Gaming With Stigma: Analysis of Messages About Mental Illnesses in Video Games

Abstract

BackgroundVideo game playing is a daily activity for many youths that replaces other media forms (eg, television); it serves as an important source of knowledge and can potentially impact their attitudes and behaviors. Researchers are, thus, concerned with the impact of video gaming on youth (eg, for promoting prosocial or antisocial behavior). Studies have also begun to explore players’ experience of gameplay and video game messages about violence, sexism, and racism; however, little is known about the impact of commercial video games in the sharing and shaping of knowledge, and messages about mental illness.ObjectiveThe aim of this review was to identify how mental illness, especially psychosis, is portrayed in commercial video games.MethodsWe performed keyword searches on games made available between January 2016 and June 2017 on Steam (a popular personal computer gaming platform). A total of 789 games were identified and reviewed to assess whether their game content was related to mental illness. At the end of the screening phase, a total of 100 games were retained.ResultsWe used a game elements framework (characters, game environment/atmosphere, goals, etc) to describe and unpack messages about mental health and illness in video games. The majority of the games we reviewed (97%, 97/100) portrayed mental illness in negative, misleading, and problematic ways (associating it with violence, fear, insanity, hopelessness, etc). Furthermore, some games portrayed mental illness as manifestations or consequences of supernatural phenomena or paranormal experiences. Mental illness was associated with mystery, the unpredictable, and as an obscure illness; its treatment was also associated with uncertainties, as game characters with mental illness had to undergo experimental treatment to get better. Unfortunately, little or no hope for recovery was present in the identified video games, where mental illness was often presented as an ongoing struggle and an endless battle with the mind and oneself.ConclusionsThe game elements of the identified commercial video games included mental illness, about which many perpetuated well-known stereotypes and prejudices. We discuss the key findings in relation to current evidence on the impact of media portrayals of mental illness and stigma. Furthermore, we reflect on the ability of serious video games to promote alternative messages about mental illness and clinical practices. Future research is needed to investigate the impact that such messages have on players and to explore the role that video games can play in fostering alternative messages to reduce the stigma associated with mental illness.

Depiction of mental illness and psychiatry in popular video games over the last 20 years

“…Ferarri et al ( 10 ) studied the messages about MI in video games by reviewing games released between January 2016 and June 2017 on the Steam platform. This study came to the conclusion that many of the reviewed games perpetuate negative stereotypes about mental illness, however, the research focused on a short time frame and one particular platform (Steam) – some of the games included in the research are not very popular and have only hundreds of players and therefore their reach is not extensive.…”

“…These titles were screened for the presence of any portrayal of mental illness or psychiatric care/treatment – this was done with a similar strategy to Shapiro et al ( 11 ) and Ferarri et al ( 10 ) – we selected both formal medical terminology and colloquial/stigmatizing keyword terms, which presence we first surveyed on each game or game series' respective Wiki webpages – collaborative encyclopedias to which users provide and edit content pertaining to video games that include descriptions of characters, settings, game mechanics and narrative. Secondly, we have applied these keywords in combination with the individual game title on the Google search engine and surveyed the first 50 results.…”

Framing Mental Health Within Digital Games: An Exploratory Case Study of Hellblade

“…Frame analysis has become an increasingly common analytical tool for game scholars [42,43]. Goffman’s notion of a frame relates to the meaning we attribute to a situation.…”

La muerte en el videojuego: A Mortician’s Tale y la visión positiva de la muerte

“…Una labor de investigación rigurosa es clave a la hora de representar una realidad de manera fiel y efectiva con qué y cómo se quiere transmitir. Algunos estudios acuden a consultores y profesionales para conocer de manera más profunda una temática delicada en sus juegos, como el caso de Hellblade: Senua's Sacrifice (Antoniades, 2017) o Debris (Clark, 2017) y la psicosis (Ferrari, et al 2019). A Mortician's Tale no es una excepción y, durante el desarrollo tuvo lugar una importante labor de documentación y consulta con profesionales.…”