Mental Health in Horror Games
*** Will contain spoilers for some games ***
Horror and mental health have long been tied together in popular media. One of the titular horror cinema icons, Michael Myers, is a giant asylum escapee. According to a survey, Halloween is one of the top ten most popular US Holidays. In video games, the horror genre is also extremely successful and, sometimes, pretty profitable. Many top streamer personalities gained popularity by playing a mix of horror and indie games. So how does mental health factor into this genre? A lot of the horror genre build upon themes of mental health. I would like to take a look at some games over the past decade or so that use these themes and what they are communicating to their players with their use of them.
Percieves Issues
Looking back on my experience playing horror games, some of the most common issues I remember seeing are:
- Use of derogatory or incorrect terminology
- Portraying asylums as dangerous or as torture houses
- Alternatively portraying mental health institutions as a place where people are driven to insanity.
- Demonizing mentally ill people as violent monsters or as targets for attack (a caricature of ‘craziness’)
- Depicting caretakers as vindictive, evil, or willfully acting against the best interest of patients
A Look at Four Games
46% of canadians believe mental illness is an excuse for bad behavior. (x)
In Manhunt 2 (2007) you play as “…a [asylum] patient suffering from amnesia as he tries to uncover his identity (source)” while guided by a sociopathic assassin. The main plot twist in the game is that the main character actually has Paranoid Schizophrenia and Dissociative Identity Disorder (DID) from a failed experiment and is both himself and the sociopath. It is then revealed that following the experiment, he went on a rampage, killing numerous people across the city and his wife.
The game opens with all the patients in the asylum being freed and immediately attacking the nearest nurses and doctors. This promotes a fabricated stigmatizing stereotype showing those with mental illness as violent individuals. Your character is then introduced as he chokes a nurse after bring tranquilized and then is led out by another patient. He then passes by a patient committing suicide and kills a nurse to continue his escape, being told that the nurse would kill him otherwise. Health professionals in this game are dangerous and murderous. Throughout the game, the player sneaks around killing others and being rewarded for the most gruesome kills. By presenting these ideas, the game actively prevents help-seeking behaviors and paints a negative image of mental health professionals and patients.
People with mental illness are more likely to be a victim of violent crime (x)
Outlast (2013) is a survival horror game where the player navigates a dilapidated psychiatric hospital that is overrun by homicidal patients (again portraying the mentally ill as unstable and dangerous). The game succeeds in creating a successful survival horror game by limiting the player's ability to see properly or to fight back. As many other games are, Outlast is set in an asylum, furthering the idea that asylums are a dangerous and ultimately scary place. Unable to attack or defend themselves, the player must avoid and run away from the pursuing patients.
The patients in this game are called ‘variants’ rather than patients or people. It could potentially be argued this is a form of dehumanization through language by describing a group of people as something other than people. This dehumanization would make it easier to see the patients more like monsters to be feared and, if possible, killed. The player spends much of the game being murdered by ‘variants’ as they try to escape and learn what is going on.
The profound reluctance to be ‘a mental health patient’ means people will put off seeing a doctor for months, years, or even at all, which in turn delays their recovery. (x)
In The Inpatient (2018) the player is an amnesia patient in an asylum undergoing ‘treatment’ (a mix of electroshock therapy and drugs). During the day you interact with your new roommate and the nurses and at night you experience harrowing and grotesque nightmares. While the game mainly uses gore and jump scares as its main mode of scaring the player, the atmosphere is built upon some of the previously established stigmas about mental illness.
A disaster leaves you and your roommate stuck in your room and, over time, his status deteriorates and he becomes more erratic. One day the door opens and as you try to escape, you learn that some patients have become wendigos and killed everyone. There is a chance of the player or another character becoming a wendigo after eating human flesh. The game portrays asylums and mental health institutions as terrifying but avoids a heavy-handed painting of patients as violent by including wendigos (although the fact that one needs to be a cannibal to become a wendigo could be interpreted as a negative portrayal). Portraying asylums as dangerous and insinuating that they have secrets to hide (the head doctor not wanting to call the police) could contribute to strengthening the stigma of mental health institutions as something to be avoided and being an impatient as a negative thing.
25% of Americans report they do not have adequate access to mental health services and 44 percent either do not have mental health coverage or are not sure if they do. (x)
Rise of Insanity (2018), like Manhunt 2 revolves around DID and does not portray it positively or accurately. In the game, a psychologist Dr. Dowell suspects a patient of his named Edward (the player) of killing his wife and son. Dowell is conducting a controversial treatment to “merge Edward’s split personalities”. Edward and Dowell are later revealed to be the same person and the culprit of the murders. This game has medical professionals using improper terminology such as ‘split personality’ and, due to the murder, portrays those with DID as violent murderers. One reviewer mimics the use of improper terminology and mentions that the game is intended to show a “minor case of split personality disorder.”
Summary
The horror genre has a fixation on mental illness and its perceived dangerousness. Illnesses such as schizophrenia, Paranoia, Dissociative Identity Disorder (DID), Sociopathy, and Psychopathy are common appearances in the genre. They are often portrayed inaccurately or are mixed together haphazardly, though. Their prevalence goes against the fact that these disorders are only present in 1% of the population. Their depiction detracts from the fact that those left untreated are more likely to be victims of abuse and are rarely violent towards others.
The Upside
Not all horror games are about being ‘crazy’, murdering the ‘crazy’, or running away from the ‘crazy’. There are other games that explore mental health issues without painting a picture of bleak hopelessness or supporting harmful stigmas. Neverending Nightmares was developed by Ininitap Games inspired by the lead designers experiences with OCD and depression. The Cat Lady is a game developed by Harvester Games that communicates an ultimately positive message despite its inclusion of more graphic and darker themes.
Other scary games that do not portray mental illness negatively:
Additionally, the ‘crazy equals scary’ fad is something that seems to be over. The most recent horror games focus more on the undead, aliens/monsters, and the general fear of the unknown. Other games have continued exploring mental health in a healthy way that serves to either empower and support those who experience mental health issues or to communicate the experience of specific mental illnesses to those who do not understand it. Some of these games include:
