Welcome to the best moment of the conference, the Film and Media Workshop. We are so psyched about this year's workshop, seriously. The title is, We're Not Making It Past 21, Juice World, Hip Hop Culture, and Substance Use Disorders. And we have two presenters and a discussant, I'm just going to introduce them briefly. Dr. Daryl Shorter is a member of AAAP, graduated from Rice University and Baylor College of Medicine. Psych residency at Ohio State University Medical Center, but most importantly did his addiction psych fellowship at NYU. So he's a New Yorker somewhere. He's an associate professor in the manager department of psychiatry and behavioral sciences at Baylor College of Medicine. He's medical director of addictions and recovery services at the manager clinic. He's program director at the Baylor College of Medication Addiction Psychiatry Fellowship. He's the author of multiple peer-reviewed publications and book chapters. So we're really honored to have him. And we also have Dr. Kristen Laster, who has the privilege of being a PGY4 resident at Baylor and under the tutelage of Dr. Shorter. She's very lucky. She's currently on the women's mental health track and has additional clinical interest in addiction psychiatry, in which she plans to complete a fellowship. And our discussant asked... What? Oh, the fellowship is going to be at Baylor? Oh, okay. Well, that's all right. And our discussant is our esteemed Dr. Kenneth Paul Rosenberg, who was the winner last year of the AAAP Arts and Advocacy Award. He is an addiction psychiatrist specializing in behavioral addictions. He's a producer and director of films about mental health issues for PBS and HBO. His first HBO film that he directed, Why Am I Gay? Stories of Coming Out in America, was on the Oscar shortlist of the documentary branch of the Academy of Motion Pictures and Sciences. And his HBO film, on which he was an executive producer, Cancer, Evolution to Revolution, won a Peabody Award in 2000. His most recent film, the PBS documentary Bedlam, premiered at the Sundance Film Festival in 2019 and won a DuPont Columbia Award in journalism in 2021. So we have a really distinguished panel and an amazing topic. Thank you. Hi. My name is Kristen. Thank you for the great introduction. And I'm super excited to be here. It's my first time coming to a conference with COVID and everything. So bear with me and the tech. Okay. All right. So running through the learning objectives. So hopefully by the end of this workshop, which will include this presentation, the film, and then discussion afterwards, you'll be able to discuss Juice WRLD's artistry, his crazy rise to fame and unfortunate demise. Also deconstruct his song lyrics to further understand his message to listeners. And hopefully be able to utilize this information in some way as a clinical tool to build rapport with your patients. Okay. So before we kind of get into all that, because that's a lot, I think it's important to define hip hop and rap music. So hip hop culture is really just a way of life. The music, the dress, the aesthetics, the language has its roots in jazz, blues, rhythm and blues genres. And then rap music is the most prominent, most famous part of hip hop culture. Rap has messaging that is complex, that offers messages of empowerment and also some illicit content. Unfortunately, especially most of the literature, they emphasize mostly the negative aspects of rap music. And in doing my lit review for this presentation, I did run across this article with historian Robin D.G. Kelly. He discussed how advocate American culture is commonly portrayed as violent and destructive, coping with the horrors of inner city life, as opposed to a more complex articulation of community and symbolic creativity. And again, like I said, the criticisms often precede the discussions about the more complex part of the music. Okay. So getting into some stats, any mental illness defined or AMI defined as any mental illness. And then illicit content on this or substance use on this slide includes marijuana, cocaine, heroin, hallucinogens, inhalants, methamphetamine, prescription pain relievers, tranquilizers, stimulants and sedatives. So when they looked at the stats, these are from 2020, the SAMHSA study, young adults age 18 to 25 had the highest rate of mental illness, mental illness and or substance use at 30.6. But when we examine black men and black women, black men reported higher incidence at 25.5 compared to black women. Unfortunately, though, they are less likely to report their symptoms. Rates of depression and substance use typically have been low in adolescence, as studies have found. And that's partially thought to be due to protective social bonds like family, school. But use increases in adolescence. And then unfortunately, that age range 18 to 25 is a real critical developmental point where a lot of the vulnerabilities that emerge are solidified, the negative trajectories. Okay. So here we have two pretty prominent artists. I think most people know who they are. So this is Mac Miller over to the left. And DMX over to the right. So I thought it was important to include both of them because they talked a lot about substance use and mental illness in their work. And I think they show two different times in hip hop culture, rap music. So Mac Miller is closer to my age. And then DMX was a tad bit older. So Mac Miller, unfortunately, died in 2018 at age 26 from an overdose of cocaine and fentanyl and alcohol. Like I said, he openly discusses addiction and depression. In a 2013 article, complex article, when he was 21, he discussed using promethazine during touring, saying he loved lean, it was great, managed his stress, but also recognized that it got out of hand and he wasn't very happy when he was using the substance. And then earlier this year in April, one of the three men implicated in his death was sentenced to 131 months in prison for the distribution of fentanyl. And this is something that I feel like is relatively new. This wasn't commonly happened, you know, going after the dealers. And again, this is DMX. So DMX, unfortunately, passed away last year at the age of 50 from a cocaine induced heart attack. He was a Grammy nominated artist and quoted as being one of the most influential rappers of all time. His 1998 classic, It's Hot, It's Dark and Hell is Hot, debuted at the top of the Billboard 200. And his sophomore album was released just seven months later and also debuted at number one. He was one of the first artists to have two number one albums within the same calendar year. And again, he spoke very openly about his years long battle with substance use and mental illness. I think they're, again, a great example of how the discussion has also been pretty fluid in the music. And leading into that. So this song, a 1-800-273-8355 is the number for the U.S. National Suicide Prevention Lifeline. And in 2017, Rapper Logic made a song about it. So the song loosely describes someone calling into lifeline saying they don't want to live anymore. And the conversation that proceeded with the counselor. The song entered the top 10 on the Billboard charts, peaking at number three. And then by the end of 2020, it had been streamed one billion times on Spotify. Data in 2021 from a study by the British Medical Journal examined lifeline calls and suicide rates following its release. So what they found in the 34 day period around the song and when it was most popular was that there was a 6.9 increase in calls to lifeline and an estimated 5.5 reduction in suicides. So it's really demonstrating that hip hop has the potential to be lifesaving. And the behaviors that they talked about in the song, the help seeking behaviors were consistent with the overall narrative. And similarly discussing other artists that have more openly discussed their history of mental illness. So in 2016, a Grammy Award winning rapper Kid Cudi announced his diagnosis of depression, suicidal thoughts, and stated that he was seeking treatment. He posted this on Facebook. And the post within 12 hours got 165,000 likes and was shared over 40,000 times. Less than 24 hours, a black woman created the hashtag, of course. You good, man. So you good is an informal way of asking, are you OK? And she was quoting as saying the hashtag was created for black men to confess, ask for help, vent, or get pointed into the direction of mental health professionals. Similar to the study that was done following the release of Logic's song, the 2021 study examined themes that were commonly discussed by black men to talk about mental health and also examined the role of hip hop celebrities in facilitating these discussions. And the discussions weren't just online on Twitter or on Facebook. There was a prominent article published in The Atlantic called Kid Cudi Sparks a Conversation on Depression, Race and Rap. So I thought it would be interesting to add or discuss some of the tweets. So three tweets, the first being, I was drinking heavily to run from my problems instead of asking for help or talking about it. I'm taking depression medication and it's OK. I hate taking pills for my depression because it makes me feel like it's the only way to get better. So I think that kind of speaks to the breadth of the themes that were discussed when these men felt safe to talk about these topics. And I think that brings us back to hip hop culture and expression, again, really driving home that it's very complex in its messaging and it is a means of authentic expression for black youth. So we move to the next part of learning objectives. OK, so this is Juice WRLD. So as I was getting ready to do this presentation, it just happened that I stumbled across this tweet that his albums, his album Legends Never Die has now been streamed five billion times on Spotify, which is like an insane amount. So Juice WRLD was born Jared Anthony Higgins on December 2nd in 1998 in Chicago, Illinois. Unfortunately, he died shortly after his 21st birthday in 2019. The official medical examiner's report stated he died from oxycodone and codeine toxicity and his death was ruled an accident. So this was his second album that was released the following July in 2020. It debuted number one, his second number one album. And then in October of 2020, he was the most streamed artist on global Spotify, only behind BTS and Drake. So it had a huge amount of influence even after he passed away. OK, so I chose two songs from the album that I think talk about his music and show how comfortable he was with discussing his struggles with mental health and substance use. And some standout lyrics like too busy drinking codeine, doing high speeds, taking a pill for a thrill. And then the song Wishing Well, if it wasn't for the pills, I wouldn't be here. But if I keep taking the pills, I won't be here. I stopped taking the drugs. Now the drugs are taking me. So I think it talks about, you know, this recreational use of substances, but also clearly acknowledging that it had gotten to a point was problematic. And in him also recognizing that this could be severely detrimental for him. And it really shows the balance between the expression of psychological stress and the glamorization of substance use. So the next several slides are based on a 2018 study that was published in the American Journal of Men's Health. It was data gathered from a series of focus groups, the purpose to examine the perception of depression and determine barriers in African-American men. So overall, the study highlighted that language to describe the symptomatology was influenced by culture, masculinity, somatization and racism. For example, depression