Posted by JMMH Editorial Team on 2026-04-15

 Amber Haque

Abstract

 

This paper explores the concepts of mental illness and its treatment in the early Ottoman era, focusing on the Edirne hospital, a prominent center for the treatment and rehabilitation of mental illness. In the 20th century, the hospital was converted into a museum. The paper outlines the classification of mental illnesses developed by Ottoman physicians and provides descriptions of various diseases. It also discusses treatment strategies, including traditional therapies, music therapy, preventive medicine, and occupational involvement, as well as legal issues concerning the mentally ill. Information about the hospital was gathered through personal visits by the authors, a review of archived notes at the site, and subsequent research.

 

 

Introduction

 

The history of psychiatric care in Turkey dates to the Seljuk period (1037-1194) and continued into the early Ottoman era beginning in 1299. During this time, hospitals were known by various names reflecting the services they offered. Common names included Bimaristan, Maristan, Darusshifa, Darussihha, Darulâfiye, Daru’t-tibb, and Sifahane (Ataseven, 1985; Benli, 2016). The term "Bimarhane" specifically referred to mental health hospitals, while "Bimaristan" or "Timarhane" described facilities for the rehabilitation of the mentally ill. Several hospitals were established in Anatolia, with dedicated sections for the care of individuals with mental illnesses (Aksel, 1959, as cited in Ozturk & Volkan, 1971). Altin (2018) differentiates between the two most commonly used terms: "Darusshifa," which translates as “house of healing”, refers to imperial hospitals associated with the Ottoman Empire, and "Bimarhane," which denotes mental health institutions.

Ottoman hospitals were among the first in the world to establish separate wards for different diseases, including mental illnesses. These hospitals operated as welfare organizations, primarily funded by the emperor, who was the main donor (Çınaroğlu, 2024). Noble families and high-ranking government officials also contributed to the upkeep of hospitals and healthcare centers. This system persisted until the early 19th century, after which healthcare organizations came under state control, leading to the establishment of new hospitals aligned with modern Western medicine (Benli, 2016, p. 2).

In the 19th century, several hospitals were converted into mental institutions, adopting terminology that mirrored Western treatment practices (Sari & Akgün, 2008). The first Ottoman psychiatric hospital was built in Istanbul during the reign of Mehmet the Conqueror, shortly after the city’s conquest in 1453. Sari and Akgün (2008) also note that many hospitals during the Seljuk and Ottoman eras served as medical schools. The Süleymaniye Medical School, constructed between 1550 and 1557, has limited documentation of its teaching methods. However, the hospital deed indicates that a master-apprentice method was used, drawing on 66 medical texts, 18 of which were written by Ibn Sina (Avicenna). The deed also mentions that courses taught at this school included logic and rational sciences. This medical school continued to train students until the mid-19th century, when new medical schools began opening in Istanbul (Ayduz, 2007).

The administrative responsibilities of all hospitals were overseen by the chief physician, who governed healthcare in both the palace and the state. The chief physician maintained a record of authorized doctors and, when necessary, appointed qualified doctors upon request. To gather historical information about the psychiatric complex from the 15^th century, the authors visited Darrushifa Sultan Bayazid II in Edirne, Turkey.

 

Darrushifa Sultan Bayazid II (Edirne Hospital)

 

Situated next to the Ottoman Complex in Edirne, this hospital is a notable facility, built between 1484 and 1488 by the eighth Sultan, Bayazid II, to serve the mentally ill (Sengul, 2015). Today, it is known as the Health Museum of the Complex of Sultan Bayazid II. Information about the hospital was gathered through the authors’ personal visit to the complex, on-site examination of notes and archives, and subsequent research.

During the 15th and 16th centuries, Edirne served as the Ottoman Empire’s second capital and was among Europe’s most significant cities. The Bayazid Complex is considered the empire’s third major complex, following those in Bursa and Istanbul. Sultans built numerous impressive monuments in Edirne and frequently visited the city because of its proximity to Istanbul.

Although built in the 15th century, the hospital in Edirne resembles 20th-century institutions, with various buildings, including treatment centers, a school, a mosque, a library, and other facilities necessary for the complex's operation. It is recognized as a pioneering institution for its original contributions to the medical sciences, particularly in the field of psychiatry.

The complex is surrounded by low-rise walls that provide security while allowing patients to enjoy time outdoors. Designed by Architect Hayrettin (Cantay, 2007), it spans 22,000 square meters and features more than 100 domes of varying sizes. At the center of the structure is a peaceful garden with a water fountain that enhances the serene atmosphere. Flowers and plants are cultivated on the grounds not only for their beauty but also for their medicinal properties.

