How the Manisa Darüşşifa was founded, its years as a mental hospital, the accounts of handicrafts and music, and how this history differs from science today.
In the old neighbourhoods of Manisa, right next to the Sultan Mosque, stands a stone building that looks quite ordinary from the outside. Those who step inside, however, find a story roughly five hundred years old. The Manisa Darüşşifa (a historical hospital), built as part of the complex founded in Hafsa Sultan's name, opened its doors to the sick for centuries, and in its final period it became a place where people in mental distress were cared for. Today the building can be visited as a museum of medical history, and it tends to leave visitors with a few questions: Who stayed here, how were they looked after, and how well documented are the accounts of handicrafts, music and the sound of water? In this article we look calmly at what we know, what we do not know, and what lessons this history might carry into the present day.
What Is the Manisa Darüşşifa? A Later Addition to a Complex
In Ottoman cities, large buildings were usually conceived not on their own but as part of a complex (külliye). A mosque, a madrasa, a primary school, a soup kitchen and a bathhouse would complement one another under the roof of the same charitable foundation. The Sultan Mosque complex in Manisa is one such whole.
According to news agencies and the museum's own accounts, construction of the complex was begun in 1522 by Ayşe Hafsa Sultan, the mother of Suleiman the Magnificent. The hospital was added to the complex in 1539. Because Hafsa Sultan died in 1534, the hospital was completed during the reign of her son Suleiman. In other words, the building now known as the "Hafsa Sultan Darüşşifa" is also a trace of a charitable work begun by a mother and continued by her son.
Adding a hospital to the complex shows that the buildings were designed not only for worship and learning but also for the city's sick. Having a place set aside for patients within a charitable institution was part of the period's understanding of social welfare.
Most of this information comes from news agencies and the museum; the accounts are consistent with one another, but for details it is always sounder to consult academic studies. In this article, too, we give the dates "as reported by the sources".
Where Manisa Fits in the Darüşşifa Tradition
The word "darüşşifa" means "house of healing". The same type of institution is also called a "bimarhane", "bimaristan" or "şifahane". Anatolia has surviving examples of this tradition from the Seljuk period: the Gevher Nesibe hospital in Kayseri and the Divriği hospital in Sivas are among the most famous. In the Ottoman period, the hospitals of Amasya, Edirne and Istanbul continued the chain. We describe how these institutions generally worked in more detail in our article what is a darüşşifa.
What these institutions had in common was that they were founded through charitable endowments (vakıf). A benefactor or a member of the dynasty would endow income-generating property, and that income paid the salaries of physicians and attendants and covered food, medicine and cleaning. The service was free of charge. This made the darüşşifa not only a health institution but also a concrete form of the responsibility society took on towards the sick and those who had no one to care for them.
What sets Manisa apart is that, in the later part of its long life, the institution turned mainly towards mental illness. Sources report that the Manisa Darüşşifa operated as a mental hospital for roughly the last two hundred years of its existence. That represents a remarkable continuity in the history of institutions devoted to mental health in Anatolia.
The medicine of the period was based on the theory of the four humours (blood, phlegm, yellow bile and black bile) and temperament, inherited from Hippocrates and Galen. According to this theory, health depended on the balance of fluids in the body, and food, air, sound and surroundings could all affect that balance. Modern medicine has abandoned this theory. Even so, the idea of arranging a patient's surroundings can be read as a historical reflection of what we now call the "care environment".
Handicrafts, Music and the Sound of Water at the Manisa Darüşşifa
The most intriguing thing said about the Manisa Darüşşifa is that people in mental distress were looked after not only with remedies but also with handicrafts, music and the sound of water. It helps to consider these three elements separately:
- Handicrafts: Patients are said to have been kept busy with work they could do with their hands. Seen from today, this meant reducing empty, unstructured time during the day and giving the person a chance to make something.
- Music: It is reported that music was played for patients. For the hospital in Edirne, it is known that Evliya Çelebi wrote of a group of musicians coming three days a week to perform for the patients; a similar practice is mentioned for Manisa, but the details are not documented to the same degree.
- The sound of water: The sound of running water is said to have been part of creating a calm environment.
The shared idea behind these accounts is to create an orderly, calm setting that speaks to the senses of a person in mental distress. This approach is consistent with the outlook of the period. But here we need to draw an important distinction.
Knowing that music was played or handicrafts were made in a historical hospital is a piece of history; claiming that these things cured mental illness is not something the sources we have can support.
From that period there are no records, comparisons or measurements, in today's sense, of what was done for which patient and with what result. It is therefore more accurate to read these practices not as "methods that healed" but as traces showing how people of the time approached mental distress.
The Manisa Darüşşifa Today: A Museum of Medical History
The building now serves as a museum of medical history attached to Manisa Celal Bayar University. The museum features medical instruments of the period and displays that bring to life the layout of the hospital and its approach to care. Visitors have the chance to see the architecture and to imagine the daily life that went on here centuries ago.
A few points are worth keeping in mind as you walk around:
- Separate documents from stories. Do not hesitate to ask which of the information on the panels or in a guide's commentary rests on archival documents and which on oral tradition. Loving history does not stop you from questioning it.
- Do not confuse the language of the past with today's. Old texts may use words such as "divane" or "mecnun" (old Turkish words for madness). These are expressions of their time; today we use more respectful and accurate language when speaking about people who experience mental health difficulties.
- Try to see it through the patients' eyes. What would someone staying here have heard in the morning, how would they have spent the day, how often would their family have visited? These questions turn a tour of a historic building into a human experience.
- Think about your own sources of calm. On your way out you might ask yourself: "Which activities give my day structure and help me settle?"
