Mental Health and Hip-Hop Edward J. Smith

Discussing Suicide without Being Crucified
The New Renaissance of Mental Health in Hip-Hop
Edward J. Smith
T
acoma Savage was my idol. His locks were long and luscious, dressed in a colorful heads-
carf, or unleashed, similar to the mane of Bob Marley. His skin was rich and smooth, the
stunning shade of coffee brown, donned with several tattoos as if to illustrate the story
of his life. His raspy, charred voice (which he never, ever raised) sounded like the crispness of
rainfall in the summer. To me as a child in the late 1980s, it felt like he would glide into a room,
in a soft fog, bringing calmness and patience to the people he met.
In addition to these attributes that aroused my imagination of him, he had a distinct
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smell. I would drown in his intoxicating aroma of marijuana, tobacco, and dark liquor. What
is more, his bangles, rings, and chains would clank together as mood music during conversa-
tions. Over the course of the decade, he played keyboard and bass guitar in my uncle’s new
wave rock band. As if he descended from the lineage of Miles Davis, John Coltrane, and Prince,
he always seemed collected, reserved, and generally “together.” He was the epitome of cool,
and I wanted to grow into his presentation of manhood. Little did I know the degree of inner
turmoil his battle with depression and anxiety would harbor.
He emerged from the 1980s without the support of most of his bandmates. After a run of
nine years, the group disbanded, in large part because of crevices caused by Tacoma’s substance
abuse. He would often arrive at shows several hours late or miss them entirely. He would have
frequent, unprovoked vocal outbursts with bandmates, family, and friends. He often took
solace under the mixture of weed, alcohol, and pills. As he transitioned into his forties, only
my uncle remained in his corner. No amount of prayers or sermons, or tough love quotes like
“Snap out of it” or “Get yourself together” could pull him from his daily battles. In fact, they
only drove him deeper into isolation.
591
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592 EDWARD J. SMITH
He evolved into a songwriter and rhythm-and-blues instrumentalist in the early 1990s,

