Content Warning: This feature contain discussions of depression, anxiety, self harm, suicide, claustrophobia, torture, abuse, and today’s topic. This will also includes topics which are sensitive and also can be considered “dark” hence, readers discretion is advised.

Also, major spoiler warning.

Hello everyone! It has been more than a year since we released the first article of the ‘Mental Health in Gaming’ feature series.

In our first MHIG feature, I talked about the indie game GRIS and the topic of grief. You can check it out here.

The topic of mental health is an important to discuss, especially where video games are concerned. Judging by the reception and feedback we got for the first article, it seems that you agree.

One of the feedback we got was from a psychology student. They told us that despite the fact that they has studied about grief, the feature actually gave them a new perspective about the topic and also made them understand that each step of grief serves a purpose.

With comments like this, we knew we had to do another one. And so, for World Mental Health Day, I wanted to do another feature for this series and talk about a game which (in my opinion) should be the very first game that should be mentioned when the topics of ‘mental health’ and ‘games’ is brought up.

The year 2017 ended up being a really good year for gaming.

Nintendo released the Legend of Zelda: Breath of the Wild, which not only redefined the open world genre but also ended up setting an industry standard.

Atlus released Persona 5. Its story, loveable cast of characters and overall visuals ended up making it a beloved JRPG.

In addition to all of this big news about big games, there was a game that made many skeptical at the time. A game that was (by then) made by a newly-formed indie studio and which they self-described as an “independent AAA game”.

It was a game that more people need to play and a game that I consider to beone of the most important games of 2017.

The game is called “Hellblade: Senua’s Sacrifice”, developed by Ninja Theory.

At this point you might be curious to know about what the game is all about. The story, lore, characters etc. What make this game really special, anyway?

However, if I were to shortly summarize the plot of the game, it will mostly sound like the game has a very simple plot: a girl who is going to the underworld to save her beloved dead husband.

Summarizing it this way feels like the famous iceberg meme. The top of the iceberg has the “simple” plot mentioned above but the deeper you go down the iceberg, the more darker and scarier the story gets.

Hellblade: Senua’ Sacrifice tackles the topic of “psychosis”. In a way you could say the entire game is based around the concept of psychosis.

Before talking about the game let’s get our definitions in order so the information is accurate.

Psychosis 101

Psychosis is defined as a condition that affects the mind and how you see the objective reality. It causes the person to lose touch with reality as they might see, hear, or believe things that aren’t real. But there is something you should keep in mind:

Psychosis is not a illness but rather a symptom for other mental disorders such as severe depression to schizophrenia to dementia and even stress.

Psychosis is often characterized by two main symptoms: one is delusion and other is hallucination.

Delusions is a false belief or impression that is believed upon even if its contradictory by the truth or reality.

Hallucinations is where someone experiences perceptions whether its seeing, hearing, tasting, or feeling things which are real but it only appears in their mind.

The topic of psychosis is sadly considered taboo and mental illness is rarely acknowledged in other forms of media such as movies.

When it does feature, both psychosis and psychopathy are somehow combined and associated with the lack of empathy. This creates an unfairly negative perception towards the condition and those who face it.

According to National Health Service (NHS), someone with psychosis has a short-term (acute) condition that, if treated, can often lead to a full recovery but a psychopath is someone with an antisocial personality disorder who lacks empathy.

Ninja Theory consulted with Professor Paul Fletcher (Psychiatrist and Professor of Health and Neuroscience, University of Cambridge) when making the game.

In fact, his name is the first name to be shown in the opening credits in this game, that’s even before the people who created the game!

The developers of Hellblade worked with experts and institutes in the field of mental health. According to them, not only they did not know much about the topic but also they themselves knew that making a game about a character suffering from psychosis and mental health was a very risky venture. Any inaccuracies in the depiction could potentially harm how groups of real people are seen or treated.

According to NAMI (National Alliance on Mental Illness) “In the U.S., approximately 100,000 young people experience psychosis each year. As many as 3 in 100 people will have an episode at some point in their lives.”