and stress were used pretty interchangeably. The men talked about seeking treatment after a breakdown or hitting rock bottom. The facilitator also asked participants what the word depression means to you. And they described feelings of isolation, separating themselves from family and friends, not feeling like themselves, suicidal ideation, and then also being encouraged by family members who were concerned with them. So it's possible that for several reasons, that when African-American men present to these primary care settings, where most Americans are diagnosed with depression and mental illness, that they're simply being missed. So they never make it to actually see us as specialists. There are also voiced concerns around mental health providers being able to actually understand where they were coming from and their experience. And then also there's this idea within the community of working hard to overcome stress and feelings of depression. So that can further mask symptoms if it seems like the person largely is functionally OK. Also, they brought up the impact of trauma, a key factor in developing symptoms. I think I spoke about the general mistrust of the medical system, especially around medications, and then got into this idea of being dependent on medications and following with that as well. This idea that mental illness could be volitional, so it's something that shows a weakness, gets pity, it's pointless, and instead turning to more acceptable forms of support like religion. But I think taking this is important, considering the context of African-Americans in this country. So stereotypes of black men have been viewed as poor, hyper-masculine, and threatening. So to counter these negative ideas, black men have downplayed their race and feelings of frustration, and overall just didn't openly talk about what they were experiencing. But what they did find from this study, which was interesting, that similar to the Twitter engagement that was seen with the hashtag YouGoodMan, that the men talked about being open to going to support groups with each other. So having nonjudgmental spaces where they could discuss these things and, like I said, get that support from each other. Previous research has showed that group-based programs have been effective in reducing maladaptive behaviors in male adolescents. All right. So we get into some of the end of our slides. So HIPPOP as a clinical tool, just some things to keep in mind as you're watching the film. I think it's important, especially if HIPPOP isn't something you listen to or you know a lot about, to be very curious about it and recognize that it is a legitimate art form. I think it's a way for you to relate to your patients, you know, asking them what artists they like, what songs they like, why they like them. And it can give you like a different type of window into where they're at, especially for younger patients to kind of see where they're at. Also, and this is funny, it's a little bit outside of my generation, social media. So TikTok, Twitter, Facebook, all those different mediums in which the younger people are talking about mental illness. And it's been more acceptable to talk about in general. And I touched on this a bit, you know, talk about their artists, preferred artists, why? What part of the music reflects your experience? What is the relationship between music and substance use? So I think, like I said, it's a way to build rapport with your patients and also provide a lot of information. So final thoughts before we get into the film, which is an amazing film. If you had someone like Juice WRLD or some of his friends come into your clinic, how would you treat them? You know, where would you start with them? And I think that's that's the big takeaway that we want you to think about with this. How do you engage, especially your black patients in mental health in a way that will keep them engaged? Yes. So over the next. Thank you, Kristen. Great job. So over the next roughly 50 minutes, we'll be viewing a portion of the documentary was filmed and shown on HBO called Juice WRLD Into the Abyss. We have truncated it so that we're not going to be watching the entire documentary today, but rather three separate videos. And so we'll ask our friends in the audio visual realm to get us started and then we'll come back for our discussion. Thanks so much. Oh, yeah. Resume to be so, you know, I got a murder. They act all tough, but in person, they be murmuring and mumbling. Put a gun out, they get to stumble and tumble in the chopper. Get the thunder shitting on all these haters like with a plunger. I'm excited because now I could throw a party. People that hate on me won't be invited. True religion like the Buddha. Indian style. I'm enlightened. I remember up in kindergarten, teacher told me I wouldn't be shit. And then she saw me play the piano and made all the other kids see sick. Even though I got a couple of demons, I'm still screaming out. Thank Jesus. Upside down pyramid on me just to compliment Jesus pieces. I was a fan of you. That's why I pull cards on these stupid hoes. Got an arrow, not a bullet. Cupid hole. I bought perks to know I'm on a plane because I heard you live. I got to take everything. Sometimes I heard to give. I make money, even though sometimes it don't make sense. Speaking of taking everything, it's time to take shit. And every single person that said I wouldn't do it. Every single person that said I was stupid. Every single person that said I was that Netflix special. What's the name of the show? Oh, Clueless. But no, I ain't clueless. I got this. I'm on top, so nobody can top this. Now it's time to change the topic. I got away with words like I'm running with a phonics book. In school I didn't do the homework, but I still got the subjects. Money ain't the object. Money is the object. Living tough, gotta admit that I'm successful. But I feel like my hair sometimes a little dreadful. I grew up on rock, rap, heavy metal. Now I'm riding bikes, pedal to the metal. I don't even got a pedal. It's a throttle, so excuse me. These niggas faking in some optical illusions. I be looking like, what the fuck is you doing? You ain't getting money. You ain't changing shit. You ain't changing the world. you just stupid. Talkin' bout you crackin' cars, sellin' drugs, killin' niggas and goin' hard, watch a real nigga come up in your car and lay with you, all scared, finna piss yourself, shit yourself, you gotta admit yourself, you need some help, I gotta admit myself, I'm on these drugs, feel like I can't save myself, sometimes I wanna take myself, break myself, so I could reshape myself, nobody ever felt the pain I felt, before I share it, put it out to the whole world, I ain't embarrassed, bunch of these niggas is my sons, I apologize to them cause I've been a bad parent, don't try me cause I'm not the one, see I won't even count the two, for all you racist white motherfuckers you got bullied by Jigaboo Jones, I'm in your home with a gun to your dome, or I'm in your home putting dick in her dome when I'm talkin' bout your mama, I'm sorry, I'm disrespectful so I beg for your pardon, but no I ain't begging for shit, I gotta say that at the beginning before I even get started. That needs to be like pulled up in the room and that shit needs to happen again. That's fucking right, you need to just put that on your album just like that. That was a special one man, so much emotion, so much emotion and yeah some of the stuff he says in it is so raw and so real, that's real art, that's not art to sell, that's just pure expression. With freestyling it's literally like all off the top of the dome, you making up words that rhyme in real time, you know what I'm saying, and when you can make up words that rhyme in real time with stories that align, it's like you one of a kind, you feel me? And so he is like, it's like all that in one and it's like it's just going and it's like wow, the top motherfucker can't do this, the top ghost rider who's riding for the top people can't do this, it's like you, you, you, you troll. He goes in and does the entire song from start to finish, the whole song, the entire thing, three minutes, four minutes, however long the beat is, he's going. So he does the whole song and he goes alright run it back again, does a whole different song, complete different song, then he goes alright run it back one more time, whole different song again and then he goes pick the best one and then we do it nine more times each time I'm in with him. And it was, in that moment my jaw dropped and I said oh I'm in the room with a superstar, like I'm in a room with a guy who's going to go down in history as one of the greatest artists of all time. I remember the first time seeing his name up there with like Drake, Juice, Taylor Swift, Post Malone, Travis Scott, these are people who have machines behind them, right? That's their whole, the whole, you know, drive behind some of these huge artists like, you know, whoever's up there is, that's part of their stature is keeping them in that top five in the world. You know Juice wasn't trying to be that, Juice just became that. It's just crazy he even said he just became that, he just became the biggest thing in the world without trying, just making good music. Hell yeah, bro. Thank you. Down you go. Down we go. Make some fucking noise! Y'all live tonight, huh? Y'all fucking live tonight, huh? Oh, come on. Fuck those people! and I don't, too, I ain't never, I'm gonna tell you straight up, I ain't, I don't think I've ever seen a motherfucker that can, that type, let me tell you, my first sit down with Juice WRLD, alright, that motherfucker got it, got it, it was a pleasure hanging with him, man, he recognized what's going down, I love what this motherfucker's doing, extremely humble, that's character, Juice, I'm talking about you, big bitch, motherfucker I wanna be by my lonely, I bought the park by my lonely, I put in work by my lonely, 40 on me, you know it's my homie, I wanna be by my lonely, I take the park by my lonely, I put in work by my lonely, 40 on me, you know that's my homie my mind sometimes gets dark and wild, my mind sometimes, I don't wanna be bothered, inhale, exhale, breathing just got a little harder, I mean well, I mean well, all's well, it ends well, inhale, exhale, losing my sanity, probably I'll see you in hell, yeah, I'ma meet you there I'm trying to have a conversation with my slime, I'm out here, that's your boy, that's your boy, that's your boy, Max Lloyd, bro, look at him, what's wrong with him, Slatt, where the fuck you at, I'm back, I'm in L.A., I'm at this little crib, I'm at, this motherfucker, it's a wave Oh God, this shit got an elevator in this motherfucker, all type of shit, shit, I just learned really within the last two, three weeks, like two or three weeks, I got decent at this shit, but look though, when I was a shorty, my, my, my homie and him stole a four-wheeler, that's how it all got started Maybe I hurt yourself on this shit, man Hell no, I can't fuck up the money I don't know if this is going to blog or not, but this is all you need in life Nah, don't go, don't, don't ever I mean everything's worth a try except for like cracking shit Yeah, exactly Wait, you're not supposed to try it? Huh? Crack? Oh no, hell no, no sir, only if like, you really want to, head ass, nah All my life, I've had like ADD, so my mom has been putting me on Vivense, Adderall, I've been on all the doctor's appointments, so it's the same shit And I don't really agree with that shit, bro, I was in fifth grade, getting diagnosed with ADD, how the fuck can you tell a fifth grader they have