The Geography of Madness: Book Summary and Notes

Last updated: July 29, 2020

Is PMS real? Can you die from voodoo? Is it possible for a man to have his penis stolen?

These things all seem real to people who experience them. But science can’t prove that they actually exist. These cultural syndromes “exists in a swirl of belief and expectancy and biology.”

Our business book club just finished reading a fascinating book: The Geography of Madness: Penis Thieves, Voodoo Death, and the Search for the Meaning of the World’s Strangest Syndromes by Frank Bures.

Five men standing close together holding the book in the middle
L to R: me, Steve Kamb, Ramit Sethi, Wayne Mulligan, and Derek Halpern.

In selecting this book, Ramit Sethi said:

I loved this book and it made me think differently. How many of our “diseases” are cultural? How many are in our head? What assumptions do we make? What else is cultural? What can we control and change? It was one of the most interesting books I’ve ever read. It’s also very different than the other books we’ve read in our book club.

Yellow book cover with title of book and sub-title
Cover of the book The Geography of Madness by Frank Bures

Our Discussion Questions

Ramit emailed our group a week before the meeting with a few prompts to help prepare our discussion about this book.

What was a specific moment where you realized others look at the world profoundly differently than you?

And that their worldview also made sense. Ramit gave the example of when he went to an Indian funeral:

Everyone dressed casually. I was shocked. My mom said, “We don’t want to ‘show off’ and take attention away from the deceased.”

Which of the following do you believe?

  • My body is like a machine — if something is broken, I should get it fixed
  • I should take Vitamin C if I start feeling sick
  • My mood changes with the weather
  • I’m in control of my life
  • If I work hard, I will be rewarded
  • I have good / bad genes

What’s an example of your body physically reacting to your situation at work or personal life?

What are some other examples of beliefs or “invisible scripts” from culture?

  • Everyone should go to college
  • Move out of your family’s house at age 18
  • Weight gain: inevitable & impossible to change due to genetics

See Ramit’s thread on Twitter here for more of his own examples and replies.

Discussion Questions from the Author, Frank Bures

I reached out to the author and he linked me to this great post on his site: Geography of Madness: Book Club Edition

Some of my favorite book club discussion questions the he shares are:

  1. Is there a belief that everyone around you holds, but that you don’t share? How did you come to doubt this?
  2. Have you ever had a health problem you were afraid to talk about, or that others didn’t believe in?
  3. How much does a your culture create you? How much do you create your culture?
  4. After reading The Geography of Madness, how would you describe what culture is?

Selected Highlights

These are a few of my favorite passages from the book:

“What is culture? What is it made of? And how are we bound to it?”

Like penis theft, all of these syndromes were terribly real to the people who experienced them. But why was it that they existed in some places and not others? Did where you lived determine how you lost your mind? Would a person who goes mad in one culture go mad differently in another? Or, maybe, would she not go mad at all? What, come to think of it, was a “culture,” anyway? And how tightly were any of us bound to it?

“Mental illnesses were shaped by the cultures in which they appeared…”

On raising his kids:

I started paying closer attention to the books we were reading them, to the movies they watched, and to the stories we shared. These, I came to see, were doing some work deep within them, providing them with outlines and scripts that would help them get through whatever might unfold in their lives, with the choices they would eventually have to make. The stories they heard were paving the roads in front of them. They were shaping the world as they entered it.

“The only thing worse than diagnosing PMS is suggesting it might be a cultural syndrome.”

Nocebo effect: the opposite of the placebo effect. While the Latin translation of placebo is “I will help,” the translation of nocebo is, “I will harm.”

On medicine and medical procedures:

  • The neuroscientist Fabrizio Benedetti has found that painkillers given surreptitiously are far less effective than those given in full view: It takes much higher dosages of a hidden painkiller to get the same relief.
  • … back surgery called vertebroplasty, which some 750,000 people in the United States get each year, and which generates somewhere between $12 and $18 billion in annual medical expenses. In one study, vertebroplasty and placebo groups had pain ratings of 6.9 and 7.2 before the procedure and 3.9 and 4.6 a month later respectively, a difference that was “neither statistically significant nor clinically meaningful.” This doesn’t mean the surgery didn’t help. But it does mean the reason it helped wasn’t the surgery itself.
  • In a randomized controlled trial of 270 people with chronic arm pain, patients were given either a placebo pill or sham acupuncture, in which the needle doesn’t actually penetrate the skin. Before the study, the patients were warned about side effects, and 31 percent of the pill group and 25 percent of the acupuncture group experienced precisely the side effects they’d been warned about. Three people even dropped out of the study because their fatigue or dry mouth were so severe.
  • In one experiment in the 1960s, patients given sugar water were told it would make them vomit, and 80 percent of them did just that.
  • In 2014, thirty students at a Minnesota high school became ill and were hospitalized with what they thought was carbon monoxide poisoning, but for which all tested negative. The cause was psychogenic. In 2013 in Danvers, Massachusetts, two dozen teenagers at an agricultural school started developing strange hiccups and vocal tics that were eventually ruled to be a mass psychogenic illness.

On bioloops:

  • The idea of a bioloop is the most elegant solution: the notion that there is a kind of circle of causation, that mental and physical states are connected so that each alters the other to some degree.
  • Cultural syndromes—and all syndromes—are a result of these loops. Each of us exists in a swirl of belief and expectancy and biology. Each of us is a very strange loop.
  • When you pause to reckon with who you are—and what that means—a piece of bioloop grows stronger and then feeds that strength back into the whole.

On how stories and storytelling work:

Which is exactly how stories work: First they make things possible. Then they make them familiar. Then they make them real. The difference between victims and non-victims was that they knew exactly what to expect.

And more on storytelling:

  • The ability to see your own life story is a powerful thing, but it’s not always easy. In the times in my life when I’ve been depressed, it’s felt like I didn’t know what story I was part of, or that the one I was living was the wrong one, or that there was simply no audience for it at all. But in better times I could see myself as the protagonist in a grand adventure and realize how lucky I’ve been. I could see the threads, the meaning, and all the things below the surface.
  • Somehow, composing the story of yourself, tinkering with it, thinking about it, has a consolidating effect. The same way we look for causal cohesion in the world around us, we look for it in our life. And when we find it, or perhaps even when we just look for it, good things happen in our biology. When the human organism sees reasons to carry on, some ancient survival mechanisms kick in. This is why so many people write memoirs, and why psychotherapy works (and indeed, it’s why all 400 kinds of psychotherapies work equally well).
  • Stories we hear are never as powerful as the ones we see. That is the secret of the peer effect, of social contagion, and of mass psychogenic illness. That’s why it’s so hard to resist the pull of the cultures we are in. We watch the people in our lives. We learn the way things go, the scripts, the schemas, the patterns: How to get something at the store. How to talk to someone you love.
  • Because I knew that people believed these stories in such modern times for the same reason we have always believed any stories. They hold our worlds together. They hold our selves together. They’re the raft on which we steer our lives down the river. If it falls apart, if we abandon it, if it’s destroyed on the rocks, all we can do is swim.


We all liked this book. Recommended!

Steve Kamb, a member of our book club, described the book like this:

It was an amazing look into tons of physical and mental maladies – all of which are very real – and how many of them are dependent or intertwined with particular societies. It has me thinking about what parts of western culture aren’t ‘facts’ and are just social constructs. Great book. ⁣⁣

More Information and Links

Previous books we’ve read in our book club:

Five guys standing together, one is holding the book in the middle
Thanks for reading to the end! Me, Steve Kamb, Ramit Sethi, Wayne Mulligan, and Derek Halpern

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