Abu Zayd al-Balkhi

Abu Zayd Ahmad ibn Sahl al-Balkhi (849–934 CE) was a Persian scholar from what is now Afghanistan who worked during the height of the Abbasid Caliphate. He wrote on geography, philosophy, theology, mathematics, and medicine (more than sixty books in all), and his fame in his own era rested mostly on geography. But among those sixty books, one survived: a medical text called Masalih al-Abdan wa al-Anfus (Sustenance for Bodies and Souls), which is now recognized as a significant early attempt to classify and treat psychological disorders through what looks very much like a systematic method of changing thought patterns. He distinguished between depression caused by organic factors and depression caused by grief, he classified anger and fear and obsessive thinking as separate disorders requiring different treatment approaches, and he argued that most people suffer more from psychological symptoms than from physical illness. The manuscript sat in a library in Istanbul for centuries. Its modern scholarly recovery only began in 1984.

Life and Context

Al-Balkhi was born in 849 CE in a village called Shamisitiyan in the Persian province of Balkh.(Malik Badri, 2013) The biographical record is thin. The main source is Yaqut al-Hamawi’s Mujam al-Udaba, and al-Hamawi’s account of al-Balkhi draws on the testimony of one of al-Balkhi’s students, Abu Muhammad al-Hassan ibn al-Waziri, who described him as a slim, reserved man of medium height with deep brown skin and a face bearing the marks of smallpox: quiet, contemplative, slow to speak.(Malik Badri, 2013) Al-Waziri also compared al-Balkhi’s writing style favorably against al-Jahiz and Ali ibn Ubaydah al-Rayhani, the two most celebrated prose writers of the Abbasid period, saying that al-Balkhi was more articulate than either: less verbose than al-Jahiz, less laconic than al-Rayhani.(Malik Badri, 2013)

He traveled from Balkh to Baghdad for eight years of study, during which his teacher was the philosopher Abu Yusuf al-Kindi.(Malik Badri, 2013) It was a formative but not uncomplicated period. Al-Hamawi records that al-Balkhi became so absorbed in philosophical questions during his Baghdad years that some religious scholars accused him of deviating from Sunni orthodoxy, at various times placing him among the Imami or Zaydi Shia, or among the rationalist Mutazilah school.(Malik Badri, 2013) Whether the charge was fair or merely the product of academic rivalry is impossible to say. He seems to have returned to orthodoxy in later life, or at least to have avoided further controversy.

After returning to Balkh, al-Balkhi entered the service of Prince Ahmad ibn Sahl al-Marwazi, the local ruler, as a katib (secretary).(Malik Badri, 2013) The prince offered him a ministerial position as well, but al-Balkhi turned it down, preferring the writing post because it left him time to work.(Malik Badri, 2013) He continued writing until the age of eighty-eight, went back to Baghdad briefly for a second stay, and died in Balkh in 934 CE.(Malik Badri, 2013)(Malik Badri, 2013)

Al-Balkhi is estimated to have authored more than sixty books across geography, medicine, theology, philosophy, politics, literature, Arabic grammar, astronomy, and mathematics.(Malik Badri, 2013) Most of them are lost or remain in unexamined museum collections.(Malik Badri, 2013) His lasting reputation in medieval Islamic scholarship came not from medicine but from geography: he founded what became known as the Balkhi School of terrestrial mapping.(Malik Badri, 2013) The medical manuscript that concerns this article may have been, as Fuat Sezgin observed, his only contribution to medicine proper.(Malik Badri, 2013)

The Work: Masalih al-Abdan wa al-Anfus

The manuscript Masalih al-Abdan wa al-Anfus consists of 361 handwritten pages and is preserved as MS 3741 in the Ayasofya Library in Istanbul.(Malik Badri, 2013) It divides into two parts: 268 pages on the health of the body, and 73 pages on the health of the soul.(Malik Badri, 2013)

