Symptomatic mental disorders are considered as conditions resulting from primary, internal factors such as infections or external factors like heatstroke or a blow to the head) or secondary damage or dysfunction of the brain, by illnesses of other organs, including “sarsām” (inflammation of head — encephalitis, meningitis) “barsām” (inflammation of the chest — pneumonia, pleurisy) urine tract infections (UTI), etc. [20, 21, 22, 31].

The “corruption” of imagination is portrayed as a syndrome when an individual’s perception (“al-his”) is impaired, whilst their thinking, (“al-fahm”) is intact, characterised by illusions, simple and complex hallucinations, such as “seeing people, fire, water, etc, or being observed picking up chips and hay, hearing sounds, or sensing smells that have no external reality” [20, 31]. Tabari believes if the frontal parts of the brain (“centrum of fantasy”) are damaged, patients experience complex visual hallucinations “like the man who was shouting at a group of people playing music opposite of his house” [19, 20]. Avicenna associated this syndrome with the damage of the “middle brain” [31]. The syndrome of impaired imagination matches with the organic hallucinosis, ICD-10 F06.0 [14].

The “corruption of thought” is outlined as a condition, when the perception is intact and “patients perceive the outside reality as it is”, nonetheless, their thinking is impaired, “like a man who closed the door behind himself, opened the windows and threw everything he could find in the room” [19, 20] or “like the man who throws a carpet and dishes from the roof (of his house) at a woman in the garden of the house. This person’s perception is intact because he recognises the objects (carpet and dishes), but he does not understand that he should not throw those objects (at the woman) in the garden” [21, 22]. This syndrome is linked with damage to the central parts of the brain, ‘the place of thinking’ [19, 20], and pathologies of the frontal lobe [31].

This condition is described as a syndrome when there is a profound change in patients thinking, emotions and behaviours, compared to their pre-morbid personality; “they say things they normally not say, like things they (normally) should not like, wish unreasonable things, desire for undesirable, do things they should not do, or hate things that they normally, do not hate” [31]. Tabari associates this illness with the damage of the posterior cerebellar areas (“centrum of memory”) caused by their “heating” (inflammation) and “dryness” (dehydration). The affected individuals exhibit complex hallucinatory experiences, thought disorders including delusions; “some believe they are made of ceramic and are scared something will hit them and they will break”, some believe they are “camels and run away from human”, or imagine they were “transformed to rooster and make noises like roosters” [19, 20]. Avicenna relates this syndrome with the impairment of central parts of the brain [31].

Both the above-mentioned syndromes resemble the organic delusional disorder, ICD-10 F06.2, characterised by predominant delusional beliefs accompanied by hallucinations [14].

“Sobārā” is portrayed as an organic “madness” due to either primary brain damage, such as “sarsām” or phrenitis (meningitis or/and encephalitis) or a secondary brain dysfunction because of “barsām” (pneumonia and pleurites), UTI and other infections, characterised by agitation, confusion, cognitive impairment and psychotic phenomena [21, 22, 31].

“Phrenitis” in ancient Greece refers to acute inflammation of the mind and body [32], or describes any mental disorder associated principally with fever, but also cranial traumatism and other somatic causes [33]. Phrenitis alongside “lethargus” used in the mediaeval Islamic medicine as “qeranits” and “lethargus” denote agitated and inhibited delirium [34]. Celsus who introduced the term “delirium” into medicine gave a detailed description of phrenitis, considering it as equivalent to mania (“madness”) and dividing it into acute phrenitis, which he called delirium, characterised by febrile paroxysms, incoherent speech and confusion, and chronic insanity or “phrensis” manifested by persistent dementia; “when the patient is so far in his senses, he entertains himself with futile imaginations; and the mind is at the mercy of these imaginations” [35].

“Sobārā” aligns with disorders ordered in the ICD-10, under the category, F06, Other mental disorders due to brain damage and dysfunction and physical diseases [14], and F07.1 Postencephalitic syndrome, presenting with nonspecific symptoms and varying from individual to individual and from infectious agents [14].

