Authors: Beyza Tosun, Esin Candaş
ABSTRACT
Psychiatry, even though the process of it being taken seriously throughout the history was a long and hard one, was and still one of the most important topics in global mental care. Closer to the end of the 18th century to the 19th century, it became more recognizable both architecturally and medically, as a result of the developments in medicine and science. In this study, these developments and their effects on the improvement of treatments in healthcare are being connected with the improvements in architecture. Beginning with the history of healthcare and hospitals around the world, the study found the pioneers of medicine are coming from ancient civilizations, which later will help to develop the basis of healthcare. Getting inspired from these developments, especially from the improvements of Islamic civilizations which are for Ottoman Empire to take examples of, the researches about healthcare and afterwards psychiatry showed that Toptaşı Asylum is one of the structures which can be given as an example. Analyzing the development of this structure both medically and architecturally showed that function and spatial organizations are the elements which are complementary to each other.
1. THE HISTORY OF HEALTHCARE
1.1. History of Healthcare Around the World
Healthcare and medicine, for centuries, were and still are one of the most important aspects in the world. To keep the population glad and balanced, the care given to the development of medicine was being considered as one of the keystones. and to understand the history of healthcare, one must look at the civilizations which have big impacts on this development, and Ancient Egypt has the leading position on this aspect[1]. As the key point of worldwide healthcare, there are so many things that helped people on the field to increase the quality of their works. Analyzing mummies, looking at the art and epigraphs shows that the history of western healthcare started very strong, and developing every day.[2] And in this feature, Ancient Egypt not only started to develop the medicine and healthcare, it also inspired many cultures, such as Greeks and Romans. According to Diodorus, the philosophers wanted to go to the Egypt to learn about the developments, which later helped Greeks to improve themselves. [3]
Afterwards, as a result of some important historical events, such as conquest of Alexandria by Romans, helped the knowledges about healthcare and medicine spread from Greek lands to Arab, Turkish and Persian lands.[4] Though, like every other civilization, the methods which has been used as treatments to illnesses were mostly traditional methods. Especially in Arab societies, similar to Jewish, Roman and Christian societies, the process of healing was related with the religion.[5] But, as the world was approaching to the 19th century, with the evolutions in education and science throughout the century, this period has been considered as the turning point for medicine and healthcare. Especially, related with science, using different types of ways to educate and methods to treat people in France made a big impact in order to develop the healthcare.[6] And it is safe to say that with these developments from past to present, the basis of the healthcare and medicine has been made strongly and continuing to improve itself around the world.
1.2. Healthcare in Ottoman Empire
In Ottoman Empire, like every other country, there were organizations established to take care of people's health. The Ottoman hospitals were called “darüşşifa” and they accepted all kinds of patients and had many other functions besides delivering treatment. Darüşşifa was an institution that provided education as well as medicine. The origin of darüşşifa actually dates back to the Seljuk period when these foundations were called dar-al shifa. The initial examples of darüşşifas carried the architectural style which has a square courtyard and iwans built as domed structures. Furthermore, it contained a kitchen for preparing meals to the patients and a place for production of medicines. Hospitals had the characteristics of medieval medicine, but with the modernization in the 19th century and the developments in medicine, they got influenced by the western healthcare and started to separate into different fields. [7]
2. THE PROCESS OF MODERNIZATION OF HEALTHCARE IN 19TH CENTURY
2.1. Developments in Worldwide and Their Effects on Ottoman Empire
After the foundations of scientific methods and connecting the medicine with logical aspects, the healthcare around the world has begun to improve itself constantly. Though, the developments on physical healthcare were one thing, but with the help of it, especially on the topic of psychiatry the world was starting to realize the importance of mental health and how the treatments which are being used are wrong. With the modernization on healthcare, the improvement on the process curing a mentally ill person was getting higher and higher.
History of psychiatry is going back to the Arab cities, such as Baghdad and Cairo, the ones that most probably built the first psychiatric hospitals.[8] In fact, not only architecturally, but also scientifically it is possible to see many Muslim physicians who helped on the growth of knowledge in psychiatry, like Ibn Sina who refused that the mental illness is related with religious features or al-Razi who wrote many books on the topic of medicine[9]. Aside from Arab cities, to understand the history of psychiatry better, one should also look to the birth of psychiatry for western countries: The first step on this aspect, the hospital in Bethlem, opened in 1330 in London, was the first psychiatric hospital in Europe.[10] Not only in Europe, also in Germany the first asylum was built in 1326; and in Spain, in 1410 the first specialised hospital to treat mainly people who are suffering with mental illnesses established.[11] These were important steps, though not for mainly psychiatric purposes. Nineteenth century was the time for psychiatry to begin as a center in the asylums which are being built by the Western governments[12]. After this development, the way Europe was developing new techniques in order to treat people who are suffering with mental illnesses helped other countries to focus on this topic too.
