Eminem’s Character, Stan: A Bio-PsychoSocial Autopsy
Akeem Sule and Becky Inkster

Journal of Hip Hop Studies, Volume 4, Issue 1, Fall 2017, pp. 43 – 49

Dr. Akeem Sule is the Co-founder of HIP HOP PSYCH and a Consultant Psychiatrist in General AdultPsychiatry, South Essex Partnership Trust, and an Honorary Visiting Research Associate at theDepartment of Psychiatry, University of Cambridge. He is also a Research Associate at Wolfson College,Cambridge University.
Dr. Becky Inkster is the Co-founder of HIP HOP PSYCH and Neuroscientist in the Department ofPsychiatry, University of Cambridge. She has an Honorary Contract with Cambridgeshire &Peterborough NHS Foundation Trust and she is also affiliated with Wolfson College, University ofCambridge. Becky did her undergraduate degree in psychology at the University of Toronto, Canada,
while also publishing articles on neurogenetics at the Centre for Addiction and Mental Health.

JOURNAL OF HIP HOP STUDIES .

Eminem’s Character, Stan: A Bio-Psycho-Social Autopsy
Akeem Sule and Becky Inkster
Eminem is a multi-platinum selling Hip Hop artist. For over a decade he has proven his mastery of multisyllabic rhyming and vivid storytelling. In this article, we dissect lyrics from one of Eminem’s mostcritically acclaimed songs, ‘Stan’, for mental health themes. We use the bio-psycho-social model toexplore contributing factors leading to the decline of Stan’s mental health. For the results, we speculatethat Stan might be suffering with emotionally unstable personality disorder of the borderline type as
evidenced by self-harm, overdose, fear of abandonment, chronic emptiness, self-image and sexualidentity issues, and impulsivity. Stan speaks of having an adverse early childhood, which we propose
relates to changes in Stan’s brain that affect his ability to cope with stress. In conclusion we highlight thefeasibility of using Hip Hop lyrics to open up dialogues around mental health and for bridging youth
culture with the medical community.
Editor’s note: The Journal of Hip Hop Studies is pleased to publish Hip Hop Psych’s “Eminem’sCharacter, Stan.” For more information, visit www.hiphoppsych.co.uk/index.html. Hip Hop studies
brings together scholars from around the world and from different fields of study, as a result, this essay
maintains the integrity of scholars from this emerging field of Hip Hop Psychiatry

Eminem is considered one of the greatest Hip Hop artists of all time. He received
the title “best-selling artist of the decade”1 in 2000 was voted “Best Rapper Alive” byVibe Magazine’s reader’s poll,2 and titled ‘Hottest MC in The Game’ in an MTV survey.3
Eminem is renowned for his multi-syllabic rhyming and vivid storytelling. Being born
into a poor socioeconomic environment, this theme is often portrayed in his lyrics,
giving a different perspective from African American and Hispanic perspectives that,until then, had dominated Hip Hop culture.
One of Eminem’s most publicized tracks is “Stan”4 from the album MarshallMathers LP that reached number one in the music charts internationally.5 In this article,
we dissect lyrics from one of Eminem’s most critically acclaimed songs, “Stan,” explore
Stan’s mental state, his actions and early adverse life experiences to unravel thiscomplex character’s psychopathology. Our methodological approach utilizes the biopsycho-social model to explore contributing factors leading to the decline of Stan’smental health. We speculate that Stan might be suffering with emotionally unstablepersonality disorder of the borderline type as evidenced by self-harm, overdose, fear of
1 James Montgomery, “Eminem Is The Best-Selling Artist Of The Decade,” MTV News, Accessed

January 5, 2017, http://www.mtv.com/news/1627833/eminem-is-the-best-selling-artist-of-the-decade/2 Shaheem Reid, "Eminem Is The Best Rapper Alive, According To Vibe Poll," MTV News,Accessed February 6, 2017, http://www.mtv.com/news/1596451/eminem-is-the-best-rapper-aliveaccording-to-vibe-poll/
3 Paul Cantor" Eminem Is the Hottest MC in the Game!," 2017. MTV News, Accessed January 5,
2017, http://www.mtv.com/news/1650705/eminem-is-the-hottest-mc-in-the-game/./4 EminemVevo "Eminem - Stan (Long Version) Ft. Dido," YouTube, Accessed December 14, 2016,
https://www.youtube.com/watch?v=gOMhN-hfMtY
5 "Stan (Song)," En.Wikipedia.Org, February 6, 2017, Accessed December 14, 2016,
http://en.wikipedia.org/wiki/Stan_%28song%29.

