Mental Health in Games - How We Can Do Better - Extra Credits

Hellblade: Senua's Sacrifice offers some great examples of how to address mental illness respectfully in games, but we found some other examples in media as well as recommendations by actual psychologists. Many thanks to Heidi McDonald and Dr. Kelli Dunlap for their research and writing for this episode!
Check out this paper: "Representation of Mental Illness in Video Games" by Dr. Kelli Dunlap
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  1. Extra Credits

    Extra Credits9 months ago

    (Today, May 1st!) Will and his music therapist friend Rosa are going to be talking further with Chat about mental health in video games while playing Hellblade: Senua's Sacrifice over on Twitch today. Come join the conversation anytime between 1:30pm and 5pm EST!

  2. Armand Arista

    Armand Arista9 months ago

    I've got a mental illness call "autisme"

  3. Shurikens Miner

    Shurikens Miner9 months ago

    I do feel I've gotta say: The "Person with Mental Illness" VS "Mentally Ill Person" as a general point doesn't really apply to people with Autism, as far as I've heard (I'm on the spectrum as well, though I personally don't care). Most people feel that their Autism DOES in fact define a part of who they are, and saying "Person with Autism" makes them feel detached.

  4. Lord of lead

    Lord of lead9 months ago

    @Alchemist I know they do

  5. Alchemist

    Alchemist9 months ago

    @Lord of lead I don't say I agree with such policies. I very much don't, consider that dumb. Just stating they do exist.

  6. Lord of lead

    Lord of lead9 months ago

    @Alchemist but no one cares about the Japanese using their flag in games or playing as the Soviet Union

  7. Adam Greenspan

    Adam GreenspanMonth ago

    A minor warning about person-first language - be careful as to what you are applying it to. I learned recently that “autistic person” is preferable to “person with autism”; many autistic people feel that being referred to as a “person with autism” is like being referred to as a “person of short stature” or a “person of Jewish faith”. In other words, you are treating something about them that they would like to be embraced as if there is something wrong with it that requires the adjective to be put in a diminished place behind the noun. This came as a shock to me, as I had previously been taught person-first was the more sensitive way. The fact is, though, that health professionals are not the only experts one should consult - the people themselves, and the advocacy groups they have formed by and for themselves (rather than those formed by others that purport to speak for them, and/or to “cure” them) should also be consulted. Deaf culture has long taken issue with this, as has the National Federation of the Blind.

  8. Dimitriy Yaroshchuk

    Dimitriy YaroshchukMonth ago

    There is a game named Night In The Woods and it is amazing, the main character suffers from a mental illness and it is shown pretty well

  9. Litis

    LitisMonth ago

    I have missed the format where we look at examples of games that do things particularly well or particularly poorly. I have a lot to catch up on but I hope to see more studies of specific games rather than just general trends.

  10. Terra

    Terra2 months ago

    Nicky Case did this well.

  11. Seth Leoric

    Seth Leoric2 months ago

    To be fair the Psychos in borderlands are all dangerous criminals

  12. catty cat queen

    catty cat queen2 months ago

    The hospital is not like in media seek help don't be afraid i have faith in you

  13. Dreaming About France & Chocolates

    Dreaming About France & Chocolates3 months ago

    I just love playing games about DID and then explaining how what they portray is nothing like DID. (Examples: Rise of Insanity, Who Am I: the Story of Dorothy, All the Delicate Duplicates (Honestly, I think this is more magical thinking/schizophrenia in hindsight rather than a dissociative disorder), and one more I forgot the name of (will edit if I remember).

  14. G B D N H B

    G B D N H B3 months ago

    2:52 Oh yeah Genital Jousting explores a deep touchy important subject of dick snakes sticking themselves into each other

  15. ViaVia

    ViaVia4 months ago

    One other common videogame trope I see that I'm a little bit surprised you didn't mention is medication for mental needs being a negative in of itself. Take the game "We Happy Few." I have no opinion on the game but easily the most striking detail of the story that the entire game emphasized was the vilifying of relying or endorsing medicine for people's minds. Don't get me wrong, I'm fully aware that wasn't the point of the game. I know that in terms of connecting the game to mental health, the critic can get a little shaky, and you can definitely argue that the real point of the pills mechanic was to criticize outward social cultures that hold unrealistic expectations for people in how to behave. My point is no matter what the intention or meaning was, it doesn't change what the game was in literal terms. I mean hey, they literally referred to the pills as "joy," which holds a lot of similarities to the comparison of the term "happy pills," that people use to discredit mental health care, and people with mental illnesses in general.

