The MindFields College Blog

I found a snippit on the science blog Neurophilosophy about an Islamic textbook on surgery and illness, published in 1465, of which the above illustration is from. The picture is thought to show the burning of small areas of tissue (cauterization) to treat various mental health problems. Apart from anything, this book is an incredible record of how important Islamic influence has been in the development of medicine.The American Journal of Psychiatry notes in its recentarticle Absence of Schizophrenia in a 15th century Islamic Medical Textbook:

“Serefeddin Sabuncuoglu (1385-1470) was a general physician who practiced during the 15th century in central Anatolia, which is now Turkey. Written in Turkish with Sabuncuoglu’s own calligraphy, Cerrahiyyetu’l-Haniyye (Imperial Surgery) is the first known illustrated textbook of surgery and contains colored, handmade miniatures of surgical techniques and instruments (6, 7). The book contains Sabuncuoglu’s descriptions of numerous medical conditions and their treatments. Several neurological conditions, including migraine headaches, epilepsy, and tremor are described. The psychiatric conditions described are melancholy (mal-i hulya) and forgetfulness (unutsaguluk). ”

What is particularly interesting however is that no condition resembling schizophrenia appears in this textbook:

“We have carefully reviewed each illustration of Sabuncuoglu’s masterpiece and report that a description of a condition that resembles schizophrenia is not present.

Individuals with schizophrenia may have existed in remote times, but the disorder might have been embedded and obscured within cultures in an acceptable form. Perhaps individuals with schizophrenia were better tolerated during the more simple times of the past. However, we would argue that the devastating nature of the illness that typically robs an adolescent of his or her premorbid personality would be difficult to ignore.

While the absence of any mention of a schizophrenia-like illness in Sabuncuoglu’s textbook does not prove that schizophrenia is a modern epidemic, it provides further evidence that this disorder was not mentioned in yet another ancient culture. If schizophrenia did not exist prior to the 1700s, then one wonders what changes have resulted in the development of the disorder.“

A reply to this article which might explain this strange finding appears from Osman Sabuncuoglu (possibly a relation to the original Turkish physician?!), M.D. and Naheeda Ismail, M.D:

“The absence of schizophrenia in Serefeddin Sabuncuoglu’s textbook may simply be related to the fact that his treatment techniques could only be applied to patients who could consent, cooperate, and comply with procedure. Schizophrenia patients are, and probably were then, very unlikely to fall within this group, and there was no room for involuntary treatment in Sabuncuoglu’s approach as revealed by the text. The illustrations also provide ample evidence that the appearance of the psychiatric patient did not differ from that of surgical patients with good self-care. The psychiatric patient was neither caged nor chained, and no assistance was required for the procedure. Clearly, the patient was very much like today’s day- or outpatient clinic patient under voluntary treatment.

So, what would happen to people who displayed symptoms of schizophrenia? Mental illness is thought to be dependent on social attitudes and beliefs that consequently determine the care and treatment that will be provided. According to Dols (1), the model of medical pluralism appears to be a helpful framework in understanding the complex and varying medical practices used to describe and treat unusual behavior throughout history. For those patients who were aggressive and destructive, there was a well-established tradition of special provision for the insane in Islamic medicine, and, until modern times, asylums were built throughout the Islamic world (1). In addition, we are aware of the existence of “hospital-villages” that functioned as community-based psychosocial rehabilitation centers for the mentally ill in Anatolia during the Medieval Ages. It is very likely that these facilities accommodated mostly patients with psychotic symptoms. Early descriptions of divine madness by Socrates seem to correspond with what was later called the wise fool, the holy fool, the lover, and the poet (1). Without mentioning either a diagnosis or a treatment, therefore avoiding stigmatizing terms, these descriptions were featured as acceptable solutions to a complex problem.”

Posted by: Eleanor