Popular culture-as expressed in popular music, literature, TV, film and theater-exists in an interesting mutual feedback relationship with current events, social attitudes and behaviors. These narrative (in that song lyrics, literature, films and shows typically tell stories) arts are reflective of the themes and emotional contours of the times they were written and can also influence the culture in ways that can be both helpful and less so. Music, film, and literature can both reflect and impact attitudes about mental health and mental illness as well-sometimes in complex and even contradictory ways.
Consider the classic 1975 Jack Nicholson film, “One Flew Over the Cuckoo’s Nest” which portrays an inpatient psychiatric facility. The film (and book on which the film was based) powerfully evoked an anti-authority attitude that was prevalent during the period of the Civil Rights movement and the Vietnam War. It was an ode to individual freedom and a warning about the dangers of unbridled and repressive authority. In a more direct way, it also highlighted the troubling conditions in many psychiatric facilities at the time and led to some helpful reflection and reform. Unfortunately, its disturbing representation of ECT (as a luridly depicted punishment for “rebelliousness”) led to this highly effective and safe treatment being underutilized for years after the film’s release (and this impact has probably continued into the present). We might make a similar claim about the more recent Netflix show, 13 Reasons Why. The series highlighted problems around teen bullying, sexual assault, difficulties in accessing quality mental health care and youth suicide. The show also raised awareness and may have facilitated a helpful national conversation around teen mental health and suicide (as intended by the producers and writers of the show). At the same time, its graphic depiction of the main character’s suicide (among other problems) may have had a deleterious and even potentially dangerous impact on some young people who watched it. The relationship of popular art and those who consume it can be unpredictably complex.
In this vein, I noted with interest a report just published in JAMA Pediatrics (Kresovich A, Reffner Collins MK, Riffe D, Carpentier FRD. A Content Analysis of Mental Health Discourse in Popular Rap Music. JAMA Pediatr. Published online December 07, 2020. doi:10.1001/jamapediatrics.2020.5155) that examines patterns in references to mental health and suicide in rap lyrics over the past 20 years. They analyzed the most popular rap songs at 5 different points between 1998 and 2018 and explored references to anxiety, depression, suicide, and life factors that might directly relate to mental health. They found that mental health references in popular rap song were relatively steady between 1998 and 2008 but then began to rise with the sharpest increase between 2013 and 2018. As with the examples noted above, I believe there is both good and some more concerning news suggested by these findings.
The Good News
The authors of the report mostly focus on the positive side of their findings in relation to mental health stigma; and this is largely correct. We know that many young people are hesitant to reach out for mental health care and this is particularly true for young men and even more so for Black young men (although we should note that rap is popular across all youth demographics). One of the major factors in this hesitancy is what we commonly refer to as “stigma”. (This is a complex term/concept and I have serious problems with it which I plan to discuss in a future post). It is very likely that at least part of the increase in mental health references in rap lyrics reflects an increasing comfort with speaking of mental health and illness which might both suggest and promote a decrease in stigma among rap fans. This would no doubt have potential for increasing comfort in help seeking as well. In fact, we have witnessed significantly increased acceptance among young people in speaking openly about mental health-and it is likely that the ease with which celebrities and other high-profile individuals have recently addressed mental health has contributed to this. This trend is promising-good news.
The Less Good News
The authors wonder in their discussion whether Kanye West releasing an album in 2008 which openly portrayed his emotional life might have influenced other rap artists to delve into these issues. In their conclusion they briefly mention the market crash of 2008 as another factor potentially contributing to lyrics expressing stress and distress. I would argue that the market crash reflected an important second turning point in national mood (the first being the attacks of 9/11/2001-and indeed there was a slight uptick in distress content in rap lyrics in the 2003 sample) that has led to significant economic and social turmoil which is being expressed in rap lyrics since 2008. It is possible that West’s album which was released soon after the market crash (I am not sure when the songs/lyrics were written but it was apparently recorded very quickly) was as much a response to the feel of the moment as an influence on further rap lyrics. To the extent that rap lyrics have become more focused on anxiety, depression, and suicide, they are giving us a glimpse into the growing social turmoil, pain resulting from income inequality and racism and political instability impacting young people and especially people of color over the past 10 years. The lyrics are reflecting the pain and challenges of the moment in time.
On the one hand, it is great that young people are more open to discussing their emotional reactions to these problems and the more recent COVID19 pandemic. On the other hand, it is important we not “pathologize” social ills and stresses and only focus on our emotional response to them. I worry that if we overemphasize the feeling piece and in fact speak of social ills in mental health and illness terms, we may diminish peoples’ sense of agency and decrease the impulse for political action and activism. So, while we should be alert to the emotional and mental health impact of poverty, racism and social/political turmoil, we should not confuse feeling angry, sad, stressed or indignant with mental illness.
The authors noted increased references to suicide starting in 2008 (there had been none in the earlier samples even though there were references to anxiety or feelings of depression). We know in any artistic reference to suicide there is danger of feeding the social norming problem (the idea that suicidal thoughts or actions are common or typical reactions to distress). This can run the risk of creating the impression that suicide and suicidal behaviors in youth are more common than they are thus inadvertently increasing risk. We know that youth who believe suicidal behaviors are more common are themselves at higher risk for suicidal thoughts and behaviors.
It is great that artists and young people seem more open to expressing and sharing their feelings and that this probably reflects greater openness to getting mental health care when needed. As we expand our national conversation around mental health it would be valuable for artists to educate themselves about safe messaging for mental health and suicide (see: https://suicidepreventionmessaging.org/) or to reach out for guidance when their efforts touch on these crucial topics.
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