Vilifying Mental Illness: Horror Games & The Insanity Trope

Evil Within

Mental health in video games is pretty black and white. Think about how many times you’ve seen someone babbling, a person in a straightjacket, or someone who decides to destroy the world because of the voices in their head? This is common among many mediums (books and movies aren’t fault free either), but there is at least some variation in the portrayal of mental illnesses in these other mediums. Perhaps it’s simply because they’ve been around longer, but the truth remains that there are more progressive portrayals of mental illness in other mediums, while video games trail behind.

It was while I was playing some Evil Within that I started really thinking about it. Evil Within has both types of insanity that are common to games. The mad antagonist who puts himself above all rules and sense while a clearly broken boy in a straightjacket mutters and repeats himself constantly. I was trying to think of a game where mental illness was handled differently. Where was the game with a character who has borderline personality disorder and suffered as quietly as they could so they didn’t bother other people? Where was the person with the crippling anxiety, or people who had trouble functioning normally due to the severity of that anxiety? Where were all the people with mental illnesses who were still high-functioning and able to mostly keep themselves on an even keel outwardly even as they suffered inwardly?

All I could think of in terms of video game representation was the idea of ‘insanity.’ Someone who is criminally insane and wants to destroy the world is easy to think of in video games. Also, playing as a main character who is slowly losing their sanity due to the events going on around them. Don’t get me wrong, people can be negatively affected by the environment and their mental health can suffer for it, but sanity is not something that would go down like a health bar. Furthermore, it leaves the eerie suggestion that people with mental health issues are only affected by traumatic events and that they are less complete than “normal” (that’s a loaded word, but I’m using it for simplicity’s sake).

If someone with low sanity is hallucinating, the suggestion is that your mind is at 50% the capacity of a mentally whole person. This stereotype effects the sanity meter, which is pushed onto the player, meaning that when people think about mental illnesses, they think about people screaming and holding their heads, hallucinating, and generally seeing the same type of mental breakdown portrayed over and over again.

Don’t get me wrong, I love the shit out of Eternal Darkness: Sanity’s Requiem and I generally enjoyed Amnesia when I played the demo. I do not want these games or any of the Silent Hill series to stop existing or not be available for players. It’s just that the pictures these repetitive tropes paint about mental illness make it look like people who are ‘insane’ all act similarly, and that they can be easily set apart from ‘normal’ people.

I think the most troubling idea to me when it comes to gamers’ thoughts about insanity is that they are not aware insanity as a mental health diagnosis does not exist. The Diagnostic and Statistical Manual of Mental Disorders (DSM) does not list insanity as a diagnosis. You can’t be deemed insane by a doctor and then treated for insanity. You can, however, be legally declared insane by a doctor since that’s what it is. Insanity is a legal term which basically states that it’s a “mental illness of such a severe nature that a person cannot distinguish fantasy from reality, cannot conduct her/his affairs due to psychosis, or is subject to uncontrollable impulsive behavior.”


Looking at it that way, insanity as a blanket term for mental health is insulting, and doesn’t consider the different nuances or degrees of disorders. Insanity is a metaphor to help the legal system make concise decisions without needing as deep an understanding as expert psychiatrists would have. If you’ve been paying attention, you’ll have realized that almost all video game characters who’ve been shown to have a mental illness could fit into that very broad definition of insanity.

People with mental health issues are more then crazed, murderous villains. They’re more than the person in the straightjacket who talks and giggles to no one in particular. For every game you can think of with a more nuanced portrayal of mental illness (Actual Sunlight), there are three games that you could think of more easily that have shallower, more negative portrayals (Portal, BioShock, Silent Hill 2).

As much as I love these games, I can also see a common trend within them. The tropes about mental illness that make people into murderers would also make it seem like it’s common for someone with a mental illness to kill people. It can stigmatize and leave people more wary of others who do not have what is perceived as “perfect mental health.” It strips people down to certain traits and leaves them stuck in two-dimensional representations of their characters. People are not their mental illnesses. While it can be a big part of people’s lives, it does not push out the other traits that they have. People can have mental illnesses and be calm, intelligent, kind, and supportive. They can have full, rewarding lives and function so well within society that there is no way for you to know that they have a mental illness without them telling you.

I have heard countless complains about video games stories and characterizations over the years. So let’s stop with the shallow, single-minded representations of the human mind, yeah? They’re boring.

10 thoughts on “Vilifying Mental Illness: Horror Games & The Insanity Trope

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  1. Great piece.

