Psychotherapy Services in South West London

Mental Asylums 500 years ago

Evidence for medical institutions for people suffering form madness first appears in the Arabic Empire. These medieval institutions, called maristrans or bimaristans pre-dated asylums in Europe by more than 500 years. Although we tend to think of schizophrenia as the hallmark of western psychiatry’s diagnostic system, depression has a much longer history by far. It was first designated as an illness by Hippocrates  around 500 BC when he called it “melancholia”. People thought to be mad were looked after by religious bodies for hundreds, perhaps thousands, of years in many societies. Evidence for medical institution for people suffering form madness first appears in the Arabic Empire that stretched in its heyday (between the 10th and 13th centuries) form Persia to Spain. As medical scholarship developed within the flowering of early science in a context of Islamic cultural traditions – where, incidentally, Christians, Jews and Muslims worked together in Arabic – the idea of mental illness proposed by Hippocrates was incorporated into a stronger medical framework. And the Arabs built hospitals for the sick (while the Greek never did) these places took in people diagnosed as mentally ill. Such institutions as having been established in Cairo (Egypt) in 683 A. D., in Aleppo (Syria) in 755 A. D, in Baghdad (Iraq) in the late 8th century and in Granada (Spain) in 1365- 1367 AD. Many of the accounts quoted by Michael Dols (Majnun: The Madman in medieval Islamic society, 1992) refer to impressive buildings, with pools, fountains, flowing water and flower gardens. It seems great care was taken to decorate the hospital wards to cheer the deranged. And generally there were good conditions, such as beds with mattresses and space for patients to wander about in. Dols quotes a travelling Rabbi who came across maristran in Cairo, commenting on the special food supplied to patients at the Caliph’s expenses, but also noting that patients were held in iron chains until their reason is restored. There is no doubt that psychical restrain was used on mental patients and visitors reported observing beatings. Dispensing of medicines was commonplace: an Arabic text mentions stimulants, sedatives, and drugs for gladdening of the spirit. Interestingly it seems that music was used to treat melancholia, reflecting a medico musical tradition well established in Islamic society. What was strikingly different about the maristans in the Arabic Empire from the early asylums in Europe over 500 years later was that they were not isolated institutions, but always in the centre of cities, easily accessible to most people. Clearly the patients were frequently visited by family and friends, and more generally seen as a apart of society.  As far as we know, these institutions were not used for confinement of people seen as socially undesirable, as was the case in European asylums.

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