Mental illness in video games and why we must do better

If you’ve spent a considerable amount of time playing video games, you may be aware of a harmful and damaging trend that permeates the medium. Games have a serious problem with depicting mental illness, often stigmatising those in need of support and compassion as violent and intimidating.

This is in spite of the fact that multiple studies state people with mental health problems are actually more likely to be victims of violence than the perpetrators. Even the vast majority of those living with less common diagnoses, such as schizophrenia and bipolar disorder, aren’t likely to show an increase in violent behaviour, although this hasn’t prevented the harmful stereotypes from reappearing time and time again.

James Harris, head of communications at the Mental Health Foundation, tells me: “In gaming, and more widely film, the backdrop of an abandoned asylum or casting a psychiatric patient as the principal villain is a common theme. Whilst acknowledging that the creator’s intention is not to increase stigma but rather to entertain, by default they are helping to perpetuate the stereotype that there is a correlation between people living with mental health problems and violent behaviour. The reality is, however, that people with mental health problems are more likely to be victims of violence.”

(Above: Outlast by Red Barrels)

A specific example of a release that plays into this representation is Outlast, a horror title from developer Red Barrels. In the game, you play as a freelance investigative reporter trapped inside a psychiatric hospital. In order to escape, you must continue through the dark and dreary hallways of the asylum whilst avoiding the inmates on the loose. Outlast portrays patients with mental health issues primarily as hostile props. This is in spite of the damage the portrayal may cause to those suffering from mental health issues, by presenting them as individuals that should be shunned, despised, or even locked away by society.

There are numerous games comprised of equally insensitive and lazy representations of individuals who have mental illnesses. Others include Manhunt 2, a game that begins with a scenario where two patients brutally murder the staff at an asylum to escape; Fahrenheit, which has players again fleeing from free roaming patients; and The Hall of Our Lady section in Bioshock Infinite, where they’re little more than creepy set decoration to gawp at.

There are plenty of other games where mental health patients are portrayed as enemies or as props to make the player feel at risk. These depictions say a lot about how ingrained the portrayal of the mentally ill as violent has become within our culture at large, where mental health patients regularly act as shorthand for a threat to an audience to elicit fear.

There’s a legitimate concern about how the harmful and incredibly outdated image of psychiatric hospitals depicted in these titles affect the judgment of those seeking treatment. In games such as Until Dawn, Affected: The Asylum, and The Evil Within, asylums are shown to be dank and miserable places filled with horrifying medical apparatus, abysmal lighting, and compulsory restraints. In these games, they serve the purpose of being prisons where undesirables are locked away, as opposed to environments where someone can take the time to recover. They may be exaggerated, but these outdated portrayals stigmatise these institutions, suggesting they are somehow dangerous or threatening to visit.

(Above: The Evil Within by Tango Gameworks)

“Many people who experience mental health problems don’t seek help,” the charity Mind argues in its guide to violence and mental health. “This is often because they fear being stigmatised, or locked up if they talk about violent thoughts or urges.” Considering some of the immense talent working in the industry today, it’s therefore disappointing to see so many developers resort to these damaging tropes, instead of taking the time to develop more accurate portrayals.

That being said, there are some titles that are exceptions to the rule, although these games mostly appear outside of the horror genre, and focus on more common diagnoses. These include titles such as Depression Quest, Elude, and Actual Sunlight, which tell deeply personal stories on a much smaller scale. They handle the topics of depression and anxiety brilliantly and encourage their audience to empathise with the characters by putting them in their shoes.

For example, the interactive fiction game Depression Quest gradually reduces the number of options you have available to you based on your previous decisions. This aims to replicate how everyday tasks can become difficult or even impossible for those living with mental health problems. With a focus on empathy rather than violence, these games succeed in giving you a greater understanding of mental illness, how it’s diagnosed, and how it can be treated. Characters also exhibit realistic symptoms rather than coming across as caricatures.

(Above: Actual Sunlight by Will O’Neill)

Whereas games such as Outlast allot cartoonish attributes to those with mental health disorders, these smaller titles take the time to explore genuine symptoms such as anxiety, sleep deprivation, and apathy, demonstrating a much more considerate take. This trend has been noted by many mental health organisations, including the Mental Health Foundation:

“There are clear signs that things are beginning to change for the better,” Harris suggests. “There is an increased awareness of mental health, and the fact that it affects so many people. This is now being reflected in gaming as more developers seek to produce titles that avoid well-trodden clichés and/or reflect lead characters who – as heroes – live with mental health problems. In this sense, gaming has to date simply reflected the views of society. We hope going forward, and given its ever growing cultural significance, the industry will now take a lead in heralding a more accepting and accurate reflection of mental health.”

So, how can video games improve the way in which they represent mental health issues? Well, most importantly, they can seek help from relevant charities, as well as campaigners, to make sure they’re producing content that isn’t playing into pre-existing prejudices. They can stop trying to profit from the misery of others and produce content that helps to educate instead of putting up walls, and they can supply the numbers for helplines with their work to assist those who may need them.

Video games are still relatively young as a medium, but that doesn’t mean they’re exempt from criticism. They should strive for better. We can help by supporting the creators that are brave enough to break from convention, as well as by boosting the voices of those who are negatively affected by poor representations. Considering that one in four people in the UK suffer from mental health issues every year, it’s important that we show due respect and care to those undergoing treatment, instead of contributing further to discrimination and dangerous typecasting.

(Above: Hellblade by Ninja Theory)

Over the next year, there are multiple titles scheduled that will attempt to address mental illness, ranging from the problematic Asylum by Senscape to the encouraging Hellblade by Ninja Theory. Whilst Asylum looks to be another game in the same tired vein as other horror titles set in psychiatric hospitals, Hellblade at least appears to be trying to represent psychosis in an appropriate and sensitive manner. This is because the developers have enlisted the help of Paul Fletcher, professor of Health Neuroscience at the University of Cambridge and a practicing psychiatrist. Nevertheless, both titles will cause great concern for those who have a stake in the accuracy of these portrayals, as many have been burnt before by individuals promising authenticity only to fail in delivering it. Video games simply must do better.

Useful Websites and helplines:

Samaritans (Open 24hrs a day): 116 123

Mind (Open Mon-Fri, 9am-6pm): 0300 123 3393

NEXT: How games such as SOMA and BioShock tap into our internal fears.