Alcohol in moderation is recommended for its “antidepressant” and anxiolytic effects; however, excessive consumption and frequent intoxication are not recommended, due to the toxic effects of alcohol on the brain and liver [31]. Alcohol-induced “insanity” is considered a benign form of psychosis with a good prognosis, characterised by delusional beliefs, hallucinations, anger, hostility [21, 22] and personality changes, such as “ignoring religious and social issues”, accompanied by the decline of cognitive functions, perception, comprehension and understanding [36, 37]. Alcohol-induced “madness” as depicted here, resembles the F10.7, ICD-10 Residual, and late-onset psychotic disorder due to alcohol, characterised by changes in cognition, affects, personality or behaviours [14].

Labelled as a condition developing from the excessive heat or aridity of “both sides” (temporal lobes) of the brain [19, 20]. The syndrome of organic mutism relates to other specified mental disorders due to brain damage and dysfunction and to physical disease, F06.8, ICD-10 [14].

Coupled with the damage of the frontal brain lobe and described both as an olfactory hallucinatory syndrome “when an individual senses smells without its external reality” and a memory illusion “when the mind is disordered, and the person remembers events that he or she has never seen or heard of” [31]. The syndrome of “tashwish” because of its ambiguity, could be classified as an Unspecified mental disorder due to brain damage and dysfunction, F06.9, ICD-10 [14].

A rare hallucinatory syndrome presenting with elementary auditory hallucinatory experiences in the form of sounds accompanied by insomnia and anxiety due to “vapours getting stuck and circling in the brain” [20]. The French physician, Boissier de Sauvages (1706–1767) portrayed a similar syndrome, “syrigmus” described as “unreal sounds perceived in the air” in 1763 [3]. The syndrome of “rotating noises in the brain” resembles Organic hallucinosis, F06.0, a hallucinatory disorder occurring in clear consciousness that may or may not be recognised by the person as such [14].

Permanent “insanities” are supposed to be “persistent disturbances of the mind” [21, 22] of multifactorial aetiology, where “physical” or biological (temperament, humours, physical predisposition, personality) “non-physical” or psychological (excessive emotions as sadness, fear, anxiety) and environmental factors interplay in their aetiology [38, 39].

Tabari’s avoidance of the term “insanity” in favour of “isolation in the wilderness with animals” offers a unique perspective on psychosis. This term encapsulates a spectrum of symptoms, ranging from anxiety and agitation to disorganized behaviours and cognitive deficits. Individuals experiencing this state may exhibit obsessive symptoms, forgetfulness, confusion, and hostility. Interestingly, Tabari notes a propensity for affected individuals to abandon human company and seek solace among savage animals. Moreover, hallucinations and nihilistic delusions, such as the belief that the sky will fall or delusions of metamorphosis such as being transformed into animals, are highlighted as prominent features. Tabari attributes the origins of this illness to environmental factors such as extreme heat or dryness (caused either by external factors such as sun heat, or infections and other febrile states), drawing parallels to the desiccating effects of fever or pleurisy [19, 20]. A similar clinical picture is described by Aretaeus, in people “who suffer from melancholia are suspicious of poisoning, or flee to the desert from misanthropy, or contract a hatred of life. They complain of life and desire to die; they become ignorant of all things or forgetful of themselves and live the lives of the inferior animals” [40]. The syndrome “isolation in the wilderness with animals” is possibly the first description of schizophrenia-spectrum disorder, namely simple schizophrenia in Arabic medicine, corresponding to F20.6, characterised by significant changes in personal behaviours, manifest as a marked loss of interest, idleness, and social withdrawal [14].

There is no mention of mania in the early Arabic medical texts, instead, the term “ekhtelāt-al-aqhl” (“the corruption of the mind”) or “junun” (“madness”) is used. Razi describes mania as “al junun ul-hāyej” or “ferocious madness” with its characteristic symptoms of agitation, aggression, fear and paranoia, delusional thinking, and impaired judgment [21, 22].

Avicenna’s exploration of mania and melancholia sheds light on the complex interplay between bodily humours, in particular “accumulation of the black bile or burnt bile in the frontal parts of the brain or its substance” and their clinical manifestations. Avicenna distinguishes two variants of mania such as “sobārī” (agitated) and “hārī” (inhibited) mania each characterised by distinct features and behaviours, highlighting the heterogeneity of psychosis and the importance of individualised approaches to treatment [31].

