Hip-hop is one of the world’s most popular music genres, with its global prominence transcending language and geography.¹ More than ever before, hip-hop artists are publicly acknowledging their mental health struggles, promoting anti-stigma campaigns around mental health, and normalising seeking treatment for mental health issues.

In our opinion, hip-hop can be a vehicle for tackling stigma around mental health and addressing cultural imbalances. Hip-hop connects with groups that healthcare has historically struggled to reach, particularly men within the Black community. Underrepresented communities are at higher risk of developing mental health problems, and they are more likely to experience worse mental health outcomes. This is, in part, due to socioeconomic disparities. They are also less likely to use mental health services. Stigma around mental health issues is common in underserved communities, and it is a substantial barrier to accessing health services. Discrimination, bias, and a lack of cultural competence from healthcare professionals can also lead to unmet needs, late presentation of symptoms, and poorer quality of care.^2-5

We highlight various progressive hip-hop songs and artists, which have progressed the narrative of normalising conversations about mental health. The purpose of sharing this information is to develop innovative ways of engaging in culturally sensitive contexts to normalise seeking treatment for mental health issues. We also hope this information helps to foster new ways for health professionals to open up conversations about mental health with their patients, given that some patients may find it difficult to talk about this in clinical settings. This may be particularly relevant when service users come from some marginalised communities—for example, ethnic minorities or younger people who are interested in hip-hop but may not necessarily trust health services.

In the 1970s, pioneering rappers like Grandmaster Flash and the Furious Five documented the harsh living conditions and social inequalities that affected their mental states.⁶ In the 1980s and 1990s, mental health issues started to emerge more explicitly in lyrics, but were camouflaged in masculinity. Mainstream “gangsta rap” portrayed machismo and discouraged weakness. However, some hints of vulnerability were exemplified by songs like “Mind Playing Tricks On Me” by the Ghetto Boys, which depicts hallucinations and delusions along with Tupac Shakur’s song “So Many Tears” which illustrates signs of trauma and depression.

The relation between mental health and masculinity is complex, as societies sometimes promote narratives such as “strong men don’t cry” or “his emotions got the better of him.” These negative views, which portray men who express their emotions as “weak,” add to the stigma around mental health issues. Men under the age of 50 are at an increased risk of taking their own lives and are less likely to seek help when experiencing a mental health crisis, which suggests that this stigma needs to be overcome.^7-8 A jarring inner conflict between anger and sadness is portrayed in Lil Wayne’s song “Drop The World,” which dramatically shifts in language use and tone. Lil Wayne once talked about accidently shooting himself in the chest when he was young, but he later revealed in his lyrics and during interviews that it was an attempt to end his life: “When I attempted suicide, I didn’t die, I remember how mad I was on that day . . . you gotta let it go before it get up in the way”. 

In the 2000s and particularly the 2010s, rappers increasingly showed a more sensitive side of hip-hop, acknowledging struggles with depression and anxiety. Artists such as Meek Mill have also discussed mental health issues around coping with trauma in urban environments, comparing this to experiences of soldiers with post traumatic stress disorder from war zones, which has also been referenced in the scientific literature.⁹ Mental health risk factors, such as childhood sexual abuse,¹⁰ have been articulated in lyrics, for example, by Angel Haze. She remixed Eminem’s song “Cleaning Out My Closet” and spoke very candidly about her own abuse as a child, saying that this particular song was “probably the realest song I ever recorded“.

P Diddy helped to normalise the acceptability of men publicly crying and grieving over the loss of a partner when his social media post received an outpouring of supportive comments, such as: “Real men cry too–it’s healing, and your healing heals the rest of the world”. In Rico Nasty’s last album, Anger Management, she channels expressions of rage and anger into a form of empowerment, saying that her “expression of anger is a form of rejuvenation”. These examples show that mainstream hip-hop artists are making topics related to mental health and vulnerability more central to their lyrics.

In recent years, mental health anti-stigma campaigns have progressed even further in hip-hop culture, with rappers actively encouraging people to seek out resources for mental health issues and to be open to the idea of seeking treatment. For example, the rapper Logic partnered with the National Suicide Prevention Lifeline [in the US], releasing a song entitled “1-800-273-8255” about a suicidal hotline caller getting support. After he performed this song at the Grammy Awards, where people who had attempted suicide appeared alongside him on stage, calls to the helpline tripled. 

