Journal of Asian and African Studies, No.29, 1985 Indigenous Healers and Healing: Their Persistence and Vitality in Southeast Asia Yosmpa, Masanori Rikkyo University, Graduate School Introduction 1. The definition of illnesses 2. The manipulation of illnesses a) Symbolic or metaphysical level b) Mechanical or physical level ©) Socio-political level 3. The social institution of indigenous healing a) Specializations and types of healers b) Selection, training and acquisition of power ©) Occupational professionalization d) The healer-patient relationship Conclusion Bibliography Introduction In addition to the cosmopolitan and regional medical systems (Dunn 1976), local or indigenous medical systems still provide a real health service for the great majority of people in Southeast Asia. Jaspan (1969) estimated that for more than three quarters of the population of Southeast Asia, the treatment of pain and disease is the province of traditional therapy and the theory of medi- cine that underlies such treatment. The demand for such skill is particularly great in the many areas of Southeast Asia where medically qualified doctors or modern medical services are not easily accessible. The indigenous healers of Southeast Asia retain a significant following among the population, even in areas where modern medical facilities have be- come available. People have simultaneous or successive recourse to both modern medical doctors and indigenous healers in need of help for illness. Many researchers have asked why indigenous health care systems persist when cosmopolitan systems are easily available and their curative capacities so readily recognized in various parts of Southeast Asia, but few extensive attempts have been made to examine this question thus far, with the exception of JasYostpa, Masanori: Indigenous Healers and Healing. 238 pan’s work (1969). Jaspan tried to examine some indigenous schools of thought about health and diseases in Southeast Asia in order to understand how and why they continue to exercise great influence on the lives of people there-most of his data were gathered on the Rejang of Sumatra, Indonesia. Tam concerned with the same medical phenomena in Southeast Asia, par- ticularly in insular Southeast Asia, because relatively rich data have been ob- tained in the course of medical anthropological studies in this region. In order to understand this medical phenomena, I will focus on the socio-cultural mechanisms of indigenous healing and the work of healers. Indigenous healers provide culturally meaningful explanation and inter- pretation of the illness experience and culturally sanctioned treatment. They seem to be the key figures in indigenous health care systems. The persisting importance and vitality of the systems depend on a continuing supply of these full-fledged medical personnel. In the healing process, three elements are constantly at work; 1) the defini- tion of illnesses, 2) the manipulation of illnesses, and 3) the social institution ‘of the healing role. I will examine how these elements operate in the work of healers to meet the people’s health needs and expectations of cure and relief, and why they are seen as efficacious in the Southeast Asian context. I will choose several indigenous healers such as the bomoh or bomor (the Malay), dukun (the Javanese and the Sundanese), dukuen (the Rejang in Sumatra), mananambal (the Cebuano in the Philippines), and fambaran (the Samaran in the Philippines) for these purposes. 1. The definition of illnesses ‘The initial stage of indigenous healing is diagnosis, the labeling or cul- tural definition of illnesses. The sickness is named or its cause is stated by the healers with their culturally sanctioned models—a body of knowledge and ideas about sickness and its cause, I will examine how illness is culturally defined and what symbolic mechanisms are used by indigenous healers to define in Southeast Asia, The most fundamental characteristics of these models is the intricate link- age between supernaturalism or religion and illnesses. The original ideas of illnesses in Southeast Asia were derived from indigenous-animistic beliefs (pan- Southeast Asia) (Gimlette 1928, Skeat 1900). ‘Then came the influence of Hinduism from about the first century A.D. to about the 12th century on the medical beliefs and practices in this region. For example, the mystical powers of dieties such as “Batara Guru” or “Seri Rama” have often been included in the incantations of the bomohs, or Malay indigenous healers, who publically attributed the real healing power to Allah (Heggenhougen 1980). In the Philippines, Christianity was introduced during the Spanish occupation in the284 TIT TDI ABSA 29 beginning of 16th century. It has since had an influence on the illness beliefs and the work of healers in this region (Hart 1969), ‘These symbolic representations constitute an important component of and provide a supernatural base for the role of healers and the source of their heal- ing power. Indigenous healers