms or outer manifestations of sickness, as much as the notions prevalent in Sri Lanka’s Āyurvēdic medicine and animistic healing rites and rituals designed to treat root causes of maladies.6 According to Buddhist philosophy, a human being should be treated as a whole, as a single unit that encompasses body and mind. Human being cannot be treated or repaired as a machine part by part, a notion nicely reflected by Wigram, Pedersen and Bonde saying that “after nearly 250 years of separation, medicine, health psychology, and music therapy are approaching each other again, realizing that man is not a ‘machine’, but a complex, bio-psycho-social being”.7 Comprehension of this notion 1 Benjamin D. Koen, Jacqueline Lloyd, Gregory Barz and Kenneth Brummel-Smith, eds., The Oxford Handbook of Medical Ethnomusicology (Oxford: Oxford University Press, 2008). 2 Gregory Barz, “The Performance of HIV/AIDS in Uganda: Medical Ethnomusicology and Cultural Memory,” The Oxford Handbook of Medical Ethnomusicology, ed. by Benjamin D. Koen, Jacqueline Lloyd, Gregory Barz and Kenneth Brummel-Smith (Oxford: Oxford University Press, 2008), 172. 3 Jerrold B. Leikin, Martin S. Lipsky, eds., American Medical Association: Complete Medical Encyclopedia (New York: American Medical Association, 2003), 634.

music and sound across the biological, psychological, emotional, social and spiritual domains of human life, spanning the world of traditional cultural practices of music, spirituality and medicine". 1Inherently integrative, often collaborative, and purposefully transinstitutional", medical ethnomusicology takes into account "localized understandings of medicine, spirituality, healing, and general health care.Music is often a bridge that connects the physical with the spiritual, two interconnected aspects that suggest to anthropologist Arthur Kleinman a 'sacred clinical reality'".2 It is not necessarily linked to non-Western cultural contexts and research paradigms, but it implies their usefulness for better comprehension of the triangle composed of music, healing and culture.For me, it implies both the new sets of knowledge and understandings on how to prevent and cure diseases in various cultures and their application for the sake of socially motivated causes.

Healing, Curative, and Therapeutic Aspects of the Rituals
Healing, cure and therapy are the three mutually related notions, which are the most important constituents of all known medical systems.Complete Medical Encyclopedia of the American Medical Association defines healing as "the act or process through which a person regains the normal structural and functional charactistics of health and wellbeing after an illness or injury". 3Cure is explained as "the restoration of health of a person who has a disease or disorder". 4Merriam-Webster's Medical Desk Dictionary defines therapy as remedial treatment of mental or bodily disorder. 5These definitions of healing, cure and therapy seem broad enough to encompass the predominant western medical notion of the removal of symptoms or outer manifestations of sickness, as much as the notions prevalent in Sri Lanka's Āyurvēdic medicine and animistic healing rites and rituals designed to treat root causes of maladies. 6ccording to Buddhist philosophy, a human being should be treated as a whole, as a single unit that encompasses body and mind.Human being cannot be treated or repaired as a machine part by part, a notion nicely reflected by Wigram, Pedersen and Bonde saying that "after nearly 250 years of separation, medicine, health psychology, and music therapy are approaching each other again, realizing that man is not a 'machine', but a complex, bio-psycho-social being". 7Comprehension of this notion enables broad understanding of disease in Sri Lankan ritualistic domains, which will be presented in this article.
According to June Boyce-Tillman, "healing is associated with a dynamic model of wellness, which is wider than the curing of individual illness.It encompasses the realization of the full potential of the self within the context of the prevailing value system and is a process of rebalancing the system and can be attained through creative activity". 8In tune with a well-known proverb that "prevention is better than cure", therapies and healing methods aim to prevent a disease in the first place, and act as a remedy of an illness in the second.In Even Ruud's terms, "… we do not want medicine that is only curative; we also need preventive as well as health-promotional medicine.In a broader folk-health perspective, greater emphasis is put on how the individual may promote his or her own health through health-performing behavior.In addition, we also find a movement toward a more humanistic way of thinking about health, where supplementary and alternative understandings of health, as well as a more critical and corrective perspectives are being welcomed". 9As presented in Figure 1, therapy refers to an action towards an ailment or disease, healing works as a process of curing it, while cure comes as the final result of it.These three notions are very much present in ritual practices, where busy life styles are negated by the time reserved for wellbeing and focused attention on individuals in need and community networking.