Avicenna explains although mania and melancholia have the same pathophysiology, they differ in their clinical symptomatology; whilst in melancholia, pessimism, negative thinking, fear, and social isolation prevail; in mania, “the worst form of insanity”, paranoia, constant anxiety, agitation, vindictiveness, hostility, and ferocity are the characteristic symptoms [31].

Mania as described in Arabic medical literature has no relation with the current understanding of mania, as an affective disorder, but is understood as a severe form of psychosis, from the schizophrenia-spectrum disorders, F20, ICD-10 [14].

“Qhutrub” or dragonfly is described as a form of treatment-resistant “madness”, characterised by erratic, and disorganised behaviours, restlessness and agitation, “wandering from night to dawn”, especially in cemeteries. Seeking solace, they retreat to cemeteries and places associated with the deceased, reacting aggressively to any unexpected encounters. These individuals isolate themselves for days, avoiding social interactions and predominantly emerging at night. Their restless behaviours are marked by aimless wandering, seemingly detached from their surroundings. Despite their frenzied movements, they pose minimal harm to others. Individuals afflicted by “qhutrub” are described as having distinctive physical appearances such as gloomy countenance, yellowish complexion, deformed faces, stunned eyes, dry tongue, and insatiable thirst. Persistent ulcers on their legs and lacklustre eyes further characterise the condition [21, 22, 31, 38, 39]. Qhutrub is believed to be hereditary [38, 39] and occurs mostly in the second month of winter (Aquarius) [31].

The term “qhutrub” originates from an insect (dragonfly) that skims the water’s surface erratically, mirroring the patient’s perpetual motion and desire to escape. Other interpretations liken qhutrub to mythical creatures like a masculine giant or a hairless wolf [31].

The clinical picture of “qhutrub” resembles lycanthropy commonly described by medieval European physicians. The Italian physician Donatus ab Altomari’s (1506–1562) description of lycanthropy as “they have usually hollow eyes, scabbed legs and thighs, very dry and pale” [23] mirrors the description of “qhutrub”. English physician Robert Bayfield (1630–1690) in 1663 gives a depiction of lycanthropy, that remarkably resembles “qhutrub” in the Arabic medical literature. Bayfield wrote: “Lycanthropy, is a disease, in which man run barking and howling about graves and fields in the night, lying hid for the most part all day, believing they are wolves…”

Clinical presentation of “qhutrub” relates to schizophrenia-spectrum disorders, particularly, with Unspecified schizophrenia, F20.9, ICD-10 [14].

“Dā al-kalb” (“the dog’s disease”) is regarded as a subtype of mania (insanity), prevalent during the spring and summer with distinctive symptoms reminiscent of behaviours observed in dogs. “Dā al-kalb” is characterised by a mixture of anger and playfulness, alternating between periods of calmness and hostility. Moderate forms of “dā al-kalb” manifests with mild features of pessimism and paranoia [31], however, its severe forms called “junun al-sabo’í” or “savage madness”, manifest with severe agitation and hostility [16, 31].

The concept of “mixed insanity” corresponding to the clinical picture of the “dog’s disease” (da’al-kalb) has its roots in ancient Greek medicine but was not known to European physicians until the 19th century. In 1844 German physician Carl F. Fleming (1799–1880) in his classification of “dysthymia” (affective disorders) portrays “dysthymia mutabilis” or mixed affective disorder [24]. In 1854 French Jules Baillarger (1809–1890), described a variant of “insanity” he called “la folie à double forme”, and Pierre Falret (1794–1870) “folie circulaire” [25]. In 1893, V. Magnan (1835–1916) labelled “folie intermittentes” or “intermittent madness” [26]; all defined as a form of mixed insanity characterised by the existence of both manic and depressive episodes. Further evolution of this concept led to Kraepelin’s hypothesis of manic-depressive insanity, introduced in 1899 [27], and subsequently, re-named bipolar affective disorder by Angst and Perris in 1966 [25].