Situated on the banks of the Tunca River, the hospital showcases a unique blend of Islamic architecture in a tranquil natural setting. Remnants of 15^th-century construction include a mosque, the hospital itself, a guest house, a kitchen, a soup house, and bathing facilities. Later additions to the complex include a water closet, a music conservatory, a room for the muezzin who calls for the five daily prayers, and an adjacent cemetery. A distinctive feature of this hospital is its fountain with sprinklers, located on the floor directly beneath the central dome, which provides an aesthetically pleasing and relaxing environment for patients (Sengul, 2015). Many books and manuscripts from that era are housed in Turkish museums, and ample information is displayed on information boards throughout each hospital room in the complex.

Initially intended for all types of patients, the hospital employed a chief physician, two attending physicians, two surgeons, two ophthalmologists, and two pharmacists. The hospital had a total of 21 staff members and 32 patient beds (Edirne, 2025). Medical books donated to the hospital have survived, and 37 of them, which describe medical practices, are preserved in the Selimiye Manuscripts Library (Edirne, 2025).

The hospital was established for patients with mental disorders and consisted of three main sections: a) outpatient rooms situated in a spacious courtyard, the first area encountered upon entering the building; b) administrative offices; and c) the inner part of the hospital designated for inpatient care, ensuring maximum privacy (Sengul, 2015). At this hospital, aggressive patients were kept in isolation, and each patient received a modified diet aimed at balancing the body's four humors to treat their ailments, following the principles of holistic medicine. Although the facility served psychiatric patients, it employed surgeons, ophthalmologists, and other specialists (Sengul, 2015). Patients traveled to Edirne from various regions across the Ottoman Empire, including the Balkans. Medications were prepared in the complex's pharmacies, and all services were offered at no cost to the patient. The hospital, now a museum, is filled with photographs of traditional medicines made from plants cultivated and processed on the hospital grounds.

 

Concepts of Mental Illness

 

The psychiatric practices of the Ottomans were influenced by the legacy of the Seljuks (Tunaboylu-İkiz, 1999; Sari, 1988). The first hospital in the world to treat both the mentally and physically ill was established in Anatolia in 1206, during the Seljuk Empire. This tradition of treating the mentally ill rather than punishing them persisted throughout the Seljuk and Ottoman empires (Ozkan, 2012).

In Ottoman hospitals, a separate section was dedicated to mentally ill patients, who received holistic care that combined medical and psychiatric treatments (Ünver, 1958). The medical texts authored by Ottoman scholars were primarily adaptations of traditional Islamic medicine, incorporating works by prominent philosophers and physicians, including Hippocrates, Galen, Abu Bakr al-Rāzī (Rhazes), and Ibn Sina. Ottoman physicians also contributed their own ideas to these translations of original sources. Most of these medical books are held in various private collections or public libraries in Turkey (Ünver, 1958).

During the reign of the Ottoman Sultans, medreses (universities) and darüşşifas (hospitals) flourished throughout the empire, which spanned Anatolia, the Balkans, the Middle East, and the Mediterranean. Some mosques housed hospitals, dispensaries, and asylums dedicated to treating physical and mental illnesses. At the time, individuals with mental health issues were neither feared nor abused; instead, they were treated as sick, even when their conditions were attributed to evil spirits. The community accepted and protected these patients, providing them with necessary treatments free of charge. Şevki (1925) notes that hospital records indicate the institution was originally established to care for various types of patients, not solely the mentally ill, before it transitioned into a psychiatric treatment facility.

The hospital foundation’s records (endowment-waqf) provide a detailed account of the responsibilities of all hospital staff. Doctors, ophthalmologists, nurses, and pharmacists were required to be proficient in their respective fields. All caregivers were expected to attend to patients skillfully and treat them gently, upholding good moral standards. The hospital employed two chefs capable of preparing high-quality meals tailored to patients' needs, as prescribed by the doctors.

According to Evliya Çelebi's writings in the foundation documents, there was also a team of musicians who played various instruments (Şevki, 1925). Çelebi noted that this musical group consisted of 10 members, including three singers and seven instrumentalists, and performed for patients three days per week (Erer & Atıcı, 2010).

