Today’s spotlight is on Hellblade: Senua’s Sacrifice. The game takes place in the British Isles in the 10th century. The main character, named Senua, suffers from a mental disorder and, after an attack by an enemy tribe, goes on a journey to find the goddess of death Hela and take revenge on her for the death of her loved one.
I enlisted the help of practicing psychiatrist Vyacheslav Fedorchenko, who also happened to be a video game enthusiast, and talked with him about how Hellblade depicts mental problems, as well as what related topics the game’s authors cover. The result of our conversation was this joint text.
"From the very beginning the voices were not something pleasant. It was partly my own discomfort to hear the voices, no matter what they said, and besides, these early messengers generally only gave bad news. In addition, it cannot be said that they liked me that much, and I could not express my point of view to them. It was a very one-sided conversation."
Mark Vonnegut, The Eden Express: A Personal Account of Schizophrenia
Talking about the presence of some disease and making a diagnosis, as a rule, begins with considering the symptoms. In psychiatry, you can understand a lot about a person just by observing him.
Where does the game begin??
A lonely boat crosses the water surface. A young woman, actually the heroine of the game, surrounded by thick fog, peers intensely into the darkness. Several voiceovers comment on what is happening. The voices are not completely nonsense, but it is difficult to understand what exactly they are talking about, what the context and purpose of what they are saying is.
They say that the severed head, tied to the girl’s belt and carefully wrapped in a piece of cloth, is breathing. That the heroine is getting closer and closer. That she should turn back and avoid the threat.
Their comments are fragments of stories and past conversations, sometimes contradictory.They leave more questions than they answer.
Sometimes voices can be heard clearly and clearly, and words are assembled into complete sentences. Sometimes it’s a barely audible whisper from afar. Sometimes they impartially comment on the heroine’s actions, then, for no reason at all, start giving her instructions.
– Come back!
— Jump!
— Focus!
Commands pour in one after another, and the commentary voice is clearly uncompromising and angry towards the heroine.
Based on the game setting – a lonely boat on the surface of the water surrounded by thick fog – we understand that the voices are heard in the heroine’s head. From the same context we learn the name of the girl – her name is Senua.
Let’s look at the scene again, now without sound. We do not hear voices, we are not aware of the constant internal dialogue, comments, commands.
Before us is a tense heroine who anxiously peers into the distance. Judging by the pupils running from side to side, by her expression, sometimes frightened, sometimes aggressive, by general movements that do not correspond to the context (the heroine suddenly turns to the side, as if carefully listening to the interlocutor sitting next to her), we get the impression that Senua is preoccupied with something, she is absent-minded, perhaps even confused. It’s as if she’s simultaneously listening to music on headphones and trying to understand what a person passing by is telling her.
Of course, without a soundtrack, any video game character may seem strange. But this exercise helps us discern the following: Senua’s behavior is not entirely out of this world, but it certainly does not fit into the context. The heroine is constantly tense, anxious, puzzled, and sometimes distracted. Sometimes she screams into the void, sometimes she suddenly laughs for no reason, sometimes she freezes in place. The observer gets the impression that Senua is constantly talking to someone. As if she is constantly listening to someone, or as if she is surrounded by a whole company, and not alone. Even without asking her any questions and with the sound turned off, we assume that Senua hears the voices of people who are not nearby.
The picture we saw fits well with the classical definition hallucinations, T. e. internal images or perceptual experiences that manifest themselves in the absence of external stimuli. Senua has auditory hallucinations, the most common type of hallucination seen in people with schizophrenia.
Now let’s look at another symptom.
According to Senua, the world around is constantly giving her signs. The time-worn runes on the doors are not just messages from long-gone tribes, they tell Senua how to get to her final goal. Senua must carefully peer into the reality around her – signs, patterns, patterns will definitely manifest themselves, you just need to look at it from the right angle. When she succeeds, the next door opens, she moves one step forward on her path to Hel.