The da’-al-kalb clinical picture to some extent is akin to mixed episode of bipolar affective disorder, and schizoaffective disorder, mixed schizophrenic and affective psychosis, F25.2, ICD -10, or perhaps mixed episode of bipolar affective disorder, F31.6 characterised by alternation of manic, hypomanic and depressive symptoms [14].

“Junun edbāri” (cycloid insanity) is defined as a form of chronic insanity commonly exacerbating in spring but during the rest of the year is in remission [16]. It appears that “junun edbāri” is a synonym for seasonal melancholia described by Rhazes attributing its occurrence in spring to the stimulation of humours by the natural environment [21, 22]. Nonetheless, Avicenna believes “junun edbāri” is a variant of “mania” (“madness”) occurring in spring and early summer [31]. It is believed that Karl Kleist (1879–1960) who in 1928 first introduced the concept of “cycloid psychoses”, described them as “bipolar disorders, that do not belong to the category of manic-depressive insanity” [28, 29]. Evidence, however, suggests that it was Pinel who in 1798 introduced the term “la manie périodique ou intermittente” (periodic or intermittent mania), resembling “junun edbāri”, into modern psychiatry [30]. Pinel, considered periodic or intermittent insanity as a form of paroxysmal, relapsing “insanity”, characterised by a high degree of physical and mental energy, without delusion and independent of the influence of the seasons [41]. “Junun dawrí” relates to F31 Bipolar affective disorder [14].

In contrast to cyclic insanity (“junun edbāri”) “junun mutbeqh” (absolute insanity) or complete insanity (“junun al- mostau’ib”), is described as a form of “insanity that totally covers the mind”. What is more, “absolute” insanity is defined as “insanity” that persists for at least one month according to the Abu Hanifa (699–767A.D.), the founder of the Hanafi school of Islamic jurisprudence. Nonetheless, according to Abu Yusuf al-Kofi (732–801 A.D.) Abu Hanifa’s disciple and the chief justice during the reign of Harun ar-Rashīd (786–809) of the Abbasid caliphate (749–1258) the “absolute” insanity persists most of the year [16]. Interestingly, ICD-10 requirement for diagnosis of schizophrenia is one month or more, (for residual, and simple schizophrenia one year), and for persistent delusional disorder, at least three months [14].

Believed to be resulting from magic, manifested by symptoms of “loss of mind and thirst” [20]. The ancient phenomena of bewitchment, existing for millennia, and still observed in clinical practice, reflects socio-cultural beliefs, and not the opinions of the medical professionals. The syndrome of “fever due to enchantment” could be included under the Psychogenic paranoid psychosis, F23.3, ICD-10 [14].

Portrayed as a psychogenic reactive psychotic state, manifesting with grief, worry, agitation, confusion, insomnia, restlessness, and fever [38, 39] as well as bewilderment of the mind, silence, weakness of sexual desire, shame and happiness when hearing the name of the beloved [20]. Avicenna paints love madness as an obsessive malady akin to melancholy, arising from the total immersion of one’s thoughts into fantasies and images of the beloved. Psychological symptoms include low mood, mood swings, poor appetite, and insomnia. Physiologically, the illness manifests in rapid eye movements, dry eyes, and sunken eye sockets, indicative of sleep deprivation. In terms of management, Avicenna advocates for a holistic approach. He recommends the administration of sedative medication and nutritious food. Psychologically, he suggests that the physician should counsel the patient that their thoughts are indicative of obsession and a form of madness. Additionally, Avicenna recommends inviting elderly women or hermaphrodites to gather around the patient and engage in conversations about their lover, attributing negative qualities to the individual to foster animosity towards the beloved. Alternatively, the physician can occupy the patient with various games or hunting activities. Furthermore, Avicenna suggests that having the patient sleep with slave girls can be an effective treatment for this condition [31].

Depending on its clinical manifestation; if the depressive symptomatology dominates the clinical presentation, “love madness” could be classified as atypical or “masked” depression, F32.8 [14]. Alternatively, the syndrome of “love madness” could be classified under somatisation disorder, F45.0 [14].