Mental Illness Portrayals in Video Games: Can They Do Good?



By Raul Szekely, Oliver Mason, and David Frohlich

Video games are a powerful form of entertainment-education, tackling various themes that reflect the complexities of the world around us. Among these, mental illness is frequently explored, but all too often through lenses that reinforce harmful stereotypes as characters with mental health conditions are depicted as violent, unstable, or misunderstood. But do these portrayals influence how we feel and act toward those affected by mental illness? The answer isn’t straightforward, but as the gaming industry evolves, there is growing potential for games to challenge outdated narratives and offer a more compassionate and less stigmatising perspective on mental health.

The Problem: Negative Portrayals of Mental Illness

Video games have long relied on mental illness as a shorthand for evil, instability, or violence. Characters are often shown as unpredictable and dangerous, especially in horror and survival games, where mental illness is used to create fear or tension.

A recent survey of 456 games since 2002 found that while one in 10 attempted to portray symptoms of mental illness, 75 percent of these depictions were negative or stereotypical. Schizophrenia-like conditions were most common, with characters frequently depicted as violent, homicidal, or delusional. This agrees with previous research on 100 games related to mental illness. Words like “insane,” “evil,” and “mad” were commonly used to describe characters. These depictions fuel the belief that mental illness is something to fear, rather than understand, which can isolate individuals with these conditions even further. However, evidence specific to games is lacking, so we must rely on broader media-wide studies.

A Step Forward: Positive Depictions in Video Games

While negative portrayals of mental illness remain common, some progress is being made in the gaming industry. Developers are starting to use their platforms to challenge misconceptions and encourage empathy toward individuals living with mental health conditions.

One notable example is “Hellblade: Senua’s Sacrifice.” Unlike traditional horror games that sensationalise mental illness, “Hellblade” portrays Senua, a warrior with psychosis, in a compassionate and humanised way. The game offers an immersive experience that portrays Senua’s internal battles with voices and visions, giving players insight into the complexities of living with a mental health condition.

Developed in collaboration with psychiatrists and people with lived experience, the game helps players understand the difficulties faced by individuals with psychosis. While “Hellblade” is a positive example, it is still one of the few that take a compassionate approach. However, recent studies support the idea that more positive portrayals can reduce negative views, at least in the short term (e.g., Ferchaud et al., 2020; Mason & Westhead, 2023).

This may be because, when we immerse ourselves in a game’s storyline, much like reading a book, we experience “transportation”—a psychological state where we become deeply absorbed in that imaginary world. This makes us more open to the messages the game conveys. In addition, identifying with relatable characters, understanding their motivations, and empathising with their experiences can further shape our attitudes.

“Goliath: Playing With Reality” is another great example of how storytelling can build empathy and change attitudes toward mental illness. Created with a real story at heart, this animated and interactive virtual reality game lets players experience what it’s like to live with schizophrenia. Players explore the emotional challenges of the condition, where symbols and metaphors represent the character’s distorted thoughts and feelings.

In our study from the University of Surrey, trainee clinical psychologists approved “Goliath: Playing With Reality” as a valuable educational tool—we found the virtual reality aspect to be especially promising in helping players experience the character’s world from the inside. These new insights could then counter misconceptions about mental illness.

A Call for Responsibility in Representation

As video games evolve, developers must take responsibility for how mental health is portrayed. This includes consulting with mental health experts, using respectful language, and aiming for accuracy in depictions. Developers should focus on showcasing the humanity of those with mental health conditions, emphasising their resilience, relationships, and everyday struggles.

At the same time, with the rise of immersive technologies like virtual, augmented, and mixed reality, there is a unique opportunity to create more interactive and engaging experiences that put players in the shoes of someone living with a mental health condition. As seen earlier, these experiences could transform how players understand and relate to mental illness.

All in all, although some progress has been made, many games keep perpetuating negative views toward mental illness. The full impact of these depictions on real-world stigma is still being researched, but it’s clear that the gaming industry must take a responsible approach, just like some screen productions such as “Silver Lining Playbook” and “Ted Lasso” have done. By promoting more positive and empathetic representations, there’s hope we can break down misconceptions and create a more supportive and understanding society.

While video games have the potential to do more than entertain, it’s ultimately up to each and every one of us—developers, players, and communities—to turn empathy, acceptance, and meaningful support for people with mental illness into a reality—both on and off screen.

Prof. David Frohlich is emeritus professor of interaction design at the University of Surrey. Dr. Oliver Mason is reader in clinical psychology at the University of Surrey. Raul Szekely is a Ph.D. student at the University of Surrey, researching virtual reality, mental health stigma, and healthcare education under the supervision of Mason and Frohlich.


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