The bodily health section covers fourteen chapters on diet, sleep, exercise, cleanliness, environmental conditions, housing, water quality, air quality, clothing, music, and sexual health, in an essentially preventive program.(Malik Badri, 2013) Al-Balkhi’s translator Malik Badri (2013) notes that this first section drew on the Greek-influenced medicine of his era, which al-Balkhi clearly knew well, and that historians of medicine will find it interesting as a snapshot of what a 9th-century Persian physician could command in that tradition.(Malik Badri, 2013) Al-Balkhi himself was candid about this. He asserted, however, that the psychological section was different: he knew of no predecessor who had written on the sustenance of the soul and its relation to the body in the way he had done.(Malik Badri, 2013)

The manuscript was essentially unknown to Western scholarship until 1984, when Fuat Sezgin, founder of the Institute for the History of the Arab-Islamic Sciences in Frankfurt and professor emeritus at Goethe University, recognized its significance and published a facsimile reproduction of MS 3741.(Malik Badri, 2013) As Sezgin first noted in his 1984 introduction, the second treatise may represent the first attempt to collect the various topics of the branch of medicine that treats mental diseases, together with psychosomatic and psychotherapeutic treatment, though he carefully left the final verdict to specialists in the field.(Malik Badri, 2013) Malik Badri, working from the manuscript, later produced an Arabic scholarly edition with Mustafa Ashwi at the King Faisal Research Centre in Riyadh, and then the English translation published by the International Institute of Islamic Thought (IIIT) in 2013, which has since gone through six reprints.(Malik Badri, 2013)(Malik Badri, 2013)

The Psychosomatic Argument

The opening move of al-Balkhi’s psychological chapters is a structural argument, not a clinical one. He begins by establishing that man is composed of both body and soul, and that both are capable of health or sickness:

We start by saying that since man is composed of a body and soul, he is bound to face from each part of them fitness or weakness, health or sickness or other symptoms that afflict his health in a negative way. The symptoms that afflict the body and upset its wellbeing are those such as fever, headaches, and various kinds of pains that affect the organs. The psychological symptoms that afflict a person are those such as anger, sorrow, fear, panic and other similar manifestations.(Malik Badri, 2013)

His term for the relationship between these two dimensions is ishtibak — intertwining or interweaving.(Malik Badri, 2013) He uses the word to describe not merely a loose connection between mind and body but an existential interdependence: if the body is ill, the soul loses its cognitive capacity and cannot find pleasure; if the soul is ill, the body may eventually develop physical disease.(Malik Badri, 2013) The argument is explicitly functional rather than metaphysical; he is concerned with how they affect each other in practice, not with ontological questions about the nature of the soul.

From this premise, al-Balkhi draws a practical conclusion about priority. He argues that psychological symptoms deserve serious medical attention partly because of the psychosomatic interaction, and partly because they are simply more common than physical symptoms.(Malik Badri, 2013) His reasoning is direct: some people pass most of their lives without major physical illness, but no one is spared from anger, sadness, or distress.(Malik Badri, 2013) People differ in how intensely they experience these states, and in what triggers them (he notes individual differences across temperament, age, and sex), but the symptoms themselves are universal.(Malik Badri, 2013)

This led him to a pointed criticism of the physicians of his time, whom he faulted for confining treatment to physical means (medicines and bloodletting) and leaving their books entirely empty of material on the sustenance of the soul.(Malik Badri, 2013) Badri’s translation (2013) frames this criticism as strikingly parallel to Herbert Benson’s modern observation that physicians are trained to separate symptoms from patients and to emphasize body over mind.(Malik Badri, 2013) Whether that parallel is historically illuminating or merely rhetorical is a fair question, but it captures something real about al-Balkhi’s position: he was arguing against a narrowly somatic medical culture from within that culture.

