Insanity

For most of Western history, people we now call mentally ill were kept at home in conditions that ranged from neglectful to brutal — chained in stables, confined in holes in floors, or fastened to stakes in workhouses. The idea that madness was a medical condition requiring specialized treatment did not take hold until the late eighteenth century, and the medical discipline devoted to it — psychiatry — did not even have a name until 1808. What followed was not a steady march toward understanding but a long, unresolved argument between those who believed insanity was a disease of the brain and those who believed it was a disorder of the mind, with patients caught between institutions that promised cures and delivered custody.

Before Psychiatry

Before the end of the eighteenth century, psychiatry did not exist as a discipline. (Shorter, 1997) Individual physicians had written about the insane since antiquity — the Hippocratic texts described melancholia, mania, and phrenitis as disturbances with natural rather than supernatural causes — but there was no common professional identity, no shared body of knowledge, and no institutional framework.

In pre-Hippocratic frameworks, madness was understood primarily as a sign of divine displeasure or supernatural intrusion. The Hebrew scriptures offered the clearest instance: Saul’s madness was read as a curse from God, and the king passed his final years in intermittent mental turmoil — “by turns fearful, raging, homicidal and depressed.” (Andrew Scull, 2015) The narrative also preserves one of the earliest recorded therapeutic interventions: David was summoned to play the lyre for Saul, “so Saul was refreshed, and was well, and the evil spirit departed from him” — music as medicine acting on the spirits responsible for madness.(Dols, Michael W., 1992) Feigning madness appears alongside genuine madness in the same ancient literature: David himself later feigned insanity before the king of Gath to secure his personal safety, relying on the commonly shared perception that the mentally disturbed were “generally harmless or inoffensive to authority” — a pattern repeated in the stories of Odysseus, Solon, and Brutus.(Dols, Michael W., 1992) The Old Testament tradition was initially ambivalent about physicians: healing was a divine preserve, and resort to human medicine could imply a failure of trust in God. That ambivalence began to shift with Ecclesiasticus (Sirach), a second-century BCE wisdom text that explicitly validated the physician as God’s instrument: “Honor the physician with the honor due him, according to your need of him, for the Lord created him; for healing comes from the Most High.” (Dols, Michael W., 1992) This reconciliation of medicine and religious faith — the physician as a channel of divine provision — foreshadowed the accommodation that Islamic medicine would subsequently negotiate with similar tensions. This interpretive framework, in which mental suffering carried theological meaning, persisted alongside Galenic naturalism throughout the medieval period and did not finally lose its explanatory monopoly until the eighteenth century.

The Hippocratic framework for mental disturbance was humoral rather than psychological. Black bile was the key substance: the concept of black bile as a distinct humour was relatively new at the end of the fifth century BCE, with the author of The Nature of Man referring to it as “the so-called black bile” — a formulation that implies the term was not yet universally familiar — and it was likely hypostatized to complete a cosmological scheme of four elements and four qualities. (Nutton, 2023) When excess black bile was added to the humoral scheme, it provided a natural-causal explanation for the depression, fearfulness, and dark imaginings that the Hippocratic authors grouped under the term melancholia. The four-humour theory itself, which underpinned these psychiatric categories, was attributed by Aristotle to Polybus, Hippocrates’s son-in-law — not to Hippocrates himself — and was a minority view even within the Hippocratic Corpus. (Nutton, 2023) What later generations treated as the canonical ancient account of mental disturbance was thus the product of one particular theoretical strand, which Galen subsequently amplified and made authoritative.

The category term “melancholia” means, literally, black bile (melas + chole), and from the earliest Hippocratic texts it denoted a condition whose cardinal markers were fear and sadness arising without apparent cause. Jennifer Radden, surveying the tradition from Hippocrates through the nineteenth century, observes that this core signature — fear or sadness without cause — varies remarkably little across two millennia of medical writing. Galen affirmed that although “each melancholic patient acts quite differently than the others, all of them exhibit fear or despondency.” Timothy Bright in 1586 and Robert Burton in 1621 echo the same pairing. (Radden, Jennifer (ed.), 2000) Within the Hippocratic scheme, excess blood heated the brain and generated nightmares; phlegm produced a quiet, muted mania in which patients “are quiet and neither shout nor make a disturbance”; while black bile yielded the agitated, disruptive type — “those whose madness results from bile shout, play tricks and will not keep still.” (Andrew Scull, 2015) The three broad named categories — melancholia, mania, and phrenitis — thus mapped onto different humoral imbalances rather than phenomenological distinctions recognizable to modern psychiatry. Running alongside this naturalistic framework, Plato and Socrates articulated an alternative conception of madness as a higher form of knowing — prophetic, erotic, creative — that would resurface in medieval Christian mysticism, Erasmus, Shakespeare, Cervantes, and Romantic literature, providing a persistent counterweight to the pathological model throughout Western history.(Andrew Scull, 2015) Outside the Greek tradition altogether, Ayurvedic medicine similarly grounded mental disturbance in a humoral framework — the imbalance of the three doshas (vata, pitta, kapha) — but extended treatment to include massage, drugs drawn from vegetable, mineral, and animal sources, and ritual therapies invoking supernatural demons and gods, reflecting a less strict separation between naturalistic and sacred causation.(Andrew Scull, 2015)

Galen elaborated the melancholia classification further, distinguishing three types by location: whether the disordered black bile was concentrated in the brain, diffused throughout the bloodstream, or originating in the stomach and hypochondriac region. This taxonomic geography determined therapy: whole-body atrabilious blood called for phlebotomy; melancholia confined to the brain did not. (Radden, Jennifer (ed.), 2000) Galen also compiled a detailed dietetic aetiology — goat, ox, ass, and camel flesh; lentils, cabbage, heavy dark wines, aged cheeses — each item identified as a generator of atrabilious blood and therefore a contributor to melancholic states. The practical implication was that diet was both the primary cause and the primary site of prevention.

The Aristotelian Problems — almost certainly not by Aristotle himself but by a follower, most likely Theophrastus, though its enormous influence derived precisely from its Aristotelian attribution — opened with a question that reoriented the entire tradition: why are all outstanding philosophers, statesmen, poets, and artists melancholic? (Radden, Jennifer (ed.), 2000) (Radden, Jennifer (ed.), 2000) The text listed Heracles, Ajax, Bellerophon, Empedocles, Plato, and Socrates as evidence and advanced a thermal explanation: black bile is unusual in being capable of both cold and hot states, and these thermal variations produce different psychological effects. Cold excess generates groundless despondency and a risk of suicide; excessive heat produces cheerfulness, song, and madness; but black bile moderated to an intermediate temperature yields the melancholic temperament proper — more intelligent and less eccentric than either extreme, superior in education, the arts, and statesmanship. (Radden, Jennifer (ed.), 2000) (Radden, Jennifer (ed.), 2000) The Problems thus separated the melancholic temperament (a constitutive quality present “by nature,” associated with achievement) from the disease produced by accidental excess (associated with incapacity), a distinction that would shape Renaissance theories of the melancholic genius. (Radden, Jennifer (ed.), 2000)

Alongside the medical tradition, medieval Christianity developed the concept of acedia — a spiritual despondency and inertia afflicting desert monks, described by John Cassian in the early fifth century as a “midday demon” producing weariness, dislike of one’s cell, and contempt for one’s brothers. Cassian’s acedia shares the affective features of Galenic melancholia — despondency, inability to concentrate — but is a spiritual condition to be resisted as a temptation and eventually classified among the seven deadly sins. The institutional category of a sin implied that confession was a form of healing, and that the sufferer was to be treated and cured rather than simply chastised — an ambiguity that illustrates how, in premodern frameworks, the boundaries between suffered disease and moral failing were not fixed. (Radden, Jennifer (ed.), 2000) (Radden, Jennifer (ed.), 2000)

The most clinically sophisticated ancient approach to mental disturbance that survives came not from the Hippocratic tradition but from the Methodists. Soranus of Ephesus, active in Rome under Trajan and Hadrian, recommended against immediately confronting a patient’s delusions. He held that it was better to agree at first with a madman’s delusions and then gradually bring him round to accept reality than to attempt immediate correction and deny any reality to his perceptions. (Nutton, 2023) This pragmatic, graduated approach — treating the patient’s inner world as a starting point rather than an error to be overridden — anticipates therapeutic principles that would not be systematized in Western psychiatry until the late eighteenth century.

Between 50,000 and 100,000 individuals were executed as witches across early modern Europe before the craze subsided. Few among the educated doubted that demons and witches were real, and to reject the belief in possession was widely understood as a step toward atheism. (Andrew Scull, 2015) It was within this climate that medical arguments for a naturalistic account of apparently supernatural behavior carried genuine social weight.

