Mental Health Representation in Games

When playing a game, you become immersed in the characters you play as. We often get asked, when those characters have mental health issues, how realistic are they? Are they good portrayals, or bad?

 

In preparation for #GreatGamesDoneSlow we have prepared a non-exhaustive list of some of the best (and worst) mental health representations we’ve seen in games.

 

1. Games that Represent Mental Health Well

 

Hellblade

Hellblade: Senua’s Sacrifice is a dark fantasy action-adventure game developed and published by Ninja Theory.

Use of Mental Health Themes

The game uses the sound design, environment, plot and puzzle elements to communicate to the player the experience of psychosis. It’s a powerful and moving game, which is exceptionally rewarding. It was designed using input from people with lived experience of psychosis, and as such, may be harrowing for some players.

 

Life is Strange

Life Is Strange is an episodic graphic adventure video game developed by Dontnod Entertainment.

Use of Mental Health Themes

Many of the characters display signs of mental health issues, including both the protagonist, Max, and her best friend Chloe. This isn’t overtly clarified but there are realistic themes communicated, and the characters are nicely rounded. There is a link in the game to help-seeking resources.

 

Celeste

Celeste is a platforming video game by Canadian video game developers Matt Thorson and Noel Berry.

Use of Mental Health Themes

The very mechanic and goals upon which this game is based could be interpreted as a frank analogy for the journey of mental illness. The protagonist climbs a literally mountain, overcoming personal challenges. There are breathing exercises built in and the game offers distinct challenge levels to match the requirements of the player.

 

Psychonauts

Psychonauts is a platform game developed by Double Fine Productions.

Use of Mental Health Themes

The game involves entering the minds of various characters, and discovering their secrets and vulnerabilities in order to help them. Sympathetically approached and cartoon-like in aesthetic, so a nice simple look at the world of mental health.

 

Neverending Nightmares

Neverending Nightmares is a video game developed by Infinitap Games. It is a horror game drawing inspiration from the lead designer Matt Gilgenbach’s experiences with depression and OCD.

Use of Mental Health Themes

This is a psychological horror experience, which we usually discourage in games that portray mental illness – however it is a very powerful and cathartic expression of the developer’s journey. There are very dark themes here, explored through the visuals and overarching narrative.

 

Pry

PRY is an app hybrid of cinema, game and novel that reimagines how we might move seamlessly among words and images to explore layers of a character’s consciousness.

Use of Mental Health Themes

This app depicts a soldier’s PTSD through his eyes. I love the way the mechanic is entwined with that theme. It’s a great little game.

 

Night in the Woods

Night in the Woods is a single-player adventure game published by Finji.

Use of Mental Health Themes

Mae sees the world in a very specific way as driven by her personality vulnerabilities and previous experiences. This is an interesting look at an exceptionally well-rounded character, a real example of tangible and realistic portrayals of human psychology. In a cat.

 

Depression Quest

Depression Quest is an interactive fiction game where you play as someone living with depression.

Use of Mental Health Themes

Created by one of our featured streamers, Zoe Quinn, this game is a personal recollection and enlightening exploration of how depression limits our options and capacity in life.

 

The Cat Lady

The Cat Lady is an indie psychological horror graphic adventure video game developed by Harvester Games.

Use of Mental Health Themes

Though initially bleak, the story in this game has a positive message ultimately. There are themes of suicide, deliberate self harm, and graphic depictions of disturbing themes, so approach with caution.

 

Actual Sunlight

Actual Sunlight is a short interactive story about love, depression and the corporation.

Use of Mental Health Themes

As above, and is based on the developer’s personal experiences. This game is far more bleak and hopeless than the others, reflecting the darker side of mental illness and the lives that some people endure. Play with caution.

 

2. Middle-Sitters

These games could go either way, depending on your perceptions and vulnerabilities.

 

American McGee’s Alice

American McGee’s Alice is a third-person psychological horror action-adventure platform video game.

Use of Mental Health Themes

This game could go either way – the entire world is allegedly a manifestation of Alice’s psyche, populated by monsters she must fight to regain her sanity. In some ways, that’s a reasonable analogy, but it’s on a knife’s edge and could dip easily into using mental illness as a plot device, and misrepresenting traumatic experiences.

 

Town of Light

The Town of Light is a psychological horror adventure game developed by LKA.

Use of Mental Health Themes

Though this game doesn’t demonise mental illness, which is obviously a big no-no, it does use the protagonist’s experiences to portray her as an unreliable narrator which perpetuates negative stereotypes. The expose of the realism of asylums is powerful and important, but unbalanced.

 

Evil Within

The Evil Within is a third-person survival horror video game developed by Tango Gameworks and published by Bethesda Softworks.

Use of Mental Health Themes

Set in a mental health institute, which to be fair, at first is pretty realistic – the experiences you have in the dream space are not the most sensitively handled. Lesley is a sympathetic but unrealistic character.

 

Fran Bow

Fran Bow is an indie psychological horror adventure video game developed and published by Killmonday Games.

Use of Mental Health Themes

An important cathartic experience for the developer and for victims of abuse, this experience can be quite overly graphic (albeit in hand-drawn cartoon-esque scenes) and therefore makes it triggering for many players.

 

Until Dawn

Until Dawn is a horror adventure video game developed by Supermassive Games.

Use of Mental Health Themes

Though not overtly demonising mental illness, the use of a psychiatry trope as a plot twist is unhelpful at best. The experiences described are quite inaccurate and may perpetuate stigma. On the other hand, there is some sympathy communicated.

 

3. Games to Avoid

These games use tropes that cause stigma, or dehumanise sufferers of mental illness in some way.

 

Outlast

Outlast is a first-person survival psychological horror video game developed and published by Red Barrels.

Use of Mental Health Themes

Set in an asylum, portraying the mentally ill as unstable and dangerous, you spend a lot of the game murdering them. Incredibly irresponsible.

 

Manhunt 2

Manhunt 2 is a psychological horror stealth video game published by Rockstar Games.

Use of Mental Health Themes

Constantly overuses stigmatising stereotypes which are completely fabricated. Encourages the user to revel in murdering the mentally ill, and demonises those who care for them. Actively prevents help-seeking behaviours. Graphic and pointless depictions of suicide. To exemplify my point, I can’t find any screenshots that would be appropriate to post.

 

The Inpatient

The Inpatient is a psychological horror video game developed by Supermassive Games.

Use of Mental Health Themes

The developers of Until Dawn took a concept that was borderline, and went way too far. Uses psychiatric care as a horror mechanic and promotes stigmatising stereotypes (and language).

 

Sanitarium

Sanitarium is a psychological horror point-and-click adventure game that was developed by DreamForge Intertainment

Use of Mental Health Themes

This game is much older and filled with unhelpful tropes. Paints an unpleasant picture of mental illness which promotes fear and discrimination.

 

Blackbay Asylum

In Blackbay Asylum, you take on the role of a confused psychopath who finds himself able to leave his cell one day.

Use of Mental Health Themes

I mean, just read that description. Not sure what else needs to be said…

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