Editor's note: This guest-authored post is part of iThrive's series on games and mental health. Articles in this series reflect iThrive's commitment to use and design games in support of teens' mental health and well-being, both within and outside of traditional therapeutic contexts.

Talking about mental illness can be difficult, confusing, and sometimes even scary. Many people first learn about mental illness from what they have seen on screen and from stories they have heard. However, relying on media portrayals of mental illness can leave people unprepared to empathize with someone coping with one since such portrayals are often exaggerated and promote harmful stereotypes. Independent video game developer Ninja Theory aims to change that with their latest and most courageous title, Hellblade: Senua's Sacrifice (rated 18+ years), whose heroic protagonist is no stranger to mental illness.

Senua's Quest
Hellblade: Senua's Sacrifice is the story of a young woman named Senua on her quest to save her slain lover. As she journeys through Helheim, the land of the dead from Norse mythology, Senua battles monsters, gods, and her own inner demons. If this game had been developed with only this premise it would have been intriguing enough, the gameplay would have been smooth enough, and the graphics beautiful enough to make it as entertaining as many other AAA games. However, developer Ninja Theory wanted to try something new.

In a behind-the-scenes interview, Tameem Antoniades, the Chief Creative Ninja of Ninja Theory, confirmed Senua suffers from "anxiety, depression, hallucinations, and delusions." To best capture what it is like for people who cope with these conditions, the developers worked with Professor Paul Fletcher, a psychiatrist and professor of health neuroscience at the University of Cambridge. The developers also worked extensively with people who had experienced psychosis and integrated their perspectives into the game. With guidance from both professionals and people with lived experience, Ninja Theory was able to create a detailed, immersive, and scientifically informed adaptation of mental illness for video game players to experience.

Senua begins her quest. Image source

In Hellblade, players experience a small measure of what it might be like to cope with severe symptoms of mental illness. For example, as soon as players start the game, they hear a series of voices telling them to turn back, questioning their every decision, and whispering worries of impending doom. These unsolicited voices warn, deride, guide, and encourage Senua throughout her quest. The audio was specifically designed so players would feel like the voices were whispering in their ears or circling around them, making it feel like the voices were in the player's own mind.

Several other aspects of the game were modeled off symptoms of severe mental illness. For example, the game requires the player to solve a series of puzzles to advance. To solve these puzzles, the player must find specific patterns in the environment. It is common for people coping with psychosis to see patterns where there are none, and this game mechanic was specifically designed to reflect that experience for the player.

Senua pieces together runes. Image source

Why We Need a Hero with a Mental Illness
The portrayals of persons with mental illness in movies, on TV, and in video games often feature disturbed, violent individuals and cackling villains. It's much harder to remember a hero with mental illness than to name scores of mentally ill villains. In Otto F. Wahl's 1995 novel, "Media Madness," he describes mentally ill characters as "more likely to be presented as villains than as heroes" (p. 66). Any "crazy," "psycho," or "schizo" villains are written to have originally been law-abiding and peaceful citizens who only become villains after developing a mental illness. This is harmful because it reinforces a social stigma that paints those who are coping with mental illness as dangerous, untrustworthy, or morally corrupt. In fact, persons with mental illness are not only less likely to perpetrate violence than they are to be victimized, they also are 12 times more likely to be victims of violence than persons without mental illness.

However misguided, stories about a pure-hearted and clear-headed hero who triumphs over the insane is how we express a fear of mental illness. Yet, to personify mental illness as a typically irredeemable villain, a being that can only exist in two ways — as maliciously powerful or permanently vanquished — does not inspire a deeper understanding of the complicated circumstances experienced by the mentally ill.

Hellblade confronts this stereotype by offering a character who is living with a mental illness and is also a hero. Her mental illness does not make her less human but instead makes her a more vibrant, complex, and sympathetic character. In other words, Senua is a fully realized character coping with a mental illness rather than a caricature playing out a tired stereotype. By inviting players to engage with a complex, humanized depiction of a person confronting severe mental illness, Hellblade creates a learning opportunity that can move the conversation about mental illness in a more compassionate and mindful direction by prompting players to consider the social stigma surrounding mental illness.

Senua battles Valravn, god of illusion. Image source

What Hellblade Offers Us
When playing Hellblade, players get to see someone with a mental illness as a hero and  as someone worthy of understanding and empathy. The game reminds us that people with mental illnesses are, despite marginalization and misrepresentation, whole people. The game also offers players the chance to compare their own struggles with Senua's. We have all, in some measure, experienced anxiety and depressive moods. By playing Hellblade, players are given a chance to think differently about their own struggles with mental health and how they have embarked on their own quests to find redemption, salvation, or simply some inner calm.

For those who have experience with mental illness, but have had trouble communicating their experiences to loved ones, this game offers a helping a hand. One of the greatest challenges when coping with mental illness is the struggle to properly communicate ourselves. Our common language (reflecting how little our society talks about or considers mental illness in everyday life) doesn't have a lot of readily accessible language for us to use to describe our complicated thoughts or feelings. This can leave us and our loved ones confused about the reality of living with mental illness. (Senua had it even worse, only being able to refer to her disorders as a terrifying and mysterious "darkness"). By showing others the depictions of common symptoms of mental illness that we see in Senua, we can show others a glimpse of our struggles and help them better understand us.

Throughout the game, Senua experiences anxiety attacks, flashbacks to trauma, out-of-body experiences, and hallucinations. According to the developers, in their behind-the-scenes footage, she even experiences episodes of compulsive behavior where she cannot to move forward in certain areas of the game until she accomplishes a task or solves a visual puzzle. People who experience any of these symptoms can use this game to show others a compassionate and heroic depiction of their struggles, something rarer and far more helpful than the villainous portrayals we often see in media.

Ultimately, Hellblade encourages players to be more mindful and compassionate of those who are coping with mental illness. Playing this game can help dispel some harmful confusion and stereotypes and give players an opportunity to practice compassion for others' mental health struggles. What Ninja Theory has done is recognized art's use as a form of interactive education and created an opportunity for any and all players to learn more about mental illness, in themselves and others, and stoked the conversation about mental illness and its representation in the media.

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About the Author

Courtney Garcia's writing focuses on the practical use of games and other forms of media as therapeutic tools for developing emotional intelligence. She is a lifelong gamer and has experience as a secondary school educator using games to enrich her social and emotional learning curriculum. She has seen, firsthand, the engagement and creativity teens experience when they approach games as educational tools that can boost their well-being, too. Courtney earned her BA from the University of California, Riverside, where she graduated magna cum laude before earning her Masters in Education. Courtney has published research in scholarly journals and regularly writes articles for Screen Therapy, a blog about games, movies, and how we can use them to help ourselves.