One of the most consequential early arguments for medicalizing behaviors previously attributed to supernatural causation came from the German physician Johann Weyer (1515–1588). In De Praestigiis Daemonum (1562), Weyer argued that women accused of witchcraft were in fact melancholics: demons exploited the melancholic humor as “a material well suited for his mocking deceptions,” distorting the imagination so that these women believed they had harmed others, while in reality they had not.(Radden, Jennifer (ed.), 2000) He documented specific delusional presentations — patients who believed themselves to be earthen vessels, that Atlas would drop the world, or that three men were the persons of the Trinity — as evidence that melancholia could produce elaborate false belief systems while leaving the sufferer otherwise functional.(Radden, Jennifer (ed.), 2000) From this diagnosis Weyer drew a legal conclusion: since the impaired will of the mentally ill “does not deserve equal punishment” with those of sound mind, accused women should receive instruction in sound doctrine rather than judicial punishment.(Radden, Jennifer (ed.), 2000) Weyer also noted that melancholia and demonic possession could coexist and were frequently confused with each other, requiring “careful judgment” to distinguish them — a differential diagnosis problem that would not be systematically addressed until the Enlightenment era.(Radden, Jennifer (ed.), 2000)

The next century produced the first explicitly psychological account of witchcraft confessions. Francis Hutchinson’s Historical Essay Concerning Witchcraft (1718) analyzed witchcraft accusations not as evidence of demonic compact but as social panic driven by rabble-rousing books and meddlesome witch-finders; confessions, he argued, were the product of social pressure and self-deception rather than actual contact with the devil.(Porter, 2000) Where Weyer had distinguished melancholic delusion from genuine demonic agency, Hutchinson dissolved the category of genuine demonic agency altogether, reducing the witch-craze to a sociological phenomenon. The British Witchcraft Act was repealed in 1736, and a pamphlet published that year to coincide with repeal explicitly congratulated England as an enlightened country where the “impostures” of priests and the folly of the “vulgar” were finally being laid to rest.(Porter, 2000) The legal end of witchcraft prosecution removed one of the principal alternative explanations for behaviors that would increasingly come to be claimed by medicine.

The surviving records of early modern practitioners illuminate the gendered distribution of mental suffering before institutionalization. The Anglican clergyman Richard Napier, who treated thousands of mentally troubled patients near Oxford between 1597 and 1634, found that women outnumbered men in cases of mental disorder by a ratio of nearly two to one: 1,286 cases among females against 748 among males, despite Napier’s open contempt for women and their intellectual capacities. Whether this disproportion reflected a genuine sex difference in vulnerability, the greater tendency of women to seek help, or the burden of unrelenting gynaecological suffering remains unresolved. (Andrew Scull, 2015)

The romantic notion that the insane in premodern communities were tolerated, even protected, does not survive contact with the evidence. Shorter’s research shows that before the mid-nineteenth century, rural communities had “a horror of those who were different, an authoritarian intolerance of behavior that did not conform to rigidly drawn norms.” (Shorter, 1997) The mentally ill who could not be managed at home were placed in custodial institutions. Among the oldest of these was Bethlem in London, founded in the thirteenth century; Valencia, Zaragoza, and several Italian cities had comparable establishments. All had solely custodial functions. (Shorter, 1997) Traditional society had no concept of delivering therapy to patients.

Medieval Europe also produced at least one specialized site that blended religious and quasi-communal care for the mad. At Gheel in what is now Belgium, the shrine of St Dymphna became a destination for families bringing lunatics to seek miraculous cure. By the sixteenth century the ritual was elaborate: lunatics were chained by the ankle inside the church for eighteen days while exorcism was attempted, and when this failed to restore sanity, many of the afflicted were placed with local peasant families, producing a community in which housing and caring for the mad had become the local economy. (Andrew Scull, 2015) Bethlehem Hospital in London, which would eventually become the most famous asylum in the English-speaking world, followed a comparable trajectory of gradual specialization: founded in 1247 as a general charitable house, it recorded only six patients “menti capti” at a visitation in 1403, and the patient population did not rise above a hundred until the late seventeenth century. (Andrew Scull, 2015) These early institutions were exceptions rather than models. For most of the medieval and early modern period, the mad remained the responsibility of their families, “either locked up via a variety of ad hoc expedients if deemed dangerous, or left to roam (and to rot) if not.” (Andrew Scull, 2015)

The Therapeutic Asylum

The idea that confinement itself could be curative was a late-eighteenth-century innovation, arising independently across multiple national contexts — Italy, France, Germany, Britain, and America. Shorter argues that this simultaneity makes capitalism or the centralized state insufficient explanations for psychiatry’s birth; Enlightenment-style scientific thinking, spanning continents, “seems to have launched psychiatry.” (Shorter, 1997)

Behind this movement lay a broader cultural shift. Porter’s Enlightenment (2000) argues that madness, alongside suicide and infanticide, was progressively secularized during the eighteenth century as part of the “disenchantment of the world”: occurrences previously explained supernaturally were reinterpreted within psychological and legal categories, with suicide shifting from sin to pathology and infanticide moving from bewitchment to child murder as a civil crime.(Porter, 2000) This transformation was the cultural precondition for the therapeutic asylum: once madness was a natural phenomenon rather than a spiritual one, it became amenable to medical management rather than moral condemnation.

The Italian physician Vincenzio Chiarugi, working in Florence from 1785, established the basics of running a therapeutic asylum before Pinel, publishing a three-volume work On Insanity in 1793-94 that argued asylums should heal patients, not merely segregate them. (Shorter, 1997) In England, William Battie’s 1758 Treatise on Madness was the first influential statement attributing therapeutic virtues to the asylum, quoting an anonymous colleague to the effect that “management did much more than medicine.” (Shorter, 1997)

The new approach was not one man’s invention. Moral treatment emerged independently and almost simultaneously in Italy, France, Britain, the Netherlands, and North America in the 1790s. John Ferriar, physician to the Manchester Asylum, described its central principle as “creating a habit of self-restraint” through “the management of hope and apprehension… Small favours, the show of confidence, and apparent distinction” rather than coercion. (Andrew Scull, 2015) William Tuke, a Quaker tea merchant, founded the York Retreat in 1792; Vincenzio Chiarugi in Florence was working along similar lines before either Tuke or Pinel had published. (Andrew Scull, 2015)

Philippe Pinel’s textbook of 1801 crystallized the movement. The original English translation of his Traité médico-philosophique sur l’aliénation mentale (1801) — widely regarded as the foundational text of modern psychiatry — opens with a forty-page history of insanity and its treatment, making Pinel’s founding psychiatric text simultaneously a historical work.(Jackson (ed.), 2011) Working at the Bicetre from 1793, Pinel stressed psychological over physical causes and replaced mechanical restraints with humane management — though the dramatic image of Pinel “striking the chains off the mad,” once beloved of historians, belongs to legend. (Porter, 1997) The unchaining was a myth created decades after the event: the actual reforms had been implemented by lay administrators Jean-Baptiste Pussin and his wife Marguerite Pussin, who possessed the extensive practical experience of managing the insane that Pinel initially lacked. It was Pinel who theorized the changes and provided the first systematic published account, and his reforms — whatever their precise origin — were foundational for the professionalization of psychiatry in France and Europe.(Radden, Jennifer (ed.), 2000) (Andrew Scull, 2015) Pinel’s traitement moral meant “mental treatment,” not moral therapy in the ethical sense. (Shorter, 1997) His pupil Esquirol developed the practical details of the therapeutic community and advocated the asylum as a “therapeutic instrument.” (Porter, 1997)

The groundwork for this nosological shift had been laid earlier in the century by Boerhaave, whose Aphorisms (1735) identified the defining cognitive symptom of melancholia as the patient being “always intent upon one and the same subject” — an obsessive fixation on a single idea that Pinel and Rush would later develop into the concept of partial insanity.(Radden, Jennifer (ed.), 2000) Boerhaave further defined madness itself as melancholy increased to wild fury, differing “only in Degree from the sorrowful kind of Melancholy” — a continuum model that Pinel and Kraepelin would challenge but that persisted as a clinical intuition well into the nineteenth century.(Radden, Jennifer (ed.), 2000)

Radden’s anthology documents Pinel’s classification and methodology in detail. His five-part taxonomy placed melancholia — defined as “delirium upon one subject exclusively” — alongside mania without delirium, mania with delirium, dementia (“abolition of the thinking faculty”), and idiotism (“obliteration of the intellectual faculties and affections”).(Radden, Jennifer (ed.), 2000) The breadth of Pinel’s melancholia category was striking: it included cases with “unruffled satisfaction” and grandiose delusions alongside those with “great depression of spirits, pusillanimous apprehensions and even absolute despair.”(Radden, Jennifer (ed.), 2000) His methodological prescription was explicit: refuse to theorize about “unobservable causes” and instead limit inquiry to “the results of a strict observation of the impairments which the various faculties can experience” — a commitment that aligned him with the broader Enlightenment project of empirical reform.(Radden, Jennifer (ed.), 2000) He documented the potential for long-standing melancholia to “degenerate into mania,” describing patients confined at Bicêtre for twelve to thirty years whose fixed hallucination suddenly reversed character and became grandiose.(Radden, Jennifer (ed.), 2000)

Immanuel Kant’s Anthropology (1793) offered a philosophical parallel to Pinel’s clinical classification. Kant distinguished “melancholia (hypochondria)” — in which the patient “is well aware that the train of his thought does not move properly” but cannot control it — from “mental disorder (mania)” — a voluntary stream of thought following its own subjective law contrary to objective experiential reality.(Radden, Jennifer (ed.), 2000) This faculty-psychological framework, which divided mental operations into the faculties of sensibility, understanding, and imagination, provided a rationalist taxonomy of mental disorder distinct from both humoral and neurological accounts.(Radden, Jennifer (ed.), 2000)

In America, Benjamin Rush refined and complicated the category of partial insanity that Pinel’s work had helped establish. His particular contribution was to tighten and subdivide “partial intellectual derangement,” producing both new terminology (tristimania, amenomania) and an extended clinical phenomenology from Pennsylvania Hospital casebooks.(Radden, Jennifer (ed.), 2000) Unlike his Enlightenment contemporaries, Rush associated melancholy primarily with delusion rather than with fear and sadness — making his account “closer to the Greek physicians than to the thinkers of his own time.”(Radden, Jennifer (ed.), 2000) A case study he documented of a suicidal youth illustrated the intractability of severe melancholic states: every therapeutic combination — employment, friendship, comfortable circumstances — failed to relieve “the insuperable disgust with life, which bore him irresistibly to self-destruction.”(Radden, Jennifer (ed.), 2000)

In York, the Quaker tea merchant William Tuke opened the Retreat in 1796. Its therapeutics — quiet, comfort, and a supportive family atmosphere — were devised largely by laypersons rather than physicians, and its founders asserted that medicine achieved nothing for the insane. (Porter, 1997) (Shorter, 1997) The challenge this posed to medical authority paradoxically drove doctors to claim insanity as their professional domain.

