EMPIRE OF MADNESS

When so many people take psychiatric drugs to survive their circumstances, perhaps something is wrong with society.

In this deeply researched narrative, the author reveals the many aspects of public life—whether in Global North or Global South countries—that influence the mental health of its citizens. Kidia, a writer, physician, and anthropologist, spends half of each year in Zimbabwe, where he was born and raised and now does mental health research, and the other half in the United States, where he attended medical school and now sees patients as a primary care doctor. His unique background affords him fertile ground for picking apart the tangled web of influences on a person’s mental well-being. Kidia shares stories from his life, such as his mother’s nervous breakdowns, his medical training, and his work on community-level interventions. He also tackles the colonial history of Zimbabwe, the link between incarceration and mental illness, and the days when homosexuality (as one example) was a psychiatric diagnosis. The book opens with the story of the “friendship bench,” a place for people to share their burden with (trained) elders. It seems a charming anecdote, until you learn that the intervention proved to be more effective than usual care. The program increased access in a country that, at the time, had only 12 psychiatrists. This story also sets the stage for Kidia’s argument that mental health is determined by a multitude of culturally relevant factors that go well beyond brain chemicals and genetics. He explores structural aspects of society that influence mental health, such as colonialism, income inequality, racism, the criminal justice system, and a culture of productivity. He critiques the evolution of psychiatric care; in the U.S., for instance, people deemed mentally ill have been lobotomized, psychoanalyzed, and institutionalized—strategies that have not stood the test of time. Current treatments rely on medication and talk therapy, which the author asserts are sometimes helpful but largely insufficient. It’s a complex story to tell, and it requires patience and an open mind in the reader. Every time you think the author is going off on a tangent, he succeeds in connecting things back to mental health.

An ambitious take on the diagnosis and treatment of mental health issues viewed through a cross-cultural lens.