A common story goes like this: in the Middle Ages, Muslim doctors treated madness as an illness in fine hospitals, while Europeans blamed demons, locked people in cages, or burned them as witches. The records examined here do not support that simple division. They describe medical writing, religious explanations, family responsibilities and institutional confinement.
What both sides inherited
Doctors in both regions drew on Greek medicine, especially Galen. In that tradition, madness was a problem of the brain, caused by an imbalance of the body’s humors, and the goal of treatment was to restore balance. Historian Michael Dols argues that this bodily approach helped create the idea of “mental illness” itself (Dols 1987, p. 4) (Strongly supported as his reading).
Arabic translations of Greek books were one route through which Greek learning reached Latin Europe. Near the end of the 11th century in Italy, Constantine the African translated Arabic medical works into Latin, and he tried to hide their Arabic origin. In the 12th century, translators in Toledo turned many more Arabic works into Latin (Hasse, SEP §1) (Documented).
The Islamic world: hospitals, doctors, and chains
Hospitals. Cities across the Islamic world built hospitals, called bīmāristān or māristān. Dols thinks it is “probable” that the first major hospitals in Baghdad, in the 800s, treated the insane. One was “certainly founded” by Ibn Ṭūlūn in Egypt in 872–73 and seems to have provided for them. These early provisions remain tentative in his account (Dols, p. 3) (Plausible).
In 1183 the traveler Ibn Jubayr described a Cairo hospital with a building of rooms with iron windows for confining the insane, and staff who checked on them daily (Dols, p. 3). In Damascus, he saw a system of treatment for confined “lunatics,” who were “bound in chains” (Dols, p. 3). Dols quotes Leo Africanus’s account of the hospital in Fez, which reports iron chains and a keeper with a whip (Dols, p. 6). Care and coercion sat side by side.
Doctors. Abū Bakr al-Rāzī (865–925) was one of the great physicians of the Islamic world. His biographers say he ran hospitals in Rayy, near modern Tehran, and in Baghdad. He also wrote The Spiritual Medicine, a book of ethical advice meant as treatment for the soul, alongside his medicine for the body (Adamson, SEP “Abu Bakr al-Razi,” §1). Ibn Sīnā (Avicenna, born around 970 or a little earlier, died 1037) wrote the Canon of Medicine (Gutas, SEP). Dols reports that Ibn Sīnā was “highly sceptical of demonology” and explained a severe form of madness as burnt bile reaching the brain (Dols, p. 5).
Religion too. Dols writes that for many Muslims, madness (junūn) was literally possession by jinn. His account also describes religious responses, including exorcism (Dols, p. 10). From the 11th century, Sufi saints and their tombs were also sought for healing (Dols, p. 11). Most care happened at home: Dols says families had always carried the main responsibility, and hospitals mostly served poor people with nowhere else to go (Dols, p. 11) (Strongly supported).
Medieval Europe: more than demons
Bethlem. London’s Bethlem, later “Bedlam,” is often called an early madhouse. It began in 1247, when the sheriff Simon fitz Mary gave land for a priory to receive the poor and visitors from the church of Bethlehem. Historian Nicholas Vincent says it was intended “not as a mad-house.” The first record of mad patients there is a 1403 report of “six insane men and three others who were sick” (Bethlem Museum of the Mind) (Documented).
A different kind of record. Books by physicians are only one source. Surviving records can also preserve how people described their own distress. For a later English example, historian Jonathan Willis examined roughly fifty letters sent to Elizabethan authorities around 1570–1600. They were subsequently gathered and labeled in ways that called their writers or contents “mad.” He argues that these archival labels should not be treated as straightforward medical diagnoses (Willis 2025, pp. 3–12).
This is an early modern example, not evidence that every medieval community behaved the same way. It shows why the maker, date and purpose of a record matter. A label can tell us about the person who applied it as well as the person it describes.
Shared work, not a single hero
A later historical article reports that Philippe Pinel credited Jean-Baptiste Pussin with removing patients’ chains and acknowledged Madame Pussin’s contribution. This supports an account of shared work, not the familiar picture of one doctor acting alone (Schuster, Hoertel and Limosin, 2011).
A later institution: the York Retreat
In England, the Quaker William Tuke (1732–1822) led the founding of the York Retreat (RCPsych), which opened in 1796 (Borthwick Institute). This is a later development, outside the medieval period.
Myth check
- “The first psychiatric hospital was in Baghdad” (or Damascus, or Bethlem). Firsts depend on how you define a hospital, and the records are patchy. This page doesn’t name a first (Unknown).
- “The Islamic world was centuries ahead.” Hospitals with space for the mad, and doctors writing about madness, are well documented. But “ahead” hides the chains, the exorcisms, and the families doing most of the work. It’s a ranking, not a finding.
- “Medieval Europe gave no treatment.” Bethlem’s records document an institution with changing functions. One institution cannot stand for all of Europe; this page makes no claim about treatment results.
How we know
What survives. Medical books (which say what doctors should do), travelers’ reports, chronicles, saints’ lives, legal records. Dols warns that medical texts are “prescriptive rather than descriptive” (Dols, p. 1).
Whose voices are missing. The patients. Leo Africanus reports that people in the Fez hospital shouted to passersby that they were held unjustly and treated cruelly (Dols, p. 6), but we hear them only through him.
How later readers used it. Both “golden age” and “dark ages” stories were built later, often to make a point about modern psychiatry.
Then vs. now
Then: In both regions, a person called mad might see a doctor, a holy person, a family member, or a keeper with chains. The examples here do not establish how often any experience occurred.
Now: Medicine places thoughts and feelings in the brain (MedlinePlus). This page describes old practices; it doesn’t recommend any of them.