How was music viewed in Turkish-Islamic medicine? The four elements, temperament theory, al-Kindi, al-Farabi and Ibn Sina, and what today's science says.
A student given "music in Turkish-Islamic medicine" as a topic for a history of medicine assignment will usually come across two extremes in their first search. On one side are enthusiastic pieces claiming that "Ottoman physicians knew which musical mode (makam) was good for which illness"; on the other, dry academic summaries full of footnotes. This article tries to chart a path between the two. We look in turn at which system of thought music fitted into within this medical tradition, which figures wrote what, which pieces of information are supported by sources and which are disputed. In the final section we consider how this history relates to our present-day understanding of mental health.
What System of Thought Underlies Music in Turkish-Islamic Medicine?
The key to understanding this tradition is the theory on which the medicine of the period rested. In the medieval Islamic world, and in Seljuk and Ottoman medicine, physical and mental health were largely explained by the theory of the four humours inherited from Hippocrates and Galen. According to this theory, the body contains four basic fluids: blood, phlegm, yellow bile and black bile. The balance of these fluids determines a person's temperament; when the balance is disturbed, illness appears.
The theory also had a wider framework. The four fluids were associated with the four elements of fire, air, water and earth, with the four seasons, and with the qualities of hot, cold, dry and moist. A harmony was thought to exist between the order of the universe and the order of the human body. The physician's task was to preserve or restore this balance by regulating factors such as food, sleep, movement, air, mood and surroundings.
An interesting consequence of this outlook was that medicine looked not only at the illness but at the person's whole life. What a person ate, how they slept, what air they breathed, with whom and in what kind of environment they lived were all within the physician's field of interest. In today's terms, this approach is an early form of an outlook that values lifestyle; but the explanation it rested on does not match what we know today.
Music fitted easily into this system. Sound was one more factor; if it could change a person's mood, it could also affect their temperament and therefore their health. The meeting of music and medicine rests largely on this logic.
A note is needed from the outset: the theory of the four humours and temperaments was abandoned by modern medicine long ago. Understanding it as history is valuable; but it is not used today to explain illness or choose treatment.
Al-Kindi, al-Farabi and Ibn Sina: Seeing Music as a Science
Behind the idea of music in Turkish-Islamic medicine stand philosophers who treated music as a serious field of knowledge. The information supported by sources can be summarised as follows:
- Al-Kindi (d. around 870): He is known to have written around ten treatises on music, four of which have survived. He associated the four strings of the oud with the heavenly bodies, the signs of the zodiac, the seasons and the four elements, and tried to explain their effect on human beings. He is also reported to have added a theoretical fifth string to the oud. Some academic studies note that he recommended using colour and scent as well to enhance the effect of music.
- Al-Farabi: He wrote his major work, Kitab al-Musiqa al-Kabir (The Great Book of Music), probably around 930, at the request of the Abbasid vizier al-Karkhi. Consisting of two books, it deals systematically with musical modes, instruments and acoustics, and is built on the principle that performance comes before theory. Al-Farabi is counted among the thinkers who held that music affects the human soul.
- Ibn Sina (Avicenna): He devoted a section of his Kitab al-Shifa (The Book of Healing) to music, defining it as a mathematical science that studies sounds and the time intervals between them.
In the tradition of classifying the sciences that began with al-Kindi, music was counted among the mathematical sciences alongside arithmetic, geometry and astronomy, and this approach continued with al-Farabi, the Brethren of Purity (Ikhwan al-Safa) and Ibn Sina. In other words, music was seen not merely as entertainment or an art but as a field of knowledge built on proportion and order. If you would like to know more about al-Kindi's views, see our article on al-Kindi's music treatises.
Frequently Repeated but Unverified Information
Some of the information attributed to these philosophers in popular sources cannot easily be verified against the primary texts. For example, you will often read:
- That al-Farabi wrote that particular musical modes produce sleep, joy or sorrow, and that this was used as a method of treatment.
