In 2014, Patrick Lindsay bemoaned the fact that, while there were increasing numbers of video games dealing with mental illnesses, the field as a whole was striking in its “woefully one-dimensional approach”. “Developers” he suggested “need to start from the person and work outward, rather than starting with the mental illness and just filling in the gaps”. Strikingly, when Shapiro and Rotter (2016) reviewed best-selling games from 2011 to 2013, a total of 42 characters were identified portraying mental illness. The majority fitted into the category of “homicidal maniac”. More recent games have addressed themselves to mental illness with greater levels of ambition and sensitivity, though, as Aaron Souppouris points out, with mixed results.

It’s a shame to see a powerful and maturing art form seemingly content to take a well-trodden path, badging insanity as a convenient shorthand to motivate an otherwise inexplicable threat of violence. Sad, but perhaps unsurprising given a much wider tendency to find explanations for shocking behaviours in simplified ideas of mental illness. Sad too given that video games are almost unique in their essentially active and participatory nature. The progress of the game, and of the story that unfolds, is dependent upon what the player does or doesn’t do, what pathways are explored, what patterns are learned, what possibilities are probed or rejected. The player, in taking the controls, tacitly agrees to see a strange new world from the hero’s perspective, to use that perspective as the basis for decision and action and to share the hero’s goals. Might this not confer the potential for establishing a remarkable relationship between the character and the player and, in doing so, could it enable more ambitious representations of mental illness, perhaps even engendering a very powerful sense of empathy?

Against a general background of simplification, stigmatisation and insensitivity, it’s good to record that my own experience of collaborating on a game has been highly positive. I was approached a couple of years ago by Ninja Theory, who were embarking on a game – Hellblade – featuring an 8th century Pictish warrior who, in the throes of psychosis, must fight her way through a Viking hell. They wanted some initial information and advice, but this turned into a much more extended and collaborative dialogue, one further encouraged, shaped and supported by Iain Dodgeon at Wellcome.

Psychosis is a much-misunderstood term. It’s a description rather than a diagnosis and refers to a situation in which someone’s experiences and perceptions are at odds with those around them: a different – and unshared – reality, beset with voices and visions, bewilderment, uncertainty and profound changes in beliefs about how the world fits together. It has many forms and causes and can be powerfully stigmatising, cutting someone off from those around them who cannot share their experiences or their reality. The stigma is made worse because many associate it with a high likelihood of aggression and violence.

Given the need for empathic, honest portrayals of such experiences, and my sense that video games may offer something profound in this respect, I was enthusiastic. And I have been gratified, and often moved, by the efforts of its makers, to weave into their game a set of principles that have hitherto been more notable for their omission, as Lindsay and Souppouris ruefully note.

First, there has been an energetic, sometimes obsessive, desire for an accurate and honest representation of the experiences and perceptions that might occur in the context of psychosis. There have been numerous discussions on the neuroscience of perception, the nature of inference and the whole question of how (and whether) we can make sense of external reality when our access to that reality is indirect and partial. These have formed a foundation for thinking about what might be altered when conceptions of reality change as in, for example, hallucinations: when someone experiences the sound, sight, touch or taste of something that is not there. Our dialogues have been numerous and rewarding, sharing ideas, literature and long conversations. Things really took off when they included, from an early stage, a group of people who have lived experience of psychosis. The game has evolved over the course of these open discussions and has been profoundly shaped by much deeper appreciations of how the sufferer finds meaning and motivation within the experiences, how their nature, tone and intensity varies and how they might reflect that person’s past experiences and inner thoughts. The content of the game is coloured too by the recognition that it would be simplistic to assume that the experience of psychosis is all about, say, simply hearing a disembodied voice. Rather, it can be an all-encompassing change in the way a person experiences and makes sense of their world and reality, which may feel bewildering, novel and sinister: a puzzle with hidden clues making each day a challenge and a quest for comprehension. But it is a world that can be beautiful and meaningful too.

A second, and perhaps more important, principle, one that was established early on, is this: Senua – the sufferer – is the hero and not the hapless victim. She has her own history. Her ways of making sense of the world, as well as her voices and visions, are meaningful in the context of this history. She is an extraordinarily attractive character, vulnerable and clearly traumatised, often despairing, but stepping forward to face the next challenge. She is no victim and it’s clear that her character owes a powerful debt to the in-depth and often very personal conversations with those whose lives have been touched and changed by such experiences.

Third, the game is free of the standard trope that mental illness is the motivation for violence. Seeing the initial combat sequences reminded me of all the unsupported but emotive opinions that surround violence in video games. There seemed a danger that, once again, we were seeing a link between mental illness and violent behaviour. Undoubtedly this will draw criticism. Whether pointing out that Senua is already a warrior will answer this criticism remains to be seen. My own view, for what it’s worth, is that the vast majority of the violence is directed toward Senua rather than initiated by her. And, in that respect too, she has something in common with those experiencing mental illness.

Throughout the venture, it has been apparent to me that the Ninja Theory team have been doing something that was risky but important. The fact that they are representing psychosis in a game setting, which demands that the player fully engages with the experience rather than simply passively observing it, really excites me. Indeed, it provides a great opportunity to show, in the context of the game, that all of us are creating our own worlds and realities all the time. Of course, it would be fanciful and misguided to aim for a representation of psychosis that applies universally: everyone’s experience, as with everyone’s reality, is of course unique. The game is the story of one person but its creation has incorporated many views and experiences. It has actively avoided simplification or the presentation of a shopping list of disconnected symptoms. It is a game and its purpose is not to lecture or educate. But it does achieve, I feel, something special.

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