Endnotes to Jay-Z’s 4:44 : Mental Health Awareness

“It’s like my therapy, making music……When language has reached its limit, disease sets in.”
– Jay-Z

On June 30, 2017, Jay-Z (Shawn Carter) released his 13th studio album 4:44, arguably the most personal and socially conscious album of his career. Subscribers to his online streaming service, Tidal, are privy to music videos for the songs on the album. In late August he released a mini-documentary, “Footnotes for MaNyfaCedGod,” and a nearly 140 minute two-part interview for the Tidal podcast Rap Radar hosted by Elliott Wilson and Brian “B.Dot” Miller. Jay-Z and the other participants address issues of therapy, self-care, and mental health awareness throughout points of the interview and mini-documentary. In this article I reflect on their commentary in relation to the larger significance of these issues in the African-American community and hip-hop culture.

So far Jay-Z has delivered “Footnotes” for past 4:44 videos, “The Story of O.J.,” “4:44,” and “Adnis.” Each of these mini-documentaries consists of him and other notable black men discussion their thoughts on race, class, fatherhood, love, and relationships. With the “footnotes for MaNyfaCedGod” the men explore subject matter that has often been ignored in the African-American community until recently: mental health awareness. The conversation begins with a discussion of black men’s inability to show emotion. One of the men admits that he cries but he will kick another man’s ass the moment he questions his masculinity. The underlying message in his statement is that black men can never show emotion, hurt, weakness or vulnerability. While this insecurity is problematic in romantic relationships, it is especially troubling when it comes to seeking professional help for one’s mental health.

“You got this thing that you can’t be hurt even when you are hurt.”
-Michael Che

“A lot of times in the black community therapy is like, ‘what you gon pay money to go talk to somebody. You better go to church.'”
-Michael B. Jordan

Rap Radar Interview: Jay-Z Speaks on Mental Health
Jay-Z addresses mental health awareness and the importance of therapy in far greater detail in his sit down conversation with Rap Radar. While reflecting upon the suicides of Amy Winehouse, Linkin Park’s Chester Bennington and music executives Shakir Stewart and Chris Lighty he states that mental health care is just as important as eating well and exercising. Jay-Z has always used music as a form of therapy to deal with his father’s abandonment, an impoverished childhood, his drug dealing past, the loss of a child, and struggles in his marriage. During the interview he admits that he has been undergoing professional therapy over the last four years. In addition to saving his marriage, therapy has helped him come to terms with his late father’s absence, his thoughts on religion/spirituality, his fractured friendship with Kanye West, and the remorse for shooting his brother.

“A lot of people going through trauma and are too embarrassed to get help… We’re not dealing with that because it’s not the cool thing to do.”

Jay-Z’s earliest experience with therapy came after he was arrested in December 1999 for stabbing Lance (Un)Rivera, a record executive and friend, because he leaked copies of his album Vol. 3… Life and Times of S. Carter (1999). At the time he was skeptical of sharing his deepest feelings with a complete stranger. He jokingly compared his therapy sessions back then to the film Get Out (2017). He felt like the film’s protagonist being hypnotized by some strange woman stirring her spoon in a cup of tea. Jay-Z’s revelations speak to more compelling issues for black people and hip-hop.

Blues People
In season two of the BET series Being Mary Jane rapper Ludacris guest stars as a disgraced journalist who commits suicide. Later in season three another character, suffering from a bipolar disorder and depression, takes her life by overdosing on pills. In recent years television has been providing a space to address mental health in the African-American community. On FOX’s Empire Andre Lyon (Trai Byers) and his grandmother Lela Walker (Leslie Uggams) both suffer from bipolar disorder, a mental illness characterized by depression and elevated mood swings called mania. In season one Andre puts a loaded gun to his head in an unsuccessful attempt to take his life in his father’s recording studio. His grandmother had a similar experience nearly 40 years earlier. Andre’s parents, Lucious (Terrence Howard) and Cookie (Taraji P. Henson) have difficulty accepting his condition. Cookie mocks his condition as a white person’s disease. Cookie’s attitude reflects popular opinions about mental illness held by many blacks. Episode 14 of the NBC sitcom The Carmichael Show (aptly titled “The Blues”) depicts the matriarch Cynthia’s (Loretta Devine) shame of undergoing therapy due to the stigma of mental illness. She and her family initially dismiss her feelings of depression as something black people just deal with. Her husband Joe (David Allen Grier) sarcastically implies that all of the best black music comes from pain.

In his 2016 action-comedy film Central Intelligence comedian Kevin Hart says black families do not seek professional therapy, they simply go to the barbershop. One of the characters on ABC’s Black-ish said talking to a therapist just feels too much like snitching. Fans of the FX series Atlanta should remember the mentally ill man at the jail, drinking out of the toilet, on episode two. The other prisoners laugh at his condition and label him “crazy”. Only Donald Glover’s character, Earn, is insightful enough to suggest that the man needs therapy not jail. Therapy has also been a topic of discussion in recent seasons of Queen Sugar and Survivor’s Remorse.

