Joveini: A Persian psychiatrist’s view and management of the insane

To the Editor

‘…I’ve treated many of these patients and they were successfully healed using my own managements to the extent that I am called “Bejeshk-e-Divanehgan” [Physician of the Insane]…’ (Matini, 1965).

Abubakr Rabi-ibn Ahmad Akhawayni Bukhari (Joveini in Latin) made this statement based on his knowledge and experience in managing patients with psychiatric problems. Yarmohammadi et al. (2013) describe Joveini as a Persian physician best known for his works in psychiatry.

Khodadoust et al. (2013) state that ‘The first and most prominent Persian medical compendium compiled in the 10th century AD by Joveini explicitly explains the use of psychiatric terminology and methods of management in the book ‘Hidayat al-Muta‵allemin Fi al-Tibb’ (A Guide for Medical Students). This is a main source of medieval knowledge of today’s modern psychiatry and was based on Joveini’s life (Matini, 1965). Early discoveries described in the book focus on issues related to “Mania” (mania), “Kabus” (nightmare) and “Ghotrab” (dementia) etc., and correspond to the present method of diagnosis using DSM-5 for known neuropsychiatric disorders, thus reinforcing the early contribution of Joveini’s work to the field of psychiatry (Matini, 1965; Yarmohammadi et al., 2013).

Joveini used symptoms such as loss of consciousness and confusion with the presence of foam in the mouth to distinguish between episodes of seizure and conversion disorder. Joveini compared normal and abnormal personality characteristics. He described people with some types of personality disorders, those who are aggressive, cruel, unjust and who break the law tend to meet the criteria of current antisocial personality disorder as outlined in DSM-5. Individuals who are denigrated and submissive might today be considered to have a dependent personality disorder. Individuals who are suspicious of others display a paranoid personality disorder. Joveini stated that these conditions were personality types, not diseases. He believed that the brain controls an individual’s personality and can be modified through behavioral therapy. Joveini discussed manifestations and ways to manage patients with mania and melancholia and claimed that his methods for the treatment of melancholia were more effective than those of Rhazes (Matini, 1965).

Joveini used creative and innovative skills in his approach to psychiatric problems, individuals suffering from any form of insanity with suppressed appetite were usually fed using the cow’s horn (with a similar function to an orogastric tube which is used today) (Matini, 1965).

Joveini was one of the first physicians to discover the use of psychiatric methodology in his work with the mentally insane. He is the primary link between Rhazes and Avicenna in the history of Persian medicine.