  16. popstarprincess123

    popstarprincess1234 months ago

    Extra credits doesn’t know or are ignoring the history of mental hospitals On top of the hypocrites against freedom and creativity

  17. sardonisms

    sardonisms4 months ago

    I get what you were trying to say here, but honestly, the fact that you implied "evil megalomaniacs bent on taking over the world" are mentally ill is more offensive than the thing you were trying to discuss.

  18. ParaEwie

    ParaEwie4 months ago

    R*tard is the worst.

  19. ParaEwie

    ParaEwie4 months ago

    Autism shouldn't be a mental illness

  20. grimciitys

    grimciitys4 months ago

    "theres more words to use if you want to be more sensitive about this" /shows a slur used to dehumanize mentally disabled people/

  21. Callise

    Callise5 months ago

    I find it hard to believe it is only 3%. The thing that angers me the most if you bring a family member to the hospital telling them they have completely lost it, they have become mentally ill they won’t care at all. They will send them right out the doors Extremely ill You call the police tell them there is something wrong with my friend. Both doctors and police say “if they are not harming themselves or others they don’t want help. Nothing we can do.” Isn’t it a self harm that another personality took over and is destroying there job, and relationships?! The police and doctors don’t do jack shit until they do commit some kind of crime. It pisses me off when the family tries to get them help nothing will come of it until it is so extremely. They wait for it to get sooo bad before they do anything. Even when there family or friends is yelling something is wrong. Shows like bates motel or Mr Robot aren’t just dark or horror maybe more extreme cases but that’s a very real reality for some one. There needs to be more ways a family or friend can help there love ones. Doctors and police should take families and friends begging to save the person they love more serious than waiting for it to get out of hand. I can’t help but to wonder how many incidents could be avoid if people had listened to the family and friends.

  22. Jason

    Jason5 months ago

    Game designers are not required to be babysitters, game players are not incapable and incompetent.

  23. Angela Warner

    Angela Warner6 months ago

    This is an excellent video! I especially liked how you pointed out how to use people first language.

  24. Rohtix

    Rohtix7 months ago

    The "don't define someone by their mental illness" notion has always been kind of silly to me, to an extent. I deal with bad anxiety and depression. It's done some real shit to me that I'm not particularly proud of. I'm working on it and doing ok, but I digress. If you were to not define me in some way that I'm depressed and often anxious, you would be pretty much lying to anyone you introduced me to. It doesn't have to be the main aspect of my personality, of course, but it IS there. It's REAL. It's a part of me whether I like it or not and at some point, it HAS to be dealt with. I've had friends walk away from me because I have issues. I've had jobs fire me for it. I've screwed myself so many times over my issues. Honestly, even though it was shitty of them, I can't really blame them, because it's nobodys responsibility but my own to deal with. If they choose to not deal with someone with issues like mine, who am I to force them to? I'd be just as bad as I think they are. It's not just "something I deal with", it's a major factor in my life that effects the world I interact with and unfortunately, it's not always something that turns out good. Defining a character solely off of their illness is dumb, obviously, because it's a poor way to write a character. One trait of a personality does not a good character make. Nobody chooses illness, but unfortunately it's a reality. People who deal with any kind of illness don't want special privileges or hand holding, because in the end, it only makes them feel weaker. All they want is to be understood and respected. That's all.

  25. Marinus van Zyl

    Marinus van Zyl7 months ago

    02:02. Aren't you missing the obvious? Why would someone with issues with mental institutions buy a game with a mental institution as a location? Aren't you also going on the assumption that everyone with a mental condition cannot handle an environment with stressors? Or are you implying that everyone with mental issues is incapable of being treated for their condition? If your therapist cannot help you with your condition, perhaps the problem is your therapist, not video games in general? o.0

  26. Paulimbo Gaming

    Paulimbo Gaming7 months ago

    *plays games set in an 1800's mental hospital* *realises its set in the FUCKING 1800'S and not set in modern bloody day*

  27. FrankieTheWop

    FrankieTheWop7 months ago

    how do you propose that a game developer analyzes the mental condition for millions if not billions of people to make sure their subject matter doesn't cause stress in a single one?