have used them to help devise ideas and theories that can explain the mysteries of why people get sick, why they recover, or per- haps why they die. In addition to the great religions, the great medical traditions have long influenced the theories about illnesses held by the healers as well as the patients in Southeast Asia. Cosmopolitan medicine has been introduced by Westerners and modern medical knowledge has become part of the medical theories of the people in Southeast Asia. For example, the Malay and the Rejang recognize the germ or virus as a probable cause of illnesses known as kuman (Osman 1976, Jaspan 1976 b:285). Humoral pathology of Greek origin (Greco-Arab medicine) was brought to the Philippines by the Spaniards and to Malaysia and Indonesia by the Moslems. The Ayurvedic medical system of ancient India and the Chinese medical system, similar to the humoral pathology of Hippocrates, also spread throughout Southeast Asia, particularly where the immigrants from those areas have resided (Hart 1969). The basic models used to describe indigenous theories about illnesses are based on their symbolic interpretations of the causes of illness. One model is the externalization of the cause of illnesses. The other is the internalization of the cause of illnesses. The former signifies the relocation of the patient’s difficulty in an external image, agent or event, such as soul Ioss, spirit intrusion, object intrusion, sorcery, witchcraft, poisoning, and anti-social actions—in- voluntary breach of taboos or failure to carry out ritual ethical obligations to living kinsmen, friends and ancestroral spirits. This model largely pertains to a personalistic etiological system which Foster describes (1976). The internaliza- tion model attributes illnesses to an imbalance of hot and cold elements within the body due to improper emotional experiences, excessively hot or cold tem- peratures, an imbalance of food intake, and the like. This model corresponds to Foster's naturalistic etiological system. Generally speaking, these two models can account for all the theories about the causation of illnesses held by both patients and healers in Southeast Asia. Dr. Jocano states that “all diseases, for the farmers of Malitobog, in the Philip- pines are caused by either supernatural beings or by the unbalanced relation- ship of elements inside the body due to the imbalance of the elements in the body by air or the overconsumption of cold or hot foods” (Hart 1969:17-18). Kalangie (1980:62) reported a similar finding in West Java, where the illnesses which are attributed to supernatural beings and sorcerers are called panyakit luar (outside illness) and the illnesses which are attributed to natural forces andYosia, Masanori: Indigenous Healers and Healing. 235 conditions are called panyakit dalem (inside illness). Many Javanese today are aware of the physical (natural or mechanical) causes for many kinds of illnesses. But there are several traditional theories of illness causation that are persistent in the minds of many Javanese. According to previous studies (Geertz 1960, Josefowitz 1978 a, b, Koentjaraningrat 1979, Suparlan 1978), the Javanese perceptions of the cause of illness are as follows. 1) Natural causes—the intake of bad food (dirty blood), the intrusion of substances such as too much air and heat (maswh angin or a kind of cold) 2) Spiritual causes—the intrusion of evil spirits, the empty soul, the work- ing of destructive magic and sorcery, a sin performed in the past 3) Emotional & psychological causes— inappropriate psychological state or undesirable, strong human emotion such as anger, greed, frequent frustration, envy, jealousy, fear, fright, anxiey, and depression 4) Social causes—violation of social rules or order (inappropriate behavior toward aged and parents, unfitting names etc.) ‘The Javanese believe that disorderly condition are caused by lack of emo- tional stability, improper food intake, lack of proper spiritual discripline or power, lack of control of spirits and other supernatural substances, and unful- fillment of social roles. The main idea that underlies the Javanese perception of the causation of illness is the concept of cocok, the belief that everything has its preordained place in the natural world. All factors in the universe must be compatible rela- tionships to sustain health. Those relationships include not only those between humans and things (internalization model), but also among human beings, and between humans and the supernatural (externalization model). For example, babies in Java often suffertd from an illness called sawanen whose symptoms are nightmares, hysterical weeping, extreme lassitude, convulsions and other i explicable behavior. This illness is caused by evil spirits (barang alus) who enter babies when they become haget, “shocked, startled and upset” by sudden loud noises, rough handling, strong tastes or physical discomfort (Geertz 1961: 92-93). ‘The indigenous healers in Southeast Asia also apply these