This is one of those times where you jump into something thinking that you’ll have much more to work with than is actually available. I pored through my games library looking for ones with ties to mental illness, but ended up with a list of only about twenty. It still feels like there might be some obvious ones absent, feel free to let me know if that’s the case.
Mental illness is something that touches most people at some point in their life. With an increasing awareness of it’s prevalence and the impact it has on those affected, the role it plays in our day to day lives finds representation in every form of art. There was, and is, a stigma surrounding mental illness that led to sufferers of a broad variety of illnesses being ostracised as crazy, subjected to inhumane treatment in asylums and denied basic human rights. While this trend has seen a great deal of change in recent years, these depictions of those afflicted still work their way into the narrative of books, films and video games. Games like Fallout, Hotline Miami and Grant Theft Auto V employ representations of mentally ill people as anti-social and psychopathic killers in order to justify the violent behaviour therein.
Examining the hefty toll that these illnesses demand is rarely the kind of introspective story offered by AAA games, but some use the moorings of a well-established genre to examine these issues. In Spec Ops: The Line, the player controls the captain of a Delta Force team sent to Dubai on a recon mission in what begins as a standard third-person squad-based shooter. After an incident where the player is forced to use white phosphorous on an enemy squad, killing multiple civilians in the process, Walker’s sanity is shown to deteriorate and his capacity to lead is called into question by his teammates. Eventually he’s forced into accepting the atrocities he has committed and rationalised to himself over the course of the game. It’s a brutal examination of PTSD and the desensitisation caused by the rise of the war shooter in gaming, and it plays to the strengths of the medium by forcing the player to make these choices and take these shots, then witness the consequences first-hand.
Silent Hill 2 similarly employed the trappings of the survival horror genre to explore the emotional trauma faced by James Sunderland, a man who has struggled to come to terms with the death of his wife, and the long-term illness which preceded it. A letter from James’ wife Mary, received three years after her death, invites him to the town of Silent Hill, wherein James encounters several others drawn to the town. Throughout the story it’s revealed that the other occupants have all suffered from trauma and that the town reflects each of their experiences. Eddie, who fled to Silent Hill after maiming a bully, is mocked and provoked to violence by the town. Angela, a victim of sexual abuse, had seen the town as constantly ablaze. James sees a woman who strongly resembles his wife murdered by a monster now synonymous with the series, Pyramid Head. Pyramid Head acts as a metaphor for the punishment which James feels he deserves, whereas faceless, buxom nurses represent the latent sexual urges he felt during his wife’s hospitalisation. The endings of the game revolve around the character either accepting and moving past his guilt, giving in to it entirely, or rejecting it and dooming himself to renew the cycle.
These examples focus on mental illness in a broad fashion, where it’s more plot device and metaphor than the primary issue to be dealt with directly within the game. Games of the latter sort don’t tend to fit with the genres that generate huge interest with bigger publishers. Indie developers take the reins here, and the smaller development teams lend themselves to much more personal experiences that deal with the issues in much closer detail.
Developed and published by Minority Media Inc., Papo & Yo reflects the designer Vander Caballero’s life growing up with an alcoholic parent. It opens with a Brazilian boy, Quico, hiding in a closet from his drunken and enraged father. There he finds a door to another world, where he is guided through a favela by a young girl named Alejandra and assisted by his toy robot, Luca. He encounters Monster, a huge and docile creature who is normally playful but becomes violent when he consumes frogs. The comparison is blatant, but no less poignant for it. Interspersed between levels are flashbacks to Quico’s real life, where he witnesses his father run over someone during a rainstorm. Alejandra is eventually caught and eaten by Monster, but directs Quico to a Shaman so as to find a cure for Monsters addiction. This proves to be in vein, as Quico finds only memories of his father where the Shaman should be, and is advised that there is no cure other than to let him go. It’s an emotional and tragic insight into the mind of a vulnerable young person growing up alongside addiction, set against the backdrop of a colourful puzzle-platformer.
The Beginner’s Guide, written and designed by Davey Wreden (creator of The Stanley Parable), tells a more overt story of a game developer named Coda who Wreden had met at a game jam in 2009. Wreden provides narration as he guides the player through multiple unfinished games sent to him by Coda, with the aim of understanding the sort of person Coda is through the games he’s made. An ongoing analysis of Coda’s supposed mental state is given by Wreden as the player progresses, with him noting that many of the games are set in prisons, or are unbeatable by design, and are filled with dialogue indicating that game development is no longer proving enjoyable. The concern that these are indicative of depression leads Wreden to share some of the game concepts with others, in order to garner feedback that might encourage their continued development. This had the opposite effect, and Coda withdraws further. One final game sent to Wreden includes messages stating that he had misinterpreted the games intention, and that it was a betrayl of trust to show them to others. He asks that the pair break contact, and for Wreden to stop showcasing his games. With this it’s revealed that the purpose behind releasing The Beginner’s Guide is to reconnect with Coda by sharing the games with the public at large, thereby repeating the mistake that had caused the rift in the first place. It ends with a reflection by Wreden on his need for validation and with him surmising that this was most likely the reasoning behind showing the games to others. It remains open to interpretation, but serves as a warning as to the dangers of projection and how coping mechanisms can be subverted by people attempting to assist without the proper tools to do so.
The above two don’t offer any advice or answers as to how to appropriately cope with mental illness, but do offer excellent insights into the mindset of those suffering with them. It’s difficult to recommend a game that would function appropriately in a therapeutic function as treatment varies depending on the individual, but kudos have to go to those involved in the Self-Care Game Jam for making some games that might serve to benefit those suffering from anxiety or depression. Also in that category are Anxiety Gaming, a non-profit organisation who aim to provide support and mental health resources for the gaming community at large.
There are a couple of games that warrant honourable mentions for how they incorporate mental health issues. Max Payne is shown as being haunted by the death of his wife and child, and featured an iconic sequence where he walks a dark and bloody path, following the cries of his murdered baby to a blood-spattered nursery. Double Fine’s Psychonauts was a light-hearted platformer but the levels explored the war-torn psyche of Coach Oleander, and the unhappy childhood the protagonist Razputin spent as a circus acrobat. Stardew Valley, the indie spiritual successor to Harvest Moon, has a number of engaging side stories featuring each of the other characters in the game. Including one where the player helps an alcoholic townsperson beat their addiction.
This isn’t to say that the representation has to be accurate to be enjoyable, some games work it in to great effect in terms of their gameplay. In Eternal Darkness: Sanity’s Requiem a sanity meter causes varying effects as it lowers. Your character might seem to disappear through the floor, or the volume could shift up and down. One by one, your characters limbs might simply pop off. Playing as a member of the Malkavian clan in Vampire the Masquerade: Bloodlines leads to all of the players’ dialogue options turning to insane ramblings, the TV speaking to them, and arguments with stop signs. Sunless Sea has a terror meter that increases as time is spent at sea, resulting in hallucinations and increasingly tense interactions with other members of the crew.
Accurately discussing and engaging with the subject of mental illness is a challenge regardless of the medium it’s represented in, and while it might not be the stuff of many million dollar games, we’re lucky to live in a time when those with the passion to share their experiences can do so without necessitating a large team or a huge amount of capital with which to fund it.