Empire of Madness: Reimagining Western Mental Health Care for Everyone

by Khameer Kidia

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.

Genres: Nonfiction, Psychology, Mental Health, Politics, Medicine, Health, Sociology

371 pages, Kindle Edition

First published February 3, 2026

Reviews

[Nathan Shuherk]

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

[Annotations&Air]

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.

[Nora Nora]

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.

[Tutankhamun18]

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!

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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.”

[(Lau)(ren)]

Wow! Most of my experiences of a book resonating with me so deeply that I'm practically vibrating--where I have to slow down and draw out the reading experience--where I know from the first chapter that the book is going to change the way I see the world--are reserved for fiction. I was not expecting to find it in a nonfiction book I found by chance while scrolling through the recently added audiobooks filter on Libby.

But this book articulated so many things I've instinctively felt but previously had no language for around the topic of mental health even as it taught me things I didn't know at all. Khameer Kidia draws on his experiences as a kid growing up in Zimbabwe, a college- and then medical student and then resident in the US, a medical practitioner and researcher and anthropologist in both countries, and a deeply compassionate human being wherever he goes to explain why we have a global mental health crisis, how it manifests differently depending on context, how we have tried and failed to treat it, and what it might really take to promote mental wellbeing for everyone.

It's way too simplistic to say "capitalism was the villain all along!" even though...that's kind of true? But this book doesn't read like a tankie Bluesky screed against some vaguely defined idea of capitalism; instead, it's a thoughtful examination of the ways in which colonialism, imperialism, and the hoarding of wealth by the powerful create a world so difficult to live in that of course people struggle.

Kidia doesn't deny that there are chemicals in the brain that can affect how we feel and operate or that certain medications can help people. But he views mental wellbeing as a holistic part of both individual and communal life that's deeply rooted in people's lived experiences, the support systems they have or don't have, and the way systemic hierarchies affect everything. He's not afraid to come right out and say, "This person probably has (what the Global North calls) severe depression because they don't know how they're going to feed their family tonight, and if you give them money, they will get better." And then backs it up with research that proves that sometimes money is the actual solution.

He's also very respectful of indigenous treatments for mental distress, not in a woo-woo kind of way, but because of an understanding that communities have created mechanisms over generations to make people feel more rooted, secure, and supported and that, when practiced in the context of the communities that created them, these can be as effective as medication or CBT or anything else that Western medicine promotes. I am famously allergic to woo, but this balanced approach seems very wise to me (and also helped me realize that I mostly hate woo because it's usually white people appropriating practices that belong to other cultures that only work within the context of those cultures, not because of those practices themselves. As usual, context is everything).

Throughout, the book is engaging, operating on multiple levels as diagnosis of a global health problem, multiple case studies both long-term (his mother) and short-term (patients he saw for a single appointment), a critique of colonialism, a sort of microhistory of the last fifty years of Zimbabwe's history, and a memoir of his own growth both as someone who experiences mental distress and someone who treats it.

I don't tend to enjoy memoir, and when a writer mixes personal experiences with cultural criticism or historical narrative, it usually doesn't work for me. But Kidia is an incredible writer in addition to being a skilled anthropologist and a caring doctor, and the way he uses the experiences of his family members, his patients, and his country in this book is really masterful. Moving backwards and forwards through time, talking about how colonialism affected both his parents and the country he grew up in, contrasting life and expectations and values in the US with Zimbabwe--he's weaving so many threads together that a less talented writer and thinker would have surely dropped a few or at least created troublesome tangles. But he carried me right through to the very end.

David Graeber (forgive me! I'm a caricature of myself!) popularized the slogan "freedom and care" as a way of describing the animating principle of anarchism. I don't quite consider myself an anarchist, despite how much anarchic thought has influenced me, but "freedom and care" are ideals I strive to live by. This book is an articulation of what happens when care is subjected to a market economy that doesn't actually care about it and where the burden for providing care falls disproportionately on under- or unpaid women, particularly black and brown women--and where that market economy creates entire societies that are leeching the resources and labor from other, poorer societies.