experiencing a rebirth when groups like SWV, Soul for Real, and Jodeci took notice of his
ability to compose love ballads. After a few years working in studios, he was back on his feet,
performing at jazz clubs across the United States, touring internationally, and writing songs
and composing music for a number of high-profile recording artists. Soon thereafter, he
became manic—working around the clock with no sleep, frequently forgetting to eat, and
drifting ever so deeply into paranoia. He told my uncle that he “never wanted to experience
life without music, even if it meant a life without love and self-care.” His face became withered
and withdrawn; the same raspy voice I enjoyed hearing became a cacophony of jumbled words
and sounds. He would tell people, “I just have to push through this. I’m good.” But the pushing
eventually broke him.
I later understood that neither what he was saying nor my boyhood imagination of him
was real. And the more he tried to deny his struggles, the more he unraveled into despon-
dency. He was hospitalized on the fifteenth anniversary of his wife’s death; I did not find that
fact ironic. For years, he withheld the grief of losing the only person he truly loved. Years of
drug abuse helped him retreat further and further from a reality that would eventually deal
with the loss. Upon evaluation, he was rendered a diagnosis of major depressive disorder
with psychotic features. He committed suicide within one year after rejecting the diagnosis.
All these years, I was unaware that he was using drugs to deal with—and recover from—his
inner turmoil and grief.
When I hear of and read about artists such as Kanye West, DMX, and others who publicly
experience the struggle to achieve sound mental health and wellness, I think of Tacoma Savage.
And when I hear artists like Kid Cudi, Kendrick Lamar, and Pharoahe Monch courageously
recount their tales of trauma, self-diagnose their depression, and use their lyrics as a way to
bring about healing and self-preservation, I ponder the painful lesson Tacoma’s life taught me;
I do not have to tell people I am “good” all the time—especially when I feel otherwise.
This chapter illustrates a new renaissance in hip-hop coinciding with evolving cultural
and communal norms among Black men as it pertains to mental health and wellness. While
violence, death, and suicidal ideation have been long-standing themes in rap music, more
recent offerings in hip-hop include narratives of mental and emotional vulnerability, and art-
ists more readily evoke help-seeking—a virtue seemingly unfamiliar in those that align more
with the prevailing themes of escapism, self-control, and hypermasculinity (Kitwana, 2002).
The chapter concludes with implications for the recursive effect of promoting mental health
and wellness through rap music (such as the potential to evoke the critical nature of therapy,
healing, and self-preservation among Black boys and men) and the potential of hip-hop therapy
and hip-hop psychology to bring about a sense of radical healing among traumatized young
people (Ginwright, 2010).
DISCUSSING SUICIDE WITHOUT BEING CRUCIFIED 593
Mental Health and Wellness in the United States: A Review of Data
The United States is experiencing a duality of consciousness with regard to mental health and
wellness.1 While there remains a societal stigma around the challenges experienced by those
with mental illnesses, there is an emerging recognition (among those in the health care com-
munity, as well as policymakers, researchers, and the public) of the importance of access to
consistent, culturally relevant, and socially practical mental health supports. Approximately
one in five adults (over 40 million Americans) have a mental health condition (Mental Health
America [MHA], n.d.; American Psychological Association [APA], n.d.). Additionally, more than
22 million people have a substance abuse disorder resulting from a mental illness (APA, n.d.).
A closer examination reveals that the status of youth mental health and wellness is evolv-
ing. Either society is increasing the frequency, rigor, and thoroughness with which it evalu-
ates the mental health of young people or their mental health conditions are deteriorating.2
For example, rates of youth depression increased from 8.5 percent in 2011 to 11.1 percent in
2014 (MHA, n.d.). This is an increase from 6.4 percent in 2005 (APA, n.d.). Even with severe
depression, 80 percent of youth are left with no or insufficient treatment for the condition
(MHA, n.d.). The share volume of mental health challenges as well as the increasing severity
of illnesses experienced by young people elevates the importance of access to sound mental
health supports.
Mental Health and Wellness in the Black Community
The history of Black life in America has foregrounded the contemporary mental health chal-
lenges within the community. Centuries of systematic oppression (e.g., slavery, Black codes,
Jim and Jane Crow,3 inferior education, residential segregation, extra-judicial killings at the
hands of law enforcement), institutionalized racism, and frequent microaggressions (Sue, 2010)
have levied blatant physical, emotional, and mental assaults on the minds and spirits of Black
people in America. Indeed, Black people are in need of healing from various forms of trauma.
Chronic fear of these experiences may lead to constant vigilance or even paranoia, which
over time may result in traumatization or contribute to post-traumatic stress disorder (PTSD)
when a more stressful event occurs later (Carter, 2007; Williams, 2015). Of little surprise to
many social scientists, data from a recent study by the US Department of Health and Human
Services’ Office of Minority Mental Health (2016) suggest that Black adults in the U.S. are 20
percent more likely to report serious psychological distress than White adults. Similarly,
while depression is one of the most common disorders in the United States (affecting over
17 million lives per year), Black adults, in particular, are 20 percent more likely than Whites
to contend with serious depression and anxiety in their lifetime (APA, n.d.). Even more, find-
ings from national studies indicate that, while African Americans4 have lower risk for many
anxiety disorders, they have a 9.1 percent prevalence rate for PTSD, compared with 6.8 percent
among Whites (Himle et al., 2009). A recent study by Malcoun, Williams, and Bahojb-Nouri
594 EDWARD J. SMITH
(2015) found that depression and PTSD affected almost 50 percent of Black men and women
being treated for trauma exposure, ranging from car accidents to deaths in the family, to
physical and sexual assault. Lastly, Black people are twice as likely as Whites to be diagnosed
with schizophrenia (APA, n.d.).
Several cross-sections of the Black community remain in deep need of mental health
care and service. For example, Black people living below the poverty line are three times
more likely to report serious psychological distress than their same-race peers living above
the poverty line (Office of Minority Mental Health, 2016). Additionally, while Blacks are less
likely than White people to die from suicide as teenagers, Black teenagers are more likely to
attempt suicide than are White teenagers (8.3 percent vs. 6.2 percent). Suicide among African
American preteens ages ten to fourteen increased 233 percent over the period 2005 to 2014
(MHA, n.d.). Lastly, research finds that Blacks are more likely to be victims and witnesses of
a serious violent crime than any other racial group in the United States (Office of Minority
Mental Health, 2016). Thus, Blacks are more likely to meet the psychological criteria for PTSD
(Carter, 2007; Himle et al., 2009).
Black Men and Mental Health and Wellness
The research on the mental health and wellness of Black men in America is scant. Yet many
mental health professionals, scholars, activists, parents, and educators agree that the ways in
which Black men address mental illness (particularly depression and suicide) is in sore need
of transformation. For instance, scholars find that there are consistent gender differences
in the prevalence and treatment of major depressive disorders within the Black community
(Hankerson et al., 2015). Men, regardless of race and ethnicity, tend to experience lower rates
of mental health service utilization than women (Hankerson et al., 2015); Black women are
four times more likely to use mental health services than Black men (Himle et al., 2009). The
impacts of underutilization can be devastating. Suicide among African American men is four
times more likely to occur than it is for African American women (Hankerson et al., 2015).
Similar disparities exist when comparing Black men with their same-gendered peers. For
example, despite evidence that rates of conditions like bipolar disorder and depression and
anxiety are experienced equitably across races and ethnicities, Black men are statistically much
less likely than White, Latino, and Asian American and Pacific Islander men to seek treatment
or even publicly acknowledge mental health challenges (Chao, Asnaani, & Hofmann, 2012;
Hankerson et al., 2015). Similarly, Hammond’s study (2012) concluded that depressed Black
men are significantly less likely to seek help compared with depressed White men. An exami-
nation by Woodward, Taylor, and Chatters (2011) of national treatment rates of men with a
lifetime of mood, anxiety, or substance disorders indicates that just 14 percent of Black men
received care from professional mental health services, compared with 29 percent of men in
their entire sample.
Disparities in Accessing and Help-Seeking Explained
In the groundbreaking comprehensive report on the mental health status of racial and ethnic
minorities in America, former US surgeon general David Satcher reported that
minorities in the U.S. suffer a disproportionate burden of mental illness because they have less
access to services than other Americans; receive lower quality care, often from services that are
fragmented, costly, and inadequate; and are less likely to seek help when they are in distress, in part
because the considerable stigma attached to mental illness in many cultures. (DHHS, 2001, p. 108)
Satcher’s observations captured a historical analysis, as much as they foregrounded future