  28. Rebypox

    Rebypox7 months ago

    Okay, lets jut ignore the awful history of mental hospitals then....

  29. FrankieTheWop

    FrankieTheWop7 months ago

    and pretend homeless people don't exist

  30. Emerald Queen

    Emerald Queen7 months ago

    If you’re interested in this subject look up Kati Morton (mental health awareness) here on USwork or Max Derrat (mostly Autism)

  31. Lichkings Vault

    Lichkings Vault8 months ago

    I get what you’re trying to do but I think you went a step to far. Using a mental hospital because it’s scary for most people to be with people who’s actions they can’t predict or because of horrific things they used to do to mentally ill people is not disrespectful. That’s using common tropes to convey a feeling. Ha ring a mentally ill person be the villain might be uncommon in the real world (not sure if you’re using conviction statistics or something else) but what some people, such as Ted Bundy, have done is terrifying it’s an explanation people can except for why someone could do such horrible things. Does that mean they are overused? Sure. Should have warnings? Probably. But not using some words because they might offend someone? That just seems over-the-top.

  32. Vanessa Fillion-Tremblay

    Vanessa Fillion-Tremblay8 months ago

    My stepdad suffers from throught mental health (psychosis) and it's so hard to help him. He says that if he's sick, that means he needs to be in an Asylum, that he's crazy and so on.. So he doesn't believe it... We don't know what to do with him and it shatters our family in the past 2 years. We need to portray mental health and how to 'cure' it under a better light

  33. Terry H.

    Terry H.8 months ago

    Ermm... how much can you miss the point? Not to say that everything you said is irredeemable. Literally show the word "r*tard" uncensored and then be like "don't use this". Also using the word cr*zy even to describe other things is still considered in bad taste. Also whether someone wants to be called a "person with mental illness" or "mentally ill person" should be up to them, everyone has different preferences.

  34. Chicken of Justice

    Chicken of Justice8 months ago

    at 5:34 you show a bunch of synonyms that you should use instead of crazy and one is insane but just before you say that you shouldn't call them insane.

  35. Ulquitous

    Ulquitous8 months ago

    "Sanity? I never had such bothersome thing to begin with." - a creatively insane swordsman

  36. vazak11

    vazak118 months ago

    Very cool!

  37. Elise Taylor

    Elise Taylor9 months ago

    I feel the need to point out that traffic conditions and weather can also be called "insane"

  38. Bleflar

    Bleflar9 months ago

    You accually want to be insane. Some of the most powerful items in the game require being insane to get.

  39. Sean Hogan

    Sean Hogan9 months ago

    I really want to make a game and have the main character have ADHD

  40. Nyctea -

    Nyctea -9 months ago

    P.T gave me an emotional breakdown. Yeah... aint too proud of that now.

  41. Belbecat

    Belbecat9 months ago

    Hmm, good point. If I suddenly found myself developing a mental illness I'd definitely be scared af to seek proper help because of what all media make out mental institutes to be like... would love an episode about the possibilities of games helping people with mental illness though surely there's lots of examples! I know you had a few episodes with stories of people and games, hope to see more.

  42. Danté Rêves

    Danté Rêves9 months ago

    And today on How Not To Offend People #457... Nah ok just messing about. I agree that if a game tries to represent a mental health issue accurately it is important to do your research. But I really don't think every game needs that regardless of game design. If you need a clichéd psycho to make your game fun, showing him talking to his mom over the phone about what topics he discussed today with his phychotherapist today would kinda seem out of place... TL;DR: Do your research if taking mental health seriously, otherwise focus on the game design.

  43. Swan Scream

    Swan Scream9 months ago

    First, as other people have said, modern day asylums sometimes are violent and abusive; everyone I know who has been forcibly sent to one has been treated cruelly and left traumatized. Some people self-admit and have an okay time. They are not all of us. The problem with scary asylum portrayals is portrayals of crazy people as inherently scary. Complaining doctors? Fuck that! Until my friends stop being sexually & physically abused, forcibly medicated & restrained by them, you better believe asylums will be violent places and many doctors violent people. Also, organizations like Mad Pride comprised of actual mad people frequently don't use person-first language, and a lot of marginalized groups generally reject it, like autistic people. ... Also, please don't literally depict madness as a demon hanging off my back. Delusions and mania and all that isn't something external tacked onto me. It's not even something universally bad. Dissociation got me through horrendous trauma. Feelings of grandeur, delusions and general psychosis were some of the only things that kept me alive. This video is like, very "I had depression and the nice doctor prescribed me some Citalopram and now I'm all good!". Which is also an experience I've had. But not the only one.

