Imagine a world where every MC who needed psychological support could write rhymes with a mental health care professional. Artists could talk with a trained hip-hop therapist to explore the emotional depth of their words. That's the idea behind the Hip Hop Therapy Global Institute, an organization founded by Bay Area social entrepreneur Tomás Alvarez III.

Alvarez began developing hip-hop therapy at Oakland youth-outreach organization Beats Rhymes and Life, which he co-founded in 2004. The organization's aim is to address what Alvarez saw as a gap between the privileged training and personal history of many mental health professionals and the lives of the disadvantaged young people they were attempting to treat. “The reality is, you may be formally educated and trained to respond to mental health and mental illness, but people who are dealing with and living with mental health conditions are experts in their own conditions and their own lives,” he explains.

Hip-hop therapy bridges this gap by encouraging youth in a group therapy setting to share their feelings and experiences through rap. In a 2006 short film that shows a Beats Rhymes and Life rap therapy program (as it was then called) in action, students at the racially diverse Berkeley High School check in with one another about their recent experiences, share rhymes they've written between sessions, write lyrics independently and together, and engage in a freestyle cypher. Group facilitators often rap alongside students.

Hip Hop Therapy Global Institute founder Tomás Alvarez III; Credit: Scott Hoag for Rockwell Creative

Hip Hop Therapy Global Institute founder Tomás Alvarez III; Credit: Scott Hoag for Rockwell Creative

As Alvarez's ideas for using hip-hop as a form of therapy have gained traction, the genre itself has been emerging as a refuge from the black community's deep stigmas regarding mental health. According to NAMI (the National Alliance on Mental Illness), “Only about one-quarter of African-Americans seek mental health care, compared to 40 percent of whites.” In America, blackness has historically required a certain amount of indestructibility, because slavery, segregation and other barriers to treatment normalized a lack of access to basic healthcare. In that context, seeking professional mental health treatment was seen as an unacceptable sign of weakness. But recently, the outspoken mental health statements of hip-hop artists have begun reclaiming an equal right to wellness.

Ian Levy, who has a hip-hop therapy program at New Visions Charter High School for Advanced Math & Science II in the Bronx, cites the example of Kid Cudi, who publicly announced his decision to enter rehab for depression and suicidal thoughts last year. “One of my favorite [Kid Cudi] lyrics on Soundtrack 2 My Life is where he says, ‘The moon will illuminate my room and soon I'm consumed by my doom.’ It’s such a powerful line, where he was obviously highlighting thoughts and feelings of depression and anxiety.”

He goes on to use Cudi's lyric to illustrate how his students' rap verses help him engage with them on a therapeutic level. “If a 15-year-old student brought me a line like that, it would be my job to ask them what they mean. What do you mean by this line? Can you break this line down? Then when they break this line down for me, I can start digging even further through that. I’m an MC myself,” he adds. “We love explaining our lyrics.”

The outspoken mental health statements of hip-hop artists have begun reclaiming an equal right to wellness.

A growing number of hip-hop artists have recently had the courage to discuss their mental health struggles. Earlier this month, Chance the Rapper opened up to Complex about his anxiety, which he believes might have been triggered by losing childhood friends to Chicago violence. “A really big conversation and idea that I'm getting introduced to right now is black mental health,” Chance told the magazine. “'Cause for a long time that wasn't a thing that we talked about.” On his just-released album I Decided, Big Sean confesses, “Voices in my head saying I could do better,” which sounds a lot like a depressed mind turning on itself. Lil Wayne, as a feature on Solange’s latest album, asked his haters if they were mad that “when I attempted suicide, I didn’t die.” On Twitter, TDE rapper Isaiah Rashad used a lyric to sympathize with Kid Cudi’s rehab admission and open up about his own mental health struggles.

Even when depression and anxiety are not directly mentioned in hip-hop lyrics, their presence can be heard. Pills, weed and lean, the holy trinity of hip-hop drug culture, are often a form of self-medication. Like Future says in “Use Me” off his HNDRXX album, “When you get high enough, you can dodge raindrops.” Hip-hop is full of rappers who are walking wounded.