EMINEM’S CHARACTER.

abandonment, chronic emptiness, self-image and sexual identity issues, andimpulsivity. Stan speaks of having an adverse early childhood, which we propose
relates to changes in Stan’s brain that affect his ability to cope with stress.
In this track, the character, Stan, is upset and writing a letter to Eminem, aka Slim
Shady, about his previous fan letters that were not replied to. As the chorus opens, wehear a female voice singing (music artist, Dido) representing Stan’s pregnant partner.
Her lyrics reference her despair about Stan’s increasing obsessions with his idol,Eminem.
In verse 1, Stan comes across as a devoted and knowledgeable Slim Shady fanand identifies with Slim Shady by finding commonalities between his friend’s suicide
and the suicide of Eminem’s uncle.6 In verse 2, we attain deeper insights into Stan’s
mental state. Stan initially writes that he isn’t mad at Slim Shady for not responding,but based on his prosodic intonation and inflection of his voice the listener can sense
Stan’s burst of anger and his feelings of betrayal. Stan comments on witnessing hisparents’ domestic abuse and never knowing his father; again, he attempts to identify
with Slim Shady. We speculate that Stan experienced an insecure attachment to hisparents as primary care givers (i.e., is a person or persons predominantly responsible
for an individual's emotional needs as a child). Bowlby7 and Ainsworth8 describe
attachment as a social connection that a child fosters (i.e., forms) with a primary
caregiver for emotional support and regulation of affect (i.e., help to control changes inmoods so they don’t become overwhelming or extreme). It has been proposed that thisattachment relationship occurs at a ‘critical period’ between the age of 6 months and 2years old, enabling the child to hold an internal working model (i.e., based onrelationships with your caregivers, e.g., parents, you learn how to love, hate and predict
how others relate to you in different situations) as a blueprint for future relationships.
Early adverse experiences that effect attachment could contribute to the development ofpsychopathology that is reflected by insecure future relationships.
Early adverse experiences can alter oxytocin levels (i.e., the ‘love’ and ‘trust’hormone) in the child and primary care giver.9 Oxytocin’s ability to enable anindividual to infer other’s mental states (i.e., understand and empathize with people’semotions) is important for human interactions as it enables an individual to read socialcues.10 Since oxytocin is a hormone that promotes social interactions, disruptions to thisneuropeptide could partly explain why Stan is alienating himself from his partner andfeels betrayed by Slim Shady. Early adverse life experiences can also lead to epigenetic
6 David LaChapelle “Eminem Blows Up,” Rolling Stone, Accessed January 9, 2017,

http://www.rollingstone.com/music/news/eminem-blows-up-20091105?page=2
7 John Bowlby, Attachment: Attachment and Loss Volume 1 (New York: Basic Books, 1969). John
Bowlby, Attachment and Loss Volume 2: Separation, Anger and Anxiety, (London: Hogarth Press, 1973).
8 Mary Dinsmore Ainsworth, “The Development of Infant-Mother Attachment, in Review of Child
Development Research, ed. B. Cardwell & H. Ricciuti (Chicago: University of Chicago Press, 1973).
9 Barbara Stanley and Larry J. Siever, "The Interpersonal Dimension of Borderline Personality
Disorder: Toward a Neuropeptide Model," American Journal of Psychiatry 167, no. 1 (2010): 24-39.
10 Gregor Domes, Markus Heinrichs, Andre Michel, Christoph Berger, and Sabine C. Herpertz,"Oxytocin Improves ‘Mind-Reading’ In Humans," Biological Psychiatry 61, no. 6 (2007): 731-733.

