Evolution of Mental Health Representations in Video Games
Over the last few decades, video games have evolved from simple pixelated experiences to complex, narrative-driven art forms that rival films and literature in terms of emotional depth and thematic exploration. Among the most significant cultural shifts in the medium has been the representation of mental health issues, which has transformed in both quantity and quality over time. Approximately 1 in 10 of the most popular video games released over the past 20 years depict symptoms of mental illness. From the stigmatized portrayals of the past to the nuanced, empathetic depictions seen in modern titles, video games now have the capacity to offer powerful insights into the human psyche. This article delves into how representations of mental health in video games have changed, exploring both the benefits and challenges of these depictions.
Early Depictions: Stereotypes and Villainization
In the early days of video games (late 1970s to 1990s), mental health was rarely addressed explicitly, and when it was, representations were typically negative or reductive. Characters with mental illness were often portrayed as "mad scientists," deranged villains, or uncontrollable lunatics, perpetuating harmful stereotypes about individuals suffering from psychological disorders.
Stereotyping Mental Illness
Games like Maniac Mansion (1987) introduced characters like Dr. Fred Edison, a "mad scientist" archetype often portrayed as eccentric and mentally unstable, following a long tradition of depicting mental illness as synonymous with evil or irrational behaviour. These portrayals reflected broader societal attitudes, in which mental illness was misunderstood and often feared. Mental health problems were perceived as moral failings or threats to societal order, a perception mirrored in how game developers constructed characters.
The Asylum as a Horror Trope
Video games in the horror genre often relied on asylums as settings for terror, feeding into the stigma that associated mental illness with danger. Many games used abandoned mental institutions as places of horror and chaos, equating them with trauma and violence. The psychological suffering of characters was reduced to background noise, serving to heighten the game’s atmosphere rather than as a topic worth exploring with nuance.
In these early years, mental health issues were not presented as something players could relate to or understand; they were obstacles or plot devices to enhance a game’s emotional stakes or antagonist's complexity. Such depictions contributed to cultural misunderstanding and often fueled stigma about mental illness.
Shift Towards Nuance: Early 2000s to 2010s
By the early 2000s, there was a growing awareness of the need for more nuanced depictions of mental health in video games, which reflected broader societal conversations around mental illness. Although stereotypical portrayals persisted, a handful of developers began exploring psychological disorders as complex and multifaceted conditions, often doing so through the eyes of the protagonist rather than the antagonist.
Psychological Horror with Depth
Silent Hill 2 (2001) marked one of the first turning points in video game history concerning mental health representation. The game's protagonist, James Sunderland, embarks on a journey through the titular town of Silent Hill, confronting not only external horrors but also the psychological trauma of guilt, grief, and depression. Unlike the horror games before it, Silent Hill 2 framed these issues in a more mature, empathetic way. The town itself symbolized James' psyche, revealing that the monsters and environment were manifestations of his unresolved inner turmoil. Here, mental illness became not just a plot device but a driving force behind the narrative.
This shift to portraying mental illness as part of the player's journey reflected a broader cultural understanding of psychological disorders as complex and deeply personal experiences rather than externalized threats.
Playable Mental Health Mechanisms
Around this time, mental health began to be incorporated into game mechanics, further contributing to player empathy and understanding. Games like Eternal Darkness: Sanity’s Requiem (2002) introduced a "sanity meter" as a gameplay element, where characters would experience hallucinations and other disturbing effects as their mental health deteriorated. While still rooted in horror, this mechanic reflected a growing awareness that mental health was an integral aspect of human experience, even if it remained within the realm of fiction.
The success of these games encouraged other developers to explore mental health as a complex, often ambiguous issue that couldn't be simplified into "good vs. evil" tropes.
Modern Representations: Empathy, Realism, and Advocacy
In the 2010s and beyond, video games matured as a medium for storytelling, and this shift has been particularly notable in the exploration of mental health issues. Developers have increasingly crafted narratives that explore mental health with empathy, realism, and respect, challenging stigma and helping players better understand mental illness.
