Dr. Khameer Kidia wants to reimagine the way we approach mental health in the West

MARK BRODIE: According to the Centers for Disease Control and Prevention, more than a fifth of all adults over the age of 18 had some kind of mental health treatment in 2020. More than 16% took medication. The CDC says in 2023, more than 11% of adults took prescription meds for depression. My next guest would like to change the way we think about and treat mental health. Dr. Khameer Kidia is a writer, physician and medical anthropologist. He’s also been an ASU Future Security Fellow and is the author of the book, "Empire of Madness: Reimagining Western Mental Healthcare for Everyone." I spoke with him earlier and asked about his main thesis in the book.

KHAMEER KIDIA: Well, this is a book really about reimagining the way that we approach mental health in the West where, you know, as a physician, I’ve been trained to prescribe meds, to send patients to therapy. But as an anthropologist working both in the U.S. and in Zimbabwe, the country that I’m from, I’ve seen that for many people living under poverty, violence, racism and homophobia, meds and therapy often aren’t enough.

And so, in this book, I’m calling for a shift in the way we think about mental health towards a more collective and structural issue that needs to be addressed not just in the clinic or the hospital, but also through care that is social and political.

MARK BRODIE: So, what would that kind of social and political care look like, you know, if you are a patient?

KHAMEER KEDIA: So, you know, something that I like to tell folks is that we’re all mental healthcare providers. And so, if you are a patient, what it means to you to take that message home is basically to think of our mental health not as formed in a vacuum, but as something social and relational. Our mental health is something that we form collectively.

And so, what that care looks like is whatever it is in your world that allows you to participate more engaged in that social and political world. That could mean being more neighborly. It could mean picking up the phone and calling your grandmother. But it could also mean going to a protest or voting in your local elections or participating in mutual aid, you know, this idea of helping each other out while we’re working to change the world to make it a better place. But that is a context-dependent thing that really only you can decide in your context.

MARK BRODIE: I wonder if somebody who is maybe going through a mental health crisis is easily able to make those kinds of decisions, though? Like, is this sort of a on a case-by-case, patient-by-patient basis you have to look at this?

KHAMEER KEDIA: I think a lot of it is both very particular to the individual, but also very structural and part of a a kind of global whole. And so, as we’re addressing problems in our lives, each of those problems will be, you know, partially individual and partially structural, both in origin and solution. The onus is not all just on you, but it’s also on all of us around each other.

And so, you know, with that perspective in mind, knowing that my mental health, for example, affects my mother’s, and my mother’s affects mine, is an important thing to take away, you know, that we it’s very hard to move through the world when those you love are in pain. And realizing that makes it part of my responsibility to help somebody who might be struggling with their mental health at a moment where they can’t help themselves but might need some help from me, and vice versa. Does that make sense?

MARK BRODIE: It does. I wonder though if we as humans really know how to help somebody who needs help with their mental health. Are we equipped to be doing that?

KHAMEER KEDIA: You know, I believe we are. I believe we’re social creatures, and that social cohesion is a really important part of how we move through the world. The problem is, in, you know, Western countries and especially in places like the U.S. and the UK, our worlds have become so atomized and individualized that we’ve forgotten this very idea that we are social creatures. And what I’m calling for is a turn back towards that.

MARK BRODIE: So, you write that, you know, as both a physician and a patient, you have prescribed and been prescribed medication for mental health conditions. Do you see some of the the social aspects as a complement to that, or do you see them maybe as a potential replacement for for meds in some cases?

KHAMEER KEDIA: Oh, you know, I think largely I see them as a complement and then perhaps someday as a replacement, but that day is far off. I think we have a long way to go in building a world that is fairer, that is kinder, that is more humane, and more just, before we can think about living without psychiatric medications.

I think that at the moment, especially for people living in the West, psychiatric medications are important way of coping. But what I want to stress is that they’re only one way of coping, and they are actually a small component of what makes up our mental health. So, the psychiatrist and former director of the NIMH, the National Institute of Mental Health, Tom Insel, he has this phrase that is basically like, you know, our mental health comes 90% from our ZIP code, our gender, our race and these social determinants in our life, and only about 10% of our mental health comes from mental healthcare itself.

And so, with that statistic in mind, what we have to be thinking about is, well, what about the other 90% of stuff that is within our control from our like social and political perspective? How do we change those things? Because that 10% that is being helped by, you know, psychiatric drugs and by therapy, that’s all well and good, but there’s so much more that we can be doing.

MARK BRODIE: Well, so the issue of control that you just brought up is an interesting one because I would think that in some cases, people have maybe anxiety or depression over things they really can’t control.

Are there ways to sort of work with that that maybe don’t require medication, or in cases like that, do people really need the meds and and maybe some some therapy as well, and then when those situations change, maybe they can can try to address it that way?

KHAMEER KEDIA: I think it’s a both-and. So, I think the meds and therapy give you the ability to cope in the very immediate term, but we also have to be thinking about the medium- and long-term goals about our patients’ lives. And so, what I want to urge folks to think about mental health as something that requires intervention both at that very immediate level, but also think about engaging even patients and doctors on how we can change that world to make it a better place.

MARK BRODIE: How big of a shift in thinking do you think it would take for more providers in the U.S. and the rest of the West to adopt some of these practices?

KHAMEER KEDIA: I think we’re closer than most people realize. Psychiatrists themselves really do understand mental health as also socially and culturally determined. The problem is that the tools that we’ve been given in medicine are blunt instruments for engaging with those social and political problems.

So, the main barrier is helping medical professionals across the board, not just psychiatrists and not just physicians, basically, you know, the full spectrum of healthcare providers need to realize that if they see that the problems of their patients are coming from their social and political worlds, then it behooves us to treat those problems as such. And that’s I think the last step.

MARK BRODIE: All right. Well, Khameer, thank you so much for the conversation. I really appreciate it.

KHAMEER KEDIA: The pleasure is all mine. Thank you, Mark.

MARK BRODIE: Dr. Khameer Kidia is a writer, physician and medical anthropologist, and author of the book, "Empire of Madness: Reimagining Western Mental Healthcare for Everyone."