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 Credits4 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 Arista4 months ago

    I've got a mental illness call "autisme"

  3. Shurikens Miner

    Shurikens Miner4 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 lead4 months ago

    @Alchemist I know they do

  5. Alchemist

    Alchemist4 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 lead4 months ago

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

  7. Jason

    Jason24 days ago

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

  8. Angela Warner

    Angela Warner29 days ago

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

  9. Rohtix

    Rohtix2 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.

  10. Marinus van Zyl

    Marinus van Zyl2 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

  11. Paulimbo Gaming

    Paulimbo Gaming2 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*

  12. FrankieTheWop

    FrankieTheWop2 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?

  13. Rebypox

    Rebypox2 months ago

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

  14. FrankieTheWop

    FrankieTheWop2 months ago

    and pretend homeless people don't exist

  15. Emerald Queen

    Emerald Queen2 months ago

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

  16. badfoody

    badfoody2 months ago

    Wolfenstein 2 had a good representation of anxiety and fear. Blascowiz goes through a lot of despair in that game. He wasn't even afraid or angry when they chopped off his head. He was kinda relieved the war was over and Anya was safe

  17. Lichkings Vault

    Lichkings Vault2 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.

  18. Vanessa Fillion-Tremblay

    Vanessa Fillion-Tremblay2 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

  19. Terry H.

    Terry H.3 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.

  20. Chicken of Justice

    Chicken of Justice3 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.

  21. Ulqcifer

    Ulqcifer3 months ago

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

  22. vazak11

    vazak113 months ago

    Very cool!

  23. Elise Taylor

    Elise Taylor4 months ago

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

  24. Bleflar

    Bleflar4 months ago

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

  25. Sean Hogan

    Sean Hogan4 months ago

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

  26. Nyctea -

    Nyctea -4 months ago

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

  27. Belbecat

    Belbecat4 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.

  28. Danté Rêves

    Danté Rêves4 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.

  29. Swan Scream

    Swan Scream4 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.

  30. sad granite

    sad granite4 months ago

    After watching this i feel bad for hello neighbor

  31. Robert Anca

    Robert Anca4 months ago

    1:29 I believe that anyone that is able to see that they have mental illness and are aware that asking for help would be a good thing to do, are healthy enough to not need to go to a mental hospital and instead traditional help from doctors would be enough.

  32. Angelos Dardagiannopoulos

    Angelos Dardagiannopoulos4 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!!!

  33. Night's Watch knight

    Night's Watch knight4 months ago

    The evil within real life

  34. Charles Dizon

    Charles Dizon4 months ago

    This is an example of media over inflating small stuff

  35. cicada keep

    cicada keep4 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

  36. Midgard Eagle

    Midgard Eagle4 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.

  37. Midgard Eagle

    Midgard Eagle4 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.

  38. Isaac Matthews

    Isaac Matthews4 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.

  39. Shibized

    Shibized4 months ago

    of course autism isnt represented in games enough...

  40. Mazera DeVille

    Mazera DeVille4 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.

  41. Steven Neiman

    Steven Neiman4 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.

  42. Icon Games

    Icon Games4 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.

  43. Todd

    Todd4 months ago

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

  44. Corbin Kramer

    Corbin Kramer4 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)

  45. Sahdirah

    Sahdirah4 months ago


  46. JoGeronimusKer of ebblepub

    JoGeronimusKer of ebblepub4 months ago

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

  47. Whyareall

    Whyareall4 months ago

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

  48. Evil Paragon 4

    Evil Paragon 44 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.

  49. Swan Scream

    Swan Scream4 months ago

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

  50. RuneKatashima

    RuneKatashima4 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.

  51. DJGreen

    DJGreen4 months ago

    You should check out Night in the Woods.

  52. Jean-Philippe Doyon

    Jean-Philippe Doyon4 months ago

    Eternal example !

  53. Sir Squidly

    Sir Squidly4 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.

