Alan Weber
Doha, Qatar

Sifting through literature we recover strange grains of medical truth.  The twelfth century poet Nizámí-i-‘Arúdí relates the following story about the celebrated physician Ibn Sīnā or Avicenna (AD 980–1037):

One of the princes of the House of Búya was attacked by melancholy, and was in such wise affected by the disease that he imagined himself to have been transformed into a cow. All day he would cry out to this one and that one saying, “Kill me, so that a good stew may be prepared from my flesh”; until matters reached such a pass that he would eat nothing, and the days passed and he continued to waste away, and the physicians were unable to do him any good.

[Ibn Sīnā has the prince bound with ropes and approaches him with knives]

“O what a lean cow!” said he; “it is not fit to be killed: give it fodder until it gets fat.” Then he rose up and came out, having bidden them loose his hands and feet, and place food before him, saying, “Eat, so that thou mayst speedily grow fat.” They did as Avicenna had directed and set food before him, and he ate. After that they gave him whatever draughts and drugs Avicenna prescribed, saying, “Eat well, for this is a fine fattener for cows,” hearing which he would eat, in the hope that he might grow fat and they might kill him. So the physicians applied themselves vigorously to treating him as the minister had indicated and in a month’s time he completely recovered and was restored to health (Browne, 1921b, pp. 91-93).

Today we would recognize that the prince was suffering from some variety of delusional disorder, perhaps schizophrenia. The Persian physician Al-Rāzī or Rhazes (854-925) attempted a similar cure on Amír Manṣúr of Bukhara, who was prostrated by rheumatism. After unsuccessful cures by the court physicians, Al-Rāzī entered the Amír’s room and threatened him with a knife, at which insult the Amír sprang out of bed. Although Al-Rāzī fled the court, the Amír was delighted at the cure (Browne, 1921a, pp. 82-83).

Noteworthy is Ibn Sīnā’s use of a mixed cure of psychological suggestion along with pharmacological interventions (drugs and draughts). In his vast medical compendium al-Qānūn fī al-Ṭibb (Canon of Medicine), Ibn Sīnā generally followed the Galenic and Hippocratic tradition that mental illnesses such as epilepsy were not divine in nature, but arose essentially from improperly mixed or corrupted humors. The Galenism transmitted to Arabic and Persian medicine recognized four humors: blood, phlegm, and black and yellow bile which composed the mixtures (al-mizaj) or temperaments (Al-Issa, 2000, p. 45). Therapeutics consisted of bringing temperaments into proper balance by purging, augmenting, or transforming or perfecting these humors (coction).

For example, al-maniya or the mania and frenzy of agitated patients indicated excess of heat and an excess of hot humors, and was treated with its opposite substance opium, classified as a cooling drug. Other physiologically-based cures for mental affliction in the Middle Ages, and still popular in Islamic folk medicine, included phlebotomy and bloodletting (hijama) or cautery with hot irons (kaii, wasm). Even a primitive electroconvulsive therapy was used by applying to the heads of patients torpedo fish (Torpedinidae) and electric catfish (Malapteruridae), which can deliver a shock of up to 350 volts. Ibn Sīnā recommended a ra’ad (“thunder”) fish for migraine headache (Finger & Piccolino, 2011, p. 81).

However, many Islamic medical authors such as ‘Alī ibn al-’Abbās al-Majūsī also recognized psychosomatic illness and somatization, the idea that emotions could manifest themselves in a bodily form. Ibn Qayyim Al-Jawziyya states in the opening of his book Prophetic Medicine: “We begin by declaring that sickness is of two kinds: sickness of the heart, and sickness of the body, both mentioned in the Qur’ān” (p. 3). Many Muslims still believe that mental conditions are caused by demonic possession–either by zar spirits or jinn, which are beings described as “smokeless fire” in the Qur’ān–and can be cured by exorcism or prayers. In fact, the common Arabic word for madness (majnūn) is cognate with the word jinn.

The spiritual and emotional nature of madness was also recognized in the medieval Islamic hospitals called bimaristan, which unlike their Christian analogues, treated the insane using music, water fountains, gardens, and flowers (Dols, 1987; Weber, 2011). Although the most violent patients were chained, other patients were free to roam and receive family visits, innovations that were not to appear in Western asylums until Pinel’s reforms in the late eighteenth century.

Whether Ibn Sīnā’s successful cure of the bovine prince is myth or reality, it encapsulates, along with religious therapy, the two major therapeutic approaches to mental illness in medieval Islamic medicine: pharmacological intervention and cognitive-behavioral therapy (suggestion).

References

1. Al-Issa, I. (Ed.). (1999). Al-Junūn: Mental illnesses in the Islamic world. Madison, WI: International Universities Press.
2. Al-Jawziyya, I.Q. (1998). Medicine of the Prophet. Penelope Johnstone (Ed.). Cambridge: Cambridge UP.
3. Browne, E.G. (1921a). Arabian medicine. Cambridge: Cambridge UP.
4. Browne, E.G. (1921b). Revised translation of the chahár maqála (“four discourses”) of Nizámí-i-‘Arúdí of Samarqand. Cambridge: Cambridge UP.
5. Dols, M. W. (1987). Insanity and its treatment in Islamic society. Medical History, 31, 1-14.
6. Finger, S. & Piccolino, M. (2011). The Shocking history of electric fishes: From ancient epochs to the birth of modern neurophysiology. New York: Oxford UP.
7. Weber, A.S. (2011). Expressive arts therapy in the Arabian Gulf: History and future. Journal of Arts in Society, 6(5), 55-66.