̽��ֱ�� of Cambridge - Akeem Sule

11 hip-hop artists who had something to say about mental health

cjb250 — Wed, 09 Dec 2020 09:55:59 +0000

How hip hop artists are opening up about their struggles with depression and anxiety, helping reduce stigma and encouraging others to seek support.

Living with adversity: What Tupac and Eminem can tell us about risk factors for mental health

cjb250 — Tue, 12 Apr 2016 08:40:56 +0000

Tupac Shakur and Eminem are often touted as two of the greatest rappers of all time. While Tupac, who was shot dead in 1996, is African American and Eminem is Caucasian, their lyrics have similar narrative story telling styles that are filled with anguished suffering and anger conveyed in their hip-hop songs. ̽��ֱ��characters they portray in their lyrics are often surrounded by challenging environments – alcohol and drug addiction, parental abuse and gun crime, for example.

Two songs that describe important issues of adversity reflecting strong emotional turmoil in their lyrics are ‘Death around the corner’ from Tupac Shakur’s album, ‘Me Against ̽��ֱ��World’, and ‘Cleaning out my closet’ by Eminem from his album, ‘ ̽��ֱ��Eminem Show’. In both songs, whether knowingly or unwittingly, the artists’ characters reveal many of the symptoms of mental illness – and also paint a picture that suggests why these problems have arisen.

In ‘Death around corner’, Tupac portrays a fictional character preoccupied with paranoia about a perceived threat to his own life and to his family. He feels the need to protect himself and his family from perceived targeted violence.

Straight away, the song opens with a skit, a dialogue between Tupac’s character, his partner, and their son. Tupac’s character is standing by the window with an AK47 firearm. His son is confused about his father’s strange behaviour and his wife is exasperated with her partner and feels he is consumed by his paranoia. She refers to Tupac’s character as “being crazy” and notes that he is neglecting his family (“you don’t work…you don’t do a…thing”). It is apparent that she does not share his concerns about their family’s safety and appears very irritated that he is preoccupied by his worries. What is particularly concerning is that the character – who is likely paranoid without justification – is carrying a potentially loaded gun at home whilst a vulnerable child and partner present and witnessing this behaviour.

̽��ֱ��first verse makes reference to his need to stay ‘high’, probably through use of either a stimulant or cannabis, which are both risk factors for developing psychosis and paranoia.

̽��ֱ��character describes his harsh urban environment as being where the “skinny” people “die” – in other words, where the weak are killed or exploited. ̽��ֱ��environment appears to be a place where vulnerable individuals can develop social defeat, which research has shown is a risk factor for psychosis.

Tupac’s character alludes to his daddy being “madder than a motherfucker”, which may indicate that the character has an increased risk of developing psychosis due to genetic factors, as we know people with a family history – particularly a parent or sibling – are at increased risk. He subsequently goes to bed “with my pistol in my sheets” due to feeling paranoid.

In the first verse, Tupac mentions his character’s use of “endo” (cannabis) and how it relieves his stress and paranoia. In the next verse, though, he mentions how smoking “…too much weed got me paranoid, stressed”. Is he contradicting himself here? Not necessarily: it depends on the type of cannabis that Tupac’s character has smoked which could explain both the increases in his paranoia and his relief from it – while some forms of cannabis are relatively benign, others, such as ‘skunk’, have been shown to increase the risk of psychosis.

Later, Tupac goes on to describe how his character was “raised in the city, shitty” at an early age, “drinking liquor out my momma’s titty” (a reference to his mother’s excessive alcohol use during early childhood whilst breast feeding), and possibly being exposed to second-hand cannabis smoke from an early age. All these risk factors highlight a chaotic household, which may have had an adverse effect on his developing brain – again leading to the development of psychosis in later life.

It’s clear from these lyrics that Tupac’s character has a family history of psychosis, that he abuses stimulants or cannabis, and that he lives in a harsh environment. All of these factors we know alter an individual’s brain chemistry and in particular how it responds to the key neurotransmitter dopamine, which research has shown leads people to fixate on or give too much emphasis to things in our environment or within our own thoughts, feelings or senses – and hence drive mental health issues such as paranoia and psychosis.

There is another way of looking at Tupac’s character, though: it’s possible that he is experiencing some form of Post Traumatic Stress Disorder (PTSD) following experiencing and witnessing life threatening situations from living in a violent hood “..I guess I seen too many murders…”. His behaviour certainly seems to match some of the common symptoms for PTSD: the frequent looking out of the window and paranoia could be seen as hypervigilance and hyperarousal which are prominent symptoms. His mention of seeing death around the corner could be referencing intensive flashbacks, ‘reliving’ of murders he has witnessed, and his use of “weed” might reflect the use of cannabis for ‘self-medication’.

