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Mental Health In Videogames: Why Is It So Hard? Part 2

So, two weeks ago I wrote about mental disorder representation in games. I'll admit to it being a somewhat rambling piece where I discussed positive and negative representations of mental disorder (although, it was mostly on depression, and a bit on schizophrenia). I had dipped into some of the reasons why negative representation occurs, but I wish to further elaborate as it is a complex issue. It's an occurrence that has many reasons, some that is the blame of people and others that are inherent to mental disorders.

So in this article, I will be talking about five of the factors that influence the representation of mental disorders in videogames. The list is hardly exhaustive, and even includes some overlaps in terms of the effects they have, however the items listed do appear to be some major problems to consider.  Like I said last time, keep in mind that I am not a professional in the mental health field so I may be incorrect. As always, if a paragraph contains a spoiler of a videogame, I will write in italics the videogame name before the paragraph so you know to skip it.

So the first influence exists outside the videogame industry, and more in the videogame industry's biggest inspiration: Hollywood. An inspiration that runs deep for many reasons and shows up in many ways. One such way this Hollywood Effect shows up is the drive for cinematic gameplay, which is gameplay that mimics the cinema experience. This inspiration does end up affecting the representation of mental illness. For instance, the display of schizophrenia in Lynch in Kane & Lynch: Dead Men is influenced more by pop culture than fact. This leads to sometimes simplistic (e.g. Darkest Dungeon with regards to all mental illnesses) and sometimes flat out wrong (e.g.  Billie Church in Clive Barker's Jericho as schizophrenic, although credit is due that they didn't make her a violent schizophrenic which is a low low percentage of schizophrenics) representations of mental illness.

Ah yes, the Hollywood cinematic experience.

Very similar to this influence, is also why some mental disorders are under-represented in videogames (e.g. personality disorders, at least as a non-enemy which occurs due to the Hollywood Effect). Like clothing, mental illnesses can become fashionable in the media. These can occur for various reasons, such as awareness campaigns (for depression) and popular films (then Multiple Personality Disorder due to Three Faces Of Eve, now is Dissociative Identity Disorder).  As the mental disorder enters the public eye, the portrayal of them can become people's perception of the condition. For example, the representation of schizophrenics by the news (as violent crimes committed by those with schizophrenia leads to a focus on them having schizophrenia) leads to the viewpoint that schizophrenics are violent. If there has been no representation, or a negative representation, this can lead to an inaccurate and potentially offensive perception of the mental disorder.

What these two influences have in common is they're rooted in the source of information of mental illness. Out of the five factors, these two are the easiest to solve as they involve doing research on mental health. While it's impossible to suddenly know of a mental illness's existence, it is possible to rectify misconceptions of a mental illness you wish to cover. There is the dry way of doing it of reading through the psychological theory behind the condition.

However, at the very least there should be reading of those with the condition (either written by those with it, or a company who has no motivation to twist it) or perhaps watch a documentary on it. While it is not everyone's goal to give an accurate portrayal, and that's fine (e.g. Darkest Dungeon is pulpy while focusing more on stress management), but if you wish to attempt for a correct portrayal research needs to be done to avoid creating misconceptions.


The next two problems that exist with regards to the portrayal of mental disorders in characters does stem from what is a mental disorder and how is it classified.

The first is the vagueness of mental disorders. Let's consider one of the most popular mental disorders: Depression. This is a mental disorder that is classically characters by feeling depressed. A sensation described by the NHS as “[feeling] sad, hopeless and [losing] interest in things you used to enjoy”.  Using this simple description actually helps illustrates some of the problems of diagnosing. So when it says you have to feel sad, how sad is sad enough? After all, sadness is not an on-and-off switch but rather a degree of severity. Do you just have to feel uncomfortable with your current situation, or have to be crying at night? With regards to hopelessness, are we talking about a feeling of unable to change things or about things are about to go terribly and there's nothing you can do? Do you have to lose interest in one thing, or everything?

