Psychosis and Hellblade: A Journey Grappling with Reality

Tameem Antoniades
Nov 25, 2016 · 11 min read
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Senua from Hellblade: Senua’s Sacrifice

Working on Hellblade: Senua’s Sacrifice as Creative Director for a couple of years now has changed my understanding of the mind and what I once thought of as reality. The premise of the game is that Senua, our Celtic heroine, is experiencing psychosis while on a vision quest into Viking territory. This was an opportunity to delve deep into a subject matter that I had little understanding of and that I am still grappling with.

Hellblade: Senua’s Sacrifice

Fantasy and Mental Illness

My interest in games comes from my love of fantasy and its power to help further understanding through allegory. Original fantasy is a construct of the mind, from Lord of the Rings to 1984 to Blade Runner to 2001: A Space Odyssey. As fantasy is born of the mind, why not go to the source?

The original idea for Hellblade was to create a new fantasy game that wasn’t derived from the well-trodden tropes that exist in entertainment. And so the idea was born that Hellblade would be a classic hero’s journey, a journey of suffering, but one where the fantasy world is a construct of Senua, the hero’s mind.

So Senua can be described as mentally ill. But mental illness is a subject that is treated as taboo and rarely acknowledged in over 100 years of cinema, never mind a new medium such as games. Where it does feature, it is superficial, usually in the form of horror or a plot twist at the end where the suggestion is that nothing was real, which in my view is as frustrating a conclusion as “it was all a dream”.

We gain little understanding with this view and it subverts or discredits the validity of the preceding journey. Why is it not represented directly and more often in fiction? My view is that most creators see the subject as a can of worms that will open the door to critical attacks.

As mental illness is a taboo not just in media but also in society, my own acknowledged ignorance of the subject led us to research and understand more about it. This resulted in a long fruitful collaboration with Paul Fletcher, professor of Health Neuroscience and Psychiatrist at University of Cambridge who has given us much time over the last two years. The project also has the support of Wellcome Trust, whose involvement has led us to regular meetings with people with direct lived experience, and voice-hearing expert, Professor Charles Fernyhough.

What I’ve learned has dramatically changed my understanding of the mind. I’d like to share what I understand up to this point.

Living in a Simulation

We like to think that we are objective, seeing the world as it is, even though we may intellectually acknowledge that much of what we experience is just our perspective. However, an objective world view is an illusion, an impossibility.

I would say that the closest context we have for objectivity is the mathematical universe. This exist outside of space and time, and constitutes a series of axioms, a framework of rules and structures, that expand out in infinite complexity.

From a narrow subset of axioms in the mathematical universe, we can derive our particular physical universe which we describe through our physical sciences: physics, biology, chemistry and so on.

From a sliver of this physical universe, we can also derive a mental universe, the one in which we exist fully, that is also infinity complex. Here we find thought, art, emotion, consciousness.

Our mental universe can only see a tiny fraction of the physical universe, which in turn only represents a fraction of the mathematical universe. We are so far removed from objective reality that the whole concept of it, from a human perspective at least, is near enough meaningless. It turns out this is not a particularly new insight as attested by Plato’s Allegory of the Cave.

Plato’s Cave: seeing shadows of reality

To understand this in a more practical way, consider vision. Light is a narrow spectrum of electromagnetic waves that enter our eye. How much of the electromagnetic spectrum can we see? About one ten trillionth. From narrow minute variations in wavelength, we categorise the world according to colour, shape, form, movement and higher social concepts like race.

We don’t even experience the world in real-time. From the time you click your fingers, to understanding what you have seen can take half a second. It takes time for that light to be registered, processed into a form that can be understood by our unconscious brain, then processed against everything we know about the world to identify it as a finger click. As sound and touch take different amounts of time to process, the signals reach our brain out of sync.

If we were to visualise the raw physiological signals that our nerve endings receive, we would be aghast at the noisy incoherent mess.