    When I was younger, I fell for the ‘mentally ill people are dangerous and violent’ stereotype hook, line and sinker. Considering I’ve always been neck-deep in media, particularly videogames, it’s no wonder I internalized this message: it’s EVERYWHERE. Growing up, I played most of the games you mentioned and then some. The kicker? I was diagnosed recently with generalized anxiety disorder with some OCD leanings. If teenage me could see me now…

    I’ve heard of a few games here and there that tackle mental health in a smarter and more natural way (like Papi Y Yo), but they’re very, very rare. Like you, I’m tired of mental health being thrown under the bus in favor of cheap shock value and super duper scary scares. Having mental illness is hard enough without escapism spitting in our faces, too.


    1. Sadly, one of the easiest villains is the “other” and while it’s becoming less okay to stigmatize sexuality, race, and gender… mental health is still fine to treat like this. Considering the backlash that some games focusing on mental illness (in a non-villain way) have gotten, I can understand why developers would be hesitant. Like you said though, people have internalized these stereotypes and it just makes it that much more of a struggle for people with mental illnesses.


  2. I have never thinks of this before, even when my brother had in one point of our lives, a heavy problem with mental illnes. It’s seem like is another trope used to much as a lazy excuse for evil characthers, or in the case of the poor boy who repeat the same always another kind of damsel in distress


    1. I’m glad that I could bring it to your attention. It’s definitely a shorthand when it comes to writing (whether it’s video games, movies, or books). It’s easier to say that a character’s crazy rather than come up with believable motives for evil acts.


  3. I must disagree about Silent Hill 2 there being such a bad example, I would say more of a mixed one. (Spoilers ahead)

    As someone with pretty severe depression and PTSD (and probably a lot of other undiagnosed stuff) I actually found it quite refreshing with how they handled Angela: incredibly traumatized by everything that have happened to her, but never portrayed as evil or a legitimate threat. That one time she threatens James with a knife, it’s obviously not meant as an actual threat but rather a panic attack, and James seem to realize that too. This have happened to me IRL, I have threatened to do terrible things during a panic attack, and seeing that represented on screen in a sympathetic way felt incredibly comforting. Also she is not acting “super crazy” all the time, she is acting like someone scared beyond belief from seeing the town conjure images of her abuse again, which is completely understandable and also of course serves as a metaphor for traumatic memories and flashbacks.

    When in the hospital there is a bit of the “spooky writings from mad people as gritty texture thing” going on yes, but it always came off to me as being less about making you scared of them and more about making you scared of the realization that seeing monsters is not a sign of madness after all but rather something that might drive somebody to madness. A bit problematic yeah, but nowhere near the same level as say the mental health hospital in Silent Hill Origins. Also, it is possible to read it as “mad people are not the real danger here” which I liked, even if the intent is sorta blurry

    Eddie, yeah he is rather problematic. I get him in theory and I still like his arch, someone being an outcast from society and then being thrown into this alternate world where he is free to enact revenge on everyone that scorned him and going mad with power, though yeah at the end with how he acted was perhaps a bit much. Then again, the fact that James seems genuinely regretful that he had to kill him in self defense is better than what one usually get from games such as Outlast where the mad people are dehumanized to such a degree they are barely recognizable as people, so there is that at least, but yeah I understand the issue with him

    That Polygon article criticizing SH2 for the way monsters are handled I completely disagree with though. To me at least it was made pretty clear pretty fast James was not “just going mad” but that there were very real dark forces exploiting his fears and insecurities to try and get to him instead (it also helps the canon ending of SH1 says as much too), and I don’t think that is inherently linked to mental illness. It’s clear James is suicidally depressed, yes, but none of the monsters seemed to be modeled after the concept of suicide, rather about the guilt from what he did and the emotions that brought him to do it, and several other characters in the series who also see monsters based on their insecurities are completely “sane” too so I don’t buy that criticism.

    Basically, if you have a problem with the way mental health is handled in Silent Hill 2 then that’s fair, it’s controversial stuff and everybody have the right to be offended about stuff or feel it doesn’t portray people in a good way. Though I would like to ask to not completely brush it off as a flawed and bad game in that regard, as at least me as a very mentally ill individual have found a lot of comfort in it and helped me deal better with my own problems.


  4. A huge part of the tropes around mental illnesses that has always irked me is the “antagonist’s madness warps physical reality”-part. It implies both that mental illness is dangerous to everything in the vicinity of the ill person and (in the scenarios where it “infects” other ppl’s minds) as contagious. I’ve seen so much of that shit and how ppl act towards ppl with mental conditions and I can just say that it hurts.


  5. This is probably a silly question, but how is Portal a bad example? I’m thinking it’s about Doug Rattmann, but as a schizophrenic person, I actually related to him a lot (and tbh I think he’s one of the best psychotic characters we’ve ever gotten). Of course, that doesn’t mean he’s not problematic, but I would like clarification.


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