Eminem’s song 'Cleaning out my closet' follows a similar trend of highlighting early adverse experiences. ̽��ֱ��song deals with Eminem’s angst against his mother.

In the first verse, Eminem highlights how he can’t keep his emotion in check and describes them as “the oceans exploding” attributing it to his parents relationship, their “tempers flaring”.

̽��ֱ��chorus indicates that Eminem wishes to exorcise his emotional demons by voicing his angst in his lyrics. He uses the metaphor “but tonight I’m cleaning out my closet” to acknowledge that he would rather reveal his “skeletons” than allow them to eat away at him.

It appears he is trying to reach out to listeners as though they are psychotherapists. His character discloses his secrets in order to feel free from torment. Sigmund Freud described depression as anger turned inwards, often towards traumatic childhood experiences, hence we can see Eminem’s psychotherapy with the listeners as an opportunity to let go of the buried anger in an attempt to protect himself from depression.

̽��ֱ��rest of the second verse involves Eminem making accusations against his detached, absent father, and Eminem promises to be different by being present for his daughter. It also reveals Eminem avoiding killing his ex-girlfriend and her partner (for the sake of his daughter), therefore he’s able to control his angry impulses.

̽��ֱ��next verse explores his mother’s addiction to prescription pills, which echoes Eminem’s self-declared battle with addiction to prescription pills. This also highlights his increased risk of substance misuse partly due to his familial genetic predisposition.

Eminem’s character accuses his mother of Munchausen’s syndrome by proxy – where a mother fakes her child’s symptoms (or even worse, causes real symptoms) to make the child seem sick – describing himself as a “victim of Munchausen’s syndrome”. In this syndrome, it is believed that the intention of the caregiver is to gain attention and to receive commendation as the rescuer of the child for saving the child in their care from the illness. They do this to fulfill their need for attention by placing the sick role on to their child.

Eminem ends the song by accusing his mother of being jealous of his success and reveals his intention of not allowing her access to his daughter to protect her from becoming a victim of the abuse he experienced.

Interestingly, in a song released by Eminem later in 2013, entitled ‘Heights’, he regrets these harsh views toward his mother as previously written in ‘Cleaning out my closet’ and instead acknowledges his mother’s difficulty raising him as a single parent.

̽��ֱ��suffering and painful feelings revealed by Tupac and Eminem’s characters offer us a valuable insight to examine mental health themes related to psychosis and social adversity. By utilising the interests of individuals who listen to hip-hop music – especially young people – we aim to enhance their understanding about mental health by delivering medical information in a context-enhanced manner. Perhaps this urban influenced approach will help empower and encourage individuals to examine what adversity is around the corner for them personally, and to explore what risk factors may still be locked away in their own closets.

Hip-hop artists Tupac and Eminem are among the most iconic music artists of the past two decades, and as Dr Akeem Sule and Dr Becky Inkster, co-founders of HIP-HOP-PSYCH, write, their lyrics can provide a valuable insight into the lives of some of the people most at risk of developing mental health issues.

̽��ֱ��suffering and painful feelings revealed by Tupac and Eminem’s characters offer us a valuable insight to examine mental health themes related to psychosis and social adversity.

Eminem - Cleanin' Out My Closet

Paal K.

Tupac banner (cropped)

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Exploring mental health through Kendrick Lamar’s lyrics

cjb250 — Fri, 01 May 2015 07:00:00 +0000

In an article online in the journal Lancet Psychiatry, the HIP HOP PSYCH co-founders explain how Kendrick Lamar’s lyrics could help both those affected by mental health issues and practitioners working in the field.

“As Kendrick Lamar’s music paints a picture of how his characters are affected by and cope with mental health issues, we believe it might help mental health practitioners and other professionals to understand the day-to-day internal and external struggles of their patients,” says Akeem Sule, Honorary Consultant Psychiatrist at South Essex Partnership Trust, and an Honorary Visiting Research Associate at the Department of Psychiatry, ̽��ֱ�� of Cambridge.

“ ̽��ֱ��lyrics could provide a valuable way for young people to understand and consider their own vulnerability and life choices, but in a way that is relevant and accessible. With this information to hand, they can start to look at their own situation and environment in order to make more informed and empowered choices,” adds Becky Inkster from the Department of Psychiatry, ̽��ֱ�� of Cambridge.

One of the tracks on the album, ‘Swimming Pools’, is concerned with addiction. In the song, Kendrick’s character is among his peers in a social gathering where alcohol is freely available. From the very outset, he paints a picture of alcohol misuse with the repetitive use of key words: “…pass out, drank, wake up, drank, faded, drank, faded, drank”. His character describes the reasons people drink alcohol – because they like “…the way it feels”, and in order “…to kill their sorrows” or to “…fit in with the popular”.