- That Ibn Sina, in his Canon of Medicine, compared the pulse to musical rhythm and directly recommended music as a means of treatment.
The primary passages for these claims have not been clearly shown in reliable, easily accessible sources. It is therefore necessary to read them as "it is said" or "reported in popular sources", and to keep this caution in an assignment or presentation as well.
The same applies to treatises on music and medicine said to date from the Ottoman period. The chief physician Gevrekzâde Hâfız Hasan Efendi (d. 1801) is regarded as one of the last representatives of traditional Ottoman medicine. A work on treating mental illnesses with musical melodies is attributed to him; however, this attribution is disputed, and some encyclopaedic sources note that Gevrekzâde had no direct connection with music.
A few practical criteria are useful for students preparing an assignment, dissertation or presentation on this subject:
- Start with an encyclopaedia entry. Academic encyclopaedias such as the TDV Encyclopaedia of Islam usually give the name of a work, the date it was written and its content, citing sources.
- Follow the chain of citation. If a news website says "Ibn Sina said this", ask which section of which work the sentence comes from. If the chain breaks somewhere, report the information with caution.
- Check the consistency of dates and names. If the same information appears in different sources with different dates or is attributed to different people, that is a sign it is disputed.
- Use the word "treatment" in context. The word "treatment" in sources from the period reflects the care practices of the time, not a measured recovery in today's sense.
These criteria are useful not only for the history of music but for any kind of health information you come across online.
Being widely shared does not make a piece of information true; for every sentence attributed to a historical figure, we need to ask where it appears in that figure's own writing.
Pairings of Musical Modes and Temperaments: Reading Them as the Beliefs of the Time
The topic that attracts most curiosity when people think of music in Turkish-Islamic medicine is the lists that pair musical modes with particular illnesses or temperaments. In these lists you will read, for example, that the rast mode is good for paralysis and the buselik mode for headaches. Some lists also match modes with particular times of day.
When evaluating these lists, it is useful to keep three points in mind:
- They contradict one another from source to source. The same mode may be paired with one complaint in one list and a completely different complaint in another.
- They rest on an abandoned theory. The logic of the pairings is the theory of temperaments and the four humours, which is not the basis of medicine today.
- They have not been scientifically tested. There are no controlled studies comparing paralysed patients who listened to the rast mode with those who did not.
For this reason, these pairings can be read as interesting documents of cultural history, but they cannot be used as health advice. Specialists in the field have also issued warnings on this point. In 2011 a music therapy specialist criticised the way information about al-Farabi and Ibn Sina was being used "with a sensationalist logic, without conforming to scientific methodology".
Let us imagine a grandfather in his seventies telling his grandchild, "This mode is good for my blood pressure; it says so in the book." There is no need to belittle the pleasure the grandfather takes in music; listening to a mode he loves may well make him feel good. But the same sentence should not become a reason to skip his blood pressure medication or put off a check-up with his doctor. In our article on the effects of musical modes on people, where we discuss the subject in more detail, you can also find out where these lists come from.
Music in the Darüşşifas: What We Know About Practice
Alongside theory, there are also some testimonies about practice. In the darüşşifas (historical hospitals), which were founded through charitable endowments in the Seljuk and Ottoman periods and provided free care, music is said to have been part of patient care.
The most solid example is the Bayezid II Darüşşifa in Edirne. Part of a complex completed in 1488, this hospital operated for around four hundred years. In his Book of Travels (Seyahatname), Evliya Çelebi writes that an ensemble of musicians came three days a week to perform for the patients; encyclopaedic sources also report that patients with mental illness were cared for with music performed by singers and instrumentalists. The hospital in Amasya, for its part, is known as the place where the celebrated surgeon Şerefeddin Sabuncuoğlu worked and where, in 1465, he wrote his illustrated book on surgery; there are academic studies that discuss the use of music there too, though the details of the method are unclear. At the Hafsa Sultan Darüşşifa in Manisa, care is said to have included handicrafts, music and the sound of water. The Fatih and Süleymaniye hospitals in Istanbul are also counted among the institutions where music was used, although the details have not been sufficiently verified.