two concepts as they define illnesses. For example. the first step in any diagnosis for Man Aher, a duken of the Rejang in Sumatra, is to determine whether the ailment or disease belongs to the hot or cold variety. The second step is to categorize the malady according to four principal pathogenis sources; wind, spirits, poison, and worms (Jaspan 1976 b:235). The bomoh primarily ascribe illnesses to evil236 TUT 77) ARCHER 29 spirits such as hantw and jin. Furthermore, they follow the ancient Greek medi- cal philosophy or humoral pathology and treat illnesses resulting from an excess of bodily humors with various foods and drugs (Gimlette 1923:31, 33, 35). It is apparent that the indigenous healer’s initial task is to find out who or what is responsible for the illness and to include a hot/cold interpretation in their diagnosis. However, it is a complicated matter to determine which models should be applied because there is not always clear-cut dichotomy between disease models and some diseases have multiple etiologies during their course (Hart 1978:71). Moreover, some ethnic groups emphasize a model of externalization, while others employ a model of internalization, probably due to historical and religious in- fluences. 1 will now introduce contrastive cases from the Philippines and Indo- nesia. In a Samaran village in Eastern Samar, the Philippines, the causes of the majority of serious illnesses are believed to be the actions of environmental spirits, sorcerers, and ancestoral souls or spirits (Hart 1978). Sickness is diagnosed by the healer as a punishment for offences against these various agents, Moreover, humoral pathology is a part of their traditional healing sys- tem, so numerous rules exist on how to retain a healthy balance of the hot and cold elements in the body. For instance, various foods and diseases are classi- fied as “hot”, “cold”, and “neutral or regular” (Hart 1978:71). However, even the most fastidious observation of this metaphysical ‘equilibrium’ does not assure good health since the primary causes of illness in the village are the various spirits. Accordingly, the majority of the healers in the village most frequently depend upon a model of externalization to define illness. An opposite case can be found in a rural village of West Java (Kalangie 1980), where some of the diseases experienced in the households are attributed to malevolent spirits or kabadik, breach of taboo or pamali, possession or Aasusupan, sorcerers and so on, but most ill health is explained without regard to supernatural causes. Rather it is due to imbalances in the bodily humors, especially in an abnormal hot/cold balance caused by an improper balance of hot and cold food intake (salah makan—having eaten improperly), excessive natural heat and cold (nyeri ati—liver ache), or strong and unsettling emotional feeling and experiences (mokla kotor—dirty blood). In the village, among the number of reported illness, those deemed “natural” in origin comprose 84.5%; only 12.2% are attributed to supernatural and magical causes (Kalangie 1980:76). These West Javanese villagers’ theories of illnesses emphasize a model of internalization rather than a model of externalization The variation in these two groups’ models of the causation of illness is per- haps related to the degree of persistence and strength of their indigenous health care systems. Especially important are the indigenous medical theories aboutYostpa, Masanori: Indigenous Healers and Healing 287 intruding elements. From variations between etiological models, some characteristics of indige- nous healing systems can be identified. For the Samaran peasants, the environ- mental spirits are certainly pre-Hispanic or pan Southeast Asia, yet the people have reinterpreted their original theories or ideas according to their folk Catho- licism. They believe that everything that happens to a person is the result of God's will. They may pray to various saints to punish another with sickness. Gaba, one cause of illness and misforturne of the Samaran, is believed to be a curse that comes from God as punishment for certain moral offences, especially disrespect for parents and other elders or abuse of natural resources (Hart 1978:68-69, Lieban 1967:81-82). These facts indicate that the Samarans’ theo- ries of illness retain their original pattern inspite of the absorption of Catholic elements into the system. In the Islamic worlds of Indonesia and Malaysia, some aspects of medical practice, such as soliciting supernatural beings, are incompatible with the strict, teachings of Islam. Most bomoh and dukun are Muslims who take their religion seriously. Such healers recite verses from the Koran and publicly attribute the real healing power to Allah, They absorb Islan elements into their original theories and try to replace them, The Indonesian case shows that there may be a correlation between a decrease in belief in the magical, spiritual world as a causation of illness and an increase in Moslem religious beliefs. The