Classification of Disorders

Al-Balkhi organized the psychological section of Masalih around four types of disorder: fear and panic (al-khawf wa al-fazaʿ), anger and aggression (al-ghadab), sadness and depression (al-huzn wa al-jazaʿ), and obsessive inner speech (al-waswasah).(Malik Badri, 2013) Badri’s translation (2013) describes this as a fourfold nosology that differentiates neuroses from psychoses and classifies emotional disorders in a way that, structurally, anticipates the categorical approach of modern psychiatry.(Malik Badri, 2013) That interpretive claim deserves some care: al-Balkhi is not using modern diagnostic categories, and the comparison involves translation across very different conceptual frameworks.

In Chapter 4 of the manuscript, al-Balkhi argues that distress or anxiety (al-gham) is the foundation of all negative emotional states, preceding anger, fear, and sadness, just as happiness and joyfulness are the foundation of all positive states.(Malik Badri, 2013)

Depression

The most detailed and historically discussed section of the manuscript is al-Balkhi’s treatment of huzn (sadness or depression). He distinguishes three categories.

The first is ordinary sadness: huzn as a normal response to the difficulties inherent in human life, what he describes as an emotion that afflicts all people everywhere because this world cannot be lived without problems and deprivations.(Malik Badri, 2013)

The second and third categories are where al-Balkhi’s clinical observation becomes more distinctive. He separates depression with known environmental causes (loss of a loved person, bankruptcy, loss of something greatly valued) from depression that appears suddenly without any reason the person can identify, persisting continuously and draining all desire for activity, food, and pleasure.(Malik Badri, 2013) The causeless type, he argues, originates in bodily factors such as impurity of the blood, and its treatment is primarily physical: purifying the blood.(Malik Badri, 2013) For this organically-based depression, he does not recommend the cognitive psychotherapy he prescribes elsewhere, because the underlying etiology is somatic and the patient may not be able to benefit from it, though he does recommend adjunctive support through music, friendly companionship, and pleasant conversation.(Malik Badri, 2013)

For reactive depression (the type caused by known loss), al-Balkhi prescribes a concentrated two-track program: external counseling, which he compares to prescribed medicine for a physical illness, and internal cognitive work in which the patient learns to change the thought patterns that sustain the depressive mood.(Malik Badri, 2013)

The distinction between what was later called endogenous and reactive depression is typically attributed to Emil Kraepelin’s work at the end of the nineteenth century. Badri’s translation (2013) explicitly argues that al-Balkhi made this same distinction ten centuries earlier.(Malik Badri, 2013) That claim is not Badri’s invention; Sezgin raised it in 1984, and it has been repeated in the secondary literature on Islamic medicine since then, including Saad and Said’s history of Greco-Arab and Islamic medicine, which identifies al-Balkhi as the first to introduce concepts of mental health and mental hygiene.(Saad Said, 2011) The priority claim should be taken seriously as a historiographic argument, not simply accepted as established fact; the comparison involves conceptual differences between al-Balkhi’s humorally-informed organic category and Kraepelin’s endogenous category that are not trivial.

Al-Balkhi describes depression in its acute form as like a blazing coal fire, while sadness is analogous to coal that remains glowing after the fire has subsided, and compares the healthy soul to the sunlight of the body that depression extinguishes.(Malik Badri, 2013)

Anger

Al-Balkhi begins his detailed discussion of specific disorders with anger, explaining the choice by noting that anger is the most frequent psychological disorder, disturbing people of every social rank almost every day of their lives.(Malik Badri, 2013) He is particularly attentive to the problem of anger in people with power: kings, rulers, anyone who has the authority to harm others when enraged, and he recommends that such people appoint wise counselors with explicit permission to intercede before punishment is carried out.(Malik Badri, 2013) The counselor’s influence, he says, should cool rage the way cold water poured over boiling water calms it.(Malik Badri, 2013)