ADD? He's in fucking fifth grade, how's he supposed, how's he supposed to act? I would think it was something wrong with a kid if he was in fifth grade and he was just wired to class like this I would think that he needs some fucking, I don't know, like Xans or some shit, I don't know Yeah, like that shit, that shit, and that shit didn't have me feeling right, bro, like I should write a book about that and expose like the whole shit, cause that's like not right And I wasn't even the only kid that was on that shit in my school But like, it just felt like, you know, you took the pill For like 15 minutes, you like, all your personality is like enhanced Like you're all social, class clown, laughing, after 15 minutes it's over It's like Yeah, yeah I mean it's like, bro, it's like Everything feels surreal So it's easy to just keep moving And I, I, sometimes I just want to take a second out of my day and think about it Like obviously I know I'm blessed, I'm beyond thankful, like I thank God every day for this shit Like I'm blessed, bro But It still feels surreal, it still feels like at any moment in time I could wake up and be in my bed and be like, what the fuck I knew this was a dream type shit But I feel like when I stop and think about it, if I stop and think about it That's how my head is gonna get too full and that's how I'm gonna become An asshole, somebody that went to Hollywood, somebody that You know, not a genuine person So I just keep it moving, I just make sure to count my blessings And sometimes this shit gets overwhelming but this is what I ask for, you know, bro Like, and I wouldn't, I wouldn't want to do anything else Yeah, I feel that I wouldn't, this is my passion, I love, I love music I love spreading a message, I love speaking my mind Yeah And me being able to do all those things on one platform is, when I say it, a blessing, bro So like Yeah I wouldn't trade it for the world even though sometimes, you know, shit is kinda Shit can get hectic Yeah It can get hectic, man, you got, you got a special soul, bro You know what I'm saying? Congratulations on all you, all you're going through, all you're making, you know what I'm saying? Thank you, bro, thank you, thank you You can tell us it's all authentic and well-deserved, you know what I'm saying? Thank you, brother Like, it's really a real thing for a real reason, man Like, you're one of the, like, special children that's supposed to come on Earth and, you know what I'm saying? Do what they supposed to and you definitely doing it Thank you, bro, I appreciate that, for real, for real It's the least to you Man, that means a lot coming from somebody like that I admire, bro, like You got that shit, bro For sure, shit's gonna be lit, bro How's it going? I'm good, no complaints, how about you? I'm doing really well, I'm excited for you, we're on the set of your Billboard cover shoot right now I'm super excited you're releasing your sophomore album, A Death Race for Love You were telling me a little bit about, you know, just how you've struggled with anxiety over the years Do you feel like you touch on that a little bit in this album? Yeah, I do touch on it, I do That's something that I feel like a lot of people neglect Which is completely and utterly wrong And me speaking from an African-American man, I know that that stuff is neglected Our community, you know, you tell your mama, your dad, your auntie, whoever that You feel like you got anxiety, you feel like you got depression, you feel like you got ADD, whatever They don't look at you like you're crazy Like, you don't got that, get out, go, get out of here, like Are you gonna tell me I don't got something, you know? That's not how it should be, but that's how it is And that needs to change And hopefully I'm one of those people that can bring that change Or at least start a chain reaction for somebody else to come and do it after me Yeah, so much money, get it up, get up and down, yeah Look at my bank account Look at the cash I got I'll get the cash I want I'll get the cash I want Look at my bank account Look at the cash I got I'll get the cash I want All right, wait, hold on. So we have an attorney right now. Yo, Herb. Who that, Herb? Yeah. Yo, Herb. Hey, Herb. I'm gonna kick your ass, boy. Hey, Herb. Hey, Herb. Pull up, bro. Pull up. I want all the smoke, bro. I want all the smoke, bro. Pull up. My. Man, on L's. Knock it off. Show you what the fuck you got all these bikes for, man. Stupid, rich ass bitches. Look at this. This a motorcycle, though. This is legal. This is street legal. Yeah. I've seen yours. Yeah, I'm popping wheelies. This is my fucking wheelie. You popped a wheelie on this? I do it right now. Oh, my, my, my, my, yeah. Oh, B.O., you got a wheelie on this? I do it right now. I swear to God. Sure, you a stupid ass. Oh, I'm scared to hop on this bitch while I ain't on. You gonna ride this one? Yeah, yeah, yeah. Teach me how to ride it right now. This E? Oh, Captain, teach me how to ride it. I'm finna get on this bitch right now. What do you got? Ah, I'm supposed to teach you how to ride. You scared of me to get on this, B? Why y'all letting him buy all these bikes, bro? He crazy, but I ain't gonna lie. I love that nigga, folk, because where we come from, man, I don't know if I had some juice, real money, I'd be buying way more than motorcycles, rather than bitches. I don't count much. You know what's up? My shorty's spinning his sack so humbly, I ain't gonna lie. He really humbly spinning his sack. I was gonna say, he doesn't really spend his money on much, to be honest. He don't. I just said, I know he don't. I'm telling you he don't. He really humbly spend his money. Yeah, he really is. That nigga don't spend his money on shit, to be honest with you. Cause look, if I went eight times platinum, swear I'd be riding this bitch acting brazy, boy. Brazy. Brazy. Yeah. Let me hear you say it. Say this shit, it's time for y'all to go to fucking hell. Hands up. All you niggas, I'm gonna ask you a hundred questions, but this time I'm gonna be quiet. For this time. ♪ Ain't nothing like the feeling of uncertainty ♪ ♪ The yearning and the silence ♪ ♪ This time it was so much like today ♪ ♪ Last time all the drugs he was licin' ♪ ♪ All legends fall into madness ♪ ♪ Sorry Drew, Diana, D.B.U. ♪ ♪ What's a 27 club, oh, oh, oh ♪ ♪ We ain't making it past 21, damn it ♪ ♪ I've been going through the pain of what I am ♪ ♪ So I always gotta keep a gun, damn ♪ Everybody be quiet real quick. My brother just did this show. He just lost his father two hours before the show started. He came and gave his heart. Make some fucking noise. Put your hands up. Put this shit, B. We fucking love you. ♪♪ ♪ I wonder if my habits kill me ♪ ♪ I don't know why, but I get that feeling ♪ ♪ When I walk into the building ♪ ♪ There's this feeling of chilling ♪ ♪ My hands are cramped the fuck up, bro, mine ♪ Hey, could you go wax CJ up real quick? Oh I So Chris McDonald's higher than negative shit, so we make dollars this morning Fuck it with it. I remember dash all girls insane It was so It's a life Fry I Record 24-7 Nothing stop it. It won't shoot up. I'm gonna get it all Started down Oh, I'll focus you better catch on Hi, my name is Perky and I can't reply I Believe it. He wants your last name Your phone It's right Love you Sorry Say if you can't I Got a dollar You Hey Watch before me. I know He's gonna interview you for 15 minutes and then the kids are gonna ask you questions This discussion On how I start really achieving our dreams in the real way like juice day because here he was sending these same seats My name is Anthony lot. I'm 13 and my question for you is What made you want to start doing music in grade school? I did a lot of sports. I played basketball. I played baseball I was just average good, you know, so like it's 30 other people just as good as me It's not better on the court at music And I gave it my all and it came easy So that's just something that I always excelled in even when I was playing piano playing guitar Whatever always just excelled in music. So why not take it as far as it can go? I Was a lot of shit on my head and I was like it was the first day I had like You know what I had first I really like thought about like making better choices in life and I was just like You know how when you try to make a change, I don't know if this is what y'all do, but this is what I do If I'm trying to make a change in something I'm trying to change myself in a way. I look at like all the all the reasons why to do that you know say so like the reason for Somebody to you know to get sober is to be there for a family or it's a you know I'm saying to be there for a loved ones or whatever Or like, you know or like my girl right, you know, I'm saying she's the type to worry so like if something happens to me she you know, I'm saying she never or or She the type that she don't want me to like Since I'm famous and everything is at my disposal. She don't want me to get tired You know I'm saying type shit. So But you know how like some people say drugs and turn somebody attitude and make somebody a different person So that's why I was like It's none of my feelings if I let them kill him my baby and never forgive me like Yeah, like it was like I was it was some real shit. I'm going over niggas hands. Yes It's really awesome I've been getting rich. I don't forgive but I still don't have to get man. That's good Man that's crazy Off the rail I pull up on them shoot on with them hollow tips I live my life like I play Grand Theft Auto shit. I've been a car me for speed on with the ship Hey, hey me and that's busy talking shit. Hey, I'm taking but it's busy. Fuck you, bitch Matter of fact, we both take it. He got a wife. We married shit Hey, you run up on me chopper hit you in your lip Hey If your mama want to smoke I shoot it in the tips a gun bisexual is to the nigga in a bitch Hey, if you try to snitch I kill you better plead the fifth Hey, if I catch a body, you won't know who did that shit wanna know why? Oh Big-old guy will go with the club. I just told the whole world they could suck a dick I didn't travel around the whole world trying to get this rich. I didn't travel around the whole world hitting all these licks Niggas giving up they old girls for autograph of the pig Yeah, I Say niggas give up a whole girl just to get a pic Oh Oh He still liked to sip lean But he didn't sip it as often because Ali Made that a thing that he couldn't do that anymore So Ali was pretty strict about that But of course he would still do it and and he would hide it And when he did get it, he would he would always be like go go pour me up this You know what? I mean go take it up and we'd have to hide it in something we thought he's asleep and stuff, but he'd be like pouring a four in this or whatever and I I'd never pour him up what he thought he was pouring up in here and then he'd be in there and Pouring a four in this but it's like, you know, you really poured like a one He'd really be pouring like a one in that and he wouldn't even know it if Ali's in the studio. He'll text me like, um Go get a can Sprite. I never forget this go get a can Sprite and pour a four in a can Sprite Now if niggas don't understand that terminology a bar is four ounces of lean four ounces No, you can pour one ounce in a soda rock out with that In a regular 20-ounce soda this nigga drops fours and a can fucking soda and What blew my mind was I'm like, whoa, like I'm reading the text like oh Okay, I'm going out to fuck around and go get it Chris long out there. He like you you gotta go I'm like, yeah, you feel me like you're you're you know, like you're like, yeah, don't don't