Video Game Portrayals of Mental Health

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Welcome to our new series: Media Spotlights! This series will highlight and analyze any form of media or art relating to mental health. Of course, that’s a broad category and holds a wealth of meaningful content. Most anyone who knows me is well aware of my love for video games. Let’s begin this series by examining a couple of my favorite mental-health-related games.


Video games revolve around player engagement and choice—or appearance of choice. This huge focus on consumer involvement separates video games from other forms of art and media. When utilized well, a developer can use their game mechanics to invoke empathy and catharsis in their player base by their actions alone. Through the generation of active emotions, a game can not only deliver a message, but inspire a user to imbibe and personalize the message. Today, we’ll focus on three video games that effectively portray mental health—XCOM2: War of the Chosen, Wolfenstein II: The New Colossus, and Hellblade: Senua’s Sacrifice.

XCOM2: War of the Chosen

XCOM2 is a turn-based strategy game combining elements of base building, overworld interfaces, and cover shooters. The game sets on Earth in 2035 after humans surrendered to aliens following a brutal war. While most humans accept the joint government formed with the aliens, the secret operation XCOM aids and spreads a resistance to retake their planet. XCOM2 effectively utilizes mechanics to cause numerous emotional tears outside of cut scenes or scripted dialogue. As an example, soldiers can form bonds that give combat bonuses as they complete missions together. XCOM2 lets you customize soldiers and create custom posters of your various pairings. One can’t help becoming attached to long-lived bonds, especially since you’ve spent time in crafting the duos. If one “bondmate” dies in battle, the other bondmate screams, fires all of their ammo at random enemies, and then bends over and can’t participate in your next turn. Additionally, the surviving bondmate loses a lot of “will” which takes some time to recover. Truly a marvelous method of procedurally creating meaningful experiences. It was one such mechanic that inspired me to write this article.

XCOM2 models PTSD by having characters develop symptomatic traits if their overstrained. Every battle taxes a soldier’s will until they’re too tired to fight. Recovering will simply requires a soldier staying at base for awhile. However, if you forcibly send a tired soldier to battle, or if a mission becomes particularly stressful, negative traits develop. As fate would have it, Obsessive-Compulsive Disorder was the first trait I received. I’m not even kidding, of the myriad of disorders in the game, I got OCD immediately. When I saw the notification, my pupils widened in interest while my eyes narrowed in apprehension. Immediately, suspicions of stereotypical OCD portrayals occupied my thoughts. The disorder read:

Obsessive Compulsive Disorder – Has a chance to reload their weapon to full after their first movement action if their ammo is not full. (“To be honest, I can never keep my count straight. Better safe that sorry.”)

I’ve never seen any consumer media so accurately capture OCD, let alone in one sentence. Sufferers of OCD have issues dealing with uncertainty. In their eternal struggles with intrusive thoughts, people with OCD reassure themselves that the thoughts must be 100% wrong—or, in some cases, 100% right. Grey area is unacceptable. In this case, XCOM2 states that you must be sure you have full ammo before every fight or else you might not have enough. Each soldiers gets two actions per turn, so the movement and reload consume your whole turn and the trooper cannot fire—imposing a very real and noticeable downside to having OCD. Comically, I constantly reload my guns in games. When playing games like Hunt, Rainbow Six, or Overwatch, I reload every single time I duck behind cover. In close quarter shooters, your enemy can hear you reloading and will try to approach you while you’re vulnerable. This creates a jumpy strategy where you try to only reload when your opponent does or retreat some distance before doing so alone. Despite the fact that constant reloading gets you killed frequently, I continue to reload my weapons every couple of seconds. As a result, I’m terrible at the games I just listed. I like them, but I’m the lead anchor of the team (especially in Siege). Through a single, simple mechanic, XCOM2 has captured both a literal manifestation of OCD and demonstrated the larger picture of compulsions.

Wolfenstein II: The New Colossus

Wolfenstein II is a steam punk first person shooter set in a world where the Nazis developed the atomic bomb before the US. The Nazis atom bombed Manhattan causing the unconditional surrender of the US to Germany. Wolfenstein II chooses to not overanalyze or commentate on such a reality. Instead, they decided to go for a fast-paced, fun, comical style and really leaned into it. The game is gratuitously violent and offers you about a hundred brutal ways to end Nazi lives. However, Wolfenstein II doesn’t only set out to bleed Nazis, but creates amazing and stylistic scenes, characters, and emotional moments. The cutscene “Drinking with Horton” captures exactly what I’m trying to say:

I absolutely love the team’s use of camera angles. Despite all the violence and drunken glory, this game boasts numerous touching moments centered around mental health issues. I’ll focus on two moments: a severally disabled individual destroys a superior’s possession and a semi-hidden NPC (non-player character) with a severe stutter.

Max Hass is a loveable and gigantic individual who accompanies your team throughout the game. Walking around a submarine that serves as your base, you can catch him drawing on walls and taking care of a pig that he refuses to let the crew eat. However, one particular cutscene stands out (17–50s):

Fergus served as a member of the Royal Air Force at RAF Kinloss during the war. One of his only remaining possessions from that critical period of his life, a shirt, gets destroyed by the mentally limited Max Hass. Understandably, Fergus becomes angry but then lashes out at Max. I particularly love this scene’s honesty about the difficulties of living with someone with mental disabilities. During elementary school, I had a neighbor who had autism. She was quite sweet, but would occasionally become aggressive and many kids avoided her. I fully believe that such individuals are innocent and mean no harm, but their actions still effect others. In this 33 second long scene, Fergus understands that Max isn’t too blame (“why wasn’t anyone watching him”) but becomes angry and mildly aggressive nonetheless. Interestingly, this confrontation occurs during a mandatory cutscene before a critical mission but is never mentioned again, i.e., the scene exists for its own purpose and character development, not to further some other aspect of the story. This interaction feels completely genuine and I appreciate the risk the developers took in creating the conflict.