trends, as disparities in access to care and treatment for mental illness have also persisted
over time. In 2011, 54.3 percent of African Americans with a major depressive episode received
treatment, compared with 73.1 percent of White adults (Agency for Healthcare Research and
Quality, 2013). Similarly, compared to 45.3 percent of White Americans, 40.6 percent of African
Americans age twelve and over were treated for substance abuse and completed their treatment
course (Agency for Healthcare Research and Quality, 2013).
There are a host of complex and enduring reasons for race- and gender-based disparities
in the usage of mental health care and support. For example, many Black men worry that some
mental health care professionals are not culturally competent enough to treat their specific
issues (Ward et al., 2013) and further contend that cultural insensitivity and bias can cloud the
relationship they can develop with mental health professionals (National Alliance on Mental
Illness, n.d.). Further to the observation of cultural misalignment, only 2 percent of American
Psychological Association members are Black (APA, 2014). Moreover, the issue of cultural mis-
alignment is compounded by the fact that some Black patients have reported experiencing an
onslaught of racial microaggressions and bigotry from therapists (Williams, 2013). Newhill
and Harris (2007) found that Black consumers of mental health services voiced concerns of
cultural insensitivity and the propensity to miscommunicate with providers as major obstacle
to seeking services and engaging in treatment.
Cultural misalignment and cultural insensitivity often fester, developing into mistrust
of health professionals, based in part on historically higher-than-average institutionalization
of African Americans with mental illness; and on previous mistreatments, like such tragic
events as the Tuskegee syphilis study (Hankerson et al., 2015). It bears repeating: the weight of
systemic oppression, institutional racism, and microaggressions ostensibly moderates access
to mental health and wellness services for African Americans.
On the other hand, a recent study by Ward and associates (2013) revealed that African
Americans tend to hold stigmas related to psychological openness and help-seeking, which
in turn affects their coping behaviors. Generally, the participants in this study were not
particularly open to acknowledging psychological problems. Not surprisingly, only 30 per-
cent of participants who reported having a mental illness reported receiving treatment or
underwent therapy (Ward et al., 2013). Consistent with previous research (see Agency for
596 EDWARD J. SMITH
Healthcare Research and Quality, 2013; Himle et al., 2009), the authors found Black men to
be particularly concerned about the stigma (i.e., appearing weak, vulnerable, and unable to
self-identify solutions to their problems). While the men appeared to be apprehensive about
seeking professional help for mental health issues, the men in the study seemed willing to
pursue other forms of help, such as talking to romantic partners, spouses, or mentors (Ward
et al., 2013). Unfortunately, most individuals with a diagnosable mental illness, regardless of
race or ethnicity, do not receive appropriate treatment. Yet still, Black men are least likely to
receive such treatment (DHHS, 2001).
Taken together with misdiagnoses, inadequate treatment, a lack of cultural understand-
ing, gendered stigmatization, as well as the gendered disposition to “toughing it out,” access
to sound mental health care and treatment can be tenuous for Black men. This oftentimes
leads to unwillingness to confront challenges, eventually leading those who experience these
challenges to suffer in isolation (Newhill & Harris, 2007). It would seem that traditional
gendered norms around the aversion to help-seeking and “toughing out” problems as long as
possible are doing Black men more harm than good. As Newhill and Harris (2007) observe, if
left untreated, mental illness exacts a heavy toll not only on the ill individual, but also his or
her family, community, and society as a whole.
Hip-Hop and Mental Health
Jeff Chang (2005) chronicled the extent to which New York City’s economic decline during the
1970s gave rise to hip-hop culture. Advancing Chang’s recollection, noted legal scholar Akilah
Folami (2007) explains:
Historically, Hip-hop arose out of the ruins of a post-industrial and ravaged South Bronx, as a
form of expression of urban Black and Latino youth, who politicians and the dominant public and
political discourse had written off, and for all intent and purposes, abandoned. (p. 244)
Hip-hop scholars and historians accurately draw connections between the critical nature of the
art form and the rawness that grew out of adverse economic, social, and political conditions.
During the 1970s and 1980s, New York would suffer immense job losses coupled with decreased
local and federal funding for social services (Folami, 2007). The South Bronx alone would lose
600,000 manufacturing jobs (40 percent of the sector) (Chang, 2005). By the mid-1970s, aver-
age per capita income in the South Bronx dropped to half of the New York City average and
40 percent of the nationwide mean (Chang, 2005). The youth unemployment rate on record
climbed to 60 percent (up from 40 percent a decade before) (Chang, 2005). Such conditions
would leave “30 percent of New York’s Latino households, and 25 percent of Black households
at or below the poverty line” (Chang, 2005, p. 46). Youth in many of America’s urban centers
were alienated from decent, life-affirming employment opportunities and confined to under-
funded schools and community programs (Rose, 1994).
Based on his analysis, political prisoner and former Black Panther Mumia Abu-Jamal posits
that hip-hop was born from a culture of young people who felt “that they are at best, tolerated
in schools, feared on the streets, and almost inevitably destined for the hell holes of prison”
(Abu-Jamal communicated to Immortal Technique, 2003). Abu-Jamal continues, “They grew
up hungry, hated, and unloved. And this is the psychic fuel that seems to generate the pain and
anger that seems endemic in much of the music and the poetry.”5
The response Abu-Jamal spoke of came in the form break-dance clubs, DJ crews, and
block parties, all of which engaged youth from neighborhoods that once fought each other to
come together and compete and collaborate through dancing, rapping, and creating music.
Hip-hop increasingly became a pivotal tool for helping deconstruct forms of systematic op-
pression, while fostering a sense of self-worth, community, and cultural vibrancy. With the
emergence of Afrika Bambataa, the pulse of hip-hop was turned to Black Nationalism, positive
creativity, vision, and healing (Henderson, 1996). Some of the positive creativity, vision, and
especially healing that Henderson interprets (1996) did not take root until 1981, when Melle
Mel coauthored “The Message,” “the first nationally recognized ‘progressive’ rap statement on
the condition of Black people in urban America” (Henderson, 1996, p. 311).
Despite this emergence of a significantly positive grounding in the music, artists embraced
conversations about environmental elements they experienced in their communities and the
impacts their environments had on them. Artists often discussed pain and hurt, still reeling
from the aforementioned societal and communal conditions. It is common for depression
to emerge as a major theme for musicians; of no surprise, depression and suicidal ideation
remain central themes in hip-hop.
Rap Therapy and Hip-Hop Psychology