pour for Don't pour before pour my line in a half if that do not pour for in that soda, you know, what's up guys? I'm Chris long. Welcome to the vlog my channel as you know juice world's photographer and videographer or whatever, so This weekend we're going to Chicago to celebrate his birthday. It was just his birthday the other day, but we're going this weekend Saturday We're flying out there. We're gonna have a birthday party with his mom and family and friends and stuff like that from out there So we're getting ready to leave right now Normally, I would just be around but I had some errands to run because I was juices my personal cinematographer But I also was his personal assistant He had a pint lean and it was hidden in my room and When I got back to the house That was gone. And then I know that him and Ali were in the room and I could hear them fighting Cuz he was really high. So while I was gone I'm pretty sure he drank that whole pint by himself and then the combination with the pills that he took We calculated it up and it was like over 20 pills a day. It was I Think that one's us straight ahead Hi, how are you? We were like six hours of late for the flight so right away the pilots probably pissed about that I Remember seeing the pilot do something that look kind of You know weird. Yes. I remember just sitting down. He was just like count the side and just observing us It was like the last flight out We should have taken off pretty fast But like we probably sat around for like 15 minutes before I took off and like something's not right I Get with the winning team Future right He's gambling with loaded dice we can't lose And then we finally took off and then that was it Before they got there was just regular we literally just drove right in and we was sitting there waiting me and the drivers So he was waiting when the when the wheels touch the ground That's when I seen cars pulling up and I pretty much thought they were fans Cuz it was marked cars and then until I seen a sheriff car Then they also didn't tell me like it was an issue because I was questioning like what was going on You know, and they wouldn't tell me anything We knew there was police there before the plane landed because we got service I knew he had his gun I mean it was just just throw up my camera back and that was it. Yeah, I'd nothing worried about That's the point of an entourage. You know, I mean like that's that's the point of having friends around that you trust He had all the money in the world with you know, everyone would have got out eventually You know what? I mean? Like it is what it is. I Remember walking off and saying through the window or the police and shit I'm thinking like what the fuck you say everybody get your passports out So I'm sitting down and juice was sitting across from me It's like me you are right now. She money was sitting right there. I Remember She listens you money shook hands She listens you money shook hands he Like that that she money Which was sitting behind him back-to-back in the same chair. Sorry. I have to close my eyes for this and I heard I like I Swear it was his demons leaving him and he screamed Ali and put his hands up to grab me To reach for me like for help and he sees that The J had a seizure Start having a seizure He's already having a seizure Ali was trying to Get him together snap him out of it. I got a froze. I Snap him out of it. I got a froze. I don't really know Like what the fuck I could do to help. So we're all just sitting there panicking. He's like, what the fuck? And that's us. We just thought he was having a seizure. The blood started coming out His mouth has those and Everybody obviously started freaking out way more than the police Came over to us all and all handcuffed us all And they handcuffed us in a line and they was like get the fuck away from him They handcuffed us all in the line except for Ali Ali was Ali was like y'all nothing He cussed me and that's Helen. I like chill out. He's fine. Chill out. He's gonna be We're all looking like bro, he's bleeding that shit was fucking me up seeing the blood come out his mouth like I Like kind of like turned and closed my eyes that she was then I also made me cry in the way I don't know. I don't really cry for real. Like I Don't know. So I like just turn away and just seeing them I don't know imagine seeing somebody you feel like your son on the floor and blood. I'm down if in the crowd most Ali was trying to Get him together snap him out of it She's yelling screaming for someone to help the cops to help No, not in time it was slow it took the time that's what it seemed like It didn't seem like it was any urgency with them thinking about it he probably he's probably gone, you know thinking about it Right then and there but they took him away And Sure, I don't think anybody really well, I haven't been in a situation like that somebody having a seizure You know, I call my aunt First thing I'm telling her is like hey The Jers, okay But they're taking him. He's gay. He just had a seizure. He's on his way to the hospital I think he was okay. I Told my aunt that My nephew called and told me that He had a seizure and they were taking him to the hospital that's like 3 in the morning and so Of course I did. That's the last thing I expected was a call like that. But Yeah, I remember it quite well That's one of those things you just you know, I will I'll never forget And turn to the sudden and shocking death of rap star juice world The 21 year old who's named billboards best new artists this year suffered a medical emergency at Chicago's Midway Airport late Chicago rapper Juice world died as a result of oxycodone and codeine toxicity That's according to the Cook County Medical Examiner's office today. He suffered the medical emergency at Midway Airport as federal agents searched the luggage on board the private jet that he was on. These startling pictures here, obtained by TMZ, show why federal authorities were taking a closer look at the flight. 70 pounds of cannabis found inside 41 vacuum sealed bags. In addition to the cannabis, authorities also discovered six prescription bottles of liquid codeine, three firearms, and metal piercing bullets. And in another cryptic tweet he shared just last week, Juice wrote, quote, this life is yours. Do what the F you want to do. Great things and change the world. Don't let no one tell you shit. And you'll be bigger than Juice WRLD will ever be. And he's going down as a legend. You know. You know. You know you fucking want it. You think he wanted to die? I do. I listen to all the music, man. And that's, he said it in over 20 some songs. Over 30 songs he said he want to die. And he freestyle. He don't write. He don't even take five seconds off to think about what he's going to say. He just go straight. So I think that's how he feel. He was so good at articulating his thoughts and feelings. We ain't really even, like, realize that that's the way he feeling. Because it's turned into so much beautiful art. He created something so precious with it. It was hard to, like, separate the two. You know what I'm saying? Like, even for him, that's what he loved to do. He loved to do everything that he did in life. He loved to record. He loved to sit in the studio. He loved to stay up late. He loved to eat pizza. He loved to get high. Like, that's what he loved to do. You feel me? And I love to do it right with him, to be honest. Like, when I'm having a good day, I used to drink lean, smoke weed, and pop pills. When I'm having a bad day, I used to drink lean, smoke weed, and pop pills. So it's hard to, you know what I'm saying, separate it. I don't know what we're doing it for. We're just doing it. The idea of no longer being on this earth anymore, it's such a, it's very simple, but it's also very complex. And I think the thought of it is easy to process, but the reality of it isn't so easy to process. And I think that's something that, you know, that Juice was experiencing. He knew anyone in that position knows the results of what these things could be, but no one really processes what that actually means. No one ever thinks that's actually gonna happen. You know, I'm talking about Juice himself. He got caught up in something that he didn't know the power of. We ain't thinking about the drugs we taking. We just taking them. We ain't thinking twice about that shit. We covering up from nothing. This some shit we done. What we was doing back when we was fucked up and broke just to maintain. It's like, you get some money, that don't mean your problems go away. So we still on the same shit. We just got more money to do it. So now you doing that shit at a higher rate. I think he was having a tough time with just like the whole mix and how everything hit him all at once. Cause like, once you start getting so much money, you can start doing so many things and so many things start coming at you at like at one time, you feel me? So it's like, how do you even know how to control some shit like that? You know what I mean? So it's like, it really goes deep. You feel me? It gets deep. The abyss goes crazy, G. Really and truly. Talk to me about the abyss. Ah, something that me and Juice talked about. We both, it's funny too. Cause me and Juice came to this terminology just by chopping it up with each other one day and just talking about how, just like how depression can go. You know what I mean? And how sad things can be and how like far you can fall into that pit. You know, that abyss of darkness and like, just, it's hard to explain. Like demons at play basically, bro. The world is crazy and really and truly when you're in that mindset of the abyss, it's like everything hits you harder. That's what he would say. He's like, I feel just detached. And I'm like, so you don't, like you don't understand like, you know that you're like this idol and like all this and like, you don't see all that. And he's like, nah, I do. But I feel like sometimes I can't feel it. And I can't, like, it's not really there. We started talking about this thing that we both have. It's called depersonalization. And we just started talking, you know, because I had never, before Juice talking about it, I didn't know what that was. And my whole life I used to tell my family, like, yo, I don't, I don't feel real. Like, I feel like fake, dah, dah, dah. And they used to, my family, they dumb ass, used to be like, oh, like what? Like this moment is too good to be true? I'm like, no, it's not that at all. It's like, I literally don't feel real. So talking to him about it was kind of like, like a relief in a way. Or like, you know, just talking to somebody who understands you and understands what you're going through. And see, I didn't really understand his music because it wasn't really for me. So I didn't understand, you know, what he was saying, but obviously his fans, they did. And there were just so many messages how he helped them with anxiety and depression. And some even said he stopped them from committing suicide. And it just, I was just overwhelmed. Something about his music just touched the hearts of people. You know, they could just relate to it and it made them feel better. One of the strangest days of my life, Juice was supposed to perform, but they turned it into a tribute show. And, you know, I had never been in front of that. There was like 75,000 people, I think. And I went out there and I just pressed play and I just saw like every single kid singing every word. I don't even think he knew. I don't even think he knew how much he meant to all these kids. I really don't. Because you couldn't know. I didn't even know until like, and I'm seeing