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Empire of Madness: Reimagining Western Mental Health Care for Everyone
An urgent rethinking of the Western approach to mental health, which treats the symptoms rather than the exploitative systems causing our distress—by a Rhodes Scholar and Harvard Medical School physician-anthropologist—offering lessons from the rest of the world.
In Empire of Madness, Dr. Khameer Kidia offers a re-evaluation of mental health in the Global North, where the answer to the structural causes of mental distress, like racism and economic inequality, has been to medicate the symptoms rather than revolutionize those causal structures. A clinician and researcher whose own mother suffers from the psychological harm of colonialism, Kidia reports from the front lines of mental health crises at home, in clinical practice and during fieldwork, highlighting the flaws in how we cope with global mental distress.
Western psychiatry, which emerged during nineteenth-century colonialism and expanded under neoliberalism, mollifies the effects—depression, anxiety, hunger, poverty—of oppressive structures rather than fixes them. "Burnout" is just one example of mental distress caused by economic and social conditions but disguised as a medical problem. Clear-eyed and open-hearted, Kidia asks the necessary questions that our current mental health system, pharmaceutically-driven and focused on one-size-fits-all solutions, doesn't address.
How do history, culture, and politics shape mental distress? Is hoarding a medical problem? Why are the outcomes of schizophrenia sometimes better in places without antipsychotics? Can a Zimbabwean grandmother sitting on a wooden "friendship bench" talk through someone's problems better than a Western-trained therapist? For those living in poverty, can cash replace pills?
Empire of Madness sharply intertwines discussions of the colonial origins of psychiatry, the long-lasting and psychological effects of oppression, and the overburdened health professionals striving to heal their patients in rigid, archaic systems to reimagine global mental health as a capacious, inclusive field where our wellbeing is mutual and everyone's voice—patients, caregivers, and health workers alike—matters.
In Empire of Madness, Dr. Khameer Kidia offers a re-evaluation of mental health in the Global North, where the answer to the structural causes of mental distress, like racism and economic inequality, has been to medicate the symptoms rather than revolutionize those causal structures. A clinician and researcher whose own mother suffers from the psychological harm of colonialism, Kidia reports from the front lines of mental health crises at home, in clinical practice and during fieldwork, highlighting the flaws in how we cope with global mental distress.
Western psychiatry, which emerged during nineteenth-century colonialism and expanded under neoliberalism, mollifies the effects—depression, anxiety, hunger, poverty—of oppressive structures rather than fixes them. "Burnout" is just one example of mental distress caused by economic and social conditions but disguised as a medical problem. Clear-eyed and open-hearted, Kidia asks the necessary questions that our current mental health system, pharmaceutically-driven and focused on one-size-fits-all solutions, doesn't address.
How do history, culture, and politics shape mental distress? Is hoarding a medical problem? Why are the outcomes of schizophrenia sometimes better in places without antipsychotics? Can a Zimbabwean grandmother sitting on a wooden "friendship bench" talk through someone's problems better than a Western-trained therapist? For those living in poverty, can cash replace pills?
Empire of Madness sharply intertwines discussions of the colonial origins of psychiatry, the long-lasting and psychological effects of oppression, and the overburdened health professionals striving to heal their patients in rigid, archaic systems to reimagine global mental health as a capacious, inclusive field where our wellbeing is mutual and everyone's voice—patients, caregivers, and health workers alike—matters.
384 pages, Hardcover
First published February 3, 2026
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Displaying 1 - 23 of 23 reviews
May 18, 2026
This is now my number 1 book recommendation for someone wanting an introduction into the politics of mental health. The writing and story telling are wonderfully attentive, but the organization of pulling together so many different parts of how we should consider mental health (from an international, a material, a psychic, an emotional, a personal, a political force) is how I think is what I think books related to health and disability have a lot to learn from.
This is a smaller note, but I think with irony culture dying and being replaced with a genuine, earnest empathy is maybe one of the things that I can’t stop thinking about with this book. This doctor CARES and I think we should bask in the beauty of what that potential holds for how we, collectively, should reconsider mental health
This is a smaller note, but I think with irony culture dying and being replaced with a genuine, earnest empathy is maybe one of the things that I can’t stop thinking about with this book. This doctor CARES and I think we should bask in the beauty of what that potential holds for how we, collectively, should reconsider mental health
February 3, 2026
5⭐️
This book validated experiences I’ve had working as an accompagneur in perinatal public health and social work for the past fifteen years.
At its core, this is a book about connection: about how mental wellness is shaped not only by what happens inside us, but by the communities, systems, and supports surrounding us. It challenges the idea that distress is primarily an individual failure and instead asks us to look honestly at isolation, inequality, and social rupture from capitalist, racist and postcolonial influences as central forces affecting mental health.
What resonated most for me was the validation of accompaniment and listening as real forms of care. Walking alongside someone without immediately pathologizing their reactions to very real stressors is often more meaningful than narrowly defined clinical interventions. This book gives language to that reality and grounds it in research, history, and compassion.
This isn’t a light read, but it is an engaging, compelling and affirming one. It confirmed what I have always found to be true from my own field work: community care matters, mental health cannot be separated from public health, and healing is rarely something we do alone.
Highly recommend for anyone working in perinatal health, public health, mental health, or anyone who has ever felt their suffering was treated as a personal problem instead of a collective responsibility.
Greatest thanks to Dr. Kidia, Crown Publishing and NetGalley for the opportunity to review a copy of this book in advance of its publication on 2/3/2026.
This book validated experiences I’ve had working as an accompagneur in perinatal public health and social work for the past fifteen years.
At its core, this is a book about connection: about how mental wellness is shaped not only by what happens inside us, but by the communities, systems, and supports surrounding us. It challenges the idea that distress is primarily an individual failure and instead asks us to look honestly at isolation, inequality, and social rupture from capitalist, racist and postcolonial influences as central forces affecting mental health.
What resonated most for me was the validation of accompaniment and listening as real forms of care. Walking alongside someone without immediately pathologizing their reactions to very real stressors is often more meaningful than narrowly defined clinical interventions. This book gives language to that reality and grounds it in research, history, and compassion.
This isn’t a light read, but it is an engaging, compelling and affirming one. It confirmed what I have always found to be true from my own field work: community care matters, mental health cannot be separated from public health, and healing is rarely something we do alone.
Highly recommend for anyone working in perinatal health, public health, mental health, or anyone who has ever felt their suffering was treated as a personal problem instead of a collective responsibility.
Greatest thanks to Dr. Kidia, Crown Publishing and NetGalley for the opportunity to review a copy of this book in advance of its publication on 2/3/2026.
February 13, 2026
I agree with about 95% of the book, however I do think the author’s attitude is a bit too idealistic.
As someone that has been working in public mental health for over 10 years now (Australia) I think there’s a risk that someone may read this book and believe that psychosocial economic factors are the only causes for mental health issues.
The existing system is not perfect, I am fully aware. However we have come a long way. We also can’t forget that medication and inpatient/ community treatment are necessary for a reason.
As someone that has been working in public mental health for over 10 years now (Australia) I think there’s a risk that someone may read this book and believe that psychosocial economic factors are the only causes for mental health issues.
The existing system is not perfect, I am fully aware. However we have come a long way. We also can’t forget that medication and inpatient/ community treatment are necessary for a reason.
February 18, 2026
Empire of Madness by Khameer Kidia is a powerful and personal critique of modern psychiatry that asks a big question: what if mental illness is not just a problem in the brain, but a reflection of inequality and oppression? Based on his personal experiences as a son, a physican and a psychiatrists and combining his lived experiences in Zimbabwe, the UK and the US, he writes a book that is personal and universal.
The book is divided into three sections, History, Diagnosis, and Prescription.