Hip-hop has always been a personal, spiritual, and social vessel (KRS ONE, 2009). Therefore,
it is not difficult to see the therapeutic properties contained in the art form. The emergence
of rap therapy (Alvarez, 2011) as well as hip-hop psychology (Roychoudhury & Garder, 2012)
offers two conceptual and practical frameworks to both encourage and understand how and
why artists vocalize depression and thoughts of suicide. Given the previously described ob-
structions such as perceived or realized cultural insensitivity, as well as the associated stigma
of utilizing supports, mental health professionals and the public are unlikely to find another
therapeutic resource more utilized by Black men than rap music.
One theory behind why rap music has been effective (in ways that traditional modes of
therapy have not) includes the purposeful integration of the original four elements of hip-hop
culture (i.e., MC’ing, DJ’ing, break dancing, and graffiti art) in a therapeutic setting to achieve
catharsis and facilitate psychosocial development (Alvarez, 2011). Numerous empirical studies
have found rap therapy to be highly effective in improving therapeutic experience and mental
health outcomes, particularly among young people living in urban settings (Alvarez, 2006, 2011;
DeCarlo & Hockman, 2003; Tillie-Allen, 2005; Tyson, 2002). Alvarez (2011) provides a strong
598 EDWARD J. SMITH
summary of the form of therapy and how it can be adapted to different educational contexts
(e.g., elementary schools, high schools, schools in a criminal justice system, postsecondary
institutions).
Psychologists Edgar Tyson (2002) and Don Elligan (2004) were the first to publish research
about the use of hip-hop music in therapy. Hip-hop psychology is often utilized to engage clients
in treatment by helping establish a working relationship with the client (Elligan, 2004; Tyson,
2002). Music and vocal performances can also help clients identify emotions, reframe cognition
and traumatic experiences, and facilitate sense-making (or processing). In many cases of hip-
hop therapy, clients are encouraged to compose their own rap verses. It has become a creative,
yet effective way to address the cultural and intellectual needs of Black teens (Robinson, 2014).
Psychologist Janie Ward (2000) argues that parents who successfully instill health psy-
chological resistance in their children help them express and cope with, rather than repress,
anger and frustration. Therefore, outlets such as hip-hop provide an essential forum to build-
ing psychological health among African Americans (Ginwright, 2010). Rap music offers the
potential for a culturally specific intervention that can help psychologists and other mental
health professionals connect with and help Black youth (Kitwana, 2002).
An Analysis of the Framing of Trauma and Mental Health in Rap Music
This chapter spotlights the transition from the more traditional framing of trauma and mental
health challenges in rap music to the renaissance of the vulnerable, yet increasingly healthy,
offerings by more recent artists. I analyzed a sample of fourteen songs by hip-hop recording
artists from the 1980s through the present day (see appendix), selecting songs that focus spe-
cifically on depression, anxiety, and suicide. I read through each song’s lyrics to discern how
and why the artist discussed these themes and scrutinized the content to see if any reflections
or diagnoses on mental illness challenges emerged as a factor that rationalized the focus on
these themes. The following summary includes a select sample of passages from six artists that
highlight the argument.
Several examples of depression, suicidal ideation, and threat to harm emerge from songs
both pre-2010 and post-2010 eras. However, the first period of music from the sample pro-
duces rappers who establish a certain degree of distance with the environmental conditions,
pain, or activities causing them trauma. The artist is more likely to state desires attain relief
and to evade or end the trauma, as opposed to seeking help to materially address the trauma.
Moreover, most of these artists maintain the perception of control over their circumstances;
treating their trauma rarely emerges as a prominent feature of the song. For example, 1982’s
“The Message” performed by pioneering rap group Grandmaster Flash and the Furious Five,
provides a sample of the enormous influence the aforementioned material conditions of the
Bronx have on Black youth, as well as the output of hip-hop (Chang, 2005; Henderson, 1996).
Many scholars and hip-hop historians acknowledge the record for its critique of the political
economy (Henderson, 1996) and for lucidly illuminating the politics (and tactics) for survival
in the South Bronx. Although not the first song to provide social commentary or “socially
conscious” lyrics about structural inequality, abject poverty, and substance abuse (see the
early music of Kurtis Blow, Brother D, and Tanya “Sweet Tee” Winley), “The Message” would
provide the first mainstream, commercially successful record to speak seriously about these
issues (Henderson, 1996; Rose, 1994).
Yet Melle Mel (the lead vocalist) provides insight into the anxiety of a young Black man
struggling to reconcile the conditions he’s experiencing with a desire to evade these conditions.
Indeed, he discloses an inner turmoil, reminiscent of someone feeling physically, as well as
emotionally, trapped. He shares the faint desire to evade, or eventually leave, these conditions,
even after stating how these conditions frustrate him:
Broken glass, everywhere

