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Early one arctic February evening, at a grimy Sheraton in suburban Maryland, the singer and songwriter SZA was wandering around her hotel room, pantsless, awaiting the arrival of the doctor her assistant, Amber, had been researching online. (“I Googled and Yelped him as much as I could, and all the reviews are good,” Amber said, nervously.) They’d been through this routine a few times before, when the singer’s voice abandoned her or her body went on strike. Like the time before SZA played “Saturday Night Live” late in the fall, six months after her debut album, “Ctrl,” was released. And again a few weeks ago, before she was set to shoot a Mastercard commercial in New York, then fly to Chicago for a show, then to Hawaii for more shows, then back to New York to perform at the Grammys, where she was nominated for five awards, the most for any woman this year.

That time, though, she was actually sick. This time the 27-year-old felt physically fine; her voice just wouldn’t work. Earlier in the afternoon, she had to go out and explain this to the crowd of fans gathered at NPR’s “Tiny Desk” studio set in Washington. “As soon as I get a shot in my booty, I’ll be fine,” she insisted, drawing a sympathetic laugh from the crowd. Later in the night, she would try to open up her throat by hot-boxing her hotel bathroom with a blend of eucalyptus steam and weed smoke. But first, cortisone.

“I don’t have pants on, let’s get right to it,” SZA rasped, greeting the doctor at the door in an oversize Harley Davidson T-shirt and sweat socks. He asked where she was from (Maplewood, N.J.) and for her real name (Solána Rowe) and, as he sorted through a pouch of vials, what “SZA” — pronounced like “sizzah” — stood for. “It’s an acronym derived from the Supreme Alphabet,” she said, with practiced poise. “Each letter stands for a different ideology.” The singer grew up in a conservative Muslim household, though she’s now more spiritually omnivorous than she was as a child. “Every now and again I might feel like, yo, I just need some straight-up Jesus today,” she told me later. “Or sometimes I feel like there’s a sura that can bring me into a really great space, or I just need the right meditation, or I need to talk to my mom.”

The doctor loaded up his syringe. “Okey-doke: buttocks,” he commanded. SZA lifted the hem of her T-shirt and bent over slightly. Afterward, as the doctor packed up his gear, he reiterated how important it was that SZA rest her voice for a few days. She laughed. “I might be getting worse,” she said with a bright smile, “but I’m not mentally acknowledging anything.”

Credit Video by Ryan McGinley for The New York Times

If you believe SZA’s own words, it’s a miracle her critically adored, commercially successful breakthrough album ever was released. “I actually quit,” she tweeted back in October 2016. Her manager, she wrote, “can release my album if he ever feels like it. Y’all be blessed.” This was after she had put out a couple of promising EPs and become the first woman signed to Top Dawg Entertainment, also home to Kendrick Lamar. She was seen as a kid sister to the tight-knit, supermasculine Top Dawg crew — and as her generation’s prime contender to carry the torch of R.&B. greats like Lauryn Hill, one of the most famous graduates of SZA’s own New Jersey high school. SZA’s music is unabashedly emotive; she writes with explicit candor about sex; with her cascading pile of hair and tendency to sing with her eyes closed and one hand outstretched, Streisand-style, she is the picture of the classic soul diva. But SZA was also born in 1990 and is a product of a post-internet culture, armed with the staggering diversity of reference points and influences that is the hallmark of the millennial mind. Like the music of Frank Ocean, her lone generational peer, her work feels deconstructed: imagistic, casual-seeming sketches that in their scattered imprecision convey the 24-7 slide-show feeling of modern life with breathtaking accuracy.

Anticipation was high for the interminably forthcoming “Ctrl,” and SZA’s tweet generated a flurry of news. But these “I quit” moments — an impulsive stomping of the foot when things don’t feel right — are actually pretty common for the singer. SZA and her team even have a name for the phenomenon: “Elmo-ing,” after the alternately excited and terrified red Muppet. They might pull up to a red carpet and find the singer refusing to get out of the car: “I just can’t, because I’m deeply Elmo-ing,” she says. “It’s a social-anxiety thing where it’s like you don’t recognize yourself.” Her manager, Terrence Henderson, known as Punch — president of T.D.E., which his cousin Anthony Tiffith, known as Top Dawg, founded in Compton, Calif. — explains it in comic-book terms. “SZA’s like Jean Gray, so I guess I play the Professor X role,” he says. “She’s definitely a Level 5 mutant. You can’t control it. You just got to try to contain it.”