Music in Healing Rituals in Sri Lanka
Healing rituals are often a meeting point of music and drama, in which both serve the purpose of restoration of a psychophysical balance."The effect of music on the psyche is based on a multifunctional process comprising physiological, emotional, and 8 June Boyce-Tillman, Constructing Musical Healing: The Wounds that Heal (London: Jessica Kingsley Publishers, 2000), 16, 18. 9 Even Ruud, Music Therapy: A Perspective from the Humanities (Gilsum, NH: Barcelona Publishers, 2010), 3-4..

CURE PRODUCT/ RESULT HEALING PROCESS THERAPY ACTION
cognitive factors as well as on anthropological, cultural and individual conditions". 10n a sense, healing rituals are related to the notion of psychodrama as defined by J. L. Moreno in the 1920s: "The method by which individuals can be helped to explore the psychological dimensions of their problems through the enactment of conflict situations, rather than talking about them". 11Just like psychodrama, they enable participants to move beyond the usual therapeutical limits and provide them with a liberating experience of dramatic enactment in an action-oriented yet protected reality, in which problems can be dynamically explored with the support of a director and group. 12ri Lanka is one of the countries with rich ritualistic practices, which are called for in order to ensure individual and communal wellbeing.In addition to cases of prevention, rituals take place at the times of prolonged illness of individuals, epidemics, earthquakes, tsunamis and other calamities.This article takes into consideration only the rituals practiced by the numerically predominant Sinhalese agricultural communities, leaving aside those practiced by Tamils, Chettis, indigenous Veddas, Malays, Burghers, Bharats and other population strata.The data presented in the article result from my fieldwork in Central (Up-Country) and Southern part of the island (Low-Country).
Traditional healing rituals of Sri Lanka are a complex of art forms, which aim to remove deeply rooted fears and forbias and through the catharsis enable building of individual confidence and strengthen communal ties.The main ritual practices are known as bali and tovil.Bali takes place when the influence of planetary deities becomes malevolent.Tovil takes place when Sinhalese villagers fear that devils (powerful non-human beings) are becoming rough and dangerous, making people sick and causing other dreadful troubles.These musically rich rituals are understood as the tools for removal of malevolences (dōsha) and for re-establishment of psychophysical balance.They are varied and directed to four principal sources of power: gods, devils, planetary deities, and dead ancestor spirits.
When confronted by unwanted challenges, such as illnesses or natural disasters, communities approach them as situations, possibly caused by a bad karma, that require a communal response. 13Individuals within a community never treat a major problem as a personal issue, which would need to be considered solely by the affected person and his or her immediate family.Instead, all community members get together to discuss the problem, sometimes (depending on the situation) with a native physician (veda mahattayā), whose recommendations incite action. 14The importance of togetherness in the Sri Lankan context is echoed in related claims about other contexts by various researchers.For instance, Penelope Gouk states that "… indigenous cultures will reveal that the whole community may often be involved in the musical rituals connected with healing", 15 while R. D. Putnam claims that "our relationship with other people will always be an important souce in defining our state of health.One of the single most important factors contributing to health has to do with our social capital, i.e., how well we are integrated into the community -our social connectedness.(...) Our abilities to create relationships and to support each other will prevent social isolation, which is seen as the worst enemy to health". 16onetheless, Heidi Ahonen-Eerikäinen points to the fact that "we need each other and some sense of ‚we-ness' in order to survive and have quality in our lives". 17Benjamin D. Koen's observation based on his study of Pamiri healing practices in Tajikistan that "the role of individual and group consciousness -the intention and attention of the performer/healer and all participants -can be seen as a key component in facilitating flexible psychological states, which give rise to healing" 18 is applicable to the Sri Lankan healing ritual context.
People become ill not only because of physical problems, but, due to various psychic problems as well.According to Robert Putnam, "our abilities to create relationships and to support each other will prevent social isolation, which is seen as the worst enemy to health". 19In a related notion, Even Ruud reminds us that people become ill because they "become disempowered by ignorance and lack of social understanding". 20onsequently, Dorit Amir claims that "Improving quality of life means that as persons we feel better about ourselves, less isolated in society, that we keep the 'right' balance between our roots (past tradition) and our present life; between our uniqueness and the group' identity". 21henever a problem arises, an individual or a group within a community seeks to discuss it with the community leader or a healer so that the root cause and other relevant facts can be identified.The decision to organize a healing ritual is based on the beliefs and sometimes also on the legends known to the given community.From the begining to the end of the ritual, there is a clear emphasis on a holistic healing, thus supporting Ruud's notion of "a danger in a medical practice that seperated biology and culture as we have seen in our times of modernity". 22As far as medical ethnomusicology is concerned here, I continuously point out to "cultural understandings and interpretations of disease and illness while focusing on the performative nature of treatment and healing, potentially leading us to a much deeper understanding of how disease is made meaningful". 23usic is an integral part of Sri Lankan rituals.In addition to music, the essential components of ritual events are dance, drama, sculpturing, painting and decorating, costume designing, preparing stage sets and props, and use of masks.