Here it is appropriate to talk about such a phenomenon as nonsense of special significance (in English speaking practice called ideas of reference) – situations when we connect random events and environmental objects into one chain that seems logical to us.
Figures similar to runes on the doors should be looked for in ancient ruins. They can only be recognized by looking at them from a certain angle – they seem to be two broken beams, and if you turn a little to the right, they intersect, and this is the rune already displayed on the doors – a sign that Senua is being shown the way, and not just a broken board. Senua is sure that there must be some kind of connection here, otherwise why would she see all these signs that have no meaning for everyone else??
In fact, we are all susceptible https://royalspincasino.uk/bonus/ to errors of perception. Our brains do not process objective reality well – evolutionary pressure forced us to survive rather than perceive the world as it is.
Unlike people with delusional ideas, most of us can be convinced. Bring to a psychotherapist, sit on a chair and, asking the right questions and cutting off unnecessary Socratic method *, help us understand our own mistakes. We all have not only a tendency towards errors of perception, but also flexibility of thinking. When we ourselves become convinced that we are wrong, our beliefs and thoughts change. A typical example here is people suffering from social phobia.
It’s not so simple with our heroine. It’s impossible to convince her. Even under pain of death, she still follows the signs that her imagination draws. All we can do is make it clear to Senua that she is no worse than everyone else, that her world – so different from ours – is one of the possible options.
This idea may seem strange to some. Shouldn’t a sick person be told that he is sick?? Depends on goals. If the goal is to save a person from suffering, then it is absolutely not necessary to tell him about pathology. There is no deception or hiding information in this. The fact that we call Senua’s condition a “disease” is secondary to the fact that, in principle, there are people like Senua (t.e. with the same perception as the heroine). Well, let’s not forget that all people have perception errors – not only those with psychosis.
When we do not use the concept of “illness” to describe Senua’s experience, this does not mean that we deny its existence. We only focus on human experience. In the 9th century, in one of the British Isles, what was happening to her was called the curse of the gods. Now, in the 21st, we are talking about brain pathology. In both cases, our common fear of otherness makes us move away from people like Senua.
The game tells us this through attacks pareidolia the main character – in the fractures of the rocks, Senua sees the face of her mother. Pareidolia is a phenomenon in which people see illusory images in real objects. For example, in the convexities of the lunar surface we can distinguish someone’s face. “There is nothing wrong with the way you perceive the world,” mother tells Senua. An internalized image of kindness and acceptance is the little that our heroine can cling to in the scattered kaleidoscope of psychosis.
Of course, psychiatrists often tell their patients with schizophrenia about their diagnosis. And for many, having a diagnosis is important – it is an explanation of what is happening to them. The game shows the fine line between a diagnosis as an explanation that gives a person the strength to fight an illness, and a diagnosis as a sign of rejection and rejection. Some people with schizophrenia will never accept that they have the disease. For mild, unexpressed forms of the disease, the diagnosis itself can be difficult. But helping such people lead a full life is a goal that in itself does not require a diagnosis.
We all perceive objective reality incorrectly. It’s just that Senua’s perceptual errors are not the same as most people’s perceptual errors. If anything, they are statistically more unlikely. But statistical probability is not a good correlate of "correctness" or "healthiness". In the same way, for example, a height of 170 cm is not more “correct” or “healthy” than a height of 210 cm. On the other hand, if a person with a height of 210 cm is found to have a pituitary tumor that secretes an excessive amount of growth hormone, then such high growth becomes a sign of a possible disease. Conversely, a completely normal height of 170 cm may be the result of physical injury or illness – for example, if a previously healthy person with a height of 210 cm had to have his legs amputated.
In general, the game clearly hints at this to us, from which side should we look?.
