Psychiatry Moves to a New Beat With Novel Hip-Hop Program

Liam Davenport

March 13, 2017

Hip-hop music and psychiatry may seem like an unlikely pairing, but two UK researchers have developed an innovative program that uses the lyrics of popular rap songs to raise mental health awareness.

Akeem Sule, MD, a consultant psychiatrist and honorary visiting research associate, and Becky Inkster, DPhil, a clinical neuroscientist, both of whom are affiliated with the University of Cambridge, founded the Hip Hop Psych program in 2014.

Rich with references to mental health disorders, including addiction, psychosis, conduct disorder, bipolar disorder, and borderline personality disorder, the researchers are using hip-hop music and culture to reach out to medical educators, clinicians, and the public to raise mental health awareness.

Dr Akeem Sule

The researchers believe discussion of hip-hop lyrics can be used as a platform to examine mental health issues, to challenge stereotypes, and to bridge the gap between psychiatry and popular culture.

The investigators have a YouTube channel that dissects the meaning of hip hop lyrics, and they have taken their message on the road, giving talks to public, specialist, and medical student audiences.

They also want to work with psychotherapists to increase the cultural diversity of the field and to conduct studies to provide an evidence base for including hip-hop in the treatment of mental illness in various populations.

This kind of approach has recently found a place in Carmarthenshire, in south Wales. As reported by the Guardian newspaper, officials have been using an enhanced case management approach that includes use of discussion of rap music lyrics to break young offenders' cycle of crime.

Dr Sule and Dr Inkster have also been spreading the word about Hip Hop Psych in a variety of ways, including giving a talk to inmates at Bedford Prison.

"That was one of our favorites, because there, we talked about resilience, about mental health problems, and we saw people really open up to us, and we were able to talk about things like epigenetics – in fact, that was one of the smartest groups we spoke to."

They also spoke at the 2015 World Congress of Psychiatric Genetics in Toronto, Canada, in which they combined lyrics by Eminem and Tupac with, among other topics, biopsychosocial theories. They have also spoken at the Cambridge Festival of Ideas.

Street Smart

Dr Sule and Dr Inkster even gave a talk to older people in Wales, the homeland of such poets as Dylan Thomas, R. S. Thomas, Gillian Clarke, and Dannie Abse, as well as children's author Roald Dahl.

Comparing these famous poets to today's hip-hop artists provided this older audience with a point of reference, said Dr Sule. "We were talking about Eminem and some of his lyrics, and analyzing the lyrics, [and] they could see the link to mental health problems and understanding [them]."

He noted that since its inception in the mid-1970s in the Bronx, New York, hip-hop has always had a relationship to mental health.

"At that time, there were lots of gangs roaming the place, there was the crack epidemic, the heroin epidemic, and run-down housing. The lyrics reflected what was happening in the environment... You would argue that that's an environment which can fuel mental health problems. However, when you see where hip-hop is today, it's basically spawned a billion dollar industry," he told Medscape Medical News.

Hip-hop lyrics often contain positive visual imagery, in which the rapper paints a picture of the life they would like to live. "Rap artists are rapping about the cars they haven't driven, the models they haven't yet dated, the champagne they haven't yet popped."

Dr Sule said such positive visual imagery can help people navigate very depressive environments. He also noted that hip-hop "always has an ear to the street" and has documented the emergence of the use of novel substances, including the abuse of prescription codeine and promethazine cough syrup, known as "purple drank" or "lean."

"It helps in engaging with marginalized communities, the youth, in America, say, the African Americans and Latino communities, but I think it can touch everyone. I also want to challenge the myth from the scientific community that you can't learn anything from these uneducated rappers.... Hip-hop is extremely rich, and we think there's no reason why it shouldn't be put on a par with poetry," he added.

Dr Sule has been a hip-hop enthusiast since 1979. Eventually he integrated his love of the genre into his professional life and started using hip-hop to teach medical students about psychiatry at Cambridge University, where he pioneered the "old school hip-hop method of teaching."

Hip-Hop as Therapy

This led to Dr Sule being invited to give a talk to the student psychiatric society, and he asked Dr Inkster to give the talk with him.

"Akeem approached me to give a talk about the portrayal of hip-hop lyrics in mental health to the Cambridge Psychiatry Society, and that's all I needed to know. I was game," Dr Inkster told Medscape Medical News.

"I've loved and used hip-hop to fuel my passions in life and work regularly, so I was in heaven. I got to wear jogging pants and my basketball shoes on stage, talk about my favorite hip-hop artists and my love of neuroscience. Sold!" she added.

Professionally, Dr Inkster saw hip-hop as an innovative way to connect with people and "a new way to start a difficult conversation." She also recognized that her and Dr Sule's mutual interest in hip-hop, psychiatry, and neuroscience provided a synergistic opportunity. "We have a very interesting relationship, [and we] feed off one another."

"I am a believer that neuroscience can help us refine, enrich, and personalize diagnoses and conditions better and offer new ways to discover how to identify, intervene, and prevent mental illness," said Dr Inkster.

"So many neuroscience tools are being discovered and integrated, and I'm pretty excited about the potential integration of this into psychiatric treatment. I have experience pulling together hypotheses and ideas across genomics, neuroimaging, epidemiology, and the use of digital technology and social media data. It's a very exciting time for neuroscientists, but we have a lot to learn about the clinical aspects of mental illnesses," she added.

Dr Inkster wants to identify evidence-based ways of showing that hip-hop can heal and prove to clinicians and academics that hip-hop, and music and art in general, can have a quantifiable and valuable role in the treatment of mental illness.

"If we can show that the highest degree of scientific rigor that engaging with hip-hop culture can help people, whether it be rewiring their brains, building a stronger immune system, or giving them a surge of dopamine when they need it, we are doing good things on a large scale," she said.

Going Global, Staying Local

In the future, Dr Sule and Dr Inkster would like to take Hip Hop Psych global. Dr Sule noted that there has been interest in the project in the United States, as well as in Kenya and Nigeria.

"Hip-hop is a global culture, so we need to leverage that. But it's also important not to lose the local touch, so we will be connecting offline with various people and communities," said Dr Inkster.

The researchers also want to work with psychotherapists. "I'm convinced we can make psychotherapy more culturally diverse by incorporating elements of Hip Hop Psych, and both Becky and I are very interested in promoting neuroscience and psychiatry as specialty, so obviously we're planning more talks with medical schools and engaging with psychiatric societies."

They are also working on an ebook, which is schedule to be published in early 2018. "We feel we can reach a wide audience this way," Dr Inkster said. "Digital strategies for reaching our audience are important."

Dr Sule and Dr Inkster have disclosed no relevant financial relationships.

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