the way these kids like crying their eyes out, singing every word. Whether he knew it or not, Juice was a therapist for millions of kids and gave them songs that could help them cope with being alone, feeling like a loser, feeling depressed, not knowing how to express yourself, you know? And he was really like a voice of that generation. Everybody just wait, wait! ♪ I still see your shadows in my room ♪ ♪ Can't take back the love that I gave you ♪ ♪ Still the point where I love and I hate you ♪ You think Juice will get as big as he did? Me, I always thought that. I think I was probably the only one. Even, I don't even think Juice thought that. I always knew when I heard the, soon as I heard Lucid Dreams, I'm like, we don't gotta do, like that song just, it was different, man. Like, it cut all the extra shit. We skipped steps with that song. You skip, you know, that's one of them songs. His numbers was crazy as fuck even when he was alive. Keeping up, battling Drake in the weekend and shit. Like, who, this thing is over here sword battling Drake for numbers and shit, son. Like, that's something serious for somebody like Juice. Come on now, bro, that's crazy as fuck. Who was basically in a game for two years. Yeah, it was like, hello. And then it started doing crazy streams, like Drake number streams. Like, I know out of nowhere, y'all just started liking Juice. It was like, y'all probably don't even know which y'all started liking Juice from, you know what I'm saying? But out of nowhere, Juice's world was there, G. Juice's legacy will be, making incredible music that is timeless, being a phenomenal person on and off the stage, in and out of the studio, being a family man, being a lover. That boy's a lover. That boy understands love more than a lot of people. That boy's a lover. I think just being a well-rounded human being, you know, I think it goes beyond the artistry with Juice. I really do. And I think as time goes on, as people appreciate him more and more, because that's what happens, you know? That's how this goes. You know, there's gonna be people who are Juice fans who aren't even born yet. You know, that's a beautiful thing. For the rest of my life, for the rest of your life, and for the rest of everyone's life who's watching this right now, every minute of every day, for the rest of all of our lives, the whole world will be playing a Juice WRLD song. He's here forever. And he's not going anywhere. And that's what a legacy is, is leaving your music behind, and your impact, and your message behind for people to adopt and then, you know, lead on with beyond that. And I think that's what Juice's legacy is. Where am I at? I'm in paradise. I'm actually FaceTiming, not FaceTiming, I'm slow. I'm on Instagram live from heaven. I made it, y'all. I'm up here, boy. So we probably all need a collective breath after that documentary. It's incredibly sobering, horribly tragic, the loss of Juice WRLD. And as I was re-watching today, I am, I never cease to be astounded, really, by how remarkably different Juice WRLD is from the rest of the world. I'm astounded, really, by how remarkably talented he was. The first clip where they show him freestyling just off the top of his head and doing so for multiple minutes. And then he says, run it back and do it again. Run it back and he does it again. Unreal. And then you look at the numbers he put up in terms of streams. As Kristen mentioned in the introduction, over five billion streams on one album. I was looking yesterday on Spotify, this is not a plug, but I was looking yesterday on Spotify at Lucid Dreams, which was one of the bigger songs. And it has well over two billion streams on one single platform. If you add in YouTube, if you add in Apple Music, if you add in whatever your, maybe your favorite streaming service is, just think about that's one song. And he was dead by 21. Which he had predicted multiple times. So just forgive me while I try to kind of get myself together, but I just, I'm very deeply saddened by his loss. But also, I think, like his friends talk about the very end, he's left his music with us, which is something for us to really wrestle with. It's something for us to use in environments like this to hopefully better understand the experiences of people who appreciate his music, who use his music as a form of therapy and self-expression, which is something I think we should talk about here. Because of its ability to really save lives. The idea that a song would come out that, where the title is the suicide hotline phone number. And that number results in people calling and not attempting or committing suicide because of their exposure. Hip-hop has the power to save lives. And yet, in many of our academic centers and practices, I don't know that we always give it the attention that we should. As a result of this, I'm beginning to ask my patients more questions about the media that they consume. I am of a certain age now, so I don't understand TikTok quite as much, or spend as much time on social media. But our patients do. Their kids do. Their families do. This is a pervasive way of interacting with each other, of building a sense of community, and of feeling understood. But what does it mean when the music that someone is consuming is also talking about their impending death? Is that a cry for help for the individual listening? Is that something that we, as psychiatrists, should be wrestling with? What about the real rampant substance use? The sort of glamorization of it? At what point do we get concerned about that in folks that listen to Juice WRLD? So this is partly, as Ken and I kind of talked about yesterday in preparation for today, part of this is about Juice WRLD, to be sure. But what about Juice WRLD fans? Those are the folks that are gonna be coming into our offices. Those are the ones who we will be talking to, and their parents, and their grandparents, and so forth. So I will go ahead and open it up to the other panelists. I wanna hear kind of your thoughts, and then we'll maybe do a little Q&A. Ken, you wanna go first? Yeah. Sure. Well, thanks for coming here and staying late, and thanks for this really beautiful kind of thing to bring to our attention. When Dr. Weiss and I saw it, there were some other films, very worthy, but we thought that this was really an important film and an important project, so thank you so much for bringing it. It's also very important for this moment, to just get it out there, that this is a time that our nation is reckoning with a past and a present, and thinking about the future. So I think that this really factors in. So how do we, and I think you raised it, but let's raise it a little further. When we'll see people like Juice WRLD in our office, that might be hard to understand, but he's a celebrity, and he brings a lot with him, but what do we do when we see the people who aren't so famous, who aren't so brilliant and talented, and how do we kind of connect to them? And I think that's an issue for us as psychiatrists, particularly in light of dealing with structural racism. Just again, to put it out there, about 5% of psychiatrists are black. We know that in the world of substance abuse, in the world of incarceration, in the world of people who are identified as being psychotic, disproportionately, black people are overrepresented in that, and I think that we have to really think about when we have the Juice WRLD fans come into our office, how is our own prejudice and failure to understand really coming across? I think that one of the beautiful things that this presentation tells us is that we really do need to understand. When people think about hip hop or rap, they're like, oh yeah, I saw Hamilton, that was cool. I could kind of understand a few words, but to really understand the culture and the meaning and what Juice WRLD was doing, which is called emo rap, if I'm not mistaken, emo for emotional, and this is not something that just Juice WRLD is doing. I happen to be making a film now where we're filming people who are not brilliant and talented like Juice WRLD, but they're wrapping their lives and wrapping their struggles with serious mental illness. So I think that we're gonna open up a little bit, I think, but one of the questions that's out there is how do we as psychiatrists better deal with the issues of people whose world, again, most psychiatrists are 40 years old plus. How do we deal with these kinds of issues? Because this is really important and these are the people who desperately need our help and it's a world that most of us don't understand. And it's in that spirit that we want this presentation to bring understanding to folks who don't get their due. That's right, thank you. Do you want to just say one more thing? So I already talked a lot earlier, but I remember when I was talking with Dr. Shorter about doing a presentation and we watched a movie and it's a lot kind of how everybody collectively felt just watching it here and it's still a lot watching it. Almost defeated feeling like, what can we do? How can we help with this problem that's so layered? He said with structural racism, our patients who aren't celebrities, who don't have access to money and wealth and all these different things. But I think a starting point is just having the conversation because the conversations aren't even being had. Like I said, it's very overwhelming to think about this as a whole problem, but even if this opens up the conversation with your patients in a way that you can relate to them, I think that's a good starting point. Something that they can relate to, build rapport with them and keep them in your clinic and keep them engaged. Yeah. Thank you. As you all were talking, I was thinking about what would it look like to employ a hip-hop intervention in my own practice? What that could look like might be, especially for folks that may really appreciate and love the art form, perhaps writing their own hip-hop song. Ooh, I'm really over 40, I don't think it's quite a song, but verse, let's go with verse. Their own hip-hop verse that maybe expresses their internal thought life, emotional life, talks about their relationship to themselves, to the family, to community, and to substances. I do want to make sure we open it up for comments and questions, so please. Greetings. My name is Carol Weddington-Hunt. First, I want to speak about having patience to write rap. I work in three places, mental health center, a jail, county jail, and ACT program. In the county jail, I have a lot of patients who like rap. I had one patient who called himself a player and had 11 children. Now his daughters are being played. I had him to write a rap as a message to his daughters. It was very thought-provoking and emotional. One of the things I wanted to point out, the young man said, I was diagnosed with ADHD. That gentleman had an excellent working memory. You do not have a working memory if you have ADHD. He was misdiagnosed, and frequently, especially people, children of trauma, are often misdiagnosed because they do not have the words to describe what they are feeling or experiencing. They become hyperkinetic. They cannot be still. They become like a running motor. We need to take a closer look at our diagnosis of our children so we don't further traumatize them. Thank you. Wonderful. Thank you so much for your comments and for your example. Thank you so much. Hi, I'm Leo. I'm so sorry. Please, go ahead. I'm Stephanie from Tallahassee. I want to say thank you. This should be at the top of the list, first thing on the agenda. I wanted to say the racial disparities are unmatched, and I want to know where to go. I like the