Drs. Sabuncuoglu and Ismail Reply

To The Editor: We appreciate the contribution of Drs. Higgins and Kose in response to our recent article that emphasized the importance of discussion on the historical presence or absence of psychiatric disorders in order to attain a thorough understanding of those disorders. First, we would like to note that because of the space limitations of the section, we were able to report only the most relevant points to spotlight the role of the physician in the history of psychiatry.

The absence of schizophrenia in Serefeddin Sabuncuoglu’s textbook may simply be related to the fact that his treatment techniques could only be applied to patients who could consent, cooperate, and comply with procedure. Schizophrenia patients are, and probably were then, very unlikely to fall within this group, and there was no room for involuntary treatment in Sabuncuoglu’s approach as revealed by the text. The illustrations also provide ample evidence that the appearance of the psychiatric patient did not differ from that of surgical patients with good self-care. The psychiatric patient was neither caged nor chained, and no assistance was required for the procedure. Clearly, the patient was very much like today’s day- or outpatient clinic patient under voluntary treatment.

So, what would happen to people who displayed symptoms of schizophrenia? Mental illness is thought to be dependent on social attitudes and beliefs that consequently determine the care and treatment that will be provided. According to Dols (1) , the model of medical pluralism appears to be a helpful framework in understanding the complex and varying medical practices used to describe and treat unusual behavior throughout history. For those patients who were aggressive and destructive, there was a well-established tradition of special provision for the insane in Islamic medicine, and, until modern times, asylums were built throughout the Islamic world (1) . In addition, we are aware of the existence of “hospital-villages” that functioned as community-based psychosocial rehabilitation centers for the mentally ill in Anatolia during the Medieval Ages. It is very likely that these facilities accommodated mostly patients with psychotic symptoms. Early descriptions of divine madness by Socrates seem to correspond with what was later called the wise fool, the holy fool, the lover, and the poet (1) . Without mentioning either a diagnosis or a treatment, therefore avoiding stigmatizing terms, these descriptions were featured as acceptable solutions to a complex problem.

As a final note, we would like to mention the significance of the rationale of ancient physicians. In order to avoid unnecessary and potentially harmful medical practices, Sabuncuoglu suggested the following advise to junior doctors: “You should not intervene, when the outcome is unpredictable.” We feel that schizophrenia is one of those conditions to which Sabuncuoglu’s principle is applicable, during his time as well as today.