“Ctrl” was released in June 2017 only because Punch refused to let SZA work on it anymore. “One day they just wouldn’t let us go back to the studio,” she says. And though the record’s wildly positive reception should feel like a fairy tale of validation — it has been certified platinum, fueled a sold-out tour and earned her endorsements with Gap and Nike, not to mention all those Grammy nominations — SZA still fixates on the “two more weeks” she wanted in the studio. The thing is, Punch says, “she comes from a background where she was teased a lot, so she developed a lot of insecurities early on. She just doesn’t see herself like the rest of us see her.”

Self-doubt may actually be SZA’s superpower. In an era of aggressively cultivated self-confidence — of squads and scars that are beautiful and sometimes performative hashtag feminism — SZA has broken through singing songs that exult in self-doubt, desperation and insecurity. On “Supermodel,” a song about an ex who leaves for a “prettier” woman, she laments, “Why am I so easy to forget like that?” On “Drew Barrymore,” she sings:

I’m so ashamed of myself think I need therapy

I’m sorry I’m not more attractive

I’m sorry I’m not more ladylike

I’m sorry I don’t shave my legs at night

Her obvious forebears may be girl groups like the Crystals and the Shangri-Las. But unlike those artists, who were made abject by their desire and imprisoned by the gender politics of their era, SZA’s insecurities are refracted through the ensuing decades of cultural and social progress — through waves of feminism and the civil rights movement, through Madonna and riot grrrl and Sasha Fierce. She wears her old-school insecurity with a decidedly modern bravery, expressing her own self-loathing with such clarity and conviction that it comes across as self-love.

Her success gets at a complicated truth: Neediness and regret are not merely the products of some pre-woke world in which women weren’t given the space to be self-actualized superheroes. They’re part of the experience of being human. SZA’s Grammys performance took place two weeks before “Fifty Shades Freed” became the No. 1 movie in America, and while her music has little in common with that film, both are clearly giving women something they want, something they aren’t getting elsewhere and often feel ashamed for desiring in the first place. Some feel women should have evolved beyond the retrograde parody of male-female desire the “Fifty Shades” franchise reflects, a more nuanced and sophisticated version of which runs through SZA’s music. But SZA isn’t ashamed or confined by needing to feel hot enough to keep her man; she is legitimately freed by the act of expressing it. After more than a decade of pop’s relentless calls to self-love, admitting you sometimes hate yourself — admitting you’re “lonely enough to let you treat me like this,” as SZA sings on “Drew Barrymore” — is a relief, an act of rebellion.

Ryan McGinley for The New York Times

Onstage at the Fillmore outside Washington back in February, SZA asked the crowd if high school was as brutal for them as it was for her. They whooped loudly. The crowd looked to be mostly middle-class, arty black kids in their late teens and 20s — the sort you might see portrayed on Issa Rae’s “Insecure,” the second season of which featured a lot of SZA’s music. (The album, Rae once tweeted, made her wish she had a bathtub, weed, candles and a temporary man.) But SZA’s reach is as diverse as her influences. When she played the full album to the producer Mark Ronson and Kevin Parker of the band Tame Impala — who are working on an album together and had SZA in the studio as a potential collaborator — Ronson says the two stared at each other in amazement. “Sure enough,” he says, SZA went on to become “the coolest name to drop, the music that everybody loves, even people who aren’t necessarily into R.&B. She just became the thing.”

SZA’s calls to the outcasts feel believable because rejection — real and imagined — is still such an evident part of her life. Backstage after the show at the Fillmore, she cataloged some of the embarrassing things she has done to avoid interacting with her own heroes. “I told Beyoncé I had to go poop,” she said. This was the first time they met, and SZA did not in fact need the bathroom. “I just said, ‘I really need to poop and find weed,’ and she was like, ‘... O.K.’ If I put my foot in my mouth early, then I remove the risk — we all know I might do something worse.” This is the self SZA sees: a hyperactive weirdo whose inner monologue — flitting, as it did during the days I spent around her, from the various types of dog dander to face serums that smell like urine to astrology — always threatens to mark her as the kind of reject she says she was as a teenager.

One of SZA’s oldest and closest friends, Ashley, started out as one of her bullies. “She was a grade ahead of me, and she was really cool and really pretty and had all the new clothes, and her brother was older and really cool,” SZA says. Even after they made peace, “it would still be weird. Like, the girls she would have me hang with would spit in my face or try to fight me.” She was a 10-year-old in a head scarf in a New Jersey commuter town when the twin towers fell. Later, it was her weight that marked her for abuse. In her early 20s, SZA was carrying more than 200 pounds on her 5-foot-4 frame; she has posted photos on Instagram.

On paper, the singer had as much of a shot at a smooth adolescence as any young person of color in an affluent American neighborhood. She lives in Los Angeles now, but she often stays in her childhood home when she’s on the East Coast, and she speaks about the backyard, with its “two big maples and a cherry tree,” with wistful sweetness. As a child, she was close to both parents — her Muslim father, who worked for CNN, and her Christian mother, an executive at a nonprofit. But she also says she has attention-deficit/hyperactivity disorder and didn’t take medication for it until she was in college. “My mother just doesn’t believe in it,” she says. “I’m black, so it’s like nobody going to no doctors for ADHD. ‘Sit your ass down and pray, you’ll be fine.’” When she was a kid, activities were her Ritalin: science camp, horseback-riding camp, church camp, softball, dance, cheerleading, track. As a high school sophomore, she was one of the top gymnasts in the state, but she soon grew “too tall and too thick” to stay competitive. “It was like, aerodynamically speaking, I kind of need to be a little slimmer and a little shorter if I really want to pop the way I want to pop,” she recalls, shrugging. “And if I can’t win, I don’t want to play.”

When I suggested to her mother, Audrey Rowe, that raising SZA couldn’t have been the smoothest experience, she laughed and said: “That’s an understatement.” Pushing her to focus on a college education, as her parents had, was an uphill battle. “She is brilliant,” Rowe says, but when it came to dictating her path, “I should have known better with that Scorpio.” SZA’s success has wound up feeling like a vindication for both of them. Rowe used to wonder if she was giving her daughter too much space — “but she’s the kind of spirit,” she says now, “that almost demands that.”

Ryan McGinley for The New York Times

At Madison Square Garden, a few days before the Grammys, Punch sat in a bank of chairs reserved for the country group Little Big Town and watched SZA rehearse. It wasn’t going well. I asked if this was the worst part — watching her anxiety, so pronounced that it sometimes seems capable of taking physical form, emerge on one of the biggest stages in the world. He chuckled. “Not for me no more,” he said. He has learned to steer clear in moments like this. “I used to try to figure out ways to fix every single thing she’d complain about, but now it’s like. ...” He trailed off. She doesn’t really want it fixed? “Right.” The anxiety is fuel? “Definitely fuel,” he affirmed. “And I believe in her talent so much I know she’s going to kill it no matter what happens before.”

SZA really has become the kid sister of the T.D.E. club. “The clubhouse is the studio,” Punch says, “and she comes in doing cartwheels and handstands — she gets away with murder!” So much so that Punch has started teasing the boss, Top Dawg: “I be like, ‘Bro, you’re getting soft.’ Because he gives her anything she asks for and he never gives it to the guys.”

It’s different, managing a woman, and not just because Punch has found himself in meetings with skin-care brands or in line to buy tampons. “With the guys, I can call them and be like, ‘Hey, we got an interview in 30 minutes, get dressed.’” He snaps his fingers. “I tried that with her before. It didn’t work so well.” And she doesn’t care about the same things; the types of internet comments that T.D.E.’s rappers can laugh at, Punch says, might really bother her. “It’s not to say that my guys don’t have insecurities; everybody has them, they just manifest in different ways.” Jay Rock, for example, is most concerned with “what his projects think — his neighborhood.” And when I ask who Kendrick Lamar is trying to impress, Punch muses: “At this point, he fightin’ the mirror.”

Some part of SZA is still trying to get mean girls to be nice to her, whereas Lamar, who was already a rap prodigy in high school, grew up the king of his realm. “And even going deeper with him,” Punch says, “his confidence, like, he’s been shot at coming home from high school, you know what I mean? That’s the alternative to making these records. We all come up that way, and she didn’t. She’s from the suburbs. So our tough love is a little different from hers.” She has, in his estimation, adapted. “She’s grown so much,” he says. “She learned our world as well.”