title. Where do we go? That's my question. Yeah. We're talking a lot about people coming to us, but I really want to know where to go. When you say where to go as a... Do we go into communities? Do we go into... Because people are afraid to come to us. Rightfully so. Yeah. I think so. I think part of it is going to the people as well as having an understanding that this is someone's reality when they walk into our treatment setting, whatever that looks like. I think about the times where someone comes into an emergency room setting, and rather than trying to connect with them, to understand them, we don't always... There was a term that was sometimes used. This was now 25 years ago, but treat them and street them. Even though we don't necessarily use that language, that same philosophy, that same way of approaching patients is still present in many of our healthcare systems, particularly in healthcare systems where you're dealing with marginalized black and brown folks. It's like, let's just get them out of here. They're just going to be back anyway. I think where we go first is internal. We go inside. We might have to start asking ourselves, well, what are my biases here, and how are those in play when I'm encountering patients? What are the automatic assumptions that I make about someone when they come in and they're maybe under the influence of a particular substance? And then to your point about when you have an opportunity to engage with someone on an ongoing basis, how am I doing that? Am I really focusing mostly on symptoms? Am I trying to adjust medications for someone that really doesn't want to be on medication anyway and doesn't believe that they work? How are we leveraging their connections with other people and their community? So I think it's sort of multifactorial, but I would start by going inside first. I love it. Great. Thank you. Yeah. Thank you. I'm Leo, Dr. Bando. I of course impulsively jumped in to say what was on my mind when I heard the word trauma, because what I kept hearing and seeing in the video was a disconnected family system where the mother didn't understand his music, didn't understand the message that he was trying to say. The mother didn't understand. Speak just a little louder. Yeah. The mother, what I saw was a disconnected family system there. The mother didn't understand his music, wasn't even aware of what he was talking about or the environment that he was involved in, apparently, and what relates to what we do, which is access to care, early intervention. She wasn't even connected to his emotional needs as a child. She didn't realize that he wasn't being serviced well. So of course there's like a familial and a social context for all of this. There's even a point in the second clip where he's performing a song and they talk about how he just lost his father like two hours before that actual performance. And then of course there's the comment that his mom makes at the very end. She's like, I didn't understand his music, it really wasn't for me. He's putting up billions of streams annually and he's got all this money and he's like 19 years old kind of living on his own independently. I'm not trying to throw mom or family under the bus, but I do think it kind of does at least raise some questions about sort of the nature of his relationship to family and who was like in his circle. I mean, clearly we sort of see that his peers were a huge, massive influence, but were they peers or were they an entourage? His whole situation for me gets very, very murky because of the wealth, because of the fame. And so I guess I would ask the audience to not necessarily use him as such a great example of what that looks like because of the complexity of just how massively successful he was. I think it probably looks very different for him, but it is interesting that his mom who was sort of like, I mean, I didn't get his music, I didn't really listen to it. I thought that that was interesting as well. After he passed, his mom wrote a piece in Rolling Stone and talked about for mental health awareness day or something like that and talked about that people should really understand what it's like to have a child with mental illness and whether it was ADHD or anxiety or depression or bipolar or just something because there were so many drugs going on. I think we might want to talk a little bit about the drugs because the drugs are interesting. He died of an opiate overdose and the feds were waiting for him because there are concerns about drugs on board. And so what he did, if I understand the story correctly, is he took extra Percocet to try to get rid of the pills and had a seizure and probably died before several doses of Narcan were able to revive him. So the whole thing, I mean, just start to finish, it's like so messed up about what happened. But mom did really want to use his life and his music and his death really as an instrument of change. Yeah. Thanks. Hi. I am really glad that a movie like this was being screened at a conference like this. My nephews listened to Juice WRLD, like I listened to Juice WRLD and wasn't a huge fan. And so this is eye opening for me. I didn't know that this documentary even existed. But one thing, a theme that came up that struck me was this concept of numbing pain and masking anxiety, depression, not even addressing it. And when my brother died of an overdose, a friend of mine gave me a book by Francis Weller called, oh, shucks, I'm forgetting the name of it at this moment, but it talks about these concepts of amnesia and anesthesia as a way of coping with different things throughout our society. You know, there'll be a huge tragedy. But then we scroll through on the next thing on Instagram and it's just something else that comes up and we're not actually spending time with that process of grief and we're not spending time with that ritual of processing what happened to us and why we feel that sense of loss. It's not just loss of the person, it's loss of so many different things. It's a loss of our own self now that's living behind, you know, after all of this. And so I found myself more connected to discussing and thinking about not only my death, but you know, just death as a concept and grief as a concept and the ways that that happens in our lives before someone straight up dies. There's a lot of different losses that happen and having that time and that space and that compassion for that and having ways so that people that have these feelings that are pre-verbal, you know, whether it's through, I think it really speaks to how art can be very freeing in a lot of different ways. You know, a lot of music, you don't need to know the language necessarily. You know, to dance, you don't even, you know, need too many things. There's so many things that can connect us to our emotions, that process of actually feeling our emotions rather than trying to numb them away and forget about everything because it ends up finding a way to present itself somehow, some way. And so I don't know, you know, how in terms of, you know, reaching, you know, people that may not even necessarily want to reach us, is there a way that we can put out media? Is there a way that we can put out art that speaks to these themes and these topics that helps at least get people started? And if it's not just the person themselves, it's also the people that are around them because they saw that something was going on and they tried to palliate it in some sort of way. And had they known what was at stake or what could possibly, how close that kind of razor edge you are between life and death really at any moment, you know, maybe somebody, you know, or some people could have had some sort of impact. Yeah, really. Thank you so much for your comment and your question. You know, as you were talking and really, I think there is an opportunity for us to step back and really think about the ways in which we can leverage multiple types of arts and different kinds of art forms in the lives of patients, families, communities. What would that look like for people to find a way to express themselves rather than numbing? You know, that's one of the first lines in the clips that we show where he talks about his use of Percocet to numb himself and then you just watch him do that for the next 50 minutes, essentially. You know, and the reality is, there's a part of me that's like, well, it's kind of natural that one would want to numb pain. I mean, right? Like, I mean, I'd stub my toe, I take Tylenol, I would like to numb my pain. So there's a very sort of human aspect to this that perhaps one of the things that we can help people to do or to understand is that that inclination is natural, but there are lots of other options that are available to you that are perhaps less, yes, that there's a, but she's making the thing, that you can widen and understand that there are lots of different ways for people to address their own, their own pain, any, I don't want to make, I want to make sure, okay, good. So thank you for your, thank you for your comment. But also leveraging other types of art form as a way of expressing that and encouraging that in patients and families and communities. Yeah. Hi, I'm Denae from Cleveland, Ohio, and I work at the Cleveland, the Cuyahoga County jail there. And this really made me think a lot about some of the younger folks that are unfortunately incarcerated there. Like we have the youngest I've seen is 16, but we have typically a lot of like 17 to 20 year olds. And I had a patient who was screened on intake for substance use. I had seen him twice before he started telling me about lean use and using like Percocets and Xanies and the way he was screened for substance use did not ask him specifically about those things. And he did not think that it was anything to, you know, to talk about. And he talked about having the flu when he first came in. I was like, what do you mean you had the flu? And then I was like, were you taking any pit, like, and I kind of went through like a, but I wasn't screening him in that way and we weren't screening him. And so how many people are we really missing? Because we aren't thinking about the way that younger people are using substances and, you know, cause I'm thinking about like, I mean, there isn't even really heroin anymore. It's just fentanyl, you know, like, so I know to ask about that, but like, what are we missing? Because a new generation of people are using things that like, I'm not really trained in for my education. There's like a slide on lean and one of my, you know, lectures. So I think we really need to think about that for this new generation who's coming up and they're going to be in our, in our treatment facilities. Excellent point. Excellent point. So one of the, one of the nice things about conferences like this is that we get an opportunity to revise our practice. And part of that is our assessment and screening practice as well. And so maybe one of the other takeaways from this particular session is like, all right, well, let me make sure I ask people about stuff like lean and purple drink and, and do a little Google search. I mean, my Google algorithm is a mess because of all the drugs that I'm constantly looking up. And so like, what, you know, what, what's being used locally and trying to use that information to enhance our own ability to detect what substances are being used, particularly among young people. Great point. Yeah, I just want to interject because I think it's a, it's a big problem in my practice because, you know, I'm in New York City and a lot of head shops have opened up lately and what they're selling is stuff