There is another important addition. Senui’s delirium – he is strange, mysterious. A person with social phobia is afraid of being rejected, ridiculed, or judged by others. These are natural and understandable fears – we do not exist outside the groups to which we belong. Such a person’s thoughts may be wrong, but they are not strange, bizarre, or confusing. The logic of Senua’s thoughts is understandable only to her. She must first find the sign on the door, then, looking from a very specific angle, see this sign in the surrounding objects. Her perception itself is split and does not give a complete picture, so the girl is constantly looking for a connection between signs, objects and doors, while this connection is illusory and objectively makes no sense.
So, Senua has a delusion (ideas of reference), in which, with a conviction that is not amenable to any influence, she connects events, objects and actions of the surrounding world into a single whole – strange, bizarre and causing bewilderment and even anger among others.
Schizophrenia and psychosis
“It all started quietly and gradually, and I hardly noticed anything. It’s as if a veil of fog appears in the sky on a clear summer day. At first it is a thin curtain covering the sun, gradually it thickens, but the light of the sun still breaks through, and only when everything around you stops, when it suddenly becomes cold and the birds stop singing, only then do you understand what is happening.»
Arnhild Lauveng, "A Road Back from Schizophrenia"
Like many things in psychiatry, psychosis – this is a syndrome, t. e. a collection of symptoms that often appear together. If it is possible to discover the specific cause of the syndrome, its pathological basis, then the syndrome becomes a disease.
Let’s add to the hallucinations delusional ideas, speech and thinking that are difficult to follow (the meaning of what is said is not clear), oddities and behavioral errors, as well as negative symptoms – lack of interest in what is happening, impoverished emotional expression, avoidance of communication – and we get the syndrome of psychosis.
Schizophrenia is a disorder that is actually based on psychosis. They overlap in many ways, but are not identical to each other. Psychosis can occur with many other diseases (for example, with dementia with Lewy bodies – the famous actor Robin Williams suffered from this disease).
Does Senua suffer from schizophrenia?? To say this is not entirely correct – the concept itself first appears at the beginning of the 20th century, when, following the concept of “early dementia” by Emil Kraepelin, the Swiss psychiatrist Bleuler writes about the “group of schizophrenias” – even then the complexity and diversity of manifestations of this disease forced authors to break them into categories.
Is she suffering from psychosis?? And to say that is also not entirely true. We can say that Senua’s condition – constant conversations with invisible interlocutors, strange behavior, travel to speculative worlds – is today perceived as signs of psychosis, and therefore (possible) schizophrenia.
Our attitude towards madness has changed many times over the course of history. By the time the profession was formed, around the 18th century, following the rapid development of medicine, doctors began to think about the biological nature of schizophrenia. The disease that Senui’s father talks about in the game is more of a fearsome curse on enemies, a mark of the netherworld. Since such a curse as a disease inspired fear, the “methods of treatment” were quite proportionate: complete isolation and a ban on almost any activity, as well as the “reaction of others” in the form of total condemnation and undisguised hatred. Note that it is our heroine who is held responsible for the attack on her home village.
Stigma and psychiatry
"What is logic really?? Who determines what is reasonable to eat?? …Only in the mysterious equations of love can we find logic and reason.”.
John Nash, American mathematician
Our heroine’s arc is about lost love – a warrior named Dillion was the only one who understood Senaya, the only person she trusted. The head tied to her belt is Dillion’s. He died as a result of a rather terrible ritual, most likely in agony.
What exactly is the arch?? Senua must accept the death of a loved one, and on the way to such acceptance she will face her own fears until she reaches the goddess of death herself, Hela.
In some critical review of the game they wrote that the heroine’s illness was taken out of context. You may not agree with this remark. Yes, mental disorders do not exist outside of context – cultural, social, historical. But Hellblade, albeit with some drama, shows the conditions in which people suffering from psychosis often find themselves.
Rejection from family and society, isolation, stigma and the label of “other” – such people often feel (although they do not always understand) their incompatibility with the “norm”. And it is no coincidence that the word “norm” is put in quotation marks here. So the authors show another theme that runs like a red line through the entire history of psychiatry – the constant debate about where to draw the line between normality and pathology.
