Introduction

We’ve gotten quite far in terms of mental health awareness and treatment today. We know a lot more about the causes of conditions like depression and anxiety, and we have developed highly effective treatment methods—such as cognitive behavioral therapy (CBT) and various forms of medication. But what if I told you there was a Persian Muslim scholar and philosopher who seemed to figure out many of these concepts almost a thousand years before the rest of us did?

This was a man whose writings appear so far ahead of their time that he undeniably deserves to be more widely considered in the history of medicine and mental health. Well, such a person actually existed, and today, we are going to explore his remarkable life and work. Please refer to last section for his introduction.

Sustenance for the Body and the Soul

There is one specific work of his that is incredibly fascinating: a book titled Masalih al-Abdan wa al-Anfus (Sustenance for the Body and the Soul). As the title suggests, it is a 9th-century medical text, but one that is staggeringly ahead of its time. The work is divided into two sections.

The first (and by far the largest) part deals with the sustenance of the body, focusing on physical medicine in the classical sense. While historically interesting, it is firmly rooted in the Galenic Greek medicine that was standard at the time—which we now know is largely outdated and scientifically incorrect. Therefore, the first half isn't particularly helpful for modern medical practice, though it does contain some universally relevant preventative advice, like the importance of adjusting your diet and exercising to avoid getting sick.

It's important to remember that the Islamic world at this time was intellectually vibrant. Through the translation movement—spearheaded by scholars like al-Balkhi's teacher, Al-Kindi—medical and philosophical works from Greek, Indian, and Persian sources were being translated (often via Syriac) into Arabic and incorporated into a new Islamic intellectual framework. Al-Balkhi was right in the middle of this.

But it is in the second, much shorter part of the book where things get truly groundbreaking. This section is dedicated to the sustenance of the soul—what we today would call mental or psychological health.

Recognizing the Mind-Body Connection

Talking about mental health wasn't entirely new back then, but the way al-Balkhi dedicated an exclusive section to it, how he connected it with physical health, and the specific clinical advice he gave was virtually unheard of. He even seemed aware of his own originality, writing in the introduction:

"As for our section on the sustenance of the soul, we do not know of anyone before us that has written on the subject and explained its contents according to the needs of the reader."

He noted that regular physicians typically ignored this subject because it didn't align with their traditional physical remedies like bloodletting or medicine. However, he argued that adding psychological sustenance to physical sustenance was an absolute necessity:

"Man's stamina is a combination of both his body and soul, and one cannot imagine that he can exist without this dual combination... Their combination gives to man his ability to respond to threatening issues and painful symptoms."

Here, he significantly links the health of the soul with the health of the body. He correctly identifies that if the body is ill, a person will often lose much of their mental function. Conversely, if one is suffering mentally, it prevents the enjoyment of bodily pleasures, causes fatigue, and can even lead to physical sickness. He explicitly states, "Psychological pain may lead to bodily illness." While psychosomatic symptoms are obvious to us today, they certainly weren't back then, when there was a much stricter separation drawn between body and soul.

Categorizing Mental Ailments

Al-Balkhi goes on to categorize the main psychological ailments into four major groups:

  1. Anger
  2. Fear and Panic (Panic being the extreme form of fear)
  3. Depression and Sadness
  4. Obsessive/Intrusive Thoughts (Essentially OCD, which he refers to using Quranic terminology as "whisperings" or waswas)

Interestingly, he theorizes that all negative mental ailments have a singular root cause: anxiety (which he refers to in Arabic). He argues that even anger only arises after anxiety over a situation takes hold, and the same goes for depression. Whether you agree with anxiety being the root of all these states is up to you, but his classification framework is fascinating. Much of what we call general anxiety today would likely fall under his "fear and panic" category.

Anticipating Clinical Depression

In his section on depression, al-Balkhi seems to anticipate psychiatric discoveries that wouldn't become the global norm for another thousand years. He categorizes depression into two distinct types.

The first is a reactionary response to external life events—like losing a job, losing wealth, or the death of a beloved relative. This is a natural, expected reaction to distress. We all experience this kind of sadness.

The second type, however, has no obvious external cause. He writes:

"It’s a sudden distress and gloom that descends over the afflicted person preventing him most of the time from exuberance of activity and the enjoyment of the usual pleasures of this world. The person afflicted is generally unaware of any clear reason for his dejection."