He recommends catching anger early. His analogy is the fire that can be extinguished when small but cannot be controlled once it fully blazes, and the horse that must be reined in the moment it begins to run; if not controlled immediately, the rider cannot stop it.(Malik Badri, 2013) The internal cognitive strategies he prescribes include: contemplating the physical harm that anger causes to the body; recalling past episodes of uncontrolled anger and the guilt that followed; directing negative feeling at the wrong deed rather than at the person who committed it; and asking honestly whether one has ever committed the same error.(Malik Badri, 2013) He also recommends deliberate delay: waiting until fury calms before deciding on a response, which he argues produces two benefits: the virtue of patience, and more effective correction of the offending behavior.(Malik Badri, 2013)

Fear

In his chapter on fear, al-Balkhi makes a phenomenological distinction that remains clinically useful. He separates terror, which requires either the direct presence of a threatening object or its imminent arrival, from distress and worry, which are the responses to threats that are distant or remote in time.(Malik Badri, 2013) A young man who contemplates his future death may feel dejected, but not afraid; the feared object must be perceived by the senses before terror takes hold.(Malik Badri, 2013)

He also describes the physiological correlates of fear and anger with some precision: anger increases circulation, changes skin color, raises temperature, and causes uncontrollable movements; fear produces yellowing of the skin as blood rushes from the surface to the internal organs, causes shaking in the limbs, and can impair the capacity to think clearly enough to find a solution.(Malik Badri, 2013)

For treatment, al-Balkhi advocates two approaches: habituation through repeated exposure, and reduction of fear through knowledge. His exposure examples include soldiers who acclimate to battlefield violence, physicians who become accustomed to wounds and operations, and sailors who lose their fear of storms through long experience at sea.(Malik Badri, 2013) His knowledge argument is that scholars are not frightened by eclipses or earthquakes because they understand the physical causes; ignorance about the true nature of feared things is behind most human terror, and educating people about what they wrongly fear would help to heal them.(Malik Badri, 2013) He adds a developmental note: children naturally outgrow infantile fears through maturity, whereas animals retain them for life, because animals cannot overcome ignorance through experience and development.(Malik Badri, 2013)

Badri (2013) connects al-Balkhi’s exposure approach directly to Joseph Wolpe’s method of systematic desensitization, and notes that the overall structure of al-Balkhi’s cognitive framework anticipates the work of Beck, Ellis, and Maulsby in the 1970s, arguing that Western psychotherapy moved through Freudian psychoanalysis and then behaviorism to arrive at cognitive therapy, a progression al-Balkhi appears to have bypassed.(Malik Badri, 2013) That argument is interpretive and comparative rather than strictly historical; it does not require that modern cognitive therapy derived from al-Balkhi, and Badri does not claim it did. He also uses the “fog analogy” as a summary of al-Balkhi’s cognitive approach: a Bedouin who has never seen fog thinks it is a solid wall, enters it, and discovers it is only humid air; just as most fears, once examined, turn out to be harmless.(Malik Badri, 2013)

Treatment Methods

Al-Balkhi’s therapeutic framework is broadly cognitive, but it incorporates several layers. He distinguishes between internal treatment (cognitive work the person does on their own) and external treatment, which comes from wise advisors or physicians.(Malik Badri, 2013) He explicitly argues that external treatment is generally more effective, for two reasons: people tend to accept from others what they cannot accept from themselves, and a person who is in the grip of severe psychological symptoms is too preoccupied with suffering to think clearly about how to overcome it.(Malik Badri, 2013)

One technique he calls al-ilaj bi dhi — treatment with the opposite.(Malik Badri, 2013) The method involves using one emotion to neutralize another. His example is a soldier with excessive fear of combat, who should contemplate the heroic men recorded in history, generate anger at his own cowardice by reflecting that such fear is appropriate only to women and children, and then allow that anger, itself a disordered emotion, to neutralize the more incapacitating fear.(Malik Badri, 2013) Badri (2013) reads this as structurally similar to the behavior therapy concept of reciprocal inhibition.(Malik Badri, 2013)

A second technique is prophylactic: storing healthy thoughts during periods of calm so that they can be retrieved in moments of emotional distress, the way a healthy person keeps medicine on hand for unexpected physical emergencies.(Malik Badri, 2013) This is a preventive cognitive model: the preparation happens before the crisis, not during it.