People pissing on the stairs, you know they just don’t care
I can’t take the smell, I can’t take the noise
Got no money to move out, I guess I got no choice
Rats in the front room, roaches in the back
Junkies in the alley with a baseball bat
I tried to get away, but I couldn’t get far
Cause the man with the tow-truck repossessed my car.
(Fletcher et al., 1982)
Another example of a song that uses suicide as an escape mechanism is provided by the
Geto Boys. Specifically, in a song widely acknowledged to be about psychosis (Ellis-Petersen,
2016), Scarface vividly discusses his paranoia and suicidal ideation after describing a plea for
repentance and while traveling through the darkness of depression and paranoia. These reflec-
tions eventually lead him to feelings of suicide, where he, like Melle Mel, seeks relief and escape
from current conditions. Scarface uses the term “worry free” to evoke the feeling of ultimate
relief, in of the same way many patients dealing with depression and suicidal ideation evoke.
Praying for forgiveness

and trying to find an exit out the business
I know the Lord is looking at me
and yet it’s still hard for me to feel happy
I often drift while I drive
I’m having fatal thoughts about suicide
Bang and get it over with
and then I’m worry free, but that’s bullshit.
(Jordan, King, & Dennis, 1991)
A song like The Notorious B.I.G.’s “Suicidal Thoughts” (1994), rooted in depression and
built around the idea that regret, self-doubt, and worthlessness eventually lead Biggie to discuss
600 EDWARD J. SMITH
suicidal ideation, is a prime example of both elements that capture this era of depression-themed
rap. While Biggie, too, seeks relief and escape, as Pearce (2015) finds, Biggie writes from a posi-
tion of perceived control. After stating a list of actions that may infringe on the happiness of
others, he turns inward and ponders ways to evade judgment—not address it, make amends,
or heal from these activities. Notwithstanding Biggie’s honesty and introspection, his lyrics
emerge from a position of perceived control, foreclosing any real opportunity for a diagnosis,
treatment, or acknowledgment of the feelings that undergird his conclusions.
My baby mother’s eight months, her little sister’s two

Who’s to blame for both of them (puffy: nah nigga, not you?)
I swear to God I just want to slit my wrist and end this bullshit
Throw the magnum to my head, threaten to pull shit
and squeeze, until the bed’s, completely red
I’m glad I’m dead, a worthless fuckin Buddha-head
The stress is building up, I can’t, I can’t believe
Suicide’s on my fucking mind, I wanna leave
I swear God it feel like death is fucking calling me
nah you wouldn’t understand (puffy: nigga talk to me, please!)
(Wallace & Hall, 1994)
Biggie and Scarface share feelings of despondency as a result of their environment, as well as
acts they have committed themselves. Living in the hood can be stressful—sometimes the life
of a hustler can be even more stressful.
Another hip-hop icon, Tupac Shakur, espouses similar desires for relief in “So Many Tears”
(1995). In the spiritual monologue, Pac shares:
And fuck the world cuz I’m cursed

I’m having visions of leaving here in a hearse (God can you feel me)
Take me away from all the pressure and the pain
Show me happiness again
Pac continues, evoking elements of paranoia and anxiety:
and though my soul is deleted, I couldn’t see it

I had a mind full of demons trying to break free
they planted seeds and they hatched, sparking the flame
inside my brain like a match, such a dirty game
no memories just the misery,
painting a picture of my enemies killing me, in my sleep
will I survive till the morning, see the sun
please Lord forgive me for my sins, cuz here I come
(Shakur et al., 1995)
Perhaps to acknowledge and name depression is to project vulnerability onto these lyrics. But
to appear in control, yet vocalize the desire for relief and freedom from anxiety while avoiding
depression, is to disassociate oneself with the image of an archetypical hip-hop star.
Stic.man of rap duo dead prez painfully professes the emotional trauma he experiences as
he watched his older brother develop a drug addiction. Rather than blame the individual, Stic.
man addresses the larger socioeconomic forces that influence and often dictate the choices
of the urban poor. Moreover, Stic.man discusses how he experiences the trauma and pain
secondhand, and how witnessing this struggle influences his motivation to persist. In asking,
“How did Black life, my life, end up so hard?” (dead prez, 2003), Stic.man states:
The same conditions that first created the drug problems still exist
And on days off, we blow off them crumbs like nothing
Getting high, cause a nigga gotta get into something
But we get trapped in a cycle of pain and addiction
And lose the motivation to change the condition
(Ibomu & Olugbala, 2003)
It is possible that Stic.man is interpreting his brother’s drug use as a coping mechanism for the
conditions under which he lives. Like Tacoma and many others, drug use is a way to escape a
reality that could be extremely adverse and harmful to bear. Hence, Stic.man captures another
evasion device and contextualizes the dual meaning of losing “the motivation to change the
condition,” both personal, as well as structural (Ibomu & Olugbala, 2003).
The Beginning of a Renaissance