cause of illness is often attributed to a moral and religious disorder stemming from the patient's inadequate faith in addition to natural causes. Despite the inroads made by non-native religions, supernatural or indige- nous-animistic elements still constitute a central part to the iden definition of the causes of illness in Southeast As yn and 2. The manipulation of illnesses The next step in the healing process is the application of culturally sanc- tioned models to treat the illness at the individual as well as at the socio-politi- cal level. These symbolically created models of illnesses or cultural definition of illness, are usually manipulated in the ritual context. The externalization of a disorder to the symbolic and socio-political levels, and the utilization of so- cial support function as crucial mechanisms in the healing process organized by the healer. ‘The main job of healers in Southeast Asia at this stage is to eradicate the externalized agents, such as various evil spirits, to exocise the injurious objects from the body, to recover something useful or necessary that has been lost, such as souls or hot/cold elements or humors, and to resolve the socio-political con- flicts occurring among patients and their fellows. The basic character of these healing techniques is compatible with the patient's set of meaningful symbols238 TET 77) ARB ICTRS 29 or models of sickness and healing. At least three levels of manipulative measures are undertaken by healers; a) the symbolic or metaphysical level, b) the mechanical or physical level, and ©) the socio-political level. Symbolic manipulation or ritual action and empiri- cal manipulation to remove the disorder are directed toward the cultural be- liefs of the patient, the physical body of the patient, and the social relation- ships of the patient. a) The symbolic or metaphysical level At this level, successful treatment means appropriately treating the plight of patients, expelling the evil spirits, which should lead to symptom relief. Levy (1969) states the symbolic significance of indigenous healing clearly; The aim of healing is not to demonstrate that there are no malevolent spirits, rather it is to demonstrate that evil spirits indeed exist, that it can be ojectified in the external world, understood, and at times controlled, by magical means (1969:219), Healers in Southeast Asia use various ritual methods such as incantations, prayers, lores, songs, food offerings, water mixed with magical herbs, formulas and the like in order to control the supernatural beings causing the disorders. ‘The majority of bomoh use Koranic and other incantations (jampi-mentra) as part of their healing ceremonies (Heggenhougen 1980 b:238). Such incanta- tions call on good spirits to counter the evil ones. In order to cope with the possible interference of evil spirits or poisoning, the procedure for exorcising such spirits necessitates a keduri rite among the Rejang, in which certain cere. monial foods are offered to the patient's ancestoral spirits, who are exhorted to assist their ill and suffering descendent by evicting the troublesome demon or devil (Jaspan 1976 b:236). In the main puteri, elaborate healing rituals in Kelantan, Malaysia, the bomoh, the patient and other participants become spiritmediums through whom puteri or spirits are allowed to enact a play, final- ly relieving the cause of the disorder in the patient (Firth 1967, Kesseler 1977). ‘The important points in indigenous healing are that the patient accepts the existence of mythical beings and the various symbolic actions provided by healers, performs the action, and finally overcomes a true organic disorder. Various incantations may induce the psycho-organic transformation of the pati- ent. The cure requires that the patient believe in the myth, the symbols and the healer. The manipulation of supernatural beings or the patient's cultural beliefs by symbolic actions primarily contributes to the relief or resolution of psychological conflicts or disorders, b) The mechanical and physical level In Southeast Asia, as in many cultures, it is believed that the cause of ill- ness lies within the physical body, so the healer directs his attention to the physical entity of the patient. He takes both symbolic and empirical manipu-Yosuups, Masanori: Indigenous Healers and Healing 239 ative measures because it is thought that illness occurs as a result of both natural and unnatural causes, the latter case being the intrusion of some sort of malevolent influences into the body. Therefore, the healer tries to remove something visible from the body, this being a central metaphor of curing. Healers in Southeast Asia manipulate the sick body externally and inter- nally with the help of massage, cupping, herbs, drugs, blood-letting, decoctions, fumigation, anointing, diet, rest and retreat, induction of perspiration and so forth. These manipulative measures are often both symbolic and empirical. For example, a ritual anointment with coconut oil