Johann Reil coined the term “psychiatry” (Psychiaterie) in 1808, articulating a comprehensive program of institutional therapy that emphasized psychological healing of the curable insane. (Shorter, 1997)

Foucault and the Grand Confinement

Michel Foucault argued in Madness and Civilization (1961) that the rise of the asylum represented a “grand confinement” — a deliberate strategy by bourgeois capitalist society to sequester the unreasonable. Shorter challenges this reading directly: even in France, Foucault’s chosen terrain with nearly thirty million people, the number of psychiatric beds before the nineteenth century was minuscule relative to the population. In England, to speak of any kind of grand confinement would be “nonsense.” (Shorter, 1997) Scull’s evidence points in the same direction: in Montpellier, a city of some 30,000 people, barely twenty mad individuals occupied institutional cells on the eve of the Revolution, and most of the mad were dealt with elsewhere. “As in centuries past, the primary burden fell upon families.” (Andrew Scull, 2015) The evidence suggests that the therapeutic asylum movement was driven more by intellectual change than by social control, though Foucault’s work permanently altered the questions historians ask about the relationship between medicine and power.

What did emerge in eighteenth-century England was a “trade in lunacy” — a private, profit-oriented system of madhouses that arose to serve families seeking to remove disturbed relatives from domestic life and public view. The stigma of madness threatened a family’s social standing, and paying for discreet confinement purchased insulation from that threat. Entrepreneurs of varied backgrounds entered the business, and the most successful could amass fortunes: William Battie, proprietor of a private madhouse and author of the first substantial treatise on the subject, rose from near-poverty to leave between £100,000 and £200,000 and was elected President of the Royal College of Physicians. (Andrew Scull, 2015)

The Asylum Century

Whatever its scale in the eighteenth century, institutional confinement expanded enormously in the nineteenth. State-mandated asylums spread across Europe and North America, driven by the exposure of horrific conditions in existing madhouses and promoted by reformers including Esquirol in France and Dorothea Dix in the United States. For the manic, the melancholic, the deranged, and the demented, a new geography of suffering rapidly emerged: “the asylum everywhere became the chosen solution to the problems posed by the Bedlam mad.” (Andrew Scull, 2015)

Early alienists framed this expansion within a theory of insanity as a disease of civilization — an affliction to which the most refined and ambitious were especially vulnerable, and one that was proliferating because the strains of modern life were intensifying. (Andrew Scull, 2015) The populations filling the new asylums told a different story. The overwhelming bulk of certified lunatics came from the poor and the “middling sort,” not from the educated elite whose vulnerability the theory had been designed to explain. (Andrew Scull, 2015) Scull notes a further complication: much of the apparent rise in asylum numbers reflected not a genuine increase in severe mental illness but “diagnostic creep” — a steady broadening of the criteria for calling someone mentally ill. The English malady of the eighteenth century was an early instance of this process, and Scull sees analogues in the late twentieth-century expansions of bipolar disorder and autism diagnoses. (Andrew Scull, 2015)

By the 1890s the therapeutic promises of the asylum system had utterly failed. In 1894, the eminent Philadelphia neurologist Silas Weir Mitchell addressed the assembled alienists on the fiftieth anniversary of their professional society. He denounced them for presiding over wards of “living corpses” — patients “who have lost even the memory of hope, [and] sit in rows, too dull to know despair, watched by attendants: silent, grewsome machines which eat and sleep, sleep and eat.” (Andrew Scull, 2015)

The Biological Turn

Wilhelm Griesinger, who brought psychiatry into the German university system, asserted that “mental illnesses are brain diseases.” His insistence encouraged brain pathology research aimed at finding the physical location of mental disorders. Yet even Griesinger conceded that not all pathological states were accompanied by detectable cerebral lesions — his aetiology was actually multifactorial. (Porter, 1997)

The intellectual ground for Griesinger’s claim had been prepared by a long debate between “somaticists” and “spiritualists” that ran through the first half of the nineteenth century. Somaticists held that insanity was a disease of the brain; spiritualists objected that the immaterial soul or mind could not be sick. Delirium served as the somaticists’ primary empirical weapon: since fever and intoxication could visibly alter the operations of the mind, they argued that mental disturbance was always rooted in bodily disturbance. (German E. Berrios & Roy Porter (eds.), 1995) The concept of delirium was deployed not merely in clinical debate but polemically: somaticist psychiatrists used it to claim that all mental illness was essentially cerebral and to establish professional identity against those who would reserve the mind for theology or philosophy. (German E. Berrios & Roy Porter (eds.), 1995) The same concept was extended beyond clinical boundaries. Nineteenth-century psychiatrists applied the language of delirium to religious enthusiasm, revolutionary political activity, and the social aspirations of the lower classes — extending psychiatric authority from the asylum into wider social life as a form of pathologization. (German E. Berrios & Roy Porter (eds.), 1995)

One memorable illustration of how psychiatry sought experimental purchase on insanity came from Jacques-Joseph Moreau de Tours, who in 1845 deliberately used hashish to produce an artificial delirium in himself and others. He argued that the drug-induced state replicated the essential features of naturally occurring mental illness and could serve as a model for understanding insanity — an early instance of self-experimentation in the service of a claim that mental illness was a unitary phenomenon admitting of laboratory investigation. (German E. Berrios & Roy Porter (eds.), 1995)

Radden’s anthology preserves Griesinger’s own clinical observations in detail. He described the stadium melancholicum — a prodromal stage of profound emotional perversion — as the initiating phase of most mental disease, noting that “the immense majority of mental diseases commence with a state of profound emotional perversion, of a depressing and sorrowful character.”(Radden, Jennifer (ed.), 2000) The phenomenological precision of his descriptions was notable: melancholic patients experience a sense that “everything around me is precisely as it used to be, although there must have been changes” — a dissociation between apparent continuity and felt total difference — combined with physical sensations of anxiety mounting from the epigastric region, “like a stone” in the chest.(Radden, Jennifer (ed.), 2000) Crucially, Griesinger observed that “exhortations, solicitude, and argument have not the slightest effect” on the depression, because the patient knows his fears are irrational but “cannot resist” — a formulation that made the brain-disease model not merely an etiological claim but a therapeutic one: psychological intervention could not override a cerebral lesion.(Radden, Jennifer (ed.), 2000) His foundational dictum “mental diseases are brain diseases” settled a dispute within German psychiatry between “psychiatrists” (mentalists) and “somaticists” (materialists) in favor of the latter, establishing the terms on which biological psychiatry would develop.(Radden, Jennifer (ed.), 2000) Germany’s decentralized university system, with twenty competing principalities each nurturing academic talent, made it the dominant force in nineteenth-century psychiatry. (Shorter, 1997)

Benedict Augustin Morel systematized degeneration theory in 1857, proposing that hereditary degeneration was cumulative over generations — descending from neurasthenia through criminality to insanity and sterility. (Porter, 1997) Scull emphasizes the ideological utility this theory offered the profession: it explained therapeutic failure not as incompetence but as the inevitable product of biological inferiority, and reframed the mad as “the dregs of society who were a biologically inferior lot” rather than victims of civilization’s stresses. The theory “provided a new justification for the isolation of the mad in asylums, and an explanation for psychiatry’s apparent therapeutic failings.” (Andrew Scull, 2015) After the 1860s, this doctrine intensified the public’s dread of psychiatric diagnosis, as the profession’s conventional terms for mental illness began to ring with hereditary awfulness. (Shorter, 1997)

Classification: Kraepelin’s System and the Unitary Psychosis Challenge

Before Kraepelin imposed his two-disease system on psychiatry, a rival doctrine had long competed with any classificatory ambition: the Einheitspsychose, or unitary psychosis. The unitary position held that there is only one psychosis, and that the apparent clinical diversity between mania, melancholia, and dementia reflects pathoplastic factors — personality, life events, observer bias — rather than distinct disease entities. The doctrine took two forms: a cross-sectional version in which different clinical forms coexist in a single patient, and a longitudinal version in which forms succeed each other over the course of one illness. (German E. Berrios & Roy Porter (eds.), 1995) Its most uncompromising formulation came from Heinrich Neumann (1859), who declared that “every classification of mental illness is artificial. We should throw it all overboard… there is only one form of mental illness, that is insanity [Wahnsinn], which does not have different forms but different stages.” (German E. Berrios & Roy Porter (eds.), 1995) This position was not clinical eccentricity but was embedded in a broader intellectual context: the zenith of the unitarian doctrine in Germany coincided with the influence of Naturphilosophie, which resisted both Cartesian mind-body dualism and faculty psychology in favor of holistic accounts of body, mind, and spirit together. (German E. Berrios & Roy Porter (eds.), 1995)

Kahlbaum began within the unitary framework but progressively elaborated subcategories — retaining the idea that all insanities derived from one vesania while distinguishing its forms — and it was in this transitional position, acknowledging both unity and clinical differentiation, that he became the strongest influence on Kraepelin. (German E. Berrios & Roy Porter (eds.), 1995)

Emil Kraepelin’s nosological classification combined earlier descriptions by Kahlbaum (catatonia), Morel (demence precoce), and Hecker (hebephrenia) into the concept of dementia praecox. His method — following the total disease picture over time rather than isolating single symptoms like excitement or depression — proved more practical than preceding systems and remains the distant ancestor of the modern DSM. (Porter, 1997) (Ackerknecht, 1955) Ackerknecht notes that Kraepelin’s system was still “purely symptomatic” and lacked any psychotherapeutic dimension. (Ackerknecht, 1955)