called Delta 8, Delta 9, Delta 10, which are synthetic forms of THC. And you know, it's just the wave is coming for more of this. So I think it's very, very important that we kind of get conversant, but, and I think that also the whole idea of people trusting us is the most important thing. So that's why we really think it's important to wherever people are at that we could really, they could feel comfortable talking to us and we're not going to kind of judge them about it. Yeah. We had a patient come in who was using gas station heroin and I was like, I don't even really know what that is. And it turns out there's a poster on that here on Tyeneptine, which is something that you're, that's very, again, regionally sort of localized, see it a little bit in Austin, definitely see it in places like Alabama. So there are regional differences that I think need to be taken into consideration as we're also trying to figure out what our specific screening and assessment practices are. Bo Christiansen, California. Hey, Dr. Shorter. Former fellow. One of the things that, as I was watching this film, like I started to recognize a lot of the emotions inside myself that were brought up in one of the things that I've struggled with in my practice is how to discuss suicide in a nonjudgmental way. Because my biggest fear as a psychiatrist is that my patient is going to kill themselves. But at the same time, you know, there's a part of me that also feels that that is our most fundamental right is to not be right. And, but at the same time, like I would see it as an absolute failure if my patient kills themselves. I didn't do something right. But at the same time, you know, patients are where they are. They feel what they feel. And I want to respect that. But at the same time, there's this piece of me that feels like if I discuss it, if I talk about it, I'm going to feed it. And I found that not to be true. And I've recognized this and I've tried to fight against it and talk about it as if it's any other issue. And the feedback that I'm getting from my patients is that they feel heard and it doesn't feed it. But, you know, it's been a real struggle to talk about suicide in a very nonjudgmental way as if it's an option, because it is an option. In the same way that relapse is an option, you know. But as I was watching, as I was watching this documentary, I started to recognize a lot of stuff internally, you know. Yeah. Thank you for sharing that. Thank you for sharing that so honestly as well. There is a part of this where you are watching this young man repeatedly say he is going to die, like over and over and over again. I mean, he raps about it and like the friend at the very end says, this is not someone who took a bunch of notes and edited and wrote something and then went into the studio. He was speaking completely from his heart, from his head, but also from his heart. And so, he really meant that. Every time he said, I want to die or I'm going to die, he meant that every single time. And so, these were his closest friends and loved ones and they struggled with believing him or they struggled with talking to him about it or confronting it. And they were the people that knew him the best and loved him. And so, we can also experience that even though, because we have that sort of objectivity and a professional relationship with someone, but we can also still experience that same kind of fear, dread, terror about asking people about their suicidal ideation. So, I think that your point is really well made. And at the same time, there's a part of me that, you know, like we kind of walk through and go through our fear in order to engage patients and talk to them about where they are. And it doesn't just have to be about the suicidal ideation that they're experiencing. It could be about all of the other aspects of their life that they're really dealing with or struggling with. You know, when I'm speaking with trainees, I mean, sometimes I just try to remind them that maybe the goal is just to get the person to come back, right? Like maybe I'm not going to get you to stop using purple drink or lean today. Maybe we're not going to get you to stop taking perks today. Maybe we're not going to get you to stop numbing your pain today. But maybe I can engage you and make you feel heard, respected, appreciated, and cared for in a way that when I make your appointment for you to come back to see me, not in 30 days, not in two weeks, maybe not even a week, but when I have you try to come back and see me as a walk, like I'm gonna sandwich you in somewhere because I see where you are, that that person is more likely to come back. And so thinking about our goals that we are setting for patients, I think we sometimes just have to make it real easy, treatment retention, coming back, period, full stop. Current fellow. My name is Bishop Popola, thank you, thank you Dr. Schroeder for introducing us back to EPOP. One of the things that when I saw this video, it made me to remember one of the patients that I saw in Westchester in New York. Now the first thing is when I was watching the video, there was a point where he talked about being diagnosed with ADHD and was being given medication and it started costing like, how would a sixth grader have ADHD, this, that, and all that. And he said he was gonna write a book or something like that, I should write a book about it. So that's, it showed at that point in time that he didn't actually trust the system anymore, he has lost trust in the system. And his music, which is EPOP, right, among black folks and I know a lot of people talk about EPOP culture, so it's like a culture, it's, you have to be competent in that culture to actually understand what the person is going through. So this kid that I saw, a 14 year old African American in Westchester, the mom thought she was doing all, everything right to get him on the right path. He was diagnosed with ADHD and the kid told me, said, I don't have ADHD. I saw him in the emergency room, said I don't have ADHD. And I had a good conversation with him. Of course, from the things I picked up, maybe he didn't have ADHD, but he has been on medication for about four years and the mom wanted him to be on point, wanted him to be on the medication and the kid told me, I don't have ADHD, but I've been on this medication, I've been made to take it and this and that. And of course, Westchester is, you know, Westchester in New York, right? It's different from Brooklyn. So the mom actually probably tried to move to Westchester, tried to give him a good environment and all that stuff. Now, when he said that he didn't have ADHD, I was concerned, but I, well, it is an emergency room, I didn't have anything to do about it. But one of the things I did was I tried to talk to him, I tried to talk to the mom, I tried to tell them to get him back in treatment and see how they can connect him with someone that is culturally competent to understand what he's going through. And the mom told me, the mom said, we've had three different psychiatrists and providers take care of this kid and it's not just working. And the kid also told me, he said, oh, I don't like the person I'm seeing right now. Of course, the mom is trying to connect him with someone really good that can help him. And, but the mom noticed that I connected with him because I was able to understand him and understand where he's coming from. And the mom was like, do you have a private practice? I was like, no, I don't. But she was so interested in connecting him with someone who is culturally competent to be able to address his needs. Otherwise, he's gonna go into drugs. We saw from this amazing rapper, he started using drugs already. He had probably some mental health background stuff going on, was expressing it, but nobody was able to actually address that issue. And there was also the loss of trust in the system. So the question is, when the people providing care for you are not representative of who you are and they're not culturally competent, how can we build trust in providing care? Yeah, that's a great question. So the idea that when you walk into a treatment setting and perhaps the provider doesn't look like you, they don't understand your culture, however you may define that here, we're talking about the hip hop culture, and there's been a loss of trust, not just in the individual, but really in healthcare systems, there's just a massive amount of mistrust globally, I think on the planet right now. But then when you think about it from, right, when you think about it from the standpoint of entering into healthcare systems, people are already walking around and they don't necessarily see themselves represented. They don't see signage that really speaks to them or they have to fill out a form that doesn't really take into consideration their multiple identities, however you wanna look at that. So people come in and they're already looking at us like, I don't necessarily wanna be here, you don't look like me, you don't look like you'll understand my experience. I'm talking to you about things that you, and you're asking me to define for you my stuff, which I know we kinda get into that very difficult place where somebody might talk about a drug like lean and you're like, okay, well, I don't really know what lean is. I'm gonna need you to tell me what lean is. And does that actually do something to erode trust? Of course, we hope that it doesn't, but it's like, well, how am I going to be understood when I have to explain to you what the hell lean is? Right, so this sort of attitude that can come up. So we have conferences like this where we can talk about it and hopefully people feel convicted to go home and Google purple drink and lean and take a look at what the regional substances are of abuse that are, sorry about that word, but regional substances that are being used and how that might be impacting your local community, doing your own sort of research so that when somebody comes in, you're kind of prepared. Like we have this great example today about like, okay, knowing that when I do my assessment, I need to actually ask someone about that specific type of way that they're combining drugs in an effort to take them. So we have a lot of work to do on our own before people come in to see us because the reality is that sometimes we can blow it because they've come in and the trust is already shaky and low. And if you say the wrong thing or look the wrong way, then forget about it. They're not coming back to see you. Go ahead. I'll add something, especially as a trainee, ask a lot of questions, but often if I sense something is going on, I just call it out in the room so we can talk about it. You know, say, you know, I understand you might feel anxious, scared, you know, what brought you here? And just as candidly as I can talk to them about it and ask if I don't know what something is, I'd rather be corrected than be wrong. So, you know, just approaching it really, really humbly and just listening and that in and of itself seems like it's so, so therapeutic for patients, just holding space for them to talk about whatever it is. So I think it's okay to ask those questions. I mean, I'm comfortable doing it. I'm a trainee, but even still, you know, I think it shows that you're genuinely interested in their experience and you want to learn more. Yeah, I mean, I think that certainly that's what makes us good psychiatrists, psychologists, social workers, that we ask questions, that we're empathic, that we're understanding, that we're not judgmental. And I think, again, part of having conversations like this, that we're also