 

Approaches to Mental Illness

Ottoman medical records indicate there were two primary approaches to mental illness. One approach involved doctors examining the condition from a biological perspective and treating it with medicine. The other approach was offered by tekkes, or Sufi houses, which provided treatment through spiritual practices, songs, and dance to induce altered states of consciousness and foster a connection with God (Hatunoğlu, 2014).

In Ottoman medicine, as detailed in the writings of Salih bin Nasrullah, the Chief Physician of the Ottoman Empire, the preservation of health rested on six essential pillars. These pillars are a) air and breathing, b) food and nutrition, c) bodily movement and rest, d) the balance of the psyche's activity and tranquility, e) sleep and vigilance, and f) urination and defecation. Collectively known as esbab-ı sitte-i-zarurriyye, these principles guided individuals from the beginning of life to its end (Aydüz, 2016).

The psyche was often referred to as the "soul," and its movement was regarded as a fundamental aspect of life (Akdeniz-Sari, 1984). The reciprocal relationship between the soul and body, a core principle of Arabic medicine, was accepted by physicians during the Ottoman era. The term most commonly used to describe a person's psychological dimension was nafs. These physicians believed that the body’s overall functioning reflects the interplay of bodily fluids (humors) and psychological events. In the 15th and 16^th centuries, both Christians and Muslims often sought medical assistance from doctors of their own faith, suggesting that medical treatment was often intertwined with religious practices.

The connection between the soul and the body underscores the importance of a physician’s close attention to a patient's emotional and spiritual well-being. An aphorism attributed to al-Rāzī states, "The physician, even if he has doubts, must always make the patient believe that he will recover, for the state of the body is linked to the state of the mind" (Ibn Abī Uṣaybiʿa, "History of Physicians," I, 314, 28–29; translated by Pormann/Savage-Smith, 2007, 41).

The "psyche of the animal," or ruh-ul-hayvani, is a condition of the psyche that corresponds to Freud's concept of the id, introduced 500 years later (Akdeniz-Sari, 1984). Ruh-ul-hayvani can move in and out of the body. For instance, during states of fear and sadness, the soul gradually moves inward, while in a relaxed and peaceful state, it moves outward. In moments of anger, the soul externalizes, moving from the body into the outer world. This can cause the person to sweat and flush, and in extreme cases, it may lead to cold sweats or even a heart attack.

All emotions are recognized as components of the psyche. This is why biological qualities—specifically, the balance of hot and cold and of dry and moist—strongly influence an individual's moral character. If a person's overall humor is predominantly hot, they are likely to become angry quickly; if it is predominantly cold, they may be fearful and sluggish by nature. Conversely, the state of the soul can significantly affect the body's balance. Psychological states such as anger, sadness, worry, fear, and pleasure are considered "non-natural" factors that can be manipulated to alter the mixture of the humors.

In his manuscript, Salih bin Nasrullah (d. 1669) discusses the dangers of emotions, comparing them to poison for the body and noting that their positive and negative effects can be more powerful than those of drugs (Nasrullah, p. 9). He notes that anger causes the blood to boil and the face to redden. While it is detrimental for hot-tempered individuals, it may have some benefits for those who are typically calm. Nonetheless, anger ultimately harms both the body and the mind. Additionally, Nasrullah points out that thoughts of sarcasm, cynicism, betrayal, or causing harm to others indicate a pattern of antisocial thinking, which he considers a form of mental illness. He also observes that while many local Turkish expressions describe emotions, other languages lack the vocabulary to convey the exact meaning of each emotion. In his Introduction to the Art of Medicine, al-Rāzī explains these factors:

Psychological emotions such as anger can be described as the turmoil of the soul directed toward a person, leading the soul to seek revenge. This state is akin to blood boiling and intense agitation caused by the choleric faculty located in the heart. In contrast, sadness reflects the soul's weakness when it becomes desperate about something. Desire stimulates heat, causing it to move toward the surface of the body. Worry, on the other hand, may direct this heat either toward the inner parts of the body or the external parts. Meanwhile, pleasure gradually stimulates the heat, also moving it toward the surface of the body. (De Benito 1979, 38).

 

The Ottoman health system was influenced by various medical traditions, including folk medicine, prophetic medicine, and mechanistic humoral medicine, which was inherited from the Greeks and influenced by Paracelsus (Shefer-Mossensohn, 2009). Paracelsus (1493-1541) believed that elements have both external and internal forms and that there is a significant relationship between humanity and the universe. This theory led to the use of herbal medicines, as diseases were thought to arise from imbalances in these elements (Turgut et al., 2014). Salih bin Nasrullah translated some of Paracelsus' works and authored a 500-page manuscript titled "Nuzhat al-Abdan fi Tarjuma Gayat al-Ihkam", which compares the medical practices of the old and new eras.