Punch remembers meeting SZA for the first time, at a 2011 performance by Lamar; she was there helping with merchandise. “She looked very distinctive,” he says. Much to her parents’ dismay, SZA had dropped out of college by that time, having cycled through “like four different schools” and almost as many majors. She put her short attention span to practical use, pogoing from marketing gigs to retail jobs, bartending at a series of strip clubs, sleeping on friends’ couches. The day after the concert, she was delivering some swag to the guys’ hotel and asked her friend Ashley to come along. But when they met Punch in the lobby, Ashley didn’t even take her earbuds out. “She was low key being rude,” SZA says. Finally, somewhat annoyed, Punch asked Ashley what she was listening to. “And she’s like, ‘It’s her!’” Punch says. “‘You didn’t know she sings?’”

“I don’t know, there’s no segue that makes sense, I don’t have one for you,” SZA told me at the Sheraton, post-cortisone, as we sat on the floor of her bathroom and watched the air fill up with steam. “It just happened.” First a boy she liked was making music with her brother and asked her to sing something, so she gave it a shot. Through a long series of aimless coincidences, she found herself onstage, billed as “Dylan,” covering an Amy Winehouse song at a showcase held by the production duo Christian Rich. She was still thinking she would find her way to a career in the environmental sciences, or maybe fashion, but songs were also pouring out haphazardly: She would simply steal beats she found on YouTube, sing over them and throw them back online. “I didn’t really have any aspirations,” she says.

It was Punch, at first, who had the aspirations: As soon as he grabbed one of Ashley’s earbuds and heard SZA’s tossed-off home recordings, he was sold. “Her voice was very distinctive,” he remembers. “So already the look is distinctive, and the voice is distinctive, and then she approached her lyrics like a lyricist, like a rapper.” Ronson was struck by that same quality. “Even if she was just speaking these lyrics, she would still be the best M.C. out there,” he says. “And she’s singing.”

It was the day after the Grammys that SZA woke up sick, a start to the troubles that would eventually have her searching for doctors who do house calls. Her performance on the show, though riveting, felt subdued. And she wound up losing all five of the awards for which she was nominated.

Those losses weren’t entirely surprising. We may live in a pop world ruled by the likes of Beyoncé and Rihanna, but women are wildly underrepresented when it comes to the Grammys’ most prestigious awards. No black woman has won Album of the Year since Lauryn Hill in 1999. When the hype over SZA’s five nominations ended in a shutout, it felt to many like yet another example of the Grammys’ trading on the cultural power and influence of women of color without ultimately recognizing their work. And then, backstage at the awards, Neil Portnow, president of the Recording Academy, told Variety that women have only to “step up” if they want to be musicians, engineers, producers or executives. SZA had met Portnow and liked him. “He was a chillaxed dude with mad cool trinkets in his office and hella cool stories about said trinkets,” she remembers. His comments left her “hurt and confused” — “and then it made me feel like, damn, were you thinking that about me when we met? Were you looking down at me?”

But part of the benefit of being so haunted by your own doubts is that you have little room to indulge other people’s. As she sat on the floor of that musty hotel bathroom, dirty makeup sponges and discarded false eyelashes on the counter, a battered copy of a devotional text called “Jesus Calling” on the tile next to the toilet, her voice shot, SZA was jubilant in a way I had not yet seen. The chaos inspired her. As she and her 21-year-old creative director, Sage Adams, passed a joint back and forth, giggling conspiratorially, I asked what I might learn if I stayed out on the road with them for another week or two. SZA’s eyes widened. “There will be so many moments that I’ve never been through before!” she exclaimed, her brow furrowing. “I’m going through mad first times, and you want to be like, ‘It’s my first time — give me a break!’” She paused and took a long drag. “Actually, I don’t need a break. I just got my second wind.” ♦

Lizzy Goodman is a journalist and the author of “Meet Me in the Bathroom.

Videographer/Editor: Steven Rico. Stylist: Dianne Garcia. Hair: Randy Stodghill. Makeup: Raoul Alejandre., News Around the world presents the latest information of national, regional, and international, politics, economics, sports, automotive, and lifestyle.

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