It’s not every day you read a book about penis thieves. But Frank Bures didn’t write just any book. He wrote The Geography Of Madness: Penis Thieves, Voodoo Death And The Search For The Meaning Of The World’s Strangest Syndromes, a completely original work, which finds him traveling to Nigeria, China, Hong Kong, and other far-flung places in search of insights into cultural syndromes that lead to mildly insane physical complaints. What interests Bures isn’t the strangeness of it all, but the humanity. What cultural factors contribute to these mysterious maladies? And what does that tell us about ourselves? Bures investigates in the best way possible: he went and talked to people. In his book he not only looks into penis thievery, which shows up in multiple countries and in medical terminology is called Koro, but frigophobia in China, which is an outsized fear of cold, and hikikomori in Japan, when people withdraw to the point they never leave home. You finish the book feeling less glib about a lot of things.
We sat down with Bures in Minneapolis to talk about the book, his writing life, and why asking if cultural syndromes are real is not the right question at all.
TP: You first had this idea back in 2001. Have you been working on the book all this time?
FB: In a sense yes. But the progress was non-linear. It was a story before it was a book, but I was always working on other articles as well. When it became a bigger project, the biggest challenge for me was feeling like I knew enough about the subjects, because every paragraph, in some chapters, is a whole research field. You have to get far enough into it so you’re conversant. Then you hope you understand it as well as you think you do, just to put it into context. Because a lot of these fields are not integrated. They’re separate, even though they’re dealing with some of the same things, such as cultural syndromes and narrative psychology. I considered my job to look at all these things and pull them together into some kind of working model.
TP: Your book is so ambitious. Were you ever concerned that you wouldn’t be able to find a through-line?
FB: I knew what I was looking for and I had confidence that there would be a story there, or different stories that would all be part of the same story. But it was largely a matter of persistence. I wanted to see it all the way through and answer the questions I was trying to raise in a meaningful way, and not in some gimmicky, book-proposal way.
TP: You decided to include parts of your own story as well.
FB: One of the questions in the book is “How do you construct a story of your own life?” We do that by looking at the stories that are taking place around us, and using our imagination to come up with some new story. We look backwards to find a story that goes from the time we were born to wherever we are now. To the extent that we can do that, it can be actually healthy.
TP: Even though our memory isn’t always a reliable narrator.
FB: It’s true, human memory isn’t a comprehensive thing. It’s built out of isolated episodes in time. How you choose the episodes that make up your life, or the world around you, determines a lot of things. When you select episodes and arrange them in a certain way, it makes them into a story with the causal flow from one to the next. It’s an implied thing. This is our default mode for understanding our life and the world.
TP: You did a deep dive into the language of medical treatments, which as you point out can greatly impact effectiveness.
FB: It goes back to the idea that part of the treatment is the belief in the treatment. Our culture has become more biomedical over the last 20 or 30 years, largely because of marketing on the part of pharmaceutical companies.
TP: You get into the question of anti-depressant effectiveness, which is a big one.
FB: There was a 2002 study called The Emperor’s New Drugs, which looked at the FDA’s efficacy data for the six most widely prescribed antidepressants from 1987 to 1999 and found that the effects were either clinically negligible or they needed a new kind of study to find some sort of efficacy. But at least partly because people believe in them, they can work. And it’s complicated because there are a lot of drugs, and I’m not just including mental health medications in this, but pain medications, which work using receptor pathways that were already there. If you open those receptor pathways with belief in the power of the treatment, you find more effectiveness. Fabrizio Benedetti is a guy who does a lot of placebo research and he finds that with a hidden administration of drugs, when you don’t tell someone you’re giving them a painkiller, you need more to get the same effect. Treatments often work best when patients use the mind and the matter, not either or.
TP: You had that story in the book about the Minnesota school that had all those reports of carbon monoxide poisoning, yet no one had anything.
FB: That was a mass psychogenic illness. It happened at an elementary school in Springfield in 2014. Thirty students had to be sent to the hospital. Those are hard to explain to the sick person because when you do, it’s like telling them they don’t have anything. You’re telling them the illness isn’t due to carbon monoxide, it’s the fear of carbon monoxide. Those sorts of narrative are hard to control because we aren’t even aware of them ourselves.
TP: In the book you explore both Western methods and Eastern methods. As a reader I kept waiting for you to come to some grand conclusion that one works better than the other. But you don’t give easy answers, because they’re not true.
FB: I went to China actually with an assumption that eventually they will all be using Western medicine to treat things like penis shrinking. But that wasn’t the case at all. Chinese medicine in southern China is as strong as ever. It’s different from young people to old people; young people tend to be more interested in Western medicine than traditional Chinese medicine. But in Hong Kong it’s really popular and it’s growing. I don’t think most people worry too much about it. They’ll think Western medicine is good for some things and traditional Chinese medicine is good for other things, so you do both and see what works. That also gets complicated, too, because sometimes you’ll have traditional Chinese medicine, which is mostly plants and living things and it’s not regulated as tightly as Western medicine. One of the doctors I talked to said that people put steroids in traditional Chinese medicine, so if people take it they feel something and they assume it’s really working. There are benefits to both. Traditional Chinese medicine is more gentle, a little more long-term, a little more lifestyle oriented, and more ritualistic.
TP: You packed a narrative in your footnotes, ala David Foster Wallace.
FB: In the main text I wanted to tell a story and keep it going in one direction. A lot of the footnotes stuff were relevant and fascinating and interesting but they were digressive, so I included the material that way. A lot of the stuff is weird and people aren’t going to believe me saying these things. So I wanted to have all these references. It was also just fun.
TP: You traveled to so many regions for this book. Where could you return and feel most at home?
FB: I could feel pretty at home with east Africa. It’s not always an easy place but I still speak pretty good Swahili so I can get by, and I know how to deal with people.
TP: You did all this great on-the-ground reporting, which made all the difference.
FB: When I was trying to figure out if there was still penis-shrinking in southern China, it was impossible to know unless you went there. Even within China, in Guangzhou, people told me that it doesn’t happen anymore. Then a couple hundred miles south they’re like, “Oh it happens every year.”
TP: You seem to love the process of reporting and writing.
FB: Yeah, I do. It just comes from being curious about the world and not wanting to be doing just one thing for the rest of your life. Not that it’s easy and fun all the time. But the challenge is part of the fun of it.
TP: What’s next?
FB: I have a few other book and story ideas. One is about writing and depression and how writing can help you be less depressed. Another is about the machine metaphor that we use for the body and mind, and the shortcomings of that. Another project is about group narratives.
TP: Which one are you leaning toward?
FB: The group narratives.
TP: How will that flesh out?
FB: Well, I think there are three types of stories that we tell each other about ourselves to make sense of things. One involves personal stories about how a person gets through life and does things to become who you are, like how you become a writer or a fireman or whatever, or how to be a good person. A level above that are group stories, which involves the groups you’re part of, either by birth or by choice and how those groups came into being. I’m interested in how those group narratives are used to separate and unite people. And a level above that are cosmological narratives about how the world came into being and what the world is made of, God, physics.
TP: We want to read that book. It occurs to us that gaining insight into our own narratives will give us more options in life, which is something we learned reading your book.
FB: Right. It gives you agency.
— This interview has been edited and condensed for publication.