Bali Healing Ritual
Bali refers to one of the principal healing rituals in Sri Lanka.It is dedicated to planetary deities and gods, who are believed to be in charge of peace and health.According to the astrology-related belief, planetary influences have strong impact on human lives.They can be favorable, unfavorable or neutral.This belief is a fusion of pre-Buddhist folk beliefs and Hindu religious concepts, covered with a superficial Buddhist coating.Misfortunes caused by planetary deities (graha dōsha) in an unfavourable astrological period (apala kālaya) call for the bali ritual, which is supposed to alleviate these misfortunes. 24According to Seneviratne, the origin of Sinhalese bali ritual goes back to the Kōtte period in the 15th century. 2526able 1 provides the names of planetary deities with translations, each deity's direction of overlordship, associated color, and symbol.Authors such as Prēmakumāra de Silva add to this list several other markers, including preferred food (bhōjana), weapon (āyudha), gem (mänik) and tree (ruksha) of each deity. 27

Direction of Overlordship
Color Symbol Exact time of birth of every child is carefully documented and an astrologer is asked to cast the child's horoscope.In times of illnesses and difficulties the predictions help to comfort the sick and console the depressed.It is believed that any matter of importance requires auspicious time for action.Taking a human being for his or her first outing, reading letters, cutting hair, arrival to school, menstruation, marriage, building a house, opening a business or any new beginning and funeral are some of the occasions at which evil consequences should be avoided.People believe that astrologers know how to avert dangers and provide remedies for certain dangers and illnesses. 28p-country bali in the central part of Sri Lanka is considered the most vibrant of all regional varieties.J. E. Sēdaraman claims that "its purity can be seen only in Udarata". 29issānāyake and Rājapakshe confirm the existence of five regionally distinctive bali rituals: Udarata, Pahatarata, Sabaragamuwa, Ūva and Nuwara Kalaviya. 30hile casting one's horoscope, the astrologer finds out the types of misfortunes to be expected and advices the client about the rituals which have to be performed to avert them.He also prepares a list of practices to be avoided (tahanchi) for the sake of self-purification, concentration and spiritual empowerment (for instance, to be strictly avoided are alcohol, meat, and any ethically questionable deeds) and a list of offerings (pooja), and recommends the appropriate ritual for the treatment of the present situation.

