While some hip hop artists and groups have addressed the issue of healthy eating, few have tackled mental health. Hip hop’s distant relationship with mental health should not be surprising, as many African Americans have considered issues such as depression, suicide, and other mental and psychiatric ailments taboo. Last month, the suicide of For Brown Girls‘ creator and blogger, Karyn Washington, served as a reminder of the enduring silence of African American depression sufferers. Washington’s death provoked conversations among black members of the media about mental health. Coincidentally, rapper Pharoahe Monch released his fourth album—Post Traumatic Stress Disorder (PTSD)—a week after Washington’s passing. In the album, Monch highlights the intersections of the stresses of inner city life, drug use, suicide, and the structural and cultural barriers to pursuing mental health care. PTSD just might serve as the perfect opening to a conversation on African American mental health.
PTSD follows Monch’s third album, W.A.R. (We Are Renegades). WAR was more of a metaphorical concept album that featured Monch performing from the perspective of an independent rap artist waging a war within and against the corporate music industry. PTSD marks Monch’s symbolic return to “civilian” life after his traumatic battles with the recording industry.
PTSD is less metaphorical than WAR and more informed by Monch’s experience with battling depression. In an interview with Tim Sanchez from the rap news site, HipHopDX, Monch talks about his bout with depression, which was induced by taking a harmful cocktail of prescription drugs to treat asthma:
I went to the dentist and had to fill out forms and list all of the medication that I was taking. The doctor came out and called me in to his private office and told me that he didn’t mean to pry into anything, but he was going over my list and noticed the combination of my medications. He then informed me that one of the side-effects of a certain one included severe depression. As he said that, I melted into the chair I was sitting in and a thousand monkeys jumped off of my back. I started bawling right on his desk. I hadn’t put it together before that point…*
Several songs on PTSD address Monch’s experience with prescription drug-induced depression and his suicidal thoughts. On “The Jungle,” Monch references the list of drugs he’s taken to treat asthma: “I’m talking epileptic episodes off that Epinephrine, that Albtuterol and them other prescribed medicines, a zombie in insomnia freaking the Amphetamines.” Monch reflects on his suicidal thoughts on “Losing My Mind” and the title track, “Post Traumatic Stress Disorder.” The artist contemplates on “Losing My Mind,” “No Medicaid, no medication. Thinking you’re better off dead. Instead should’ve been dedication to education. I spin, the cylinder on my revolver, I spin, the cylinder…” Monch’s suicidal thoughts are also evident on the album cover, which depicts him holding a gun to his head while wearing a gas mask. When reflecting on his darkest moment, Monch stated,
It’s true. You go to friends and family and people are like, ‘Fuck it.’ You just need to go get some help and shit.’ At the time, I was confused and befuddled on what happened all of a sudden, and I couldn’t put my finger on it. Cats ended up coming to my apartment and taking things away from me. They told me that I seemed to be going through some things and that I shouldn’t have these weapons around.
Monch’s reference to the lack of access to Medicaid on “Losing My Mind” points to another underlying theme—the racial and economic barriers to pursuing mental health care, especially for African Americans. “My family customs were not accustomed to dealing with mental health. It was more or less an issue for white families with wealth,” Monch raps. According to the 2012 National Healthcare Disparities Report, a little more than 50% of African Americans who endured a major depressive episode received treatment whereas close to 75% of whites received treatment. And between 2008 and 2010, white American adolescents and adults were more likely to receive treatment than African Americans. Monch’s observation about Medicaid also highlights the political barriers to affordable access, especially for African Americans. In an effort to resist implementation of the Affordable Care Act, Republicans in twenty-one states have blocked expansion of Medicaid. Several of the states where Republicans have resisted the expansion are located in the South—Alabama, Mississippi, Louisiana, Georgia, to name a few. Coincidentally, as Drew Desilver reported for the Pew Research Center, the South boasted the highest poverty rate in the U.S in 2012. According to the think tank, the Henry J. Kaiser Family Foundation, the black poverty rates in Alabama, Mississippi, Louisiana, and Georgia in 2012 were 37%, 44%, 44%, and 33% respectively.
Monch also points to cultural impediments to explain why many African Americans refrain from talking about their mental health openly. African Americans, especially black men, are often expected to endure the depressive episodes arising from life’s difficulties without medical or psychiatric help. “Tough” black masculinity requires black men to confront stress triggered by daily social, economic, and political struggles without showing any signs of emotional and physical “weakness.” And, as Monch alluded to in “Losing My Mind,” some African Americans have coded seeking therapy as “white.” Instead of seeking help, African Americans self-medicate. Monch reiterated this point in an interview with the Wall Street Journal’s Tom Olmstead: “…and I was going to friends telling them how I was feeling. Just really depressed. Heavily depressed. Some people were like, ‘Have a beer! Smoke some weed.’”
While Monch often dwells in the dark recesses of his consciousness on PTSD, the action of performing his depression signals a way forward for African Americans interested in destigmatizing mental health. Ultimately, for Monch, talking openly and honestly about one’s emotional and psychological well-being represents a welcome step in breaking the silence. However, pointing towards self-help-based and individualistic solutions obscures the complexity surrounding the problem of mental health for African Americans. It is imperative that we reexamine and reflect upon the cultural, especially the gendered, assumptions governing our responses to emotional and mental distress. Monch and others may rightfully identify the silence around mental health as a legacy of the black experience of dealing with white supremacy. While this seems admirable, relying on some mythical cumulative “strength” of all of black Americans and silent suffering will not prevent future Karyn Washingtons.
Yet, aside from the individual and intra-racial responses to depression and mental despair, Monch’s record also reminds listeners that merely highlighting the problem and identifying individual and cultural solutions will not suffice. Mental health is also a political issue that must be addressed collectively, specifically by African Americans, and ultimately by all Americans. People have to demand full implementation of the Medicaid expansion and the rest of the Affordable Care Act in order to gain greater access to mental health care. Taking advantage of mental health resources has to become the norm for all Americans, not just those who deem it acceptable and who can afford it.
 PTSD takes a conceptual queue from Marvin Gaye’s classic 1971 album, What’s Goin’ On. Gaye centers What’s Goin’ On around a black Vietnam War veteran who returned home to find the country divided by the war and ravaged by racism, drug use, and urban decline. With songs such as “Damage,” “The Jungle,” “Post Traumatic Stress Disorder,” and “Heroin Addict,” Monch also deals with the various structural forces that could trigger, or exacerbate, PTSD, such as the stress accompanying racism and economic inequality, gun violence, and drug use. However, PTSD is darker and devoid of the brief optimistic moments contained in What’s Going On.
*Pharoahe Monch also explains his experience to Melissa Harris-Perry on her MSNBC show.