Al-Balkhi’s approach treats emotional disorder as a learned habit rather than a categorical illness.(Malik Badri, 2013) He does not speak of a person as a “patient” but as someone whose emotional overreactions have become habitual.(Malik Badri, 2013) Badri (2013) argues that this is a more humane approach that need not divide people into normal persons and patients, anticipating modern critiques of the medical model of psychotherapy.(Malik Badri, 2013)

Al-Balkhi also incorporates an Islamic cognitive dimension, though not a sermonizing one.(Malik Badri, 2013) He frequently reminds anxious and depressed persons that this world is neither the place of total happiness nor the place where all wishes are granted, and that genuine happiness belongs to the afterlife.(Malik Badri, 2013) He views the origin of medicine itself as rooted in divine inspiration, arguing that the convergence of physicians across distant cultures on similar medical principles points to a common heavenly source.(Malik Badri, 2013)

Obsessive Disorders

Al-Balkhi described obsessive inner speech (waswasah) as distinct from other psychological symptoms in having a shared organic and psychological etiology, and as being the most harmful and least tractable of the four disorders.(Malik Badri, 2013)

He classifies obsessive disorder into two subtypes. The first is constitutional, arising from a natural predominance of black bile in the person’s temperament; such persons have characteristic bodily and psychological features: solid, dense body with large bones and tense muscles, dry skin, thick blood, curly hair, dusty complexion, and temperamentally dismal, aggressive, slow to forgive.(Malik Badri, 2013)(Malik Badri, 2013) The second type appears later in life as a result of negative experiences disrupting the balance of humors to produce excess black bile secondarily; this sudden-onset type is more acutely distressing because the person has no prior experience with it.(Malik Badri, 2013)

He notes that obsessive thinking is not limited to fearful intrusions. It can also take the form of obsessive love, an irresistible falling in love that so preoccupies the mind that nothing else can be thought, though he considers the fear-based type far more harmful.(Malik Badri, 2013) He describes extreme pessimism as a core feature: obsessive thinkers worry about trivial things, always anticipate the worst outcome, and systematically suppress optimistic interpretations of their circumstances.(Malik Badri, 2013)

For external management, al-Balkhi’s primary recommendation is to avoid solitude.(Malik Badri, 2013) His reasoning is that the soul is perpetually active either externally (through conversation and engagement with others) or internally, through memory and reflection; when not occupied externally, it has no alternative but to turn inward, and for a sensitive, imaginative person, that internal activity will be particularly intense and potentially harmful.(Malik Badri, 2013) He also recommends frequent variation of activities, because obsessive thinkers habituate to pleasures more rapidly than ordinary people and quickly return to harmful rumination when any single activity becomes routine.(Malik Badri, 2013)

For the cognitive dimension of obsessive disorder, al-Balkhi recommends a reality-testing technique: the person should observe whether those around them are disturbed by the same feared thoughts; since they are not, the person should conclude that the feared event must be unreal, because people are only alarmed by genuine threats they can perceive.(Malik Badri, 2013) He also offers the oil lamp analogy: the wick is the body, the oil is nourishment, the light is life itself; as long as no external force extinguishes the flame, and the person lives safely and eats well, there is no rational ground for catastrophic death fears.(Malik Badri, 2013)

On etiology, al-Balkhi is notably pluralist.(Malik Badri, 2013) He attributes obsessive disorder either to the dominance of certain body humors or to the devil assigned to a person (qarin).(Malik Badri, 2013) He then states explicitly that the source of the disorder does not matter much; whether it originates in body chemistry or in the work of Satan, the treatment approach should be the same.(Malik Badri, 2013)

