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The Royal College of Psychiatrists Improving the lives of people with mental illness

A fantasy based in reality: how service user and specialist input informed the portrayal of psychosis in Hellblade

Recently a targeted advertisement for a video game came across my Facebook feed. Usually, most games I’m told to buy, to my shame, are Candy Crush and their ilk. This advert, however, was slightly different, featuring a behind-the-scenes glimpse of a game; the video was titled “Myth and Madness”.

A game that dealt with ‘madness’ as a theme? I watched the video with trepidation, worried that the game would resort to the “villainous lunacy” trope so often seen in entertainment media. However, after watching it, I felt that the video game developers were not merely paying lip-service to the issue of mental illness, but had invested time and energy into researching it.

The game was called Hellblade: Senua's Sacrifice. Hellblade is an action-adventure game that tells a story of a Celtic warrior named Senua, who is on a vision quest to retrieve the soul of her sacrificed lover. The story is told from the viewpoint of Senua, who experiences psychosis in the form of hallucinations and delusions.

With Senua as the protagonist, the game promises a “strong character story”

 

I was fortunate enough to be able to interview Dominic Matthews from Hellblade’s development team Ninja Theory (where he holds the enviable title of “Product Development Ninja”), about Hellblade and the psychiatric themes the game would cover.

Ninja Theory have a good reputation for developing well-rounded, aesthetically-pleasing, action-heavy games. Their reboot of the Devil May Cry series (retitled to DmC: Devil May Cry) critiqued modern consumerist culture, whilst their previous game Enslaved: Odyssey to the West was praised for its mature narrative. Hellblade is Ninja Theory’s first step in creating a game as an independent developer, free from mighty-publisher constraints.

Dominic described how Ninja Theory chose to cover mental illness as a theme. “This is our first independent game, so we have been fortunate to find ourselves in a position where we are able to make a game that we can control creatively. Without creative restriction, we wanted to do something unique and special, and that’s how we came across this topic.” The prospect of covering mental illness had clearly struck a chord with the developers. “Although it is not something we talk about overtly, this is a subject that is close to a lot of people in the team. We felt that it would be a great opportunity to make a video game and tell a compelling story, which we can develop.”

Dominic stressed that the purpose of Hellblade, a work of entertainment, “isn’t primarily about raising awareness or necessarily being educational.” However, within this entertainment medium, Ninja Theory have the opportunity to deliver a strong social message. “I think there is a lot of stigma attached to psychosis and to mental health difficulties. Exposure will ultimately lead to understanding. And the understanding will lead to destigmatisation.”

Brutal combat, a hallmark of Ninja Theory games, is of course present

 

Through their development process, Ninja Theory became involved with the Wellcome Trust. The Trust has a team dedicated to supporting entertainment and art projects that engage a wide audience on scientific themes, and has supported the Hellblade project through their Public Engagement Fund. “So we first met them,” Dominic explained, “and started discussing the project. We first got the development grant which was something that helped us to put together the concept, and now we are partners in co-production, so they have a financial grant into the project and that grant is helping us both deliver the game and make sure the scientific theme, in our case psychosis, is portrayed in an accurate manner.” Through the Trust, the developers were linked up with mental health service users as well as clinicians, including Paul Fletcher, Professor of Health Neuroscience at Cambridge University. “Through that, we have been able to make this link through art and its creative side and the scientific community and the service user community.”

Our discussion moved to how mental illness had been portrayed within video games in the past. “I think games have not always done a great job of tackling sensitive subjects,” said Dominic. “There is a whole number of areas where games have tried to tackle mental health. Sometimes they can reduce experiences of psychosis into gameplay mechanics; games with a ‘sanity meter’, which goes up and down. That is a very mechanical way of representing psychosis, and people’s perception of psychosis is very binary: ‘there is me and there is the person with psychosis’. Instead, what we have learnt through our work with Professor Fletcher and the Wellcome Trust is that psychosis is based in how we all perceive the world, the way we perceive our own reality, and how we all have different interpretations of our reality. What we are trying to do in Hellblade is present our character in a very truthful manner. I think in the past games have not necessarily done that.”

Eternal Darkness (2002) used a ‘sanity meter’ as a blunt measure, with depleted ‘sanity’ resulting in hallucinations

 

Ninja Theory is actively trying to move away from a mechanical representation of mental illness. “We created fantasy games for the last fifteen years, and in many ways Hellblade is the same. In the case of this game, the fantasy is the creation of Senua’s mind. So I think what people will experience in the game would be a unique experience that would have root in people’s real experience of psychosis and the scientific foundations behind it. It is part of the story; it is part of the character. Just like how we are our own characters, she is another character who happens to experience psychosis.”

