As a child, John Kieswetter played video games with his younger sister and two cousins who lived nearby as often as he could.
When Kieswetter’s sister died unexpectedly almost a decade ago from complications following a surgery, gaming provided a refuge from his overwhelming grief and sadness. When he felt up to it, Kieswetter would play games, and sometimes he’d talk with his gamer friends about what he was going through. Many of them reached out to offer support.
“Gaming gets your mind off things for a little while, and that helps,” says Kieswetter, who lives in Ontario, Canada. “Gaming has had a huge impact on me as far as my mental health. The friends I have made over the years are so incredibly supportive and I consider them family. They have been there for me, and I’m there for them.”
Like many people worldwide, Kieswetter has turned to gaming to cope with the isolation and anxiety of the past year. A recent Microsoft study within the Xbox Research Accessibility Community Feedback Program, a group made up of players with disabilities, looked at gaming and mental health during the pandemic. The study found that 84% of respondents agreed gaming has positively impacted their mental health over the past year, while 71% said gaming helped them feel less isolated.
这些调查结果特别激怒，因为全世界的人们标志着心理健康意识月，这可能是大流行的大约16个月。但即使在大流行之前，研究人员都引用了benefits of gamingon mental health, and game creators have in recent years begun portrayingmental illness in gamesin more thoughtful and less stigmatizing ways than in the past.
Those includeHellblade: Senua’s Journey, whose main character struggles with psychosis;Celeste, about the quest of a girl who has anxiety to climb a mountain; andPsychonauts, about a boy who projects himself into other people’s mental worlds and helps them fight their demons.
Kelli Dunlap, a clinical psychologist who has a master’s in game design, says video games can help people living with mental illness by providing a way to relax, connect with others and feel competent.
“These are things that are crucial to mental wellbeing in general, but they’re not things that we get a lot of in our daily activities. Even if you don’t dislike your job, you’re probably not getting all the mental health vitamins, so to speak, out of your job. So games can be incredibly helping in meeting needs that are not being met otherwise.”
对于患有严重精神疾病的人来说,邓拉普说, games can help counteract the self-defeating narratives that often accompany conditions such as anxiety and depression, “when our brains lie to us and tell us, ‘You’re no good, you’ll never accomplish anything, you’re worthless.’
“People rarely have that experience when they’re playing games, because games induce the opposite — you’re the hero, you are Master Chief saving the universe from intergalactic space zombies,” she says. “You can do the thing, and there’s constant feedback about ‘you’re doing good and you’re progressing.’”
Raffael Boccamazzo understands that as well as anyone. He became fascinated at an early age with video games, which offered a predictable framework and made sense to him in a way that social interactions with his peers often didn’t. Through gaming, he felt a sense of empowerment and capability that could be elusive in real life.
Boccamazzo got into role-playing games in his teens, and in his early 20s realized that the charismatic, extroverted characters he played in games, who were “sort of a fantasy wish fulfillment” for him, came from within him. If he could play that person in a game, he reasoned, he couldbethat person in real life.
在35日被诊断出患有自闭症的Boccamazzo继续成为临床心理学的博士，并在临床和教育环境中使用桌面角色游戏的专家。“B博士”，因为他所知，现在是临床主任Take This, a nonprofit based in Kirkland, Washington, that focuses on combating stigma and increasing support for mental health in the gaming community. (Dunlap is the organization’s community manager.)
In 2019, Boccamazzo helped create a Dungeons & Dragons adventure in which players enter the subconscious mind of a young woman to battle the monsters of anxiety and depression plaguing her.Gardens of Fogaims to depict some of the ways anxiety and depression can affect people, Boccamazzo says, and draws from his own experience with both issues.
Boccamazzo and others emphasize the need to involve people who have experienced mental health challenges from the start when creating any game depicting mental illness. Even before that, Boccamazzo says, game creators should ask themselves why they want to depict mental illness and what purpose it serves.
“Whose story are they telling, and are they using mental illness or mental health challenges as a vehicle?” he says. “There are lots of other compelling stories you can tell.”
Tanya DePass, a Take This ambassador who lives in Chicago, says mental illness is often used as a justification for game villains’ actions. Instead, she says game creators should “explore reasons for someone to do bad things other than mental illness.
“Because doing that reinforces the idea that mentally ill people are dangerous. And the most dangerous a mentally ill person is is to themself, not society.”
