Understanding Mental Health in Video Games: “Hellblade: Senua’s Sacrifice”

Understanding Mental Health in Video Games: “Hellblade: Senua’s Sacrifice”

Rarely will you come across a video game that so earnestly portrays mental illness, in this case mainly schizophrenia, and how this condition can shape or reshape a person’s perception of reality. Hellblade: Senua’s Sacrifice tells the story of Senua and her journey through her own hellish reality. It is a story that in 2017 needed to be told via the video game medium.


In an age where medical advances are moving forward in leaps and bounds and people’s general understanding of their bodies and how they function improves, it is striking how ignorant most of us are concerning mental health issues. Even in the year 2017 the topic of mental issues is stigmatised and misunderstood by the public – media and news representation play no little part in this. Let me just outline the issue and afterwards we will get into how Hellblade’s developer, Ninja Theory, approaches the topic.

The following will contain certain spoilers on content and the games ending.

One of the main problems is that we do not actually talk about mental health issues openly. This is strange considering 1 in 4 people will face a mental health problem during their lifetime (Mentalhealth). But how do you explain a mental issue to a person who has no experience with it? We all understand a cut hurts because we have experienced something similar and see the physical evidence of the bleeding, or the agony of a toothache because of the pain, but how can you understand the inability to leave your house or even get out of bed, without having experienced it? Video games could help – and there is reason to believe that helping people understand will aid (Corrigan & Watson) – because the medium is action based, it is just as significant when you as the player are unable to perform an action as it is when you are able to do so. Juxtaposing the two may for instance help us understand the limitations one can face at times when simply “going outside for a walk” is not viable option. If video games are to positively impact people’s understanding of mental health issues and potentially counteract some of the discrimination, it is important that the medium avoids common stigma pitfalls. In news media the main pitfall for a long time has been, as is the case with many topics, that the medium mainly reports the negative stories. Moreover the framing is problematic, since often mental health issues are connected to acts of violence, painting a picture of the two being closely related. I.e. it may cause a public perception of mental disorders as dangerous because we believe that someone with for instance schizophrenia is more prone to be violent. This view is further supported in the public eye via film and tv where there is a general trend of utilising what can be called the Norman Bates Stigma (Disler). Again, this is the stereotype that mentally ill people are violent, in Psycho (1960) Norman Bates suffers from dissociative identity disorder, adopts his mother’s identity, and becomes a serial killer. A, seemingly, jovial example of this is also seen in the comedy Me, Myself & Irene (2000) where Jim Carrey portrays a character with multiple personality disorder. Where the main personality is a kind and well-meaning police officer, the second personality is violent and dysfunctional, which again reinforces the stigma of the dangerous mentally ill. Another issue is portrayed by One Flew Over the Cuckoo’s Nest where the book, and film, may attempt to portray mental illness more positively in the sense that McMurphy states, ‘What do you think you are, for Christ’s sake? Crazy or something? Well you’re not!’. The story does however paint a bleak image of the mental institutions – one which to an extent still remains to this day. In other words, not only does a general stereotype of the violent mental ill exist, but there is also this idea of the mental institutions being a place for the lost causes in society – if you have to receive treatment in an institution, you are a social outsider and it is a matter of containment.
There are lots of potential stigmas attached to the subject, and if we are to change our understanding and perception of the people who suffer from some sort of mental illness it is vital that media stops misrepresenting the conditions. That also goes for video game representation.

This finally brings me to Hellblade: Senua’s Sacrifice. It is evident that Ninja Theory was aware of the above when they began developing this game from their behind the scenes documentary. So by aspiring to create a video game story with a lead character suffering from a severe mental health issue they also challenged themselves to represent this character and her psyche in a manner that avoids past stigma and misrepresentation. They generally succeeded in doing so by working with the challenges of mental health on several levels within the game.


First take a look at character design. We play the role of Senua, a young girl with a tormented past. In fact, the further into the game we get the more evident it becomes that she probably suffers from schizophrenia (including auditory hallucinations), has done so as long as she can remember, and has struggled for acceptance for just as long. It also becomes increasingly evident that she is a strong character, a female warrior who has not let herself be held back by her condition. Making her a strong character who is also driven by her love for those close to her heart is important to dispel initial notions of the schizophrenic person being dysfunctional and dangerous. She does of course perform acts of violence throughout the game, as this is where the video game’s action gameplay stems from, but manages to do so without suggesting that Senua cannot control her actions – she is not unpredictably violent as a character. At the beginning of the game, we might not quite understand what set Senua on her path down into Helheim (Norse version of hell) – we understand that she wishes to set her lovers soul free from those who took it. Only later is it revealed that this entire journey is most likely her response to a traumatic event. This traumatic event was seeing her lover being gruesomely strung up in the sky in a Norse Blood Eagle. Legend says this was the worst viking death sentence – any screaming whilst undergoing the sentence and your soul is taken to Hel. Her lover was the one person that truly believed and supported her, and so upon seeing him in such a way taken away from her, one could only imagine the trauma would cause a certain amount of dissociation. In other words, we come to understand that the journey that we embark upon with Senua is not one of the physical world, but a journey down into her own psyche – a journey into what is at that point Senua’s reality. As is usually the case with traumatic experiences, one of the hardest but most vital elements that paves the way towards recovery is an acceptance of what has happened, and this is our true journey.