There are other symptoms to go along with this, each one of these have to be self-reported by the individual feeling these sensations. They first have to be acknowledged as abnormal thoughts and not just “things that just happen”. Next, they have to be described to a professional who uses their perception on the narrative being told to decide if the individual does or does not have a mental disorder. If they do have one, then which mental disorder do they have? There are many problems with self-reporting symptoms for diagnosis, but I will only talk about one to save time (if people want me to elaborate, I'll be willing to write a future article on it).

In 1974, Loftus and Palmer devised an experiment. They showed people a clip of a car-crash, and then asked how fast the cars were going when they smashed/collided/bumped/hit/contacted. Depending on the word used in the question, people estimated the cars were travelling at different speeds. By the use of a singular word, the memory of what they had seen had been altered. Consider what would happen if an individual used the phrase “Lately, I've been sad/depressed a lot”. It's simplistic to boil it down to a phrase, I'll admit, but phrases can load the rest of the conversation and create expectations. This type of phrasing is most likely unintentional, but the effects are the same.

Surprisingly, in the study they didn't use the question "How fast do you think the car was going when it crashed after being stalked/hounded/harassed/chased/tailed by the press."

Things like shows that mental disorders is actually a very complex yet vague thing. The difference between mentally ill and mentally well is an imbalance of hormones, a singular event and/or a phrasing of something as abstract and complex as mental thoughts. So to be able to convey something this abstract and complex in a plausible, interesting and representable manner is a hard task. Especially while making the mental disorder noticeable for people to pick up on with a resemblance of certainty, but not  invasive enough to make the character a singular note. After all, things like a mental disorder can colour a character, but it shouldn't be the entire colour nor unnoticeable.

Now, if this wasn't hard enough, you face the second problem: The variation of those with the same condition. While not impossible, it's hard to find two people who experience the same mental disorder in the same way. Two people with autism will very likely experience anxiety differently, struggle with social interaction/language in different ways and feel attached to order for different reasons. That's even ignoring severity of mental illnesses do vary wildly from barely noticeable to being required to live their life in a ward. So this creates a problem: How do you make a mental disorder representable?

The only hope you have is to avoid depicting the same type of symptoms. Talking about the schizophrenic with the paranoid sub-category is a tale that is old, especially with regards to aliens or governmental conspiracy. What about the Residual Type, where hallucinations and delusions are in a low intensity? Maybe you can have an autistic individual who isn't high functioning, but rather low-functioning?

Neo Nazi without a balding problem?

These two problems are things that can not be helped really as they stem from the complexity of human thought. As mentioned, one of the main ways you can help create an interesting and believable character is to pick a less mainstream interpretation of the condition that still falls in line of what is to be expected of the condition. Besides that, all that can be done is to be cautious, do research on people with the condition and go from there.

The final problem is one that affects some conditions more than others. Some mental disorders can be hard to represent in a way that doesn't create other problems. Some scenes that could appear in videogames due to mental illness of a character could be distressing, not only to those without the condition but also those with it. A classic example of this is suicide in videogames. In those without the condition, it can stir up reminders if they knew someone who also killed themselves as well as be particularly shocking to the player. To those who have thought about suicide, it can trigger suicidal thoughts as they are reminded of the desire to leave. This is why on some websites, they use the term “trigger warning” if they are about to talk about suicide, so those who may be triggered by themes such as this can avoid seeing it.

Zero Escape: Virtue's Last Reward

Likely due to it being a touchy subject, is why suicide is relatively rare in videogames and why experiencing the individual committing the act is especially rare. Off the top of my head, the main example I can think of where a game depicts an individual trying to commit suicide on screen is Zero Escape: Virtue's Last Reward. One of the times you experience a child who is 10 yelling “I have to get out of this body! They can't lock away the soul! Once my body's gone, my soul can escape! Please! You have to let me go! I'm trapped here! Let me die! I have to die!”. There are more like this. While it's not due to a mental disorder, it's obvious that this could act as a trigger to some.

So, needless to say, great care has to be made crafting characters doing things that could create severe discomfort in the player. Unless, of course, that's the point, which is fair enough. Although at least warnings should exist if such themes are in the game so those who may be triggered by suicides in videogames can avoid it.