In History, Kidia explores how psychiatry has often worked alongside systems of power. He looks at examples like drapetomania, a fake diagnosis once used to pathologize enslaved people who tried to escape, and connects it to present day practices that silence or overmedicate marginalized patients. Drawing on cross cultural research, including studies comparing voice hearing in the United States, Ghana, and India, he shows that experiences we call mental illness are deeply shaped by culture, economics, and politics.
In Diagnosis, Kidia questions the authority of psychiatric labels. He argues that diagnoses are constructed categories that simplify complex human experiences. He challenges the idea that addiction is purely biological and points out how race, class, and power influence who gets labeled “noncompliant” or “disordered.” He introduces ideas like structural violence and epistemic injustice to explain how institutions can dismiss or distort the voices of people who are already marginalized. Throughout this section, he emphasizes that most health outcomes are shaped less by healthcare itself and more by housing, debt, food access, racism, and poverty.
In Prescription, Kidia shifts from critique to possibility. Instead of relying mainly on medication, he advocates for social prescriptions such as stable housing, direct cash transfers, and policies that reduce economic insecurity. He supports a Housing First approach and argues that giving people money can significantly improve depression and anxiety. He also introduces the idea of cognitive liberty, the right to choose whether and how to alter one’s consciousness. Ultimately, the book makes a bold but practical claim: if poverty and oppression drive mental distress, then justice and material support may be the most effective forms of treatment.
I LOVED THIS BOOK!
-
Quotes
empire of madness
“As an American-trained doctor, I've been taught that the key to removing stigma around mental distress is to medicalize it—to call it a disease, to say that it is a fault in your brain, no different from a faulty pancreas in diabetes. But this often has the opposite of the intended effect, both for mental illness and for diabetes. It forces the illness into the individual and private realm, and it says that the problem is within you. It is your fault… I saw that Western medical approaches to mental distress are designed to anesthetize the pain of oppression, not fix it. They are, in other words, tools in an empire of madness… I'm saying that we need to completely reenvision the way we approach the problem of mental distress, thinking of it as a much bigger, structural issue, rather than one that is confined to the individual patient with the illness.”
“For a white woman who'd slept with a Black man, the only culturally legitimate narrative available to her about the experience was one of trauma, even if the relationship had been consensual.
This is how the individual psychology of trauma can become a political force for oppression.”
“To understand how this violent culture derived from profit making can shape our psychology, I turn to Tanya Luhrmann, a psychiatric anthropologist at Stanford who studies how mental illness is influenced by culture. A study she published in 2015 still makes my jaw drop. With a team of psychiatrists, Luhrmann interviewed sixty patients who heard voices and met diagnostic criteria for schizophrenia in three countries: twenty in the United States, twenty in Ghana, and twenty in India. Patients in San Mateo, California, all described the voices they heard in negative terms-intrusive and riddled with vio-lence. "Usually, it's like torturing people," a patient told Luhrmann.
"To take their eye out with a fork, or cut someone's head and drink their blood, really nasty stuff.” In Ghana and India, on the other hand, patients described voices as familiar, usually people the patient already knew, such as a relative.
The voices were mostly peaceful. In Chennai, India, for example, the voices often told patients to complete important chores around the house. "They just tell me to do the right thing," a man from Ghana said. "If I hadn't had these voices I would have been dead long ago."?1 The patients from Ghana and India rarely referred to themselves using diagnostic categories like schizophrenia and were less disturbed by their voices than patients in the United States.”
“The way the global economic system is structured smacks of indirect rule-the more common kind of colonialism where European countries, without establishing settler colonies, extracted wealth, natural resources, and labor from poor countries by co-opting local elites to do their bidding. In the same way, the IMF and the World Bank shape the economies of poor countries to feed into a global system that ultimately benefits Western superpowers and depletes the human and natural resources of poor countries. This is how the French ruled in Algeria, how the Portuguese ruled in Mozambique, how the British ruled in Uganda.”
“Diagnoses themselves are not natural entities but invented categories that help doctors analyze symptoms in their heads-narrowing the complex histories we hear from patients into manageable buckets.”
“In medicine, there are fine lines between drug tolerance, depen-dence, and addiction. Tolerance is when you need increasing amounts of a drug to achieve the same effect. Dependence is when you cannot function without a drug. And addiction is when you are dependent on a drug but cannot function with it. In other words, addiction is when you are not able to live the life you want to live, according to the norms of the society you want to live in, due to the detrimental effects of a drug you have little choice but to take… The line between dependence and addiction is not biological; it is socially con-structed. There is no brain scan or blood test doctors can do that lights up and allows us to say, "Aha, you're an addict." I have patients who are dependent on and take astronomical doses of stimulants and opioid painkillers multiple times a day. They go about their days as usual— performing the responsibilities of the society in which they partici-pate: caring for children, paying their taxes. Unless the drug causes harm in their life, I would not diagnose them with addiction.”
“In my experience as a clinician, immigrant, and mental health researcher trying to understand how poverty affects people's mental wellbeing all over the world, I keep coming back to the diagnosis of debt.”
“Unfortunately, Samuel had developed the worst possible movement side effect of Haldol; tardive dyskinesia, which is an incurable condition characterized by lip smacking and writhing tongue move-ments. Unlike the other movement symptoms, tardive dyskinesia is permanent, even after the drug is discontinued. If you've ever ridden the New York subway on a regular basis, you've probably seen someone suffering from tardive dyskinesia and mistaken their condition for an illness that required medical attention, not an illness caused by medical attention.”
“Gatekeeping is an unusually common function of medicine.”
“This has been happening since the early days of psychiatry. Drap-etomania, for example, was a pseudoscientific mental illness coined by the American physician Samuel A. Cartwright in 1851. It was applied as a diagnosis to Black slaves who tried to escape captivity. To physicians at the time, slaves who tried to escape were considered insane rather than rationally responding to subjugation, deprivation, and violence.”
“I've seen this play out over and over in clinical practice. Black patients like Earl come to the hospital for help, but when they try to advocate for themselves, they instead leave with stigmatizing psy chiatric diagnoses like schizoaffective disorder and coded language in their medical charts that make them sound insane or criminal. "Pa-tient is a frequent flier.""Patient is noncompliant.""Patient with multiple admissions for functional pain, frequently refuses care resulting in AMA [against medical advice] discharge."”
“But history keeps repeating itself because people in the dominant caste truly feel unsafe. They are genuinely terri-fied. They want safe spaces, but they cannot see that they are the safest people in the world.”
“The reason many drugs have such nonspecific effects is that our bodies are full of receptors (alpha 1, alpha 2, beta 1, beta 2, D1, D2, V1, V2, mu-to name a few) that are dispersed throughout our tissues, blood vessels, nerves, and organs. Most medications hit multiple receptors in multiple places causing multiple effects. It's why a couple of doses of an asthma inhaler also increases heart rate or why aspirin treats pain, fever, and heart attacks. It's why minoxidil, the active ingredient in hair loss treatments, is also a potent blood pressure medi-cation. This understanding of pharmacology may be one of the most important ideas I learned in medical school: a schema that goes be yond what you can get on a first-pass internet search—one that helps us understand how to use drugs beyond what they're famous for and to parse the taur bind between therapeutics (how we heal) and intro genesis (how we harm).”
“We do this because we have no choice. It is cheaper for hospital corporations to make us quiet patients with antipsychotics, or even to physically restrain them, than it is to hire more doctors, nurses, and sitters. In the absence of more human capital, antipsychotics allow hospital corporations to extract the most labor from the fewest workers to maximize profit. Without extra workers, we use antipsychotics to keep our patients in line: tucked in, peaceful, wearing gray hospital socks and pajamas— sardines brined in a can of Haldol.”