But our experience of seeing the world feels nothing like what this implies. We feel like we are in a world that is fully three dimensional and present, with us at the centre, and this we call “objective reality”. Our mind is able to construct this fallacy of objectivity, an estimated simulation of the world no less, based on all of our prior knowledge and experience since birth.

So if you’ve ever wondered whether you are living in a simulation, then the answer is yes. Only it hasn’t been created by aliens or AI entities running simulations on planet-sized computers but by your own fragile, slow, wet and lumpy brain.

We do not passively perceive a world without us, but actively simulate a world from within.

Think of moments when you were fearful at night and couldn’t help but see suspicious shadows in the dark, or when you saw the world red with anger, or the grey lathargic world of grief. Our simulation of reality is malleable and constantly shifting. Evidence suggests that we are all in a perpetual state of hallucination, delusion and bizzare beliefs because this is the only way our minds can function in a noisy messy world.

In this context, it becomes easier to conceive of scenarios where our mind, with its endlessly adapting feedback loops, can divert from the standard we term “normality”.

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Paintings by Louis Wain, believed to have suffered from progressive schizophrenia

The Mind’s Eye

The implications go far deeper than perception. Our neurons not only underpin what we see, hear and touch, but also what we feel, think and believe. The myriad of entertaining illusions you see online are not one-off quirks and curiosities: they may point to the fundamental way the mind works outside of perception.

The McGurk Effect: a simple example of our malleable reality

What if everything you experience, think and believe is shaped by similar deeper neurological illusions? Once that idea sinks in, what you think of as reality starts to feel extremely fragile.

It’s clear to me now that the notion of objective experience and normality is extremely problematic but that doesn’t mean we must surrender to an irrational state of mind.

We can all still see the shadows of Plato’s cave if we look for them, and without losing sight of them, we can strive to gain higher levels of abstraction to understand and model a better world for ourselves and our peers. Scientific and evidence-based reasoning is all we really have to anchor us to the shadows of existence.

Great teachers, philosophers, scientists and artists that are able to see a higher level of abstraction, a truth, in their field are able to communicate this to the rest of us and drag us up into new ways of seeing the world that can be shared with others and future generations.

Survival of our Species through Mental Diversity

Our progress as a civilisation depends on outliers, people attaining higher levels of abstract perspectives. The only reason we have computers, spacecraft, medicine, poetry, art and videogames is because individuals were able to simulate new abstract realities in their minds and share them with the rest of us.

We need people to be diverse in the way they think and see the world in order for us to survive.

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Sir Isaac Newton: Alchemist who stared into the sun to see what would happen

In the same way that evolution creates biological mutation and variety to further our survival, it also creates a mental spectrum across all of us. The price we pay for genetic variety in evolution can be chronic or physical conditions that disable or kill us as individuals but that, on balance, increase our chance of adaptation and survival as a species. Similarly, the price we pay for the neural diversity we need to survive as a species may result in the severe suffering of the individual.

So if reality as we know it doesn’t exist, and each one of us see the world differently on a broad spectrum, where do we draw the line between normality and mental illness? This line is largely arbitrary and depends on what country we live in, what culture we are part of, and where science and medicine is at.

The Stigma of Thinking Differently

Homosexuality was once considered a mental illness, and pretty recently at that. A grim example of what societal standards can inflict on people is the ostracisation, chemical castration and suicide of Alan Turning, the genius who lay the foundations of the modern computer.

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Alan Turing

Asperger’s syndrome is a more recent example of a diagnosis that is transitioning from an undesired mental condition to a normalised example of neurodiversity. Bill Gates, Alfred Hitchcock, Albert Einstein are notable examples of people said to have this “disorder”. A quote that made me chuckle by author Steve Siberman follows, “By autistic standards, the normal human brain is easily distractable, obsessively social and suffers from a deficit of attention to detail.”

I believe that a similarly different view will apply in future to people who hear voices and see visions. It may surprise you that a great many people who hear voices and see visions do not fit our definition of mentally ill. Gandhi, Churchill, Sigmund Freud are some examples.