 

Classification of Mental Illness

 

Ottoman medical manuscripts contain extensive information on mental illnesses and their classifications. In Turkish medical texts from the 15th to 17th centuries, mental and neurological disorders were categorized under the title “diseases of the head” (Shefer-Mossensohn, 2009). These manuscripts explained all diseases using three headings: causes, symptoms, and treatment. The etiology and treatment of these illnesses were attributed to physical causes (Sari & Akgun, 2008). Conditions such as hysteria, anxiety, obesity, other psychosomatic disorders, and sexual disorders were considered physical disorders. Alcoholism, opium use, and tobacco addiction were identified as separate entities, now referred to as addictions. Gevrekzade, a well-known physician, noted that motor and sensory disturbances could be organic results of head trauma. Personality disorders were classified as a distinct category. Mehmed Said, a physician in 1815, defined 56 types of madness (Tunaboylu-İkiz, 1999).

The table below presents the classifications of mental and neurological diseases, listed alphabetically, that were grouped under the title "Diseases of the Head" in Ottoman medical manuscripts (Sari, 1986). These classifications are based on symptoms and organic factors and are accompanied by brief descriptions.

 

Table 1

 

A.    Diseases of the Head

 

Devvar	Dizziness or when the patient reported the “world turning around.” Today this is known as vertigo or hypertension.
Eblehlik	This referred to mental retardation in which the person showed feeble- mindedness. Their behavior looked like children, and it was considered hereditary.
Flegmoni	Inflammation of the brain and/or encephalitis.
Ihtelat al zhn	This term was used to describe confusion in the patient with hallucinations or perceptions of things that do not exist, e.g., seeing people, animals, and objects that do not really exist or perceived by other people.
Kurtub	State of fugitiveness.
Mal-i-hulya	A state of discomfort involving many different diseases. The name in Ottoman Turkish is merakî (delusion), and the symptoms are anxiety, fear, obsession, and sadness.
Sara	Excessive contractions in the brain and body; loss of consciousness; foam coming out from the mouth; epilepsy. The manuscripts list different kinds of epileptic episodes.
Sersam	Meningitis and brain inflammation. One type of sersam called “subari” is known as the worst and the symptoms are madness and anxiety. Symptoms of “sersam” are forgetfulness, headaches, and insomnia. Sersam was also defined as one of the head injuries resulting in confusion and talking gibberish. A patient may also suffer from fever and trembling. One type is sersam called cold sersam was without fever, and the symptoms were forgetfulness, headache, and sleepiness.
Suban	Water collected in the skull and brain membranes or hydrocephalus. The patient experiences heaviness in the head, difficulty closing their eyes, etc. This was observed mostly in children.
Suda and Shakika	A term used for headaches and migraine. In old manuscripts, more than ten types of headaches were described according to their etiologies. Both organic and inorganic factors are listed as reasons. For example, walking too long in the sun, sitting in front of the fire, taking a long bath, hunger, cold sitting for a long time without movement, anxiety, and heavy reading may cause headaches (Sari, 1986).
Subari	Madness and agitation
Teza’zu dimağ	Traumatic head injuries. Several motor and sensational disturbances were considered organic results of head trauma.
Unutkanlik	Forgetfulness or amnesia. As soon as they see, hear, or look, they also forget. This could also be what later came to be known as Alzheimer’s disease.
Unutsaguluk	Those suffering from this disease catch everything they see and hear with great clarity, but immediately after they forget.

 

 

B.    Addiction disorders

 

Afyonkeşler ve berşe müptelâ olanlar	Opium addiction
Bagimliliklar	A category for addictions including alcoholism, opium use, tobacco, etc.
Hadr	Numbness or sensorial organs functioning poorly caused by opium use, bitten by poisonous animals, and vertebra dislocation.
Sûcîye müptelâ olanlar	Alcoholism
Tiryakiler	Tobacco addiction

 

C.    Sleep disorders

 

Kabus	The state of fear during sleep; nightmares.
Seher Subati	Drowsiness and sleeping with the desire to sleep deeply losing consciousness. The person with seher şubatı cannot fall sleep, and he wakes up again and talks nonsense. Subat-i-şehri was the opposite condition of oversleeping.
Ilet-i seher	Lack of sleep. Not being able to sleep at night. Insomnia.
Nevm-i müfrit	Excessive sleepiness. Hypersomnia.