“To describe this type of oppression, my mentor the late physician anthropologist Pail Farmer popularized the termi "structural violence," the idea that there are institutions and governing structures that obstruct people's ability to access health care, obrain food, and otherwise flourish in life, thus inflicting violence.”
“After all, "healthcare itself," explains Tom Insel, the psychiatrist and former director of the NIMH, "explains only about 10 percent of health outcones." The remaining 90 percent of health outcomes, including mental health outcomes, ure determined by structural facton like access to food, shelter, transport, and oppression due to race, clas gender, sexuality, and disability.”
“Through DNA methylation and demethylation, when a small molecule is added or subtracted from a piece of DNA, the environment and stressful life events can turn a gene on or off without altering the gene itself.”
“This unwillingness to grasp someone else's understanding is called cistemic injustice: the hierarchy in which some people's knowiedge systems are more valuable than other people's knowledge systems. It is a fact, for example, that fewer people would read this book if I were not a physician.
There are two types of epistemic injustice, according to Miranda Fricker, the philosopher who popularized the concept. Testimonial injustice is when we don't believe what people say because of their inferior status in society. Hermeneutic injustice, relatedly, is when we don't have words for people's experiences. "An example of the first," writes Fricker, "might be that the police do not believe you because you are black; an example of the second might be that you suffer sexual
"harassment in a culture that still lacks that critical concept."" Both types of epistemic injustice are involved in trauma: both the inability to believe that some people's responses to trauma are real and the fact that there aren't ways to discuss trauma responses that don't fit a Western narrative of the concept.
As scholars of epistemic injustice point out, some voices simply aten't taken seriously, in part because they do not appeal to Western ideas of what a voice can say and how a voice can speak."
“Living bisected between worlds an ocean apart has made me interrogate how this universalizing tone flattens the multiplicity. of trauma; how it forces an overly simplistic conception of well-being. and suffering in places where such a conception may not be useful or welcome.”
“A social prescription could be a gym membership or a
1950s
dance class. It could be a housing voucher or food stamps. It could be a nature walk, or even much needed, hard cash. But Jack Geiger (1950s) believed, as do I, that social prescribing is about not only individual-level prescriptions for structural problems faced by patients but also structural prescriptions (such as the pit latrines in South Africa) that build healthier environments to improve the well-being of many individual patients at scale.”
“Because of this, housing is one of the most potent social prescriptions for mental illness and should be the first step in mental health care, a principle called Housing First, which espouses getting patients into housing before any of their other problems can be dealt with.”
“A 2019 study in Biological Psychiatry showed that in the first year of residency medical trainees had significant shortening of their telomeres, which are the protective bits of DNA at the ends of our chromosomes that hold them together and prevent them from unraveling.® Each time a cell divides, its telomeres shorten, until eventually the telomeres can no longer protect our chromosomes and the cell "dies" or becomes
"senescent." When the rate of telomere shortening is normal, this process is protective; it kills off cells that could otherwise become cancer-ous. But when the rate of telomere shortening is more rapid than normal, as it was for medical trainees in this study, senescent cells from chronic stress can cause inflammation throughout the body, which is associated with premature aging and early mortality.”
“In the United States, people spend their lives in the pursuit of happiness, but it is a cultural assumption that happiness is the best way of being. It is almost impossible for us to imagine that our patients wouldn't always prefer to feel happy.
What this projection of our own emotional ideals does, intentionally or not, is invalidate people's suffering and potentially worsen their mental health. It says to patients that the way they are feeling when they are sad or anxious or paranoid is not warranted, even when it is a rational response to a toxic environment.
To maximize autonomy and limit projecting our normative emotions onto our patients, a helpful framework for clinicians and patients in mental health is cognitive liberty, a twofold idea that argues that everyone should have the right to "mental self-determination." First, everyone should be able to alter their own consciousness however they see fit, whether through drugs, therapy, medications, or yoga. Second, everyone should be free from coercive efforts by others to alter their consciousness; in other words, people should not be coerced or forced into taking psychotropic medications.”
“Indigenous Zimbabwean knowledge explains mental health proba lems in spiritual terms, most commonly through ngozi, angered spir-its.' People experiencing madness are suffering the consequences of angry spirits who demand retribution for wrongdoing. There are f range of offenses that might create this situation: livestock theft, mur der, domestic violence, unpaid dowry. And, while the wrongdoing might have been committed by a single person a long time ago, misfortune due to ngozi reverberates throughout the kinship system and across generations.”
“I'm not saying that we should recode all instances of ngozi as
"trauma," but there is a broad parallel: In both ngozi and trauma, a bad thing happens, and people suffer intergenerational distress because of it. This tells me that the phenomena might be related but have different cultural explanations, what medical anthropologists call explanatory models.”
“But researchers throughout the world have demonstrated that cash transfers improve people's physical health, depression, anxiety, school attendance, maternal-child health, nutrition, and even mortal-ity. People who receive cash transfers are less likely to murder, be incarcerated, die of overdose, transmit HIV, commit domestic vio-lence, and visit the emergency department. In a large meta-analysis pooling more than twenty-six thousand participants, researchers at Oxford looked specifically at the impact of cash transfers on depression and anxiety in poorer countries. They found, unsurprisingly, that giving people free cash significantly reduced symptoms of mental ill-ness? "Financial insecurity," explains the psychiatrist-anthropologist Eric Reinhart, "is a major driver behind cycles of poor mental health, disease, violence, crime, and incarceration-all of which, in turn, further entrench poverty, destabilize families, undercut public health and childhood education, and constrain people's life opportu-nities."
“When people are living in poverty, what actually helps their mental health is the most obvious but least often prescribed: cash.”
“If depression gets better when you give someone money. and rets worse when you take it away, this is even stronger evidence that the cause of depression is a lack of money, otherwise known as poverty.”
“If you are paid to do something, you have the option to stop that job and forfeit your pay.
That freedom is good for mental well-being. (Labor specialists call this
"job control," which is associated with better mental health.)" But if you do something purely out of moral obligation, or, as women have been socialized to do, out of "love," that care work is harder to escape, making it more likely to worsen the carer's mental health.”
The book is divided into three sections, History, Diagnosis, and Prescription.
In History, Kidia explores how psychiatry has often worked alongside systems of power. He looks at examples like drapetomania, a fake diagnosis once used to pathologize enslaved people who tried to escape, and connects it to present day practices that silence or overmedicate marginalized patients. Drawing on cross cultural research, including studies comparing voice hearing in the United States, Ghana, and India, he shows that experiences we call mental illness are deeply shaped by culture, economics, and politics.
In Diagnosis, Kidia questions the authority of psychiatric labels. He argues that diagnoses are constructed categories that simplify complex human experiences. He challenges the idea that addiction is purely biological and points out how race, class, and power influence who gets labeled “noncompliant” or “disordered.” He introduces ideas like structural violence and epistemic injustice to explain how institutions can dismiss or distort the voices of people who are already marginalized. Throughout this section, he emphasizes that most health outcomes are shaped less by healthcare itself and more by housing, debt, food access, racism, and poverty.
In Prescription, Kidia shifts from critique to possibility. Instead of relying mainly on medication, he advocates for social prescriptions such as stable housing, direct cash transfers, and policies that reduce economic insecurity. He supports a Housing First approach and argues that giving people money can significantly improve depression and anxiety. He also introduces the idea of cognitive liberty, the right to choose whether and how to alter one’s consciousness. Ultimately, the book makes a bold but practical claim: if poverty and oppression drive mental distress, then justice and material support may be the most effective forms of treatment.
I LOVED THIS BOOK!