Kidia's prescriptions are a) redistribute wealth globally because humanity is an interconnected web, b) prioritize autonomy and dignity for those who are dealing with mental distress (this is where the "freedom" part comes in), and c) find treatments--from mutual aid to indigenous spiritual rituals to group houses to community aid workers--that work for the specific community you're working in. Things don't always translate across cultures or even across cities. One-size-fits-all solutions both do not work and also fundamentally misunderstand how people actually live in the world.

As is typical when I come across a book written by someone who is a keen-eyed observer of the problems of society but also works hard to care for those he can, I came away both discouraged and encouraged. The scale of the problem is huge. But economic eras wane, new ways of organizing ourselves emerge if we work hard enough, and change is always possible.



Protip: read the appendices first. Even if you listen to the audiobook. He talks a lot about language and why he uses the words he uses and I think it's really helpful in understanding his project.

[Maura]

Really enjoyed this, though it did make me quite sad! The state of the world! Is very awful in some ways! That said, it offered some very interesting alternatives to typical US mental health care and explored the sociological factors of mental health (like poverty is probs causing people a lot of distesss!!!!!) in a really engaging but sophisticated way! Highly rec

[Lu]

An abolitionist view of “mental health” and whatever that means. Very mind expanding, I would put this on a non-fiction must read list.

[Aadil Khan]

I can agree with most of what Kidia argues here. The fix that people need is structural like canceling debt, give poor people free housing, pay reparations for slavery and colonialism. That makes sense as treatment, you're going to the source and making the world more fair and humane. He rightfully tackles mental health through a multicultural lens. But calling for an overhaul of psychiatry where laypeople take on a bigger counseling role doesn't give me confidence. Training grandmothers in Zimbabwe made sense because of a shortage of actual psychiatrists. Scaling that to more urban areas raises questions the book doesn't answer like who screens for suicide risk, what's the supervision structure, how do dire situations get escalated. I like the idea and would love to see some kind of plan to make it happen.

[Leanna]

Probably like 4.5 stars

[Marina]

I'll be recommending this to so many colleagues, students, and friends who feel discontented or unsure about the community health benefits of individualized psychiatry, psychology, etc.! I like how the author can self reflect, demonstrate his growth, and offer in process ideas about how to collectively heal - on the basis of nuanced implementation science-ish community health research AND an honest sharing on how much harder this is when it's your own community and family, even if you know all the factors and all the best practices in improving holistic health in theory.

Some good example quotes from the book to demonstrate how he writes and what the writing touches on:

▪ 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 movements. 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.

▪ Our society has done a great job at portraying people with schizophrenia in a constant state of florid psychosis, when, in fact, nothing could be further from the truth. People with schizophrenia, both on and off antipsychotics, take the bus, go to the grocery store, have friends, read books, go to school, become lawyers. Despite his apathy, I remember that Samuel was gentle, kind, and always calm. This, in fact, is how most people with schizophrenia are, most of the time.

▪ She had grown up in a Christian family in the Midwest and moved to New York for school. Her assigned sex at birth was male. At age seven, when she was alone at home, Vanessa would raid her mother’s closet and sample her jewelry, carefully replacing everything before anyone arrived home.
I had come to enjoy psychiatry intakes. The interview allowed me to ask about stuff we don’t typically talk about in regular conversation: suicidality, hallucination, histories of sexual and physical abuse. There was something voyeuristic about hearing the full story, from the very beginning.

▪ Gatekeeping is an unusually common function of medicine. Doctors give veterans “service-connected conditions” like PTSD to receive VA disability benefits.[7] We fill out forms for workers’ comp so that patients who are injured on the job can receive at least a portion of their wages while they recover. We decide if immigrants are “healthy enough” to receive green cards or refugee status.[8] We even decide if rich women can bring their “emotional support” Chihuahuas on airplanes. But the truth is that these are not decisions that we’re taught to handle in medical school; they are judgments we make based on our social mores, which are assumed to be in the interest of wider society.
Of course, we can and should keep diagnosing trans people with gender dysphoria so they can get what they need. In our current system, it’s the best we can do. But we cannot stop there; we must also work to make those systems more just and equitable so that lifesaving care doesn’t have to be rationed. And perhaps the question we should be asking is whether we doctors should be society’s adjudicators at all.

