Baseline on Clinical Psychology of Islam

http://jalaledin.blogspot.com/2009/01/baseline-on-
clinical-psychology-of.html
Sunday, January 11, 2009
Clinical and medical approach (Courtesy of Wikipedia)

Unlike medieval Christian physicians who relied on demonological explanations for

mental illness, medieval Muslim physicians relied mostly on clinical psychiatry and
clinical psychology, and clinical observations on mentally ill patients. They made
significant advances to psychiatry and were the first to provide psychotherapy and moral
treatment for mentally ill patients, in addition to other new forms of treatment such as
baths, drug medication, music therapy and occupational therapy.[32]

[edit] Al-tibb al-ruhani and diseases of the mind

The concepts of al-tibb al-ruhani (translated as "spiritual health" in Arabic) and "mental
hygiene" were introduced in Islamic medicine by the Persian physician Abu Zayd Ahmed
ibn Sahl al-Balkhi (850-934), who often related it to spiritual health. In his Masalih al-
Abdan wa al-Anfus (Sustenance for Body and Soul), he was the first to successfully
discuss diseases related to both the body and the soul. He used the term al-Tibb al-Ruhani
to describe spiritual and psychological health, and the term Tibb al-Qalb to describe
mental medicine. He criticized many medical doctors in his time for placing too much
emphasis on physical illnesses and neglecting the mental illnesses of patients, and argued
that "since man’s construction is from both his soul and his body, therefore, human
existence cannot be healthy without the ishtibak [interweaving or entangling] of soul and
body." He further argued that "if the body gets sick, the nafs [psyche] loses much of its
cognitive and comprehensive ability and fails to enjoy the desirous aspects of life" and
that "if the nafs gets sick, the body may also find no joy in life and may eventually
develop a physical illness." Al-Balkhi traced back his ideas on mental health to verses of
the Qur'an and hadiths attributed to Muhammad, such as:[3]
"In their hearts is a disease."
— Qur'an 2:10
"Truly, in the body there is a morsel of flesh, and when it is corrupt the body is corrupt,
and when it is sound the body is sound. Truly, it is the qalb [heart]."
— Sahih al-Bukhari, Kitab al-Iman
"Verily Allah does not consider your appearances or your wealth in (appraising you) but
He considers your hearts and your deeds."
— Musnad Ahmad ibn Hanbal, no. 8707

[edit] Mental hospitals

As a result of the new positive Islamic understanding of mental illness, the first mental
hospitals and insane asylums were built in the Islamic world as early as the 8th century.
The first mental hospitals were built by Arab Muslims in Baghdad in 705, Fes in the early
8th century, and Cairo in 800. Other famous mental hospitals were built in Damascus and
Aleppo in 1270.[4][33]

[edit] Al-‘ilaj al-nafs and tibb al-qalb

Ali ibn Sahl Rabban al-Tabari's Firdous al-Hikmah written in the 9th century was the first
work to study 'al-‘ilaj al-nafs (translated as "psychotherapy" from Arabic)[10] in the
treatment of patients. His ideas were primarily influenced by early Islamic thought and
ancient Indian physicians such as Sushruta and Charaka. Unlike earlier physicians,
however, al-Tabari emphasized strong ties between psychology and medicine, and the
need for al-‘ilaj al-nafs and counseling in the therapeutic treatment of patients. He wrote
that patients frequently feel sick due to delusions or imagination, and that these can be
treated through "wise counselling" by smart and witty physicians who could win the
rapport and confidence of their patients, leading to a positive therapeutic outcome.[14] In
his chapter on mental illness, al-Tabari first described thirteen types of mental disorders,
including madness, delirium, and Fasad Al-Khayal Wal-Aqo ("damage to the
imagination, intelligence and thought").[34] He also clearly highlighted mental illness as
a speciality of its own.

The Tunisian Arab Muslim physician,[35] Ishaq ibn Imran (d. 908),[36] known as
"Isaac" in the West,[37] wrote an essay entitled Maqala fil-L-Malikhuliya, in which he
first described psychosis, and also described a type of melancholia: the "cerebral type" or
"phrenitis". He described the diagnosis of this mental disorder, reporting its varied
symptoms. The main clinical features he identified were sudden movement, foolish acts,
fear, delusions, and hallucinations of black people.[36] This work was later translated
into Latin as De Oblivione (On Forgetfulness) by Constantine the African.[35]