-
Quotes
empire of madness
“As an American-trained doctor, I've been taught that the key to removing stigma around mental distress is to medicalize it—to call it a disease, to say that it is a fault in your brain, no different from a faulty pancreas in diabetes. But this often has the opposite of the intended effect, both for mental illness and for diabetes. It forces the illness into the individual and private realm, and it says that the problem is within you. It is your fault… I saw that Western medical approaches to mental distress are designed to anesthetize the pain of oppression, not fix it. They are, in other words, tools in an empire of madness… I'm saying that we need to completely reenvision the way we approach the problem of mental distress, thinking of it as a much bigger, structural issue, rather than one that is confined to the individual patient with the illness.”
“For a white woman who'd slept with a Black man, the only culturally legitimate narrative available to her about the experience was one of trauma, even if the relationship had been consensual.
This is how the individual psychology of trauma can become a political force for oppression.”
“To understand how this violent culture derived from profit making can shape our psychology, I turn to Tanya Luhrmann, a psychiatric anthropologist at Stanford who studies how mental illness is influenced by culture. A study she published in 2015 still makes my jaw drop. With a team of psychiatrists, Luhrmann interviewed sixty patients who heard voices and met diagnostic criteria for schizophrenia in three countries: twenty in the United States, twenty in Ghana, and twenty in India. Patients in San Mateo, California, all described the voices they heard in negative terms-intrusive and riddled with vio-lence. "Usually, it's like torturing people," a patient told Luhrmann.
"To take their eye out with a fork, or cut someone's head and drink their blood, really nasty stuff.” In Ghana and India, on the other hand, patients described voices as familiar, usually people the patient already knew, such as a relative.
The voices were mostly peaceful. In Chennai, India, for example, the voices often told patients to complete important chores around the house. "They just tell me to do the right thing," a man from Ghana said. "If I hadn't had these voices I would have been dead long ago."?1 The patients from Ghana and India rarely referred to themselves using diagnostic categories like schizophrenia and were less disturbed by their voices than patients in the United States.”
“The way the global economic system is structured smacks of indirect rule-the more common kind of colonialism where European countries, without establishing settler colonies, extracted wealth, natural resources, and labor from poor countries by co-opting local elites to do their bidding. In the same way, the IMF and the World Bank shape the economies of poor countries to feed into a global system that ultimately benefits Western superpowers and depletes the human and natural resources of poor countries. This is how the French ruled in Algeria, how the Portuguese ruled in Mozambique, how the British ruled in Uganda.”
“Diagnoses themselves are not natural entities but invented categories that help doctors analyze symptoms in their heads-narrowing the complex histories we hear from patients into manageable buckets.”
“In medicine, there are fine lines between drug tolerance, depen-dence, and addiction. Tolerance is when you need increasing amounts of a drug to achieve the same effect. Dependence is when you cannot function without a drug. And addiction is when you are dependent on a drug but cannot function with it. In other words, addiction is when you are not able to live the life you want to live, according to the norms of the society you want to live in, due to the detrimental effects of a drug you have little choice but to take… The line between dependence and addiction is not biological; it is socially con-structed. There is no brain scan or blood test doctors can do that lights up and allows us to say, "Aha, you're an addict." I have patients who are dependent on and take astronomical doses of stimulants and opioid painkillers multiple times a day. They go about their days as usual— performing the responsibilities of the society in which they partici-pate: caring for children, paying their taxes. Unless the drug causes harm in their life, I would not diagnose them with addiction.”
“In my experience as a clinician, immigrant, and mental health researcher trying to understand how poverty affects people's mental wellbeing all over the world, I keep coming back to the diagnosis of debt.”
“Unfortunately, Samuel had developed the worst possible movement side effect of Haldol; tardive dyskinesia, which is an incurable condition characterized by lip smacking and writhing tongue move-ments. Unlike the other movement symptoms, tardive dyskinesia is permanent, even after the drug is discontinued. If you've ever ridden the New York subway on a regular basis, you've probably seen someone suffering from tardive dyskinesia and mistaken their condition for an illness that required medical attention, not an illness caused by medical attention.”
“Gatekeeping is an unusually common function of medicine.”
“This has been happening since the early days of psychiatry. Drap-etomania, for example, was a pseudoscientific mental illness coined by the American physician Samuel A. Cartwright in 1851. It was applied as a diagnosis to Black slaves who tried to escape captivity. To physicians at the time, slaves who tried to escape were considered insane rather than rationally responding to subjugation, deprivation, and violence.”
“I've seen this play out over and over in clinical practice. Black patients like Earl come to the hospital for help, but when they try to advocate for themselves, they instead leave with stigmatizing psy chiatric diagnoses like schizoaffective disorder and coded language in their medical charts that make them sound insane or criminal. "Pa-tient is a frequent flier.""Patient is noncompliant.""Patient with multiple admissions for functional pain, frequently refuses care resulting in AMA [against medical advice] discharge."”
“But history keeps repeating itself because people in the dominant caste truly feel unsafe. They are genuinely terri-fied. They want safe spaces, but they cannot see that they are the safest people in the world.”
“The reason many drugs have such nonspecific effects is that our bodies are full of receptors (alpha 1, alpha 2, beta 1, beta 2, D1, D2, V1, V2, mu-to name a few) that are dispersed throughout our tissues, blood vessels, nerves, and organs. Most medications hit multiple receptors in multiple places causing multiple effects. It's why a couple of doses of an asthma inhaler also increases heart rate or why aspirin treats pain, fever, and heart attacks. It's why minoxidil, the active ingredient in hair loss treatments, is also a potent blood pressure medi-cation. This understanding of pharmacology may be one of the most important ideas I learned in medical school: a schema that goes be yond what you can get on a first-pass internet search—one that helps us understand how to use drugs beyond what they're famous for and to parse the taur bind between therapeutics (how we heal) and intro genesis (how we harm).”
“We do this because we have no choice. It is cheaper for hospital corporations to make us quiet patients with antipsychotics, or even to physically restrain them, than it is to hire more doctors, nurses, and sitters. In the absence of more human capital, antipsychotics allow hospital corporations to extract the most labor from the fewest workers to maximize profit. Without extra workers, we use antipsychotics to keep our patients in line: tucked in, peaceful, wearing gray hospital socks and pajamas— sardines brined in a can of Haldol.”
“To describe this type of oppression, my mentor the late physician anthropologist Pail Farmer popularized the termi "structural violence," the idea that there are institutions and governing structures that obstruct people's ability to access health care, obrain food, and otherwise flourish in life, thus inflicting violence.”
“After all, "healthcare itself," explains Tom Insel, the psychiatrist and former director of the NIMH, "explains only about 10 percent of health outcones." The remaining 90 percent of health outcomes, including mental health outcomes, ure determined by structural facton like access to food, shelter, transport, and oppression due to race, clas gender, sexuality, and disability.”
“Through DNA methylation and demethylation, when a small molecule is added or subtracted from a piece of DNA, the environment and stressful life events can turn a gene on or off without altering the gene itself.”
“This unwillingness to grasp someone else's understanding is called cistemic injustice: the hierarchy in which some people's knowiedge systems are more valuable than other people's knowledge systems. It is a fact, for example, that fewer people would read this book if I were not a physician.
There are two types of epistemic injustice, according to Miranda Fricker, the philosopher who popularized the concept. Testimonial injustice is when we don't believe what people say because of their inferior status in society. Hermeneutic injustice, relatedly, is when we don't have words for people's experiences. "An example of the first," writes Fricker, "might be that the police do not believe you because you are black; an example of the second might be that you suffer sexual
"harassment in a culture that still lacks that critical concept."" Both types of epistemic injustice are involved in trauma: both the inability to believe that some people's responses to trauma are real and the fact that there aren't ways to discuss trauma responses that don't fit a Western narrative of the concept.