Considering the way mental illness has been portrayed in video games up to this point, naturally there are concerns about how the concept can be reduced to a gimmick within narratives. “Mental illness is very much essential to the game,” Dominic reassures. “It is a story about a character on a journey; a quest where she happens to experience psychosis. So it is very embedded into the game; it is not something that is a twist at the end. It is something we are very upfront about. As the player, you will experience the world just as Senua does. You will experience the world through the visions and the voices that she hears, as well as other unique experiences.”

I wondered about the balance of creativity and clinical-accuracy in this game, and whether there had been any compromise in either direction. “We have worked with the academia and people who have experienced psychosis,” said Dominic, “and a wide range of different people who may just hear voices or people who may have unique beliefs which dominate their lives. It has always been important for us to do our research in the subjects we are portraying. But I think that working with Professor Fletcher and Professor Fernyhough (Charles Fernyhough, Professor of Psychology at the University of Durham) allowed us to understand the latest scientific thinking regarding psychosis and exactly how it manifests, and then we tried to represent that in the game. I think a lot of game developers, when they think of collaboration with science, they might think that science could restrict their creativity, but in actual fact it enriched our creativity. So many concepts, ideas, and experiences that people have come across are in the game, and it is much more compelling because of that input.”

The links that Ninja Theory made were useful beyond the bounds of professional game development. “On a personal level,” said Dominic, “and for many other people on the team, having the opportunity to not only speak to people who are experts in this field, but people who actually have these experiences, it has actually been very, very valuable. And it is something which we would like a lot of people to do: to sit down, and speak, and to understand.”

Dominic expanded on the team’s experience working with service users and clinicians.  “We were very up front about the mental health part of the game when talking to clinicians and groups, but we really didn’t know what the reaction would be, because historically video games tackling subjects about this have not been great. But we had a lot of support. Working with the service users has been fantastic. They have been very supportive and I think they enjoyed the experience of working with us in trying to manifest some of the things that they experience.”

“It has been great to talk to them, hear about the things they experience, to then translate that into the game world and show it back to them and see their reactions. And with a lot of things we tried, they said ‘Yes, yes,’ that’s very close to their experience. I think it has been a very fantastic collaboration. Also, I think having the opportunity to talk to us about those experiences is a different context for them. This isn’t a clinical context talking about these things, this is a context of creating entertainment.”

Senua must undergo a journey as the game progresses

 

I often find, when mental illness is depicted in media, that there is not enough emphasis on the types of help available, and people with mental illness can be shown as suffering with no means of support and no route to recovery. I wondered how Hellblade would portray the main character managing her experiences. Dominic noted that the game has a historical setting (so presumably effective treatments don’t yet exist in this world), but he also stressed that we can expect Senua to progress along with the story. “I don’t want to give too much away, but it is not only a journey with Senua, but also a journey with her experiences. It is a difficult journey, but it is a journey of understanding.”

With Hellblade, the developers Ninja Theory are taking a bold step into independent games development without the backing of a large publisher. Dominic was excited about this prospect. “If we were creating this game as a big blockbuster title, we wouldn’t be creating this game the same way we are, with this collaboration with the scientific community that we're working with. We get to create the game we want and get to grasp interesting opportunities. There is a lot riding on this game for us because we want this game to be the first of many... so there are risks there for us but we are definitely enjoying this challenge.”

Dominic’s team feels well placed to deliver a meaningful representation of psychosis to players. “Our aim with the combination of technology and creativity is to try to make it feel as close to the real experiences as we possibly can. It is a compelling thing, and I think when you lay on top of it that this is something that people live their lives with, we have the opportunity to help people understand a bit more.”

The film industry has produced works of entertainment that take steps to promoting understanding of mental illness, and this could potentially be a role within the video games industry. The initial groundwork of involving service users in the development process shows that Ninja Theory have taken a more inclusive approach to incorporating the experiences of psychosis that many people in society have. It suggests that we may be looking forward to a more subtle and accurate depiction of mental illness, and I am looking forward to seeing the outcome upon the game’s release.

 

Authored by Sin Fai Lam

Hellblade: Senua’s Sacrifice releases on August 8th for PlayStation 4 and Windows.

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