JOURNAL OF HIP HOP STUDIES .
alterations (i.e., loose chemical tags which attach to certain parts of DNA switching
harmful or protective genes on or off; for example, switching the glucocorticoid
receptor gene on, which leads to increased activity in the stress pathways in the brainand body). For example, childhood maltreatment can lead to altered epigenetics (calledDNA methylation) of the glucocorticoid receptor gene (i.e., which produces the ‘stress’hormone), resulting in an exaggerated hypothalamic–pituitary–adrenal axis (aka theHPA axis; i.e., the brain’s stress pathway) response to stressors.11 Such factors may
interfere with Stan’s ability to moderate stress. Evidence suggests that oxytocin helps todecrease excessive HPA axis activity (consequently decreasing stress response); if
oxytocin levels are relatively low then this can lead to an overactive HPA axis withpossible pathological outcomes.12 Early childhood experiences can alter brain-derived
neurotrophic factor (BDNF; i.e., ‘brain fertilizer’) gene expression via epigenetic
mechanisms13 leading to a reduction in the size of the hippocampus, making this brain
region less effective at controlling HPA axis activity.14
Stan speaks about his “Slim Shady” tattoo on his chest; this can be regarded bysome as being unusual and possibly considered taboo from a machismo-promoting HipHop cultural perspective. We speculate that Stan may be experiencing problems withhis sexual identity: 'P.S. We should be together too'. This could hint at Stan’s possible
homosexuality. Stan also talks about cutting himself to get a “sudden rush”, which
could be a form of self-medication. Stan might be managing his nasty/unpleasantfeelings through increasing endogenous opioid peptides (i.e., ‘feel good’ chemicals
which are released during exercise for example), creating a “feel good” sense ofeuphoria. Research revealed that cluster B Borderline Personality Disorder (BPD)15
patients who self-harm have low levels of opioid peptides in the cerebrospinal fluid. It
has been hypothesised that low levels of opioid peptides and compensatory
upregulation (i.e., increased number of receptors) of opioid peptide receptors in BPD
patients who self-harm produces a heightened response of receptors to opioid peptide
release in response to pain. This would provide self-soothing, euphoric calmness andanalgesia effects for the pain after cutting. There appears to be an idealization of Slim
11 N Perroud, A Paoloni-Giacobino, P Prada, E Olié, A Salzmann, R Nicastro, and S Guillaume etal. "Increased Methylation Of Glucocorticoid Receptor Gene (NR3C1) In Adults With A History Of
Childhood Maltreatment: A Link With The Severity And Type Of Trauma," Translational Psychiatry 12,
no. 1 (2011): e59.
12 Markus Heinrichs, Thomas Baumgartner, Clemens Kirschbaum, and Ulrike Ehlert, "Social
Support and Oxytocin Interact to Suppress Cortisol and Subjective Responses To Psychosocial Stress,"
Biological Psychiatry 54, (2003)
13 Tania L. Roth, Farah D. Lubin, Adam J. Funk, and J. David Sweatt, "Lasting Epigenetic
Influence of Early-Life Adversity On The BDNF Gene," Biological Psychiatry 65, no. 9 (2009): 760-769.
14 James P. Herman, Michelle M. Ostrander, Nancy K. Mueller, and Helmer Figueiredo, "Limbic
System Mechanisms of Stress Regulation: Hypothalamo-Pituitary-Adrenocortical Axis" Progress in NeuroPsychopharmacology and Biological Psychiatry 29, no. 8 (2005): 1201-1213.
15 Alan R. Prossin, Tiffany M. Love, Robert A. Koeppe, Jon-Kar Zubieta, and Kenneth R. Silk,"Dysregulation of Regional Endogenous Opioid Function In Borderline Personality Disorder," American
Journal of Psychiatry 167, no. 8 (2010): 925-933.

EMINEM’S CHARACTER.

Shady as evidenced by Stan’s words 'everything you say is real'; Stan is spending
increasingly more time devoted to Slim Shady, neglecting his pregnant partner.
Stan’s anger and perceived betrayal escalates in verse 3. His tone and actions
suggest he now devalues Slim Shady (e.g., ripping Slim Shady’s pictures off his walls).
We speculate this reflects a phenomenon called ‘splitting’, highlighted by object relation
therapist Melanie Klein,16 who described this phenomenon of a child experiencing the“good breast mother” (i.e., a mother that is able to satisfy the child’s needs all the time)
as being different from the “bad breast mother” (i.e., a mother that is unable to satisfy
the child’s needs therefore letting the child down) depending on if the child’s needs aremet (i.e., paranoid schizoid position). As the child matures he/she is able to integrate
the mother as a cohesive whole, leading to the ‘depressive position’. The child sees bothtypes of mothers (i.e., good and bad) as two different mothers initially but withmaturity the child realizes that they are one/the same and the child feels disappointed(i.e., ‘depressive position’). It is postulated that failure of an individual to integrate acohesive view of themselves or others, could lead to polarized views of others withsubsequent disappointment with that person.
Stan is now driving impulsively and recklessly over the speed limit whilst
intoxicated. There is evidence Stan has taken an overdose of “downers” (e.g.,benzodiazepines, opiates etc.) and feeling “drowsy.”17 Notably, when Eminem wasinterviewed he discusses his addiction to “downers” (e.g., zopiclone, hydrocodone,diazepam and his methadone overdose). There is evidence of aggressive behaviour as it
becomes apparent that Stan’s pregnant partner is tied-up in the trunk of the car. Stanblames this situation on Slim Shady’s rejection. Throughout verse 3, Stan riles against
perceived betrayal, abandonment and rejection from Slim Shady and seeks to punish
him for this. It appears that his intention is to end his life by driving over the bridge,
killing himself, his partner and their unborn child. The scene ends with Stan’s
realization that his recorded message to Slim Shady might not reach him, illustratingpoor planning and impulsivity.
Through these verses, we speculate that Stan is probably suffering withemotionally unstable personality disorder of the borderline type as evidenced by selfharm, overdose, fear of abandonment, chronic emptiness, self-image and sexual identity
issues and impulsivity;18 these recurrent themes are likely to be long standing issues.
We speculate that Stan’s early childhood neglect and psychological trauma have led tochemical changes in his brain making him less able to cope with stress and difficulty indeveloping trusting relationships. Such factors may have led Stan to self-medicate by
cutting himself to deal with his unpleasant, distressing feelings, which, taken together,
16 Melanie Klein, "Notes on Some Schizoid Mechanisms," in Envy and Gratitude and Other Works
1946-1963, (London: Hogarth Press and the Institute of Psycho-Analysis, 1975).
17 Shaheem Reid, "Eminem Admits He 'Almost Died' From Drug Overdose,” MTV News,Accessed December 6, 2016, http://www.mtv.com/news/1610557/eminem-admits-he-almost-diedfrom-drug-overdose/
18 World Health Organization: The ICD‐10 classification of mental and behavioral disorders:clinical descriptions and diagnostic guidelines, Geneva, 1992.

