IIAS Newsletter | #30 | March 2003 11 > Theme By Fabrizio Speziale I n Muslim medical sciences the inter- pretation and treatment of psychi- atric disorders is based on at least two different schools (although some sci- entific concepts are common to them both). A secular, and medically ground- ed, theory and clinical practice, based on Greek-Arab science (called unani, lit. Ionic or Greek, in India), can be differ- entiated from a religious-spiritual set of interpretations. The latter has been moulded by several roots: the tibb-i nabawi (prophetic medicine), that is the collections and commentaries of the sayings of the prophet Muhammad (d. 632) on hygiene and medicine, sufi rit- uals and the cult of sufi saints, and other elements derived from esoteric sciences and folk beliefs. Unani medicine and psychiatry In unani theory the interpretation of psychiatric disorders is based on the doctrines of Galen (d. 200 ca.) and Avi- cenna (Ibn Sina, d. 1037), and the phys- iology of the four humours (blood, phlegm, yellow, and black bile) that cir- cle the body. Humours are a combina- tion of the four universal elements (fire, air, water, earth) and have four basic qualities (hot, cold, dry, and moist). Individual health is a state of relative equilibrium of the humours, characterized by the dominance of one humour, which determinates mizaj, the individual temperament (for exam- ple, the dominance of phlegm or black bile determines the phlegmatic or melancholic characters respectively). Alteration and excess of humours pro- duces diseases, in particular black bile (cold and dry), which induces depres- sive disorders. Excess of yellow bile (hot and dry) leads to hysteria and maniacal disorders. The aim of the physician is to restore the normal mizaj of the person, by dif- ferent means. Pharmaco-therapy is today the most common. University pharmaceutical laboratories (such as Hamdard in Delhi and the Tibbiya Col- lege of Aligarh), as well as private ones, offer traditional compound drugs and electuaries for disorders such as mania, hysteria, epilepsy, melancholia, and sleep and sexual disorders. In the past, treatments such as phlebotomy, cupping, Turkish baths, aroma-thera- py, poetry reading, and music-therapy, were used, and clinical cases of Mus- lim physicians using suggestion and cognitive therapies are well docu- mented in literature. Due to the impact of modernization, however, these are rarely practised today. Religious medicine In religious medicine the interpre- tation of human suffering is part of a wider spiritual and ethical framework. According to Islamic psychology, human personality has two funda- mental components, the nafs (pl. nufus) or individual ego, and the ruh (pl. arwah), or soul, conceived as aggre- gates of different nufus and arwah. On account of its relation to desires, sin, and the ‘whispers’ of Satan, the lower nafs is the origin of psychological suf- fering. Thus, the nufus are hierarchi- cally ordered - from the lower nafs (‘prone to evil’), to the ‘perfect’ or ‘sat- isfied’ nafs. Psychiatric disorders are commonly interpreted as possession by the shaytan (devil) and jinns (spirits mentioned in the Quran as created from fire, who inhabit a subtle world in which mankind is immersed, as into a liquid). in general, during critical phases of life. Even today, sufi shrines working as psychiatric in- and out-patient cen- tres are common in many urban and rural areas, and are visited by patients from all social classes and religious backgrounds. Some dargahs provide tens of rooms, which are rented to patients and their relatives. Those possessed by danger- ous devils are put in chains and some of them might reside in a dargah for months or years. Not uncommonly, most of the patients in dargahs in the cities have previously been treated unsuccessfully with drugs in a public psychiatric facility. With the help of donations from wealthy pilgrims, many dargahs also offer meals for the poor. Tradition and modernization The two branches of Islamic psychi- atry have responded in their own dif- ferent ways to the colonial and post- colonial processes of globalization, and the confrontation with biomedicine. Both traditions have ably adapted their identity and role to accommodate con- temporary social, political, and eco- nomical changes. The unani school and its hospitals have lost important tradi- tional features, but have also retained a refined pharmaco-therapy that, through mass advertising in the cities, can today compete with modern drugs and