Ravi
Not unlike other ritual practices in Sri Lanka, bali requires long preparations, which may last for several days.Special structures should be erected in an outdoor space for the ceremony where the whole community will gather. 31On the ritual day, healer comes to the patient's house to make final arrangements and ensure presence of all required components for the ritual.At the auspicious time, he blesses the clay from which the images of deities associated with the planets will be moulded.Other decorative sets will be made out of natural ingredients, too.In Gunawardhena's words, "Large clay effigies, sometimes as tall as three meters, representing the planetary deities are constructed in bas-relief fashion, and mounted in upright position before the commencement of the ceremony". 32Once the images are completed, they are painted in bright colours, such as red, yellow, blue, white, green, and black. 33here are two types of bali: (1) kada bali, in which the planatery deities are depicted on a large cloth, and (2) ämbum bali, in which the images of the deities are moulded in clay, painted and placed on a frame.The choice of the type of bali depends on the affordability of the client (comp.Dissanayake 34 ).The moulded figures are bigger than normal human size.The ritual requires a characteristic image (picture 1), flower altar mal yahan (picture 2), altar for food offerings (picture 3), plantain stems, tender leaves of the coconut palm (gok-kola), and coconut and areca-nut inflorescences.Coconut leaves and banana barks are composite ceremonial appliances at folk cults. 35For the sake of consistency, all pictures used in this article refer to a single ämbum bali ritual event that took place at the patient's compound in the village of Ämbokka, Matale district, on 2nd August 2007.The pictures were taken by the author of the article as a part of the documentation process.Ritual starts in the evening of a day recommended by astrologer.Buddha is invoked to dispel evil and the ritual starts by offering homage to the Buddha, Dhamma 36 and the Sangha. 3738The patient is seated on a mat, in front of the bali image and two virgins are seated on either side (picture 4).Music is present during the entire ritual, all night long.Chanting the mantras is followed by singing of short poems, drumming on upcountry gäta bera drums, dancing, playing of vajra miniya handbells (picture 5), and other sound offerings such as on a sak conch shells and by anklets which are believed to be the medium of connecting planetary world and human world.Food offerings, inscense offerings, and other ancillary performing arts are provided to planetary deities throughout the ritual.The healer recites several stanzas each of which is followed by a choral recitation of a blessing39 started by the two virgins' wishes for a long life.At the end of the ritual, the patient's receipt of protection from the evil influences is symbolized by the pirit huya ritual thread tied around his/her wrist.It is believed that the bali ritual provides mental strength to a weak individual.Once the ritual is over, all carefully moulded planetary images are destroyed, which symbolizes the total eradication of the evil influences of the planetary deities.
Healers' costumes for bali are more intricately elaborated than for other rituals, including the earlier mentioned tovil.Costumes of the healer and the dancers in bali are the same.Up-country people wear headdresses, colorful earings, bangles, anklets, and necklesses decorated with red ribons, beeds and pearls.The main healer (picture 6), dancers and drum accompanists always wear white color in bali, because this color symbolizes cleanliness, spiritual purity, and devotion.Seen as authorities with exemplary power to communicate with the intangible world, they expect their patients to be dressed in white as well.Healers are in most cases associated with the lower social strata. 40At the same time, they are highly respected due to their perceived purity and power to heal sickness.Women are considered unsuitable for the role of healers because of their widely perceived physiological uncleanliness caused by their menstrual periods.Maturity and wisdom acquired through the aging process are widely regarded as necessary for the role of a healer.Consequently, there are no young healers.
Rhythms provided by the drummers, commonly three or more, create a distinctive soundscape for healer, patient and community members.Performance of recitations, playing of musical instruments, burning incense sticks, and the use of dummala incense powder and pandam torches 41 all help to open up and maintain a channel of communication between the perceived two worlds: one of the planetary deities and the other of the humans involved in the ritual.According to Anne Sheeran, "Drummerdancers use hand-held bells to create an encompassing sonic envelope; they move gently and quietly, with their feet supposedly never lifted from the floor.Even the singing in parallel fourths, perhaps somewhat jarring to the unaccustomed ear, helps to delineate an arena of peace and tranquility". 42Bali in the Up-country areas features antiphonal singing while in the Low-country areas there is more emphasis on dance accompanied by intense drumming.In words of a drummer and senior lecturer Karunāratne Bandāra, "sound of the bass-drum directly affects one's heart in Low-country rituals.Strokes named gum or gugunda are essential.People achieve the state of trance thanks to these bass sounds" (personal communication, 2007).
In fact, Sri Lankans rather seldom get a chance to adjust their bodies and minds to a continuous musical rhythm for many hours, except at the rather recent young generations' rave parties.Ritualistic events provide people with the extraordinary opportunity to harmonize their bodies and minds throughout the nightlong period.The sound environment created by repetitive drum patterns can be compared to the experience of meditation in the sense of undisturbed mental move.The whole ritual event can be compared to a surgical operation, at which a specialist (medical doctor), assisted by nurses and other personnel, works for an extended period of time to re-direct harmful development in the patient's body.In the ritual context, a healing specialist, assisted by dancers, drummers, and other helpers, works for more than twelve hours to restore harmony in the patient's system. 43tirring of the body creates an inner state of flow and resonance in tune with musical patterning.Fritjof Capra claims that the illness originates in the lack of integration of rhythmic patterns (comp.Capra 44 ).From this perspective, synchrony becomes an important measure of health.Individual organisms interact and communicate with one another by synchronizing their rhythms and thus integrating themselves into larger rhythms of their environment.To be healthy means to be in synchrony with oneself and with the surrounding world.When a person is out of synchrony, illness is likely to occur.It is customary for the healer to work closely with musical assistant, who provides the rhythmic accompaniment. 45According to Erich Fromm, many esoteric traditions associate health with the synchrony of rhythms and healing with a certain resonance between healer and patient (comp.Fromm 46 ).E. T. Gaston considered that this concept contributed to the early acceptance of music therapy, the discipline being grounded in very basic patterns of human behavior. 47everal researchers pointed out to the musicians who serve as active healing forces in their sociocultural contexts.One of them, Joseph Moreno, emphasized historical connections between music and healing in ancient shamanic traditions and related the sustaining, stimulating and organizing aspects of rhythm used by both shamans and contemporary music therapists. 48The fact that repetitive drum patterns create hypnotic effects and help the healer to enter the altered state of consciousness (trance) is very true in Sinhalese rituals.