  44. supa oof oof sad gacha

    supa oof oof sad gacha9 months ago

    After watching this i feel bad for hello neighbor

  45. Angelos Dardagiannopoulos

    Angelos Dardagiannopoulos9 months ago

    Having worked at a mental hospital and being a game designer, I think you should be able to do whatever you want to do. People shouldn't feel forced to talk to professionals, specialists etc if they feel like they don't want to (given it makes the presented experience hold more weight). There's a wide spectrum of what mental illness even is and it already has a lot of stigma so maybe my stance isn't that good for it, but I believe in freedom of expression. Not everyone has the same experience with mental illness so not everyone will see your representation as accurate. Games are a work of fiction, and if you're basing your perception of mental illness just off entertainment representations, you're doing them and mental illness a disservice. We need to do a better job of helping our youth understand what mental illnesses are and help people in need. Loved the video! Great work Extra Credits team!!!

  46. Night's Watch knight

    Night's Watch knight9 months ago

    The evil within real life

  47. Charles Dizon

    Charles Dizon9 months ago

    This is an example of media over inflating small stuff

  48. cicada keep

    cicada keep9 months ago

    Coming from the horses mouth(aspergers syndrome ) meny mental heath institutions are underfunded, understaffed, remote and secluded, and severely mismanaged. The location I was forced legaly to attend was over male capacity so I attended the female group time instead of the male one

  49. Midgard Eagle

    Midgard Eagle9 months ago

    To be honest, I just found Forrest Gump a silly movie and his character more of a mockery of mentally challenged people, but to each their own, I suppose. I agree with everything else this video says, though. It was wonderful.

  50. Midgard Eagle

    Midgard Eagle9 months ago

    Agree with all of this, from the portrayal of mental hospitals to "mental illness as only reason/motive for being evil". 1:55 this was so me. I was committed to a psychiatric hospital at 18, and I was terrified because I had no idea of what it would be like, and all I had to go on were all these weird portrayals of what they would be like. As the video says, this stigmatisation of mental disorders and conditions does everyone a huge disservice.

  51. Isaac Matthews

    Isaac Matthews9 months ago

    If anyone tries (or has tried) to make a game with a focus of ASD then I wish them all the luck. You could make an entire RPG with all the playable characters having ASD and still have a child identify each one separately because of their personality. I read once about a bunch of people who as young people (and even as adults) got locked up into solitary confinement, given drugged food because of their meltdowns and were not allowed to do things like go for a walk. This was within this year's newspapers, the stigma is deserved and history repeats itself for a reason.

  52. Shibized

    Shibized9 months ago

    of course autism isnt represented in games enough...

  53. Mazera DeVille

    Mazera DeVille9 months ago

    From the title, I half-expected some political lecture about insensitivity in games. Good to see that only a very small segment was dedicated to that topic. Agree with most of what's been said except the aforementioned subject about using more sensitive terminology. The fact of the matter is that people will be called "crazy" or "retard" etc. in real life so I disagree that developers should censor their work to create a more pleasant portrayal of the mental health issue. As long as the portrayal is done in an educated manner that (at least somewhat) accurately depicts the struggles and stigmas people with mental health issues face (preferably with a depiction of their journey in overcoming such struggles), I see no reason to ask of a developer who has already made public a content warning to avoid using possibly offensive terms.

  54. Steven Neiman

    Steven Neiman9 months ago

    There is kind of a tricky question with the whole "scary mental hospital" thing. On one hand, it's often used carelessly as just another stock horror setting, and there is a nonzero risk of convincing people that modern (mostly positive) mental health care is as bad, but on the other hand there's a history behind the treatment of the mentally ill which I would consider ever bit as horrifyingly fucked up as the Holocaust (if not on quite the same scale). It's a history which I think could be used to make a very compelling game with a compassionate, positive message.