Through Senua’s conversations with her mother, through the successful solution of game puzzles, for which necessary use symptoms of psychosis, through descriptions of the cruelty of “normal” people from Senui’s past – through all this, the game blurs the boundaries of the normal and familiar. Hellblade points to our sometimes obsessive interest in normality, in the average. People who are very out of context become not just “sick”, they become “strangers”. We reduce our fear with an injection of cruelty – exile, labeling of evil spirits, curse or even physical destruction. In modern cities, the situation varies in form, but not in content: people with serious mental disorders are more often homeless, it is more difficult for them to find permanent social support, and they often spend time behind bars. Whether it’s a Pictish tribe in the 9th century or a major metropolis in the 21st, madness continues to frighten and repel us. And the developers from Ninja Theory demonstrate this perfectly.
Senua, on her way to Hel, suffers and copes with her suffering in the same way as the rest of us – in a completely human way. It is difficult for her to accept the death of her loved one; she blames herself for it for no reason. She has to face her fears, shame, grievances. Just like the rest of us, she has difficulty accepting the inevitable connection between life and trauma. Only through accepting the cruelty of the world as some constant does Senua find peace. Hela turns into our ally, and the voices stop their constant hubbub. Death gives the heroine another chance. Everything is like in life: our past then ceases to define us when we fully accept it. These completely ordinary sufferings, presented as a beautiful fairy tale about a girl from the Pictish tribe, help the player to get an inoculation against fear. Senua is much closer to us than it might seem. Accepting the death of a loved one, coping with your fears, and gaining the experience of loss is a natural process for all people. By creating a narrative around such a heroine, rather than just another typical video game hero with a weapon at the ready, and showing what the world looks like for a person with mental problems, Ninja Theory introduced this topic to gamers, many of whom were not previously interested in such issues. Thus, it can be said that the game has added a lot to the destigmatization of mental disorders.
When restrictions are good
However, in addition to speaking on such a complex topic, the authors of the game were faced with another task – how to reconcile the narrative and gameplay. We can say that finding the right angle sets the tone not only for the plot, but also for the gameplay. Development studio Ninja Theory has a history of producing cinematic action games with cool characters and complex combat systems. Actually, many fans of the studio’s work were waiting for the same product from Hellblade. And then the authors decided to reduce the combat mechanics of the game: our heroine has only a couple of hits and no advanced combos or special attacks. Throughout the game, although we fight with enemies, we do not feel like an invincible warrior who easily breaks through crowds of opponents: Senua is vulnerable and battles are not easy for her. Plus, you can remember an additional source of stress in the form of rot, which moves up the girl’s arm. The heroine is afraid that when the rot reaches her head, it will kill her.
This technique of limiting gameplay capabilities is not uncommon in the gaming industry: for example, awkward controls and a limited combat system are among the obligatory elements of the survival horror genre. For horror, it’s important to create a sense of discomfort and give the player so many tools to fight opponents that he feels like he’s barely coping with the danger. Give the player a little more freedom and the mood will instantly change: fear will turn into delight, and horror will become action.
So back to Senua: she moves forward, but never feels like an ultimate force, superior to her enemies or the challenges she faces.
Conclusion
What really amazes me. This is how much weight the stigma hangs over the topic of mental illness, especially bipolar disorder. In my opinion, it takes balls of steel to live with manic depression.»
Carrie Fisher, American actress, about her bipolar disorder
Psychiatry, like any niche profession, has the danger of burying itself deeper into its own mine and not coming out for years. It is clear to an outside observer that some activity is going on, something is happening, but everything else is hidden by a thick layer of soil and rocks. It’s difficult to get there.