Imagine a university student visiting the museum for an assignment. In her notebook she writes: "Patients did handicrafts, so even then people seem to have thought that sitting idle was not good for them." This observation is a good example of linking historical information to the present without exaggerating it: it says an idea existed in history, but it does not turn it into a treatment prescription.
From History to the Present: Makam Lists and Scientific Evidence
When you read about the Manisa Darüşşifa or similar institutions, you will often come across online lists claiming "which makam (melodic mode in Turkish classical music) is good for which illness". These lists, which pair the rast makam with paralysis or the buselik makam with headaches, are based on treatises written in, or attributed to, the Ottoman period. There are, however, several important problems: the lists contradict one another from source to source, they rest on the abandoned theory of temperaments, and they have not been tested by scientific methods.
For this reason these lists are interesting as documents of cultural history, but they cannot be used as health advice. Telling a relative with a serious illness to "listen to such-and-such a makam" cannot replace the medical care they need. We discuss this in more detail in our article on the effects of makams on people.
So what do we know today? Modern music therapy is defined as an approach in which a trained practitioner engages in musical interaction with a client within a therapeutic framework; simply listening to recorded music does not fall under this definition. According to a Cochrane review, music therapy added to usual treatment may reduce symptoms of depression in the short term, but the evidence was rated as being of low to moderate certainty. In other words, music and creative activities can be supportive, but they do not replace medication, psychotherapy or medical care.
Handicrafts call for the same balanced thinking. In mental health today, there is an emphasis on how structuring the day with meaningful, regular activities can contribute to mood. When working with depression, for example, gradually bringing small activities that give a sense of enjoyment and achievement back into a person's day can be an important part of therapy. That does not mean the practice of five hundred years ago is "proof" of today's methods; it simply shows that some human intuitions have appeared in similar forms in different eras.
Changing Views of Mental Distress: Care Instead of Shame
One of the most important things institutions like the Manisa Darüşşifa remind us of today is that, even centuries ago, mental distress could be seen as a condition requiring care. Of course, conditions then were very different from now, and it would not be true to say that people with mental illness always lived in good circumstances throughout history. Still, the fact that a foundation's income was set aside for these people shows that society did not entirely exclude them.
Another important change concerns where care takes place. In the past, people with mental illness often stayed in institutions for long periods. Today, the weight of the approach has shifted towards supporting the person, as far as possible, within their own life, keeping their ties with family, work and community. Outpatient appointments, short admissions when necessary and follow-up carried out in the community are all part of this understanding. The long years spent within the walls of the Manisa building also help us notice how profound this change has been.
Part of this change concerns families too. Today, families whose relative is in mental distress do not have to "carry" that person alone; it is possible for both the person who is unwell and the relatives looking after them to receive support separately. Accepting that carers can become exhausted and need to attend to their own needs is one of the important gains of the modern understanding of mental health.
In Turkey today, many people still tend to put off seeking psychological support. Thoughts such as "What will the neighbours say?", "In our family we don't go to psychologists" or "If I pull myself together a bit, it will pass" can delay seeking help for months. In extended families, a relative's mental distress is sometimes brushed aside without being discussed, and sometimes covered up with explanations such as "the evil eye" or "a bout of gloom". Yet mental health, like physical health, is an area that needs attention and effort.
Here, visiting a historic building can unexpectedly open a conversation about the present. If a family leaving the museum says, "So people had these troubles back then too, and others tried to look after them," even that simple sentence can break a little of the silence around mental health difficulties.
When Should You Seek Professional Support?
History shows us that people have always tried, in one way or another, to cope with mental distress. Today we have a body of knowledge that investigates which method helps whom and under what conditions. If you notice any of the following in yourself or someone close to you, it may be helpful to talk to a mental health professional:
- Low mood, lack of motivation or hopelessness lasting more than two weeks
- Marked changes in sleep, appetite or energy levels
- Intense anxiety that disrupts daily tasks, work or school
- Experiences such as hearing voices others do not hear or losing touch with reality
- Changes that those close to you often describe as "you're not yourself"
- Thoughts of self-harm or of ending your life
If the last point applies, call 112 (emergency services) without delay or go to your nearest emergency department.
In psychological support today, creative activities such as drawing, music or handicrafts can play a supportive role alongside evidence-based therapies. In therapy, for example, a person might talk about noticing which activities calm them and deliberately building these into their day. The core work, however, is a structured process focused on the person's thoughts, feelings, behaviours and relationships. In individual therapy, self-care tools of this kind can be explored together with the person's own preferences; where symptoms are severe, an assessment by a psychiatrist also becomes part of the process.
Frequently Asked Questions
When was the Manisa Darüşşifa built?
According to the sources, Hafsa Sultan began construction of the Sultan Mosque complex in 1522. The hospital was added to the complex in 1539. Because Hafsa Sultan died in 1534, the building was completed during the reign of her son, Suleiman the Magnificent.
Why is the Manisa hospital remembered as a mental hospital?
The institution worked for a long time as a general hospital; sources report that for roughly the last two hundred years of its life it functioned mainly as a mental hospital. That is why today it is remembered above all for its care of people with mental illness.
Were patients here cured with music?
It is said that music was played for patients, that they did handicrafts and that the sound of water was used. However, there is no evidence in today's sense that these practices cured illness; they should be read as traces of the period's approach to care.
Can the museum be visited?
The building currently serves as a museum of medical history attached to Manisa Celal Bayar University. As opening hours and conditions may change, it is a good idea to check the latest information before you go.
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Eda Erkan Alapala
Klinik Psikolog. İstanbul Kent Üniversitesi Klinik Psikoloji Tezli Yüksek Lisans mezunu; bilişsel davranışçı terapi, çocuk merkezli oyun terapisi ve çocuk-ergen psikoterapisi alanlarında eğitimlerini tamamlamıştır.
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