What is a darüşşifa, and is it the same as a bimarhane? Read how Seljuk and Ottoman hospitals worked, what we know about music in them and what remains today.
Visitors to the Museum of Seljuk Civilisation in Kayseri often stop in the middle of the stone courtyard and exclaim, "So this used to be a hospital." Students who visit the complex on the banks of the Tunca in Edirne tend to leave with a similar question: what is a darüşşifa, who was treated in these buildings, and how were people with mental distress cared for? In this article we start with the meaning of the word and look at how hospitals in the Seljuk and Ottoman periods were founded, how they worked and what they tell us about mental health. Alongside the historical facts, we will try to separate out the stories that circulate widely but cannot be verified, because the story of these buildings is one that makes people proud and is also easy to exaggerate.
What Is a Darüşşifa? The Meaning of the Word and the Institution's Other Names
The Arabic-derived word "darüşşifa" literally means "house of healing": "dâr" means house or home, and the second part refers to recovery. Sources also use other names for the same type of institution. "Bimaristan" or "bimarhane", derived from the Persian word "bîmâr" meaning "sick", and the mixed Turkish-Arabic "şifahane" usually describe the same kind of building.
Thinking in today's terms, a darüşşifa resembles a combination of a hospital and a medical school. In some buildings, physicians trained students while they treated patients. The fact that the building in Kayseri is also known as the "Double Madrasa" (Çifte Medrese) is a good example of how health care and education went hand in hand.
One of the most striking features of these buildings is that they were founded through charitable endowments (vakıf). A sultan, a woman from the sultan's family or a wealthy benefactor would endow income-generating shops, land and similar resources, and this income paid for the darüşşifa's staff, food, medicines and upkeep. Sources state that the service was free of charge for patients.
In short, the brief answer to the question "what is a darüşşifa" is this: health institutions in Seljuk and Ottoman lands that were sustained by endowment income, where patients were cared for free of charge and where physicians were sometimes trained. Over time, some of these institutions became especially associated with the care of people with mental illness.
How Did Darüşşifas Work?
Each darüşşifa had its own arrangements, and these changed from one period to another. Even so, it is possible to sketch a general framework.
- The endowment deed: The institution's rules, who would work there, their salaries and its sources of income were written in a document called the vakfiye. Thanks to this document, the institution continued to exist after its founder's death.
- Physicians and staff: Alongside the physicians who examined patients, there were various staff who prepared medicines, cooked, cleaned and looked after patients.
- Education: Some darüşşifas were places where medical students trained alongside physicians. The building in Amasya is particularly well known in this respect.
- Architectural layout: Many darüşşifas consisted of rooms arranged around a courtyard. The courtyard, pool and garden provided both light and a place to rest.
The medicine of the period was based on the theory of the four humours, inherited from Hippocrates and Galen. According to this theory, the human body contains four fluids, blood, phlegm, yellow bile and black bile; health was attributed to the balance of these fluids and illness to its disruption. Diet, sleep, air, movement and state of mind were seen as factors affecting this balance. Modern medicine has abandoned this theory, but you need to know this framework to understand practices in the darüşşifas.
Examples of Darüşşifas from the Seljuk Period
The oldest darüşşifas still standing in Anatolia today date from the Seljuk and Beylik periods. Three examples are mentioned particularly often.
Kayseri: The Gevher Nesibe Darüşşifa
It was built in 1206 by the Seljuk Sultan Kaykhusraw I (I. Gıyaseddin Keyhüsrev) in accordance with the will of his sister, Gevher Nesibe Sultan. Together with the neighbouring madrasa, it is also known as the "Double Madrasa". It served as a health and education institution in the Seljuk and Ottoman periods and can be visited today as the Museum of Seljuk Civilisation. It is often written that music therapy was practised in this building, or that special rooms had a "music system"; however, these stories have not been verified by reliable sources.
Sivas: The Divriği Darüşşifa
It was built in 1228 in the name of Turan Melek, daughter of the Mengujekid ruler Behram Şah. Together with the Great Mosque it forms a complex and is on the UNESCO World Heritage List. The idea that the sound of water from the pool at the centre of the building and its acoustics were designed to soothe patients is an interpretation offered by some art historians. This interpretation is intriguing, but it is not a tested finding; it is more accurate to say "it is thought to have been so".
