So I’ve finally gotten around to playing HELLBLADE: SENUA’S SACRIFICE, and, as someone that has struggled with mental illness, I am so glad that I did. In many ways, the game had gripped me on a deeply personal level.

Through its narrative, gameplay, and the lore-heavy world it managed to accurately portray both the inner and outer battle against one’s own darkness – and so, I became engrossed. It isn’t rare nowadays for video games to tackle mental illness. But it is rare for it to be handled the same way it was handled in HELLBLADE. Most video games have delivered nothing more than lunacy and banality, yet HELLBLADE went beyond that standard depiction.

HELLBLADE is a dark fantasy action-adventure game created by Ninja Theory, developers of HEAVENLY SWORD and DMC: DEVIL MAY CRY. It is both an indie and a triple-A game. Much like the tale of Orpheus and Eurydice, the Celtic warrior Senua attempts to go to the Norse underworld, Helheim, to retrieve the soul of her dead lover.

Mental Illness in Video Games

Senua is also a woman that suffers from psychosis. Ninja Theory went as far as to work with neuroscientists, mental health specialists, and people with psychosis to portray this appropriately; and I believe it paid off. Since its initial release on August 8, 2017, it’s been highly praised and has gone on to win various awards. For a game that has to do with mental illness, this is no small feat.

I’m sure most people can assume this, but mental illness has never really been depicted in video games with the same level of care and respect as it was in HELLBLADE. Even now, some of those negative and uneducated portrayals from back in the day can still be seen in most modern games.

Yet, indie games like HELLBLADE have begun to steadily change that norm. Let’s take a look back at how poorly mental illness has been portrayed in video games and how much we’ve progressed from it.

Note: Most of the games mentioned here are games that I actually really enjoy, but just because you enjoy something doesn’t mean you can’t point out its flaws!

The Classic Horror Trope

The negative depiction of mental illness originated from the horror genre. In older video games, the only representation there was for anyone with a mental illness would usually be of a straight-jacket wearing, drooling and babbling, creepy character stumbling around in a horror title.

mental illness in video games - SANITARIUM
Ah yes, just your average “crazy” person casually bashing his head in the 1998 game SANITARIUM. Image courtesy of DreamForge Intertainment

Video games aren’t the only perpetrators of this as this has always been the standard for horror movies, shows, and books. It is probably the easiest way to make the audience/reader feel unsettled. Tropes that relate back to the idea of the “insane individual” (someone that is wild, brutish, and unpredictable) have been ingrained into horror. This can be traced back to the conceptualization of the 18th-century Gothic horror.

The tropes are so established in our entertainment that they occasionally spread into other genres. This happens whenever creators want to go a bit darker, like with BATMAN: ARKHAM ASYLUM. This game isn’t a horror game, but its asylum setting and “crazy” villains stem from those ill-informed mental illness tropes of the horror genre.

Although all of this doesn’t necessarily bother me because it’s offense. It bothers me more so because I’m a fan of horror that’s tired of seeing the same old thing over and over. Not only are these tropes problematic, but they are just not original and effective. But, like I said previously, there are some recent developers that still can’t seem to let go of these poor portrayals.

mental illness in video games - INPATIENT
Even though INPATIENT is just a prequel to the game UNTIL DAWN, that really doesn’t make me roll my eyes any less. Image courtesy of Supermassive Games 

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Madness: A Convenient Cliché

There is a reason why these tropes are still around in recent games and that is because of the convenience of them. “Madness” can be an incredibly easy tool to use for throwing players off, from settings to symptoms. I’m sure you can think of a game where a character trips out and ends up god-knows-where. As for developers that would rather focus on creating a good scary story than world-building a unique and scary environment, the asylum setting was always the easiest cop-out.

mental illness in video games - THE EVIL WITHIN/OUTLAST
I loved THE EVIL WITHIN and OUTLAST, but I was so glad that the creators chose to step away from asylums for their sequels. Images courtesy of Tango Gameworks and Red Barrels

Then there are those games that would use the existence of mental illness as either a game mechanic or a mere side note for their troubled characters. Stress meters or sanity meters in games are admittedly interesting mechanics. But, they don’t necessarily add much when it comes to character depth or narrative depth.

