A Physician Grapples with Western Medicine's Individualism
Khameer Kidia says we can't help people's mental health without addressing it communally.
Khameer Kidia has a very impressive resumé. He’s a physician, an anthropologist working at Harvard Medical School, and a Rhodes Scholar. He was educated in the kinds of Western, elite institutions that are responsible for the world’s understanding of mental health as a problem treatable at an individual, and often chemical, level. But through his work with queer people in his home country of Zimbabwe, Kidia’s worldview began to crack.
He started to see mental health as a structural problem that had to be addressed at a communal level, not something that could be solved solely with medications and individual therapy. This revelation put Kidia’s views in direct conflict with those of the institutions that helped educate him.
And so he wrote a book about it, with the hopes of convincing others that our Western, individualist view of mental health is keeping people in distress much more than they need to be.
In Empire of Madness: Reimagining Western Mental Health Care for Everyone, Kidia delves into his personal and familial histories, reframing them as struggles in large part caused by trying to survive in a colonized world. And he delves into the history of medicine itself to show how the Western, capitalist version of medicine and medical thinking became so hegemonic.
[This interview has been edited and condensed]
In the book, you talk a lot about your parents’ struggles with mental health, and how those struggles were contextualized through this Western, individualist lens, when really they had a lot to do with their histories—facing racism, colonialism, trying to live under capitalism. Is that where the desire to write this book came from?
My parents’ stories are a large part of the framework of the book, but it wasn’t actually my family’s story that brought me to write it. It was actually my work more than a decade ago in Zimbabwe in the queer community there. I am a queer person and consider myself part of the community there, and I’d been working there for nearly 10 years on mental health research and advocacy. And a lot of queer people started to come up to me and asked me what we could be doing for queer people’s mental health in Zimbabwe. Zimbabwe is a country with extremely repressive laws, state sanctioned violence. It’s a very difficult place to live if you’re queer, and trans and intersex people especially have been suffering—there have been a lot of suicides, and they feel like they’re in a crisis.
A few years ago, I started to collaborate with some NGOs and different queer organizations to think through these things. But at this point I was mostly a researcher and so my goal was to do more research. I was working on an NIH grant to study queer people’s mental health in Zimbabwe, and spent a lot of time working with my mentors at Harvard on the grant. But after a while, it became clear to me that what my mentors at Harvard wanted me to do with this grant was not at all what queer people in Zimbabwe wanted. The people at Harvard wanted me to create an HIV-focused intervention that combined medical care with mental health care. But that’s not what queer people in Zimbabwe wanted. They told me they just wanted safe spaces, places where they could hang out.
I decided to stop writing the grant and start studying a lot more queer theory and LGBTQ literature. And eventually what had started as a project about queer mental health became about queering mental health—applying queer theory and queer life to a very cis, heteronormative patriarchal system of Western psychiatry. I wanted to know how to destabilize some of these normative concepts in Western medicine. I wanted to know how to privilege the perspectives and experiences of the people who were suffering, rather than just the opinions of the experts.
There was a group called the Harare Queers that were doing a lot of mutual aid, and so I started to explore how that functioned in relation to people’s mental health. I started writing essays about all this, and started developing a critical lens for the concept of trauma itself.
Did your experience in the queer community in Zimbabwe and your research into queer theory and history start conflicting with your very Western, traditional understanding of medicine, trauma, and mental health?
Yeah, absolutely. It was existentially unmooring. At first, I felt like a bit of a conspiracy theorist, seeing all these systems at work. I also felt as though I was going against everything that I’d been taught and acculturated to believe. And that was incredibly hard for me. It took a lot of unlearning and relearning and expanding my own vision to re-understand what mental health was for me, and writing the book was part of that. It wasn’t that I alone had all these fantastic ideas, it was that other people had these ideas, and they were teaching me about them, and I was learning to integrate them into my own life experience, and then deal with the repercussions of a changed world view.
What exactly was so hard about squaring those two ideologies or lenses on mental health?
Well, you know, they’re in a sense antithetical. The Western approach is focused on the individual. I was taught that the way to approach people’s mental health was to send them to therapy or prescribe them medications. I became really good at prescribing medications. And I did a lot of extra training in psychiatry, both as a medical student as an as an internal medicine resident.
But then in my experience in this queer community, and in my work as an anthropologist, I saw that for so many people, therapy, psychiatry, medications, were, at the very least, not enough. If you’re living under poverty or violence or racism or homophobia, the individualist treatments aren’t sufficient.
And so I started to think about the shifts we’ve had historically in psychiatry from what was once a sort of spiritual idea, and then became a biological idea, and then became a psychological idea. And I wondered if we could have another shift to make it more a social and political idea. I wondered if we could make things more collective, more structural, less individualistic, and start to address these problems not just at the clinic or hospital.
I feel like the “conspiracy theory” of it all that you mentioned is that once you start down this rabbit hole, you start realizing things like: if you were a very powerful person who wanted to create a society that causes massive amounts of trauma, it’d be very helpful to then blame individuals for experiencing that trauma, and make it their complete responsibility to heal from it, because then that kind of obfuscates the source, right?