JOURNAL OF HIP HOP STUDIES .
could infer a potential diagnosis of emotionally unstable personality disorder of theborderline type.
We highlight the feasibility of using Hip Hop lyrics to open up dialogues inmental health. In this article, we have speculated on the possibilities of mental healthproblems and diagnoses in a fictitious character; however, diagnosing a mental healthdisorder is a complex process and clinicians who diagnose mental health disorders takeinformation from patients and obtain collateral history from close relationships aroundthem. We also need to stress that we are not attributing violent acts to a significant
number of people with mental health problems, and are aware of the vulnerability andstigma faced by people experiencing mental health problems. The social venture, HIP
HOP PSYCH, generates material available for use by practitioners in order to open up
youth-focused dialogues with patients.

EMINEM’S CHARACTER.

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Domes, Gregor, Markus Heinrichs, Andre Michel, Christoph Berger, and Sabine C.
Herpertz. ”Oxytocin Improves ‘Mind-Reading’ In Humans." Biological Psychiatry
61, no. 6 (2007): 731-733.
EminemVevo. “Eminem - Stan (Long Version) Ft. Dido". YouTube. Accessed December
14, 2016. https://www.youtube.com/watch?v=gOMhN-hfMtY.
Heinrichs, Markus, Thomas Baumgartner, Clemens Kirschbaum, and Ulrike Ehlert.
"Social Support and Oxytocin Interact to Suppress Cortisol and Subjective
Responses to Psychosocial Stress". Biological Psychiatry 54, no. 12 (2003): 13891398.
Herman, James P., Michelle M. Ostrander, Nancy K. Mueller, and Helmer Figueiredo.
“Limbic System Mechanisms of Stress Regulation: Hypothalamo-PituitaryAdrenocortical Axis.” Progress in Neuro-Psychopharmacology and BiologicalPsychiatry 29, no. 8 (2005): 1201-1213.
Klein, Melanie. "Notes on some Schizoid Mechanisms." Envy and Gratitude and otherWorks 1946-1963. Great Britain: Hogarth Press and the Institute of PsychoAnalysis, 1975.
LaChapelle, David. “Eminem Blows Up". 2017. Rolling Stone. Accessed January 9, 2017.
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Accessed January 5, 2017. http://www.mtv.com/news/1627833/eminem-is-thebest-selling-artist-of-the-decade.

JOURNAL OF HIP HOP STUDIES .
Perroud, N., A Paoloni-Giacobino, P Prada, E Olié, A Salzmann, R Nicastro, and S
Guillaume et al. “Increased Methylation Of Glucocorticoid Receptor Gene
(NR3C1) In Adults With A History Of Childhood Maltreatment: A Link WithThe Severity and Type of Trauma.” Translational Psychiatry 1, no. 12 (2011):eBook.
Prossin, Alan R., Tiffany M. Love, Robert A. Koeppe, Jon-Kar Zubieta, and Kenneth R.
Silk. “Dysregulation of Regional Endogenous Opioid Function in Borderline
Personality Disorder.” American Journal of Psychiatry 167, no. 8 (2010): 925-933.
Stanley, Barbara, and Larry J. Siever. “The Interpersonal Dimension of Borderline
Personality Disorder: Toward A Neuropeptide Model.” American Journal ofPsychiatry 167, no. 1 (2010): 24-39.
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http://www.mtv.com/news/1596451/eminem-is-the-best-rapper-aliveaccording-to-vibe-poll/Roth, Tania L., Farah D. Lubin, Adam J. Funk, and J. David Sweatt. “Lasting Epigenetic
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