The developers from Ninja Theory succeeded. By showing the phenomenology of mental disorders through the personal experience of the heroine with psychosis, the authors not only successfully conveyed the sense of the world of such people, but also touched upon basic issues of psychiatry – about stigma, what a diagnosis is, about the “gray zone” between normality and pathology. And they did it all without tediousness and medical vocabulary.
There are questions about the game, including about the description of the symptoms themselves. Let’s not forget, many of those who suffer from schizophrenia remain on the sidelines of life and certainly cannot be the heroes of this or that story. Rare exceptions rather confirm this rule (for example, John Nash, an American mathematician and Nobel laureate in economics, was treated for schizophrenia for many years). Chronic psychosis, as a consequence of schizophrenia or another illness, is a very unpleasant thing.
On the other hand, the symbiosis of the gaming industry and psychiatry turned out to be interesting.
The authors presented a unique experience, making the player experience mixed feelings towards the heroine. It’s impossible not to sympathize with Senua, who longs for the same thing we all do—acceptance and love. On the other hand, her fractured perception of the world, tightness, stubbornness, and aggression maintain a certain degree of discomfort and distance from the heroine. Experiencing and resolving this conflict ultimately breaks the wall of stigma of mental illness.
We hope that the problem of mental disorders will still manifest itself in video games. This topic is “untilled field”. It is important, as in the saga about Senaya, to most accurately convey a person’s inner experience. There are already enough caricatured characters in psychiatry. Perhaps soon we will see games about how sociopaths/psychopaths/antisocial personalities achieve high results in politics and business (After all, in the real world there are much fewer people who are ready to cut off heads and hunt their victims than those who use their inability to empathize to their advantage); about how impulsiveness leads to arson (pyromania) and theft (kleptomania); about faking symptoms, but not for the purpose of simulation and avoiding responsibility (Munchausen syndrome or factitious disorder). There are many more topics in psychiatry that might be of interest to modern players.
What else could it be?
If we look at the variety of cases in psychiatric practice and imagine how they could be implemented through gameplay, then we are entering the territory of a game designer. Let’s start by answering the questions: what can this character do?? What resources does he have?? What are his goals and what is the meaning of the game or winning for him??
T.e. Unlike Senua, he will not necessarily hear voices, but perhaps his processes of perceiving the surrounding reality will be different.
For example, you can show a character who lacks empathy due to a pathology of mirror neurons in the brain, and as a result, in the dialogue system, he will seem to “miss” or not see the requests of other people, ignoring the appeal to their feelings, due to which others will perceive him as a cold and heartless person. It would be possible to build 2 modes or show the same situation from the perspective of an ordinary person and from the perspective of a hero with mental problems. So the same dialogue for a person with problems will contain fewer phrases, because he is “blind” in recognizing other people’s emotions, and full phrases will only be available when playing for another character.
Another example: you could show a character with bipolar disorder. We know that his life is divided into two cycles: a manic phase and a depression phase. You can play them by analogy with the life cycle of vampires, who hunt at night and sleep during the day. That is, we have a limited mental resource and goals for the active phase. Therefore, while we are on the rise, we need to complete tasks before we fall into another peak. Here we can look for medications to temporarily correct our condition, because the peak of mania is also not good, as well as slowing down the transition to the depressive phase. Then you can think about how to display the depressive phase – the character will not just be dumb and sit with an indifferent look. You need to give him something to do, even in the abstract idea of assembling Tetris, keeping your mind from overflowing with negative thoughts.
The same factitious disorder, known as Munchausen syndrome, may well lie on the rails of the quest. A patient with this syndrome feigns the presence of disorders, deliberately distorting his clinical picture. The motivation for such actions may be a lack of attention, a desire to attract others and receive support.
Then we indicate that the character has an attention scale, and the location has interactive elements that will help him portray some kind of fake symptom or change his state. For example, drink coffee to increase your heart rate, drop drops to dilate your pupils and pretend to have a concussion, etc. n. After filling a certain level of the attention scale, the plot can move further.