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In the Know with Mo Flow: How Low Can You Go

By February 13, 2012 No Comments
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Shakir Stewart was a young, vibrant record executive who had a huge presence on the Atlanta music scene. He famously took over for Jay-Z as the head of Def Jam Records. Coincidentally, he was responsible for signing Beyonce Knowles, as well as other famous artists including Rick Ross and Young Jeezy. On November 1st, 2008, Mr. Stewart was found dead in his home with a self-inflicted gunshot wound to the head. His family released a statement indicating that in the weeks prior to his suicide, he was exhibiting uncharacteristic behavior. His family and friends had reached out in attempts to help him, but nevertheless he was in deep pain and suffering in silence.  When I first heard the news, I could not help but think of my grandfather, who had taken his life in the same way 10 months earlier. He, too, carried his pain and suffering alone, and the shock and sadness of his tragedy is still with my family and I to this day.

Clinical depression is caused by a chemical imbalance of neurotransmitters in the brain that leads to feelings of intense sadness, worthlessness, and/or pessimism, irritability, loss of energy and interest, difficulties with memory and concentration, and significant changes in appetite, among other symptoms. These symptoms may persist on a daily or near-daily basis for weeks or even months. In the United States, depression, in all its various types and forms, is a major contributor to physical and mental morbidity across all ethnic groups, and is one of the primary causes of suicide.   In general, women experience depression about twice as often as men; however, men with depression are four times more likely to commit suicide than women.  Susceptibility to depression often runs in families, and people are often more likely to attempt to overcome depressive symptoms with food, alcohol, or illicit drugs than with medical treatment.

Studies claim that Whites are more susceptible to depression, although this remains a subject of debate as it  might be due to under-recognition and underdiagnosis among other ethnic minority groups. Approximately 10% of the African-American population will experience clinical depression at some point in their lives. The statistics regarding depression and suicide in this population are startling. For example, between 1980 and 1995 the number of African-American youth between the ages of 15 and 19 that committed suicide increased by 146%, and the number between the ages of 10 and 14 increased by 233%.   However, African-Americans are severely underdiagnosed. Studies have suggested that physicians are less likely to recognize symptoms of major depression in African-Americans in comparison to Whites,  in part due to attitudes, beliefs, and coping mechanisms related to African American culture, as well as physician factors.

As Hip Hop artists have served as journalists chronicling the struggles of their communities, the incidence and prevalence of depression among minorities has not been overlooked by this formidable genre. There are a number of Hip Hop songs that have vividly described feelings of depression and thoughts of suicide, such as “Suicidal Thoughts” by The Notorious B.I.G., “Shed So Many Tears” by 2Pac, and “Slippin” by DMX.  New Jersey-based artist Joe Budden has consistently used his artistry to describe his experience with clinical depression. Some argue that the vulnerability of the African-American population to depression is caused by experience of being Black in America itself, which has historically been characterized by hardship including vulnerability to poverty, racism, violence, and crime. However, what is interesting is that self-reported depression in the Hip Hop community is often the result of fame and fortune.  For example, Chicago-based artist Lupe Fiasco recently opened up about his recent battle with depression and thoughts of suicide, using the song “Beautiful Lasers” to detail it. His depression was mostly brought on by the pressures placed on him by record company executives and fans to produce to a certain standard, which is common among artists of all genres.  Southern rap king David Banner acknowledged a bout of depression following a struggle to pay off a debt to the IRS resulting from the lavish spending of his earnings, which is often encouraged and glorified in the music industry.

Depression can also be induced by the loss of a loved one, as chronicled by the songs “Tha Crossroads” by Bone Thugs ‘N’ Harmony, “Life Goes On” by 2Pac, “The Message” by Dr. Dre, and “I Miss My Homies” by Master P, among others.  Eminem, one of the most prolific rappers of all time, disappeared from the limelight as he slipped into a deep depression following the murder of his best-friend Proof from the group D-12. Depression following the loss of a loved one usually subsides after a few months, but sometimes it can persist for much longer, especially if it is compounded by other hardships.  Loss can also be experienced via the destruction of social capital and the dwindling of familial and social networks due to illness, incarceration, and other means.

African-Americans are less likely to seek and receive treatment for depression for a number of reasons.  The disproportionately high levels of uninsured and underinsured in minority populations is one major contributing factor.  The well-known distrust of the medical community by African-Americans as well as a lack of cultural competence among psychiatrists and psychologists is also a factor. In addition, patient-physican discordance may also play a role and it does not help that African-Americans represent only 2% of psychiatrists and psychologists and only 4% of social workers.  In general, mental and psychological health is a taboo subject among African-Americans, and this may lead to increased denial of symptoms. Some believe that the perception, and oftentimes reality, that African-Americans have to be “twice as good” in order to be considered equal by members of the majority places disproportionate pressure on African-Americans to avoid the appearance of weakness or vulnerability, which may also contribute to the lack of seeking treatment for depression and underdiagnosis.

Hip Hop artists including Scarface and DMX often talk about faith in their songs. One of the most critically-acclaimed Hip Hop songs to address faith is “Jesus Walks” by Kanye West. Such songs illustrate the fact that African-Americans often turn to their faith as a means by which to cope with their depression. According to a study by the National Alliance for the Mentally Ill, almost two-thirds of African-Americans believe that mental illness, including depression, is a shortcoming that can be overcome through prayer and faith. For example, the artist Malice, a member of the successful rap duo Clipse, began working independently of his partner Pusha-T following a battle with depression brought on by problems with friends and family, issues with the law, criticism by the media and other artists, and financial troubles.  He recently published a book about his struggles called Wretched, Pitiful, Poor, Blind & Naked and is now creating more positive, faith-centered music. Gangsta Boo of Three 6 Mafia is another artist who claims that her faith led her out of depression, causing her to officially leave the group and change her name to Lady Boo.  Although the power of prayer and faith is undeniable from a research perspective, it must be also be coupled with evidence based medical interventions in an effective fight against depression in minority communities.

Clinical depression can be effectively treated with psychotherapy, light therapy, and/or antidepressant medication, depending on the type and severity of the depression. However, it is also imperative that culturally-sensitive mental health treatment and promotion centers, initiatives, and interventions become more widely available to African-American communities as well as other minority communities. Efforts should also be made to boost the power and effectiveness of existing resources such as faith-based institutions, community organizations, and mentoring initiatives.  Exercise and diet are major weapons in the fight against depression. However, there are significantly high rates of sedentariness  and high access to foods with high fat, salt, and sugar content in African-American communities.  With the Hip Hop H.E.A.L.S. (Healthy Eating and Living in Schools) and Hip Hop F.E.E.T. (Finding Exercise Energy Thresholds) programs, the Hip Hop Public Health team hopes to educate younger generations about the tremendous physical and mental benefits of a healthy diet and a regular exercise routine. We teach the children that, in combination, not only can they help you to look good, but they can help you to feel good too!

As a people, it is important that African-Americans recognize the reality of depression and other forms of mental illness on a larger scale, and work together to dissolve the stigma surrounding depression in acceptance of its impact and pervasiveness as well as the power and appropriateness of medical and psychological treatments.  It often takes many hands to lift someone out of the abyss, but only one to needs to reach out first for the others to follow. If you notice that someone around you is exhibiting depressive symptoms, please do everything in your power to extend yourself and your resources to that person. You just might save a life, in more ways than one.

– By Monique Hedmann