The Amasya Darüşşifa
It was built in 1308–1309, during the Ilkhanid period. The famous surgeon Şerefeddin Sabuncuoğlu worked here and in 1465 wrote his illustrated surgical book, Cerrâhiyyetü'l-Hâniyye. In academic studies, Amasya is also listed among the institutions where music was used; however, there are few details about how this was put into practice.
Mental Health in Ottoman Darüşşifas
In the Ottoman period, darüşşifas continued to be founded as part of large külliyes (mosque complexes). The Fatih and Süleymaniye darüşşifas in Istanbul are frequently mentioned together with those in Edirne and Manisa. From the point of view of the history of mental health, Edirne and Manisa stand out.
The Bayezid II Darüşşifa in Edirne: It is part of a complex completed in 1488 and served for about four hundred years. Today it can be visited as the Trakya University Health Museum. It is said that people with mental illness were cared for here with the sound of water, music and the scent of flowers. Evliya Çelebi, in his Book of Travels (Seyahatname), wrote that a group of musicians performed music for patients three days a week. More detailed stories, such as "a ten-person ensemble that played a different makam (melodic mode) for each illness", have not been verified.
The Hafsa Sultan Darüşşifa in Manisa: It was added in 1539 to the complex that Ayşe Hafsa Sultan had begun in 1522. Because Hafsa Sultan died in 1534, Sultan Suleiman the Magnificent had the building completed. For more than its last two hundred years, the institution functioned mainly as a mental hospital, and it is said that handicrafts, music and the sound of water were used there. Today it is a museum of medical history affiliated with Manisa Celal Bayar University.
The picture that emerges from these accounts is this: in some darüşşifas, people experiencing mental distress were not simply locked away and forgotten; they were given shelter, food and a routine of care. However, it is not possible to say that every institution of the period showed the same humane attitude. Historical documents suggest that there were large differences from one institution, and one period, to another.
Music, the Sound of Water and the Garden: What Do We Know and What Don't We Know?
When it comes to darüşşifas, the topic people are most curious about is music. Sentences such as "The Ottomans cured the mentally ill with makam music" circulate widely on social media. This subject needs to be untangled carefully.
What we know: That patients in Edirne were played music is known from Evliya Çelebi's account. It is reported that music was part of care in other institutions such as Manisa and Amasya as well. In the intellectual world of the period, philosopher-physicians such as al-Kindi, al-Farabi and Ibn Sina (Avicenna) treated music as a serious science, and the view that music affects the human soul became widespread.
What we don't know: There are few reliable details about which makam was played to which patient and for how long. Popular lists contain pairings such as "the rast makam is good for paralysis, the buselik makam for headaches"; however, these lists contradict each other from source to source and have not been scientifically tested. They should be read as the beliefs of the period.
The most valuable thing the darüşşifas left us is not a makam prescription, but the idea that a person experiencing mental distress also deserves care, sound and beauty.
If you are curious about how music is used in mental health today, you can read about modern practice and its limits in our article on music therapy. The approach described there, unlike the practices in the darüşşifas, is a supportive method tested by research, and it does not replace medical treatment or psychotherapy.
What Does the Question "What Is a Darüşşifa" Tell Us Today?
Being curious about history is also a way of understanding the present. There are several ideas from the story of the darüşşifas that can be carried over into today's understanding of mental health.
- Mental distress is also part of health. In these institutions we see that people with mental illness were treated under the same roof as people with physical illness, as a health problem.
- Surroundings matter. A courtyard, a garden, the sound of water and a regular daily routine are still recognised today as elements that support wellbeing. They do not replace treatment, but they form the humane face of care.
- Social responsibility: The endowment system was based on the idea that caring for the sick was the responsibility not only of the family but of society as well.
- The fight against stigma is still on the agenda: The fact that expressions such as "fit for the madhouse" (tımarhanelik) are still used as insults today shows how far attitudes towards people with mental health problems still have to go. We discuss this separately in our article on mental health stigma.
