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.