228 Am J Psychiatry 164:2, February 2007
ajp.psychiatryonline.org

The Disorder of Love in the Canon of Avicenna (A.D.
980–1037)

Abu Ali al-Hussain ibn Abdallah ibn Sina, known as
Avicenna
in the West, was born in the village of Afshaneh near
Bukhara in
Old Persia in A.D. 980 (1). His native language was
Persian, al-
though he educated himself in Arabic, which was the
formal lan-
guage in the Islamic territories of his time. Avicenna
became
versed in the sciences of the time by age 10. He
continued to study
philosophy and medicine and went to Jurjan, Ray,
Hamadan, and
Isfahan. Avicenna reviewed all previous medical
knowledge and
added his own observations to compile the Canon of
Medicine
(Al-Qanun fi al-Tibb), which led the way for medicine
during the
medieval age. He died in Hamadan in A.D. 1037. The
Canon was
written in five books, the third of which dealt with
disorders of the
nervous system and the psyche (2). We summarize a
chapter of
the Canon dealing with the so-called disorder of love,
which could
represent the first mention of an adjustment disorder.

Avicenna wrote the following:
A cachectic patient was brought to me with a plethora
of
chronic and debilitating diseases and prolonged fever,
all of
which were related to the love disorder. By reaching
his
sweetheart, I was amazed at how quickly he became
reener-
gized. So, it became clear to me that human health is
obedi-
ent to and under the control of mind. (2, p. 136)
Avicenna described the love disorder as an obsessive
disorder
resembling severe depression in which the patient is
overloaded
with imaginary figures and obsessive thoughts.
Physically, this
disease is characterized by poor grooming, sunken and
dry eyes,
repetitive blinking, and excessive laughing with
intermittent cry-
ing. Cardiopulmonary changes, such as rapid and paused
breath-
ing, perspiration, and an irregular pulse may occur.
Inappropriate
affect and sleep impairment are commonplace. This
disorder
may also present itself as depression, mania, and
conduct disor-
ders, requiring their specific treatments.
Avicenna stated that the identification of the beloved
one is the
cornerstone in the management of such patients. As a
diagnostic
tool, numerous names should be spoken while monitoring
the pa-
tient’s pulse. A change in the pulse rate and the
quality upon nam-
ing the appropriate name might indicate the name of
the beloved
one. The test also should be repeated for different
titles, vocations,
places, and cities together with the liable name to
further locate
the suspected person. This name and pulse test is a
classic exam-
ple of a psychosomatic reaction. Avicenna recommended
that
physicians make the effort to verify a legitimate
marriage of the
patient and his or her beloved one if the diagnosis is
certain. If this
is not possible, other options must be undertaken. The
patient
may be provoked to love someone else so that he or she
may forget
the initial person. Blaming and scoffing may sometimes
work. Dis-
cussion with the patient on the obsessive and manic
nature of his
or her disease is also useful. The patient can be kept
busy by
means of (artificial) conflict and struggling with
others to divert
his or her attention. The patient may also benefit
from outdoor ac-
tivities, such as hunting and gaming. The denunciation
of the be-
loved one may be beneficial but may also have a
negative impact.
The love theme has always been a critical issue in
Persian liter-
ature. A medical consultation for this might have been
a signifi-
Left: Persian Miniature of “Layli and Madjnun in the
School” From the 15th Century (Versified by Nezami of
Gandja in A.D. 1188 , the legend
of Layli and Madjnun is a Persian romance. The young
lovers become acquainted at a traditional school and
fall desperately in love. Madjnun
is rebuffed by Layli’s father and leaves everything
for the wilderness to live a miserable life. The story
ends with Layli dying of sorrow and Madj-
nun weeping desperately to die. Image courtesy of Art
Arena [http://www.art-arena.com]. From Persian-Tajik
Poetry in XIV–XVII Centuries Min-
iatures by M.M. Ashrafi.) Right: A Love Theme Painted
by Hossein Behzad, a Prominent Iranian Miniaturist
(1894–1968) (Image courtesy of
Asar Galleries of Art [http://persianpaintings.com].)
IMAGES IN PSYCHIATRY
cant occurrence in medieval Persia so that Avicenna
specifically
regarded the love disorder as a distinct entity. The
description of
the love disorder includes features of mood, anxiety,
conduct, and
obsessive-compulsive disorders. The presence of an
identifiable
stressor together with the resolution of symptoms upon
its termi-
nation suggests that such descriptions correspond with
an ad-
justment disorder. Avicenna wisely differentiated
severe mood
and anxiety disorders, although he noted that the love
disorder
may mimic them. Now, it is well known that coping with
a stressor
is essential in managing an adjustment disorder (3).
The clarifica-
tion and interpretation of the stressor, cognitive
behavior therapy,
and interpersonal psychotherapy are treatment options
for an ad-
justment disorder (3). Similar notions can also be
found in the
writings of Avicenna. Ultimately, Avicenna contributed
much to
psychosomatic medicine by his novel descriptions of
various psy-
chiatric disorders and their relations with body
physics.
References
1. Naderi S, Acar F, Mertol T, Arda MN: Functional
anatomy of the
spine by Avicenna in his eleventh century treatise
“Al-Qanun fi
al-Tibb” (The Canons of Medicine). Neurosurgery 2003;
52:
1449–1453
2. Sharafkandi A: The Canon of Medicine of Ibn Sina,
Vol 3 (trans-
lated from Persian). Tehran, Iran, Soroush, 1987, pp
135–137
3. Strain JJ: Adjustment disorders, in Treatments of
Psychiatric
Disorders. Edited by Gabbard GO. Washington, DC,
American
Psychiatric Association Press, 1995, pp 1656–1665
MOHAMMADALI M. SHOJA, M.D.
R. SHANE TUBBS, M.S., P.A.-C., PH.D.
From the Department of Anatomy and Neurosurgery,
Tabriz University of Medical Sciences, Tabriz, Iran;
the Department of Cell Biology, Section
of Pediatric Neurosurgery, University of Alabama,
Birmingham; and the Children’s Hospital, Birmingham,
Ala. Address correspondence and re-
print requests to Dr. Shoja, No. 9, Bonbast-e-Jhaleh,
Qatran-e-Shomaly Ave., Tabriz 51738, Iran;
amohadjel@... (e-mail).
Both authors report no competing interests.



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