MENTAL  WELL-BEING IN ISLAM & ANCIENT ISLAMIC HOSPITALS 

 

Author:Dr. Akeel. A. Abdul Wahab

Fellow & Member of The Royal College of Psychiatrists (UK)

FRCPsych. (UK), MRCPsych. (UK), Board Neuropsych. (London University, UK), Dip.Psych. (London University, UK), MB.ChB. (Basra University, Iraq )

Formerly Senior Consultant Psychiatrist & Clinical Professor

   

Abstract:

This article attempts to prove that the principles and rituals of islam have an impact on the general mental wellbeing by bringing happiness and to create a balance between the mind and the desires, Islam also emphasise on humanity and not on the individual, social, race or cultural background.

Special attention paid in Islam to mentally ill people, therefore, for this reason, mental health care  was an important component of the Islamic hospitals. The Muslim physicians were very expert in  recognising the relationship between physical and the  psychological component of health, in this paper illustrated settings of ancient Islamic mental health care in some of the prominent hospitals in Baghdad, Damascus, Cairo and Andalusia.  

Spiritual perspective 

Islam has honoured health as a fundamental right of every human being, which makes it a powerful source of guidance and information. Islam has prioritised health, placing it as second in importance to faith.

Many verses of the holy Quran emphasise the healing of physical and mental ailments.

(يا أيها الناس قد جاءتكم موعظة من ربكم وشفاء لما في الصدور وهدى ورحمة للمؤمنين- يونس ٥٧)

“O Mankind!, there has come to you a direction  from your Lord and a healing for the diseases in your hearts and for those who believe, a guidance and a mercy.” (Surah Yunus, verse 57)

(وننزل من القرآن ما هو شفاء ورحمة للمؤمنين –الإسراء ٨٢)

“ And We send down from the  Quran  that which is a healing  and mercy  to those who believe.” ( Surah al-Isra'. 82). 

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Islamic medicine also followed the words “Hadith"- of the Prophet Muhammad (peace and blessing of Allah be upon him)  "Allah never inflicts a disease unless Allah makes a cure for it,” – Ref: Imam Muhamed Al Bukhara 810-870 AD), and the Prophet said “ There is no disease that Allah has created, except that Allah created its treatment" – Ref: Abu al-Darda 580-652 AD). 

It has been attempted by  some western scholars in the fields of psychology  to  elucidate   the Islamic conceptualisation of the self,  Arabic :nafs    النفس, onto the Freudian psychoanalytical approaches to the “self” – where al-nafs al-amara  -Arabic:        النفس الأمارة is seen as the lowest element, at mercy to instinctual  temptation and inclination (i.e., the id), al-nafs al-lawwama    -    Arabic:   النفس اللوامة which enables reason and decision making and self-reflection (i.e., the super-ego), and al-nafs al-mutmaenna         Arabic: النفس المطمئنة  corresponding to inner peace, tranquility, satisfaction, and self-actualisation and the desired state of attainment, which has been linked to the concept  of intellectual  reasoning. 

Generally, the Islamic perspective on mental health is a holistic one, in which positive mental health and good physical health are viewed as being interconnected. 

Islam emphasis the concept of the relationship between  the soul and the body, and in line with the Islamic principles, the Muslim appeal to Allah must evoke physical and spiritual purity, hence the religious requirements  for  cleanliness (ablution “washing before praying” thus, positive  physical and mental wellbeing are essential for the performance of religious obligations.

Islamic Health Care

It has been reported that, the first known Islamic health care setting was set up in a tent by Rufaydah al-Aslamiyah during the lifetime of the Prophet Muhammad (Peace and blessing of Allah be upon him). Famously, during the Ghazwah Khandaq (Battle of the Ditch), she treated the wounded in a separate tent erected for them (1). 

 

The first known Muslim hospital  was  for patients with leprosy, constructed in the early eighth century in Damascus under Umayyad Caliph Walid ibn ‘Abd al-Malik 705 to 715  AD (86-96 H), Patients were constricted in hospital for long time  as leprosy was recognised to be contagious, while in hospitals  their families received  support and allowances 2.

Islamic hospital was one of the great achievements of ancient Islamic society, a more elaborate institution with a wider range of functions.

In Islam it is generally a moral imperative to treat all the ill regardless of their 

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social, or financial status, age, gender and religion. The hospital usually provides treatment, a convalescence environment following recovery, sheltered for poor and homeless people for the aged and infirm who lacked family care.

