The Psychologist from Balkh

Zaynab Ahmed, Year 3

Depression, anxiety, OCD, personality disorders and the like, have all streamed their way into the daily vocabulary of most people today. Hence, it is often attributed to ‘modern medicine’. Truth be told, I view this as arrogant since we have a lot to thank our forefathers in medicine for. Psychopathology has undoubtedly had many struggles and hurdles along its way to being formally recognised, much of which depends on the fact that mental disorders cannot be observed. These disorders are called ‘latent variables’; they are inferred from a matrix of symptoms and are assumed to be the cause (Salkind, 2010).

Whilst studying GCSE History Medicine through time, I was disappointed to hear passing mention of only two Muslim physicians/polymaths, by their imposed anglicised names. Yet there is a vast legacy of Muslim physicians belonging to the Golden age of Islam, recognised from the seventh to the sixteenth century (Al-Hassani, 2012).

Therefore, I humbly invite you to tread the path in pursuit of the forgotten Islamic medical history. Our story begins with Abū Zayd Al-Balkhī, a ninth century polymath born in Balkh, now a part of modern-day Afghanistan (Encyclopaedia Britannica, 2013). Although little is known about Al-Balkhī, he wrote an impressive number of books—the most famous being ‘Maṣāliḥ Al Abdān wa al-Anfus’, translated to mean ‘Sustenance of the Bodies and Souls’. The original Arabic manuscript is held in the Ayasofya library in Istanbul. The book is divided into the body and the soul; the soul is then divided into a further eight chapters. These eight chapters have been translated by Malik Badri in the book Abu Zayd al-Balkhī’s Sustenance of the Soul, The Cognitive Behaviour Therapy of a Ninth Century Physician (Balkhī and Badri, 2013) and this article will aim to provide a modest summary.

Background

It is important to note from the onset that al-Balkhī was not writing from purely a treatment perspective. Rather, he spoke with a holistic understanding of mental illnesses, placing more emphasis on their prevention like Greek medicine. Greek philosophy laid the foundations of psychology, which was adjusted through history (Shuttleworth, 2010). However, the information was often scattered, and more focus was on the balance of the four humours (Awaad and Ali, 2015). 

The soul?

The Soul?

Admittedly, reading a translation is never the same as the original manuscript. Arabic is no exception; it is a cornucopia of linguistic achievement. Badri mentioned that the Arabic term ‘nafs’ is synonymous to the psyche, ‘but with an Islamic spiritual dimension’ (Balkhī and Badri, 2013, p.11).

Generally, ‘nafs’ is used in the meaning of ‘self’; for example, ‘he spoke to himself’. This is found in the Qur’ān in numerous places and sometimes translated as soul. More specific to Islamic spirituality and mindfulness is the aspect of desires and the ‘lower self’. The purpose of a Muslim is worship of God and working for the hereafter by reducing the attachment to the earth and the ‘lower self’ –the nafs; this is another way it is understood within the Qur’ān and prophetic narrations. It is apparent from al-Balkhī’s preventative strategy of mindfulness, gratitude and introspection that he meant a combination of the two. 

The Mind and Body are Intrinsically Linked

Compared to Freudian theory—which is criticised today for its lack of evidence (McLeod, 2018) and sole focus on the unconscious mind (Paris, 2017)—al-Balkhī determined it was a mix of internal and external causes, and diseases of the body that could cause diseases of the mind. This is especially pertinent when exploring the relationship between disabilities and depression. Noh et al (2016) mentioned that risk factors for depression include ‘abuse; loss of roles; and stressors related to poverty, environmental barriers, and/ or lack of access to appropriate health care’. Al-Balkhī suggests talking therapy and he notes that negative thoughts are the cause of psychological disorders (Balkhī and Badri, 2013) which we call Cognitive Behavioural Therapy (CBT) today (NHS, 2019). The reality is that we all experience negative feelings on occasion; al-Balkhī does not claim that these feelings will be removed altogether but he offers coping strategies and a rational approach to negative feelings.