̽��ֱ��lyrics portray the character as being at a sensitive and vulnerable crossroads in which there is potential for him to develop later adult alcohol-dependence if he continues to follow this pattern of misuse – or in contrast, he may be experiencing changes in the brain that help build his resilience against alcohol dependence. Kendrick’s character’s prefrontal cortex – the area of the brain responsible for controlling our behaviour – even gets to speak a few lines, as the clear, penetrating voice of his conscience: “if you do not hear me then you will be history, Kendrick”.

̽��ֱ��song also explores the genetic and environmental factors that affect an individual’s risk of developing alcohol addiction, referencing a history of alcohol misuse in the character’s family, specifically his grandfather who “had the golden flask”. ̽��ֱ��album cover of good kid m.A.A.d. city shows Kendrick’s grandfather and two uncles sitting at a table with the young Kendrick, a child who is notably within reach of a 40 ounce bottle of malt liquor beer. Environmental factors such as early life exposure to alcohol and degree of parental monitoring of alcohol interact with genetic factors to influence the risk of alcohol misuse and dependence.

In the article Dr Sule and Dr Inkster also look at the songs ‘u’ and ‘i’ on Lamar’s latest album To Pimp A Butterfly, released in March 2015, which in addition to exploring alcohol dependency also touch on the theme of depression vulnerability and resilience to stress and depression.

In the song ‘u’, Lamar’s character appears to be drowning his sorrows, enhanced by the sound effects of clinking bottles. ̽��ֱ��setting for this track involves Kendrick’s character, a successful hip-hop artist, who is alone in his hotel room, intoxicated with alcohol, and talking to himself in the mirror. He might be suffering with clinical depression, say the authors, and certainly describes key symptoms of low self-confidence and low mood: “ ̽��ֱ��world don’t need you…I know depression is restin’ on your heart”.

As well as ruminating on his condition, Kendrick’s character describes hopeless and suicidal thoughts. There is also evidence of distortions in his thinking patters – he has a tendency to magnify his failures – in this case, his absence at his dying friend’s bedside – and minimise his successes (“You preached in front of 100,000 but never reached her”).

̽��ֱ��polar opposite of ‘u’ comes later in the album through the song ‘i’. His character displays evidence of resilience factors against stress, for example optimism (“One day at a time, sun gone shine”) and translating stressful, negative, and depressing thoughts into more positive and beneficial alternatives, as well as a resolution to love himself irrespective of life’s challenges. Kendrick’s character reveals his belief in God has helped him overcome his personal traumatic experiences: “Trials, tribulations, but I know God” – interestingly, a study involving African American adults who had experienced trauma showed that a higher frequency of religious service attendance was a protective factor against psychiatric illness.

“Kendrick Lamar’s rich narratives take his listeners on a complex journey, entrenched with conflict and social pressure, describing what life is like growing up as an inner city youth,” say the authors. “His character’s powerful ability to navigate his mind, body, and spirit through life’s obstacles to overcome environmental factors stacked up against his innocence has and will continue to inspire a generation.”

Reference
Akeem Sule and Becky Inkster. Kendrick Lamar, street poet of mental health. Lancet Psychiatry; 30 April 2015.

Kendrick Lamar’s major-label debut album good kid m.A.A.d. city, released in October 2012, provides rich narratives relating to important mental health themes, including addiction, depression and stress resilience, according to the co-founders of HIP HOP PSYCH, a new initiative to tackle mental health issues through hip-hop.

Kendrick Lamar’s music paints a picture of how his characters are affected by and cope with mental health issues

Akeem Sule

Kendrick Lamar - i (Official Video)

Eli Watson

Kendrick Lamar

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HIP HOP PSYCH initiative aims to tackle mental health issues through hip-hop

cjb250 — Tue, 11 Nov 2014 00:01:22 +0000

Hip-hop originated in the South Bronx area of New York during the early 1970s. Many of the original artists – and even performers still today – came from areas of high social and economic deprivation and this is often reflected in their lyrics, for example ̽��ֱ��Message by Grand Master Flash & ̽��ֱ��Furious Five, released in 1982, which opens with the lyrics:

Broken glass everywhere
People pissing on the stairs, you know they just don’t care
I can't take the smell, can't take the noise
Got no money to move out, I guess I got no choice

Now, HIP HOP PSYCH, a new initiative aims to use hip-hop to help improve people’s mental health and to address issues including stigma towards mental illness and the lack of diversity within the psychiatric profession. ̽��ֱ��initiative is introduced by its co-founders, Dr Akeem Sule and Dr Becky Inkster, in today’s edition of ̽��ֱ��Lancet Psychiatry.

