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16th Oct 2018

How a new breed of video games are exploring mental illness in ways movies or TV never could

Wil Jones

Brought to you by Time to Change

One of the most difficult things facing those affected by mental illness is simply explaining what it is like to the people around them

Unlike physical ailments, there are often no visible symptoms. Well-meaning acquaintances offer up advice like, “Just don’t worry about it,” or “Try not to be sad,” with no idea how unhelpful that is.

There have been many admirable movies, books and television shows that have tried to illustrate the experience of living with mental health issues. Some have done an excellent job of it – and some less so.

Yet possibly the most interesting way this subject is being explored is through the medium of video games.

Far from the Uncharteds and Call of Dutys of the world, underground, independent developers – and sometimes even just a lone coder – are putting their experiences into games.

(Note: many of these games deal with mature themes and depictions of mental illness, that could be triggering for those affected by the issues discussed).

“When you have an anxiety/panic attack, you only have one thing in mind: survive.”

Take, for example, Anxiety Attacks, created by Italian one-man development team Alessandro Salvati. The first-person game sees the player walking through a forest, while you also control a simple rhythm mechanic that represents your breathing. The aim is to find safe zone orbs in the forest, but the player is bombarded with blinking, almost subconscious messages like “Am I crazy?” and “I’m desperate… I can’t breathe”.

Salvati himself has lived with anxiety, and based the game on his own experiences. “After years of inappropriate therapies, and since I felt very shy about posting a game publicly, I decided that making a game, even a small one, would have been nice,” he explained.

“I couldn’t do much more than staying home crippled by anxiety and panic attacks, but I still had my programmer skills. Coding is my passion, and that was my safe place. So, when deciding what to create, well, I couldn’t find any better subject than anxiety itself”.

As the game progresses, dark storm clouds periodically swarm the player, throwing the breathing meter out of whack. It seems simple, yet it becomes a genuinely stressful experience, as gruelling as any Resident Evil game.

This was definitely Salvati ‘s intention. “Suffocation and the feeling of passing out are a strong and pretty common manifestations of anxiety. Even the simplest thing such as breathing becomes a struggle. Doesn’t matter if the sense of danger is real or not. Your perception is tricked. You feel like dying.”

“When you have an anxiety/panic attack, you only have one thing in mind: survive.”

Anxiety Attacks is far from the only game like this. Dr. Sachin Shah is part of Gaming the Mind, a group of mental health professionals who look at issues around mental health and video games, and he says there is a long list of interesting indie titles that feature autobiographical takes on mental illness.

“Where you previously had options in the game, the depression is cutting them off.”

One of the games he thinks does it best is Actual Sunlight, made by independent Canadian developer Will O’Neil, again based on his own experiences. On first glance, Actual Sunlight looks like an old-school, top-down RPG, like the 16-bit versions of Zelda or Final Fantasy.

Only the protagonist of Actual Sunlight is not a battle-hardened warrior or powerful mage – instead, you play as Evan Winter, a young professional in Toronto who experiences severe depression.

The game takes the familiar RPG engine and plays with your expectations, revealing the reality of Evan’s life. As life gets harder for him, the traditional action boxes disappear or repeat themselves, as depression takes its grasp.

“There is a bit at the end, not to spoil it, but just as he gets more desperate in his thought patterns, you are losing options,” says Shah. “Where you previously had options in the game, the depression is cutting them off. It is telling someone who has not been in that situation, this is how it gets – it gets very tunnel vision, where you don’t see any other way out”.

“Games that explore the human experience.”

Not every game concerning these subjects is about self-expression though – they can also work as a tool to educate people close to those with mental illness as to what their loved ones are going through. Doris Rusch heads up the Deep Games Laboratory at DePaul University in Chicago, which aims to develop “games that explore the human experience”. Rusch has a humanities background and came to game design late. She saw the potential for games to bring difficult abstract to life, and her first project, Akrasia, dealt with substance abuse.

Her 2010 game Elude conceptualises the experience of living with depression as a 2D platformer, with a free-flowing top level and a slow-moving underground representing the protagonists changing moods. It came about explicitly to explain the condition to those close to people going through it.

“I was in touch a psychiatrist that I met at the Games for Health conference the year before,” Rusch recalls. “When he heard me talk about the substance abuse game, he approached me and asked if we could make a game together”.

“His motivation was that caregivers and the families of people with depression often have a really hard time understanding what is going on. And so the purpose of the game was not just an expression of what it is like to have depression, but also with an eye on communicating it to others, and to promote a dialogue and understanding.” And Rausch says she has had many people come up to her, thanking her for helping them understand what their loved one is going through.

“We start seeing people as just shapes, not as real people.”

Mental health is also being tackled in more mainstreams titles, and games that are not explicitly about serious issues. Night In The Woods was one most acclaimed adventure games of last year. On the surface, it is a fun, colourful exploration game. In a small town full of anthropomorphic animals, you control Mae, a young cat who has returned home from college to find her hometown has changed, and there is something mysterious going on in the woods.

But the game is far more than Stranger Things with cute critters. The creators of the game have been open about their own mental health experiences, and programmer Alec Holowka even co-hosts a podcast about the subject. No mental health condition is explicitly mentioned, but it is clear Mae is going through a tough time.

“They never say outright what she is going through, but there is a great depiction of what seems like dissociation, which you don’t see very often in games,” says Shah, praising the way the game depicts it. “We start seeing people as just shapes, not as real people. And that could be an example of dissociation.”

“I like it also because of how supportive all the characters are when she is going through this stuff,” he continues. “As far is being a good role model of how to treat your friends who are going through this, it really normalises stuff. From her perspective, she’s not having a good time but no one else is giving her a hard time about it.”

“You sympathise for the person that it is happening to – because it is you.”

Dr Shah thinks mainstream games still have a long way to go in terms of their depiction of mental health. Just like movies and TV, too often a mental illness is used as an easy shorthand to motivate a violent character. “There’s a big trope of having the villain have a psychiatric condition,” he says, pointing to Far Cry 3’s Vaas as a perfect example. “They perpetuate the stereotype. People with mental health issues are less likely to be violent than they are to have violence perpetrated against them”.

Yet games have so much potential for educating people on the subject, especially when compared to more traditional forms of media. ”Books and movies are passive experiences, and video games are active, so you are putting yourself in the shoes of the characters, making decisions for them, and experiencing those consequences”, says Shah. “It helps you identify more with what is going on, and also sympathise for the person that it is happening to – because it is you”.

Games are shaping the future of entertainment, and we are only just scratching the surface of their possibilities. More and more, it is the medium where we are going to be talking about the important stuff. “Video games are the biggest entertainment medium in the world,” Shah points out. ”So if you want to get your message across, you can do that more through video games. You are going to get to more young people. It is just how people communicate these days, through interactive experiences”.

For more information about mental health campaign Time to Change, visit their website.