The French clinical tradition had also been developing conceptual apparatus for states between acute delirium and chronic dementia. Philippe Chaslin, working in the 1890s, gave confusion mentale its systematic clinical form: a state of generalized weakness and slowing of mental activity characterized primarily by disturbance of consciousness rather than the hallucinations or behavioral excitement of acute delirium. This concept played a transitional role, occupying a distinct clinical space between delirium and dementia and providing one of the bridges through which the modern notion of psychosis was constructed. (German E. Berrios & Roy Porter (eds.), 1995) From the German side, Karl Bonhoeffer (1910) contributed the complementary idea of “exogenous reaction types”: the proposal that delirious states were stereotyped, non-specific responses of the brain to various noxious stimuli, so that different causes produced the same clinical picture because the brain had only a limited repertoire of responses to damage. (German E. Berrios & Roy Porter (eds.), 1995)

Even Kraepelin himself ultimately acknowledged limits to his own classificatory confidence. In his 1920 paper “The Manifestation of Madness,” he abandoned the view that symptoms could be pathognomonic, stating that symptoms “are not limited to a distinct disease process but occur in the same form in response to different morbid insults.” He cast explicit doubt on his own two-disease division, conceding that “we shall have to get used to the fact that our much used clinical check-list does not permit us to differentiate reliably between manic-depressive illness and dementia praecox.” (German E. Berrios & Roy Porter (eds.), 1995) This late concession brought Kraepelin’s nosology closer to the unitarian position he had spent a career opposing, and anticipated the debates about diagnostic boundaries that continue in contemporary psychiatry.

The Nervous Euphemism

A parallel history ran alongside the asylum: the century-long use of “nervous” as a euphemism for “insane.” For patients, the label of nervousness offered escape from the stigma of madness and the implication of hereditary taint. For physicians, it opened the door to lucrative private practice with middle-class patients outside the asylum. (Shorter, 1997)

The social stakes of an asylum diagnosis were sufficiently severe that wealthy Victorian families went to extraordinary lengths to avoid submitting disturbed relatives to public institutions. Private arrangements ranged from building a cottage on a secluded portion of an estate and hiring dedicated attendants to placing the disturbed person in single lodgings or simply sending them abroad, beyond the reach of official scrutiny and neighborhood gossip. (Andrew Scull, 2015) The asylum was, for those with the means to avoid it, a last resort and a mark of family failure.

The deception ran deep. Doctors and patients used the same terms with entirely different meanings: patients believed their “nervous” problems stemmed from overwork or humoral imbalance, while physicians understood nervous complaints to indicate constitutional brain disease with a heavy genetic component. (Shorter, 1997) German private asylums systematically renamed themselves from “institutions for the insane” to “clinics for nervous patients” from the 1840s onward — a marketing strategy to attract paying middle-class families. (Shorter, 1997)

George Beard’s concept of neurasthenia (1869) pathologized exhaustion and nervous weakness in American middle-class life, providing a non-stigmatizing umbrella diagnosis for a wide range of functional complaints. (Shorter, 1997) Middle-class patients sought psychiatric care at spas and hydropathic establishments rather than asylums, making the spa “the first place of refuge from the asylum.” (Shorter, 1997)

Charcot, Freud, and the Psychodynamic Turn

Jean-Martin Charcot, founding his clinic at the Salpetriere in 1862, became what Ackerknecht calls “probably the most representative clinician of the period.” (Ackerknecht, 1955) But his hysteria studies failed for a reason Porter identifies clearly: the hysterical behaviours of his star performers were artefacts produced by his own personality and expectations within the theatrical atmosphere of the hospital, not objective phenomena waiting to be scientifically observed. (Porter, 1997)

Sigmund Freud, originally a neurophysiologist who studied under Charcot, developed psychoanalysis in collaboration with Josef Breuer, first publishing their work on hysteria in 1893. (Ackerknecht, 1955) The decisive turn came in September 1897, when Freud abandoned his seduction theory and replaced it with the theory of infantile sexuality and the Oedipus complex. Without this reversal, psychoanalysis as a theoretical system would not exist. (Porter, 1997) Ackerknecht notes a persistent practical limitation: psychoanalysis was “of little avail when confronted with psychoses such as schizophrenia and manic-depressive insanity” but proved beneficial for neuroses like hysteria and compulsion neurosis. (Ackerknecht, 1955)

Freud’s model had a further theoretical consequence that distinguished it sharply from the Kraepelinian framework. Kraepelin had erected what Freud called an apparently impenetrable barrier between the biologically degenerate inmates of the back wards and the sane majority. Freud, by contrast, denied that madness was the problem of the Other: it lurked, to some degree, in all of us. “Civilization and its discontents,” he proclaimed, “were inevitably and irretrievably locked in an indissoluble embrace.” (Andrew Scull, 2015) This move democratized pathology at the cost of diluting the distinction between illness and ordinary suffering that clinical medicine required.

Therapeutic Collapse and Recovery

By 1900, the therapeutic optimism with which the century had opened had almost entirely collapsed. Asylums filled with incurable patients; moral therapy gave way to mere custody. Georg Dobrick, a German asylum doctor, captured the mood in 1910: “We know a lot and can do little.” (Porter, 1997)

Recovery came from pharmacology. Psychopharmacology from the 1950s — lithium, phenothiazines, imipramine — restored therapeutic optimism and accelerated deinstitutionalization and community care. These drugs promised a relatively safe, cost-effective method of alleviating mental suffering without recourse to lengthy hospital stays, psychoanalysis, or irreversible surgery. (Porter, 1997)

The Unresolved Tension

Porter frames psychiatry’s entire history as caught between organic brain disease models and psychodynamic approaches. As the twentieth century closed, psychiatry lacked unity and remained, in his words, “hostage to the mind-body problem, buffeted back and forth between psychological and physical definitions of its object and its techniques.” (Porter, 1997) Shorter concurs from a different angle: the pressure on psychiatrists to tell patients what they wanted to hear — first “nervous,” then “stress,” then whatever the current euphemism — reflects a profession perpetually negotiating between what it believes about the brain and what patients can bear to hear about their minds. (Shorter, 1997)

The Anti-Psychiatry Challenge

The year 1961 saw the simultaneous publication of two of the most influential critiques of psychiatry in the twentieth century. The sociologist Erving Goffman, in Asylums, introduced the concept of the “total institution” — a closed world whose rhythms and compulsions destroyed the individual self and manufactured the very disability it claimed to treat. Thomas Szasz, in The Myth of Mental Illness, denied psychiatry any legitimate claim to scientific diagnosis, arguing that what psychiatrists called mental illness was in fact a set of problems in living that had been inappropriately medicalized. (Andrew Scull, 2015) Scull, who devotes considerable attention to both figures, explicitly rejects Szasz’s position. In his view, “madness — massive and lasting disturbances of reason, intellect and emotions — is a phenomenon to be found in all known societies,” and the claim that it is all a matter of social constructions or labels is “so much romantic nonsense, or a useless tautology.” (Andrew Scull, 2015) He considers mental illness real, not a myth, but acknowledges the devastating force of these critiques at the time. (Andrew Scull, 2015)

The preceding year, R. D. Laing’s The Divided Self (1960) had offered a different approach to the same challenge. Rather than denying that madness existed (Szasz) or exposing the asylum as an institution of social control (Goffman), Laing argued that madness was comprehensible once approached on its own terms. He characterized the standard psychiatric jargon — following the Dutch phenomenologist van den Berg — as “a veritable ‘vocabulary of denigration’” that implied a normative standard of being human against which the psychotic was measured and found deficient. (Laing, R. D., 1960) The patient’s behavior, he argued, was not a disease symptom to be read by a detached observer, but a communication shaped partly by the relational context in which it occurred: “the standard psychiatric patient is a function of the standard psychiatrist, and of the standard mental hospital.” (Laing, R. D., 1960)

Laing proposed a test of sanity that exposed its fundamentally interpersonal character: sanity or psychosis is tested by “the degree of conjunction or disjunction between two persons where the one is sane by common consent.” The critical indicator of psychosis was “a lack of congruity, an incongruity, a clash” between patient and clinician — making diagnosis a relational event rather than a clinical observation. (Laing, R. D., 1960) His related claim was that no one “has” schizophrenia like having a cold: “The patient has not ‘got’ schizophrenia. He is schizophrenic. The schizophrenic has to be known without being destroyed.” (Laing, R. D., 1960)

At the same time, Laing offered a positive account of what the ontologically secure person possessed: “a centrally firm sense of his own and other people’s reality and identity” from which he could encounter all the hazards of life. (Laing, R. D., 1960) Madness, on this account, was not the absence of personhood but a particular mode of being that arose when the foundations of that security had been denied. When a person said he was dead or unreal, he was expressing existential truth literally, not metaphorically — and “the price to be paid for transvaluating the communal truth in this manner is to ‘be’ mad.” (Laing, R. D., 1960)

By the 1965 Pelican edition, Laing had sharpened this into an explicit political claim: psychiatry could be “a technique of brainwashing, of inducing behaviour that is adjusted, by (preferably) non-injurious torture,” and the “normal adjusted state is too often the abdication of ecstasy, the betrayal of our true potentialities.” (Laing, R. D., 1960) (Laing, R. D., 1960) His analysis of how families constructed the category of madness was particularly influential: he identified a three-stage sequence common to family descriptions of schizophrenic relatives — “Good - bad - mad.” The patient was first perceived as good (compliant), then bad (when the true self began to emerge through disruption), then mad (when the truth of that disruption became too threatening to acknowledge as truth). (Laing, R. D., 1960)

David Rosenhan’s 1973 experiment, published in Science as “On Being Sane in Insane Places,” drove the point home empirically. Pseudo-patients presented at mental hospitals claiming to hear voices, were admitted as schizophrenic, and then behaved normally — yet staff could not distinguish them from genuine patients, while fellow patients frequently could. When the pseudo-patients were eventually discharged, many received the diagnosis “schizophrenia in remission.” (Andrew Scull, 2015) Studies of the period showed psychiatrists agreed on diagnoses only about half the time for major disorders, and the Rosenhan study was widely seen as confirmation that the profession lacked reliable diagnostic tools.