accompanied by prayer is one of the most common forms of treatment among the Samarans in Eastern Leyte (Nurge 1958:1166). Another example is water blessed with magical formulae to be drunk by patients in West Java (Kalangie 1980:92-93). Kalangie (1980:93) mentions that whatever their technique, all dukuns administer treat- ment by saying “In the name of God, the Merciful, the Compassionate”. When an illness is diagnosed as hot/cold imbalance, an opposite measure is always taken. “Hot” illnesses require febrifuges such as quinine and cooling drugs. “Cold” ailments require heat and sudatory treatment (Jaspan 1976 b: 235). Among the Sundanese, a case of physical disorder due to a hot/cold im balance is corrected by reducing excessive heat by means of massage and dietary control (Horikoshi 1979), ©) The socio-political level At this level, the social relationships of the patient are externally and symbolically manipulated and the social atmosphere of the healing context is exploited. The first procedure ultimately aims at resolving the physical or mental disorder by transforming the patient's relationships at the socio-political level, as Turner vividly demonstrated (1967). Social relationships often become a source of enmity, jealousy and conflict. Sorcerers and other human agents are believed to be responsible for many illnesses in Southeast Asia (Lieban 1967). Disorders due to conflictive social relations will be resolved by the manipulative power of healers as organizers in the healing sessions. In these societies, the causes of disorders are not considered to be the fault of the patients themselves, but of externalized social relationships. So, patients are not necessarily regarded as shameful. ‘The social atmosphere surrounding the patient in the healing rituals plays an important role in relieving the symptoms of his illness. During the healing session, there is often constant positive group support from the cult members. The mananambals’ (Cebuano healers) treatments and consultations are carried out in the open, in a much more public fashion than those of medical doctors in Western countries and are witnessed by those waiting and anyone else in the vicinity (Lieban 1981:219, 1978:110). Rejang doctors expect the patient’s kins.240 TOT 77) WR RSCDE SE 29 men and friend to be in constant attendance at the healing session (Jaspan 1976 b:270). Both healers and the lay public believe that a seriously ill patient requires his kith and kin near him because they give him moral support, material succor, and tangible proof that he is loved and wanted (Jaspan 1976 b:288). Among the Iban of Borneo, all healing ceremonies involve at least the family, friends, and neighbors of the patient. They become directly involved with the patient’s problems, may have responsibilities for the preparations needed for the healing ceremony, and often must observe certain taboos after the ceremony to keep the patient well (Torrey 1972:97). In the healing rituals, healers also pay attention to the audience itself in order to explain the general meaning of the disorder to them and become the professional abreactor for the benefit of the public. The audience has its own view of reality reaffirmed in the treatment of the disturbing illness and also gives the patient sympathetic social support, but it keeps a distance. They experi- ence an enthusiasm and intellectual satisfaction which produces a spirit of col- lective support. The patient also wishes to share this experience with the group members (Kleinman 1980). It is apparent that the aspect of social support in the ritual context contributes to the emotional and psychological well-being of the patient who suffers from disorders. This healing mechanism indicates ‘a close connection between physical/mental disorders and the social environ- ment. ‘The three levels of the healing procedure are not conducted separately, but together. If they are not, the treatment has little effect (Heggenhougen 1980 b: 238). We will recognize that indigenous healing systems tend to treat the whole body-mind-spirit complex. This character of the healing process will meet a patient's expectation of a miraculous cure or particularly contribute to the af fective and social side of healing. 3. The social institution of indigenous healing I will examine several elements of this institution which provides for a diversity of health care needs. a) Specialization and types of healers Compared to the specialization of medical practitioners in Western society, the degree of specialization in indigenous healing roles is less marked. Even so, people in Southeast Asia show a variety of health needs and a diversity of curing roles are distinguishable, depending upon the nature of the illness— acute/chronic, minor/serious, the cause of the illness—supernatural /natural, the healing skills, and the different styles of acquisition of power. In this section, I will describe the indigenous healers who are classified as general practitioners and