3. THE ARISE OF PSYCHIATRY IN 19TH CENTURY
3.1. The Process of Formation of Psychiatry in Ottoman Empire
In Ottoman Empire, people with mental diseases were taken care of in the asylums called “bimarhane”. According to history professor Michael W. Dols, the word “bimarhane” comes from Persian and it means the place where patients are being treated and as a further information; it is known that once, bimarhane was being used synonymously with the word “darüşşifa”. However, in the Middle Ages, the medical organizations such as darüşşifa were incorporating all medical fields, but in 19th century the modern medicine privatized each field and the psychiatry was formed. Medical historian Ayten Altıntaş reveals that 19th century bimarhanes in Ottoman Empire focused only to patients with psychiatric illnesses.[13]
4. AN OTTOMAN ASYLUM IN 19TH CENTURY: TOPTAŞI BİMARHANESİ
4.1. The History of Toptaşı Bimarhanesi (Toptaşı Asylum)
It is safe to say that Toptaşı Asylum is one of the best examples that reflects the developments in Ottoman Empire in 19th century. Toptaşı Asylum was a part of “Atik Valide Külliye” complex, but after the developments in medicines and seeing new techniques are being increased, in 19th century it was decided to be used as the asylum for only psychiatric illnesses with modern techniques.
4.2.The Architectural Development of Toptaşı Asylum
Before transforming into a psychiatry center, Toptaşı asylum was a part of Atik Valide Külliye in İstanbul. Because of the unsatisfactory result in improving healthcare in Süleymaniye Asylum, in 1873 the patients were transferred to Toptaşı Asylum.[14]
As modernization in mental healthcare arose throughout the world in the 19th century, Toptaşı Asylum had gone through a period filled with developments related to medical treatments and architectural organization. Physician Luigi Mongeri played an important role in modernizing the system held in the asylum. The spaces started to be designed in accordance with the given importance to daily routines and the fresh air intake of patients during the treatment. The healing process took place in the wards, the courtyard and the observation rooms.[15]
In the beginning, the capacity fell short and maintenance was needed in the building. Thus, in 1875 there had been a plan made to enhance the functioning of the asylum. It was decided to make repairs and additions. Although it is not known whether the entire plan has been carried out or not, it was a very comprehensive plan and the following additions were expected to be done: a pharmacy, a storage room, a mosque, and restrooms.[16]
Due to the large number of patients coming into the asylum over time, there had been a proposal for an expansion in 1891. This new plan included additional stories for new wards. In the year 1893, the asylum went under quarantine due to several cases of cholera seen inside. This had a huge impact on the spatial organization inside at the time. There were isolation rooms built and disinfection stations added. After the outbreak, in 1909, the asylum continued to make improvements and followed the medicalization process by making a laboratory, buying medical supplies, and placing cameras. [17]
With the evolution of scientific research in the field of psychiatry, there had been new ways to approach mental healthcare. The Toptaşı Administration tried to keep pace with the changes and its further plans included building an amphitheater and a lecture room inside the asylum.[18]
5. CONCLUSION
Humans constantly shape their environment with their increasing knowledge and give new directions to the way they build architectural structures. On the other hand, the architecture they are surrounded with continues to affect people's quality of life greatly. After many studies conducted on mental health, the change of the perspective on this issue in the 19th century made a significant impact in the fields of medicine and architecture all around the world. The Ottoman State followed these developments and took further steps in the works of mental care and architecture. It can be clearly observed in the case of the Toptaşı Asylum that the new approach to mentally ill people and the modernized psychiatric treatments brought the need for additional spaces. The changing conditions also differentiated the use of the architectural design. Thus, it can be concluded that the function given to a place is determined by the evolving nature of human knowledge. This directly reflects into the architectural structuring creating a close relationship between spatial organization and human life.