 

D.    Motor disorders

 

Ahze	A condition when motor behaviors and emotions stop suddenly, and the patient is in a state of opisthotonos, i.e., in a sitting or standing position. “Ahze” corresponds to modern-day catalepsy or catatonia. People with this disorder can sit or stay in difficult positions for a long time.
Falig and Teşennuç	Paralysis, hemiplegia, when muscles fail to function. This may also refer to paraplegia. The term tesennuc were symptoms of muscle spasm and cramps that resulted due to humidity, cold, etc.
Intelaq	An involuntary convulsion of the muscles.
Lakve	Facial paralysis. Patients cannot chew properly, spit, or hold their own saliva.
Ra’se	Involuntary movement of hands, shoulders, or head that interferes with normal movements. If this happened in old age, then it was incurable. It could be the equivalent of modern-day Parkinson’s disease.
Sekte	A type of contraction that occurs suddenly resulting in dysfunction of the organs.

 

E.     General disorders

 

Ashk	Obsessive love, separation, and bereavement were also considered illnesses. When separation happens, the victim felt very sad and cried.
Daul-e-Qalb	Mania or excessive energy and movement.
Ihtenakir Rakm	Hysteria observed in women going through menopause.
Enva-e-divanelikler	A term used for a variety of mental illnesses.
Ihtenakir Rahm Sekte	A condition of apoplexy when patients start experiencing dizziness and vertigo. The patients who have difficulty in breathing may be suffocated and unconscious.
Infialat-i nefsaniye	Separate entities of personality disorders.
Levi	The state of immobility from obsessive and binge eating.
Meraki	Hypochondriasis of the digestive system.

 

 

 

Treatment of Mental Illness

 

Preventive medicine

 

The Ottoman medical approach relied primarily on humoral theory, known as "hılt" in Ottoman medical texts. This theory originated in Greek medicine, particularly the works of Hippocrates (460–377 BC) and Galen (AD 130–201), and was widely used in classical Islamic medicine (Kahya, 2006). According to humoral theory, mental illnesses were categorized based on imbalances among four fundamental bodily fluids. In Ottoman hospitals, mental illnesses were treated in a manner similar to physical illnesses (Çınaroğlu, 2024).

During this period, the understanding of mental health was not limited to the absence of illness; it encompassed an overall state of well-being. This holistic perspective included both the treatment of illness and the recognition of preventive medical interventions. Hayatizade Mehmed Emin b. Ahmed (d. 1747), in his translation of Reshid b. Ebi'l Hasan's book *Tedbīr-i ḥıfzu's-sıhhati'l-bedeniyye* (as cited in Akdeniz-Sari, 1984; Sari, 2021), advised individuals to socialize with those who possess wisdom, humanity, and good morals. He also recommended environments such as riversides, flower gardens, and water fountains for relaxation and enjoyment.

During the Ottoman era, palaces, villas, and homes were often built near rivers or the sea, and many residential areas featured flower gardens. Growing flowers was common not only for beauty but also for producing medicinal derivatives and for aromatherapy. Water fountains were integral to the courtyards of mosques and other buildings, reflecting the architectural aesthetics of the period (Akdeniz-Sari, 1984).

In line with traditional Islamic practices, horseback riding was recommended because it engages the whole body and is considered beneficial for both the body and mind. Certain activities were recommended to target specific bodily organs. For example, to improve brain function, memorizing parts of the Quran was recommended to sharpen memory, and engaging in debates or discussions was recommended to enhance cognitive abilities. They used the term kuvvet-i müfekkiresi to denote cognitive strength. Reading the Quran for its rhythmic qualities was recommended to soothe the heart, and so on. Hayatizade, narrating a hadith of Prophet Muhammad, wrote that "when people get angry while standing, they should sit down and when they are angry while sitting, they should lie down" (Akdeniz-Sari, 1984).

 

Music

 

Music served as a common form of treatment for mental illness during the Ottoman era, with its origins dating back to 1700 BC (Ak, 2017). The use of music to treat mental health issues was prevalent even before the Seljuks and Ottomans and can be traced back to Shamanism in Central Asia, which incorporated rituals of music, dance, and magic. However, following the Turks' conversion to Islam, these musical traditions underwent modifications.

Classical Turkish music was used as a therapeutic intervention in various Ottoman hospitals, including the Bayezid II Hospital, from the 9th to the 18th centuries. This approach demonstrated effectiveness in treating mental illness (Öztürk et al., 2017).