In Italy, the anti-psychiatry movement found its most consequential expression in the work of Franco Basaglia, who from the early 1960s systematically dismantled traditional asylum structures, first at Gorizia and then at Trieste. His campaign culminated in Law 180 of 1978, which prohibited new admissions to public mental hospitals and provided for their eventual closure — making Italy the only country to formally abolish the public asylum system by legislation. (Andrew Scull, 2015)

Deinstitutionalization and Its Aftermath

The emptying of the asylums in the second half of the twentieth century is often attributed to the introduction of chlorpromazine and the other antipsychotic drugs. Scull argues the causation ran the other way: deinstitutionalization began before the drugs were widely available and was driven primarily by fiscal pressures. In the United States, the introduction of Medicare and Medicaid in 1965 created powerful incentives to transfer patients from state-funded mental hospitals into nursing homes and community facilities where federal money could be tapped. (Andrew Scull, 2015) In Britain, the Health Minister Enoch Powell declared in his 1961 “Water Tower” speech that the great Victorian asylums were “doomed institutions” and set a target of halving their beds within fifteen years. (Andrew Scull, 2015) Shorter concurs from a different angle: the antipsychiatry movement provided an intellectual climate hospitable to closing hospitals, but the main engine was economics, not ideology. (Shorter, 1997)

Chlorpromazine itself was synthesized in December 1950 by Rhône-Poulenc, introduced psychiatrically by Henri Laborit, and brought to the clinic by Pierre Deniker and Jean Delay at the Salpêtrière. Smith, Kline & French obtained FDA approval in 1954 and grew from $53 million to $347 million in sales by 1970, primarily from this single product. (Andrew Scull, 2015) The drug did transform ward life — chronic patients became manageable, staff injuries fell, locked wards could be opened — but it did not cure the underlying conditions, and the side effects, particularly tardive dyskinesia, were severe.

The diagnostic crisis provoked by anti-psychiatry was addressed by the DSM-III of 1980, developed under Robert Spitzer at Columbia. The task force abandoned any attempt at aetiological explanation and instead built a symptom-checklist system designed to maximize inter-rater reliability. It was dominated by biologically oriented psychiatrists who marginalized psychoanalysis and eliminated “neurosis” as a diagnostic category. Insurance reimbursement then made the DSM obligatory for all American mental health professionals. (Andrew Scull, 2015)

What Scull finds most troubling is what happened to the patients themselves. A substantial fraction of discharged chronic patients — schizophrenics, manic-depressives, demented elderly — ended up not in community care facilities but homeless, wandering the streets, or cycling through emergency rooms and jails. Prisons became the de facto largest psychiatric institutions in the United States, confining the seriously mentally ill in facilities with no therapeutic aspirations whatsoever. (Andrew Scull, 2015)

Islamic Medicine and the Treatment of the Mad

The Galenic and Hippocratic medical traditions survived the collapse of the Western Roman Empire largely through Persian and Byzantine preservation. The ninth-century Christian scholar Hunayn ibn Ishaq, working in Baghdad, translated 129 Galenic texts into Arabic — a work of active preservation as much as transmission, since Hunayn noted that Greek medical works had become extremely rare and required diligent searching to obtain. (Andrew Scull, 2015) The most consequential product of this tradition was Avicenna’s Canon of Medicine, completed in 1025, which became not merely the standard Arabic medical compilation but the most widely disseminated medical textbook in European universities until the eighteenth century. Printed in 1473, it had appeared in sixteen editions before any printed Galen. (Andrew Scull, 2015) (Andrew Scull, 2015)

The Arabic term for a mentally disturbed individual was majnūn (plural majānīn), meaning “the possessed” or “madman,” derived from the verb janna (“to cover or conceal”). It was the most common designation for such a person throughout the medieval Arabic, Persian, and Turkish traditions.(Dols, Michael W., 1992) The term carried theological resonance: Muhammad himself was accused by his opponents of being majnūn, which God repeatedly denied in the Quran. The controversy illuminates the semantic range of the word for early Muslims, for the jinn-possessed could be a poet, diviner, sorcerer, or madman, and the charge against Muhammad implied any or all of these.(Dols, Michael W., 1992) The imprecision of the category was acknowledged within Arabic discourse itself: the expression al-junūn funūn — “madness is of many kinds” — captured the wide variability in assessments of unusual behavior.(Dols, Michael W., 1992) Dols identifies three principal models for interpreting mental illness in the Islamic world: the disease model (mental illness as brain dysfunction), the deviation model (mental illness as divergence from normative behavior), and the intelligibility model (mental illness as deprivation of reason).(Dols, Michael W., 1992) He argues that medieval Islamic society permitted considerably wider latitude in the interpretation of unusual behavior than modern Western societies, and granted non-violent disturbed individuals much greater freedom to remain integrated within the community.(Dols, Michael W., 1992) Reason (ʽaql) was pivotal in the Islamic worldview — linking body and soul, individual and community — yet the madman was accommodated by medieval Islamic society and was not treated as a pariah or scapegoat.(Dols, Michael W., 1992)

Running alongside the rational medical tradition was the institution of prophetic medicine (aṭ-ṭibb an-nabawī) — instruction on matters of health and illness drawn from reports of the Prophet’s own deeds and pronouncements, compiled by Muslim jurists from the ninth century AD. Prophetic medicine used Galenic medicine to explain the physical working-out of God’s actions in the body, while simultaneously supplementing religious practices with therapeutics; it occupied the space between purely somatic medicine and purely devotional healing, reconciling the two by making God’s action the cause and Galenic process the mechanism. (Dols, Michael W., 1992) The Islamic tradition also inherited from the Christian Middle East the category of holy mania — a sacred form of madness that had been distinguished from pathological madness for centuries before the Arab conquest. “Holy idiocy” was the feigned madness used by ascetics to conceal their spiritual life and nurture it in private; “holy folly” was the ecstatic madness of the lover of God wholly absorbed in the divine. In Islam, “the fool for God’s sake” was most commonly the Sufi mystic who sought union with God. (Dols, Michael W., 1992) Sufism extended this possibility to all Muslims: the prospect of “holy folly” or sacred lunacy was open to anyone, since a Muslim could be drawn involuntarily to God without regard to spiritual merit, making the holy fool a familiar and tolerated figure in medieval Islamic society — distinct from the majnūn of medical discourse, but overlapping with that category at the edges. (Dols, Michael W., 1992) The famous Arab story of Majnūn and Laylā crystallized the cultural imagination of madness caused by love: the youth who went mad for chaste, consuming love of an unattainable woman, and who willingly sacrificed himself for it. During the later Middle Ages, Persian and Turkish poets reworked the romance into a mystical allegory, so that Majnūn became a symbol of the human soul consumed by its love of God — lovesick madness as the most intense form of devotion. (Dols, Michael W., 1992)

In Islamic law, the insane possessed no rights but also carried no obligations: like a child, the madman was outside the law but safeguarded by it. The primary legal instrument was guardianship supervised by a judge, and the Quran reinforced family responsibility with an explicit injunction: “Do not give to the incompetent their property that God has assigned to you to manage; provide for them and clothe them out of it; and speak to them honourable words.”(Dols, Michael W., 1992) The obligation of the Islamic state toward the insane was otherwise minimal.(Dols, Michael W., 1992) As in ancient Greece, where Plato had stipulated that “a madman is not to go about at large in the city, but is to be taken care of by his relatives,” family care was the primary expectation for the mentally disabled across most of history; the family customarily managed the insane at home and preserved their property.(Dols, Michael W., 1992)

For melancholia specifically, Avicenna systematized the Greco-Arabic humoral inheritance into a detailed clinical account. He defined melancholia as caused by abnormal black bile (sauda, literally “blackness” in Arabic) rendered pathological through overheating and sedimentation, and retained Galen’s three-location taxonomy — brain, hypochondriac region, or diffused throughout the body. (Radden, Jennifer (ed.), 2000) His symptom list extended Galen with clinical specificity: unreasonable fears (patients believed the sky would fall on them, that the earth would devour them, that they had been transformed into wolves, kings, or birds), anxiety, love of solitude, fixed downward gaze, sleeplessness, dryness, and darkening of complexion. (Radden, Jennifer (ed.), 2000) Avicenna defined mania (māniyā) as “bestial madness” (al-junūn as-sabuʽī), caused by burnt black or yellow bile in the brain; when a patient was deemed dangerous to himself, Ibn Sīnā recommended tying him up securely and placing him “into a cage that is suspended from the ceiling like a cradle.”(Dols, Michael W., 1992) Ar-Rāzī observed a practical distinction that anticipates modern nosology: the common people called someone majnūn who was afflicted by epilepsy, melancholia, or mental confusion, but ar-Rāzī insisted these were quite different conditions — the melancholic does not rush at other people; the epileptic is healthy between attacks; madness proper is characterized by jumping about, quick movements, insomnia, and persistent mental confusion.(Dols, Michael W., 1992) In vernacular Arabic, epilepsy was called the “prophetic disease” (al-maraḍ al-kāhinā) because of the obscurity of its causes and attribution to the jinn; doctors called it the “great illness,” “falling sickness” (ṣarʽ), or “possession/madness” (junūn), while the Greeks had called it the “sacred disease.”(Dols, Michael W., 1992) Avicenna also mapped how black bile mixed with different humors produced distinct psychological outcomes — happiness and laughter when mixed with blood, laziness when with phlegm, agitation and mania when with yellow bile, and — if pure and undisturbed — a characteristic deliberateness and reduced frenzy. (Radden, Jennifer (ed.), 2000) The transmission of this knowledge back into Western Europe passed through Latin translators: Constantine Africanus at Montecassino in the eleventh century and Gerard of Cremona in the twelfth rendered key Arabic medical texts into Latin, making the entire tradition accurately termed “Greco-Arabic medicine” rather than simply Arabic medicine. (Radden, Jennifer (ed.), 2000)