Sources
[1]Lippi, Donatella. “A Short Story of Medicine”. Cooperativa Libraria Universitaria Editrice Bologna. CLUEB, Bologna (2015): 15. [2] Ibid., 15. [3]A. Ziegler, Tiffany, and Tiffany A. Ziegler1. “Medieval Healthcare and the Rise of Charitable Institutions.” SpringerLink. Palgrave Pivot, Cham. Accessed April 17, 2022.: 28. [4] Ibid., 32. [5] Ibid., 35. [6]Ibid., 85. [7] Meriç Kurtuluş, “ Osmanlı’nın Meczubları ve Mecnunları: Erken Modern Dönemde Hastaneler ve Deliliğe Bakış”, Milli Folklor Dergisi, no.110(2016): 100-113. [8] Pridmore, Saxby, and Mohamed Iqbal Pasha. “Psychiatry and Islam.” Australasian Psychiatry, December 2004.: 382-383. [9] Ibid.,382-383. [10] Hodak, Jelena. 2022. "Psychiatric Hospital-From Asylums To Centres For Mind-Body Wellness". Academia.Edu.: 979. [11] Ibid., 980. [12] Dowbiggin, Ian. 2013. “The Art Of Medicine: Clinic And Compassion In Nineteenth-Century Psychiatry”. Quarterly Vol.120, Iss. 1.: 63. [13] Meriç Kurtuluş, “ Osmanlı’nın Meczubları ve Mecnunları: Erken Modern Dönemde Hastaneler ve Deliliğe Bakış”, Milli Folklor Dergisi, no.110(2016): 101 [14] Burçak Özlidil Altın, “Psychiatry,Space, and Time: Case of an Ottoman Asylum”, Journal of the Ottoman and Turkish Studies Association, no. 1 (2018): 67-89. [15] Ibid.,70. [16] Ibid.,76. [17] Ibid.,79-84. [18] Ibid.,85.
Further Reading
Artvinli, Fatih. “Etker Şeref Bimarhaneler ve Mecanin yönetimi: İki taslak ve Süregelen Tartışma”, Osmanlı Bilimi Araştırmaları 14, no.2 (2013): 1- 40
Dowbiggin, Ian. “The Art Of Medicine: Clinic And Compassion In Nineteenth-Century Psychiatry”. Quarterly Vol.120, Iss. 1. (2013). https://www.proquest.com/docview/1348889530?accountid=8623
Hodak, Jelena. "Psychiatric Hospital--From Asylums To Centres For Mind-Body Wellness". (2022). Academia.Edu.
Hook, Kimberly., Sergiy Bogdanov.. “Mental Health Care in Eastern Europe and Central Asia: An Analysis of Needs and a Call for Greater Investment.” The Lancet Regional Health - Europe 10 (November) (2021).
doi:10.1016/j.lanepe. 2021.100182.
Kutlu, İ., Ergün, R. "Tarihi Yapılarda Yeniden İşlevlendirme Süreçlerine Sistematik Bir Yaklaşım; Atik Valide Külliyesi Örneği". Avrupa Bilim ve Teknoloji Dergisi (2021): 172-184
Kurtuluş, Meriç. “Osmanlı’nın Meczubları ve Mecnunları: Erken Modern Dönemde Hastaneler ve Deliliğe Bakış”. Milli Folklor Dergisi 14, no.110(2016): 100- 113.
Lippi, Donatella. “A Short Story of Medicine”. Cooperativa Libraria Universitaria Editrice Bologna. CLUEB, Bologna (2015).
Özlüdil Altın, Burçak. “Psychiatry, Space, and Time: Case of an Ottoman Asylum.” Journal of the Ottoman and Turkish Studies Association 5, no. 1 (2018): 67–89. https://doi.org/10.2979/jottturstuass.5.1.05.
Rüya, Kılıç. "Osmanlı Devleti’nde Deliliğin Tarihi: Toptaşı Örneği”. BİLİG Türk Dünyası Sosyal Bilimler Dergisi (2013).
Pridmore, Saxby, and Mohamed Iqbal Pasha. “Psychiatry and Islam.” Australasian Psychiatry, December (2004).
Sarı, A., Zabun, S. "Bimarhaneler Hakkında Alan Yazın Çalışması". Uluslararası Sağlık Yönetimi ve Stratejileri Araştırma Dergisi 7 (2021): 585-599.
Scull, Andrew. “The Asylum As Utopia (Psychology Revivals) : W.A.F. Browne and the Mid-Nineteenth Century Consolidation of Psychiatry”. Psychology Revivals. Abingdon, Oxon: Routledge (2014).
Ziegler, Tiffany. “Medieval Healthcare and the Rise of Charitable Institutions.” SpringerLink. Palgrave Pivot, Cham. Accessed April 17, (2022). https://link.springer.com/book/10.1007/978-3-030-02056-9.
Comments