specialists, according to their skills. Most healers in insular Southeast Asia are specialists who are well knownYostos, Masanori: Indigenous Healers and Healing zat for one skill in particular, such as spells, herbs, massage, bone-setting, or dental treatment, Samaran healers in the Philippines have a special skill for the treat- ment of poisonous bites (Nurge 1958, Hart 1978), and other skills are found among specialists throughout insular Southeast Asia. ‘There are a number of specialists in each community to whom the people in the community come for help (Koentjaraningrat 1979, Geertz 1960). The healing skills of these healers are empirically acquired from parents or other older relatives. No magical elements are usually involved, and the hot/cold dichotomy is central to much of the work of specialists (Kalangie 1980). On the other hand, bomoh, dukun, dukuen, mananambal, and tambaran are general practitioners who have all kinds of skills. They do not go into trance, and are not possessed in the course of their healing sessions. Some of the general practitioners such as bomoh and dukun are possessed healers (Geertz 1960, Windstedt 1961), but specialists are not possessed. Only a limited number of people are thought to be suited to the vocation of general practi- tioners, so there are more specialists than general practitioners in any com- munity. Some general practitioners attract a great number of clients from distant places for a variety of physical, psychological and spiritual problems (Heggen- hougen 1980b, Lieban 1967, 81, Geertz 1960, Koentjaraningrat 1967, 79, Boed- hihartono 1980). General practitioners who are not so well-known serve the local people by attending to their minor problems in place of such well-known healers and specialists (Lieban 1981). People seem to make effective use of these two types of healers. For ex- ample, as Kalangie (1980:86) observed, the villagers in a rural West Java have a very good idea as to the kind of healer they need, whether to consult a general practitioner or a specialist. They also have a good idea of who the really com- petent professionals are, and who is to be avoided. b) Selection, traing, and acqisition of power ‘The reputation and power of indigenous healers depend upon how they became healers, that is, to what degree they have the requisite knowledge and devices for treatment, and whether or not they have supernatural connections. It is believed that only indigenous healers can cope with supernatural ailments with their miraculous and extraordinary therapeutic powers. In order to become a general practitioner, the healer has to accumulate necessary esoteric and empirical knowledge about sickness and cure. In addi- tion, he or she has to establish a special communication with the supernatural beings or helpers which validate his or her practice. The differences in the super natural relations make for different types of healers, but all healers claim to have them. ‘The medical knowledge that a healer must have is acquired by one or more24 TIT +77) ABSIT 29 of the following means. The first two measures are empirical, but the last three are miraculous in nature, 1) A prospective healer tries to gain magical and empirical knowledge un- der an apprenticeship with an established healer or guru (mananambal, dukun, and bomoh). 2) A prospective healer learns the skills from other healers, parents, and other older relatives (bomoh). 3) A person receives the healing skills through a miracle. He or she is possessed suddenly without any preparations (dukun tiban, bomoh). 4) By fasting and meditating, a prospective healer attempts to establish contact with a spirit and asks it to grant him the ability to cure the sick (dukun, bomoh). 5) Most often, a person involuntarily gets in touch with spiritual beings such as ancestoral souls of dead healers, environmental spirits such as tiger spirits, saints, Christ or God in dreams and visions. He or she told by the spirit how to deal with illness and is urged to serve as a healer (mananambal, tambalan, bomoh, and dukun). There are not formal medical schools or training institutions for indigenous healers in Southeast Asia, so the training of healers takes the form of an ex- tended apprenticeship to a skilled and experienced practitioner (Jaspan 1969, Koentjaraningrat 1979, Suparlan 1978). In addition to learning under a guru or teacher, some establish relationships with supernatural helpers through dreams and visions, and by fasting and meditating in order to gain the inner strength and esoteric skills necessary to help patients. ‘The extraordinary experiences a trainee has as he acquires healing skills and knowledge give supernatural validation to his medical practice (Lieban 1962, 67, Osman 1976). The aid of supernatural helpers such as God, saints, Christ, spirits of dead healers, and Allah is considered vital for the indigenous clinical practice, for without it there can be no healing (Jaspan 1969, Osman 1972). The healer’s ability to communicate with the