“Much of hip-hop comes from areas of great socioeconomic deprivation, so it’s inevitable that its lyrics will reflect the issues faced by people brought up in these areas, including poverty, marginalisation, crime and drugs,” explains Sule. “In fact, we can see in the lyrics many of the key risk factors for mental illness, from which it can be difficult to escape. Hip-hop artists use their skills and talents not only to describe the world they see, but also as a means of breaking free. There’s often a message of hope in amongst the lyrics, describing the place where they want to be – the cars they want to own, the models they want to date.”

In their article, the co-founders give the example of Juicy by ̽��ֱ��Notorious BIG, which is “dedicated to all the teachers that told me I'd never amount to nothin', to all the people that lived above the buildings that I was hustlin' in front of that called the police on me when I was just tryin' to make some money to feed my daughter”, but goes on to describe how he has become successful:

Super Nintendo, Sega Genesis
When I was dead broke, man I couldn't picture this
50 inch screen, money green leather sofa
Got two rides, a limousine with a chauffeur
Phone bill about two G's flat
No need to worry, my accountant handles that
And my whole crew is loungin'
Celebratin' every day, no more public housin'

̽��ֱ��co-founders point out the similarities with ‘positive visual imagery’, a technique investigated by Professor Emily Holmes’ group at the ̽��ֱ�� of Oxford. This technique is a form of therapy whereby the patient is encouraged to use the power of their imagination to help them through difficult times, including through depression and bipolar episodes. By integrating hip-hop into psychotherapies, they believe psychologists can refine their tools to make these more relevant to their users.

“We believe that hip-hop, with its rich, visual narrative style, can be used to make therapies that are more effective for specific populations and can help patients with depression to create more positive images of themselves, their situations and their future,” says Sule.

̽��ֱ��co-founders are keen to take HIP HOP PSYCH into prisons, schools, and hostels to promote positive self-esteem through engagement with hip-hop artists. They have already taken their project to Mama Stone’s Exeter-based nightclub, lecture halls, the Oxford ̽��ֱ�� African Caribbean Society, Cambridge Festival of Ideas and Pint of Science, and had an extremely positive response from the hip-hop community, with artists such as Juice Aleem and Inja offering their support.

“We’ve had an enormous response from the global community, from patients, prisoners, and parents to artists and fans alike,” says Inkster. “We are overwhelmed and excited by requests from people around the world reaching out to us who want to help. It has been moving to see how honest and open people have been with us.

“I recently received a hand written letter from a prisoner incarcerated for the past 18 years who expressed his fascination with our plans. In his letter, he describes how he turned his life around through training as a drug counsellor and psychotherapist, and he is interested in incorporating HIP HOP PSYCH into a creative youth project. He wishes to set up with schools, youth clubs and prisons, providing life lessons for teenagers who have been excluded from school, and trying to discourage them from embracing a criminal lifestyle.

“It’s been about forty years since hip-hop first began in the ghettos of New York City and it has come a long way since then, influencing areas as diverse as politics and technology. Now we hope to add medicine to the list.”

HIP HOP PSYCH also hopes to use their project to help tackle the crisis currently facing psychiatry. Despite the steady increase in the number of cases of mental illness, mental health support continues to decrease worldwide. ̽��ֱ��situation is exacerbated by the fall in the number of medical students choosing to specialise in psychiatry over the past 25 years and the low retention rates amongst psychiatry trainees. Sule and Inkster believe that by demonstrating the relevance of hip-hop to psychiatry, they can help in the recruitment of a mental health workforce from more diverse ethnic and socioeconomic backgrounds.

HIP HOP PSYCH is co-founded by Dr Akeem Sule and Dr Becky Inkster. Sule is a Consultant Psychiatrist in General Adult Psychiatry, South Essex Partnership Trust, and an Honorary Visiting Research Associate at the Department of Psychiatry, ̽��ֱ�� of Cambridge. Inkster is a Clinical Neuroscientist in the Department of Psychiatry, ̽��ֱ�� of Cambridge and she holds an Honorary Contract with Cambridgeshire & Peterborough NHS Foundation Trust. Inkster and Sule are both affiliated with Wolfson College, ̽��ֱ�� of Cambridge.

̽��ֱ��two worlds of hip-hop and psychiatry are being brought together in a unique project led by researchers at the ̽��ֱ�� of Cambridge, which aims to use the lyrics and music of artists such as Nas and Tupac to help tackle issues surrounding mental health.

It’s been about forty years since hip-hop first began in the ghettos of New York City and it has come a long way since then, influencing areas as diverse as politics and technology. Now we hope to add medicine to the list

Becky Inkster

Garry Knight

Hip Hop Musik (cropped)

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