As scholars of epistemic injustice point out, some voices simply aten't taken seriously, in part because they do not appeal to Western ideas of what a voice can say and how a voice can speak."
“Living bisected between worlds an ocean apart has made me interrogate how this universalizing tone flattens the multiplicity. of trauma; how it forces an overly simplistic conception of well-being. and suffering in places where such a conception may not be useful or welcome.”
“A social prescription could be a gym membership or a
1950s
dance class. It could be a housing voucher or food stamps. It could be a nature walk, or even much needed, hard cash. But Jack Geiger (1950s) believed, as do I, that social prescribing is about not only individual-level prescriptions for structural problems faced by patients but also structural prescriptions (such as the pit latrines in South Africa) that build healthier environments to improve the well-being of many individual patients at scale.”
“Because of this, housing is one of the most potent social prescriptions for mental illness and should be the first step in mental health care, a principle called Housing First, which espouses getting patients into housing before any of their other problems can be dealt with.”
“A 2019 study in Biological Psychiatry showed that in the first year of residency medical trainees had significant shortening of their telomeres, which are the protective bits of DNA at the ends of our chromosomes that hold them together and prevent them from unraveling.® Each time a cell divides, its telomeres shorten, until eventually the telomeres can no longer protect our chromosomes and the cell "dies" or becomes
"senescent." When the rate of telomere shortening is normal, this process is protective; it kills off cells that could otherwise become cancer-ous. But when the rate of telomere shortening is more rapid than normal, as it was for medical trainees in this study, senescent cells from chronic stress can cause inflammation throughout the body, which is associated with premature aging and early mortality.”
“In the United States, people spend their lives in the pursuit of happiness, but it is a cultural assumption that happiness is the best way of being. It is almost impossible for us to imagine that our patients wouldn't always prefer to feel happy.
What this projection of our own emotional ideals does, intentionally or not, is invalidate people's suffering and potentially worsen their mental health. It says to patients that the way they are feeling when they are sad or anxious or paranoid is not warranted, even when it is a rational response to a toxic environment.
To maximize autonomy and limit projecting our normative emotions onto our patients, a helpful framework for clinicians and patients in mental health is cognitive liberty, a twofold idea that argues that everyone should have the right to "mental self-determination." First, everyone should be able to alter their own consciousness however they see fit, whether through drugs, therapy, medications, or yoga. Second, everyone should be free from coercive efforts by others to alter their consciousness; in other words, people should not be coerced or forced into taking psychotropic medications.”
“Indigenous Zimbabwean knowledge explains mental health proba lems in spiritual terms, most commonly through ngozi, angered spir-its.' People experiencing madness are suffering the consequences of angry spirits who demand retribution for wrongdoing. There are f range of offenses that might create this situation: livestock theft, mur der, domestic violence, unpaid dowry. And, while the wrongdoing might have been committed by a single person a long time ago, misfortune due to ngozi reverberates throughout the kinship system and across generations.”
“I'm not saying that we should recode all instances of ngozi as
"trauma," but there is a broad parallel: In both ngozi and trauma, a bad thing happens, and people suffer intergenerational distress because of it. This tells me that the phenomena might be related but have different cultural explanations, what medical anthropologists call explanatory models.”
“But researchers throughout the world have demonstrated that cash transfers improve people's physical health, depression, anxiety, school attendance, maternal-child health, nutrition, and even mortal-ity. People who receive cash transfers are less likely to murder, be incarcerated, die of overdose, transmit HIV, commit domestic vio-lence, and visit the emergency department. In a large meta-analysis pooling more than twenty-six thousand participants, researchers at Oxford looked specifically at the impact of cash transfers on depression and anxiety in poorer countries. They found, unsurprisingly, that giving people free cash significantly reduced symptoms of mental ill-ness? "Financial insecurity," explains the psychiatrist-anthropologist Eric Reinhart, "is a major driver behind cycles of poor mental health, disease, violence, crime, and incarceration-all of which, in turn, further entrench poverty, destabilize families, undercut public health and childhood education, and constrain people's life opportu-nities."
“When people are living in poverty, what actually helps their mental health is the most obvious but least often prescribed: cash.”
“If depression gets better when you give someone money. and rets worse when you take it away, this is even stronger evidence that the cause of depression is a lack of money, otherwise known as poverty.”
“If you are paid to do something, you have the option to stop that job and forfeit your pay.
That freedom is good for mental well-being. (Labor specialists call this
"job control," which is associated with better mental health.)" But if you do something purely out of moral obligation, or, as women have been socialized to do, out of "love," that care work is harder to escape, making it more likely to worsen the carer's mental health.”
Read
May 11, 2026An abolitionist view of “mental health” and whatever that means. Very mind expanding, I would put this on a non-fiction must read list.
March 3, 2026
3.5 stars. Very interesting! I loved all of the cultural insights, especially surrounding how a violent culture might influence the violence of voices that a schizophrenia sufferer might hear, whereas in a more peaceful culture, the voices often tell the person to finish their chores or do what they need to do.
I thought he did lean too heavily sometimes into the "money will solve their problems" idea. I do agree that sometimes it is that simple, but I don't believe that mental health would suddenly be fine if everyone had all of their financial needs met. I think there is more to it.
I thought he did lean too heavily sometimes into the "money will solve their problems" idea. I do agree that sometimes it is that simple, but I don't believe that mental health would suddenly be fine if everyone had all of their financial needs met. I think there is more to it.
Review of advance copy received from Netgalley
Thanks to NetGalley & Crown Publishing for the ARC!
Dr. Khameer Kidia’s Empire of Madness: Reimagining Western Health Care for Everyone is a research-backed, memoir-hued book with a simple premise: “That suffering, though it is internally experienced, is externally determined.”
To put it another way, mental illness is revealed in the individual, but it is rooted in—and resolved through—the community.
To put it a third way, maybe you’re depressed because you can’t afford your groceries. Maybe you have ADHD only because productivity is elevated as gospel.
For readers familiar with social theory, much of what Kidia says here isn’t anything new—Western capitalism medicalizes and individualizes social ills, and then it stigmatizes those who experience them. Coincidentally, those who are sickest often look the least like those in power. The author’s vital addition to care-related discourse is, perhaps, his positionality as much as his message. He isn’t an “anti-medicine hippy” or a political mouthpiece. He’s a Princeton-educated doctor saying, “Hey, we are under-serving people when we aren’t also looking at the circumstances causing their problems.”
By looking outside of the patient, Kidia invokes the concept of ubuntu in a call for deeper focus on “ministering to suffering.” With this emphasis on practice, the politics of the book feel accessible, which is so important for a project as topically far-reaching as Empire of Madness.
Kidia’s writing lives in nuance. He writes about how he happily helped a trans woman get top surgery before recognizing that the requirement of diagnosed gender dysphoria codifies stigma. He describes the impact of care facilities that mirror prisons and questions what “the carceral nature of mental health” says about our beliefs surrounding recovery. He explores how COVID stimulus checks functioned as a “social prescription” that alleviated mental stress. Above all, the author writes with a willingness to learn, and one of the pleasures of Empire of Madness is that it isn’t didactic—it's personal.
Throughout the book, Kidia is remarkably focused, and a key reason for that is his use of auto-ethnography as a scaffold for his arguments. Born to Indian parents in Zimbabwe and educated in the US, he has seen and experienced the disconnect between Western talking points and the way they inflict harm. He has witnessed how a decimated economy impacted his mother; how his community couldn’t get COVID vaccines because the American government stockpiled them; how US sanctions on Zimbabwe prevented him from crowdfunding medical access to people who had already suffered at the hands of their government. The author writes all of these critiques with grace and humility, identifying his past mistakes and using them as the foundation for reflection. It’s a generous approach to such a heavy topic.