Mental Health as a Central Theme
Games such as Celeste (2018) and Hellblade: Senua’s Sacrifice (2017) stand out as examples of modern games that focus heavily on the internal struggles of their protagonists, depicting mental health challenges not as simple obstacles but as central themes.
Celeste explores anxiety and depression through its main character, Madeline, as she climbs the symbolic Mount Celeste. The game offers a poignant exploration of self-doubt, fear of failure, and the importance of perseverance, all while maintaining a hopeful message about learning to accept and live with one’s mental health challenges. The game’s narrative subtly conveys the importance of compassion and understanding, not only for the character but for players who may face similar struggles in real life.
Similarly, Hellblade: Senua’s Sacrifice focuses on psychosis and grief, offering one of the most sensitive and accurate portrayals of mental illness in gaming history. The game’s developers worked closely with mental health professionals and individuals who have experienced psychosis to ensure an authentic representation. The game features auditory hallucinations, visual distortions, and narrative disorientation, which help players understand the protagonist's psychological experience. By centering the game around a character with a serious mental health condition, Hellblade offers players not just entertainment but a window into a disorder that is often stigmatized and misunderstood.
Empathy Through Interactive Experiences
Video games are unique in their ability to let players step into another person’s shoes, and modern developers have increasingly leveraged this medium to foster empathy for those with mental health conditions. Games like Night in the Woods (2017) and GRIS (2018) explore depression and trauma through atmospheric storytelling, character development, and interactive environments, allowing players to experience the emotional and psychological weight of these conditions first hand.
In Night in the Woods, the protagonist, Mae, struggles with depression and dissociation, and the game tackles themes such as economic anxiety, friendship, and intergenerational trauma. Its portrayal of mental health is subtle and multifaceted, focusing on the everyday reality of coping with internal struggles rather than dramatizing them for shock value.
Indie Games and Mental Health Advocacy
The rise of indie games has also contributed significantly to mental health representation in video games. Independent developers, often operating with smaller teams and budgets, have more creative freedom to tackle sensitive subjects like mental illness. Games such as Actual Sunlight (2013) and Depression Quest (2013) were among the first to explicitly focus on depression, aiming to raise awareness and foster empathy through interactive storytelling.
Depression Quest, in particular, is notable for offering players a direct experience of living with depression. Choices in the game are presented with limitations to mimic the sense of helplessness that accompanies the disorder, providing players with a glimpse into how mental health can affect decision-making and quality of life. The game was designed as an advocacy tool, aiming to educate players about depression and combat the stigma surrounding it.
Challenges and Limitations
Despite these advancements, the representation of mental health in video games still faces challenges. One common criticism is that while games may strive for authenticity, they sometimes simplify complex mental health issues for the sake of gameplay. Additionally, there are concerns about how mental health conditions are gamified, with some players feeling that reducing psychological trauma to mechanics or puzzle-solving might inadvertently trivialize real-world suffering.
Moreover, although progress has been made, mainstream AAA games still occasionally revert to stigmatizing depictions of mental illness. Villains or antagonists are sometimes characterized as suffering from vague or undefined psychological conditions, feeding into stereotypes that equate mental illness with danger or evil, with studies suggesting around 75% of these portrayals present characters with mental illness in a negative light.
Simply Put: The Future of Mental Health in Video Games
The representation of mental health in video games has come a long way, evolving from simplistic, stigmatized portrayals to more empathetic and complex narratives. Modern games are increasingly becoming powerful tools for mental health advocacy, providing players with a deeper understanding of psychological conditions and fostering empathy. As the industry continues to evolve, it’s likely that video games will play an even larger role in challenging mental health stigma and offering therapeutic experiences.
Looking forward, the future of mental health representation in games could involve even more collaboration with mental health professionals to ensure accurate portrayals and innovative uses of interactivity to help players cope with and understand mental health challenges. As society continues to move toward destigmatizing mental illness, video games have the potential to serve not just as entertainment, but as important cultural tools for education, empathy, and healing.