A 2014 study by Stanford Anthropologist, Tanya Luhrmann, highlighted a fact which may have far-reaching consequences in the approach to issues of mental health. In it, diagnosed schizophrenics from different countries (USA, India and Ghana) were interviewed about their auditory hallucinations – the ‘voices’ they heard in their heads. The most striking difference between the responders was that, while many of the African and Asian participants reported predominantly positive experiences and friendly ‘relationships’ with the voices, not a single American did.

While many of the Ghanaians and Indians attributed the voices to a god, to their ancestors or to talking, disembodied spirits – features of phenomena which were widely accepted in their cultures – the Americans were more likely to view the voices as intrusive and harsh; as violations. Accordingly, the Ghanaian and Indian voices would often offer direction and comfort, while the American voices dispensed threats and hate.

Luhrmann concluded that it was the notion of normality and acceptance in the mind of each participant which dictated the relative tone of the voices they heard, which is to say that the Americans – and by extension, the rest of the West – could benefit similarly without any need to validate claims of the supernatural. There is every reason to believe that an environment in which individuals feels safe from reproach and ostracism not only makes their experience of an episode far more bearable, but also facilitates the treatment of their disorder. Modern approaches to treatment of schizophrenics can now involve giving names to voices; engaging with, rather than resisting them; acknowledgement, rather than denial of what is a reality for the individuals having this experience.

The analogy with physical injuries may have its limitations, but it serves a purpose here: if you sprain your ankle, it does no good whatsoever to act as if nothing is the matter. You don’t walk it off. You don’t try and pretend it isn’t happening. You don’t tell your friends that, yea, of course you’re up for playing football tomorrow. You strap it up, elevate it and keep your weight off as best you can.

But what if you felt obliged to keep your sprained ankle a secret?  What if you were isolated and confused by your injury and couldn’t explain it to anyone, let alone seek treatment?

The question of why the stigma surrounding mental illness exists can likely be stripped down to that most human of qualities: fear of the unknown. The sometimes sudden onset of symptoms, such as irrational behaviour or a distinct change in personality, can be difficult to make sense of and challenging to deal with. But, as tends to be the case in other contexts, the most effective antidote to ignorance is education; the best we can do is learn more about that which we don’t understand.


I look back across the table at what was fast becoming my primary source on the subject of bipolar disorder. I’ve read up on the subject previously and come across personal accounts online. I’ve even witnessed what was later diagnosed as having been a manic episode first hand, and yet, none of this had really illuminated the matter for me quite like Roger’s retelling of his own experiences. He has just told me about the lows – the enveloping cloud of lethargy, the crippling self-consciousness – and now I want to hear about, for lack of a better term, the highs.

“The first two manic phases I experienced were probably similar to John’s (we had been discussing the recent episode of another, mutual friend), smoking joints all day long, hanging around with whoever was out, the confidence that went with it… but the third was the most worrying. That one came with paranoid beliefs and the thought that I was going to die … that I was going to be killed.” The ensuing tale could fill several pages. Shapeshifters and past lives; murderous Germans and paedophile rings; high speed chases and a sense of impending danger that loomed round every corner. I’m fascinated by the whirlwind narrative, by the stranger-than-fiction plot that would put Hollywood screenplays to shame. But whatever academic interest I have is checked by the thought of how easily things might have gone wrong. It would be disingenuous for me to say I didn’t understand why so many people still elect to hide their issues, and a thought occurs to me. Is the only difference between Roger and those who slip through the cracks, their support network? Were it not for his family, fighting for him when it mattered, would he be in the position he is now? The balance Roger currently enjoys in his life is in large part to his personal merit – his intelligence and candour greatly facilitate his healing process – but there is no doubt that positive circumstances also worked in his favour.

But what happens when one doesn’t have this combination of factors working in their favour? When nobody catches the early warning signs, or there’s nobody around who cares? A look at the prevalence of mental health issues amongst homeless populations seems to shed some light on this question, in what is a damning indictment of our collective failure to provide adequate care and support to all those who need it.

And this care and support begins with a little conversation. A gentle reminder that you understand when someone is having trouble; or even if you don’t understand, that you accept it. Some problems will pass, some problems will linger; others will snowball and need outside intervention. People with mental health issues have different needs in different situations: whether it’s time, space, conversation, medication or a combination thereof. The last thing they need is the added stress and anxiety of having to keep it all a secret for fear of people responding negatively.

The diagnosis of mental illness is a nascent science which we are only now beginning to understand aspects of, but at this dimly lit juncture, let’s make the effort to be a small source of light for those who might be faced with this struggle.

If you would like to share your experience with mental health issues – positive or negative, openly or anonymously – please get in touch with an organisation, friend, or family member. This is a topic which we need to keep open and current, at all times.

If you need support or would like more information on mental health issues, please get in contact:

Gibraltar Samaritans: 116123 / [email protected]
Gibraltar Mental Welfare Society: 54710000 / [email protected]
Childline: 8008 / [email protected]
Author: [email protected]