Sometimes they can try and normalize and give insight, like with the popular RPG DARKEST DUNGEON, but most of the time it is like AMNESIA: THE DARK DESCENT where the symptoms of mental illness are there just to hinder your character and punish the player for letting the meter go down.

mental illness in video games - SCHIZO-PHRENZY
While the game is no longer up, I remember Adult Swim’s SCHIZO-PHRENZY being completely terrible at portraying Schizophrenia. The sanity meter would make you see disturbing images if it went down. Image courtesy of Adult Swim Games

Troubling Representation

In regards to the creation of troubled characters, developers sometimes seemed to simply slap on a label of a mental illness or two and give their characters the respective symptoms that would best progress the plot.

PTSD, with the accompanying amnesia or blackouts, seemed to be a pretty common one. There was Ethan in HEAVY RAIN, who blacked out occasionally due to trauma, James in SILENT HILL 2, who had suppressed memories, and Alex in SILENT HILL: HOMECOMING, who had both blacks out and suppressed memories. Nothing is inherently wrong with these portrayals except for the fact that they oversimplify PTSD. The cherry-picked symptoms are merely convenient plot-wise.

The “Crazy” Caricature

Some of these well-known, troubled video game characters noted to be afflicted with a mental illness or disorder could be defended as being decent representation. Team Silent, the original creators of SILENT HILL and my all time favs, did an amazing job of humanizing characters like James and making their characters well-rounded and likable.

The over-simplification and simple labeling of a mental illness is not the main problem for these video games. The biggest problem was that there was always a layer of violence to the afflicted characters. No matter what, it always seemed like mentally ill=violent, or mentally ill=villainy, or even mentally ill=hopeless.

mental illness in video games - SILENT HILL
Angela from SILENT HILL 2 didn’t deserve to suffer the way she did. Nor did she deserve to have been painted as an unstable, violent, and hopeless cause. Image courtesy of Konami

The Main Problem

Always seeing bad guys written to have some type of mental illness is bad enough. But having violent protagonists that are also mentally ill could only serve to perpetuate the negative stigma associated with mental illness.

American McGee’s ALICE is an awesome reimagining of Alice in Wonderland. Their version of Alice suffers the trauma of losing her family and loses herself to a warped, demented wonderland. She becomes a strong female protagonist that fights whatever is in her way. But in their sequel ALICE MADNESS RETURNS, she seems to enjoy the bloodshed of wonderland creatures too much. She also eventually causes harm to a human and ends up with a somewhat hopeless ending.

When I originally played it I rooted for Alice and felt that her actions were justified. But I know now that it isn’t the best mentality to have. While the game is fictional and the violence could sometimes be cathartic it still does more harm than good as far as representation goes.

mental illness in video games - ALICE MADNESS RETURNS
A badass female protagonist? Heck yeah. A good portrayal of a mentally ill woman? Heck no. Image courtesy of Spicy Horse

Yes, there are some people out there with a mental illness that may cause them to harm others, but it is nowhere near as constant as video games have always depicted. states that:

“Most people with mental illness are not violent and only 3%–5% of violent acts can be attributed to individuals living with a serious mental illness.”

While one may argue that video games don’t need to be so realistic, it isn’t hard to look around at the current discussions in America surrounding mental illness to see why more realistic representation should matter.

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A Change through Indie Games

Most gamers should remember the rise of indie games around 2010-2013. Indie games, independent games usually made without publishers through digital distribution, steadily became popular before 2010 but really blew up afterward, especially in 2013.

Thanks to easily accessible development programs like Unity and Unreal engine, platforms like Steam and Kickstarter, and the popularity of lets players — it suddenly became much easier for almost anyone to create and distribute a video game. With this creative freedom outside the constraints of a big name studio, indie developers were able to throw most mainstream tropes away. The results were truly unique and enlightening creations.

While there was a good amount of indie games that carried on with the standard that triple-A games set, many gems came from the rough. There were games created by developers that were inspired by their own mental illnesses, like the successful NEVERENDING NIGHTMARES. Games that attempted to simulate what living with mental illness is like, like ANXIETY ATTACKS and DEPRESSION QUEST.

And, games that wanted to tackle mental illness in a visceral way, like THE CAT LADY and FRAN BOW. Honestly, the list goes on and it is amazing. Even lesser known games like ELUDE and KEEP IN MIND do a great job. These games attempted to change the standard depiction. But, even they weren’t without some fault.

mental illness in video games - ANXIETY ATTACKS/THE CAT LADY/ELUDE
ANXIETY ATTACKS, THE CAT LADY, and ELUDE understood the reality of mental illness. Images courtesy of NeatWolf, Harvester Games, and GAMBIT

Indie Flaws

The majority of these games didn’t stray far from the horror genre where it’s easy to slip back into problematic tropes/clichés. Not to mention most of their mentally ill characters ended up being violent because of this. There are indie games outside of the horror genre that didn’t lean on anything problematic, like NIGHT IN THE WOODS.

