Eminem is one of the greatest Hip Hop artists of all time, selling more than 32.2m albums by the end of the noughties and recently racking up more than 100m digital singles. The rapper is renowned for his multi-syllabic rhyming and vivid storytelling. he was born into a poor family – and this theme is often portrayed in his lyrics, giving a different perspective from the African American and Hispanic views that had previously dominated Hip Hop culture.

“Stan”, one of Eminem’s most famous tracks, was released on Eminem’s third album, The Marshall Mathers LP, in November 2000. It tells the story of Stan, a fan who looks up to Eminem’s alter ego, Slim Shady. Over four verses, however, Stan becomes disillusioned and his mental health deteriorates with tragic consequences.

We wanted to explore Stan’s mental health and how his early childhood neglect and psychological trauma may have contributed to chemical changes in his brain that make him less able to cope with stress and develop trusting relationships. Violent acts aren’t carried out by the majority of people with mental health problems, and we’re aware of the vulnerability and stigma faced by people with mental health problems, but we wanted to unravel this particular complex character’s mind.

We used a bio-psycho-social model to analyse Stan’s mental state, his actions, and early adverse life experiences. We think Stan might have suffered with emotionally unstable personality disorder of the borderline type as evidenced by self-harm, overdose, fear of abandonment, chronic emptiness, self-image and sexual identity issues and impulsivity.

Understanding Stan’s decline through the story is part of our project, HIP HOP PSYCH, which uses Hip Hop to open up youth-focused dialogues in mental health.

Stan the fan

In verse one, Stan comes across as a devoted Slim Shady fan and identifies with his hero by finding commonalities between Stan’s friend’s suicide and the suicide of Slim Shady’s uncle. In verse two, we get deeper insights into Stan’s mental state. Stan writes that he isn’t mad at Slim Shady for not responding, but from the sound, tone, and emphasis of his speech, the listener can sense Stan’s anger and his feelings of betrayal.

Stan comments on witnessing his parents’ domestic abuse and never knowing his father – again, he attempts to identify with Slim Shady. He appears to have experienced an insecure attachment to his parents – the social connection that a child forms with a caregiver for emotional support and mood regulation. This attachment happens during a “critical period” between the ages of six months and two, and enables the child to create a working blueprint for future relationships.

Early adverse experiences that affect this attachment can create insecure future relationships by altering oxytocin levels (the “love” and “trust” hormone) in the child (and their primary caregiver). Oxytocin enables people to relate to emotions and read social cues from others. Disruptions to this hormone could partly explain why Stan alienates himself from his partner and feels betrayed by Slim Shady.

Early adverse life experiences can also lead to epigenetic alterations, heritable changes that switch harmful or protective genes on or off and which affects how cells read these instructions. We know that switching the glucocorticoid receptor gene on leads to more production of the “stress” hormone cortisol. We know that childhood maltreatment of the sort that Stan has experienced can lead to changes to this receptor gene, resulting in an exaggerated response to stressors.

Stan’s decline

Stan talks about cutting himself to get a “sudden rush”, potentially a form of self-medication. Stan could be managing his feelings through an increase in “feel good” chemicals called opioid peptides. Research has revealed that patients with a Borderline Personality Disorder who self-harm have low levels of these chemicals in the fluid around their brain and spine. And it’s been suggested that a compensatory increase in receptors to these chemicals produces a heightened response to pain. Cutting in turn provides self-soothing, euphoric calmness and pain relief.

In verse three Stan’s anger and perceived betrayal escalates. He now resents Slim Shady, ripping pictures of him from his walls. This turnaround may reflect “splitting”, a psychological phenomenon developed by psychoanalyst Ronald Fairbairn in which a person fails to come to terms with the positive and negative sides of themselves and others.

It is sometimes called “all or nothing thinking”. The process starts when a child experiences the (good) mother – one that is able to entirely satisfy its needs – and the (bad) mother – one that lets the child down. Initially the child sees two different mothers, but is later able to integrate both into the idea of a cohesive whole. In some this realisation leads to excessive disappointment and a polarised view of others if their needs aren’t met – or excessive idealisation of others if they are.

Stan is now speeding recklessly while intoxicated, and appears to have taken an overdose of “downers”, such as benzodiazepines or opiates. His aggression is apparent as his pregnant partner is tied up in the trunk of the car. Stan blames this situation on Slim Shady’s rejection. He rails against perceived betrayal, abandonment and rejection and seeks to punish Slim Shady. His intention appears to be to end his life by driving over the bridge, killing himself, his partner and their unborn child. The scene ends with Stan’s realisation that his recorded message to Slim Shady might not reach him, again reflecting impulsivity and an inability to think ahead.

All these recurrent themes in Stan’s story are likely to be longstanding issues. Of course our analysis speculates on the possibilities of mental health problems and diagnoses in a fictitious character – diagnosing a mental health disorder in reality is a complex process and clinicians take information from patients and obtain other information on history from close relationships around them.

Stan is a channel for dissecting issues relating to mental health and we stress again that it is not to attribute violence to the mass majority of those who deal with mental health issues.