Gevrekzade Hasan Efendi (d. 1801) was the last representative of traditional Ottoman medicine. In his treatise, *Er Risaletu'l-Musikiye Mine'd-devai'r-ruhaniyye*, he discussed music therapy and its benefits, particularly the effects of maqāms (classical Ottoman musical melodic modes) on the human mind. It was believed that these maqāms could evoke specific emotional responses.

To identify the most suitable music maqāms for patients, several factors were considered, including the patient's occupation, nationality, zodiac sign, and, notably, their skin complexion. This practice echoed humoral theory's categorizations based on bodily fluids, using skin complexions to describe personality traits through a specific combination of cold, warm, humid, or dry characteristics. For example, the Iraqi maqām was deemed appropriate for individuals with dark skin complexions (associated with a warm and dry disposition), the Isfahani maqām for those with olive skin (linked to a hot and humid disposition), the Rast maqām for blond individuals (characterized by a cold and dry disposition), and the Kûçek maqām for fair-skinned individuals (identified with a cold and humid disposition) (Turabi, 2015).

Ottoman music therapy employs specific musical modes prescribed for particular physiognomies and cultures. It can be classified into several categories: a) treatment of mental illnesses; b) treatment of physical diseases; c) maintaining or restoring harmony within the individual by achieving a healthy balance among body, mind, and emotions through pleasurable experiences; d) guiding emotions, such as eliciting laughter or tears, to prevent negative feelings and promote positive ones; and e) facilitating self-discipline and personal growth, ultimately leading to self-perfection.

Ottoman physicians of the 17th and 18th centuries lacked knowledge of modern physiology and psychology, yet they recognized the interaction between the body and mind. Throughout history, manifestations of the autonomic nervous system have been observed, with literature and illustrations depicting the effects of music on various parts of the body, particularly the heart. Today, we understand that music can possess suggestive, persuasive, or even compelling elements, largely depending on the harmonies present in different sounds. Often, the processes of music and the body's responses interact with one another, and even in the absence of cortical involvement, sound has the ability to stimulate the autonomic nervous system (van Putten, 1992).

In his encyclopedic work “Miftāḥ al-ṭibb wa-minhāj al-ṭullāb” (The Key to Medicine and a Guide for Students), Ibn al-Hindū (d. 1019), a Persian practitioner of Galenic medicine, outlined the essential disciplines physicians should learn to master their craft. Among these, he emphasized music and theology (Nasser & Tibi, 2007). Another author suggested that physicians should be familiar with both the theory and practice of music, particularly the techniques for playing string instruments, as this knowledge could enhance their ability to perform pulse diagnosis (Burgel/Kas, 2016).

Choosing the appropriate maqām was crucial because each maqām influenced patients' moods in distinct ways. Some maqāms made patients laugh, while others helped them fall asleep, soothed their senses, or alleviated their fears. For instance, the maqām Iṣfahān was particularly beneficial for patients with memory issues. The time of day when a maqām was played was also crucial, whether in the morning, at noon, or in the evening (Isgandarova, 2015).

During our visit to the museum and subsequent research in the archives, we discovered that at the Edirne hospital, a group of musicians—including three singers, a ney (flute) player, a violinist, a miskal (pan flute) player, a santur player, a dancer, an Ottoman harp player, and a lute player—performed for mentally ill patients. Certain maqāms, such as Neva, Rast, Dügah, Segah, Çargah, and Suzinak, were considered beneficial for these patients. Other maqāms, such as Zengüle, Buselik, and Rast, were known to improve overall well-being and aid healing for all patients. Specifically, Rast was played for individuals suffering from convulsions and paralysis, while Zirefkend was used for those with back pain. For heart disease, practitioners used Zengüle; headaches were treated with Rehavi; urological issues with Hicaz; and malaria with Uşşak.

Evliya Chelebi also reported that in Edirne, Sultan Bayazid II established the state hospital in 1488, where sound and music therapy were regularly prescribed to treat various illnesses, particularly mental health issues. On different days of the week, the hospital's music therapy team performed for the patients. Doctors, trained to understand the effects of music on human health, observed how various maqāms influenced heart rates and determined which melodies were suitable for treating specific ailments.