If there is a critique to be made, it’s that the final “prescription” for change rings a little hollow, losing the specificity of earlier chapters in favor of limp suggestions that there should be less stigma and less punitive debt. Yes, one thinks, but how? Ultimately, it highlights just how vast these structural issues are— it’s hard to know where to even begin tackling them. By the end of the book, I felt very sure of the diagnosis but uncertain if it could be treated.
Despite this small complaint, I think Empire of Madness is excellent, and for readers who are interested in what it means to be well, the book might be just what the doctor ordered.
Dr. Khameer Kidia’s Empire of Madness: Reimagining Western Health Care for Everyone is a research-backed, memoir-hued book with a simple premise: “That suffering, though it is internally experienced, is externally determined.”
To put it another way, mental illness is revealed in the individual, but it is rooted in—and resolved through—the community.
To put it a third way, maybe you’re depressed because you can’t afford your groceries. Maybe you have ADHD only because productivity is elevated as gospel.
For readers familiar with social theory, much of what Kidia says here isn’t anything new—Western capitalism medicalizes and individualizes social ills, and then it stigmatizes those who experience them. Coincidentally, those who are sickest often look the least like those in power. The author’s vital addition to care-related discourse is, perhaps, his positionality as much as his message. He isn’t an “anti-medicine hippy” or a political mouthpiece. He’s a Princeton-educated doctor saying, “Hey, we are under-serving people when we aren’t also looking at the circumstances causing their problems.”
By looking outside of the patient, Kidia invokes the concept of ubuntu in a call for deeper focus on “ministering to suffering.” With this emphasis on practice, the politics of the book feel accessible, which is so important for a project as topically far-reaching as Empire of Madness.
Kidia’s writing lives in nuance. He writes about how he happily helped a trans woman get top surgery before recognizing that the requirement of diagnosed gender dysphoria codifies stigma. He describes the impact of care facilities that mirror prisons and questions what “the carceral nature of mental health” says about our beliefs surrounding recovery. He explores how COVID stimulus checks functioned as a “social prescription” that alleviated mental stress. Above all, the author writes with a willingness to learn, and one of the pleasures of Empire of Madness is that it isn’t didactic—it's personal.
Throughout the book, Kidia is remarkably focused, and a key reason for that is his use of auto-ethnography as a scaffold for his arguments. Born to Indian parents in Zimbabwe and educated in the US, he has seen and experienced the disconnect between Western talking points and the way they inflict harm. He has witnessed how a decimated economy impacted his mother; how his community couldn’t get COVID vaccines because the American government stockpiled them; how US sanctions on Zimbabwe prevented him from crowdfunding medical access to people who had already suffered at the hands of their government. The author writes all of these critiques with grace and humility, identifying his past mistakes and using them as the foundation for reflection. It’s a generous approach to such a heavy topic.
If there is a critique to be made, it’s that the final “prescription” for change rings a little hollow, losing the specificity of earlier chapters in favor of limp suggestions that there should be less stigma and less punitive debt. Yes, one thinks, but how? Ultimately, it highlights just how vast these structural issues are— it’s hard to know where to even begin tackling them. By the end of the book, I felt very sure of the diagnosis but uncertain if it could be treated.
Despite this small complaint, I think Empire of Madness is excellent, and for readers who are interested in what it means to be well, the book might be just what the doctor ordered.
March 9, 2026
Thank you so much to the author for the gifted copy! This book was published in the US by Crown on February 3rd, 2026.
Some books clarify your thinking. Others make you feel, with a kind of sick recognition, how much harm has been hidden inside what we are taught to call care. Empire of Madness did both for me.
Khameer Kidia’s book is the decolonial critique of mental health care I have been wanting for a long time, and it delivers that critique with remarkable clarity. Drawing on his experience in Zimbabwe and the United States, Kidia argues that mental distress is not a private failure lodged neatly inside the individual body. It is shaped by colonialism, capitalism, racism, debt, violence, dispossession, and the daily brutalities of precarity. What psychiatry too often does, they suggest, is take suffering that is socially produced and rename it as an individual disorder, then medicate people so they can survive systems that should never have been allowed to stand in the first place.
What makes this book so compelling is that Kidia never lets the argument become abstract. They move between history, clinical practice, political economy, and personal narrative with ease, showing how the DSM, psychiatric diagnosis, carceral institutions, and pharmaceutical treatment are all entangled with power. His analysis of the colonial roots of psychiatry is especially strong, as is their insistence that Western medicine has repeatedly dismissed Indigenous and community-based forms of healing in order to preserve its own authority. The sections on debt, housing, incarceration, and queer and trans psychiatric pathologization were particularly affecting because they make plain how often distress is a rational response to an unlivable world.
I also appreciated how accessible Kidia’s prose is. The writing is sharp and urgent, but never dense for the sake of performance. He is able to explain complex structural arguments in a way that remains grounded in people’s lives, which only makes the book’s critique hit harder.
Empire of Madness left me feeling both devastated and newly language-rich. It reminded me that social care should never be secondary to medical care, and that any framework for healing that refuses to confront power will always reproduce harm. I genuinely think anyone touched by mental illness should read this, especially clinicians.
📖 Read this if you love: abolitionist and decolonial critiques of medicine, global health justice and the politics of care, explorations of the social roots of mental distress, or books that examine how capitalism, colonialism, and structural violence shape everyday life.
🔑 Key Themes: Structural Causes of Mental Distress, Colonialism and the Politics of Psychiatry, Capitalism and Precarity, Psychiatric Carcerality, Medical Authority and Power, Indigenous and Community-Based Healing, Social Prescriptions and Collective Care, Abolitionist Futures for Mental Health.
Content / Trigger Warnings: Gun Violence (minor), Murder (minor), Racism (minor), Colonialism (severe), War (minor), Alcoholism (minor), Drug Use (minor), Genocide (minor), Suicide (minor), Drug Use (moderate), Drug Abuse (minor), Death of a Parent (minor), Sexual Assault (minor), Homophobia (severe), Medical Content (severe), Pandemic (minor), Suicidal Thoughts (minor).
Content note: Please note that this book contains a H*rry P*tt*r reference on page 54.
Some books clarify your thinking. Others make you feel, with a kind of sick recognition, how much harm has been hidden inside what we are taught to call care. Empire of Madness did both for me.
Khameer Kidia’s book is the decolonial critique of mental health care I have been wanting for a long time, and it delivers that critique with remarkable clarity. Drawing on his experience in Zimbabwe and the United States, Kidia argues that mental distress is not a private failure lodged neatly inside the individual body. It is shaped by colonialism, capitalism, racism, debt, violence, dispossession, and the daily brutalities of precarity. What psychiatry too often does, they suggest, is take suffering that is socially produced and rename it as an individual disorder, then medicate people so they can survive systems that should never have been allowed to stand in the first place.
What makes this book so compelling is that Kidia never lets the argument become abstract. They move between history, clinical practice, political economy, and personal narrative with ease, showing how the DSM, psychiatric diagnosis, carceral institutions, and pharmaceutical treatment are all entangled with power. His analysis of the colonial roots of psychiatry is especially strong, as is their insistence that Western medicine has repeatedly dismissed Indigenous and community-based forms of healing in order to preserve its own authority. The sections on debt, housing, incarceration, and queer and trans psychiatric pathologization were particularly affecting because they make plain how often distress is a rational response to an unlivable world.
I also appreciated how accessible Kidia’s prose is. The writing is sharp and urgent, but never dense for the sake of performance. He is able to explain complex structural arguments in a way that remains grounded in people’s lives, which only makes the book’s critique hit harder.