Negative tropes about mental illness — the mad scientist, the psycho killer, the insane asylum — have existed in video games since at least the early ‘80s, Dunlap says. But the game industry, she says, is ahead of the curve in depicting mental illness in more positive ways than in film and television.
“If you’re putting out a stereotypical portrayal of mental illness, you can be doing a lot of harm, because individuals with mental illness are a vulnerable population,” she says.
“If you want to address something like suicide in a game, that’s a very emotionally triggering kind of content. It’s not that you can’t include it, but be mindful about how you’re doing it.
When Dom Matthews and Tameem Antoniades set out to make what would become Hellblade, they decided to center the game on a character who experiences psychosis. They thought Senua’s unique way of interacting with and seeing the world would make for a compelling game and journey but understood the gravity of taking on an oft-maligned and misunderstood illness.
“We knew that we had to do our research. We had to get it right,” says Matthews, the studio head for Ninja Theory, a Cambridge, England-based video game studio that is part of Xbox Game Studios.
“We had to do it justice and tell a story that would be truthful to someone who experiences psychosis.”
So Matthews and Antoniades, Ninja Theory’s co-founder, reached out to the nearby University of Cambridge and connected with Paul Fletcher, a professor of health neuroscience who specializes in psychosis. Fletcher did a presentation about psychosis to the project’s development team, then connected them with people who had experienced psychosis.
That input informed how the voices Senua hears are depicted in the game — instead of just adding voices, the team used binaural audio, a way of recording sound that uses two microphones to create a 3D effect, to reflect how people with psychosis hear voices externally and from various directions.
“That was one of the things the group really loved,” Matthews says. “It felt so genuine to them.”
Similarly, the development team learned through those conversations that though the experience of psychosis can be very difficult, it can also have moments of positivity and warmth, Matthews says. That reality is reflected in a moment when Senua steps into a sunlight-soaked scene bathed in radiance and color. One woman in the group told Matthews the scene was her favorite part of the game because it showed the “sheer beauty” that can come with psychosis.
“If we didn’t have that collaboration, we never would have learned those things,” Matthews says.
Hellblade won multiple awards, including one from theRoyal College of Psychiatrists, and was broadly heralded by critics. But it was the messages that poured in from fans, compiled in a touching视频, that meant the most to Matthews. They wrote that Senua’s journey made them feel seen and understood, less alone, that the game gave voice to what they’d felt but struggled to express.
“We achieved success from whichever perspective you look at it, and that’s great,” Matthews says. “But by far the most fulfilling of those successes is meeting those people and reading comments from people about how the game impacted them.”
Tim Schafer didn’t set out to make a game about mental health when he created Psychonauts, released in 2004. But the game focused on the inner struggles of its characters and conveyed a hopeful message about healing.
Schafer also consulted with mental health experts including Boccamazzo. That input led to the inclusion of a content warning for the game and some language changes. Schafer believes games depicting mental health issues can be helpful, provided those portrayals are sensitive and informed by experience.
“Showing someone positively healing and dealing with some of these problems … it’s not an instant fix or anything, but I feel like just showing that can be a positive step for people,” he says.
“I think gaming is a proxy for facing troubles in your own life. It’s a very low-stakes way to experience practice emotions and practice anxieties and go through them in a safe way and build up the capacity to do that in the real world.”
A2016年研究近100个最销售的视频游戏发现，超过四分之一描述了至少一个具有精神疾病的性格，但大多数是“凶杀型疯狂的”品种。Dunlap说这更改了，与Hellblade和其他人这样的游戏，如Adventures with AnxietyandStardew Valley, portraying mental illness with more empathy and understanding.
“There’s a lot of innovative stuff coming out of indie game studios,” she says. “I’m very excited about that transition.”
Game creators have only recently started to more explicitly address mental health challenges in video games. Tara Voelker, one of Xbox’s accessibility program managers, says that while game developers are attuned to thinking about accessibility in gaming for people with physical disabilities, there’s less awareness about players with mental health issues.
“I think the accessibility space is growing and more becoming inclusive, and so we have to do that education now.” The Microsoft gaming accessibility team has started planning what that education for developers could look like as part of their future work.
A gamer herself, Voelker is open about her struggles with post-traumatic stress disorder and says games help channel her energy and divert her mind from potential triggers. Mental health issues are often isolating, but seeing those challenges reflected in games can help normalize mental illness and break down the stigma around it, Voelker says.
“We all have mental health struggles,” she says. “The more examples we can have out there, the more normal it becomes. The more we can help normalize mental health struggles, the more comfortable people will be talking about them and seeking care.”