One of the most infamous cases of Indian history, known by as the “Burari deaths”. The police have ruled that the deaths were motivated by shared delusion or psychosis.

THE SETTING OF HELLBLADE

It is about time where I told you about the actual story of this game.

Hellblade is a story of a Pict warrior named Senua, who journeys into the Norse underworld called Hel (or Helheim) in order to rescue the soul of her dead lover from the goddess Hela.

As for Senua, well she suffering from severe psychosis.

Instead of talking more about the story, it would be much better to understand the setting of the game as you will get a clear picture on what’s going to happen.

From the 3rd to 10th century, there were a group of Celts that lived in Northern England known as the Picts. They were known to be fearsome warriors and for their distinctive warpaint. Orkney, an archipelago in Scotland were known to be inhibited by the Picts and the developers made that to be Senua’s home.

In the last 8th century, the Vikings arrived on Orkney island and the population of Picts began to drop. And in the following century Norsemen came.

Many cultures have viewed mental illness as a form of religious punishment or demonic possession. This also applies to Celts too but, they had a very different perspective regarding mental disorder and used a term called “Gelt”.

Gelt is a man or a woman who is driven by a curse, battle trauma, or grief. Gelt would take to a life in woods in search of penance, punishment, and purgation.

The village branded Senua as a Gelt as she was cursed by “darkness” and has gone to the wilds to search for redemption. Also, Senua happens to be the daughter of the villiage chief but despite this, she was not given any differential treatment.

Another word they used for Gelt is “Druth” which means a fool or liar. One who utters the words of god.

There happens to be a character named Druth in Hellblade. This character is inspired by a man named Fridan who is an Irish Celt who was enslaved by the Vikings and later escaped to Orkney and became a monk.

After Senua meets Druth, it is the stories about the Northmen and their beliefs and culture that he tells Senua that fuels her quest.

A quest that is filled with mental and mythological elements. A fantasy created by Senua’s own mind and we are going to experience it with her, along with her, from her eyes, from her perspective.

(If you wish to not get spoiled by the story you can skip the next subheading)

A STORY OF DELUSION

The game starts with a long opening sequence of Senua arriving at the border of Hel.

Senua herself believes that she is suffering from a curse which allows her to hear the voices of the spirits which she refer to them as the “Furies“.

It is these Furies that introduce us to Senua and set the stage for the kind of game that we will be playing during the opening sequence.

Along with the Furies, she is also followed by Darkness, a dark entity who seems to have cursed her.

If we are to follow a hero’s journey, we should already know that there will always be some hardships, it won’t always be simple.

For Senua to enter Hel, she needs to overcome tests which are located in two domains controlled by the Fire Giant Surt and Valravn, God of Illusions. She needs to defeat them in order to unlock the door to the bridge to Hel.

As she crosses the bridge, she in confronted by Hela herself who defeats her with a single blow which also shatters her sword. Senua barely survives it.

After this encounter, she thinks about committing suicide. This is due to the things that happened to Senua in the past and also because of what Hela says to her.

The journey just barely started and the universe is already giving her signs that this journey won’t end well. Encountering Hela was a massive blow to Senua’s journey.

However, instead of giving up, she decides to move on with her journey and scars herself with her broken sword as a mark of determination.

No matter what the universe throws at her, she will move forward and save her lover’s soul; the one person who loved and understood her.

Senua’s backstory is revealed in different parts of the journey through her hallucinations and let me tell you, it is incredibly sad and heartbreaking.

Her mother Galena was a healer also suffered the same curse as Senua but treated it as gift. Her father Zynbel is a Druid did not accept it and burned her alive.

Senua witnessed the entire thing when she was just about 5 years old. This was the first of two incidents which ended up making her own psychosis worse.

Meanwhile, her father was convinced that Senua was also tainted by this evil so he abused her physically and emotionally. He also isolated her from the rest of the world.

One day, Senua met Dillion while he was visiting the village.

