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Join us as we explore the intersection of medicine and art. Our guest, Farid Alsabeh, a clinical psychologist, delves into the rich tradition of medical poetry during the Islamic Golden Era. Discover how Arabic poets transformed scientific knowledge into captivating verses, with Ibn Sina’s “Rajaz Poem on Medicine” as a shining example. We discuss the relevance of medical poetry in the modern world, its potential applications in health care, and even share examples of poetic diagnostic criteria. Tune in to revive the lost art of medical poetry and appreciate the beauty of medicine through a creative lens.

Farid Alsabeh is a clinical psychologist.

He discusses his KevinMD article, “Reviving the art of medical poetry.”

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast and get CME for this episode by clicking on the CME link in the show notes. Today we welcome back Farid Alsabeh. He is a clinical psychologist, and we’re going to talk about his KevinMD article “Reviving the art of medical poetry.” Farid, welcome back to the show.

Farid Alsabeh: Thank you. Thanks for having me back on.

Kevin Pho: So for those who listened to our first episode together, just briefly share your story and journey to where you are today.

Farid Alsabeh: Absolutely. I got my undergraduate degree in neuroscience; I’ve always been interested in the mind. I spent a couple of years doing hospice care and working at an optometry clinic. I then went back to school for my master’s in clinical psych, and I currently work as a psychotherapist in both private care settings and community mental health.

Kevin Pho: All right. So tell me, what is the behavioral health setting today? What kind of cases are you typically seeing?

Farid Alsabeh: In community mental health, typically severe mental illness, psychosis, severe depression, and anxiety, but also more of what we would call the biopsychosocial side of things: helping people get acclimated in their local communities and develop strong social support networks. Then in the private care setting, again, anxiety, depression, and a lot of, I would say, isolation and meaninglessness, loss of purpose. So there I get more of what you’d call the existential side of things. So that’s a bit of the lay of the land, so to speak.

Kevin Pho: So you just mentioned things like isolation and loneliness. I think the Surgeon General recently brought attention to that phenomenon. So what are some resources? What are some ways that you’re counseling people in these predicaments?

Farid Alsabeh: Definitely the first thing is developing strong social connections. It’s fascinating how sometimes, the more people you know, actually the less socially connected you feel, because you have an expectation that if you’re around people, if you’re hanging out with them, then they will understand you and they will connect with you in a deep way. But really, it’s about quality over quantity. So I would say the first thing to do is to really connect with people who have a similar background, who share a similar life philosophy to you, and really open up to them and try to create that strong bond. Because as humans, we are social creatures, and we are wired to seek out those relationships and then get a lot of sustenance from them. So I would say the number one thing is to develop those strong social bonds.

Kevin Pho: All right. So let’s transition and talk about your KevinMD article, “Reviving the art of medical poetry.” Now, before I talk about the article itself, tell me about your interest in medical poetry that led up to this article.

Farid Alsabeh: Yes. My parents are immigrants from Syria, and I grew up speaking Arabic at home. Poetry is inscribed in the Arabic language. In fact, there’s a lot of research that shows that the development of the Arabic lexicon and grammar was actually suited for poetic production. So I grew up hearing a lot of Arabic verses, narrative poetry, from my dad in particular. And then, of course, here in the United States, there’s the rich tradition of hip-hop, and particularly Lil Wayne, who I think is the GOAT, and I got an appreciation for meter and rhymes from that thread as well. And of course, learning about the mind, learning about psychology, sort of gave me that kind of didactic background. So I see medical poetry as kind of the influx of all three of those influences.

Kevin Pho: All right, so tell me a little bit of the background of Arabic poetry. I know you talked about some of that in your article. For those who aren’t familiar with it, tell us some of the things that make it so special.

Farid Alsabeh: Yeah, so the origin of the story begins about 2,000 years ago in the Arabian Peninsula. There, a group of nomadic peoples called the Bedouins were beginning to speak a distinct language called Arabic, and it was not a literary language at all. Interestingly, there wasn’t even a script developed for it. But what they lacked in a script, they made up for in a rich oral tradition of poetry.

Fast-forward a couple hundred years, and you have the rise of Islam, and you have the dispersion of Arabic-speaking peoples to different regions of the world, but also to different, you could say, intellectual spheres: the Greeks in the west and the Persians in the east. So then you had a situation where this Arabic language, which was traditionally used in a poetic tradition, combined with the intellectual tradition of the Greeks and the Persians primarily. And so you get this kind of rich hybrid that comes out of it, which is didactic poetry, namely poetry that is used in the service of teaching certain knowledge. You had these teachers who were well versed, no pun intended, in creating verses, creating poems that were intended to teach students, in a very catchy way, the knowledge that they wanted to impart.

Kevin Pho: So as it relates to medicine and health, is there any history in the Arabic poetry tradition that teaches medical knowledge?

Farid Alsabeh: Absolutely. As I just mentioned, there was the didactic poetry tradition that included such things as astronomy and anatomy. But then you have, of course, the crown of all knowledge as far as Arabs are concerned, which is medicine. In fact, medicine is so highly regarded by the Arabs that in some Arabic dialects, a doctor is called the hakim, which literally translated means “the wise one.” So medicine is considered the height of wisdom. So of course, in the tradition of didactic poetry, what would emerge as one of the richest forms of it would be didactic poetry of the medical genre.