culturally sensitive as well. But, you know, we do have the advantage of being therapists and we should, in part, you know, be curious. I mean, so much of what I learn about the world of my patients, I treat patients with sexual compulsivity. For better, for worse, that's not my problem. So, but there's so much I need to learn. And I think people, you know, my patients like the fact that I'm like, I don't know what that thing is and can you explain it? So, yeah, but I think it does come down to like just trust, right? People really trusting that you have their best intentions and I can think you could get away with a lot if they know, you know, you got their back. So really the asking of the question has to come after the establishment of rapport and trust, I think. It's kind of what, maybe what we're saying. I don't mean to suggest that you don't ask your patients questions, but really this idea that there are certainly members of communities where if you ask them questions about themselves, they feel like they are explaining stuff to you. And so it's a tight rope that we're walking really where either outcome is possible. So just something to be aware of, but thank you. Go. Hello, I'm Mildred Barnett from Tampa and it's a pleasure to be here and this is a great presentation and dialogue. So I'm really happy to be here. Two quick things. I'm not gonna kind of speak more about relatability and how important that is. You can't predict who's gonna come and see you and need help from you. You just have to be there with an open mind and feel comfortable enough to ask questions to really get into your patient's world and be able to understand what brought them in and be able to help them. But if somebody like Juice World comes and sees me, you know, that is an important thing, that relatability. But another thing I wanna talk about general kind of being a celebrity, one of the curses that you see in this pattern that you see it with Kurt Cobain, Amy Weinstein, Prince, is that they have the power to surround themselves with people who say yes and the kind of people who are going to enable their tendencies and their habits. And that's ultimately what greatly contributes to their demise. And yeah, a 19 year old kind of living this life on his own, you know, sadly, you know, contributed to this demise. Yeah, thank you. You know, enabling can look like a lot of different things too, actually. I mean, this is a much more extreme, wealth-centered way of understanding that process of enabling. But that's certainly something that I think we all contend with with patients and their families and communities when the substance use or mental health condition is really allowed to just continue sort of unchecked and in fact supported by giving people, you know, even $20 a day, because you know what they're gonna do with that 20, right? So I think that's the skill that we have to kind of work on in intervening with patients and families is present regardless of how much money the person has. That's a great point. I'm Jennifer Malone. I'm practicing in Florida, but I'm a graduate of Baylor. Residency and fellowship, and I'm really proud to be a Baylor-ite tonight. So a couple of things I thought about, like one was it made me sad that Juice's one interaction with mental health was really focused on externalizing symptoms rather than internalizing symptoms. And I don't know if he didn't have the vocabulary to report that, but I think that's a pretty common experience for minority, especially male minorities, which felt kind of sad. It felt like we missed an opportunity. But the other thing I was thinking of is I saw this thing on Facebook where I find all the interesting things I say, where Jim Carrey was talking about a director who spoke to him before he made Eternal Sunshine of a- Spotless Mind. Spotless Mind. Did you guys see that? Where he said, the director said, I guess Jim Carrey was going through a depression at the time, and the director said, you look so beautiful right now. Don't treat that. And it made me think about Juice as more than people enabling or letting him down, but being very predatory because how much money would Juice WRLD make if he were a happy, well-adjusted Juice WRLD? And the same as yesterday when we listened to a talk about a opioid-addicted woman who was hospitalized and how her husband, Pimp, was sort of wanting her to get out of the hospitalization. It just made me think about, and I hadn't thought about this before, but people may profit off the failure to recover of our patients and how I don't even think to say, as part of their ambivalence, it may be that their recovery would actually be letting people down financially or otherwise. Absolutely, great point. I mean, we see this with, there are multiple examples of this, actually, and the first one that popped to my mind was Whitney Houston and her unfortunate demise, which then, of course, extended to that of her daughter as well, almost a year to the day. I'm a huge Whitney Houston fan. No one in here is surprised. Michael Jackson. I mean, you can run them down, actually. There are a number of folks. It's a great point. I think we may be almost out of time. Hi, Mike Susco. Well, yeah, we may have only a couple more topics. Yeah. Hi, Mike Susco from the Finger Lakes, New York. And when I was watching this, I said, oh, I can't identify with this at all. And then the more I got to know him and then see his friends who were very articulate, they started to use some deep words there. So I got a deeper understanding of hip-hop culture, and I never thought of hip-hop culture as a culture, like they're ethnic cultures and they're all kind of cultures, but I got to think of this much more deeply now. And when they were talking about drinking, I said, well, this young man, he really had an alcohol withdrawal seizure compounded by this, that, and the other thing. And I liked when the young man said, we drank because the sun came up, we drank because the sun went down, we got high, and you hear that from run-of-the-mill alcoholics. In terms of black mental health, there is a difference, black mental health, right? I hear a lot of people say, oh, blacks don't commit suicide. And when I talked that with a black patient, I said, you do commit suicide. And eventually, we start to talk about that. And eventually, if I'm working with a black patient, I'll talk about this, third, fourth session is. So what's it like working with a white doctor? And I usually get a little pushback like this, and then we end up talking very freely. One person taught me about all the brilliant black philosophers and all, after the Civil War and so on and so forth. So thank you for this. And when I looked at Juice WRLD, I thought about Spice WRLD, that's how old I am. Then when I heard Lucid Dream, I love Lucid Dream. I used to call my kids, I said, I just heard this song, Lucid Dream. This is a fantastic song. I'm nearly 70 years old, but that song, he got to me with that. And I think what I was really hearing, he was really associating. When he raps, when he does, he's speaking without any filter whatsoever. And sometimes you need to look at that. And you need to say, why is this young man talking about this? Why is a 21 year old with a world at his fingertips getting high every minute of the day? He's in a Learjet. Unfortunately, what happened to him, he got victimized, he got criminalized. Instead of saying, there's this kid who's really high on a plane, he's a great star. Instead, they sent him out to arrest him. And he probably died because they were arresting him first, instead of taking care of him first. And people's reference to Prince and Whitney Houston, I mean, those were tragic stories. In our day, and I'll look to this doctor right here, we used to lose people at 27. Jimi Hendrix, Janis Joplin, Kurt Cobain. You know, we used to look to 27. It seems like now the death rate is going to go down. So just a comment, and I'd like to really thank you, because I never looked at hip hop as a culture, but now I'm looking at it as a culture. I have to look at it as a culture. That's great. Thank you. Thank you, thank you. 2.2 billion streams on Spotify, Lucid Dreams. One song. Oh, I think, okay. I can only take one more question. It's been, I must announce that. Thank you. Dr. Weiss. Good timing on my part. We've been focused as psychiatrists, obviously, on the internal struggles, and maybe to play off a little bit on the last comment, a couple things that we haven't stressed is, number one, I haven't heard this, that here was somebody using opioids all the time, as were his friends and colleagues, and no one seemed to have naloxone. And I mean, he's got a security group, and they definitely should have had that. And so this is something we always need to remember to tell any patient we see, that they need to have naloxone, and the people around them need to. The other comment is, again, what just came up is, why were the police, as I understood it, he took extra because he knew the police were after him, which, I don't know if that was paranoia or that was real, but it is certainly not unusual for a young black man using drugs, well, a young black man to feel that way, and that shouldn't be. So it was really these two things, I think, that made the difference between this day and him overdose and dying, and every other day when he was just using and knew how much he was using and didn't overdose. Yeah, that's a great point. So the interesting thing about NARCAN, conversations about NARCAN, particularly in racially minoritized communities, is that if you do not see yourself as being part of this opioid epidemic, right, like the opioid epidemic has historically had a very white face, opioid use disorder treatment has historically had a very white face, and so you don't necessarily see yourself as part of that now. Now, and I'm gonna qualify that because I do think that heroin use disorder, of course, has had a very black face, but when we think about the way that the opioid epidemic has changed and more often mutated over the last several years, we recognize that prescription opioids are still by far the most powerful factor among opioid use disorder among black people, but you don't hear that conversation, right, like that part of it is absent, and so if you're not talking about that to begin with, then how the hell are you gonna talk about NARCAN? I'm not even represented over there. That's not my problem. So we have actually, we gotta go back in the conversation before we can get over here. When you look at, if you're gonna Google, me and this Google today, Jesus, if you're gonna Google opioid epidemic and you're looking at the images of what that looks like, take a look at that and see who's represented. And how that's a reflection of our broader societal and cultural understanding of it. And if we can address that part of it, then maybe we can then start talking about what it looks like to have NARCAN in certain communities. Okay, I better stop. Thanks. We don't need this room afterwards for anything, and we knew that so much would come up, and we welcome people to stay if the panel can stay and talk, so there's no limit on that, but we do have to sort of formally say that the session is over, and can't thank the panel enough for an unbelievably stimulating. Thank you. Thank you. You're fantastic, you're a superstar.

Juice WRLD

hip-hop culture

substance use disorders

rap music

mental health

artists

clinical tool

African-American community

Juice WRLD's music

documentaries

mental health support

destigmatization

substance abuse

media consumption

cultural competence