Content Warning: The following article contains discussions of depression, suicidal ideation, addiction, and PTSD.
While other forms of media like books and film have long, storied histories presenting realistic looks at mental illness, video games have only recently begun to successfully depict characters living with depression, anxiety, post-traumatic stress disorder, and other mental health issues.
Although many games still frustratingly play these conditions for cheap effect, others attempt to present them more honestly and realistically. While different games have used unique narrative and presentation strategies to get their messages across, all of the most realistic games depicting mental illness can help players better understand how others experience their lives.
Life is Strange
Each game in the Life is Strange series has been critically acclaimed for its complex, realistic characters and relatable narratives, but the original does a particularly good job of showcasing how severe social anxiety and depression affects young people. This five-episode experience has players following the journey of Max Caulfield, an 18-year-old who has returned to her hometown to enter a photography program for her senior year of high school.
Max has the ability to rewind time, and her decisions ripple out to affect several of Life is Strange's most interesting characters. How the player interacts with and responds to both positive and negative turns in the story affects the mental state of several characters, including Max's friend Kate, who is struggling with intense depression and thoughts of suicide.
What Happened
What Happened is a mind-bending, abstract game that attempts to tackle serious subject matter. This "walking simulator" tells the story of a high school student struggling with the after-effects of severe addiction and the way their substance abuse has damaged themselves and those around them. The game presents the protagonist's mind, Styles, primarily through metaphor, though the stranger stretches of gameplay are paired with narration and flashbacks that tie everything to realistic experiences.
Most of the gameplay in What Happened is walking through narrative setpieces, but there are also light puzzle elements for players to figure out. The game is notable for not painting people living with addiction in black-and-white but instead complex shades of gray that frequently change.
Night In The Woods
Night in the Woods has been critically praised for its portrayal of mental illnesses because it isn't a game about mental illnesses. Instead, Night in the Woods centers on realistic, complex characters with drives, ions, and fears, many of which also happen to be living with some form of mental illness. The protagonist, Mae, is dealing with anxiety and depression as she moves back to her hometown after dropping out of college.
While Mae does come into conflict with various internal and external roadblocks brought on by her depression, the Night in the Woods makes it clear that it's okay to struggle and take challenges one at a time when things seem overwhelming or impossible.
Depression Quest
Depression Quest is a game that forgoes large setpieces or complex narratives in favor of something more simple to help players relate and understand what it's like to live through seemingly ordinary days and situations with severe depression. Most of the game is text-based, and the narrative changes based on players' decisions.
Visuals, such as image clarity and color, also change to reflect the changing mental states of the protagonist. According to the game's Steam page, the creator, Zoe Quinn, made Depression Quest to help players understand life with depression and so players with the illness can take solace in the fact that they aren't alone.
Celeste
Celeste is one of the hardest platformer games of all time, but it also uses the medium to tell a story about a girl trying to deal with anxiety and damaged self-esteem. The protagonist, Madeline, wants to climb Celeste mountain simply to experience the feeling of accomplishing something. Throughout the game, Madeline has to overcome challenges created by the manifestation of her self-blame and self-doubt. Her projections are constantly trying to stop her from achieving success, and Madeline must learn to accept and ultimately overcome her internal barriers before she can appreciate the strong person she really is.
Gris
Gris is one of several games that attempts to portray mental illness — in this case debilitating, life-threateningly intense grief — realistically through the use of visual abstraction and metaphors. Gris doesn't try to convince players that mental illnesses need to be beaten back or forgotten but instead that it's okay to accept when things aren't okay and time and help are necessary.
As Gris confronts and acknowledges who she is and what she needs, she slowly regains autonomy and control over her life and puts back together the pieces of what her grief had destroyed.
Forget-Me-Knot
There aren't many video games that attempt to portray characters with realistic symptoms of Alzheimer's, but Forget-Me-Knot tries to show players what it's like to live with this challenging progressive disease. Forget-Me-Knot puts players in an unfamiliar home and asks them to piece together various situations based on what's around them.
While the system isn't perfect, the game's designer wanted players to understand what it can be like to be unsure of where they are, what they're supposed to be doing, or what they've been through.
Pry
Video games, especially several of the best first-person shooters, tend to glorify combat and ignore the psychological impact of someone committing repeated violent acts. Pry attempts to do the opposite by showing players what it's like to live with post-traumatic stress disorder.
Pry blurs the line between games and literature as players explore the memories of a veteran of the Gulf War. The experience bounces between the past and present as it also transitions back and forth from physical reality to flashbacks and mental images. The designers have attempted to show the sudden, sometimes uncontrollable branching that happens in the mind of those that have experienced intense, traumatic events.
Hellblade: Senua’s Sacrifice
the best Norse mythology-inspired games of all time, it's also one of the most narratively deep. The game follows the titular Senua as she attempts to rescue the soul of her deceased lover. She has severe psychosis that she believes to be a curse, and the narrative and gameplay are heavily affected by her symptoms.
The developers at Ninja Theory worked closely with neuroscientists and people who have psychosis to depict the illness respectfully. Players should note that the game is best played with headphones on if at all possible. The voices that frequently interject into Senua's thoughts are meant to sound close to the head, and there are often subtle directional effects.
Drowning
Drowning forgoes almost all forms of gameplay for something more straightforward. In this narrative experience, the player simply has to walk forward. As they do so, they're presented with bits of text that tell the story of an unnamed protagonist's years going through school.
The story is quite affecting, and players slowly observe the protagonist go through challenges and develop a strong case of clinical depression. The experiences cover several difficulties of depression, like strained relationships, familial misunderstanding, and lost ion in an intimate, realistic way.