spiritual world raises the patient’s hope of cure and lends credence to the healer’s models (Kleinman 1980). ©) Occupational professionalization Another characteristic of indigenous healing which is quite different from the modern medical system is occupational professionalization. Healing is one of the most important roles in any society and great prestige is accorded those who occupy the status of “healer”. In Southeast Asia, and in many other devel- oping countries, indigenous healers are not full-time professional workers who depend for their livelihood on their practice of medicine, though they are recognized to have this speciality. Indigenous healers are generally engaged in some other occupation in addition to medicine. In Java, they are black-smiths,Yosups, Masanori: Indigenous Healers and Healing 43, puppeteers, farmers, civil servants, religious teachers, landholders and the like (Geertz 1960, Koentjaraningrat 1979). They exercise their special skills mainly in their spare time, or during the slack agricultural season (Jaspan 1969:29). ‘The healing role brings some monetary or material rewards today. But in- itially, and ideally today, healers were and are reluctant to accept payment for their medical services because they are not supposed to profit from the medical aid they offer (Jaspan 1976 b:233, 1969:29, Hart 1978:80, Lieban 1967:85). ‘The practice of folk medicine is meant to be a secondary occupation, although healers do accept small gifts. Regardless of the ideals of folk medicien, as Hart (1978), Kalangie (1980), and Lieban (1967) have mentioned, indigenous healers are getting interested in money and goods in return for their services due to urbanization, commer- cialization and inflation in both rural and urban areas. There are no healers who do not accept some payment in rural West Java (Kalangie 1980:88-89). By 1977, most curers on the Samaran Island were accepting a small monetary payment for their services (Hart 1978:80). Lieban (1967: 85) reported that pay- ments are usually made in cash in Gebu city. The patient feels obliged to give something in return for the help he has received, for he fears he will other- wise be denied his healer’s consultation in the future. 4) The healer-patient relationship Perhaps the most fundamental aspect of the healing institution is the healer-patient relationship. First of all, a congruent relationship has to be established between patient and healer for the management of the healing pro- cess. However, all the persons involved in the healing process, that is, the healer, the patient, and even the onlookers or audience, have their own views about the definition of illness and the way of treatment; they each have their ‘own explanatory models (EMs) (Kleinman 1980). According to Kleinman, a healer cures an individual by providing him with explanatory models. Patients who are anxious over specific discomforts try to accept a healer’s EMs and to. place them in some understandable context. So, the healing potential of indige- nous medical practice lies in the mutual understanding of role expectations (Foster and Anderson 1978) or in co-ordinating EMs on health and sickness. Through this healing mechanisms, the healer makes the symptoms and problems the patient faces culturally and socially meaningful for him. It will be useful to ask the following questions concerning the nature of the therapeutic relationship between healer and patients in insular Southeast Asia; 1) Do the patient and healer speak mutually intelligible languages? 2) Do they share similar socio-cultural background? 3) How long does it take for consultation? 4) How much do they discuss the illness and other matters?a4 TOT 77) DEBT 29 5) To what degree do they comply with each other's opinions? 6) What is the mutual expectation of the patient and healer in the medi- cal encounter? 7) Does the patient confront the healer with the problem? If so, what does the patient do next? 8) Do healers allow the patients to go to the medical doctor or other indigenous healers? Some of these questions are answered from the following data. The Rejang doctor listens to the diagnosis of the patient's close relatives with patience and emphathy. He is certainly not intolerant of lay opinions. Nor does he con- sider their views irrelevant. Their professional-lay dichotomy is not as fine as it is in Western medicine (Jaspan 1976 b:233). The Cebuanos’ perception of indigenous healers brings them to a mana- nambal for more than the reasons that a mananambal is nearer, can be paid less, or seems more considerate than a physician. When patients being treated by mananambal for illness diagnosed as induced by spirits were asked whether they had been to a doctor for the illness, they replied that the doctor did not know how to cure this kind of illness (Lieban 1967:96). The traditional medi- cal knowledge or EMs of patients helps sustain their belief in their healers. Kalangie (1980) reported a more comprehensive case of therapeutic inter- views and