By contrast, details such as "a ten-member ensemble that played a different mode for each illness" do not rest on a verified primary source. For a broader picture of how these institutions worked, see our article on music-based care in the Ottoman era.
What we know about practice can be summed up briefly: it is clear that music was played to patients and that efforts were made to keep the environment calm and well cared for. There is, however, no record in today's sense of what result this produced in which patient.
The Difference Between Music in Turkish-Islamic Medicine and Today's Science
When comparing the historical tradition with today's science, the real difference lies in method. In that period there was observation, tradition and inference based on theory. Today, researchers try to test through comparative studies whom a method helps, under what conditions and to what extent.
What these studies say is more cautious than what enthusiastic popular articles say. For example, according to a Cochrane review, music therapy added to usual treatment may reduce symptoms of depression in the short term; however, the evidence has been rated as low to moderate in certainty, and guidelines do not yet recommend it as a routine addition. In addition, "music therapy" in such research covers musical interaction within a therapeutic framework with a trained practitioner; simply listening to recorded music is not the same thing.
In short, music is still valued today as a supportive element; but it does not replace medication, psychotherapy or medical treatment. This conclusion does not diminish the value of the historical tradition. On the contrary, the fact that people were already reflecting on the relationship between sound and emotion centuries ago shows how old human curiosity about this question is.
In Turkey, music therapy is one of the methods defined in the 2014 Regulation on Traditional and Complementary Medicine Practices (Geleneksel ve Tamamlayıcı Tıp Uygulamaları Yönetmeliği). Under this framework, the authority to practise is given mainly to certified physicians. This arrangement, too, points to music being considered alongside medical assessment, not in place of it.
Supporting Yourself with Music, and Professional Support
A healthy lesson that can be carried from this history into the present is this: music can affect our mood and can be used as a self-care tool in everyday life. For example:
- Noticing the music that calms you or gives you energy during the day and listening to it during short breaks,
- Trying a short music break in which you listen attentively, rather than leaving music playing in the background,
- If you play an instrument or love singing, keeping this up as a regular source of enjoyment.
These suggestions are not, however, a treatment. If you have been experiencing low mood, hopelessness, marked changes in sleep and appetite, an inability to carry out daily tasks or intense anxiety for weeks, it is more appropriate to see a mental health professional. If you have thoughts of harming yourself or ending your life, call 112 (emergency services) without delay.
When working with depressive symptoms, structured methods such as cognitive behavioural therapy form the basis; gradually bringing activities the person enjoys, music included, back into daily life can also be part of this process. Support in the area of depression and mood treats such activities not as a replacement for evidence-based work but as something alongside it.
Frequently Asked Questions
What is the theory of temperaments, and is it still valid today?
The theory of temperaments is an approach, inherited from Hippocrates and Galen, that explains health through the balance of four fluids in the body (blood, phlegm, yellow bile and black bile). It formed the foundation of medieval Islamic and Ottoman medicine. It has been abandoned by modern medicine and is not used today for diagnosis or treatment.
Did al-Farabi and Ibn Sina treat illnesses with music?
Al-Farabi wrote a comprehensive work on music theory, and Ibn Sina treated music as a mathematical science in the Book of Healing. Popular claims that either of them prescribed music to treat particular illnesses have not been verified against primary sources.
Can I use lists of musical modes and illnesses in my assignment?
You can, but you need to present them as the beliefs of the period and as documents of cultural history. Noting that the lists contradict one another and have not been scientifically tested will make your work more credible.
Does listening to music help my mood?
Many people experience music as having a positive effect on their mood, and it can be a self-care habit. However, listening to music does not replace professional support for ongoing mental health difficulties.
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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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