The conversation around mental health in the music industry has evolved over the period
between 2010 and 2016, particularly with a new cadre of rappers, and some veterans, harness-
ing the courage not only to chronicle their pain and anxiety, but to take themselves and their
listeners to a vulnerable place through music. In addition to wrestling with depression, anxiety,
and suicidal ideation in their lyrics or positioning these issues as central to the composition
of songs and albums, artists have been discussing these issues in the media.
Veteran emcee Pharoahe Monch has been outspoken about his battle with depression,
which he has stated has been induced by a combination of medications he was taking follow-
ing his hospitalization for his asthma (Harris-Perry, 2014). As foregrounded by his 2014 album
title, PTSD, Monch includes frank, vulnerable lyrics about his struggles to stabilize his mental
health and wellness, as well as candid discussion about the stigma of depression within the
Black community. In “Losing My Mind” (2014), Pharoahe Monch raps, “My family customs
were not accustomed to dealing with mental health / It was more or less an issue for White
families with wealth.” He continues, “Void, I defected, employed self-annoyed / Went indepen-
dent, enjoyed stealth / Now doctors prescribed sedatives and Prozac.” In an interview with
Melissa Harris-Perry (2014), Monch elaborated on the first passage, “Coming up, you couldn’t
602 EDWARD J. SMITH
talk about [mental health] out in the open. People would isolate you for many reasons. Your
career might not last.”
Elaborating on the second passage, Monch in several media outlets discussed the “cocktail
of drugs” that drew him into depression. His revelation speaks to the concerns that many
Black families have about the devastating implications of misdiagnoses and overprescriptions.
Moreover, the first passage describes hesitancy to uncover some of these issues because, as
many Black men share, his parents were “strong and hardworking,” as if to make the point
that his problems may pale in comparison to those experienced by previous generations of
Black people in America. Both concerns are elevated in the literature; I saw both as salient
features of Tacoma’s trials. Yet, how is it that Monch finally finds the courage and artistic
freedom to discuss mental health and wellness in a way that, as he implies, would have iso-
lated him in the past?
Rapper and actor Kid Cudi told his fans and Twitter followers in the fall of 2016 that he had
checked into a rehabilitation center to treat his ongoing battle with mental health illnesses.
He wrote about his struggles in a long and forthright Facebook post:
It’s been difficult for me to find the words to what I’m about to share with you because I feel
ashamed. Ashamed to be a leader and hero to so many while admitting I’ve been living a lie. . . .
Yesterday I checked myself into rehab for depression and suicidal urges. I am not at peace.
In discussing rehabilitation, Cudi shares:
If I didn’t come [to rehabilitation], I would’ve done something to myself. I simply am a damaged
human swimming in a pool of emotions everyday of my life. Theres a ragin violent storm inside of
my heart at all times. Idk what peace feels like. Idk how to relax. My anxiety and depression have
ruled my life for as long as I can remember and I never leave the house because of it. I cant make
new friends because of it. I don’t trust anyone because of it and Im tired of being held back in my
life. I deserve to have peace. I deserve to be happy and smiling.
This post was emotionally raw and unexpectedly vulnerable, and although he apologizes to his
fans for “letting them down,” he acknowledges that he is indeed “scared” and that he is “sad.”
Cudi’s forthright Facebook post prompted several hundred responses, sparked a trending
conversation on Twitter, and provoked a slew of opinion editorials, blogs, and essays on the
status of Black men’s mental health and wellness. Outgrowth from the social media firestorm
included the hashtag #Yougoodman and #OKtonotbeOK, with tagged tweets including nar-
ratives, reflections, and advice from Black men who struggle with mental health challenges.
The overwhelming consensus was that Cudi’s post was brave, touching, and necessary
given the severity of mental health challenges experienced by Black men, as well as the impli-
cations of untreated illnesses. Yet Cudi has made a career of self-disclosure and vulnerability.
It is possible that he has been at the forefront of this renaissance—and that he has adjusted
the norms (or reflecting the changing norms) among Black men with respect to self-disclosure
and help-seeking.
Cudi has a relatively short, but influential, history concerning vulnerability and has spoken
publicly in many mediums about his mental health. For example, a spring 2016 interview with
Billboard included reflections about the pressure of wanting to appear fine while he was using
drugs to address his depression. Cudi states, “I thought about how much of a struggle it has
been the past eight years, to be in the news and pretend to be happy when, really, I was living
a nightmare” (2016). Moreover, the following passage is offered from the song “Soundtrack 2
My Life” from his first album, Man on the Moon: The End of Day (2009): “I’ve got some issues
that nobody can see / And all of these emotions are pouring out me . . . my heart is an open
wound that I hope heals soon.”
A proclaimed advocate for suicidal prevention, Cudi explained the following in an inter-
view with late-night talk show host Arsenio Hall (2014):
My mission statement since day one has been to help kids not feel alone, and to stop kids from
committing suicide. That’s something that has affected me for the last five years. There wasn’t a
week or day that didn’t go by where I said, “You know, I want to check out.” I know what that feels
like and I know it comes from loneliness not having self-worth, not loving yourself.
Cudi has not only spent the better part of seven years using his music has a therapeutic instru-
ment, but he has intentionally encouraged others to identify their own challenges, unveiling
a relatively dark mood in hip-hop, but a rather healthy one.
In a song widely recognized about depression and anxiety, California’s Kendrick Lamar
offers the gut-wrenching song “u” off of his second solo album, To Pimp a Butterfly (2015). In
brutal honesty, he describes the life of someone slipping into bipolar episodes with manic
features. Interestingly, the language Lamar uses is a bit more vivid and consistent with a for-
mal diagnosis:
I know your secrets, nigga

Mood swings is frequent, nigga,
I know depression is restin’ on your heart for two reasons, nigga
Lamar continues, discussing the ways in which his anxiety and depression affect his loved ones:
You the reason why Momma and them leavin’

No, you ain’t shit, you say you love them, I know you don’t mean it
I know you’re irresponsible, selfish, in denial, can’t help it
Your trials and tribulations a burden, everyone felt it . . .
You shoulda felt that black revolver blast a long time ago
And if those mirrors could talk it would say “you gotta go”
And if I told your secrets
The world’ll know money can’t stop a suicidal weakness
(Duckworth, Arnold, & Brown, 2015)
604 EDWARD J. SMITH
Lamar raps as a character who appears to be drowning in his sorrows. The track is en-
hanced by the sound effects of clinking bottles and features Lamar rapping on- and off-beat,
his cadence speeding up and slowing down without an apparent trigger, and his voice goes
from smooth to deeply raspy. Lamar recounts the triumphs of a successful recording artist
who finds himself alone in a hotel room, intoxicated with alcohol, and talking to himself in
the mirror. He might be suffering with clinical depression, which would be evidenced by the
language and key symptoms demonstrated in the lyrics (e.g., low self-confidence, self-worth,
hopelessness) as well as suicidal ideation: “The world don’t need you . . . I know depression is
restin’ on your heart” (Duckworth, Arnold, & Brown, 2015).
Several samples of the interconnectivity between drugs and mental health issues come
from rapper Lil Wayne. Of particular note is the following passage from the song “I Feel Like
Dying” off of his mixtape The Drought Is Over 2 (The Carter 3 Sessions) (2007):
I am a prisoner, locked up behind Xanax bars

I have just boarded a plane without a pilot
And violets are blue, roses are red
Daisies are yellow
The flowers are dead
I wish I could give you this feelin’
I feel like buying
And if my dealer don’t have no more, then I feel like dying.
(Carter & Jonsin, 2007)
Finally, Chicago rapper Vic Mensa follows up on the theme of drugs and mental health issues,
with the title track to his There’s Alot Going On extended play (2016) sharing: “The violence
and the lies slipped suicide into my mental health / I did acid in the studio one day and almost
killed myself ” (Mensah et al., 2016).