  55. Icon Games

    Icon Games9 months ago

    Games can do more than just portray health issues. I was in a really bad place some (not so long) time ago - then I learn about the "Bitsy" game engine: a very simple HTML5 game engine, where you can make simple games with no coding at all. I let my imagination (and feelings) run wild, and did a very, VERY DARK (and unsuitable for kids) game. But - get this - I felt light as a feather after making it. The weight of the world came off my shoulders. Someone from the area should really investigate this: making games as a form of treatment. I can almost guarantee it will wield good results :) And the game I've made? Its here if anyone wants to try it: BEWARE - its unsettling.

  56. Todd

    Todd9 months ago

    Hey the artstyle is different ! Pastel-like or someting I like it, it's relaxing

  57. Corbin Kramer

    Corbin Kramer9 months ago

    I know this has been mentioned, but I want to address this because its been in my mind since I watched this. The idea that media stereotyping mental health hospitals as scary places full of straight jackets and being held down to be injected with drugs is what prevent people from accessing mental hospitals or centers is a bit incomplete. PoC, women and LGBTQ have been routinely denyed care, agency, and dignity. The stratification of doctors and patients is real. It is not uncommon for doctors to talk ill of their clients to ignore their concerns or their own research on a drug or treatment. The idea that many don't check in because of the SPoOkY NuThouSe is not fully true. There are other reasons for why folks don't seek care and I feel this video isn't giving a more panoramic view. Games that acknowledge the stratification and paternalism of the mental health industry are important. Games that validate the insecurity of clients and mistrust for care professionals are important. And I feel that needs to be mentioned. (Idk what the culture of part of USwork is like so I hope I won't regret this)

  58. Sahdirah

    Sahdirah9 months ago


  59. JoGeronimusKer of ebblepub

    JoGeronimusKer of ebblepub9 months ago

    1:01 Joker doesn't have a mental ilness. He is just Super Sane😆

  60. Whyareall

    Whyareall9 months ago

    Genital Jousting Edit: That's an actual game???

  61. Evil Paragon 4

    Evil Paragon 49 months ago

    I mean to be fair, Splicers in Bioshock don't _technically_ have mental illness. They are insane, but it's insanity caused by permanent withdrawal from their ADAM addiction.

  62. Swan Scream

    Swan Scream9 months ago

    ...I mean, do you think people split hairs that fine before applying their prejudice to someone muttering to themselves on the train?

  63. RuneKatashima

    RuneKatashima9 months ago

    I respect the message but I don't agree with your viewpoint. Namely with the censoring of words you guys pointed out. For reference I suffer from mental health issues and so do some of my friends. I have a Schizo in my friend group. That same person is also trans. If you only use "mental health professional approved language" you stifle storymaking. Moreover, dialogue will start to sound like the "Gamer talk" you hear often in fps demos. Like for Anthem. It sounds fake. If you want to write an abrasive character who uses the word "Retard", you should. And no one should shame you for doing so nor should you be expected to do a callout "this guy is a bad person." Because then you're just lawyering personalities and that's not a world people want to live in unless they like Dictatorships. I have some gripes with the rest of the video but they're minor and I have no intent to undermine the message your video is trying for. I just want to criticize the worst part about it. FWIW I am not a first time viewer. Been around for a long time and I think your content has usually been great. I have noticed a change in writing style though. I thought James wrote everything, but it makes sense the voice has an influence too, but it seems more than just slight alterations and more social justice-y.

  64. DJGreen

    DJGreen9 months ago

    You should check out Night in the Woods.

  65. Jean-Philippe Doyon

    Jean-Philippe Doyon9 months ago

    Eternal example !

  66. Sir Squidly

    Sir Squidly9 months ago

    I was slightly hoping for an episode more about how Sanity is treated in games specifically, as I find it strange yet interesting how games attempt to quantify metal well being, and how it can tie into the mechanics overall, such as how Amnesia apparently distorts and affects the environment depending on the current sanity, or how in Darkest Dungeon sanity can inflict penalties, or can actually rebound to improve the character. I mean, this seems to be more generalized to how mental health is treated in all of media, which while it is important, doesn't feel as related to games specifically.

  67. E K

    E K9 months ago

    This is silly but can you do a fire emblem extra cedrits

  68. ANIME IS A SIN! k

    ANIME IS A SIN! k9 months ago

    Depression quest was a terrible game. Made by a terrible person. But! This video was very interesting, informative and well written, as usual of course.

  69. Jacob Wathen

    Jacob Wathen9 months ago

    How so?