The earliest documented hospital established by an Islamic ruler was built in the 9th century in Baghdad by the caliph Harun al-Rashid. 

In Egypt  the first hospital was built in Fustat (Cairo)  in 872 AD (259 H) by Ahmad ibn Tulun, the Abbasid ruler of Egypt. It is the earliest for which there is clear evidence that care for the insane was provided. 

In the 12th Century, Saldin founded the Nasiri Hospital in Cairo, followed by the Mansori Hospital in  1284 (638 H) after which it remained operational through the 15th century.  

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The Nur al-Din Hospital, a hospital and medical school in Damascus, was founded in the 12th century. Today it is the Museum of Medicine and Science in the Arab World.

Al -Nuri Hospital  in  Damascus was founded in the middle of the 12th Century and remained operational into the 15th century. Nur al-Din al-Zangi was the first great leader to defeat the Crusaders, over half a century after they set foot on 

Islamic land. He was well known  as a righteous, religious and charitable Ruler. The revenues of the hospital, according to Al Maqrizi (medieval Arab historian during the Mamluk era 1364-1442 AD), were owed to the fact that Nur-al-Din had made a prisoner a European king, and had planned to have him executed. But the king paid  his ransom, and he was released. Nur-al-Din decided to use this ransom to build the hospital in Damascus that was named after him 3. 

In Al-Qayrawan, a hospital was built in the 9th century, and early ones were established at Mecca and Medina. 

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In Rayy, Persia a hospital was founded by A-Razi prior to his moving to Baghdad.

Many hospitals were founded under the Ottomans in the 13th century. 

Hospitals were comparatively late in being established in Islamic Spain, the earliest possibly being built in 1397 (800 H) in Granada. The Hospital of Granada was founded by the Nasrid sultan Muhamed V  in 1365 AD,  it was located near the 11th century bathhouse known hamam al-Yawza (today known as El Banal), it was especially notable  for treating mental illness, it was one of the earliest hospitals in Europe that took care of mentally ill 4.

A comparable institution in Christian Spain only appeared in the early 15th century with the foundation of the Hospital of Our Lady Mary of the Innocents in Valencia, the first purely psychiatric hospital in Europe. 

The Hospital constitution

The Islamic Hospitals buildings usually have four central Iwans or courts, each with a water fountain in the centre to provide a supply of clean water and baths, separate wards for men and women and for different diseases, a dispensary, lecture halls, and  out-patient clinics with a free dispensary of medicinal (from where patients were visited at their homes), In addition there  were with many adjacent rooms including kitchens, storage areas, a pharmacy, some living quarters for the staff, library, quarters for spiritual practice, meetings or therapies activities such as Music 5.

There was a separate hall for women patients and areas reserved for the treatment of physical conditions   (such as Eye, gastrointestinal complaints, and fevers). There was also an area for surgical cases and a special ward for the mentally ill. 

 

 

 

 

 

 

 

 

 

 

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Musician and storytellers entertained the sick  (Major 1954:260;Porter1997:104-105;Guthrie1958:95,96

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The staff included physicians pharmacists and assistants, physicians also visiting of in -patients,  assisted by male and female attendants who tended the basic needs of the patients.There were also instructors (mu`Allimon), possibly aspiring medical students, who trained the non-professional staff.The  responsible for the management of the hospital was an administrator who was not usually trained in medicine.The chief of staff, on the other hand,was a medical man.

Little detailed information is available regarding the hospitals as teaching institutions.

HOUSE OF WISDOM (Bayt Al-Hikmah Arabic: (بيت الحكمة ) 

 

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Baghdad 1,200 years ago was the thriving capital of the Muslim civilization. For about 500 years the city boasted the cream of intellectuals and culture. For more than two centuries, it was home to the House of Wisdom, an academy of knowledge that attracted brains from far and wide. From mathematics and astronomy to zoology, the academy was a major centre of research, thought and debate in Muslim Civilization (Sketch: 1001 Inventions).

The House of Wisdom (Bayt Al-Hikmah Early 9th century) is well documented as one of the leading libraries in Islamic history that appeared during the Abbasid dynasty (Golden age of Islam). Bayt Al-Hikmah has had a very organised management system especially in collecting and book cataloguing, the library had a great interest in debating and scientific circles in various topics and subjects.

The Abbasids attained their most sparkling period of intellectual and political life (5-9).