Blood Eagle

This acceptance does not come easily and is therefore represented through numerous battles in the game. Senua battles her own demons and fears in life. This journey through her mental state, and the struggle, is also represented in some of the game’s mechanics. Most notably the perma-death feature, or at least the promise thereof. In the game we are told that “rot” will grow up Senua’s arm each time she fails, and when it reaches her head, her quest can no longer continue. The growth of the rot represents her struggle to win her mental battles, and if she continuously fails to come to terms with past events, the rot and darkness in her mind will take over. Not to drive her insane, but more along the lines of rendering her in a state where she no longer has the fortitude remain alive. In more pratical terms, the player is told that is he or she dies too much in the game, and the rot reaches Senua’s head, the game is over and all progress is lost. However, this feature has naturally been tested and has more or less been debunked, which in itself is rather clever. If you are unaware of the feature’s non-existence, the player will play through the game in real fear and anxiety of losing, not just a certain battle but all progress in the game. As you pour several hours of your time into the game, a lot is suddenly at stake. But since losing progress is not actually possible we, exactly like Senua, live in fear of something that in reality does not exist. We are anxious of losing our progress in the game, even though this is not possible. Senua fears the darkness and what hides within, even though it in reality is empty.

We closely share this experience with Senua; if our mind makes something we fear real to us, then whether it really exists or not is insignificant.

From their research, Ninja Theory learned about some of the terrifying experiences people with severe mental disorders, such as schizophrenia, sometimes live through. And even though these experiences are large hallucinatory in nature they are real to those seeing and hearing it. Hellblade does a marvellous job of conveying such experiences by instilling elements of horror into the game. Together, the player and Senua must face total darkness, overwhelming fire, and confusing visual hallucinations. The video game does not rely on jump scares, but instead spends the necessary time on building the tension and only offering momentary relief – supported by the fear of perma-death.

Senua travelled deep down into her own psyche. So deep that maybe it should have been impossible for her to return? However, the premise of her state was always one of acceptance (accepting the loss of the one person who saw her as she is, helps her accept herself, something she was otherwise not able to do), which requires a certain amount of letting go of those past events in order to move forward. Letting go, not giving up. By finally doing so, things change. Senua finally accepts her lover is gone, but also that his soul is free, and she also seems to have come to terms with the voices in her head. This sets her schizophrenic condition, and the traumatic event apart from each other. But they both came together in a psychosis that enabled her to travel down into her own mind and deal with fears that had plagued her since childhood. She comes out on the other side, still a strong warrior, but now with an additional understanding of herself and her mental condition. In the game, schizophrenia helped her find patterns otherwise hidden and advised her via the voices. This does suggest a somewhat positive outlook on the benefits connected to schizophrenia, such as helpful voices and the aid of apophenia. However, Hellblade does not attempt to paint a rosy picture of what it is like to suffer from schizophrenia, but balances the dark and horrifying experiences with a suggestion that seeing the world differently to other people is not inherently bad.

By telling Senua’s story via the video game medium, the player not only comprehends that her condition is serious, but comes to understand how tough and at times terrifying mental health conditions can be thanks to the gameplay that exposes the player to the idea experiencing a psychosis. Mental health issues are to be taken just as seriously as physical ailments, and include everything from stress and depression to post-traumatic stress, schizophrenia, and dissociative identity disorder. These conditions should not be perceived as a threat to anyone else, but as a threat to those who suffer from them, as they can be seriously debilitating or even life threatening to the individual. Important to understand that our lacking understanding of these conditions is what may lead to dangerous situations first and foremost to those who suffer from the condition, but as a consequence potentially also to their surroundings. Hellblade: Senua’s Sacrifice helps us understand this, but also helps us understand that even someone with a serious mental illness should never be perceived as weak. What anyone with a mental health issue has to face, possibly on a daily basis, may just make them the strongest people any of us will ever encounter. If even a fraction of this is understood by the people who play the game, then Hellblade has achieved something truly great and can be considered a positive media contribution to the public’s understanding of what has for too long stood as a taboo topic.



Corrigan & Watson, 2002, “Understanding the impact of stigma on people with mental illness”: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1489832/

Disler, 2013, “Out of the Cuckoo’s Nest”: http://harvardpolitics.com/covers/cuckoos-nest/

Matulewicz, 2016, “Hearing Voices in Dissociative Identity Disorder”: https://www.healthyplace.com/blogs/dissociativeliving/2016/06/hearing-voices-in-dissociative-identity-disorder/

Mentalhealth, 2017, “Stigma and Discrimination”: https://www.mentalhealth.org.uk/a-to-z/s/stigma-and-discrimination



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