Institutionally, Islamic hospitals began appearing in the late eighth century and quickly proliferated; by the twelfth century, no large Islamic city lacked one. Among the patients for whom they made systematic provision were the insane. (Andrew Scull, 2015) The institutional vehicle for this clinical tradition was the bīmāristān — Persian for “place of the sick” — which Peter Pormann and Emilie Savage-Smith, in Medieval Islamic Medicine (2007), trace to the late eighth or early ninth century in Iraq, where the earliest hospitals were funded through charitable endowments (waqf). By the early tenth century, the caliph al-Muqtadir and his court had established prominent institutions in Baghdad, and al-Rāzī himself served as a hospital director. (Pormann, 2007) Over time, the shortened term māristān came to denote mental asylum specifically, and in popular Arabic parlance the word is still used today as a vivid description of any situation resembling an asylum in its chaos and madness.(Dols, Michael W., 1992)

The earliest documented evidence of institutional care for the insane in Islam comes from the hospital founded by Ibn Ṭūlūn in Cairo in AD 872–3, where an anecdote records an administrator testing a patient’s sanity by offering him a pomegranate — when the man ate it rather than throwing it, the hospital director recognized he was feigning madness.(Dols, Michael W., 1992) The twelfth-century Jewish traveller Rabbi Benjamin of Tudela described the caliph’s provision in Baghdad: “every month the officers of the caliph visit all those who have become insane and who are imprisoned in the Dār al-Māristān… every one who shows that he has regained his reason is discharged. All this the caliph does out of charity.”(Dols, Michael W., 1992) The Manṣūrī Hospital founded in Cairo in 683/1284 became the most famous hospital in the Islamic world; its endowment declared it open to all “without distinction between rich and poor,” with the duration of treatment unlimited.(Dols, Michael W., 1992) Ibn Jubayr, visiting Cairo in 1183, described the Nāṣirī Hospital’s provision for the insane: a large building with iron-barred windows serving as a place of confinement, where staff daily examined patients and administered appropriate treatments.(Dols, Michael W., 1992) Evliyā Chelebi, visiting the Manṣūrī Hospital four centuries later, described a harsher scene: some patients in gloomy cells, others in open rooms with pools and fountains, the insane “bound like lions with chains around their necks.” A government order was required for admission because of the daily cost of one piaster.(Dols, Michael W., 1992) The medieval Islamic hospital occupied the center of the city and was accessible to most people, offering in-patient and out-patient services, medical education, and drug dispensing.(Dols, Michael W., 1992)

Dols argues that the Islamic hospital does not fit Foucault’s model of the “great confinement.” Even the largest institutions like the Manṣūrī Hospital contained only a few dozen insane patients at one time — a very small number relative to Cairo’s population — and the hospital was emphatically not intended for indiscriminate incarceration of the disadvantaged poor.(Dols, Michael W., 1992) Medical treatment for insane patients included baths, fomentations to the head, compresses, massage with oils, bloodletting, cupping, and cauterization.(Dols, Michael W., 1992) Opium was the primary pharmacological sedative in this hospital treatment. Ibn Abī Uṣaybiʽa records a case at the Nūr ad-Dīn Hospital in Damascus in which the physician Muhadhdhab ad-Dīn prescribed “an ample amount of opium to be added to the barley-water” for a patient afflicted with māniyā (bestial madness); “the man improved and the condition disappeared.” (Dols, Michael W., 1992) The hospital primarily served the needs of the urban poor who had no other recourse; violence of the insane was a major factor compelling families to relinquish care, and institutionalization of women was unusual because Muslim families strongly preferred familial confinement.(Dols, Michael W., 1992)

The Baghdad hospitals were not merely custodial. Pormann’s study of the Pormann-Rufus volume documents that Baghdad was simultaneously the locus of the translation movement that rendered Rufus’s On Melancholy into Arabic, and that these same hospitals developed specialized facilities for treating mental disorders including melancholy. (Pormann, Peter E. (ed.), 2008) Al-Kaskarī, a tenth-century hospital physician in Baghdad, worked directly from Rufus’s framework but insisted on testing recommendations through his own clinical experience with melancholic patients in the wards, explicitly integrating Indian pharmacological imports — myrobalan, unknown to Rufus — alongside the Greek remedies. (Pormann, Peter E. (ed.), 2008) Al-Rāzī’s clinical notes in his Book of Experiences record a case of a young man who “plucked his beard and showed his anger by tearing out clay from the wall,” treated with phlebotomy of the basilic vein followed by epithyme decoction — precisely the remedies Rufus himself had recommended two centuries earlier. (Pormann, Peter E. (ed.), 2008) Rufus’s influence on the Arabic tradition operated along two distinct channels: direct quotation of his treatise by Isḥāq ibn Imrān, al-Rāzī, and al-Kaskarī, and indirect transmission through Galen, who had adopted Rufus’s tripartite classification and two-type black bile theory without acknowledgment, so that later physicians absorbed Rufus’s concepts as Galenic doctrine. (Pormann, Peter E. (ed.), 2008) The expansion of the hospital’s psychiatric function was eventually encoded in language: by the eleventh century, the word bīmāristān had acquired the more specific meaning of mental asylum, reflecting the degree to which treating melancholy and related disorders had become a recognized institutional responsibility in the Islamic medical world. (Pormann, Peter E. (ed.), 2008)

The therapeutic regime for the mad, as documented in both medical texts and hospital records, was humoral in logic but harsh in execution. (Andrew Scull, 2015) In cases of prolonged mental confusion that did not respond to treatment, some Islamic physicians recommended physical restraint, painful beating, and slapping, believing these could awaken a patient’s reason.(Dols, Michael W., 1992) This formal medical practice coexisted throughout the Islamic world with popular beliefs attributing madness to jinn possession: even as elite culture absorbed Galenic naturalism, supernatural explanations persisted alongside it, and religious remedies were sought when medical interventions failed. (Andrew Scull, 2015) The Islamic tradition of patient acceptance drew on hadith in which illness was framed as a divine trial or blessing for the believer; Muhammad himself, when Abu Harīra said fever was a curse, replied that “it cleanses sin in the like manner that fire cleanses the dross of iron.”(Dols, Michael W., 1992) A comparable pattern obtained in Byzantine Christianity, where religious healing was sought primarily for chronic illnesses, often before attempting professional medical treatment, while doctors were recommended for acute conditions.(Dols, Michael W., 1992) Byzantine churches and monasteries functioned as healing centers for the mentally disturbed through the practice of incubation; the medical saints Cyrus and John reportedly declared that “our church has become the hospital of the world.”(Dols, Michael W., 1992) George Rosen argued that Hebrew prophets occupied an analogous boundary position: they were not psychotics but “normal individuals who were especially predisposed to dissociative states,” and their ecstatic, frenzied behavior shared characteristics with the obviously mad, yet prophets were believed sincere, inspired, and socially valued.(Dols, Michael W., 1992) A striking contrast is provided by Usāma ibn Munqidh’s twelfth-century account of Crusader medicine: a Frankish physician treated a woman’s mental disorder by shaving her head and incising a cross on her skull, then rubbing it with salt, killing her — whereas the Syrian Islamic doctor had treated the same woman with diet and moistening remedies.(Dols, Michael W., 1992)

In the Islamic prohibition of alcohol, insanity played a central definitional role. The second caliph ʽUmar reportedly gave the reason for the ban as mental incapacity — “Wine is what obscures the intellect” — and the Arabic word khamr (wine) was believed derived from khamāra, meaning “to seize,” designating anything that seized or overwhelmed the mind.(Dols, Michael W., 1992) Hashish use apparently developed alongside the growth of Sufism from the twelfth century, with Sufis and scholars frequently defending it for its influence on the imagination as an aid to religious experience or intellectual work.(Dols, Michael W., 1992) Az-Zarkashī (d. 794/1392) catalogued the supposed harms of cannabis, including that it “destroys the mind (ʽaql)”; Ibn al-Bayṭār, the thirteenth-century botanist, warned that excessive doses could lead to mental disorder and insanity.(Dols, Michael W., 1992) Opponents of cannabis characterized its effects through humoral theory and through a vocabulary of cognitive destruction: habitual use was said to “change the mind” (tughayyir al-ʽaql) or make it “absent or remote” (tughayyib), removing it from reality.(Dols, Michael W., 1992) Medical euphemisms such as maʽjūn (“paste, electuary”) or tiryāq (“theriac”) served as cover-names for hallucinogenic drugs including hashish; attempts to control mind-altering substances were intermittent and ultimately half-hearted.(Dols, Michael W., 1992) A sixteenth-century Turkish official compared coffee-house patrons under the influence of various substances to hospital inmates, observing that certain coffee-houses were “filled with drooling madmen deprived of reason and understanding” while the mental hospitals “yearn for mental patients.”(Dols, Michael W., 1992)

(Dols, Michael W., 1992): I have used the word majnūn (pl. majānīn), ‘possessed’ or ‘madman’, in a generic sense to encompass this wide variability in the assessment of a man or woman’s unusual behaviour; it was the most common designation for such an individual in Arabic during the medieval period, and later in the Persian and Turkish languages.