It was widely accepted that the maqām Isfahan helped patients with memory problems, while Rehavi was beneficial for treating anxiety, and Kuchi was effective in alleviating depressive thoughts and dysthymia. Chelebi also noted that another notable Ottoman ruler, Bayezid Veli, founded his own charity hospital and appointed ten musicians who performed for patients at least three times per week, playing instruments such as the ney and string instruments such as the santur, keman, çengi, and ud. Chelebi claimed that patients particularly benefited from various maqams, especially Zengüle and Buselik (Isgandarova, 2015).

 

Occupational Involvement

 

It was believed that work could help alleviate grief and sadness. Ibn Serif, the author of a traditional medicine book called *Yadigar*, lived in Anatolia during the 15th century. He recommended that patients try something new and unfamiliar, as this would stimulate positive emotions and empower them to take charge of their behavior. At the time, there was significant emphasis on traveling to new places, as novel experiences could distract people from their thoughts and relieve their stress.

 

Herbs and Medications

 

Herbal remedies played a crucial role in Ottoman medical practice, drawing on Greek, Persian, and Indian sources (Kahya, 2006). Ottoman physicians, known as "hakims," used a wide range of plant-based treatments, believing these remedies could restore the balance of the body's humors and promote good mental health. In her article, Elmallwany (2022) discusses the use of herbal remedies in Ottoman mental health care, particularly phlegm-reducing agents for patients suffering from depression and anxiety. These treatments often included herbs and substances such as saffron, roses, and violet flowers. The remedies were typically prepared as syrups, teas, or tablets and administered to patients to address mental health conditions (Gorji & Ghadiri, 2002).

Pharmacology in the Ottoman Empire was a well-developed field, as evidenced by the use of works by scholars such as Dioscorides and Galen. Their texts were translated and studied alongside Islamic medical literature. Dioscorides' "Materia Medica" was an essential reference for Ottoman physicians in identifying and utilizing medicinal plants. Pharmacies, often associated with hospitals, dispensed these herbal remedies, prepared according to complex recipes that included minerals and animal products. These remedies were used to treat a variety of mental health conditions, ranging from depression and anxiety to more severe psychoses.

Salih bin Nasrullah (d. 1669) recommended cold beverages, apple and floral syrups (e.g., rose or lemon), and cold, soothing foods as part of treating anger. He also advised engaging in enjoyable activities, such as listening to relaxing music, sharing humorous stories and comics, and maintaining polite conversations. Moreover, he emphasized the importance of spending time with caring friends and participating in social engagements to help alleviate anger. Similarly, Ibn-e-Sharif (2003) recommended cold syrups, offering apologies, enjoying comics and games, sharing jokes, and socializing as effective methods for managing anger.

A significant book by Shefer-Mossensohn (2009) examines medical cures in the Ottoman era, exploring their underlying causes, the concept of the integrative body, and the role of religion as medicine. This work is a valuable resource for research. Additionally, an article by Al-Rawi and Fetters (2012) discusses traditional Arabic and Islamic medicine, which was also practiced by the Ottomans. This article is a useful resource for clinicians and researchers interested in the topic.

The treatment of individuals with mental illness was characterized by tolerance and compassion, reflecting Islamic traditions. Patients were encouraged to recognize and appreciate the positive aspects of their lives and the supportive people around them. They were informed about the opportunities, freedoms, and choices available to them, with an emphasis on responsibilities and consequences in this life and the hereafter. In challenging situations, patients were guided to focus on their ethics, manage their thoughts, and seek enlightenment. Although extra care was generally provided for those with mental illnesses, some reports indicate that punitive measures were implemented in a few state hospitals during the later stages of the Ottoman era (Öztürk & Volcan, 1971).

 

Legal Issues of the Mentally Ill

 

Sari (2016) notes that the Ottoman courts resembled modern courts, with judges, attorneys, witnesses, plaintiffs, and defendants, and a rich vocabulary for describing mental illnesses and related procedures. The terms were derived from Quranic descriptions of human capabilities, and the legal framework was primarily based on Shariah law.

Mental incompetence was defined as the inability to reason. The term "akl" referred to the ability to discern right from wrong, while "idrak" described a person's capacity for comprehension and perception. The phrase "yarım akıllı" referred to individuals with mental challenges. Only those deemed mentally intact were held accountable for their actions and faced consequences for breaking the law (Uzunpotasi, 2007).

Mental illnesses were categorized as either chronic (cünün-i mutbik) or temporary (cünun-i gayr-i mutbık), with the belief that individuals with mental illnesses could be fully cured. The term used for such individuals was "cünun-i mufik" (Dönmez, 1993).

