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Psychosis in the Firdaus al-Hikmat, the first major Arabic medical text

Published online by Cambridge University Press:  02 January 2018

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Abstract

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Copyright © Royal College of Psychiatrists, 2010 

Abū al-Hasan Alī ibn Sahl Rabban al-Tabari, known in the Islamic medical tradition as Rabban al-Tabari, wrote the first major Arabic medical text, Firdaus al-Hikmat (‘The Paradise of Wisdom’), in the 9th century. He was descended from a learned family in Tabaristan, Iran and served three Abbasid caliphs as court physician. Fluent in Syriac and Greek, al-Tabari recorded his observations on the opinions of Western authorities such as Hippocrates and Galen as well as Indian experts like Sushruta and Charaka. Historical accounts verify that his text circulated widely.

The Paradise of Wisdom lays out diagnoses, symptoms and treatments based on organ systems similar to those in contemporary textbooks. Psychiatrists can recognise his interests in neuroanatomical localisation and descriptive psychopathology. Under the section ‘On the signs of the diseases of the brain and what appears in them’, al-Tabari has detailed the causes and manifestations of major diseases. Though we now consider fantasy, thought and memory to be complex operations of neural interconnections across many pathways, he attributed their locations to the front, middle and back of the brain respectively. Deficits in these areas from corruption of the humours elicited unique symptoms and resulted in the majority of psychiatric disturbances.

For al-Tabari, the entire brain housed the rational self. Global lesions produced what we understand as psychotic symptoms. He noted common delusions: some thought they were made of pottery and feared they would shatter upon touching objects; some thought the sky was falling and proceeded slowly while yelling; some thought they were wild camels and fled from people; some believed they were chickens and shouted accordingly. al-Tabari also noted the following hallucinations: hearing sounds and rings despite their absence, seeing fire or gadflies between the eyes, seeing doubly. His anecdotes illustrate a major theme within cultural psychiatry – the biology of people across societies remains conserved even as they draw upon different cultural meanings to express symptoms.

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