Ill Camille; Credit: Pic Van Exel

Ill Camille; Credit: Pic Van Exel

“It’s difficult to cope without something,” says Los Angeles MC Ill Camille. “I’m not a drinker, and I don’t smoke like that, but being so hypersensitive and being exposed to a lot of different personalities, a lot of rejection daily, and financial issues that come along with committing to doing the art, it’s hard to cope.”

In her music, Camille is unafraid to explore dark periods in her life. “Few Days” on her new album, Heirloom, is a song that explains why Camille’s friends and family haven’t seen her in a while. “There was a lot of loss. Not just my dad, my grandmother too … she died a couple months before. And then the day of my dad’s funeral, my Uncle Sammy passed away. It was like that whole 'things happen in threes' shit.” She dealt with insomnia due to the premonitions she experienced around that time, and lacked support from her then partner. “Few Days” was one of the first songs she wrote after grief sapped her creativity. “I basically shaped Heirloom around that song.”

Camille believed that using a mental health professional “was just something black people didn’t do” until the benefits of supportive treatment became undeniable. “I’ve seen the positive impact it has on people, not just artists but people all around; how it’s helped them change their perspective.”

Levy’s hip-hop therapy program in the Bronx has, in many ways, formalized what rappers have been doing on their own for years. Levy’s program has a studio, so for students who experience trauma, they can go to school the next day and discuss their lyrics before recording. Students have used hip-hop therapy to grieve the loss of black lives due to police brutality, as well as more personal issues like the loss of a fellow student who died of suicide. The program's success has attracted the attention of The New York Times, as well as the syndicated radio show Sway in the Morning.

Hip-hop therapy may not be appropriate for people too incapacitated by depression and trauma to record a song. “I can’t even get myself together to put a fucking song together,” Camille says of her low moments. “You can’t always resort to putting shit in songs because some people don’t even have a consistent means of recording.” In situations like this, crisis care and traditional therapy that focuses on mood stabilization may be more suitable.

AJ Supafly has used hip-hop therapy to write some of his most powerful rhymes.; Credit: Jordan Mateos

AJ Supafly has used hip-hop therapy to write some of his most powerful rhymes.; Credit: Jordan Mateos

But when an MC is stable enough to write and record, that’s where hip-hop therapy comes in. Levy’s student Alhaji, a 15-year-old junior (who asked that his last name not be printed), reveals the potential of hip-hop therapy, despite being an unlikely candidate for picking up the mic.

“Originally I didn’t like hip-hop at all. I didn’t like it at all because of the mainstream portrayal of it. I found it [had] no concept, no substance,” Alhaji remembers. “Until the summer before ninth grade, I started listening to old-school hip-hop, I got into it. So when school started, I saw there’s a hip-hop club [Levy's program] and by then I was into old-school hip-hop. That led to me rapping and then it took off from there.”

Alhaji goes by the stage name AJ Supafly. In his song “Skrt,” he was able to process emotions that were bubbling beneath the surface. “The way I started writing this verse was basically I was on the train and my brother had called me and he told me to connect to one of his friends on three-way. I’m on the phone, I’m listening to the conversation.”

Alhaji found himself on a phone call with his incarcerated older brother and a man who could soon be incarcerated for avenging the death of a friend who “got shot by these dudes from another part of the Bronx, the east side,” Alhaji explains. “When you’re in the streets, when somebody hits one of your homies, you have to get them back. My brother is like, trying to convince him and tell him, it’s not worth it. Look at the predicament that he’s in. He’s talking to you from a pay phone, he doesn’t want you to have to go through the same things. … Jail strips away your humanity. As I’m listening to this conversation, and I already have this beat with no topic, I’m like, let me write a verse about this and put it to the beat.”

Alhaji doesn’t just use hip-hop therapy for himself. He refers students in need to Levy’s program and presents the benefits of hip-hop therapy at conferences. “I want to spread the message that hip-hop can be used for pretty much everything you can think of.”

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