Although there are a lot of names I could mention, the medical poem of Ibn Sina, also known in the West as Avicenna, is probably the most well-known. It was passed on to Europe and actually taught in medical schools in Europe, and it’s about 1,300 lines that, in rhymed verse and metered verse, encapsulated almost all of the medical knowledge that was known in his time.

Kevin Pho: Oh, tell us a little bit more about Ibn Sina’s poem. So it encompasses all the medical knowledge at that time. Go into more detail about that.

Farid Alsabeh: Yeah, so for example, you find a definition of medicine at the very beginning. [recites the line in Arabic] So even non-Arabic speakers can notice that the ends of those two half-lines rhyme, and the translation of that line is, “Medicine is the preservation of the health of the body and the removal of symptoms that appear in the body.” And so it was intended as this kind of catchy phrase for doctors in training to be able to remind themselves, “OK, what is this art that I’m practicing? What is this theory that I’m learning?”

You also find sections about how to take care of the ill during travels. You also find sections about the four humors of the body, which was an outdated but actually a very complex theory that existed at the time. And really, almost as we would consider it, a review of systems: ophthalmic issues, gastrointestinal issues, issues related to the muscles, and so on. So it really is a very comprehensive description of medicine, again, encompassing almost everything that was known at the time.

Kevin Pho: You mentioned that that poem specifically had a lot of influence throughout Europe. Talk about some of those influences you mentioned.

Farid Alsabeh: Yeah, so for example, it was taught in a medical school in France. And I just really want to emphasize to the listeners how remarkable it is that this would be taught in a non-Arabic setting, because, of course, half of the magic of it is the fact that it’s in this verse that follows a meter and follows a rhyme. So it really speaks to the high-quality didactic training that it had that, even removed from that original poetic context, the content itself was enough to be translated into Latin, which was, of course, the primary language for instruction at the time, and disseminated, I want to say, until the 1700s or 1800s, with the rise of modern medicine.

Kevin Pho: So your KevinMD article was titled “Reviving the art of medical poetry,” so that assumes that medical poetry has become a little bit more in the background. So talk about the state of medical poetry in medicine today.

Farid Alsabeh: Yeah, so I believe there was one poet, an MD allopath, maybe 150 years ago. That’s the only source I could find, and maybe in a future article I’ll talk about the remnants of it, so to speak. But I do believe that we live in a dark age of medical poetry, and that’s why I developed some of the examples in my article. I’m wondering if I could recite one of those examples to you now.

Kevin Pho: Of course.

Farid Alsabeh: Perfect. So for example, one of them is one that I use when I’m doing an intake with a client and I suspect that they may have a depressive disorder. And so the rhyme starts like this:

For depression at least one of two / loss of interest or a lowered mood
And then some of these symptoms combined / so in total they make at least five
Changes in appetite or in weight / sleeping too much or staying awake
Agitation or movements are slow / high fatigue or the energy is low
Thoughts of guilt or of not having worth / trouble concentrating on your work
And the last one is thinking to die / either thoughts about it or to try
And symptoms continue at least / a duration of time of two weeks

So there you have all the diagnostic criteria of a major depressive disorder, along with the chronicity. So this is something that I use when I’m in an intake, for example, and I suspect that the client has a depressive disorder, in order to remind myself. There I am with my clipboard, I’m listening to the client, but then I can kind of have this very catchy verse running in the background of my computer, so to speak, that will help me really figure out what the specific criteria are that I should be asking about, and then what the chronicity is, and so on and so on.

And you’ll notice, Dr. Kevin, that it is quite catchy, and there are two reasons for that. The first is that it does follow a set meter; the technical name for the meter is a triplet. Another thing is that it follows a doublet rhyming: “For depression at least one of two / loss of interest or a lowered mood.” So these two aspects of the verse are taken directly from Arabic didactic poetry, because Arabic didactic poetry follows a meter called rajaz, which in Arabic actually refers to the movement of a camel’s leg as it’s shaking, because there is kind of something oscillating about the rhyme: “For depression at least one of two / loss of interest or a lowered mood.”

And so you talk about reviving. What I would love is for health care providers, who I know are very clever and have many talents, to try to express certain bits of medical knowledge, or even diagnostic criteria that they have to memorize, in particular in the form of rajaz, so triplet meter and doublet rhyming. Because I’ll speak for myself: It is so fun to do that. I mean, maybe I’m a bit of a dork, and maybe I’m the only one that thinks it, but I truly do believe that it works both your theoretical mind, your knowledge mind, but then also kind of the creative part.