All her life people treated her the same way as her father did. They abandoned her and treated her very differently.

However, Dillion was different. He saw Senua as different and misunderstood instead of the curse. He helped her control the curse.

The two fell in love and left her father to be with him in his village. After some time a plague came to Dillion’s village which killed many of the villagers. Senua believed that she was the reason the for the plague and left the village in exile.

The next part in the story also is the most tragic one.

If you know anything about Vikings, you should be well aware of the fact that the Vikings were known for their brutality in raids and combat.

After a year, Senua returned to her village after conquering the Darkness only to see that her village was raided and everyone was killed by Vikings.

As she walks through the village she ends up in a hill where she sees her beloved Dillion killed. He was just killed simply like the rest of his people. Norsemen raiders sacrificed him to the gods in a Blood Eagle.

Blood Eagle. Without context, it sounds kind of cool in a video game kind of way, right?

Well, the reality is actually horrifying. Due to the brutal nature of it, I cannot fully describe what the Blood Eagle is except that the body is shown as a display after everything is done.

If you intend to look this up on your own, be warned; the blood eagle is one of the most brutal and unpleasant method of execution in human history…

So yes, Senua sees Dillion, the one person who loved her, the one who didn’t treat her differently, and cared for killed and put on display.

Personally, I think this is the second incident which makes her psychosis not only worse, but takes it to a point of no return.

At that moment, she remembers the stories told by Druth, who served as Senua’a friend and mentor during her self-imposed exile. She swears that she will save Dillion’s soul from the gods.

Back to the present and now Senua follows visions of Druth and a light which she believes to be a Dillion, to a great tree where she had to go undergoes four trials that tests her body, mind and spirit and is rewarded with a powerful weapon that could kill Hela; the legendary sword Gramr.

During the journey there were moments where she had to fight against the influence of the Darkness. After getting the sword, she goes to the “Sea of Corpses”, survives the place, and defeats the beast Garm at the gates of Hel.

Before entering Hel, she realizes that the Darkness, the one which have been cursing her for all of her life is the representation of her own’s fathers abuse. She also temporarily imprisons the Furies

Senua confronts Hela who summons a legion of warriors. She fights them off but the warriors keep on coming and coming to the point that she is overwhelmed.

In a desperate attempt she tries to bargain with Hela. In her final moments, she recalls Dillion telling her the importance of accepting loss.

As the imagery of Helheim fades away, Hela stabs Senua with Gramr and drops Dillion’s head into the abyss, but as the camera returns to her, Senua is standing in her place, with a dead Hela at her feet.

She finally accepts that it was never possible to bring her lover back and that she is not responsible for his death or anyone else’s.

Hence, she banished the Darkness and accepts the Furies not as a curse, but as a part of who she is.

The game ends by Senua inviting the player to follow her, saying that there is another story to tell.

VOICES IN MY HEAD

For a gamer there will be moments in games that they will find epic and cool but there are “special” moments that they will always remember them forever. One of those special moments for me would be the opening sequence of Hellblade.

I will always remember it.

As mentioned before the game starts with Senua arriving at the borders of Hel. The roughly 6 minute sequence does indeed set up what the game is all about.

The sequence starts with the narrator talking directly to you about Senua. When I say directly, I meant it literally as it feels like the narrator is very close to you and then the Furies starts talking to you.

You won’t exactly when and where they will talk. It is not just one voice but a cacophony of voices talking to you at the same time in different angles to both of your ears. Headphones recommended for maximum impact.

Hearing those voices made me claustrophobic and scared me a little. Claustrophobic in the sense that these voices are up and close to you and it made me feel like I don’t have my own personal space.

In a way this entire sequences did indeed describe and showed the experience of how it feels to have voices in your head. The sound design was spectacular.

Throughout the game there will be four voices that you will hear which includes the the narrator who provides you will lore and often breaks the fourth wall by talking directly to you; Druth, who tells you about the Norse legends and mythos and also helps when you need to solve puzzles; Darkness, the dark presence with torments Senua from time to time; Furies, the multiple voices that have a own mind of their own as they will be encouraging, aiding, mocking and belittling Senua.