University of Texas at Austin professor King Davis is leading a groundbreaking research project on the history of mental illness and therapy in the African-American community. In his 2016 paper, “Central Lunatic Asylum for Colored Insane 1865-1900: the First 50,000 Admissions,” he presents an overview of the earliest recorded cases of blacks with mental illness. According to Davis, the common belief in colonial era medical schools was that only wealthy whites experienced mental issues. Due to their property ownership, their lives were more stressful. However, in the 1840s hospitals in Virginia began admitting free blacks as patients. On June 7, 1870, the Central Lunatic Asylum was opened to treat blacks labeled mentally insane. This was the first hospital of its kind in the world. A similar hospital was opened in Crownsville, Maryland, in 1911. The black patients in Crownsville were forced to participate in “industrial therapy,” which meant working in the tobacco fields, basket weaving, and other forms of agricultural labor. They were also given “hydrotherapy,” a practice of placing patients in ice cold tubs. The black doctors, who began working at the hospital after the 1940s, believed that that this treatment was not only therapeutic, but also helped to uplift the race.

Racist attitudes tainted the diagnoses of several black patients. Besides manic episodes and depression, blacks were admitted for the some of the following causes: religious excitement, unhappy marriages, idiocy, masturbation, talking back to white superiors, criminal deviance, and freedom. Racist white physician Samuel A. Cartwright coined the Greek derived phrase “Drapetomania,” in 1851, to refer to a mental illness that caused slaves to run away from their plantations or seek freedom. In his book Sick from Freedom: African-American Illness and Suffering during the Civil War and Reconstruction (2012), Jim Downs documents the number of diagnosed cases of newly freed blacks who experienced a host of sicknesses. Black families developed a distrust of psychiatrists causing mental health to become a stigmatized topic. Historically black parents have taught their sons and daughters to be emotionally strong. The past experiences of the ancestors during slavery and Jim Crow serve as examples of the innate fortitude that all blacks are supposed to possess. Far too many black parents or their children are still suffering from mental illness in silence. “With black Americans leading the country in unemployment, child abuse, domestic violence, all of which can exacerbate stress, it is not surprising that the community leads the country in mental health struggles,” writes Keli Goff in a 2013 article for The Root. Goff reports that many blacks do not seek professional medical attention due to a stigma, lack of insurance, and a belief that the church and prayer will solve their problems. Psychology Today notes that black men and boys are less likely to seek treatment because it makes them look weak.

Between 1993 and 2012 the suicide rate for black boys increased from 1.78 to 3.47 per million. With the increasing alarm over police brutality and images of black males being killed on social media I wonder how this is impacting the mental health of young males.

Too Blessed To Be Stressed
In the “Footnotes for MaNyfaCedGod” Michael B. Jordan says that blacks will often tell each other to go to church if they have trouble. In season two of Empire Andre stops taking his prescribed medication after he joins the church and gets baptized. Professor King Davis says that there is a great deal of truth in Empire’s fictional narrative. Davis tells a story of a black pastor in Texas who was encouraging his members to bring all their prescription drugs to the front of the church and give them over to the Lord. I had the privilege of interviewing Rev. Danielle Graham, an associate black pastor in her early thirties at Metropolitan Baptist Church in Largo, Maryland. Rev. Graham was diagnosed with depression and anxiety in 2008. After a suicide attempt, while in seminary, she went to her pastor in Pittsburgh, Pennsylvania, for counseling. She was saddened by the lack of support and understanding from a few church leaders whose best advice was: “Pray about it.” Her family members gave her similar advice based on their understanding of Paul’s epistle to the Philippians, chapter 4, verses 6-7, which says, “Be anxious for nothing, but in everything by prayer and supplication, with thanksgiving, let your requests be made to God; and the peace of God, which surpasses all understanding will guard your hearts and minds through Jesus Christ.” Rev. Graham soon realized that prayer was not enough to solve her problems. Graham needed self-care which included consulting with professional clinicians. She believes that most black church lack staff members trained to properly handle mental health issues. “You would not tell someone with diabetes or cancer to just pray it away,” says Graham.