  54. E K

    E K4 months ago

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

  55. ANIME IS A SIN! k

    ANIME IS A SIN! k4 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.

  56. Jacob Wathen

    Jacob Wathen4 months ago

    How so?

  57. Lon Johnson

    Lon Johnson4 months ago

    I always got annoyed when my therapist would correct me when I used the term "crazy" to describe myself. For how I felt at the time, the term worked for me. Don't be afraid of words, especially if they fit the situation. (On the other hand, don't be mean, just to be mean.)

  58. Weaver

    Weaver4 months ago

    I... think this could use some distinction between characters saying things, the setting saying things, and the game itself saying things. I mean, you can probably avoid using negative language in your UI and the names of enemies and items and things, but if you're working in the quasi-real present or earlier, having your characters all follow these guidelines is going to be strange and dissonant depending on what else you're handling and how. I mean, this is slightly hinted at when you mention content warnings, but the different "voices" with which a game expresses things (UI metadata vs in-world writing/broadcasts/etc vs characters not recorded vs visual design vs mechanics) and how those can be in sync with each other or not and how they have different kinds of authority, etc., really could probably use its own episode, especially WRT things like propaganda games. There's also the complication that mood disorders are a blurry mess and hard to pin down, and many disorders can be better or worse over time in different contexts-- a lot of this, from what I've experienced, happens over time scales much longer than most game stories deal with, and requires a lot of time with patterns of behavior, when it's not at pathologic life-interrupting levels...

  59. Alex Hyer

    Alex Hyer4 months ago

    Thank you so much for making this video. As someone who struggles with a mental disorder, I often find media oversimplifies and even makes light of my issue. Hellblade was a truly cathartic experience and I can't recommend it highly enough to everyone. I have so much respect for the developer's of that game. The message of this video is a much needed one and I hope media creators truly imbibe your words. Again, thank you.

  60. Kez Hap

    Kez Hap4 months ago

    Remember when people said that having a degree in psychology was useless?.... they were wrong

  61. BlizzardofKnives

    BlizzardofKnives4 months ago

    It'd be fascinating to see mental health expertise used in the creation of Warhammer and Lovecraftian fiction.

  62. Fallon Braddy

    Fallon Braddy4 months ago

    Let's not forget that many people have not documented their mental illness with a doctor. If society were less stigmatized toward recognizing mental illness (and if we had better treatment) I think many of the statistics here would look a lot different.

  63. Angelo Acosta

    Angelo Acosta4 months ago

    3:26 And THIS right here is what bothered me so much about DDLC. I didn't know what it was at the time, but I did know that something just felt really bad about the way that game portrayed it. In retrospect, I can't really blame Salvato since it was hardly a serious attempt at making a game and more so an elaborate publicity stunt to promote the game that he was actually working on. Regardless, it really did irk me that so many people were promoting the game because of it even though it was done purely to get reactions

  64. William Dye

    William Dye4 months ago

    The Rattman comic (from Portal and Portal 2) is an example worth mentioning.

  65. Ryan Rockz

    Ryan Rockz4 months ago

    Can you do a video on 2b 2t, the seever

  66. Ryan Rockz

    Ryan Rockz4 months ago


  67. Minix NerdyGamer

    Minix NerdyGamer4 months ago

    not a mental illness but "quiet man" was a horrible representation of hearing impairment

  68. SanitariumPr

    SanitariumPr4 months ago

    Well not surprised when I saw the title. Btw Depression Quest is not “a game” but silly simulator from not really “Game developer” but attention seeker.

  69. Fusilier

    Fusilier4 months ago

    Here before the video starts to say if there's not at least one Celeste reference in here, my own mental health will take 1d6 of damage.

  70. Jacob Wathen

    Jacob Wathen4 months ago

    What did you roll?

  71. Danielle Crowder

    Danielle Crowder4 months ago

    I think a good example of mental illness in video games is Futaba Sakura from Persona 5. I just love how Atlus handled her character