Empire of Madness left me feeling both devastated and newly language-rich. It reminded me that social care should never be secondary to medical care, and that any framework for healing that refuses to confront power will always reproduce harm. I genuinely think anyone touched by mental illness should read this, especially clinicians.
📖 Read this if you love: abolitionist and decolonial critiques of medicine, global health justice and the politics of care, explorations of the social roots of mental distress, or books that examine how capitalism, colonialism, and structural violence shape everyday life.
🔑 Key Themes: Structural Causes of Mental Distress, Colonialism and the Politics of Psychiatry, Capitalism and Precarity, Psychiatric Carcerality, Medical Authority and Power, Indigenous and Community-Based Healing, Social Prescriptions and Collective Care, Abolitionist Futures for Mental Health.
Content / Trigger Warnings: Gun Violence (minor), Murder (minor), Racism (minor), Colonialism (severe), War (minor), Alcoholism (minor), Drug Use (minor), Genocide (minor), Suicide (minor), Drug Use (moderate), Drug Abuse (minor), Death of a Parent (minor), Sexual Assault (minor), Homophobia (severe), Medical Content (severe), Pandemic (minor), Suicidal Thoughts (minor).
Content note: Please note that this book contains a H*rry P*tt*r reference on page 54.
February 24, 2026
4.5 stars ⭐️
I flew through Khameer Kidia’s Empire of Madness. Part memoir and part researched based evidence, his lived experience, plus his work as a doctor and researcher enables him to make a compelling case to reimagine our global mental health crisis.
Growing up in Zimbabwe and watching his mother suffer from mental breakdowns, he focused his work on understanding why she and so many others suffer and what brings the most impactful and sustainable relief.
Kidia makes the case that instead of more psychiatry, we need to use social justice to counteract mental distress. Historically we diagnose mental health as an individual illness but Kidia shows how it is often a rational response to structural violence. He outlines why a world structure where the rich profit off the poor and require them to worry about and continually strive for stable income, housing, and healthcare is the cause for a lot of mental issues.
His explanation of Ubuntu, the idea that a person’s humanity is deeply connected to the humanity of others and that connection of us taking care of each other (monetarily, physically, emotionally) is what enables people to withstand or overcome the mental distress of living.
For me, it makes so much sense, because I’ve always found the most impactful healing is through a listening ear or someone being curious and understanding about my feelings.
But it goes beyond therapy. I mean Kidia asks us to do the hard work of putting people over profits and to get off the striving “American dream.” He brings up points about universal income and taxing the rich and really examines the ways the structure of societies harms people and medicates them into continuing to function in this harmful system rather than creating lasting solutions to their mental distress.
One of the parts I found really interesting was the study he detailed about how people from different countries hear voices differently. The study found that people in America tend to hear voices that are violet or harm inducing, while those in other countries hear familiar voices that encourage them. They typically are not afraid of the voices they hear.
I also liked how instead of anxiety, other cultures refer to it as “thinking too much.” And again, if you’re worried about where you’ll sleep or when you’ll eat again, or how you’ll pay off debt, it makes sense you would think a lot about it.
They were so many interesting historical examples like the thousands of farmer’s in India who poisoned themselves with their own fertilizer because they were ashamed they were unable to afford their farms. Or even his own family’s experience in Zimbabwe where inflation fluctuated so severely day to day.
I nerded out at this book but I thought it was so compelling and so clear of a better path forward, or at least a path forward worth trying to alleviate the world’s suffering.
I flew through Khameer Kidia’s Empire of Madness. Part memoir and part researched based evidence, his lived experience, plus his work as a doctor and researcher enables him to make a compelling case to reimagine our global mental health crisis.
Growing up in Zimbabwe and watching his mother suffer from mental breakdowns, he focused his work on understanding why she and so many others suffer and what brings the most impactful and sustainable relief.
Kidia makes the case that instead of more psychiatry, we need to use social justice to counteract mental distress. Historically we diagnose mental health as an individual illness but Kidia shows how it is often a rational response to structural violence. He outlines why a world structure where the rich profit off the poor and require them to worry about and continually strive for stable income, housing, and healthcare is the cause for a lot of mental issues.
His explanation of Ubuntu, the idea that a person’s humanity is deeply connected to the humanity of others and that connection of us taking care of each other (monetarily, physically, emotionally) is what enables people to withstand or overcome the mental distress of living.
For me, it makes so much sense, because I’ve always found the most impactful healing is through a listening ear or someone being curious and understanding about my feelings.
But it goes beyond therapy. I mean Kidia asks us to do the hard work of putting people over profits and to get off the striving “American dream.” He brings up points about universal income and taxing the rich and really examines the ways the structure of societies harms people and medicates them into continuing to function in this harmful system rather than creating lasting solutions to their mental distress.
One of the parts I found really interesting was the study he detailed about how people from different countries hear voices differently. The study found that people in America tend to hear voices that are violet or harm inducing, while those in other countries hear familiar voices that encourage them. They typically are not afraid of the voices they hear.
I also liked how instead of anxiety, other cultures refer to it as “thinking too much.” And again, if you’re worried about where you’ll sleep or when you’ll eat again, or how you’ll pay off debt, it makes sense you would think a lot about it.
They were so many interesting historical examples like the thousands of farmer’s in India who poisoned themselves with their own fertilizer because they were ashamed they were unable to afford their farms. Or even his own family’s experience in Zimbabwe where inflation fluctuated so severely day to day.
I nerded out at this book but I thought it was so compelling and so clear of a better path forward, or at least a path forward worth trying to alleviate the world’s suffering.
May 11, 2026
3 sentence synopsis: How do you provide mental healthcare to people forced into poverty by colonization, racism, and capitalism in the Global South? Dr. Khameer Kidia, a physician who grew up in post-colonial Zimbabwe and went to medical school in the US, shares his unique, evolving perspective on this topic. This book addresses how mental health is medicalized in Western medicine, how western doctors can learn from care networks in the Global South, how mental illness is triggered and exacerbated by systems of oppression, and why capitalism must go if we desire to care for everyone.
Even though it’s only May, I know that “Empire of Madness” will be one of my top nonfiction reads of 2026. My tl;dr for this book is “why capitalism is terrible, especially for global mental health.” Add this to your anti-capitalism reading challenge.
In an environment where the HHS secretary demonizes SSRIs and advocates for quackery, I was curious to read a book with the tagline “Reimagining western mental healthcare for everyone.” This book brought the nuance, evidence-based medicine, and empathy missing from our current leadership by an actual expert. It rightly condemned the harm enacted by the Trump admin, but went further in criticizing the shortcomings of western medicine.
“Empire of Madness” has 3 sections. First, Kidia writes about the history of Zimbabwe, the former colony of Rhodesia, and also shares his family’s history of growing up Indian in colonial Africa. It was fascinating and heartbreaking. The second section covers different mental health diagnoses and examines how capitalism/colonialism/racism/poverty play a role in the etiology of mental illness. Humanizing stories make this standout. In the final portion, Kidia addresses differing prescriptions for mental illness informed by his experiences.
I loved this book. When the author quotes Paul Farmer, Toni Morrison, Jason Hickel, and Matthew Desmond, you know it’s fire. But what stands out to me is that no one other than Dr. Khameer Kidia could have written this book. His unique experiences across multiple cultures and identities made “Empire of Madness” deeply memorable and meaningful.
Fun fact: I did my postdoc at the same institute where Dr. Kidia attended medical school, so while we didn’t overlap, I appreciated the shared context.
Overall rating: 5 stars
Even though it’s only May, I know that “Empire of Madness” will be one of my top nonfiction reads of 2026. My tl;dr for this book is “why capitalism is terrible, especially for global mental health.” Add this to your anti-capitalism reading challenge.