▪ I was not, in any way, providing care. I was putting Vanessa on trial. This is what all psych intakes feel like. They are information-gathering missions that judge another person’s thoughts, emotions, and behaviors with a bias toward seeking out pathology. There is nothing “objective” about them.

▪ In that moment I knew that if I ever wanted to return to Zimbabwe, I couldn’t train as a psychiatrist in America.[9] In Zimbabwe, there were no benefits to having diagnoses of PTSD or schizophrenia or gender dysphoria; psychiatry had no social power to help mitigate political problems; it could not be used to access disability insurance or gender-affirming surgery or special housing. In an American psychiatry residency, I’d learn to apply DSM diagnostic criteria and prescribe a handful of expensive meds largely unavailable in Zimbabwe. But I would be unable to really help people back home. Taking American psychiatry to Zimbabwe felt at best insufficient and at worst harmful. It was clear to me that if I wanted to make a meaningful difference in mental health in Zimbabwe and other parts of the world outside the United States, it wasn’t going to be as an American-trained psychiatrist.

▪ A stark example is available for schizophrenia, which physicians diagnose among Black men at a rate four times greater than among white people even though, epidemiologically speaking, schizophrenia affects patients of all backgrounds evenly (it is not more prominent in one group than another psychiatrist-historian Jonathan Metzl meticulously documented how psychiatric diagnoses were weaponized against Black civil rights activists in the 1960s. Antipsychotic drugs like Haldol were advertised with images of “angry black men with clenched, Black Power fists.” Biased medical literature from that era describes how schizophrenia took on a more violent form in Black patients. Psychiatrists regularly diagnosed Black men with “protest psychosis,” in which they “developed ‘hostile and aggressive feelings’ and ‘delusional anti-whiteness’ after listening to the words of Malcolm X.” These Black men, Metzl writes, “required psychiatric treatment because their symptoms threatened not only their own sanity, but the social order of white America.”[6]
An even newer diagnostic fad that

▪ But history keeps repeating itself because people in the dominant caste truly feel unsafe. They are genuinely terrified. They want safe spaces, but they cannot see that they are the safest people in the world.

▪ Pharmaceutical companies market drugs as magic bullets headed toward a diseased bull’s-eye. They give patients the binary sense that drugs have targeted actions and were created to treat, fix, or reverse singular abnormal biological conditions. But this is untrue of many of the most common drugs we prescribe in medicine and especially in the subfield of psychiatry. In fact, psychosis isn’t even the most common reason for prescribing antipsychotics. Sixty percent of antipsychotic prescriptions are for conditions other than schizophrenia or bipolar I disorder—the two primary FDA-approved indications for antipsychotics.[1] In my clinical job as a general internist, I prescribe antipsychotics off label for nausea, pain, hiccups, insomnia, delirium, and anxiety.
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 m

▪ sat at Geraldine’s bedside and played on my phone while I watched her fall asleep. She looked comfortable. I was frustrated. It was clear to me that Geraldine didn’t need Haldol; she needed the human attention of a sitter who could be with her, offer emotional support, and redirect her away from picking at the wires or falling out of bed. It’s not as if sitters need to be highly trained; it’s just that in-person, human labor is expensive, and hospital corporations simply don’t value patient care enough to hire more staff. Instead, to prevent falls, they look for cheap work-arounds: bed alarms that are triggered when a patient tries to escape, but that often go off for no reason; continuous video monitoring where a camera is installed in a patient’s room and a remote worker watches hundreds of screens and often alerts nursing staff when it is too late; a wide array of physical restraints—some soft, some hard, some for the wrists, some for the feet, some that are like human cages; and, of course, chemical restraints like Haldol.
I felt my pager buzz against my leg.

▪ thought this meant that as a researcher I was doing a good job advertising the mental distress faced by my participants; the West was listening. But the reality is that in every new edition of the DSM the section on cultural diagnoses expands exponentially: Western psychiatry literally can’t keep up with the mental distress Western capitalism creates around the world.