So, as stated earlier this is hardly a comprehensive intense look at all the problems of depicting mental disorders in videogames, but they are a few factors that I believe are important to note. However, as I've stated a few times through-out, it's okay for a videogame to not try to depict mental illnesses in a realistic fashion if it serves the goal. It's okay for Darkest Dungeon to take hints from the pen & paper game Call Of Cthulhu in infecting it's characters in a Hollywood-esque depiction of various mental illness. It's okay, because the simplistic nature of doing so allows the player to not get bogged down about the ins-and-outs of each condition. However, the developers shouldn't expect anyone to find a character that is built badly with the mental illness poorly implemented remotely interesting or enjoyable.

Horror games where the main source of fear is of those with mental disorders are even worse than bad characters.

While I haven't dabbled really with regards to trying to simulate mental illness in videogames, a lot of the problems mentioned above do apply. Especially the complexity, as you are trying to simulate why a mental disorder creates one way of thought rather than another. As said before, the closest I know of a good mental illness simulator is Depression Quest as it uses mechanics to show how some options can be cut off due to feeling too depressed or hopeless. Although I do hope in the future that there are more depictions of characters with mental illnesses and good simulations of mental illness. As isn't one of the goal of videogames to help explore new and exciting narratives?


So, through-out this article I've discussed the problems of mental health diagnosing. However, I speak from an element of personal experience that it is better to seek help rather than suffer in silence.

During my fourth year at university, then doing a Masters in Social Research Methods, I had slowly been stressed out. I had lost friends, one or two friends I knew had finished their three year course and moved away and I was slowly becoming distrustful of the field (as I learned some ins-and-outs that somewhat disgusted me about sociology). I'd even had to abandon going home for Christmas (I lived the other side of the country) so I could catch up with work that I'd slacked off due to focusing problems.

It was in January that things started really going badly. I had received some shocking news about someone I knew (all I'll say is it wasn't a health issue, and it didn't really affect me in any real way), I had deadlines around the corner and I was surrounded by people who were obviously not on a similar mental thought pattern so I had no one to really discuss things with. So I began failing things I should have passed, as I was unable to focus in on the work. I began panicking more-so than usual. I had to even excuse myself from lectures a few times so I could take a breather as being in the room made me feel miserable.

It took a few months of this, to finally admit defeat and look for counselling help. The first meeting was just an assessment meeting, and upon talking about most of the symptoms (I kept some things to myself) and even included my previous mental health diagnosis, they labelled me with depression and told me to go get medication. I responded that I'd rather just have the CBT, and no medication.

Both counsellors who I saw in the limited time I had left before I ended up full out failing the course were people who saw past the easy diagnosis and said it was my existing anxiety-condition being more intense.

While I can't say if certainty if they helped me out of the emotional problems I was having, they could have gone for an easy diagnosis and tried to get me on medication. Instead, they decided to help with the anxiety I was facing which had started to create depression-like symptoms with CBT.

So, despite all the problems I've mentioned as well as more (e.g. preferring type I error to type II error (a.k.a prefer to diagnose where no mental illness exists, than to not diagnose where one exists)), it's still important to look for help if you need it. Failing seeking help in the usual counselling/psychiatric way, there are communities out there willing to talk about any mental health issues such as Reddit. This isn't limited to depression, which in the wake of Robin Williams is the in-thing, but includes many other types of conditions if you feel you must discuss them. Just don't worry, there's always someone somewhere out there happy to just listen.

I think after all that, we could both do with some nice pictures.

Note: I'm sorry this took two weeks to write. It was due to me getting a bit ill recently. Not entirely over the illness, but I'm nearly there I think.
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About Riobuxone of us since 5:18 AM on 03.23.2013

Hey, I'm Riobux. I joined Destructoid a good deal back due to Podtoid when Jim Sterling, Jonathan Holmes and Conrad Zimmerman used to do it, and when Phil & Spencer did the Destructoid Twitch channel. I'm a Sociology With Psychology graduate who has a particular interest in videogame culture and the creation of videogames. These days I just punt out recaps, but you can also find me creeping around news story comments.

When I'm not here attempting to act like a civilised being, making odd jokes only I snigger at or being way too late with posting recap, I can be found on Bagogames attempting to ramble as a previewer/reviewer.

You may also find me working out how the hell the new strange world of social media on Twitter works at @Riobux.