Al-Balkhi had essentially discovered what we now call clinical depression or major depressive disorder. He recognized that this type of depression can just descend upon a person, rendering them unable to get out of bed or find motivation, with no external trigger to blame. For many people, this becomes a chronic, lifelong struggle.

He also correctly hypothesized that this second type has physical, biological roots (what we now know as genetic or chemical imbalances in the brain). While he incorrectly relied on outdated Galenic science to explain the biology (blaming "impurity" and "coolness" of the blood), his fundamental premise was spot on: the causes are bodily, and therefore the treatment must be both physical and psychological. Just as modern psychiatry combines medication and therapy, al-Balkhi recommended treating the body while simultaneously using "gentle, encouraging talk" and listening to music to bring warmth to a gloomy soul.

The Argument for Talk Therapy

A recurring theme in the text is the use of both internal and external treatments. When treating mental illness, the primary external method al-Balkhi recommends boils down to what we now call talk therapy or counseling.

He emphasizes the importance of having therapeutic discussions with a trusted friend, loved one, or counselor. I absolutely love the section where he explains why we must rely on others rather than trying to fix ourselves internally when we are suffering mentally:

"The benefit one obtains externally from advice and counseling is more useful than a person's internal thoughts. This is due to two reasons. First, man in general accepts from others what he does not accept from himself. His reasoning and thought are intermixed with his passions, each implicated by the other. Second, one suffering painful psychological symptoms is so occupied and overpowered by them that he cannot clearly think how to overcome them. He needs others to show him the way to recovery."

We can all agree there is deep truth to this. We are much more receptive when someone else gives us perspective, as our own judgment is too clouded by our pain and emotions.

He also offers internal treatment methods. One simple strategy he suggests is to "save" positive thoughts when we are feeling well—metaphorically keeping them in our pockets—so we can pull them out and use them to comfort ourselves when we feel bad.

Pioneering Cognitive Behavioral Therapy (CBT) and Exposure Therapy

Perhaps the most mind-blowing part of al-Balkhi's work is found in his section on treating fear and panic. His advice is essentially exactly what we know today as Cognitive Behavioral Therapy (CBT), and specifically its core component: Exposure Therapy.

Modern CBT does not seek to dig up deep childhood trauma like traditional psychoanalysis. Instead, it looks at behavioral patterns, self-talk, and the avoidance tactics we use to alleviate discomfort. For example, if you have a phobia of elevators, your anxiety makes you avoid them. But by avoiding the elevator, you are reaffirming to your brain that the elevator is genuinely dangerous, trapping you in a vicious cycle of fear.

Exposure therapy forces you to break that loop under controlled circumstances. You ride the elevator for one stop, then two stops, teaching your nervous system that the threat isn't real. By breaking the behavioral pattern, you free yourself.

Al-Balkhi writes almost the exact same thing in the 9th century. He notes that the expectation of a threat is almost always worse than the reality of the threat itself. He uses a brilliant analogy:

"Some scholars have likened the things that frighten people to a thick ground fog in a cold country. An uninformed person, like an Arab bedouin living in a hot desert, would think it to be a solid black object without any outlets and that it can trap people inside it. However, if daring to enter, he would find it to be simply moist air that he can breathe."

He concludes that the best way to tranquilize fear and panic is to force yourself to face it:

"Force oneself to repeatedly expose one's hearing and sight to noxious things, though disliking the practice, until one's senses are familiarized by them. In tolerating the pain of this exercise, one is in fact training oneself like the riding of an animal forced by the whip to move again and again near the thing that it is scared of until it becomes used to it and loses its fear."

This description could be lifted word-for-word from a modern CBT manual. While the ancient Stoics also laid philosophical groundwork for CBT, I have never seen a premodern source so clearly and clinically express the absolute essence of exposure therapy.

A Profound Understanding of OCD (Obsessive-Compulsive Disorder)

On a personal level, I am most fascinated by his final section dedicated to obsessive and intrusive thoughts. Al-Balkhi uses the Quranic language of waswas (the "whisperings of the soul," famously referenced in Surah An-Nas regarding the devil whispering into the hearts of men). However, his explanation is completely devoid of simple supernatural or theistic dismissals. Instead, he provides a highly nuanced clinical description of Obsessive-Compulsive Disorder (OCD).

Today, people use the term OCD liberally to describe someone who likes a tidy house. But actual OCD is an incredibly debilitating mental handicap. While some OCD takes external forms (like compulsively washing hands or checking locks), it can also be entirely internal. This is known as "Pure O" (Purely Obsessional) OCD, where a person gets trapped in severe mental spirals accompanied by intense anxiety.