Soon after the caliphate was established. The founder of Bayt al-Hikmah was Abu Ja'far al-Mansur (95-135 AH) who collected books on medicines, astronomy, engineering and literatures that have been translated in his reign, moreover some other publications on Hadith (prophetic tradition), history, Qura'nic sciences, Al-Mansur has gathered all collections of books in his palace that was the nucleus of the house of wisdom. He motivated Muslims to study sciences and promote translation of literatures and books from Greek, Persian and Indian languages. Among the books that al-Mansur initiated their translations were the book of Al-Sind Hind a book on mathematics and a huge collection of Aristotle, Euclid and of Claudius Ptolemy writings, literature, and history were gathered in his palace that later on was developed becoming the house of wisdom.

The Caliphate reached its prime during the time reigns of Harun al-Rashid (149-193 AH) and his son al-Ma'mun (170-217 AH). The house of wisdom was one of the leading libraries that distinguished the Abbasid times, it opened its doors for researchers, scholars and leaders. 

The life of Muslims throughout history was correlated with the establishment of libraries which enhance  a great interest in debating and scientific circles in various topics and subjects, and represent intelligence and mental inheritance for all humankind.

Bayt al-Hikmah was the preferable destination for intellectuals because it offered everything they needed including libraries, classrooms, divisions of binding, translating, and publishing , etc.

Bayt al-Hikmah preserved the knowledge and heritage of the ancient civilizations and it contributed with a remarkable and  unprecedented discovery that the western civilization has utilized to thrive.

The most famous of the translators was Hunayn ibn Ishaq al-`Ibadi, a Syriac-speaking Christian originally from southern Iraq who also knew Greek and Arabic. He was the author of many medical tracts and a physician to the caliph al-Mutawakkil (ruled 847-861/232-247 H), but he is most often remembered as a translator, and known at that time, half of the Aristotelian writings as well as commentaries, various mathematical treatises, and even the Septuagint. Ten years before his death he stated that of Galen's works alone, he had made 95 Syriac and 34 Arabic versions (6,7 ).

MEDICAL TEACHING & TRAINING

Formal teaching, instruction and clinical training at bedside in hospital was available at certain hospitals such as the  AL Adudi  hospital in Baghdad, the hospital was founded by the ruler, the Aḍud al-Dawla, the Buyid Dynasty, (Arabic:    عضد الدولة "Pillar of the Abbasid Dynasty”,949-983AD) Al-'Adudi 

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Hospital was considered one of the most innovative and modern hospitals of the medieval Islamic time period. Amongst well-known physicians of the time period was Al Razi who was chosen to decide the ideal location for Al-'Adudi Hospital. 

 981 A.D. on the western banks of the Tigris River.

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In the late ninth century, leading physician and polymath Muhammad ibn Zakariya al-Razi helped establish Al-'Adudi Hospital in Baghdad staffed with 25 doctors, optometrists, surgeons and bonesetters. The illustration above, from a 13th-century European translation of Al- Razi (Abu Bakr Muhammad ibn Zakariya A Razi, was born in Rayy, Persia 865(251H) and died in the same town about 925 (312H).

Al-'Adudi  Hospital was known as a medical institution and an institution for practicing  and for learning medicine.

It served individuals of all backgrounds regardless of race, religion, sex, and social background, were treated at the hospital by expert physicians of different areas of medicine that created set plans for patients.

The period between the eighth and 15th centuries – or the second and ninth centuries of the Islamic calendar –invoke the images of Europe darkness (medieval Europe) where as Andalusia (as Muslim ruled Spain was known) evoking images of enlightenment, tolerance, culture and civilisational achievements.Science, literature and the arts flourished, several of its natives, such as Ibn al-‘Arabi from Murcia became among the greatest spiritual thinkers.

Andalusia was part and parcel of the vast Muslim world that extended from the Atlantic coast of the Iberian Peninsula in the west to China in the east.

Andalusia’s contributions to Islam had been immense, though the same can be said of its contributions to the Latin West. Its intellectual contributions were largely in the field of mathematics, natural science and medicine. Arab-Muslim science in Andalusia flourished for several centuries. Its origin and rapid growth

as a scholarly effort and as a state supported institution could be traced to the 

10th century patronisation of scholarship initiated by Abdul Rahman III (d.961), founder of the Umayyad caliphate in Cordoba. He sought to create a new learning culture in Andalusia on the basis of the cultural and scientific achievements of Baghdad. His son, Al-Hakam II (d.976), energetically continued this court tradition of learning and scholarship (7-9).

