Insight

Essay
Kendrick Lamar, street poet of mental health
Kendrick Lamar has received critical acclaim as the hottest
hip-hop artist of the past decade. A native of Compton(California, CA, USA), he has had a meteoric rise over thepast 3 years. He released his major-label debut album goodkid m.A.A.d. city (acronym meaning “my angry adolescencedivided”; “my angels on angel dust”) in Oct, 2012, which
Rolling Stone considered “worth all the hype”, describing
Lamar as “a dazzling street poet” unlike any other from hisgeneration. This album covers the trials and tribulationsof an adolescence spent in an inner-city subculture ofviolence and drugs. His heavily anticipated sophomore
album To Pimp a Butterfly was released in March, 2015, andwas viewed by many critics as a masterpiece covering evenwider subject material, such as the sociopolitical strugglesof African-Americans growing up in America, the pressuresthat come with success, racism, black empowerment, andspirituality. To Pimp a Butterfly showcases a diverse array ofmusical and artistic genres, including jazz, hip-hop, blues,and spoken-word, and an interlaced poem that develops
through the album. To that, we would add that Lamar’s
rich narratives relate to important mental-health themes,
including addiction, depression, and resilience. As cofounders of a social venture called Hip Hop Psych, we areinterested in interpreting hip-hop lyrics through the filtersof psychiatry and the neurosciences. In this essay, we offera glimpse into our work through the dissection of Kendrick
Lamar’s conscious lyricism.
The song “Swimming Pools”, from good kid m.A.A.d.
city, is about addiction. The title serves as a metaphor foralcohol misuse during adolescence. Kendrick’s character
is among his peers in a social gathering where alcohol isfreely available. From the very outset, Kendrick paints a
picture of alcohol misuse with the repetitive use of key
words: “…pass out, drank, wake up, drank, faded, drank,faded, drank.” In the first verse, Kendrick’s character
describes and relates to the biopsychosocial model ofalcohol misuse; eg, he describes the reasons people drink
alcohol—because they like “the way it feels” (biological),
to “kill their sorrows” (psychological), or to “fit in with thepopular” (social). These mechanisms have been underlined
in a review, which also discusses neural correlates andenvironmental factors that are relevant to alcohol misuse.
The second verse could be read, from a neuroscientificpoint of view, as a conflict between the reward andpleasure pathway of the character’s mesolimbic system (“Igot a swimming pool full of liquor…I’mma dive in it”) andthe executive functioning of his prefrontal cortex (“Immadrown in some poison abusin’ my limits”), which warns himof the dangers of getting intoxicated. The lyrics portray thecharacter as being at a neurodevelopmentally sensitiveand vulnerable crossroads at which there is potential for
him to develop future adult alcohol-dependence if hecontinues to follow this pattern of misuse—or by contrast,
he might be experiencing resilience, brain maturation,
synaptic reorganisation and, in particular, strengtheningof inhibitory projections in his prefrontal white matter.
Kendrick’s character’s prefrontal cortex even gets to speaka few lines, as the clear, penetrating voice of his conscience:“if you do not hear me then you will be history, Kendrick.”But what about the backdrop to the conflict for Kendrick’s
character? “Swimming Pools” emphasises genetic risk factors for alcohol misuse, referencing a history of alcohol
misuse in the character’s family, specifically his grandfather
who “had the golden flask”. The album cover of good kid
m.A.A.d. city shows Kendrick’s grandfather and two uncles
sitting at a table with the young Kendrick, a child who isnotably within reach of a 40 oz bottle of malt liquor beer.
During an interview Kendrick commented on this image,“…that photo just says so much about my life and how
I was raised in Compton, and the things I’ve seen throughinnocent eyes.” Environmental factors such as early-life
exposure to alcohol and degree of parental monitoringof alcohol interact with genetic factors to affect the risk ofalcohol misuse and dependence. Kendrick Lamar’s lyrics
indirectly map onto research that examines gene–by–environment interactions of alcohol misuse. For example,
the reported association between a genetic variant of theμ-opioid receptor gene (OPRM1) and early-onset alcohol
misuse seems to be partly moderated by the degree ofparental monitoring of alcohol intake; another study
examined the relationship between alcohol misuse inadolescence, family conflict, and a gene variant in theserotonin system. More directly through these lyrics,
however, we understand the powerful influence of peerpressure. Research shows that risk-taking and impulsive
behaviour in adolescent males is increased in the presenceof peers, as shown by simulated driving experiments;
therefore, since Kendrick’s character expresses concern
about social pressures, such pressure might further increase
his risk of misusing alcohol because of detrimental social
interactions and not choosing environments that areprotective.
Much like the metaphor of drowning in a swimming
pool full of liquor, the theme of alcohol misuse continues
to develop in the song “u” on Kendrick’s second majorlabel album, To Pimp A Butterfly. His character here seems
to be drowning his sorrows, enhanced by the soundeffects of clinking bottles. The setting for this track
involves Kendrick’s character, a successful hip-hop artist,
who is alone in his hotel room, intoxicated with alcohol,

www.thelancet.com/psychiatry Published online April 30, 2015 http://dx.doi.org/10.1016/S2215-0366(15)00216-3