The existing body of literature on mental health awareness in the African American community supports Rev. Graham’s commentary on the church. According to Harold Neighbors and James Jackson, in the American Journal of Community Psychology, there has been an underutilization of mental health services in black households due to various stigmas. For some blacks who seek professional counseling outside of the church, the pastor is used as a referral source. V. Salgado de Snyder, in “Pathways to health and mental health care,” calls the pastor a “gatekeeper” to therapy. As Rev. Graham mentioned earlier the problem was not with the church’s attempt to offer mental health counseling. The problem was that many pastors and leaders in these churches are not properly trained to handle these issues. In 2012 The Institute for Urban Policy Research & Analysis at the University of Texas at Austin released a policy report by King Davis and Albert Thompkins titled “Mental Health Education in African American Divinity/Theology Schools.” The paper highlighted the deficiencies in mental health counseling that future black pastors receive from some of the nation’s elite divinity schools. The phrase, “Too Blessed To Be Stressed” is a wonderful meme or mantra. But it also misleads the public into thinking that praying and tithing alone is enough to prevent depression, anxiety, loneliness, and unhealthy stress. “When language has reached its limit, disease sets in,” says Jay-Z. In other words, if you are stressed out, if you are hair is falling out, if your liver is going bad, you do not ignore that because those problems escalate. Rev. Graham prayed for healing, but eventually the warning signs forced her to realize that prayer was not enough. As the son of a minister I always valued prayer over therapy.

Mind Playing Tricks on Me
Mental health awareness has been an underlying theme in hip-hop for decades it just was not as clearly stated or respected until more recently. One of the hottest rap songs in 1991 was “Mind Playing Tricks on Me” by Houston trio Geto Boys. Most listeners were unaware of the pain these rappers were battling with at the time. Bushwick Bill was so high on PCP that he was pronounced dead earlier that year. The group’s album cover for We Can’t Be Stopped was inspired by the night Bill was rushed to the hospital. Scarface, the group’s lead emcee, has been dealing with mental illness since the age of 12. Scarface, born brad Jordan, talks about his diagnosis as a manic depressant in his memoir Diary of a Madman: The Geto Boys, Life, Death, and the Roots of Southern Rap.

“I wanted to die back then. Andy if you ask me why… I have no idea. Maybe I felt worthless.”

Recently, I was watching an episode of Complex magazine’s YouTube series Everyday Struggle hosted by Nadeska Alexis, Joe Budden, and DJ Akademiks. The hosts were watching a clip from a recent interview on The Breakfast Club Power 105.1 FM in which Styles P and his wife Adjuna discussed the suicide of their 20-year-old daughter. Neither Styles nor Adjuna would credit mental illness as the source of their daughter’s suicide. But Styles did say that as a black man from the hood who has been dealing with an incredible amount stress on a daily basis. He confessed to often feeling homicidal. He has wanted to kill other people, not himself. Budden, a survivor of mental illness, was so moved by the interview that he started crying. In a past episode of Everyday Struggle Budden opened up on his bout with depression and anxiety. When he performed in the 2014 Slaughter House Cypher he dropped subliminal messages about committing suicide as he rapped standing on the George Washington Bridge in New York. Budden told his co-hosts that he heard similar subliminal messages in recent songs from Chris Brown (“Pills & Automobiles”) and Lil Wayne (guest verse on Solange’s “Mad”).

“Rap is misleading…most of these ni_ _as are telling us how sick they are and what they are going through. Great, Chris Brown you’re talented, but let’s get you some help. Cudi, B.o.B, Kanye. You want to talk about the artists that really need help with mental health that will be a long show.”
-Joe Budden

Joe Budden makes a lot of great points regarding the willingness of artists to express their pain in the music, but not seek professional help or admit that they are sick. When The Notorious B.I.G. recorded the eerie track “Suicidal Thoughts” and the hook to “Everyday Struggle” on his debut album Ready to Die (1994) was he really crying out for help? Tupac’s music – post Me Against the World – was filled with themes of death. Perhaps this was the result of anxiety caused by being shot five times at Quad Studios in New York City or serving time in prison.

“I don’t wanna live no mo’ sometimes I hear death knockin at my front do.’”
-The Notorious B.I.G., “Everyday Struggle”

“And they wonder why we suicidal running ‘round strapped. Mr. Police, please try to see that there’s a million motherfu_ _ers stressin’ just like me.”
-2Pac “Only God Can Judge Me.”

Eminem, who is diagnosed with bipolar disorder, has recorded numerous songs about being addicted to prescription drugs (Vicodin, Ambien, and Valium), alcoholism, domestic violence, and suicide. One of his seminal records is “Stan,” which focuses on mentally ill fan who commits suicide. Eminem was hospitalized in 2007 after overdosing methadone. DMX’s past addictions to crack cocaine and other drugs has been well documented. However, the media talks less about his mental health issues which may have contributed to some of his addictions.