discussed the nature of the interaction between patients and healers in therapeutic settings in a rural village of West Java. I will summarize a case briefly; In the beginning of the consultation, many aspects and events of the patient’s life are touched upon—jobs, household problems, kinship rela- tionships, local news and the like. The patient explains his symptoms and expresses both hope and confidence that the healer can help him. Next, the healer asks about the patient’s name, his age, the places he has visited recently, and sometimes possible social friction with other people. He then goes to the part of his consultation room where he keeps his magical and medical paraphernalia. He diagnoses the nature and cause of the patient's illness through contact with the supernatural, meditation, prayer, or manipulation of magical formulas in the room. Finally the patient ac- cepts without question the dukun’s medical prescription (Kalangie 1980: 140-141, Summarized by Yoshida). This interaction between patient and healer indicates that the most im- portant factor in achieving a cure is that the patient has absolute faith in the spiritual powers of the healer. He accepts the healer’s questions and actions as totally relevant and logical. The patient assumes the healer’s EMs or cultural models on illness and cure. If a patient does not have confidence in a healer's power, or does notYosipa, Masanori: Indigenous Healers and Healing 5 want to accept his EMS, he will search for someone else. For Javanese patients, the unsuccessful healer is not the jodoh or cocok (partner) of the ailment that afflicts the patient (Geertz 1960, Suparlan 1978, Kalangie 1980). The problem is then to search for a more powerful healer who is more likely to be the jodoh ‘of the illness suffered by the patient. In other words, when there is little con- gruence between the two EMs, the patient looks for more suitable, more satis- factory models by changing healers. For a patient, a particular model may be very powerful and satisfy his or her health needs. Therefore, the people's quest for compatible models or healers does not stop and their faith in indigenous healers is not likely to fade in the future. Conclusion ‘The use of indigenous healers is a common phenomena in Southeast Asia I have attempted to explore the principal mechanisms of the work of indige- nous healers in this region in order to understand its persistence and vitality. ‘Although there are regional variations in the role and behavior of the healers due to the degree of influence of the great religions and cosmopolitan medicine, the role and behavior of indigenous healers in this area have something in com- mon and attend to the people’s health needs in similar ways. Indigenous healers may not cure all the patients who come to them, but they assist a great number of them. As I have shown, the basis of indigenous healing is the sharing of cultural models of sickness and cure by both patient and healer. In the therapeutic encounter, a healer encourages a positive atti- tude and religious faith which are of curative value for psychological and phy- sical ailments. It is important how a patient feels about a healer. Patients of ‘one bomoh stated that the bomoh was particularly adept at making people “feel better” (Heggenhougen 1980 a:42). People are empirical and do not reject other healing systems in the com- munity. The people who consult dukuns or bomohs also use cosmopolitan health services on the basis of their evaluation of the efficacy of the resources. In general, it is believed that when modern health care services are easily available, the need for indigenous healing resources gradually decreases. How- ever, recent studies of indigenous healers and people's health-sceikng behavior in Southeast Asia indicate that where modern medical facilities are readily ac- cessible, people do not stop consulting the indigenous healers (Lieban 1981, Boedhihartono 1980, Haggenhougen 1980, b). People today suffer from various physical and psychological complaints such as chronic illness or anxiety that are caused by stressful life styles. The majority of patients who come to mananambal in Cebu city, orang pinter or dukun in Jakarta, bomoh in Malaysia felt that they had not been helped or relieved by246 TOT 77) ABBR 29 cosmopolitan medicine. As their illnesses persisted for long period, they began to feel that the cosmopolitan system was incomplete, and reinterpreted their illnesses by their cultural models, attributing them to the supernatural, Such cultural interpretation of persistent illness makes indigenous healers the most appropriate people to consult. Cultural models of illness and cure are largely responsible for the persistence of indigenous healers and their work. jography Boedhihartono 1982 “Current State and Future Prospects of Traditional Healers in Indonesia", In Indo- nesian Medical Tradition, David Mitchell (ed), pp. 21-34, Monash Univ. Chen, Paul ©. 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