Two main reasons make it easy to overlook and underestimate the importance of the
apparent shift in social and gendered norms and language either brought about or reflected
by these artists. First, the language is clear and vivid and illustrates a tale of yearning, much
richer and more vulnerable that past cohorts of emcees. It is clear that these artists are not
immunized from depression or suicidal ideation by money or outward signs of success. And
they do not run from vulnerability or self-help, either. Oftentimes, society fails to empathize
with entertainers and celebrities, generally, who open up about their struggles to achieve
sound mental health. It is often the case that society reinscribes the misguided notion that
“successful” people should not be depressed, feel anxiety, or develop or espouse threats to harm
themselves. Essentially, it may cause them to continue to spiral deeper into isolation, shame,
and further impede them from seeking help.
Second, mental illness is oftentimes confused with pathology and violence (Alvarez, 2011;
DHHS, 2001; Hadley & Yancy, 2012). Hence, when someone is struggling with mental illness
(particularly a Black man in hip-hop culture), self-advocacy can sometimes be dismissed. Even
still, rappers become active agents in their own recovery and treatment rather than passive
receivers of treatment, or “clients.” This is ownership and partnership with the listener—and
hopefully this provides a therapeutic outlet to the listener. This therapeutic process is perhaps
the longest-standing and durable outlet that acknowledges the ways in which systematic op-
pression and a history of joblessness, poverty, violence, and poor education have been toxic
to Black men and Black communities in general.
Discussion, Implications, and Conclusion
Indeed, hip-hop is in dire need of a mental illness healing call. News of Kanye West’s hospitaliza-
tion in the fall of 2016, which landed him in the psychiatric ward of the University of California
at Los Angeles, reportedly for stress and exhaustion, was jarring, but unsurprising to many
(Ellis-Petersen, 2016). Following a week of erratic behavior on stage during his concerts that
rocked fans and the public alike, several observers and mental health professionals predicted
hospitalization and intense treatment would be the likely outcome of such behavior. The final
straw, perhaps, was the report that West suffered a mental breakdown at his personal trainer’s
house (Ellis-Petersen, 2016); West abruptly cancelled twenty-one dates of his Saint Pablo tour.
Reports claim, among other things, he has been struggling with paranoia and mental exhaustion
from nonstop touring, the work on his fashion and sneaker lines, plus the ninth anniversary of
the death of his mother, Dr. Donda West (Ellis-Petersen, 2016). These features of Kanye West’s
story are eerily similar to the decades-long battle with depression Tacoma Savage experienced.
In 2011, rapper DMX admitted in several interviews that many of his struggles with addic-
tion and crime were related to his bipolar disorder (Pearce, 2015). In 2014, Chris Brown was
diagnosed with bipolar disorder and PTSD (Pearce, 2015). Harlem’s Charles Hamilton, who
emerged to prominence in hip-hop culture from New York City’s battle rap scene in the late
2000s, experienced a public unraveling years later with a similar tale of public outbursts and
evasive behavior. He returned to rap in 2016 to admit in several interviews and media outlets
that he lived with bipolar disorder. Hamilton spoke candidly about his hesitance about and
financial challenges in accessing therapy and securing culturally responsive treatment. Chi-
cago’s Vic Mensa has extended the vulnerability listeners hear in his music, releasing several
statements and interviews about his own suppressed mental health challenges. Mensa claims,
“I just didn’t trust anybody. I didn’t leave my house, I just made music all the time. I was fight-
ing depression, I shut myself in. I wanted to commit career suicide, physical suicide, spiritual
suicide, I didn’t care anymore” (Ellis-Petersen, 2016).
In light of the recent public, yet candid, discussions and activism around mental health
illness, hip-hop still reels from a wave of suicides. Pro Era’s Capital Steez committed suicide
at the end of 2011, claiming to “end it all” and relieve himself from “suffering” (Ellis-Petersen,
2016). Former Def Jam executive Shakir Stewart and longtime talent manager Chris Lighty re-
portedly committed suicide, in 2008 and 2012, respectively. Stewart led one of hip-hop’s most
durable record labels and helped facilitate the careers of some of hip-hop’s most successful
606 EDWARD J. SMITH
acts, including Young Jeezy and Rick Ross. Lighty was a mainstay in the culture and represented
some of hip-hop pillars like Q-tip, Busta Rhymes, Missy Elliot, 50 Cent, and LL Cool J. Indeed,
whether a person is relatively obscure or at the top of the culture, mental health and wellness
are an important aspect of the culture.
As hip-hop scholar and former Green Party vice president candidate Rosa Clemente asserts:
Hip-hop and the larger community of Black and Brown, progressive, radical, social justice activists
[need to] figure out a way to begin a dialogue, to not just break the silence around depression, but
to stop the shamming of those who suffer from this disease. (Clemente, 2012)
One way to achieve such a dialogue may include integrating mental health services with
general medical care. It would also be appreciated if medical insurance covered mental illness as
well as physical ills, a recommendation proposed by the DHHS and several other organizations
(DHHS, 2001; Newhill & Harris, 2007). Another viable option may include using rap therapy
to expand discussions around treatment and recovery. Newhill and Harris (2007) suggest that
many of the young Black men in their study would respond best to talking with other young
Black men who have been “successfully treated for mental health problems themselves” (p. 115),
adding that “such individuals would be viewed as credible role models for seeking treatment”
(Newhill & Harris, 2007, p. 115). Indeed, some of the artists mentioned have helped operation-
alize rap therapy. For many, rap music reflects a mirror on urban life in America and provides
insight into the minds of a heterogeneous swath of Black men.
If mental health and wellness remains a taboo subject for Black men, hip-hop is bound to
have unproductive conversations about it. And as social norms change—or, as in many cases,
hip-hop itself changes social norms—Black folks and Black youth in particular will employ more
positive, productive conversations on mental health and wellness. Many times, as in therapy,
those conversations start with feelings, emotions, rawness, recollections of trauma, and pos-
sible feelings of suicide. As discussed in this chapter, these features are salient, yet durable, in
rap music. Only then can Black men and hip-hop culture, at large, begin to heal and continue
to evolve. It is my argument that although dark and uncomfortable to hear at times, the new
renaissance of mental health conversations in hip-hop represents the best of what hip-hop has
to offer society: a powerful and challenging critique of systematic and institutional oppression
that I hope inspires collective action and healing instead of individual escapism.
Appendix. Songs Analyzed
SONG TITLE PERFORMER(S) YEAR WRITER(S)