“Listed as a manic-depressive with extreme paranoia.”
-DMX “F_ _kin Wit D”

Bun B has been dealing with anxiety and depression since his rap partner, Pimp C, passed away in 2007. Bun’s wife Angela has been diagnosed with and takes prescribed medication for anxiety. Kendrick Lamar dedicated the song “U” on his 2015 Grammy nominated rap album To Pimp a Butterfly to his bouts with mental illness. Kid Cudi checked into rehab in October 2016 to treat a five-year battle with depression and suicidal thoughts. Cudi was extremely brave because he did not care if other rappers or social media thought he was weak for showing emotion and brokenness. Rather than pull an Amy Winehouse and make songs about rejecting rehab he sought out professional assistance. Newer artists Lil Uzi Vert and XXXTentacion have made songs about suicidal acquaintances. Social media is still buzzing about Logic’s performance of “1-800-273-8255” at the 2017 MTV Video Music Awards. The song speaks to Logic’s own past struggles with depression. Logic was joined on the VMA stage by suicide attempt survivors wearing t-shirts with the National Suicide Lifeline’s phone number: 1-800-273-8255.

“I want you to be alive. I want you to be alive. You don’t gotta die today.”
– Logic

I personally believe that Kanye West is suffering from some form of mental illness. Danielle Belton, managing editor of The Root, posted an article in February 2016 insinuating that Kanye West was showing signs of bipolar disorder or some form of mental illness. Belton, who was diagnosed with bipolar disorder years ago, wrote the article from her own personal experiences of ignoring the warning signs that led to her emotional breakdown. She often masked her illness at parties with excessive drinking, self-deprecating humor, and by making herself the center of everyone’s attention. “Kanye West is partying through his breakdown. We think it’s funny, but it really isn’t,” wrote Belton. “I don’t know what issues West does or doesn’t have; but I know that he drops verses about Lexapro and Xanax, two drugs I’m familiar with in my own journey from bipolarity to stability. He raps about his demons, his fears. But, in the photos it’s all smiles.”

A day before Thanksgiving the police were called to his trainer Harley Pasternak’s home. Kanye’s erratic behavior forced paramedics to transport him to the Ronald Reagan UCLA Medical Center for evaluation. He was hospitalized at the Resnick Neuropsychiatric Hospital at UCLA for eight days. This scary episode happened just days after he cancelled the remaining 21 shows of his Saint Pablo tour in wake of several disturbing rants on stage and the armed robbery of his wife Kim Kardashian.

Kanye was made to take an independent medical examination. Reports said that his behavior had been induced by a failure to take prescribed medication for mental health related issues. Kanye’s associates disputed those claims, blaming his behavior on exhaustion and sleep deprivation caused by his wife’s robbery. Others said that the anniversary of his mother Donda’s passing may have also contributed to his emotional breakdown. “He’s under spiritual attack,” said one of his sources.” In August 2017 news outlets reported that the insurer for his tour, Lloyd’s of London, refused to cover the cost of the cancelled concerts because they believe that his mental breakdown resulted from an overuse of marijuana. Kanye has not confirmed these rumors of drug abuse and has filed a $10 million lawsuit against Lloyd’s. Drug abuse has frequently been associated with these stories of mental health in hip-hop.

“Ni_ _as ain’t Molly Percocets cuz it’s all good. Not cuz they’re waking up with a lot of hope for the future… that’s why we see people overdosing on the lean, Xanax and heroin because they’re self-medicating.”
– Vic Mensa

In an earlier mini-documentary “Footnotes of Adnis” Jay-Z attributes drug abuse and mental health problems to his father’s reasons for abandoning the family when he was 12-years-old. After his father’s brother was stabbed to death he began experiencing severe bouts with depression. His father (Adnis) began using drugs heavily to self-medicate himself. After a certain point he was too ashamed to return home. Jay-Z did not reconcile with his father until he was 36-years-old. His father passed away not long afterwards.

All I Really Want is to be Happy
With 4:44 Jay-Z has given fans and causal listeners advice on fiscal responsibility, black excellence, black pride, fatherhood, relationships, and masculinity. Now he is becoming an advocate for therapy, self-care, and mental health. Jay-Z has a platform to really create positive change in the African-American community if he decides to fully take this on. Imagine Jay-Z teaming up with the likes of Beyonce, Kanye, Kendrick, Eminem, Logic, the Obamas, Oprah, pastors, and mental health clinicians to lead a national campaign for mental health awareness. While most of us lack Jay-Z’s influence we can still do our part by taking care of ourselves and encouraging friends, family, or co-workers struggling with these issues to seek proper counsel.

*This article contains excerpts from “Paranoid: Kanye West, Millennials, and the Black Church’s Response to Mental Illness” by Joshua K. Wright (The Journal of Hip Hop Studies 2018)

By Joshua K. Wright, Ph.D

Joshua K. Wright, Ph.D. is an associate professor of History and coordinator for the Social Studies Teacher Education Program at the University of Maryland Eastern Shore.