It was quite a revelation to have the opportunity to talk to a couple of young voice hearers at our studio about representations of voice-hearing. The term “mentally ill” clearly did not apply nor cross my mind in this particular discourse. I empathise with the frustration they endure on a daily basis in trying to convince a wider world that this can be the case.

You may not know of anyone in your circle who hears voices or sees visions but statistics suggest that you likely do. With such stigma associated is it surprising that people tend not to advertise their experiences?

Currently, if you told people you hear voices, you will have to deal with the stigma, perpetuated by media, which suggests that you are probably likely to end up hurting someone. You may be diagnosed as psychotic which could start a chain of events that lead you to being isolated from friends, family and society. If enough people tell you that you are ill and abnormal, then you will tend to believe it and possibly end up traumatised by it. If it can happen to Alan Turing, it can happen to any one of us.

While the societal, largely arbitrary lines that define mental illness are vague, unsatisfactory, and constantly shifting, there is no doubt that mental illness exists and is a very serious and life-threatening condition.

There are a great many people who suffer greatly from psychosis and need help and support in order to recover or to live with their condition. Psychiatry, medicine and social support are vital in these cases and can offer relief and recovery from the suffering.

Simulating other Minds

The understanding of psychosis is still very much a mystery and ways of treating it are still primitive compared to physical illness. Cancer, Aids, leprosy and many other stigmatised physical conditions had to be brought out into the open before they attained the awareness, understanding and treatment that now saves countless lives. The fear of the conditions held us back.

Similarly the same process will have to take place for serious mental conditions such as schizophrenia. Reading about the symptoms in literature and articles help us understand it intellectually but not experientially and the powerful human force that is empathy is left missing.

In science, the focus is correctly directed at understanding the condition in the physiological sense, but as people, we should strive to understand it in our mental perspective of emotion, empathy, and experience.

After all, it is easy to see the pain and suffering caused by a physical disease like cancer or the physical trauma of a bomb victim with limbs blown off.

But we cannot easily see mental suffering and trauma of severe mental illness which is no less horrific, violent and distressing for those who experience it.

One of our goals in Hellblade is to give an empathetic experiential view of a fictional character who sees visions, and hears voices in a way that reflects what many people see and hear. With the support of Professor Paul Fletcher, voice hearing expert Professor Charles Fernyhough and many with lived experience, we have simulated some of these symptoms in the game experience using binaural sound for voice hearing and visual effects for visions.

Every few months we invite a group with lived experience to our studio to show them what we are doing in the game and garner feedback and suggestions to help us refine our portrayal. Some of these groups refer to themselves as “service users”, others describe themselves as “voice hearers’, of having an “unshared reality”, and others call themselves “mentally ill”. The range of terminology reflects the range of experiences that is not served by the binary language that prefers to categorise people as either “normal” or “mentally ill”.

Imagine if we were to describe the full range of physical illnesses in the binary terms, “normal” and “physically ill”, and we begin to understand just how basic our understanding of mental illness is.

In Hellblade, we are reaching a point where the visual and auditory aspects we are simulating are resonating closely with those with lived experiences.

Simulating the voice hearing experience in Hellbade

Representing perception is one thing but it is much tougher to portray the emotional turmoil, thinking patterns and belief systems, which sit under the imprecise and narrow umbrella of “delusions”. It is however very possible in a game to create arbitrary rules that players follow without question that can reflect some aspects of the inner mental thinking that can occur. Rules that can have a negative and positive impact on the well-being of Senua. And storytelling can approach the inner turmoil of a character.

Our work is beginning to attract the attention of clinicians and we were recently invited to demonstrate and discuss our results at the houses of parliament. Ideas are starting to form about how gaming technology could be used to help understanding of these conditions in the future.

In the immediate future, we hope that by creating a compelling and aspirational character in Senua who feels very much real, albeit in a fantasy setting, we can provide a lens into her reality, a different one to yours, and achieve a level of empathy and understanding that is difficult to convey or describe in lengthy essays such as this one.

Thank you for reading.

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