Every Day Is a School Day
How I learned about the history of psychiatric medicine in the Islamic world.
Posted Apr 10, 2012
One of the things I like most about this life is that you never stop learning. It doesn’t matter who or what provides the instruction, there is always the opportunity to learn. During my time as an orderly in the Locked Ward, I learnt a great deal from the patients I was privileged to be with.
Wasim was a young man of 26, of Bangladeshi descent, but born in the UK. He was a handsome man: dark-skinned, with liquid brown eyes and a beard trimmed close to his chin. He was also an observant Muslim. But, in his case, his faith was not distorted by his illness or vice versa. There are swivel-eyed fundamentalists in all religions, but Wasim was not one of those. He said his prayers quietly in his room, I believe five times a day, although he was left in privacy to say them. He read the Qur’an. He ate halal food, prepared for him by the kitchens. And he was quiet, polite and thoughtful. I liked him a great deal. Wasim’s problem was that he suffered from periodic bouts of depression.
We got friendly, after the time I said to him in Urdu, “Maaf kijiye, sahib. Khaiiye,” when I took him his halal meal in his room. He smiled at me and asked, “Apko Urdu aate hai?” I had to tell him that, frankly, very little Urdu was coming my way, but I knew how to say, “Excuse me, sir. Please eat.”
(It’s a thing of mine—languages. I have always enjoyed learning them, since our class took part in a trial project in Primary School French in 1962. Any time we’ve travelled abroad, I’ve tried to learn some of the language, at a basic, conversational level. I think it’s only courtesy to try to speak to your hosts in their own tongue. And it can bring remarkable benefits. I’ve been misunderstood and taken for a German in France, Italy, Spain and the Netherlands. In Germany, I was simply misunderstood. They recognised my Scottish accent for what it was. I learned some of the rudiments of Hindi/Urdu in my previous profession.)
In any case, it was enough to help bond Wasim and me. That, and a shared love of cricket. Wasim, like most men with roots in that part of the world, loved the game and could talk passionately and knowledgeably about it. I am very fond of it too, unlike most Scots, who detest it, regarding it as a subspecies of English eccentricity, like morris-dancing. But I like it. My colleague, Clyde, having been born in Jamaica, was obliged by statute to like it. So we sat together and blethered about wood on leather; sometimes all three of us, sometimes just Wasim and me.
Later, we moved on to other topics. I said to Wasim that I had always thought that Muslim people were rather wary of being treated in hospital wards where they couldn’t be sure of being treated by a fellow Muslim. Or was that just an infidel’s ignorance?
No, he said; by and large, that was the case. On his first presentation in the hospital, however, he had been treated by a Muslim psychiatrist who was the Senior House Officer for the ward at that time. Coincidentally, the current SHO was also a Muslim, by the name of Majeed. Both Wasim and his father had been struck by the kindliness and the good offices of the staff, Muslim or not, and so they had no qualms about his occasional readmittance to the ward.
Anyway, he said to me, was I aware that it was in the Islamic world that the first psychiatric hospitals had been built? No, I said, I wasn’t. But every day’s a school day.
I read up on it. He was right. Where mediaeval Christian physicians were often ready to attribute mental disorder to the influence of the Devil, Islamic physicians of the time proceeded by clinical observation.
The Persian physician Rhazes (Muhammad ibn Zakariya Razi, born in 865AD and died in 925) wrote two significant studies which recorded clinical cases of his own experience, defined certain illnesses, and described symptoms and treatments. A century later Avicenna (Abu Ali al-Hussein ibn Abd Allah ibn Sina) was the first to describe a number of psychiatric conditions such as hallucinations, mania, melancholia and dementia.
The medieval Islamic world also pioneered the concept of psychiatric hospitals. The first was built in Baghdad in 705 AD, the second in Fes in the early 8th century, and the third in Cairo in 800 AD. Later examples were built in Damascus and Aleppo. Muslim physicians developed several therapies, including psychotherapy, medication, music and relaxation, and occupational therapy. As in so many other disciplines, Islamic scholars were ahead of their time.
A humane attitude is enjoined upon Muslims, in any case, by the Qur’an. Sura 4;5 (Al-Nisā) states: “Do not give the property with which God has entrusted you to the insane: but feed and clothe them with this property and speak kindly to them”. There’s hardly a better recommendation for treatment even today.
(Slightly edited from my memoir, 'The Locked Ward'.)