“Therapy isn’t for black people” may seem like a dated concept, but there is still a very real stigma attached to seeking treatment for anxiety and depression in black communities. According to the National Alliance on Mental Illness, approximately 43.8 million adult Americans—one in five people—suffer from mental illness each year. Black Americans are 20 percent more likely to suffer from serious mental health issues but also half as likely to use mental health services compared to white or Asian Americans. Historically, hip-hop’s attitude toward depression and therapy has reflected this larger cultural imbalance.

Many rappers have long reinforced the anti-therapy narrative. Three years ago, when asked if he’d ever see a psychologist or go to therapy, the late, great New York rapper Prodigy responded, “Hip-hop is our therapy. I can’t see myself sitting here talking to somebody like, ‘Hi, we’re going through this and this.’ Like, what are you going to tell me? There’s nothing that you could tell me. My experience told me more than what you going to tell me.”

For years, rappers from Eminem to Ice Cube have echoed this faulty idea of rap as a replacement for therapy. (“I’m my own psychiatrist,” Missouri MC Tech N9ne once said.) These days, though, the relationship between rap and therapy is going through a radical evolution. Earlier this year, just before his death by accidental choking, Prodigy sat down with Dr. Siri Sat Nam Singh on Viceland’s “The Therapist.” The show, which puts musicians in a room with Singh to “discover what lies beneath their public personas,” has made a point of speaking to rappers—including Chief Keef, Freddie Gibbs, Waka Flocka, and Young M.A—encouraging a shifting attitude when it comes to rappers being open to therapy, or simply sharing with someone.

There is no truer benchmark for how rap’s views on therapy have changed than Jay-Z, who spent the majority of his career guarded, slowly coming around to the concept of sharing across two full decades. In 2010, he told USA Today, “I’m not a person who will sit and talk about my feelings. But the music just pulls it out, and it’s like, ‘Man, I can’t believe I held that in for 12 years!’” But recently, Jay has become increasingly aware that rapping about pent-up emotions is not the same as having someone respond to those concessions and challenging your view of yourself to help you reassess. His new outlook was shared on this year’s 4:44, where he raps specifically about his therapist, and, in all likelihood, the new, more critical self-judgments their conversations provoked. Given his role as one of the most cautious and reluctant sharers rap’s ever seen, there is an especially potent power in Jay-Z talking about therapy’s role in his life.

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In the 4:44 companion video series “Footnotes,” Jay sat down with Michael B. Jordan, Chris Rock, Michael Che, Trevor Noah, and Meek Mill to talk about black mental health, in what felt like its own series of mini therapy sessions. At one point, in a move that would’ve been implausible for Jay-Z just a few years ago, the rap icon implores black people to open up to someone about their traumas: “Three of your brothers are dead and your mother used to beat you. You need help. Someone needs to talk you through why you’re feeling these feelings.”

A few weeks later, Jay reinforced the key difference between “rap as therapy” and actually going to therapy in an interview on the Rap Radar podcast, dissecting his previous comments: “Music has always been my therapy, but I’ve been doing therapy for about four years now,” he said. “When I first went to therapy, it was a probation thing. And I hated it… I wasn’t ready for that level of getting to know yourself. It’s easy to get to know other people. Get to know yourself and really ask yourself the question you don’t wanna hear: What role did you play in the things you’ve done?”

Kid Cudi was one of the first rappers to candidly talk about his therapy. “A year ago I wouldn’t even go to a therapist or psychiatrist. But I gave it a shot,” he told Complex in 2013. “It’s working for me but it’s not for everyone. I’ve got some fucking problems. It’s good for me to talk to someone who helps me see things. I had no other choice.” Last year, he revealed he’d checked himself into rehab for depression and suicidal urges.

In recent years, more rappers have been vocal about seeing therapists. Logic is at the forefront of rap’s battle for mental health; he first admitted to seeing a therapist in 2014 and he still goes. His recent hit “1-800-273-8255” was released in partnership with the National Suicide Prevention Lifeline, and he performed the song at the VMAs. Last year, Run-D.M.C.’s Darryl McDaniels put out a book called Ten Ways Not to Commit Suicide, in which he admitted to first seeking professional help in 2004 and pushed for more black men to seek treatment. “When I went to therapy I realized … that therapy isn’t ‘soft,’” he said. “My saying is, ‘Therapy is gangsta.’ It actually empowered me.”

Rappers empowered by therapy are exposing others to the effects. Chance the Rapper recently opened up about his struggles with anxiety and how the larger discourse surrounding mental health in rap is helping him speak up. “I’m starting to get a better understanding of that part of my life,” he told Complex.

Ironically, while rappers themselves have only recently tuned in to the benefits of therapy, their work has been helping people for nearly two decades. Psychologist Don Elligan published a study in the Journal of African American Men introducing the concept of “rap therapy” in 2000. And in a 2002 study published in the Journal of Poetry Therapy, Edgar Tyson coined the phrase “hip-hop therapy” and outlined its core principles.

Hip-hop therapy has continued to expand this decade, making its way into Bronx classrooms and more recently counseling offices in Philly. In 2014, psychologist and researcher Cendrine Robinson-Head published a report through the American Psychological Association explaining why she played Meek Mill for patients in their therapy sessions, finding that “clients found it much easier to talk about their experiences in the context of Mill’s lyrics.” Listeners continue to find rap to be a tonic: Last year, the Ringer story “Young Thug Is My Therapist” examined the healing properties of the elusive artist’s music. Meanwhile, the Hip Hop Therapy Global Institute uses rap for therapeutic techniques in its outreach programs. So, as black artists warm to the idea of therapy, so do many members of their captive audience.

Additionally, in a New York Times article from last year called “How to Stay Sane While Black,” poet Morgan Parker explored the black sanity myth—the way black faith can be tantamount to blind trust where mental health is concerned—and suggested that therapy should almost be a birthright for black Americans. “Sometimes I think my depression is the most normal thing about me,” she wrote. “We should all get free therapy. We could call it reparations.”

Pleas from other rappers young and old are louder now than ever, and these kinds of calls to action are valuable. There’s already tangible proof that they can work: According to a CNN report, calls to the National Suicide Prevention Lifeline increased by 50 percent following Logic’s VMAs performance. When rappers open up, fans listen; and in this case, they’re moved to open up, too.