Long before Freud’s reclining couch or Wundt’s status as the father of modern psychology, the bustling streets of medieval Damascus, Baghdad, and Cairo held a revolutionary secret: the world’s most advanced mental health care system at the time.

While mental health care in Europe relied on chaining patients and attributing ailments to metaphysical forces, Arab physicians were pioneering treatments that Western medicine would take centuries to rediscover. This was not a lucky guess, it was the result of careful observation, documentation, and a remarkably modern understanding of the human mind.

The Arab world’s medieval legacy traces back to early forms of talk and cognitive behavioural therapy, psycho-somatic conditions, psychiatric care, and medical descriptions of what we now recognize as anxiety, depression, and postpartum psychosis.

The early contributors

Meet Abu Bakr Muhammad ibn Zakariya al-Razi (854-925 CE), the revolutionary physician who could be considered the world’s first psychiatric specialist. Known as “Rhazes” in the West, he was the first to challenge the prevailing notion that mental illness was a form of divine punishment or demonic possession.

Al-Razi’s approach was ahead of his time: he emphasized holistic care, focusing on the psychological and physical roots of mental illness. His clinical observations of melancholy (depression) and mania were so precise they closely resemble modern diagnostic criteria

“Depression,” he wrote, “may arise from external causes or from within the body itself.” This understanding that mental illness could have both psychological and physical causes was revolutionary for its time. Al-Razi prescribed treatments ranging from talk therapy to dietary changes, always emphasizing the importance of treating the whole person, not just their symptoms.

The movement spread across the Arab world. The Al-Mansuri Hospital in Cairo, built in 1284, introduced collaborative patient care, where multiple physicians worked together on diagnoses and treatments—a practice that wouldn’t become standard in Western medicine until the 20th century. In Damascus, the Nur al-Din Bimaristan (1154) pioneered systematic patient interviews and, remarkably, post-discharge follow-up care.

The legacy of these Arab physicians and communities reminds us that progress isn’t always linear.

By Luma Makari, Co-Founder of Elggo

There was Ibn Sina (980-1037 CE), known in the West as Avicenna, whose “Canon of Medicine” became the standard medical textbook in both the Islamic world and Europe for over 700 years. Ibn Sina was among the first to suggest that emotions could affect physical health, introducing the concept of psychosomatic conditions, an idea that Western medicine widely embraced only in the 20th century

Bimaristans: The first psychiatric hospitals

The story begins during the Islamic Golden Age, a period of extraordinary scientific and cultural achievement spanning from the 8th to the 14th centuries. During this time, Arab scholars weren’t just preserving ancient knowledge- they were actively revolutionizing it, particularly in the field of mental health.

The story begins in 805 CE when the first dedicated psychiatric ward opened its doors in Baghdad.The crown jewel of this revolution was the bimaristan – a Persian word meaning “house of the sick.” These weren’t just hospitals; they were sophisticated medical complexes that included dedicated psychiatric wards. With design structures including gardens for therapeutic walks, flowing water for calming sounds, and even music rooms for what we now call music therapy.

These hospitals had something else that was centuries ahead of their time: a strict policy of treating all patients with dignity, regardless of their condition.

The power of community

The Arab approach to mental health has historically been distinguished by something remarkable: its deep integration of community support, family involvement, and spiritual healing alongside medical treatment. This unique synthesis created a support system that, in many ways, anticipated modern community mental health practices by centuries.

In traditional Arab societies, the family unit played a crucial role in mental health care that went far beyond the modern concept of “family support.” Extended families would often restructure their entire living arrangements to accommodate and care for a mentally ill member. This wasn’t seen as a burden but as a natural extension of family duties, reflecting the Arabic concept of “takaful” – mutual responsibility.

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“The family is not just a support system,” wrote Ibn Qayyim al-Jawziyya (1292-1350 CE), “it is the primary environment for healing.” This approach meant that individuals with mental illness remained integrated within the community rather than being isolated in institutions – a practice that wouldn’t become common in Western medicine until the deinstitutionalization movement of the 20th century.

Community support extended beyond families to the broader neighbourhood through the Hara System, documented in the 9th century. Local leaders monitored vulnerable individuals, neighbours shared caregiving responsibilities, community events included everyone regardless of mental state, and businesses often provided informal employment to those in need.

Prevention and wellness

But perhaps most revolutionary was the Arab world’s approach to prevention. Early Arab physicians recognized that mental health was not just about treating illness but maintaining wellness. They prescribed lifestyle changes, balanced diets, and regular exercise—principles that align closely with modern preventive mental health practices.

Lessons from the Arab mental health legacy

As we face modern mental health challenges, perhaps we could learn from these forgotten pioneers. Their emphasis on holistic treatment, prevention, and dignity in mental health care feels surprisingly relevant to current discussions about mental health reform.

Arab scholars weren’t just preserving ancient knowledge- they were actively revolutionizing it, particularly in the field of mental health.

By Luma Makari, Co-Founder of Elggo

The legacy of these Arab physicians and communities reminds us that progress isn’t always linear. Sometimes the most innovative solutions to modern problems can be found by looking back at the wisdom of the past. In the case of mental health care, the integrated approach developed in the medieval Arab world – combining sophisticated medical care with comprehensive community support – might offer valuable insights for addressing contemporary mental health challenges.

This remarkable history challenges us to think differently about mental health care. Rather than seeing it as either a medical or social issue, the Arab model shows us how effective care can integrate professional treatment, family support, community involvement, and spiritual well-being into a comprehensive system that treats not just the illness, but the whole person within their social context.