Reception and Rediscovery

The Ayasofya MS 3741, copied in 1479 CE (884 AH), is a key manuscript for Masalih al-Abdan wa al-Anfus.(Malik Badri, 2013) Fuat Sezgin’s 1984 facsimile reproduction of this manuscript represents the primary scholarly recovery effort.(Malik Badri, 2013)

Al-Balkhi’s connection to the wider history of Islamic medicine surfaces in an oblique way through Manfred Ullmann’s Islamic Medicine (1978), which identifies him not primarily as a psychological thinker but as a patient. Ullmann documents that al-Razi (Abu Bakr Muhammad ibn Zakariya al-Razi, the Persian physician working in Baghdad) wrote a case report on al-Balkhi’s seasonal cold that appeared every spring when the roses bloomed, and correctly identified rose scent as the cause, recommending avoidance of aromatic vapours.(Ullmann, 1978) Ullmann credits al-Razi’s account as the first description of seasonal allergic rhinitis in the medical literature. Al-Balkhi appears here as the presenting patient, not the physician.

The broader historiographic argument, that Western histories of psychology have systematically omitted Islamic contributions by jumping from ancient Greece to the European Renaissance, is a central theme of Badri’s translation. He points to standard Western histories of psychology that honor Pythagoras, Socrates, Plato, Aristotle, and Euclid, then skip fifteen centuries to Roger Bacon, with no mention of any Islamic thinker.(Malik Badri, 2013) This is a specific and checkable claim about specific texts, not merely an abstract complaint. Badri also notes that Robert Burton’s Anatomy of Melancholy (1621), which focused narrowly on melancholy and is sometimes cited as a major pre-modern Western work on psychological suffering, was published eight centuries after al-Balkhi’s manuscript, and covered considerably less ground.(Malik Badri, 2013)

The argument for al-Balkhi’s historical importance in psychology rests on the accumulated claims of his scholarly recovery chain: Sezgin (1984), Badri and Ashwi’s Arabic scholarly edition, and Badri’s English translation (IIIT, 2013). The primary obstacle to Western recognition was not historiographic malice but simple inaccessibility: most of al-Balkhi’s sixty-plus manuscripts were lost or remained in uncatalogued collections, the surviving psychological text was in Arabic in a Turkish archive, and its significance required someone with both psychological training and deep knowledge of Islamic intellectual history to make legible.(Malik Badri, 2013) That person was Malik Badri, who came to the manuscript through a course he taught at the International Institute of Islamic Thought and Civilization (ISTAC) in Kuala Lumpur.

See Also

• al-razi — Contemporary who described al-Balkhi’s rose allergy; the leading clinical physician of the 9th-century Islamic world
• abu-yusuf-al-kindi — Al-Balkhi’s teacher in Baghdad; first major Islamic philosopher
• avicenna — Later synthesizer of Islamic medicine; his Canon codified the tradition al-Balkhi worked within
• ishaq-ibn-imran — 9th-century physician whose treatise on melancholy represents a parallel Islamic psychological tradition
• al-ghazali — Later Islamic scholar who used the same al-ilaj bi dhi technique; points to a shared intellectual tradition
• masalih-al-abdan-wa-al-anfus — The manuscript itself; housed as MS 3741 in the Ayasofya Library, Istanbul

Sources

Badri, Malik, trans. Abu Zayd al-Balkhi’s Sustenance of the Soul: The Cognitive Behavior Therapy of a Ninth Century Physician. London: International Institute of Islamic Thought, 2013. [Primary source: badri-abuzaydalbalkhi-2013]

Saad, Bashar, and Omar Said. Greco-Arab and Islamic Herbal Medicine: Traditional System, Ethics, Safety, Efficacy, and Regulatory Issues. Hoboken, NJ: Wiley, 2011. [Cross-reference: saad-said-greco-arab-islamic-herbal-2011, ch. 2]

Ullmann, Manfred. Islamic Medicine. Edinburgh: Edinburgh University Press, 1978. [Cross-reference: ullmann-islamicmedicine-1978, ch. 6]