Even so, most of the time (especially in this games case) they end up isolating some gamers. Being too dialogue/story heavy can do this. Also being too directed at a very specific demographic (in this case millennials). Gamers that don’t have a mental illness are less likely to give games like these a chance. Not to mention that indie devs sometimes can’t deliver their exact vision with the budget and resources they have. HELLBLADE, on the other hand, opened itself up to everyone by doing everything right.

mental illness in video games - NIGHT IN THE WOODS
NIGHT IN THE WOOD’s lol random humor isn’t for everyone. Image courtesy of Infinite Fall

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What HELLBLADE did Right

Once I started playing HELLBLADE I knew it would be different. It began with Senua’s voices ushering me along as a witness to her trials. Senua even acknowledges the player at times. Getting such a personal, front row seat didn’t just make me empathetic. It put me in her shoes.

Playing this game is beyond captivating if, like me, you’re someone that knows the manipulative, abusive, and painful hold of mental illness. And know what made it all better? There wasn’t a single horror trope, cliché, or problematic portrayal in sight. Every detail resonated without breaking me out of the intimate immersion. Senua’s realistically human.

mental illness in video games - HELLBLADE
Senua getting a moment of reprieve. Image courtesy of Ninja Theory 

This game was successful without the typical norms because of the ways it differed and how it isolated no one. While the game is a dark fantasy, the only horror elements there are lie in the tight situations and the traumas of her past. It is also implied that this Nordic world of hers is no hallucination.

She doesn’t “wake up” in our reality having slaughtered a ton of people instead of monsters. This world of mythos is real and not all in her mind. While her voices are slightly a game mechanic, they are helpful and well done. The voices guide you as you fight for your life. It metaphorically shows how mental illness (while damaging) originates from your mind trying to protect you.

There are no tropes that surround Senua and, most importantly, she is NOT violent. Instead of harming the person that abused her, she only unsheathes her sword to keep them at a distance. She never even attacks the people that harass her for believing shes evil. She kills zero humans and I can’t stress enough how important that is.

A Journey for Everyone

As for being a game for all gamers, Senua’s journey is obviously more than just the battle against her darkness. By avoiding the problematic norms, they kept her in the realm of fantasy as a warrior that also happens to suffer from psychosis. For a story that revolves around mental illness, this is exceptionally unique.

It makes it a game for gamers tired of the same old things. And, on top of that, there is the gameplay. The gameplay difficulty and strict death mechanic were actually the most talked about aspects of the game early on. Some might say that could isolate gamers, especially mentally ill ones, but I believe the opposite.

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I’m a casual gamer, so, yes, I did get extremely frustrated at times. However, as soon as I got to the ending after fighting through hordes of demons, I felt light. The end embraces acceptance and is (unlike other games) hopeful for someone with mental illness. Fighting through mental illness is hard — it’s beyond tasking. But when you do manage to fight through it you realize that it was all worth it. That was how I felt by the end, that pushing through the difficult gameplay made it all worth it.

How Far We Can Go

Mental illness in video games was once just another reminder of how society perceives individuals that struggle internally. Horror games use to be the only place there was for representation. Though, that representation was never good. Over the years, developers attempted to do more with mental illness. Sadly, they could never figure out the perfect balance between realistic, nonviolent, depictions and a game the majority would play. The progress that is HELLBLADE came from the trials and errors of all games before it.

HELLBLADE has given me so much hope for the future of video games. I believe that developers can learn from it and take their games further. We haven’t reached the ideal landscape of gaming just yet. No game is perfect. HELLBLADE only covers a certain amount of psychosis and it is still in a dark genre.

The difficulty is also something that may turn away the more sensitive gamers. Even still, unlike the games before it, HELLBLADE successfully portrayed someone with a mental illness in an appropriate way. If more developers do research and avoid tropes and clichés we will definitely get more games like it.

My hope for the future is that we get more games that revolve around mental illness. Specifically, ones outside of the darker genres. I would also love to see more games made by developers that have or have had experience with mental illness. Either way, I look forward to the future of gaming and I would definitely recommend everyone play HELLBLADE. If you’re currently going through your own darkness, allow Senua to help you realize the warrior you are inside.

Featured images courtesy of Spicy Horse and Ninja Theory 

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