As someone who personally struggles with OCD—particularly the Pure O kind—I am entirely convinced that al-Balkhi had personal experience with this condition. He describes it with a presence and accuracy that most people even today cannot articulate. My theory is that his documented shyness and reserved nature were directly tied to these internal mental health struggles.

He describes the condition perfectly:

"Its persistence in the human heart or mind causes repetitive repulsive or immoral thoughts that result in apprehension and unhappiness to the extent that the one obsessed may lose his ability to enjoy the pleasures of the body and the soul."

He notes that while everyone has occasional uncomfortable intrusive thoughts, for some, the rumination "interferes with everyday chores and becomes strongly debilitating." Furthermore, he explains a specific, terrifying aspect of OCD that is very hard to convey to non-sufferers: the way irrational thoughts trick your nervous system into feeling that an imagined disaster is imminent, or has already happened.

"As the symptom intensifies, the sickened soul would give the person afflicted a strong feeling of the distant event in space and time being imminent or about to happen... The sufferer imagines impending danger and threatening occurrences in his wakeful inner whispers while the dreamer sees these frightening incidents in his sleep."

For anyone with OCD, this hits incredibly close to home.

Treating and Accepting Intrusive Thoughts

How does he suggest treating these obsessive thoughts? He reiterates the value of talk therapy and exposure therapy. By exposing ourselves to the uncomfortable thoughts without performing compulsions, the perceived danger of the thought decreases.

He also gives some highly practical advice: Don't be alone too much. Hang out with people, converse (even about your obsessions), listen to music, and be intimate with your partner. Keep a job or a profession to occupy your mind. While this might sound simple, doing things you value despite the presence of anxiety teaches your brain that the anxiety isn't dangerous, which facilitates healing. It proves to you that your life isn't "ruined" by your thoughts.

Finally, as a devout Muslim, he offers theistic strategies like trusting in God's plan. But even if you are an atheist or non-theist, the core of his argument remains highly effective because it is essentially an argument for radical acceptance. The anxiety of OCD often stems from our desperate resistance and attempts to control our thoughts. Acceptance removes that friction.

Al-Balkhi urges the sufferer to accept that their OCD is simply a biological reality—how their brain is wired. Getting a diagnosis and understanding the mechanism is immensely comforting. He writes:

"The sufferer would come to the conclusion that his symptom... was actually rooted in his natural disposition and temperament. He should then convince himself that any predisposed psychological disorder should not cause him to be disturbed or scared since he knows of its origin... In this he should be like the one suffering from a chronic physical bodily complaint. Such a person quickly learns to live with it and familiarizes himself with its pains."

By accepting that these thoughts won't endanger your life, you can learn to tolerate them and live happily alongside them.

Who Was Abu Zayd al-Balkhi?

Abu Zayd al-Balkhi was a polymath and brilliant scholar who lived between the 9th and early 10th centuries, right in the middle of what has often been called the Golden Age of Islam, when the Abbasid Caliphate was at the height of its power. He was born around 850 CE in the region of Balkh (in modern-day Afghanistan) and spent much of his life there.

Sadly, we don't know all that much about his personal life outside of a few mentions in later biographical sources, but some fascinating details have emerged. He was an endlessly curious and intelligent man who mastered a vast array of fields. In his own day, his main claim to fame was geography—he even spearheaded the "Balkhi school" of geography and mapmaking. However, his expertise also spanned medicine, Arabic grammar, philosophy, Islamic theology, literature, poetry, mathematics, astronomy, astrology, and much more. He is said to have composed over 60 works on various topics and was famed for his great eloquence.

At some point, al-Balkhi traveled to Baghdad—the intellectual center of the Islamic world at the time—and studied with the great Arab Muslim philosopher Al-Kindi. It was likely Al-Kindi who taught him many of the philosophical topics he would eventually master himself. Eventually, he returned home to Balkh, working as a scribe while composing many of his philosophical texts.

Interestingly, the few biographical accounts we possess describe him as quite reserved and shy. He kept to himself and didn't socialize much. This might explain why we know so little about his day-to-day life, but I would argue it is also a key reason why he had such a nuanced, profound understanding of mental health and internal psychological struggles. It is highly likely that he, like many of us, personally experienced these difficult mental states.


Credit: Let's Talk Religion: A 9th-Century Cure for Anxiety and Depression