The Persian physician Muhammad ibn Zakarīya Rāzi (Rhazes) (865-925) wrote the
landmark texts El-Mansuri and Al-Hawi in the 10th century, which presented definitions,
symptoms, and treatments for many illnesses related to mental health and mental illness.
Razi's texts made significant advances in psychiatry. Razi also managed the mental ward
of a Baghdad hospital. Such institutions could not exist in Europe at the time, because of
European fears of demonic possession.[32]

In the centuries to come, Islam would serve as a critical waystation of knowledge for
Renaissance Europe, through the Latin translations of many scientific Islamic texts. Razi,
al-Tabari and Ahmed ibn Sahl al-Balkhi were the first known physicians to study al-‘ilaj
al-nafs.
Ali ibn Abbas al-Majusi (d. 982) discussed mental illness in his medical text, Kitab al-
Malaki, where he discovered and observed a type of melancholia: clinical lycanthropy,
associated with certain personality disorders. He wrote the following on this particular
mental illness:[36]
"Its victim behaves like a rooster and cries like a dog, the patient wanders among the
tombs at night, his eyes are dark, his mouth is dry, the patient hardly ever recovers and
the disease is hereditary."

Avicenna (980-1037) often used psychological methods to treat his patients.[23] One
such example involved a prince of Persia who had melancholia and suffered from the
delusion that he was a cow. He would low like a cow, crying "Kill me so that a good stew
may be made of my flesh," and would not eat anything. Avicenna was persuaded to
undertake the case, and sent a message to the patient, asking him to be happy, as the
butcher was coming to slaughter him, and the sick man rejoiced. When Avicenna
approached the prince with a knife in his hand, he asked, "Where is the cow so I may kill
it." The patient then lowed like a cow to indicate where he was. By order of Avicenna in
his role as the butcher, the patient was also laid on the ground for slaughter. When
Avicenna approached the patient, pretending to slaughter him, he said, "The cow is too
lean and not ready to be killed. He must be fed properly and I will kill it when it becomes
healthy and fat." The patient was then offered food, which he ate eagerly and gradually
"gained strength, got rid of his delusion, and was completely cured."[38]

[edit] Music therapy

Al-Kindi (801–873) was the first to realize the therapeutic value of music. He was the
first to experiment with music therapy, and he attempted to cure a quadriplegic boy using
this method.[39]
Later in the 9th century, al-Farabi also dealt with music therapy in his treatise Meanings
of the Intellect, where he discussed the therapeutic effects of music on the soul.[15]

[edit] Cognitive therapy

Al-Kindi developed cognitive methods to combat depression and discussed the

intellectual operations of human beings.[14]
According to the psychologist Amber Haque, the medieval Islamic scholar Abu Zayd
Ahmed ibn Sahl al-Balkhi (850-934) was "probably the first cognitive and medical
psychologist to clearly differentiate between neuroses and psychoses, to classify neurotic
disorders, and to show in detail how rational and spiritual cognitive therapies can be used
to treat each one of his classified disorders."[40]

Al-Balkhi classified neuroses into four emotional disorders: fear and anxiety, anger and
aggression, sadness and depression, and obsession. According to Haque, al-Balkhi further
classified three types of depression: normal sadness (huzn) which is "today known as
normal depression", "endogenous depression" which "originated within the body", and
"reactive depression" which "originated outside the body".[40]

Al-Balkhi also wrote that a healthy individual should always keep healthy thoughts and
feelings in his mind in the case of unexpected emotional outbursts in the same way drugs
and First Aid medicine are kept nearby for unexpected physical emergencies. He stated
that a balance between the mind and body is required for good health and that an
imbalance between the two can cause sickness. Al-Balkhi also introduced the concept of
reciprocal inhibition (al-ilaj bi al-did), which was re-introduced over a thousand years
later by Joseph Wolpe in 1969.[40]

[edit] Physical and psychological disorders

The Muslim physician Abu Zayd Ahmed ibn Sahl al-Balkhi (850-934) was a pioneer of
al-‘ilaj al-nafs, and the first to compare "physical and psychological disorders" and show
"their interaction in causing psychosomatic disorders." He recognized that the body and
the soul can be healthy or sick, or "balanced or imbalanced", and that mental illness can
have both psychological and/or physiological causes. He wrote that imbalance of the
body can result in fever, headaches and other physical illnesses, while imbalance of the
soul can result in anger, anxiety, sadness and other mental symptoms. He recognized two
types of depression: one caused by known reasons such as loss or failure, which can be
treated psychologically through both external methods (such as persuasive talking,
preaching and advising) and internal methods (such as the "development of inner
thoughts and cognitions which help the person get rid of his depressive condition"); and
the other caused by unknown reasons such as a "sudden affliction of sorrow and distress,
which persists all the time, preventing the afflicted person from any physical activity or
from showing any happiness or enjoying any of the pleasures" which may be caused by
physiological reasons (such as impurity of the blood) and can can be treated through
physical medicine.[3] He also wrote comparisons between physical disorders with mental
disorders, and showed how psychosomatic disorders can be caused by certain interactions
between them.[40]