has found a definite place in the Indian plu- ralist and globalized pharmaceutical market. Conversely, the popularity of sufi shrines to treat psychiatric patients has not been affected by modern institu- tions. However, important aspects of the sufi tradition in particular have been subject to considerable change. While previously sufis were among the main practitioners of unani medicine, they lost their double role as doctor and instructor in the post-independence period, when the teaching of unani medicine (which had previously been based on family transmission) was institutionalized in universities. The large influx of pilgrims to many of the dargahs nowadays feeds a prolific mar- ket of medico-religious tourism that is profoundly changing the ethics of the profession. The result is that sufis, who traditionally did not accept money, are increasingly being replaced by a new type of smart and business-minded spiritual healer, who may not have any relation to sufi orders. < Bibliography - Bürgel, Christoph, ‘Psychosomatic meth- ods of cures in the Islamic Middle Ages’, Humaniora Islamica I (1973), pp.157–172. - Fârûqî, Rahbar, Islâmî tibb shâhânah sarparstiyûn men, Hyderabad (1937). - Speziale, Fabrizio, ‘La medicina greco- araba in India’, Storia della Scienza Vol. II, Istituto della Enciclopedia Italiana, pp.921–926. Dr Fabrizio Speziale teaches social anthro- pology at the II° Faculty of Medicine and Surgery of the University La Sapienza of Rome. He received his PhD from the Ecole des hautes études en sciences socials in Paris. spezialef@yahoo.com Islamic medicine and psychiatric care were introduced to the Indian subcontinent in the twelfth and thirteenth century, during the Muslim invasion of the region. Today Muslim medicine offers a psychiatric care system alternative to that of biomedicine and is used by Muslims and non-Muslims alike. The inclusion of the secular branch of Islamic medicine (see below) in the state public health systems of the region has lead to increased modernization of the traditional and, consequently, to important changes in its scientific identity and to the decline of particular treatments. Research > South Asia Tradition & Modernization of Islamic Psychiatric Care in the Subcontinent Masters of the sufi orders are tradi- tional religious healers who treat instances of possession and other ail- ments by recitations of the Quran, tal- ismans, and prescription of behav- ioural and ritual instructions. A cardinal element of these healing ritu- als is the pilgrimage to shrines and tombs of sufi saints, where healers usually reside and where incubation of healing dreams is a common practice. Muslim medical institutions A main contribution to Muslim med- icine in India was the introduction of the Arab model of the hospital, where patients of all backgrounds (regardless of caste and religion) were treated free of charge. It facilitated the diffusion of Islamic medicine among non-Muslims. Hospitals were often provided with wards for the insane, where drugs, as well as music-therapy and Turkish baths, amongst other things, were applied. The first known psychiatric wards of Muslim India were founded in Delhi and Mandu, during the four- teenth and fifteenth centuries. In the post-colonial epoch, surviving unani hospitals were incorporated into the state health system and new ones were created. The role of traditional asylum wings, however, was taken over by mod- ern psychiatric hospitals. Since medieval times some sufi shrines have specialized in the treat- ment of psychiatric disorders. These institutions, called dargahs, are archi- tectural compounds which can include tombs, a monastery, houses, a mosque, and even rooms for patients. Tradi- tionally, both unani hospitals and dar- gahs were endowed with donations and properties (waqf) by Muslim kings. Muslim saints could provide protec- tion, quite specifically against illness and possession by devils, but also more A complete medical system, based on Greek medical science and further developed in an Islamic context is contained in the al-Qanun fil-Tibb, by Ibn Sina (972-1036). The first book of these works, which came to be known in Europe Avicenna’s Canon, is shown here. Yunani Tibb, lit. Greek medicine, is an old form of medicine that has combined Greek and Islamic elements and is still practised in India and Pakistan. Exhibition poster designed by J.J.Witkam Al-Qanun fi ‘t-Tibb by Ibn Sina, Or.63, f.2a, Leiden University Library (UB), Legatum Warnerianum. Arabic writing, not dated.