While in the submarine, you can wander around and listen to many of your crew members conversing with each other. If you get to close to them, they’ll stop and say hello, and may or may not resume their conversation based on its content. Talking to a character can reveal their opinions on another character or they may tell you a small story. Midway through the campaign, a girl shows up in the corner of the armory. You’d be forgiven for not even realizing she exists. When you strike up a conversation, you immediately notice she has a severe stutter. Refreshingly, she doesn’t say “I have a stutter and here’s why,” she simply stutters. It’s a part of who she is and your interaction is completely natural. Virtually no one with a disorder states “I have a disorder and here’s my history with it” when meeting someone (Alex looks awkwardly in the mirror). Her natural conversation feels true to life. Of course, being Alex, I exhausted all of her dialogue and she does eventually explain that she was not born with a stutter. Rather, she developed one after she was forced to flee her town while Nazis destroyed, i.e., her stutter was a manifestation of PTSD—a legitimate symptom.

Wolfenstein II pays mental health homage by not only representing it accurately, but doing so subtly or via potentially contentious interactions. Most media that includes disordered individuals tend to unidimensionally define said character by their disorder. Yet this lone woman in a corner had a speech disorder that simply is and does not define her. While Max is much more defined by his mental impairments, the difference in definition is logical. Having a third of his brain missing, most of Max’s actions will be directly related back to this fact. Even then, a lot of Max’s expressions, such as painting on random objects, are only found if you go looking for them. Wolfenstein II lets you discover the mental health message.

Hellblade: Senua’s Sacrifice

Wow. Where do I even begin with Hellblade? This game is a masterful, insightful, beautiful, engaging, riveting, unabashed, terrifying, tear-jerking, inspiring, saddening, hopeful piece of masterful art. I can never truly express my love, adoration, and appreciation for the experience Hellblade offers. If you haven’t had the immense pleasure of playing this game, its only $30 and available on console and Steam. Get. It.

A Fuller Analysis

I plan on making a detailed review video and write additional articles about this game with the developer’s blessing. This article will only focus on one particular concept.

Hellblade: Senua’s Sacrifice is a simulation of psychosis with light puzzle segments and soulsborne combat. Arguably set entirely within Senua’s mind or within a barren landscape, Senua’s Sacrifice draws its environment from Norse mythology. Ninja Theory successfully set out to make a game that caused people to witness psychosis and participate in delusional activities. They collaborated with mental health institutions and consulted with people suffering from psychosis to ensure their designed experience actually emulated psychosis proper. Brilliantly, Ninja Theory laced the game with small mechanics that almost “trick” players into emulating psychotic symptoms. Today, we’ll focus on one before I bombard you with links to all the YouTube videos you must watch immediately or else.

The game fills your head with voices. There are three different voices that dance and spin around you at most times. They belittle you, insult you, dredge up your past. But they’re not always bad. Listen closely to this clip:

When in combat, the voices occasionally give accurate information about the location of enemies or instructing you to evade attacks that you cannot block. Through a few simple, well-timed line, the game causes you to trust the voices. The words and crafts swirling within your head and ears may have value and you need to listen. Maybe they tell you when you’re close to a clue, maybe they’re lying. Are the voices truth? Are they always right? How much should I listen to them? Is it dangerous to ignore them?

Senua also hears new voices during select memories. I won’t get specific here as it would necessarily contain huge spoilers, but I’ll say what I safely can. As Senua enters environments that revive old memories, various appropriate voices speak to her. During active recollection, the voices are definitely just those in the memory, e.g., hearing your mother’s voice when you remember her chastising you. However, those voices begin to creep into your head more regularly and inappropriately. By inappropriately, I mean that she’ll hear the voice of a friend outside of reliving memories, e.g., mid-combat. Ninja Theory brilliantly establishes real voices amongst the psychosis before contorting that belief into itself.

Hopefully I’ve piqued your interest in this marvelous work of art. Below are three videos/playlists I highly recommend you watch. They do all contain spoilers, so do not watch them until after you play the game—if you intend to do so.

Hellblade Feature
Hellblade Feature is a roughly 30 minute documentary made by Ninja Theory about how they approached Senua from a mental health persepctive.
Hellblade Development Diary
Hellblade was made on a budget. The Development Diaries detail how Ninja Theory made such an amazing game with few resources.
Living with Psychosis
Sidcourse sufferers from psychosis and reviews Hellblade in this light. I find this review captivating and suggest that everyone watches it.


Video games deliver messages through their mechanics, cutscenes, and characters. Developers can drive home messages through presentation and, more powerfully, participation. Engaging in the mental struggles of characters you’re invested in creates understanding and deep sympathy or empathy. XCOM2, Wolfenstein II, and Hellblade: Senua’s Sacrifice exemplify how to educate people about mental health through the medium of video games. Ultimately, creative and impactful presentation of mental disorders in consumer media will improve our acceptance of them.

Have a great day and always practice self-compassion!

A Fantastic Friend of Mine

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