▪ What I had failed to see at the time was that thinking too much isn’t a cultural variant of depression at all, but rather a window into oppression. By looking more closely at what people are thinking too much about, we see that embedded in their mental distress are the clues to its source.[6] In Western medicine, the causes of mental distress do not factor into the diagnosis because the tools at our disposal—drugs and psychotherapy—don’t tackle those causes. But that doesn’t mean we shouldn’t tackle those causes with tools outside medicine. After all, “healthcare itself,” explains Tom Insel, the psychiatrist and former director of the NIMH, “explains only about 10 percent of health outcomes.”[7] The remaining 90 percent of health outcomes, including mental health outcomes, are determined by structural factors like access to food, shelter, transport, and oppression due to race, class, gender, sexuality, and disability.

▪ When I first read that opening, I assumed Van der Kolk was going to discuss the traumatized villagers who had suffered murder and rape. Instead, his focus was on the American soldier who committed the murder and rape. I learned that you can be traumatized by perpetrating trauma, at least if you were an American soldier

▪ Since I first arrived in the United States for college, I have been indoctrinated in the American social system on how to think about—and live—life. I soon learned that if you weren’t trying to live as long as possible, there was something wrong with you. You were probably depressed. Maybe even suicidal? It’s no surprise to me that simply watching the COVID-19 death toll rise was traumatic to many Americans via “vicarious traumatization.” That’s because the way we make meaning of events in our lives, including trauma, is determined by our context.

▪ In Crazy Like Us, Ethan Watters writes of how, in 2004, Western traumatologists flocked to Sri Lanka after a tsunami hit Southeast Asia. They believed there would be a “second wave” of psychological distress and that the biggest problem faced by Sri Lankans would be the depression, PTSD, and suicide that followed. An industrial complex of trauma therapy and research ensued in what Watters calls “the largest international psychological intervention of all time.” The therapists imported techniques like play therapy, yoga, meditation, and, of course, Mitchell’s critical incident stress debriefing

▪ As scholars of epistemic injustice point out, some voices simply aren’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.[17] If you cannot articulate yourself in English. If you cannot tell a story in a linear, coherent manner with clear distinctions between victims and perpetrators. If you cannot explain events in a way that fits with the social mores of Western society, if you experience not rape or battery but poverty or famine or the centuries-long, slow-burning trauma dumpster fire of colonialism, it is harder to get a Harvard physician like Bessel van der Kolk or Judith Herman (the author of Trauma and Recovery) to say that what you’ve experienced is trauma.

▪ But looking back, I wonder whom I included in this “we” and “all.” Over and over during the pandemic, I kept hearing that its defining feature was that, for the first time in a century, everyone, everywhere, was undergoing the same experience. But my work with colleagues in Zimbabwe confirmed that this was far from true, even as doctors. 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.

▪ Maximizing patient autonomy in mental health care is less a prescription than a principle with which to prescribe. This is where I’d like to remind all clinicians that we are ethically bound to maximize patient autonomy. Our responsibility is to elicit from patients what their wishes for treatment are and help them figure out what the best option is for them, even if we would personally make a different decision. The agency given to patients to make these choices on their own rather than have choices forced upon them can be healing in and of itself.[7] Autonomy is particularly important for psychological well-being because the freedom to make our own choices—what pop psychology calls being in control—has a grounding effect with research-proven mental health benefits.
Yet giving patients autonomy in mental health care comes with the challenge of emotional subjectivity: It is hard for providers not to project onto patients their own beliefs of what an ideal mental state should be. 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.

▪ More recently, Partners in Health, the global health organization co-founded by Paul Farmer, joined the Family Van, a Boston-based mobile health service, to use CHWs to improve access to mental health care in underserved neighborhoods.

▪ Trauma recovery, which draws a clear distinction between victim and perpetrator, takes on an individual form. It’s the victim’s job to heal their trauma—in therapy, on meds. Trauma therapy isn’t usually about confronting perpetrators or seeking justice; it’s about internalizing and processing your pain so you can move on with your life.
With ngozi, however, the spirits are trying to make things right for people who are suffering by “forc[ing] reconciliation and compensation to take place.”[7] Although the motivation of ngozi spirits may be a wrongdoing committed by an individual a long time ago, because of how misfortune due to ngozi affects entire families and clans, the “whole family must come together to solve the problem,” another healer explained to me. Madness, according to indigenous Zimbabwean knowledge, is a collective diagnosis requiring a collective prescription.