In an environment where the HHS secretary demonizes SSRIs and advocates for quackery, I was curious to read a book with the tagline “Reimagining western mental healthcare for everyone.” This book brought the nuance, evidence-based medicine, and empathy missing from our current leadership by an actual expert. It rightly condemned the harm enacted by the Trump admin, but went further in criticizing the shortcomings of western medicine.
“Empire of Madness” has 3 sections. First, Kidia writes about the history of Zimbabwe, the former colony of Rhodesia, and also shares his family’s history of growing up Indian in colonial Africa. It was fascinating and heartbreaking. The second section covers different mental health diagnoses and examines how capitalism/colonialism/racism/poverty play a role in the etiology of mental illness. Humanizing stories make this standout. In the final portion, Kidia addresses differing prescriptions for mental illness informed by his experiences.
I loved this book. When the author quotes Paul Farmer, Toni Morrison, Jason Hickel, and Matthew Desmond, you know it’s fire. But what stands out to me is that no one other than Dr. Khameer Kidia could have written this book. His unique experiences across multiple cultures and identities made “Empire of Madness” deeply memorable and meaningful.
Fun fact: I did my postdoc at the same institute where Dr. Kidia attended medical school, so while we didn’t overlap, I appreciated the shared context.
Overall rating: 5 stars
March 15, 2026
Empire of madness is a powerful and personal critique of modern psychiatry, how we define the diagnosis and how we treat patients. What makes this book very powerful is the personal narrative that Khameer provides in this book, he describes his own mental health struggles and those of his family (he also narrates the audiobook).
He is originally from Zimbabwe and trained and currently practices in the US so provides snapshots on how mental health is treated abroad and in the US but also critiques how capitalism and poverty are likely fueling and worsening our current mental health. I also agree with him that as much SSRIs as you throw at someone if they don’t have stable housing or enough money to pay for food you won’t fix their main cause of stress/anxiety/depression.
Through out the book he strongly advocates for community and social care network. We not only need each other but we also need a healthcare system and government that isn’t driven by profit.
May 23, 2026
I initially rated the book three stars due to a mediocre reading experience. This was not surprising as the author revealed towards the end that he had to take significant breaks to care for his mother when writing the book. The lack of continuity in both thoughts and prose is a downside but understandable.
However, after I organized the quotes and my thoughts (see the Medium article), I decided to add a start to the rating because the questions raised in the book were potent. For example, there is a Western dominance of thought that mental illness should be treated the same way as bacterial infection--just find the right chemical compound, package it into a pill, and prescribe to the patient. Yet this thought ignores the societal and cultural complexity in mental illness and more often than not only masks the symptom, not treats the root cause. Sometimes, pills do more harm to a person's mental wellbeing, but it is the easy way out compared to relying on the more effective but also more difficult solution from the community.
In addition, the author points out that poverty is the main contributor to a lot of mental illness. Yet for political, economical, and ideological reasons, we'd rather pour billions of dollars down the new drug discovery pipeline than using it to solve poverty, many times over probably.
These questions are worth asking and thought provoking. Even though I don't recall any convincing path forward proposed by the author, the book is of higher quality once I ruminate on it and glance over the roughness of its presentation.
However, after I organized the quotes and my thoughts (see the Medium article), I decided to add a start to the rating because the questions raised in the book were potent. For example, there is a Western dominance of thought that mental illness should be treated the same way as bacterial infection--just find the right chemical compound, package it into a pill, and prescribe to the patient. Yet this thought ignores the societal and cultural complexity in mental illness and more often than not only masks the symptom, not treats the root cause. Sometimes, pills do more harm to a person's mental wellbeing, but it is the easy way out compared to relying on the more effective but also more difficult solution from the community.
In addition, the author points out that poverty is the main contributor to a lot of mental illness. Yet for political, economical, and ideological reasons, we'd rather pour billions of dollars down the new drug discovery pipeline than using it to solve poverty, many times over probably.
These questions are worth asking and thought provoking. Even though I don't recall any convincing path forward proposed by the author, the book is of higher quality once I ruminate on it and glance over the roughness of its presentation.
December 8, 2025
Empire of Madness is perhaps the most affirming, revolutionary book I have read as a mental health scientist and clinician. Dr. Khameer Kidia's brilliant, humanistic case for decentering Western perspectives in mental health is at once a comprehensive accounting for capitalist mental health industry as a tool of empire and oppression, a poignant reflection on their own personal and professional journey, and a masterful case for radical empathy and the healing power of community. I firmly believe this text should be required reading in all mental health training programs. Full review to come after publication.
Also: seeing a methods and position section in a nonfiction text warmed my qualitative heart and participatory action researcher soul :)
Also: seeing a methods and position section in a nonfiction text warmed my qualitative heart and participatory action researcher soul :)
February 27, 2026
The core of this book is brilliant, though I definitely did some skimming. His points are so good and I highlighted so much. The essence is compelling and backed by research and personal experience: “What we really need for mental health is a multidimensional model: acknowledging that psychiatric diagnoses are made-up categories that help us group patients and that mental health is far more than just the chemistry in our brains; it is also part of the social and political fabric in which we are wrapped.”
At times, the personal history and stories went on too much. I found myself skimming through them just to get back to the core essence of his argument. If you don't mind a bit of fluff to get to the good stuff, it’s definitely worth the read for the perspective shift alone.
At times, the personal history and stories went on too much. I found myself skimming through them just to get back to the core essence of his argument. If you don't mind a bit of fluff to get to the good stuff, it’s definitely worth the read for the perspective shift alone.
March 9, 2026
Dr. Khameer Kidia is an ethnically Indian Zimbabwean doctor/anthropologist who examines mental healthcare from the unique lens of his lived experience alongside his extensive studies. Though he is eminently qualified to speak on this given his many credentials from elite institutions, it is his critical lens and memoir-esque reflection that makes this book a compelling read. Right now is a popular time for books calling to decolonize mental health, and I found this one to be on the less preachy side. Dr. Kidia comes across as someone who takes the time for deep reflection, noticing the many contexts in which people exist in order to address tough topics.
May 6, 2026
As someone who rarely reads nonfiction and almost never enjoys it, I am surprised that I'm a fan of this book. The author deftly weaves together his lived experiences growing up in Zimbabwe and training as a doctor in the United States, with years of research and his prescription for healing the mental health crises around the world.
The descriptive writing is lyrical, and the technical writing easy to understand for the layperson. While the solutions to mental health sound simple and fair, I fear that it won't be easy.
The audio book is read beautifully by the author.
The descriptive writing is lyrical, and the technical writing easy to understand for the layperson. While the solutions to mental health sound simple and fair, I fear that it won't be easy.
The audio book is read beautifully by the author.
March 13, 2026
This book calls into question the structural dynamics of mental health, providing a framework beyond the Western paradigm for mental health. He also isn't subject to the constraints of UBI and is willing to look at ways it's helped and ways it's hindered. America needs a cultural reset to collectivism and care over individuality which is leading to mental distress. In building community, we build mental wellness.
April 2, 2026
Excellent diagnosis of pitfalls in western mental health care - failures to distinguish depression from **oppression**, failures to address systemic and structural root causes, failures to uplift community care.
February 5, 2026
5⭐️
Soft 5 stars. Intriguing analysis of psychiatry and mental health
Soft 5 stars. Intriguing analysis of psychiatry and mental health
April 23, 2026
Superb book.
Read
May 19, 2026DNF @ 40%
There is a lot of good information in this book, but it felt repetitive in a way that was not applicable enough to make me continue reading.
There is a lot of good information in this book, but it felt repetitive in a way that was not applicable enough to make me continue reading.
May 8, 2026
grateful for dr. kidia’s multicultural perspective - personal and professional - on mental health. not groundbreaking, but validating.
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