Let's say a student preparing an assignment for a history of medicine course visits the museum in Edirne and then tells her mother, "In the old days they used to solve psychological problems with music." A more accurate summary might be: "In the old days, some hospitals also played music to people with mental illness; we don't fully know today what effect that had, but we can see that they tried to care for those people attentively." Telling history without exaggerating it is a fairer stance, both towards the past and towards people who are seeking support today.
What should you watch out for when reading for an assignment or a visit?
There are many articles about darüşşifas on the internet, and some of them multiply the same claim by citing one another. As a student researching the subject or a curious reader, asking the following questions will make your work easier:
- Where does this information come from? Is it an encyclopaedia entry, an academic article or a thesis, or a news story with no source given?
- Are the dates and names consistent? If the founding year or the founder of the same building is given differently in different articles, you need to consult an academic source.
- Is this a historical practice or a present-day recommendation? "Physicians of the period recommended this" and "you should try this too" are two very different sentences.
- Is there exaggerated language? Words such as "a cure for every ill", "heals instantly" or "the forgotten secret of our ancestors" may suggest that the information is being used to sell a product or a service.
When you visit the museums, looking at the plan of the building, the position of the courtyard and the pool and the size of the rooms also tells you a great deal. These details help you imagine what kind of daily routine the institution envisaged. But do not forget to separate the interpretation that a space was designed to be "soothing" from a documented fact. In this way you keep your interest in history alive without contributing to the spread of misinformation.
How Is Mental Health Support Approached Today?
The biggest difference between the era of the darüşşifas and today is that mental health problems are now assessed and addressed with methods that have been tested by research. A mental health professional listens to the difficulty a person is experiencing, recommends an assessment by a psychiatrist if needed, and together they build a road map that suits that person.
It may be helpful to talk to a professional in the following situations:
- If you have been experiencing deep reluctance, unhappiness or restlessness for weeks
- If there is a marked disruption to your sleep, appetite and daily tasks
- If anxiety or fear makes it difficult for you to leave the house or go to work or school
- If you notice new and marked changes in someone close to you, such as losing touch with reality or speaking incoherently
If you are having thoughts of harming yourself or ending your life, do not wait; in an emergency, call 112 (emergency services).
Today, music, art, writing and other creative activities can also play a part in psychological support; however, these are usually complementary and are considered within the limits that research has shown. For example, in individual therapy, alongside a structured approach such as cognitive behavioural therapy (CBT), bringing activities that make a person feel good back into their life can also be addressed as a goal. Listening to music, spending time in a garden or doing handicrafts is close, in this respect, to the intuition of the darüşşifas; the difference is that these are now planned as part of a scientific assessment.
Frequently Asked Questions
Is a darüşşifa the same as a bimarhane?
Largely, yes. Darüşşifa, bimaristan, bimarhane and şifahane are names used in the sources to describe the same kind of health institution. Over time, some of these names came to be associated particularly with places where people with mental illness were cared for.
Were only people with mental illness treated in darüşşifas?
No. Darüşşifas were general hospitals; people with physical illnesses were also cared for there. Some institutions, such as the darüşşifa in Manisa, mainly served people with mental illness in their later periods.
Which darüşşifas can be visited today?
The Gevher Nesibe Darüşşifa in Kayseri is open to visitors as the Museum of Seljuk Civilisation, the Bayezid II Darüşşifa in Edirne as the Trakya University Health Museum, and the Hafsa Sultan Darüşşifa in Manisa as a museum of medical history. The building in Divriği can be seen together with the Great Mosque. It is worth checking opening hours in advance.
Can the music therapy of the darüşşifas be practised today?
Historical makam pairings have not been scientifically verified, so they cannot be recommended as a treatment for an illness. Today, music is used within supportive approaches that are tested by research and added to usual treatment. It is valuable if music does you good, but it should not take the place of the treatment you need.
Bu yazı genel bilgilendirme amaçlıdır; tanı veya tedavi yerine geçmez. Yaşadığınız güçlükler için bir ruh sağlığı uzmanına başvurmanız önerilir. Acil bir durumda lütfen 112'yi arayın.
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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