▪ This made us question whether the rural version of the Friendship Bench, as magical as it was, might still be over-medicalizing valid mental distress due to structural problems like poverty.

▪ What we really need to address mental health problems in the United States at scale, as discussed earlier, is to de-silo mental health—to make it less specialized and part of everyone’s work, not just psychiatrists’. We need surgeons to help patients cope with the emotional weight of the cancers they cut out. We need physical therapists to help their patients with the mental strain of losing mobility. We need primary care providers to help people like Alice (my patient who was housing insecure and kept fainting) to cope with the stress of poverty and chronic illness.

▪ Paying for care also limits the types of care considered legitimate. The state, for example, is bound to value care centered on nuclear, cis, heteronormative families over care for people who may not fit those societal norms. What if I need to care for a nonrelative queer friend who relies on me and is just as important to me as my mother? Will I still be eligible for FMLA (Family and Medical Leave Act)? The answer is no.
Perhaps a more structural way to increase autonomy

▪ Perhaps a more structural way to increase autonomy and value care for everyone (not just the dominant class) is to allow people to work less. When I think back to the destructive effects of the American culture of productivity on my own mental health—at Princeton and throughout my career in medicine, research, and NGOs—I realize that when I came to the United States, I became part of a society where the work ethic is the greatest virtue, where I have been tricked into “loving” work and thinking of my job as an identity. In this country, instead of being allowed to work less, I was pathologized and medicated until I conformed.

▪ But I’ve come to learn that work isn’t going to love me back and no job should define who I am.[14] I was not suffering from underproductivity; I was suffering from the unrealistic demands of a work culture centered on never-ending growth and production. It doesn’t have to be this way.

▪ At some points in my life, like in the midst of medical residency, I’ve thought that if I had to care for a single person more, it would unravel my mental well-being. Yet, somewhere, just around the corner, there is always a person in need of my care. To truly accompany my patients and loved ones, I need time and emotional energy, which, in some affective economy, feel finite.

[Lauren Avance]

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.

[Debbie Gale]

CW: medical trauma primarily around mental health, drug dependence, homophobia, racism, colonial violence. (Also thank you to the author for actually providing content warnings at the beginning of this book.)

Khameer Kidia starts with this book with a strong statement-- Kidia (as a physician and mental health researcher) wants to end how psychiatry is currently practiced because "most mental distress I encounter isn't spontaneous, it is a rational reaction to colonialism and capitalism. My patients are not suffering from *depression*, they are suffering from *oppression*... psychiatry does not heal so much as mollify. It makes the intolerable tolerable. Instead of taking responsibility for its plundering, the West offers antidepressants to the people whose lives it has plundered."

EMPIRE OF MADNESS is largely about how mental health researchers have more evidence that a person's environment effects their health than a person's neurochemistry and yet, we don't do the work to make people's environment better. Many people are suffering from depression and anxiety because they are facing poverty and/or violence. This book is a long-form argument about why colonialism is evil and how it impacts the mental health of folks (both rich and poor) around the world. Kidia likens our need to end poverty and these huge disparities in wealth to John Snow removing the water pump in the cholera epidemic.

Kidia sets the scene with their own experiences, as a child growing up in Zimbabwe with a mother suffering from depression, a pre-med student with an ADHD diagnosis who develops a dependency to Adderall, as a medical student, practicing as a physician (where they writes composites of patients), and as a mental health researcher.

The scene that Kidia wrote about taking Adderall during a chemistry final, taking a palpitation nap, and then waking up to be "focused" was so stressful to me as a chemistry professor. Kidia talks many times in this book about how usually the problem isn't the person with a mental illness, but the fact that our capitalist world is not built for people that struggle with executive function or other neurodivergence. It was a reminder to me again of how important it is that we universally design our classrooms so that students can thrive with or without medication. Kidia shared how difficult it was to end his Adderall dependency and how it took losing his father to a heart arrhythmia to finally never take "another little blue pill again."

Something I will take away from this book is the concept of "thinking too much" which is called "kufungisisa" in Zimbabwe to describe a patient's behavior when suffering from poverty created by capitalism & colonialism. Kidia shared the story of Chipo (a composite person, I think?) who was born with HIV, that should be very manageable and treatable if taking daily medication, which requires money for meds, transportation, and the mental capacity to take these meds. And sometimes, when people are "thinking too much" the daily task of taking these meds becomes extraordinarily difficult when people are also thinking too much about structural problems like finding a job with a livable wage, affording food, housing, education, and also facing racism, sexism, homophobia etc.