In the early 10th century, Muhammad ibn Zakarīya Rāzi reported a psychotherapeutic
case study from a contemporary Muslim physician who treated a woman suffering from
severe cramps in her joints which made her unable to rise. The physician cured her by
lifting her skirt, putting her to shame. He wrote: "A flush of heat was produced within her
which dissolved the rheumatic humour."[32]

Ali ibn Abbas al-Majusi (d. 982) elaborated on how the physiological and psychological
aspects of a patient can have an effect on one another in his Complete Book of the
Medical Art. He found a correlation between patients who were physically and mentally
healthy and those who were physically and mentally unhealthy, and concluded that "joy
and contentment can bring a better living status to many who would otherwise be sick
and miserable due to unnecessary sadness, fear, worry and anxiety."[3] He also first
discussed various mental disorders, including sleeping sickness, memory loss,
hypochondriasis, coma, hot and cold meningitis, vertigo epilepsy, love sickness, and
hemiplegia. He also placed more emphasis on preserving health through diet and natural
healing than he did on medication or drugs, which he considered a last resort.[15]

Avicenna (Ibn Sina) (980-1037), considered a father of modern medicine,[41] was a

pioneer in neuropsychiatry, physiological psychology and psychosomatic medicine in
The Canon of Medicine, and contributed to the nature versus nurture debate with his
theories of empiricism and tabula rasa.

Avicenna (980-1037) recognized "physiological psychology" in the treatment of

"illnesses involving emotions" and develop "a system for associating changes in the pulse
rate with inner feelings" which is seen as an anticipation of "the word association test of
Jung." Avicenna identified love sickness (Ishq) when he was treating a very ill patient by
"feeling the patient's pulse and reciting aloud to him the names of provinces, districts,
towns, streets, and people." He noticed how the patient's pulse increased when certain
names were mentioned, from which Avicenna deduced that the patient was in love with a
girl whose home Avicenna was "able to locate by the digital examination." Avicenna
advised the patient to marry the girl he is in love with, and the patient soon recovered
from his illness after his marriage.[32]

Avicenna also gave psychological explanations for certain somatic illnesses, and he
always linked the physical and psychological illnesses together. He described
melancholia (depression) as a type of mood disorder in which the person may become
suspicious and develop certain types of phobias. He stated that anger heralded the
transition of melancholia to mania, and explained that humidity inside the head can
contribute to mood disorders. He recognized that this occurs when the amount of breath
changes: happiness increases the breath, which leads to increased moisture inside the
brain, but if this moisture goes beyond its limits, the brain would lose control over its
rationality and lead to mental disorders. He also wrote about symptoms and treatments
for nightmare, epilepsy, and weak memory.[23]

[edit] Nosology and psychopathology

In nosology, the Arab Muslim physician and psychological thinker Najab ud-din
Unhammad (870-925) described in detail nine major categories of mental disorders,
which included 30 different mental illnesses in total. Some of the categories he first
described included obsessive-compulsive disorders (anxious and ruminative states of
doubt), delusional disorders (which "manifested itself by the mind's tendency to magnify
all matters of personal significance, often leading to actions that prove outrageous to
society"), degenerative diseases, involutional melancholia, and states of abnormal
excitement.[42]

Unhammad made many careful observations of mentally ill patients and compiled them
in a book which "made up the most complete classification of mental diseases theretofore
known." The mental illnesses first described by Najab include agitated depression,
neurosis, priapism and sexual impotence (Nafkhae Malikholia), psychosis (Kutrib), and
mania (Dual-Kulb).[32]
Unhammad also listed nine classes of psychopathology. This included the earliest
description of Souda a Tabee (febrile delirium), which was in turn subdivided into Souda
where patients showed impairment of memory, loss of contact with the environment, and
childish behaviour; and Jannon (agitated reaction) which occurs when Souda reaches a
chronic state and is characterized by insomnia, restlessness and sometimes "beast-like
roars."[43]
Posted by The Opening at 11:05 AM