Hip-hop culture is shifting away from denying professional help or managing one’s feelings in isolation (“I’m usually to myself . . . . I’m my own psychiatrist” said Tech N9ne) towards views such as “When I went to therapy I realized . . . therapy isn’t soft . . . Therapy is gangsta. It actually empowered me,” said Darryl McDaniels from Run-DMC. Another advocate of therapy is rapper Kid Cudi, who posted on social media about seeking rehabilitation treatment and later stated: “A year ago I wouldn’t even go to a therapist or psychiatrist. But I gave it a shot . . . It’s good for me to talk to someone who helps me see things”. Kudi’s announcement on social media about seeking treatment received positive comments from his fans on social media, such as: “You helped me a lot too, and I hope you get the help you gave me and a lot of other lost kids”. Jay Z’s album “4:44” documents his own experiences in therapy, pointing out the benefits of “having someone respond to those concessions and challenging your view of yourself to help you reassess”.

There is still more that hip-hop can do to tackle stigma, and there are some remaining negative aspects too. There have been insensitive statements from some artists and managers within the hip-hop community—for example, around stigmatising patients using medication as part of treatment for mental health problems and insensitive remarks about people who have died by suicide. 

Self medication is a serious risk in hip-hop culture,⁶ with some rappers contributing to the normalisation of poor self care by ignoring destructive symptoms. For example, references to self medication and suicidal ideation are arguably being normalised in some lyrics within the hip-hop subgenre known as “Emo-rap” (also known as  “SoundCloud rap” or “sad rap”). Artists within this genre have openly articulated their mental health struggles and attempts to cope, but this also raises concerns that it could increase the risk of a contagion effect.

Hip Hop Psych, a social venture that we co-founded, aims to bridge the gap between the medical community and hip-hop culture by working directly with health professionals and the public to raise awareness about mental health in accessible and evidence based ways. 

We explore the mental health symptoms and emotional states of characters described in hip hop songs, and we interpret the lyrics and language in order to raise awareness about various mental disorders (including depression, psychosis, anxiety, borderline personality disorder, etc). We also translate medical terms and information (such as the “biopsychosocial model”) into much more accessible and contextualised language (eg,^11-12) so the general public can understand them. In addition to generating culturally sensitive psychoeducational resources, we perform “anti-stigma” events in various settings (prisons, nightclubs, African and Caribbean societies, etc),¹³ and we use a similar approach to educate health professionals and academics to help increase their awareness of how some people describe their personal experiences with mental health. 

We  need to create innovative ways of engaging with people from ethnic minority communities who face culturally sensitive barriers to accessing mental health services.¹⁴ For those who embrace hip-hop music and culture, we believe this medium could facilitate engagement, help normalise mental health, and promote seeking access to treatment. In addition, we hope that the awareness gained from engaging with resources related to mental health and hip-hop can provide new ways for opening up conversations between health professionals and patients (such as asking if the patient likes music, and whether any particular genre, artist, and/or song resonates with how they are feeling at the moment). Health professionals do not need to have any knowledge of hip-hop. Culturally sensitive and context relevant approaches might open up more patient centred ways of building trust and deepening discussions about mental health, which can otherwise feel very stigmatising. Likewise, understanding how mental health is portrayed in hip-hop can offer a different perspective for healthcare professionals, helping them to build empathy with someone whose experiences may be completely different to their own. This knowledge might also help health professionals to be more aware of any potential trends that link the contagion effects of suicide, self harm, and self medication from hip-hop icons to some of their patients, and to be prepared for this.

Hip-hop is an art form filled with passionate expression, and its lyrics resonate with people all over the world. Art and culture are powerful mediums for self expression and for translating experiences. It can also help shape perceptions, challenge opinions, bridge communication, and help to understand other people’s points of views. Since the genre’s conception almost five decades ago, hip-hop’s progressive narratives have increasingly addressed stigma around mental health problems. Hip-hop artists are speaking candidly through their art form, and they may be helping people around the world to acknowledge their own inner struggles.

Akeem Sule is a co-founder of Hip Hop Psych. He is a consultant psychiatrist working at Essex Partnership University NHS Foundation Trust and is affiliated with the University of Cambridge.

Becky Inkster is a co-founder of Hip Hop Psych. She is a self employed neuroscientist and digital mental health adviser and is affiliated with the University of Cambridge and the Alan Turing Institute.

Competing interests: none declared.

References:

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