Hearing voices is among the attributes of psychosis but the developers had no clue on how to implement it in the game so they got help from Professor Charles Fernyhough (Professor of Psychology, Durham University). He helped the developers understand how voices work in the sense that voices can vary depending on the space.

They recorded the audio using technique called binaural audio which records the 3D spatial position of sound heard by humans. Normally sound can be heard from one side but by doing binaural audio the voices feel very real, they have a character and personality.

One of the best examples of that would be when the “Darkness” talks. When he talks it is very terrifying. It is not because he has a deep voice nor he talks with an angry tone.

It’s because when he talks you can feel the anger from his words. The point of everything that he says is to belittle you, make you feel worthless and he does a good job of it.

When he talks you also gets the feeling that he is looking down on you and it’s all because of the binaural audio.

AM I HALLUCINATING….?

One of the most important things in a game would be it’s mechanics. Mechanics are the rules and procedures that guide the player and the game response to the player’s moves or actions. Mechanics is what defines a game is also a key factor which makes a game enjoyable or not.

To represent psychosis in the best way as possible, the mechanics do not need to be symbolic, but rather it should be the literal representations of the symptoms of Senua’s condition.

And so, mechanics are implemented in a way you to face the realities of what condition can do to people. One such symptom is hallucination, where you see things but they are not real.

According to Professor Fletcher, “people begin to see patterns in the world, they begin to link things that most people wouldn’t link. Most of the things that we might think would be coincidence or not worth commenting on. Nevertheless that might have a particular salience or importance to them.”

There is actually a term which describes that and its called apophenia. Psychiatrist Klaus Conrad explains it as “Borrowing from ancient Greek, the artificial term ‘apophany’ describes this process of repetitively and monotonously experiencing abnormal meanings in the entire surrounding experiential field, eg, being observed, spoken about, the object of eavesdropping, followed by strangers”.

In short, it is the tendency to see connections and patterns that are not really there.

Things like seeing animals in clouds, symbols when lines connect, that is what apophenia is.

This also serves as the basis of the puzzles that you will be doing throughout the 8 hours you will spend on the game which in a way representative of how Senua’s psychosis manifests.

Each section of the game involves a puzzle where you are looking around finding the pattern which will unlocks the next section of the game. These puzzles do get the boring but at the same time it shows us how the mind of someone who goes through it works. At some point you it will make you paranoid if you are unable to get the pattern right so you will be checking the smallest and the insignificant places as those might be important to solving the puzzles.

Hallucinations also used in cutscenes to tell more of the narrative, especially the flashbacks and the execution of it is done really well. To the point where at some point you dont even know what is real or not

THE GREATEST ENEMY IS YOURSELF!

The gameplay of Hellblade is considered by many to be not good. They also consider the game not “fun” as they believe that the main purpose of any game is to be fun.

But “fun” is only one of the experiences a game can deliver. And due to the context of this specific game, this “unfunness” is actually a good thing.

The purpose of Hellblade’s gameplay was to convey psychosis as a narrative through interactivity. The game does indeed plays with your expectations as you will never know what’s going to happen next.

Mental illness is a constant battle against yourself which at times can feel impossible. Even the smallest victories stand out. Despite being able to deal with it better over time, it can continue to affect one’s life.

To show all of this in a game that is about mental health, the game need not be “fun” to play. This game set out to tell a specific story of suffering and it excels at it.

One of the most common problems players had about Hellblade was the camera angle. One of the key aspects that makes a game’s combat great will be the camera and especially when it comes to games with melee weapons.

The camera in Hellblade is fixed as you are unable to move the camera in any way possible. The camera sticks very close to Senua.

The camera is fixed to the enemy and if there are multiple enemies, the one you targeted will be the one the camera will show.

This is something the developers made intentionally claustrophobic and personal, as a commitment to the game’s theme.