Kidia also shared research on the benefits of The Friendship Bench, where community health workers are trained to work with members of the community who are struggling with mental health. The Friendship Bench (started in Zimbabwe) is fantastic in some ways because in a country where there are very few psychiatrists, these health workers can reach many more people. The problem? When mental health researchers set out to study the benefits of the friendship bench there was a conflating factor. Researchers were paying the participants a small amount of money for transportation, but that money seemed to do as much or more for the patients mental health than the actual conversations on the friendship bench. Kidia shares the benefits of cash transfers on mental health. Prescribing cash can be as effective as a pharmaceutical drug.

I would highly recommend this book. A well-researched anti-capitalist take on mental health written by a queer physician who has lived in both the global south and the global north so they have a particularly important perspective. I am glad Kidia wrote this book.

My only big question after reading is what mental health care looks like in countries that are more socialist like Japan. What are the roles of SSRIs and antipsychotics in those countries?

(4.5 stars)

[Brice Montgomery]

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.

[Ailey | Bisexual Bookshelf]

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.

[Bekka]

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.

[Jillian]

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

[Sol]

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.

[Fanchen Bao]

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.

[Emma Cathryne]

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 :)

[Lauren Delaney Wallace]

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.

[Anne-Marie McCartan]

Khameer Kidia, MD, an internist specializing in mental health, brings new perspectives to addressing mental health conditions from his perspective as a Zimbabwean, queer, anthropologist, and devoted son of a mother with poor mental health. Having no professional background in this field, I can only come at this topic with an open mind. He makes many convincing arguments (to a layperson) that the Western model of medicating and traditional psychiatry needs to be rethought. The basic argument is that people often present with symptoms broought about not by "chemical imbalance" or "disease," but rather due to intergenerational trauma, poverty, chronic unemployment, and other stressors. Why not offer solutions to those problems in order to improve their mental health?

[Casey]

Excellent concept, but this missed the mark for me. This seemed like another opportunity to discuss mental health care and the cultural nuances. I recently read “Crazy Like Us” by Ethan Watters which was excellent. This was an attempt to pull together so much, and it came through as scattered.

This started as part memoir, part introduction to healthcare. Threads of anti-capitalism political perspectives on how neoliberalism and western (largely American) culture force a mentality of productive above all, and a he strain that provides on mental health. Reparations and universal basic income, community health workers and listening benches.

There was probably some genuine insight possible,m but it was muddled amongst the various lines of thought.

[Shana]

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.

[Tom]

3.5 stars. Not that I disagree with most of it, but it felt fairly surface level and doesn't really go deep exploring the implications.

The tone feels proselytizing and the writing just unfortunately isn't emotionally well done enough to drive home the personal stories, leaving it floundering quite often. It's like watching a Netflix adaptation of your favorite childhood TV show, except the stakes are far higher. Because this is a topic that's very near and dear to me, I'm admittedly more harsh on my critique - but I just don't see this convincing anybody that doesn't already agree with most of the premises because of the way it's written.

[Sue Micinski]

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.

[Jenny D]

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.

[Kimberley Warsett]

I loved the structural analysis. I thought in many places when listing groups of outliers that’s expertise could be considered, he could have specifically mentioned people with lived experience of psych diagnoses. He mentioned some things the community already does but not a lot. A great book, I would like to see another one written by someone who spent half their life in the depths of the system.

[Scotty]

This was a very good and very eye-opening book that challenged the way I think about mental health and wellbeing. The author has such an interesting worldview and set of life experiences that gives extra authority to what he writes. Maybe authority isn't the best word for it, but what I mean to say is it's so much more than theorizing.

[allie]

some really compelling chapters that do a great job illustrating how our sociopolitical work impacts mental and physical health much more than many people realize. i also enjoyed kidia’s commentary on how disorders are given unevenly and based on marginalizations. a bit too memoir vibes at times but still very interesting read!

[Wendy]

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.