Lancet Psychiatry 2015
Published Online
April 30, 2015
http://dx.doi.org/10.1016/
S2215-0366(15)00216-3
For additional reading andreferences see Online forappendix
For Kendrick Lamar’s
music and videos see
https://www.youtube.com/user/KendrickLamarVEVO
For more on Hip Hop Psych see
http://www.hiphoppsych.co.uk
and Lancet Psychiatry 2014;
1: 494–95
For the review onalcohol misuse see
Nature 2014; 512: 185–89

1Insight

For more on the default mode
network see
PLoS One 2014; 9: e91102 andBiol Psychiatry 2015.
DOI:10.1016/j.
biopsych.2015.02.020
For more on the research byBeck and colleagues see
Arch Gen Psych 1963; 9: 324–33
and J Consult Clin Psychol 1989;
57: 309–10
For the review on depression
and negative bias see
Curr Opin Psychiatry 2006;
19: 34–39
For the study on spirituality
and resilience see
Am J Psychiatry 2008;
165: 1566–1575

2Dan Prackopcyk/The Hell Gate/ Corbis

For more on the International
Classification of Diseases
revision 10 see
http://apps.who.int/
classifications/icd10/
browse/2015/en

and talking to himself in the mirror. He might haveclinical depression; he certainly describes International
Classification of Diseases revision 10 symptoms of low selfconfidence and low mood: “the world don’t need you…I
know depression is restin’ on your heart.” But what is theneuroscience behind this? We speculate that Kendrick’s
character is having increased activation of low-frequency
brain oscillations in his brain’s default mode network,
which is a network of brain regions including the medial
temporal lobe, medial prefrontal cortex, and posterior
cingulate cortex that is activated when an individual is notengaging with the outside world (eg, during daydreaming,
perspective reflection, or introspective thinking). The
default mode network has been studied in patients withmajor depressive disorder. Based on the ruminative
style of the narrative throughout this song, we suggestthat Kendrick’s character might have a hyperactive andhyperconnected default mode network, and increased
functional connectivity between the default mode
network and his subgenual prefrontal cortex. This spiralof rumination is associated with the character’s hopelessand subsequent suicidal thoughts; not a surprise given
prior research by Beck and colleagues, which showed that
hopelessness is a strong predictor of suicide. Beck also
describes cognitive distortions that are found in Kendrick’slyrics; eg, his character has a tendency to magnify hisfailures—in this case, his absence at his dying friend’s
bedside—and minimise his successes (“You preached in
front of 100 000 but never reached her”). Furthermore,
the character draws attention to so-called black andwhite thinking, which is a tendency to think in absolutes.
Throughout the song, Kendrick’s character believes that hewill be judged either as a total success or a total failure; heseems to be more focused on negatives than positives. This
type of thinking relates to studies reviewed by Leppanen
and colleagues, showing that patients with depression
show a negative bias when interpreting stimuli that areintended to be ambiguous.

The polar opposite of the song “u” comes later in thealbum through the song “i”, which is full of optimism,confidence, self-efficacy, and self-empowerment. The songrefers to resilience factors for the resolution and preventionof depression and suicidal thoughts. For example, Kendrick’scharacter reveals a strong internal locus of control. The
psychologist Julian Rotter described this as a tendency for
an individual to believe they can control events affecting
them. Kendrick’s character uses this concept to stay positivein the face of adversity. Resilience factors against stressare also evident. These include optimism (“one day at atime, sun gone shine”); cognitive reframing, translatingstressful, negative, and depressing thoughts into morepositive and beneficial alternatives, and a resolution to love
himself irrespective of life’s challenges; mastery; and stressinoculation. Through the anaphoric reference hook of thissong—“I love myself”—Kendrick’s character discusses theproblems he faces in his environment and his ability toadapt and overcome them. Kendrick’s character reveals that
his belief in God has helped him to overcome his personal
traumatic experiences: “trials, tribulations, but I know God”.
Similarly in this context, a study of African-American adults
who had suffered trauma showed that a higher frequency
of attendance of religious services was a protective factor
against psychiatric morbidity.
Kendrick Lamar’s lyrics have underlined several psychiatricthemes around addiction, depression vulnerability, andresilience against stress and depression. How might thishelp with the pressing problem of mood and other disorders
among young people in harsh, urban environments? First,
listening to Kendrick Lamar might help mental-healthpractitioners and other professionals to understand the dayto-day internal and external struggles of their patients. Hiphop might also be a way for young people to understandand consider their own vulnerability, resilience, and life
choices in a culturally relevant and easily accessible manner.
Kendrick Lamar’s rich narratives take his listeners on
a complex journey, entrenched with conflict and socialpressure, describing what life is like growing up as an innercity youth. His character’s powerful ability to navigate
his mind, body, and spirit through life’s obstacles toovercome environmental factors stacked up against hisinnocence has inspired a generation, and will continue
to do so. We highly recommend that, as we are doing,
you explore the remaining songs from these albums andconnect with Kendrick’s message of resilience against theodds, something which goes far beyond the boundariesof Compton and hip-hop. As Kendrick himself put it: “Atfirst, I was scared to show fear because you can never besure how people will perceive you. But I dared myself to dothat, to stand out.”

Akeem Sule, Becky Inkster
hiphopsych@gmail.com

www.thelancet.com/psychiatry Published online April 30, 2015 http://dx.doi.org/10.1016/S2215-0366(15)00216-3