So in my view, reviving would mean, first of all, recognizing that there is this rich tradition of didactic poetry that the Arabs, I wouldn’t say they started it, but they definitely contributed to, and then knowing that there is actually a set meter and rhyme scheme that you can follow that’s firmly in that tradition, and then really just having fun with it. I mean, listen, I’m not a physician, but I tried my hand at hyponatremia in the article, as you probably read. And I believe, and now we’re really going to test my theory, because I have to think:

If the sodium level declines / so it’s lower than 135
Then you know right away when you’ve seen it / that the patient is hyponatremic
And the follow-up test has to be / for the serum osmolality

And I promise you, I haven’t looked at that in probably a couple of months, since I wrote the article. But again, it’s catchy because it follows the meter and it follows the rhyme. And I would really encourage any health care providers who have even the slightest hint of an interest in poetry, in what’s considered rap today, in any kind of verse writing, to follow these guidelines and just have some fun with it.

Kevin Pho: How difficult, or how long did it take for you to come up with those verses?

Farid Alsabeh: The depression one, probably an hour, an hour and a half. And the one on hyponatremia, I have to tell you, first of all, I was very ambitious, and I thought I was going to get down the whole algorithm. It was honestly a learning experience for me, because I tend to be a perfectionist, and so I think the longest part of that was just accepting that, “All right, dude, you’re not going to be able to encapsulate the whole thing. I’m no Ibn Sina.” So that one took me a little while. I would say that one probably took me a combined total of two and a half to three hours. And I think the hardest part is just finding the rhymes. With the meter, once you get the hang of it, you figure out what phrases you can use, but then figuring out the rhymes takes a bit of creativity.

Kevin Pho: Any tools that you use to help you out? I know that online there are a lot of different tools to help people write poetry. Any tools that you use, or is this purely something that you just came up with by yourself?

Farid Alsabeh: I shouldn’t say this, but technically, there is a website called RhymeZone, where if you plug in a word, not only will it give you the exact rhymes, but something called near or slant rhymes, which can actually be very useful. Now, I would never use something like that, wink wink, because I’m a purist and I would only come up with my own ideas. But let’s say someone needs a bit of inspiration in terms of finding the rhyme, which again, in my experience, is the hardest part of creating meters like this and verses like this. RhymeZone can be a good tool.

And honestly, listening to rap and listening to hip-hop, because then you kind of get a sense of being able to find phrases that fit in certain meters. I would also suggest that people look up the triplet meter in particular, again, to reiterate the point, which, in addition to being present in the didactic poem of Ibn Sina, in the verse of rajaz, is also present in quite a few rap and hip-hop songs today.

Kevin Pho: Now, you mentioned that you use these verses just for your own benefit, in terms of remembering some of the diagnostics. Just in your ideal world, what are some other ways that we can use this? You mentioned didactics. I assume teaching?

Farid Alsabeh: Yes, teaching as well. In my mind, I have an image of a bunch of pre-med students anxiously preparing for the MCAT, and then one of them gives a certain verse to remember something, and they all break out into laughter. By sharing that image, I want to really impart to the listeners that not only is it didactic, but it’s really fun. It’s really fun. And I’ll give you an example. Almost everyone in grade school remembers “In 1492.” Actually, Dr. Kevin, finish that: “In 1492.”

Kevin Pho: Columbus sailed the ocean blue.

Farid Alsabeh: Yes. So that really says something, that it is kind of this shared cultural experience, and you know exactly how to finish that sentence. I also remember learning, “Red sky at morning, sailors take warning; red sky at night, sailors delight.” Now, the funny thing is, I have no idea why that is, but I have it memorized because it’s catchy, and it’s actually quite fun to memorize these things.

So I would say, yeah, especially students, especially in my generation, who grew up on rap and hip-hop and kind of have an intuitive sense of creating verses that follow a meter and rhyme scheme: Just have fun with it. Whatever you have to learn, try to put it in verse form, share it with others, and try to teach each other. I know some mnemonics from when I was an undergrad, for example, FLAT PEG, for teaching the hormones that are released from the anterior pituitary, but I can’t really think of any kind of versified mnemonic devices for, let’s say, the typical pre-med or pre-dental or pre-nursing curriculum. So I would just love for people to take this specific meter and rhyme scheme and be able to develop cool ways of learning with each other, and again, just have fun with it.

Kevin Pho: And my final question: Tell us some of your take-home messages that you want to leave with the KevinMD audience.

Farid Alsabeh: Learning can be fun. I know it’s daunting in the process of, let’s say, becoming a physician, or becoming a psychologist, a dentist, a nurse, you name it. There’s a lot of anxiety, to go back to our conversation about mental health, associated with this process. But there are moments where you can have some fun with it, especially if you’re in a communal setting. Again, to go back to what we talked about, finding social bonds, I see didactic poetry as a tool that people can use to really have fun, to keep it light as they go through the admittedly daunting task of going through some of these processes of becoming health care providers.

So get among yourselves, find the most poetically inclined friends that you have, and go for it. And who knows, maybe in the future someone will create another KevinMD article that touches on a different topic that follows this meter and rhyme scheme. That’s what I’m hoping for: a revival and proliferation of this really unique poetry form that I feel is good for the people who are learning and also for the people who are developing it as well.

Kevin Pho: All right. Thank you so much for sharing your time and insight, and thanks again for being on the show.

Farid Alsabeh: Thank you, Dr. Kevin. I really enjoyed it.