The combat get somewhat easier over time as the former enemies which were challenging can be overcome easier. And interestingly, this is not because you are able to do additional moves or through power-ups, but through the player’s own growth and discovery during the trials you go with Senua.

The one thing which the game asks of the audience is to accept that the narrative of the game is something that puts you on equal ground to Senua herself. As such, you will experience the same fear and paranoia as she does.

At the very start of the game, it threatens you with a mechanic which is only found in the highest difficulty in some games, “permadeath”.

Basically if you die, its game over literally as you will lose all progress and have to start the game over again.

There is a dark rot that growing in Senua and the more you die the rot will progress further to her head which will kill her. This ends up making the player be one their toes to make sure Senua doesn’t die in any of the combat sequences.

This makes each combat sequence an incredibly tense affair.

But guess what? The permadeath mechanic is just a bluff!

In a way, you could say that the game made you accept something that wasn’t real as real by making you believe that permadeath is on the table while in reality, it was not.

The more you play the game the more you question about what’s real or not and this is a great example of it.

“A large part of the game is about fear, and a large part of mental illness – psychosis in particular – is about fear,” Tameem Antoniades, the director of the game explains. “I was speaking to one fellow who described it as a fear of death. This was one person – I don’t want to generalise to everyone – but in this particular case, during [psychosis] episodes, there was a palpable fear that he was going to die. So that’s what we wanted to try to find an analog for in the game.”

EMPATHY

During my research about psychosis and Hellblade, I came across a certain youtube video which actually ended up changing my perspective and also greatly influenced this article.

Watching the video made me realize that most of the people who write articles about topics like these are just people like me who don’t necessarily experience these things but do their research and write their thought and opinions.

But what about the people who are suffering from these mental health issues? They are the only people in the world who would know what it is like to go through the issues they face. Even if they explain to us, we may never fully comprehend it.

“It is easy to see the pain of suffering caused by physical trauma but what about physical diseases or physical trauma. It is not so easy the mental suffering and trauma of severe mental illness. But what if we could find a way to see it. Games are capable of drawing you in for hours on end and playing a role of a character who is different from you and experiencing their perspective an actively involving you in a world that functions with a different set of rules.” Antoniades said.

Games allows you to have a new perspective on mental illness and at the same time allows player to engage with it in a away that just wouldn’t be possible in any medium.

That is the beauty of Hellblade. The game invites the player to understand how it feels to have psychosis by offering a story from the perspective of someone experiencing it.

This is the big reason why this one of the best representations of mental health in gaming and also I consider it a work of art.

One of the most beautiful about this game is psychosis is never considered evil.

For a game which tackles mental health, the person who portrays Senua should be someone with great acting skills. A person who is able to show different emotions, talk and act in different ways in scenarios.

What I’m trying to say is that you’d think they would need someone with professional acting skills, right?

Surprisingly, this was not the case. The person who ended up with the role was Melina Juergens, who is actually the video editor for Ninja Theory!

She was actually the “stand-in” actor while Ninja Theory learned about mo-cap. The director knew her well enough to trust her with the role and it did indeed paid off.

She was so good that critics praised for her performance and also won Best Performance at The Game Awards 2017 (think of this award ceremony like the Oscars or Grammys but for games).

One of the coolest thing that I found about this game is that the people who were consulted were somewhat part of the development team for the game.

They acted as “testers” where the developers show them their progress in frequent sessions and they give feedback on them on how to improve.

Hellblade is a game which is played best with a blind playthrough, which means you are playing the game without having any knowledge about it or in other words without any spoilers.

Yes, I’m well aware of the fact that I’m writing this at the end of the feature after talking everything about the entire game.

“It’s refreshing to see a representation of psychosis in which the person isn’t just a sort of passive receptacle for madness.” Paul says. “Senua is the hero of her own story, trying to make sense of her experiences and work her way through them.”

Thank you for reading about Hellblade: Senua’s Sacrifice. Now, I encourage you to play it for yourself if you want to experience this incredibly gripping game.