Three Medical Systems in Sri Lanka
The three major medical systems in Sri Lanka are healing rituals, Āyurvedic medicine, and Western medicine.In healing rituals music is an integral part of the holistic healing process, in Āyurvedic medicine music is not present, and in Western medicine music therapy is considered suitable for certain medical conditions.Survey of these three remedial systems in Sri Lanka would be incomplete without a reference to the question of their mutual relationships (more in Kalinga Dona 2009 49 ).
Co-existence of the three systems on the continuum between local rural tradition and westernized urban modernity is a clear advantage from the patient perspective.In everyday life, patients are generally free to decide which medical system to use for the treatment of their illnesses.Moreover, carriers within each of these systems, aware of both advantages and limits of their own and of the other two, feel free to propose to their patients where to expect best treatment for their medical conditions.Sometimes, one complements the other.For instance, victim in a car accident is most likely to receive the initial treatment in Western medicine, but if there is a need, permanent physiological cure may be sought in Ayurvedic medicine, and restoration of psychological balance in a healing ritual.Restoration of health is the ultimate aim and there is a general concensus that boundaries among the three systems would be counterproductive.Personal value systems and beliefs are subject to change due to urbanization, westernization, and other ongoing processes in Sri Lanka.Nowadays, healing rituals are certainly more likely to be an option for a villager than for a convinced urbanite.Still, the three systems continue to be intervowen.Table 2

Concluding Remarks
1. Bali ritual demonstrates and reinforces the importance of Sinhalese rural beliefs, community-based values, and their contemporary performance.2. It demonstrates and reinforces the importance of holistic healing in trying to reach and treat the root cause of the problem.3. Music combines all episodes and scenes together and keeps the whole community awake throughout the ritual.4. Music acts as a medium in connecting the human world with the supernatural world. 5.A specific sound environment, lasting from the beginning to the end of the ritual event, significantly contributes to the mood of the patient and leads to restoration of his or her psychophysical balance.6. Continuous musical sound enables the healer to acquire a special mood and enter the state of trance.7. Incenses, dummala (rosin), turmeric powders, various flowers, betel leaves and all other herbs destroy bacteria and viruses in the ritual arena.

Figure 1 :
Figure 1: The Notions of Therapy, Healing and Cure.

Figure 2 :
Figure 2: An ämbum bali image in upright position.

Figure 5 :
Figure 5: Patient (in the middle) and two virgins Picture 5: Vajra miniya handbell (at either side) sitting on a mat during the ritual.

Figure 6 :
Figure 6: The main healer of the Bali ritual.

Table 2 :
shows the comparison of the three remedial systems practiced in Sri Lanka: The Three Remedial Practices in Sri Lanka.