“The Message” Grandmaster Flash 1982 Clifton Chase, Edward Fletcher, Melvin Glover, and Sylvia
and the Furious Five Robinson
“Mind Playing Tricks on Me” Geto Boys 1991 Brad Jordan, Doug King, and William Dennis
“Suicidal Thoughts” Notorious B.I.G. 1995 Christopher Wallace and Robert Hall
“So Many Tears” 2Pac 1995 Tupac Shakur, Gregory Jacobs, Randy Walker, Eric Baker,
and Stevie Wonder
“Slippin” DMX 1998 Earl Simmons
“Window to My Soul” dead prez 2003 Khnum Muata Ibomu and Mutulu Olugbala
“Whatever It Takes” Joe Budden 2003 Joe Budden, Clinton Sparks, and Carolyn Franklyn
“I Feel Like Dying” L’il Wayne 2007 Dwayne Carter
“Losing My Mind” Pharoahe Monch 2014 Troy Jamerson and Jesse West
“u” Kendrick Lamar 2015 Kendrick Duckworth, Terrace Martin, and Michael Brown
“Only Human” Joe Budden 2015 Joe Budden, Emanny Salgado, and Karon Graham
“Soundtrack 2 My Life” Kid Cudi 2016 Scott Mescudi and Haynie
“There’s A lot Going On” Vic Mensa 2016 Victor Mensah, Alex Baez, Darian Garcia, Kevin
Rhomberg, Carter Lang, and Peter Cottontale
“Mad” Solange featuring L’il 2016 Solange Knowles, Dwayne Carter, Dave Longstreth,
Wayne Raphael Saadiq, and Sir Dylan
n Notes
1. For the purposes of this chapter, mental health includes a person’s emotional, psychological,
and social well-being. The concept helps determine how people handle stress, relate to others,
and make choices about their lives. For more information, see the US Department of Health and
Human Service’s web page, www.mentalhealth.gov, and the National Institute of Mental Health,
www.nimh.gov.
2. For the purpose of this chapter, youth are defined as persons under the age of eighteen.
3. Jane Crow, in this context, describes the specific practices, laws, and customs that constrict the
lives of US women of African descent. Additional interpretations of Jane Crow have been applied
to capture the practices, laws, and customs that discriminate against women and alienate them
from the Equal Protection Clause of the Fourteenth Amendment of the US Constitution. For more
information, see the work of Rosalind Rosenberg (2017), Jane Crow: The life of Pauli Murray.
4. It is important to note that mental health research has used the term “Black” to describe
individuals from various ethnicities of the African diaspora (e.g., African American, Caribbean,
and others). The terms Black and African American are used interchangeably in this chapter to
reflect the use of both terms in the relevant literature.
5. Immortal Technique (2003). Homeland and hip hop. Revolutionary Vol. 2. New York: Viper Records.
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Mental Health and Hip-Hop Edward J. Smith

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Discussing Suicide without Being Cruciﬁed

The New Renaissance of Mental Health in Hip-Hop

He evolved into a songwriter and rhythm-and-blues instrumentalist in the early 1990s,

Mental Health and Wellness in the United States: A Review of Data

Mental Health and Wellness in the Black Community

Black Men and Mental Health and Wellness

Disparities in Accessing and Help-Seeking Explained

Satcher’s observations captured a historical analysis, as much as they foregrounded future

Hip-Hop and Mental Health

Rap Therapy and Hip-Hop Psychology

An Analysis of the Framing of Trauma and Mental Health in Rap Music

Broken glass, everywhere

Praying for forgiveness

My baby mother’s eight months, her little sister’s two

And fuck the world cuz I’m cursed

Pac continues, evoking elements of paranoia and anxiety:

and though my soul is deleted, I couldn’t see it

The Beginning of a Renaissance

In discussing rehabilitation, Cudi shares:

I know your secrets, nigga

You the reason why Momma and them leavin’

I am a prisoner, locked up behind Xanax bars

killed myself ” (Mensah et al., 2016).

Discussion, Implications, and Conclusion

Appendix. Songs Analyzed

SONG TITLE PERFORMER(S) YEAR WRITER(S)

Harris-Perry, M. (2014). The Melissa Harris-Perry Show, April 14. MSNBC.

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