In the 9th century, the physician al-Balkhi recognised that the balance between body and soul is necessary to enjoy good health, while an imbalance between the two can cause illness. He also introduced the concepts of mental health and the use of cognitive therapy to treat anxiety and depression.


Dr Jesús de la Gándara, head of the psychiatry service at the University Hospital of Burgos, considers that the pandemic will have a considerable psychosocial impact. More than three months of confinement have left consequences in our mental health. A recent study has shown that around a 35% of the Spanish population has presented symptoms and it is at risk of suffering anxiety and depression. The consequences of post-confinement, probably more long-lasting than the virus itself, will have to be addressed by medical doctors and psychologists.

There is a general perception that the discipline of psychology together with mental health treatments began in Europe in the 19th century and cognitive therapy began in the mid-20th century. However, mental illnesses were known and treated as early as classical Greece. In the Islamic context, from the 8th century onwards, there was a concern to understand the human mind and hospitals were created to treat patients with mental disorders. But it is in the 9th century that the physician al-Balkhi normalized mental illness by dismissing taboos and stigma, introduced the concepts of mental health and mental hygiene and pioneered the use of cognitive therapy to treat anxiety and depression.

Ahmed ibn Sahl al-Balkhi (850-934), considered by some authors to be possibly Ismaili, was born in Sijistan, near Balk (now Afghanistan). He was a disciple of the philosopher al-Kindi and worked for al-Husayn b. Ali al-Marwazi, a powerful emir of the Samanid dynasty, who converted to Ismailism and was appointed as the head of the da'is of northeast Persia (Daftary 2007: 111,113, 116; Walker 1993: 34).

Al-Balkhi, a polymath scholar – in disciplines such as philosophy, grammar, geography, mathematics, medicine, and psychology – is known mostly for his work Masalih al-Abdan wa al-Anfus (Sustenance of Bodies and Souls)(1)  where he considered that the balance between body and soul is necessary to enjoy good health, while an imbalance between the two can cause illness. When the body gets sick, the mind loses much of its cognitive ability and fails to enjoy the pleasures of life and when the soul gets sick, the body may develop a physical illness. Al-Balkhi is believed to have been the first to diagnose that mental illness can have psychological and physiological causes and he was the first to typify four types of emotional disorders: 1) fear and anxiety, 2) anger and aggression, 3) sadness and depression, and 4) obsessions. As well as two types of depression: 1) depression originating from within the human being, caused by fear of loss and failure, which must be treated psychologically through conversations and advice in order to generate thoughts that help to undo the depressive condition. 2) clinic depression, caused by external factors – that generate pain and anguish and prevent physical activities or enjoy life – which must be treated through medicine.

Al-Balkhi was a pioneer of cognitive therapy for each of these disorders in order to restore body and mind to their natural state. He noted the importance of having a suitable house and of taking active care of the body and of the soul. His recommendations included:

To enjoy beauty; to monitor nutrition with a healthy diet, drinking plenty of water, sleeping well, breathing fresh air and going to walks into nature; to groom the body with relaxing massages, perfumes and oils and with physical activity, protecting it from extreme temperatures, having an active sex life and listening to music; to avoid the inner monologue of catastrophic thoughts and obsessive thoughts, focusing on creating a repository of healthy thoughts to counteract the unhealthy ones; to accept that problems are part of live, using emotions to neutralize them, interacting with other human beings, staying active avoiding laziness, boredom and being unemployed, contributing to the well-being of others, talking about problems with friends, family and the doctor, listening and accepting their help.

His approach was both preventive and therapeutic, which shows a deep understanding of the human condition, its emotional states and the need for appropriate treatments. Al-Balkhi also included references to the Qu´ran, the sayings of the Prophet Muhammad, and the value of faith in God. Al-Balkhi's work has long been ignored by western medicine. Although the eight chapters of his book seem to be taken from a current text of cognitive psychotherapy, it has taken more than ten centuries to get to be appreciated.


(1)Terms nafs, sg., anfus pl. have been discussed throughout history; often philosopher and theologians did not reach a consensus about their interpretation, typologies and uses. With regards to al-Balkhi´s context, anfus would correspond to anfus natika or “reasoning souls” of human being, which produce the faculties such as common sense, imagination, memory and reason. In our days it is used as a synonym of the psique o mind. Also, the term nafsaniyyah used by al-Balkhi corresponds to the contemporary notion of the psychological.


  • Badri, M., Abu Zayd al-Balkhi’s Sustenance of the Soul: The Cognitive Behavior Therapy of a Ninth Century Physician, International Institute of Islamic Thought, 2013.
  • Calvery, E.E. and I.R. Netton “Nafs,” in The Encyclopaedia of Islam vol. VII, Brill (1993), pp. 880-883.
  • Deuraseh N. and M. Abu Talib “Mental health in Islamic medical tradition,” in The International Medical Journal 4 (2005), pp: 76-79.
  • Daftary, F., The Ismailis. Their History and Doctrines, Cambridge University Press, 2007, second edition.
  • Walker, P.E., Early philosophical Shiism. The Ismaili Neoplatonism of Abu Ya'qub al-Sijistani, Cambridge University Press, 1993.


About the author

Miriam Ali-de-Unzaga, PhD in social and cultural anthropology from the University of Oxford, GPISH student (cohort 2000), visiting scholar, The Institute of Ismaili Studies.