(Dols, Michael W., 1992): The imprecise meaning of madness in Muslim society is clearly conveyed by the simple Arabic expression al-junūn funūn, ‘madness is of many kinds’.

(Dols, Michael W., 1992): What becomes evident is that this society permitted a much wider latitude to the interpretation of unusual behaviour than does modern Western society and much greater freedom to the disturbed, non-violent individual. The fact that the deranged were assimilated in medieval society in many different ways may not be startling, but it does highlight a number of significant aspects of Islamic culture.

(Dols, Michael W., 1992): Legally, the insane possessed no rights but neither did they have any obligations. Like a child, the madman was outside the law but was safeguarded by it; Islamic law strongly reinforced the customary care of the insane man by his family and the preservation of his property. The major legal instrument for this protection was guardianship, which was supervised by a judge who was generally responsible for communal welfare.

(Dols, Michael W., 1992): Reason was pivotal — it was the link between the visible and the invisible, the body and the soul, and the individual and society. Reason was the prerequisite for a Muslim’s full participation in his community. Yet, paradoxically, the madman was accommodated by society, so that he was not a pariah, an outcast, or a scapegoat.

(Dols, Michael W., 1992): the common expectation was that the mentally disabled would be provided for in the home. For example, Plato had stipulated that madmen should be kept at home by every possible means: ‘A madman is not to go about at large in the city, but is to be taken care of by his relatives. Neglect on their part is to be punished in the first class by a fine of a hundred drachmas, and proportionally in the others.’

(Dols, Michael W., 1992): Ar-Rāzī says that the common people call someone majnūn who is afflicted by epilepsy, melancholia, or mental confusion, but that between these three conditions there are great differences. The epileptic is healthy except during attacks of the disease. The melancholic does not have insomnia, does not eagerly approach other people… As for madness, its victim is characterized by jumping about, quick and vigorous movements, insomnia, and persistent mental confusion.

(Dols, Michael W., 1992): When mental confusion was prolonged and no treatment was successful, it was necessary to fetter the ill, to beat him with many painful blows, and to slap his face and the top of his head; he would then recover and return to his senses… The advice of Jūrjīs ibn Jibril ibn Bakhtīshūʽ is similar; he mentions beating with whips because it was supposed to awaken a man’s reason.

(Dols, Michael W., 1992): Ibn Sīnā states that mania is bestial madness (al-junūn as-sabuʽī), and rabies is a kind of mania. The cause of mania is burnt black or yellow bile in the brain… the maniac was mentally very disturbed and was highly agitated. Indeed, his appearance was like that of a wild animal… If there were concern that the madman would inflict injury on himself, he should be tied up securely and put into a cage that is suspended from the ceiling like a cradle.

(Dols, Michael W., 1992): Ibn ʽImrān notes that the Greeks called this illness the ‘sacred disease’ and considered it to be a divine punishment. In vernacular Arabic, one was accustomed to calling it the ‘prophetic disease’ (al-maraḍ al-kāhinā), according to Ibn ʽImrān, because of the obscurity of its causes and its attribution to the jinn. The doctors called it the ‘great illness’, ‘falling sickness’ (ṣarʽ) or ‘possession’/‘madness’ (junūn).

(Dols, Michael W., 1992): In reiterating this rule, ʽUmar, the second caliph, gave the reason for the ban — mental incapacity; he is reported to have said: ‘Wine is what obscures the intellect.’ The Arabic word for wine khamr was believed to have been derived from khamāra, meaning ‘to seize’, so that khamr was anything that seized or overwhelmed the mind.

(Dols, Michael W., 1992): As a result, the word māristān came to denote primarily, if not exclusively, an insane asylum, and in popular parlance, the term is still used in Arab lands today as a vivid description of any situation that resembles an asylum in its chaos and madness.

(Dols, Michael W., 1992): The earliest evidence that we have for the institutional care of the insane in Islam comes from the hospital founded by Ibn Ṭūlūn in Cairo in AD 872–3… a madman was brought to Ibn Ṭūlūn… Ibn Ṭūlūn said: ‘Is this the insane man? He does not appear to me to be insane.’ Ibn Ṭūlūn… gave the man a pomegranate. The man ate it, and did not throw it.

(Dols, Michael W., 1992): every month the officers of the caliph visit all those who have become insane and who are imprisoned in the Dār al-Māristān; and every one who shows that he has regained his reason, in which case they are discharged. All this the caliph does out of charity to those that come to the city of Baghdad, whether they be sick or insane.

(Dols, Michael W., 1992): ‘I constitute this as an endowment [waqf] for my equals and those below me, for the king and the mamlūk, the soldier and the prince, the great and the small, the free and the slave, and for male and female.’… the number of admissions to the hospital was not fixed; all had access to it, without distinction between rich and poor. Besides, the duration of treatment was not limited.

(Dols, Michael W., 1992): The Islamic hospital in general does not fit Michel Foucault’s popular interpretation of the function of the hospital movement in seventeenth- and eighteenth-century Europe as the ‘great confinement’ of the socially undesirable. The Islamic hospital was certainly not intended for the indiscriminate incarceration of the disadvantaged poor, as in pre-revolutionary France.

(Dols, Michael W., 1992): recommended treatment for the mentally disturbed usually included baths, fomentations (particularly to the head), compresses, bandaging, and massage with various oils. Blood-letting, cupping, and cautery were also widely used. In sixteenth-century Cairo Prosper Alpin noted the very common use of bleeding for head ailments, especially bleeding and cupping for the insane, as well as cauterization of the head.

(Dols, Michael W., 1992): The Qurʼān and Islamic law strongly reinforced this ancient duty. The Qurʼān states: ‘Do not give to the incompetent [sufahāʼ] their property that God has assigned to you to manage; provide for them and clothe them out of it; and speak to them honourable words.’

(Dols, Michael W., 1992): The hospital appears to have served primarily the needs of the urban poor who had no other recourse. The violence of the insane was probably a major factor in compelling a family to relinquish its obligation and to place a family member in a hospital. Furthermore, the unusual provision for women in Islamic hospitals, instead of in the home, would seem to suggest the complete inability of their families to provide for their care.

(Dols, Michael W., 1992): He put the woman on a diet and applied moistening remedies. Then, a Frankish physician appeared… ‘This woman has a devil in her head who has fallen in love with her. Shave her hair off.’… he took a razor, incised a cross on her head and pulled off the skin in the middle until the bone of the skull appeared; this he rubbed with salt, and the woman died forthwith.

(Dols, Michael W., 1992): Saul agreed, and David was brought to court in order to perform this service… ‘And whenever the evil spirit from God was upon Saul, David took the lyre and played it with his hand; so Saul was refreshed, and was well, and the evil spirit departed from him.’