Diagnosing "madness" involved observing the patient's behavior, speaking with those close to them, and collecting testimony from others. Regardless of the context, a physician's report was required for a formal diagnosis of any mental illness. Additionally, patients could assert a claim of mental illness to receive treatment.

During this period, if a person with mental illness disrupted community harmony, others could petition the court to have that individual hospitalized. Larger cities had hospitals and care centers for those unable to care for themselves, including individuals with mental challenges. In some instances, adult children or siblings could seek guardianship through the court, allowing them to provide care and treatment for their ill relatives at home. In all cases, physician expertise and approval were required. It is believed that medical professionals of that era were well trained and knowledgeable about mental health issues, and their services were both sought after and respected. Notably, Ottoman rules and regulations were flexible and compassionate, with each case evaluated individually based on the severity of the illness, specific needs, and treatment options (Bilir & Artvinli, 2021).

A review of centuries-old court records shows that courts acted in patients’ best interests, guided by Islamic principles of charity and the moral imperatives concerning the rights of individuals with mental health conditions (Sieben & Yildirur, 2020). Patients' rights related to heritage, property, marriage, and divorce were referred to as hak ehliyeti and were protected by the court (Shefer-Mossensohn, 2010). If patients were unable to manage their estate, the court appointed a guardian, known as a veli, to assist them. This guardian was required to be of mature age, mentally healthy, functional, and willing to act on behalf of the mentally ill person (Bardakoğlu, 2013). Mentally incapacitated individuals were not held responsible for their actions and therefore did not incur criminal liability. Guardians were held accountable for any damage caused by individuals with mental illness, and restitution for such damage was paid from the patient's own funds (Bardakoğlu, 1994). Misuse or misconduct by guardians was not tolerated; in such cases, judges could nullify the guardianship (Bardakoğlu, 2013). According to Islamic law (Sharia), business agreements involving individuals deemed insane were considered invalid. However, guardians were permitted to sign documents on the patient’s behalf. Additionally, if one partner in a marriage was unaware of the other partner's mental illness, the marriage could be deemed null and void.

Significant guardianship cases were documented. In one instance, a trustee was appointed to manage a patient's estate. Additionally, a son who served as both guardian and caretaker for his mentally ill mother was granted financial assistance from her estate. Records indicate that in some cases, more than one judge was involved, with documents signed and sealed by as many as five judges (Acartürk, 2006).

It was also common for Christian citizens to seek guardianship or other legal matters concerning their mentally ill relatives in Muslim courts. Historical records reveal that Christians, Armenians, Greeks, and Turks used the same hospitals and healthcare facilities until the mid-19th century. Only after the 1850s did these minority groups begin establishing their own hospitals (Shefer-Mossensohn, 2010). During this period, Christians, Muslims, and Jews were granted equal rights and opportunities to access public health systems. Moreover, minority religious groups were allowed to practice their beliefs freely and to enjoy religious services and the rights of citizenship.

Another record indicates that during the evaluation and assessment process, experts considered an individual's sanity "at the time of the offense," as supported by expert opinions. Some court cases are documented as being signed by notable community figures, such as professors, sheikhs, and religious scholars (Acartürk, 2006). For instance, in one case in Konya, a junior army officer who had become mentally ill was serving time in prison but was released after community dignitaries filed an application (Gürbüz, 2009). In all circumstances, the primary principle for treating physicians was to "do no harm" to the patient. Physicians were prohibited from using patients as experimental subjects and were advised to prioritize the healing power of nature (Sari, 1977).

 

Conclusions

 

The hospitals and welfare organizations established by the early Ottomans were remarkable for their comprehensive services. Even in the 15th century, most hospitals in Turkey also served as medical schools, using a range of texts, including 16 works by Ibn Sina, to educate and train medical students. Many services recognized in modern healthcare trace back to the treatment and care provided in Ottoman-era hospitals, which emphasized holistic approaches grounded in the mind-body connection.

Sufi houses also provided spiritual and psychological treatment for psychiatric patients, supported by religious practices. Ottoman physicians developed a classification system for mental illness that included many of the psychiatric diagnoses we recognize today. They prioritized preventive medicine, music therapy, occupational therapy, and patients’ legal rights in their treatment approaches.

Looking ahead, the legacy of mental healthcare in the Ottoman era underscores the need to further explore treatments used across diverse populations, traditional healing practices that remain popular in contemporary care models, and the development of equitable mental health services to better serve diverse communities.

 

 

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