Josh Pappenheim speaks to the gamers and developers using video games to break the stigma around mental illness
Insane asylums, “crazed” cults, voices that follow you around a room before a clichéd jump scare – video games have a terrible track record when it comes to portraying mental health issues.
Thankfully, most of these tropes have disappeared in recent years, but games such as Silent Hill and Amnesia that rely on “insane” villains to drive a story still make up the foundations of gaming. But now developers are trying to tell the other side of the story.
Titles such as Night in the Woods, Depression Quest, and Hellblade: Senua’s Sacrifice (which recently won big at the gaming BAFTAs), put players in the shoes of characters with mental health issues, rather than set them up as a foe to be feared.
Several studies have shown that moderate gaming can lead to better mental health and wellbeing, but can games now help tackle the stigma of mental health issues, and help to spread awareness beyond “let’s shoot the crazy person”?
Dr. Sachin Shah of Gaming the Mind, a group of mental health professionals who have an interest in video games, feels so strongly that games can be used to highlight mental health issues that the group are currently developing a roleplaying video game that puts medical students in the shoes of psychiatrists.
“Games have had a sketchy past when it comes to portrayal of mental health issues, with a history of very negative and pejorative depictions,” he tells me.
“Hellblade is a well-known example of a game featuring a more informed portrayal of psychosis,” Shah says, explaining that the game’s developers, Ninja Theory, consulted people with experience of psychosis as well as experts such as Cambridge neuroscientist Paul Fletcher.
“If you play Hellblade with headphones on, you will get a good idea of what having hallucinations of voices feels like.”
Shah says the game strikes the right balance in making the voices realistic but not “overly dramatic or disturbing”. The voices, which Shah says are typical of schizophrenia, talk to each other and discuss what the character Senua is doing. “Senua isn’t someone the player must fear, but rather, someone the player can identify with.”
While realism can help raise awareness, do games like Hellblade actually tackle the stigma around mental illness? Shah says yes – by giving the player first-hand insight into “the person behind the label”.
“They can challenge harmful stereotypes,” he says. “They can help the player identify with people with mental health conditions by placing them in that person’s shoes. And they can help people with mental health conditions tell their stories, and have a voice within media to give their perspective.”
Hamish Black, a filmmaker who creates long form video game essays on YouTube, has made analysing video games into a full-time job. His video on Dark Souls, where he compares his experiences with depression to “the hardest game ever made” (as it is commonly thought of), is an instant classic – but he’s not so sure that putting the player in the head of someone with mental health issues is always a good idea.
“The Hellblade team’s dedication to going deeper than ‘oogabooga spooky sounds in your ears,’ and instead directly representing the symptoms of Senua’s condition in the game is absolutely to be commended. I’d go so far as to say I think it’s incredible,” he says. And yet:
“It also hit so close to home that it made me deeply miserable and I don’t ever want to play it again.”
Black says he struggled to imagine “who the game is really for”. While he praises the developers for not fetishising mental illness, he also feels the game failed to be “affirming”.
“I suppose it’s valuable to those who have no personal experience of psychosis to gain some kind of understanding of it. It’s just interesting because when you hear that a game is ‘about mental health’ there are these expectations that we perhaps naively form: that it will affirm our existence in some way.”
Though Hellblade has received praise and attention for its unique approach to storytelling and inclusive production, it doesn’t seem to have started a genuine conversation about how psychosis is portrayed in the media outside of the media itself. For every Reddit post praising the game for its story, there’s another complaining that “everyone has some sort of depression/anxiety now a days [sic]”.
“In terms of games changing how I view mental health issues, I tend to gravitate towards those games that are more symbolic rather than symptomatic,” Black says, explaining that Dark Souls resonated with him because of his own mental health.
“I found affirmation in its difficulty, where progress would be glacial and often insignificant in the grand scheme of things, but it was deeply important to me because it was my progress.” On top of this, Black praises the game for getting him out of the house and helping him to appreciate the world around him.
“[It] allowed me to directly prove to myself that I was better than my conditions. If that’s not testament to the narrative power of video games, then I don’t know what is.”
Cal, a 25-year-old gamer and video creator, credits Firewatch and Night in the Woods as games that had an impact on how he views mental health.
“I’d never considered the other side of someone who needs to get away from something so troubling until I played Firewatch [which is about a man who takes a job as a fire lookout in Wyoming after his wife develops dementia].
“How something so bad can impact those around you is rarely approached, usually the focus is on the person suffering, so to see it from the perspective of someone else – especially if that person doesn’t see themselves as a good person – was so refreshing and I think made me more empathetic as a whole.”
Cal thinks games don’t explicitly have to declare “This is about anxiety or depression or PTSD!” to be about mental health. He prefers games that aren’t immediately upfront about it but instead “drop it in here and there”.
Whether or not video games can change the way we discuss mental health, or help someone who’s noticing some signs or symptoms seek help, there’s no denying the gradual decline of the “mental baddie” and the ascendance of neuroatypical protagonists can only be a good thing.