(Dols, Michael W., 1992): Feigning insanity was not an unfamiliar feature of ancient and medieval non-medical literature, as in the stories of Odysseus and Solon, Brutus and Key Khosrow. Whether historical or legendary, the ruse, which was used to achieve personal safety, relied on a commonly shared perception of the mentally disturbed as generally harmless or inoffensive to authority. (Dols, Michael W., 1992): Muḥammad was accused by his opponents of being majnūn, which God repeatedly denied. Although majnūn is not defined in the Qur’ān, the controversy about Muḥammad’s character indicates the possible meanings of the word for early Muslims: the jinn-possessed could be a poet or diviner, a sorcerer or a madman. Thus, from the inception of Islam, majnūn was a familiar but ambiguous term. (Dols, Michael W., 1992): Briefly, there are three principal interpretations of mental illness, which I have adopted as the framework for this study. The traditional disease model is the most familiar and widespread; it regards mental illness as a pathological condition, specifically as a dysfunction of the brain. Second, the deviation model considers mental illness as a social issue or a divergence from normative behaviour… And third, the intelligibility model interprets mental illness as a deprivation of rationality or the breaking of the constitutive rules of reason. (Dols, Michael W., 1992): A third [building] that adjoins [the other two buildings of the hospital] is a large place, having rooms with iron windows; it serves as a place of confinement for the insane. They also have persons who daily examine their condition and give them what is fitting for them. All these matters the sultan oversees, examining and questioning, and demanding the greatest care and attention to them. (Dols, Michael W., 1992): Some of our insane brothers are in gloomy cells while others are in open rooms. In the rooms with the pool and wall fountains, the insane are bound like lions with chains around their necks… They cannot place him in the hospital without this order because of the daily cost of one piaster. (Dols, Michael W., 1992): the medieval hospital was placed in the centre of the city and accessible to most people. The hospital provided in-patient and out-patient services (to the sane), it often offered instruction to medical students, and it manufactured and dispensed drugs and medications to all. Family and friends naturally visited the hospital patients, including the insane. (Dols, Michael W., 1992): Hashish use apparently developed with the growth of sufism, whose orders spread rapidly across the Middle East from the twelfth century. Sufis and scholars were frequently the defenders of hashish because of its influence on the imagination, which was considered a useful aid to religious experience or intellectual endeavour. (Dols, Michael W., 1992): Going beyond traditional medical opinion about cannabis, az-Zarkashī (d. 794/1392) attributed to it practically every possible human ill. He begins his catalogue of its ravages by saying: ‘It destroys the mind (ʽaql)…’ Ibn al-Bayṭār, the famous thirteenth-century botanist… commented: ‘Taken in too large doses, it may lead to light-mindedness (ruʽūnah). Some users were affected by mental disorder and driven into insanity; it may also kill.’ (Dols, Michael W., 1992): ‘In the most commonly used Arabic words, hashish “changes the mind” (tughayyir al-ʽaql), or it “makes it absent” or “remote” (tughayyib), removing it from reality.’ (Dols, Michael W., 1992): ‘Certain coffee-houses of this city are filled with drooling madmen deprived of reason and understanding while at the same time the [mental] hospitals [of the city] yearn for mental patients.’ (Dols, Michael W., 1992): ‘Medical euphemisms such as maʽjūn “paste, electuary” or tiryāq “theriac” were suitable cover-names for all kinds of hallucinogenic drugs, including hashish.’… attempts to control or limit the use of mind-altering drugs in medieval societies were intermittent and ultimately half-hearted. (Dols, Michael W., 1992): it would appear from the Saints’ Lives that religious healing was sought primarily for chronic illnesses—frequently before attempting professional medical treatment—while a doctor was often recommended for acute illnesses… The accommodation of Greek medicine within Christian communities appears to hark back to the compromise reached in the Jewish book of Sirach and to foreshadow that within Islamic society. (Dols, Michael W., 1992): ‘The church building itself, in the practice of incubation becomes a hospital, and the sick lie about in the confines of the church awaiting a visitation from the physician- saints in the hope of being healed of their infirmities. “Do you not know that our church has become the hospital of the world?” ask the medical-saints Cyrus and John.’ (Dols, Michael W., 1992): Rosen argues that these Hebrew prophets were not psychotics; rather, they were normal individuals who were especially predisposed to dissociative states. Moreover, this process was an accepted means of establishing a direct relationship with God. Rosen draws a comparison between the Hebrew prophets and the dervishes in Islam. (Dols, Michael W., 1992): When she was sick, she rejected the suggestion that she pray in order to ease the pain. It was God’s will; as Rābiʽa said, ‘It is not right to oppose one’s Friend.’ This episode is representative of a persistent Muslim attitude towards illness that survived through the Middle Ages… ‘It is not a curse, for it cleanses sin in the like manner that fire cleanses the dross of iron.’ (Dols, Michael W., 1992): The concept of lycanthropy (quṭrub) was not derived by Islamic doctors from Galen but from the translation of the work of Aetios of Amida, a sixth-century Byzantine physician… This malady caused mental confusion and the sufferer roamed about all night, especially in cemeteries, like a dog… It was caused by black bile and was a type of melancholic delusion. (Dols, Michael W., 1992): a man from the Yemen named Ḍimād, who was a magician (rāqī), came to Mecca, and he heard the people calling the Prophet a majnūn. He went to Muḥammad and offered to treat him, but the Prophet responded that he trusted entirely in God and that he was God’s messenger… The intent of the pious legend appears to be that Islam is superior to magic. (Dols, Michael W., 1992): There were three degrees of men with magical powers; in descending order, they are those who exercised their power only by their minds or spirits over others and the natural world; those who used astrology and various techniques to make talismans; and thirdly, those who played on other people’s imagination by creating phantoms and illusions. Ibn Khaldūn says that the ‘philosophers’ call the first magic, the second theurgy, and the third prestidigitation. (Dols, Michael W., 1992): The early Muslims pursued the policy of executing sorcerers, beginning with ʽUmar’s instructions to Jazʼ ibn Muʽāwiya in Dasti-i Maysan in AD 643 to kill every magician and sorceress… As far as Christian and Jewish sorcerers were concerned, three of the legalists believed that they should not be executed while Abū Ḥanīfa did; they were liable, according to other jurists, to corporal punishment or to death if they had harmed a Muslim. (Dols, Michael W., 1992): aṣ-Ṣanaubarī gives a short chapter on the treatment of waswās, delusions or melancholia. He says that, on the authority of Galen and on the basis of what has been tested, someone who is afflicted by waswās or junūn would benefit from eating the brain of the Egyptian vulture (rakhama), if God willed. Also the deluded and the madman were healed by the scent of cock, and the melancholic or depressive was aided by drinking a potion made of dill for three days. (Dols, Michael W., 1992): ‘In Morocco, there is no single, socially chartered therapeutic system with final authority.’ The choices are considerable: the fuqaḥa or scribe and the Qur’ān teachers who specialize in writing amulets and talismans; herbalists; Galenic doctors; barbers, who traditionally also let blood; the aguza, an old woman who knows herbal and magical concoctions, or her male counterpart; the exorcist, who may be a Qur’ān teacher, member of a brotherhood, or a respected cherif (a descendant of the Prophet); the brotherhoods themselves; and Western medical practitioners. (Dols, Michael W., 1992): unlike modern Western medicine, there is no distinction between physical and mental illnesses. Crapanzano divides Moroccan theories of causation into two categories: naturalistic and preternaturalistic… a gradual wasting sickness, not madness, is the most characteristic effect [of the evil eye]. On the contrary, the madman was more commonly suspected of being the vehicle or source of the evil eye than its victim. (Dols, Michael W., 1992): Medicine-women appear to have relied principally on folk beliefs and practices that were unrelated to the learned traditions of magical healing and were basically non-Muslim… ʽAbd ar-Raḥmān considered it a ‘low trade and mean occupation’, his account has the advantage of being from a native point of view. He says that this trade is practised by charlatans… the success of their remedies was due either to the natural healing of illnesses or to ‘the play of imagination and nervous volitional influence’.

Lycanthropy (quṭrub) entered Islamic medicine from the sixth-century Byzantine physician Aetios of Amida, not from Galen. The condition caused men to roam at night in cemeteries, was attributed to black bile, and was treated as a variety of melancholic delusion.(Dols, Michael W., 1992) Magic and the treatment of the mad were deeply intertwined in popular practice. A hadith about a Yemeni magician named Ḍimād encapsulates the orthodox Muslim relationship: Ḍimād came to Mecca, heard the Prophet called a majnūn, and offered to treat him; the Prophet responded by declaring his trust in God and converting Ḍimād. The legend asserts Islam’s superiority over magic while implicitly acknowledging that magicians commonly exorcized the possessed.(Dols, Michael W., 1992) Aṣ-Ṣanaubarī al-Hindī’s fifteenth-century ar-Raḥma fī ṭ-ṭibb wa l-ḥikma integrated medical and magical remedies for waswās (delusions/melancholia) and epilepsy: eating the brain of an Egyptian vulture for the deluded, drinking dill for the melancholic, and methods to constrain, expel, or destroy jinn including burning, striking, whipping, and restraining them.(Dols, Michael W., 1992)

Ethnographic evidence from Morocco in the twentieth century demonstrates the persistence of medical pluralism in Islamic societies. Crapanzano documents multiple therapeutic options coexisting without any single system claiming final authority: fuqahā (scribes), herbalists, Galenic doctors, barbers for bloodletting, the aguza (old woman with herbal and magical knowledge), exorcists, Sufi brotherhoods, and Western medicine.(Dols, Michael W., 1992) In this pluralistic framework there was no distinction between physical and mental illness, and theories of causation divided into naturalistic (mechanistic) and preternaturalistic (caused by jinn, evil eye, or witchcraft). The madman was more commonly suspected of being the vehicle or source of the evil eye than its victim.(Dols, Michael W., 1992) In traditional Egyptian medicine, “old wives’ medicine” (ṭibb ar-rukka) was practiced by older women as the natural collectors of medical lore, their remedies passed orally from mother to daughter, combining suggestion, empiricism, and personal involvement with the patient.(Dols, Michael W., 1992)

Ibn Khaldūn described three degrees of men with magical powers: those who exercised power through mind or spirit alone; those who used astrology and talismans; and those who merely played on the imagination through phantoms and illusions. The first two degrees he considered real; the third was not.(Dols, Michael W., 1992) Ibn Khaldūn did not limit himself to taxonomy. He gave a first-person account of witnessing a sorcerer at work: the man formed a picture of a person to be cast under a spell, spoke evil words while collecting spittle, tied a knot over the symbol, and entered a pact with jinn to participate in his spitting. Ibn Khaldūn’s account — “This (human) figure and the evil names have a harmful spirit; it issues from (the sorcerer) with his breath and attaches to the spittle” — is notable as an eyewitness endorsement of sorcery’s reality by one of the most rigorous analytical minds of the medieval Islamic world. (Dols, Michael W., 1992) Alongside oral and performative magic, medieval Islamic society produced an extensive written magical literature. Al-Būnī (d. c.1225) composed the Shams al-maʽārif al-kubrā — the “Great Sun of Knowledge” — which became the most famous Islamic magic manual, and magical amulets and talismans continued to be produced without interruption from the pre-Islamic era through the later Middle Ages, gradually acquiring an Islamic character that became predominant. (Dols, Michael W., 1992) The early Islamic state took a severe stance toward sorcerers: ʽUmar instructed his governor in AD 643 to kill every magician and sorceress, though non-Muslim (Christian and Jewish) sorcerers presented a distinct juristic category on which authorities disagreed.(Dols, Michael W., 1992)

See Also

• Asylum
• Biological Psychiatry
• Melancholia
• Moral Therapy
• Neurasthenia
• Degeneration Theory
• Hysteria
• Philippe Pinel
• Emil Kraepelin
• Sigmund Freud
• Jean-Martin Charcot
• Medicalization
• Psychoanalysis

Sources

Auto-generated from evidence card IDs listed in frontmatter.

(Dols, Michael W., 1992): Dols, Majnūn (1992), Ch. 1 (Dols, Michael W., 1992): Dols, Majnūn (1992), Ch. 1 (Dols, Michael W., 1992): Dols, Majnūn (1992), Ch. 1 (Dols, Michael W., 1992): Dols, Majnūn (1992), Ch. 1 (Dols, Michael W., 1992): Dols, Majnūn (1992), Ch. 7 (Dols, Michael W., 1992): Dols, Majnūn (1992), Ch. 8 (Dols, Michael W., 1992): Dols, Majnūn (1992), Ch. 10 (Dols, Michael W., 1992): Dols, Majnūn (1992), Ch. 10