The period was the most productive in terms of scientific creativity and literary output, but the brilliance was not unique to Andalusia. Although the region might have been the most advanced centre of scientific activities in Europe, on the larger international stage, it shared the limelight with other places such as the Middle East and Central Asia. It was not just the golden age of Andalusian science, but also the golden age of Islamic science as a whole.

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Appendix:Ancient Renowned   Muslim physicians and Medical Scientists

  

Al Razi  lived from 865 to 925 C.E.

physician, chemist, alchemist, philosopher, and scholar, pioneered ophthalmology, “The father of paediatrics,” 

penning more than 200 scientific books and articles. 

Medical Ethics :“The doctor’s aim is to do good, even to our enemies, so much more to our friends, and my profession forbids us to do harm to our kindred, as it is instituted for the benefit and welfare of the human race, and God imposed on physicians the oath not to compose mortiferous remedies.” AL Razi 

Ibn Sina (Avicenna)

Ibn Sina, he wrote approximately 450 books and articles, 240 of which still exist today. Forty of these focus on medicine.

Among ibn Sina’s significant contributions to medieval medicine were “The Book of Healing,” an expansive scientific encyclopaedia, and “The Canon of Medicine,” which became essential reading at several medical schools around the world.

Ibn al-Baytar in the 13th century. Ibn al-Baytar was perhaps the greatest pharmacist of medieval times

Ibn Rushd, better known as a commentator on Aristotle, was credited with several medical works including an encyclopedia entitled The Book of Generalities on Medicine, and his commentaries on Ibn Sina’s medical works. Maimonides wrote 10 medical works, all in Arabic.

Ibn al-Nafis (1213–1288)  Ala-al-din Abu al-Hassan Ali ibn Abi-Hazm al-Qarshi al-Dimashqi, now widely known as ibn al-Nafis. The physician was born in Damascus .

Muslim polymath whose area of works  (8-9)

 included  medicine,surgery,physiology,anatomy,biology,Islamic studies, juisprudence and philosophy.  He is known for being the first to describe the pulmonary circulation of the blood .The work of Ibn al-Nafis regarding the right sided (pulmonary) circulation pre-dates the later work (1628) of William Harvey’s De motu cordis .Both theories attempt to explain circulation. the second  century Greek physician  Galen’s theory about the physiology of the circulatory   system remained unchallenged until the works of Ibn al-Nafis, for which he has been described as "the father of circulatory physiology”

The leading botanists were Abu ‘Ubaid al-Bakri and Ibn Hajjaj in the 10th 

century, al-Ghafiqi (d. 1 165) and Ibn al-Awwam in the 11th  century, Abu’l-‘Abbas al-Nabati and Abu Marwan Ibn Zuhr (d. about 1 161) in the 12th century, and Ibn al-Baytar in the 13th century.

Al-Zahrawi, the greatest Muslim figure in surgery. Concession Kitab al-tasrif), the work that earned him the title “father of surgery,” was translated into Hebrew, Latin and Castilian

Jurjis ibn Jibra'il ibn Bakhtishu Christian Syriac-speaking physician `to Baghdad from Gondeshapur in southwest Persia . serving as physician to the caliph Harun al-Rashid.

 

References & further readings :

 

1.Hospital in islamic history , Hossam Arafa, 19January,2018, hit://aboutislam.net

 2.The Beginning of the Islamic Hospitals-Muslim heritage     by FSTCPublished on: 10th January 2003,4.5/5 ,Published on: 10th January  2003, 3.5 / 5. Votes 170

 3.The Bayt al-Ḥikmah (“House of Wisdom”), founded in ad 830 in Baghdad, contained a public library with a large collection of materials on a wide range of ..I Iraq   5.29 Sep 2016 — Known as Bayt al-Hikma in Arabic, the House of Wisdom was founded in 8th century Baghdad by Caliph Harun al-Rashid

 4.Al-Razi, the clinician. (2011, December 15)
https://www.nlm.nih.gov/exhibition/islamic_medical/islamic_06.html

5. Retief FP, Cilliers L. The evolution of hospitals from antiquity to the renaissance. Acta Theologica Supplementum. 2005;7:226.

6. Lakhtakia, R. (2014, November). A trio of exemplars of medieval Islamic medicine: Al-Razi, Avicenna and Ibn Al-Nafis. Sultan Kaboos University Medical Journal, 14(4): 455–459
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4205055/

7. .Medieval medical knowledge: Medieval superstitions and Muslim knowledge.http://www.bbc.co.uk/schools/gcsebitesize/history/shp/middleages/medievalknowledgerev2.shtml

 

 

 

 

 

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