Anxiety

An example of a discussion in the book is al-Balkhī’s mention of ‘al gham’, anxiety, and it being a trigger for anger, frustration, fear and terror. He holds the view that if anxiety is the root of all negative emotions, then similarly joy is the root of health. This is referred to as opposite therapy. Al-Ghazāli employed this technique for patients with mental disorders and it is widely practiced as a spiritual ailment today (Yaacob, 2013) because as the Prophet Muhammad ﷺ (Peace and Salutations be Upon Him) said:

The cure for ignorance is to question (Abū Dāwūd).

Much of what al-Balkhī discusses would fit comfortably in a self-help book today in terms of positive affirmations, meditation and anger management. Often, I found myself shutting the book and spending time introspecting. 

Mindfulness

The remedies revolve around a healthy internal dialogue, positive affirmations and reflection, which I would translate as mindfulness. Al-Balkhī does not shy away from the spiritual remedies either, by prescribing contemplation on the blessings surrounding oneself, worship of God and in his words ‘he should strongly hold on to the conviction that Allah (God) has not created a disease of the body or a disorder without creating its antidote’ (Balkhī and Badri, 2013). As a Muslim I firmly believe that spirituality in the religious sense can aid treatment and this is apparent from reading the works of the ninth century polymath al-Balkhī, especially when it is only now researchers are drawing links between spirituality and health (Carmody et al, 2008). Contributions to medicine happened across time and across nations and this article gives just a taste of that.

References

Al-Hassani, S., 2012. 1001 Inventions: The Enduring Legacy Of Muslim Civilization. 3rd ed. National Geographic Society, p.17.

Awaad, R. and Ali, S., 2015. Obsessional Disorders in al-Balkhi′s 9th century treatise: Sustenance of the Body and Soul. Journal of Affective Disorders, 180, pp.185-189.

Balkhī, A. and Badrī, M., 2013. Abū Zayd Al-Balkhī”s Sustenance Of The Soul. London: International Institute of Islamic Thought.

Carmody, J., Reed, G., Kristeller, J. and Merriam, P., 2008. Mindfulness, spirituality, and health-related symptoms. Journal of Psychosomatic Research, 64(4), pp.393-403.

Encyclopedia Britannica. 2013. Balkh | Afghanistan. [online][Accessed 11 November 2020]. 

Available at: https://www.britannica.com/place/Balkh

McLeod, S.A, 2018. What Are The Most Interesting Ideas Of Sigmund Freud?. [online]. [Accessed 15 November 2020]. Available from: https://www.simplypsychology.org/Sigmund-Freud.html#:~:text=Sigmund%20Freud%20emphasized%20the%20importance,to%20make%20the%20unconscious%20conscious.

nhs.uk. 2019. Cognitive Behavioural Therapy (CBT). [online]. [Accessed 15 November 2020]. Available from: https://www.nhs.uk/conditions/cognitive-behavioural-therapy-cbt/

Noh, J., Kwon, Y., Park, J., Oh, I. and Kim, J., 2016. Relationship between Physical Disability and Depression by Gender: A Panel Regression Model. PLOS ONE, 11(11), p.e0166238.

Paris, J., 2017. Is Psychoanalysis Still Relevant to Psychiatry?. The Canadian Journal of Psychiatry, 62(5), pp.308-312.

Salkind, N.J 2010, Encyclopedia of research design, vol. 0, SAGE Publications, Inc., Thousand Oaks, CA.

Shuttleworth, M., 2010. Aristotle’s Psychology – History Of Psychology. [online]. [Accessed 15 November 2020]. Available from: https://explorable.com/aristotles-psychology 

Yaacob, N., 2013. Cognitive Therapy Approach from Islamic Psycho-spiritual Conception. Procedia – Social and Behavioral Sciences, 97, pp.182-187.