What the 'Illest' Hip-Hop Can Teach Us About Mental Illness

In hip hop, words like "crazy," "sick," and "ill" are compliments. But what happens when they're also literally true?

I thought a lot about hip hop and mental illness while I was watching Dirty, a heartfelt new documentary about Ol' Dirty Bastard (ODB). Before he overdosed on cocaine and Tramadol in 2004, ODB was probably the most outlandish member of the Wu-Tang Clan: He spat rhymes with a singsong delivery that dissolved into grunts and gibberish; he interrupted concerts with his bizarre rants; he spoke nervously about government agents following him; and he famously pulled a Kanye before Kanye, storming the Grammy stage in 1998 to declare, "Wu-Tang is for the children!" and complain about how much his outfit cost all while someone else was accepting an award.

While this behavior raised legitimate concerns about ODB's mental stability, hip-hop faces an even bigger issue: Some of our most innovative rappers really do suffer from ailments like clinical depression, bipolar disorder, and drug addiction. Examples can be found throughout the culture — Kanye West and Childish Gambino have both gone through severe depression and contemplated suicide, and DMX recently revealed his struggles with drug addiction and bipolar disorder. Even the legacies of dead rappers, like Tupac Shakur and ODB himself, are marred with questions about their mental health.

Yet hip-hop often encourages these destructive qualities. Activist and journalist William Upski Wimsatt wrote that, through the slang reappropriation of words like "mad" and "ill," hip hop actually "[celebrates] mental illness." It's strange to think that these words may have preserved their original meaning, but, to some extent, they have. How many rappers do we applaud or dismiss as "crazy" without asking if they actually are? How often are we consuming mental illness as entertainment?

The music industry remains a key channel for these rappers to profit from their pain. This is old news, of course, and not unique to hip-hop: Artistic success has long been associated with mental anguish. But hip-hop is somewhat different because it's a creative expression rooted in poverty, and not just any poverty: Hip-hop comes from a racialized kind of poverty that crushed black and Latino communities after the de-industrialization of American cities in the late 20th century. Without this, hip-hop wouldn't exist.

Poverty, which birthed the culture we love, is a shameful reminder of the tolls American inequality takes on the physical and psychological circumstances of our lives. Many who have emerged from these environments had inadequate access to mental health treatment growing up, even as they were raised around the same trauma and violence that breeds mental illness in the first place. To this day, rappers reference this poverty to show how "real" they are, and use the language of illness to describe their skills. All the while, we applaud their efforts without thinking twice about the basis of those skills in real pain and suffering.

The next time a rapper goes on a so-called "rant," for example, or storms the stage to interrupt an awards ceremony, don't simply dismiss him/her as "crazy." Make an effort to empathize. Speak up in his/her defense. Try understanding that the behavior might be more than just a narcissistic by-product of fame and celebrity, and that mental illness could be at play. The fact that we must question rappers' mental health in retrospect means we're failing to do so in the moment, and that reinforces our collective ignorance around these issues. Learning about mental illness now means we can better address it moving forward, in hip-hop and beyond. After all, this music should breed understanding — not dismissal.