Hellblade Creates Empathy for Mental Illness Through Game Design

Hellblade's real success is with empathy, not neat gameplay tricks.

Analysis by Matt Kim, .

Hellblade: Senua's Sacrifice could have easily been a macabre look at mental illness. Instead, the game succeeds on its core promise to diligently translate symptoms of psychosis into game design, thanks to a surprising element the game couldn't easily telegraph through trailers and press releases. It's not just about recreating the elements of psychosis, but going further-beyond morbid fascination and towards something rarer: empathy.

Hellblade recontextualizes Celtic myths in the guise of modern psychiatry. Senua's descent into hell to save the soul of her lover kickstarts the game. But her encounters with visions, voices, things that in Senua's world are labeled as curses and dark magic, or the works of shamans and mystics, are explored as symptoms of mental illness. It's a smart way of tackling the setting and environment while also incorporating aspects of Celtic lore—weaving fantasy and mental illness into a grounded world where old superstitions and myth are given medical context.


Ninja Theory's success hinged on treating this subject with respect, and not just as a well to start crafting neat little gameplay mechanics. Ninja Theory largely succeeds because they show demonstrable restraint. Instead of treating mental illness as a means to make a cool game, Ninja Theory chose to use Hellblade as a means to look at mental illness with empathy.

There's a lot to unpack in the design of Hellblade. From the very start of the game Hellblade utilizes binaural audio (so please play it while wearing headphones) to simulate voices—multiple voices—that constantly bombard Senua with their stream of consciousness chatter. Voices chip in constantly, about how we're doing something wrong, where to go next, or to just disorient players from the tast at hand. It's stressful and overwhelming, but luckily not theatrical. It's too unnerving and constant for the shock to eventually turn into entertainment. If anything, it becomes exhausting. But that's the point.

However, it's difficult to make a compelling game that fights against you, or works actively to stress you out or trigger your anxiety without some kind of payoff at the end. But there is no payoff, only a sustained and evolving relationship with the stress and fear Hellblade tries to elicit in players through its sound, visual, and game design. The absence of thrills is why Hellblade isn't a horror game, despite all the frustrations of one. It's not all just because of the voices either.

Hellblade doesn't feature a tutorial, forcing players to jump directly into the action. Visually, the screen cuts out with flashing lights, or throws players wantonly into moments of pitch darkness without so much as a warning. Senua herself encounters moment of shocking brutality. Senua's actress, Melina Juergens, throws herself into each moment screaming and wailing, raging against her surroundings. It's awe-inspiring, if not downright terrifying.

Old magic gives way to modern science.

Something changes though. The adrenaline stops pounding away at the base of your skull and the voices whispering in your ears softens over time. You realize that the game completely mastered its neat little audio and visual tricks so that before you even realize it, the sharp and jagged moments of frustration in the first half of the game gives way to a kind of understanding, or management if you will. If you have experience with mental health, you'll know that management is a key goal for those who suffer with a mental illness.

You learn to manage these terrifying elements, rather than overcome them as gameplay handicaps, which really helps give the feeling that these things, as unique as they are, aren't just one-off tricks. It also helps explain the effort Ninja Theory puts into confounding and antagonizing the player early on in Hellblade, slowly building a space of understanding between the player and the game, as well as the player and Senua.

Ninja Theory needed Senua to anchor the game, but Ninja Theory doesn't make it easy. Bug-eyed and placed in moments of immense distress, players could have distanced themselves from her simply because getting too close feels dangerous, and contributes to the game's overall stress. Ninja Theory clearly believes in its heroine, and without her, these gameplay tricks wouldn't work half as well. But she's not accessible until the player commits to her character.

Juergens acts the hell out of Senua, and when you're face-to-face with her, who oftens leans close to the player through the TV, you can see the why Ninja Theory is so proud of its motion capture technology. A reoccurring moment occurs throughout the game where Hellblade puts players eye-to-eye with Senua constantly, having her speak directly towards the screen, towards the players. As if to remind you who it is you're trying to share a headspace with.

The humanity helps ground Hellblade, and it's there where there are interesting things Ninja Theory does throughout the game to humanize Senua. Senua's model is motion-captured, but other actors and characters are live-footage of humans, juxtaposing Senua's humanity and artificial construction with real people. Hellblade constantly wants you to know that Senua is as real as a person, and so are her struggles.


I'm hesitant to say to crown Hellblade's portrayal of mental health in video games only because I don't have experiences with the some of the things featured in the game, like voices in your head or hallucinations. But it shows that Ninja Theory did put a lot of thought in how to best handle mental health.

There was a good chance that the things like binaural audio or extensive motion capture could just be seen as "cool" things, with a hand-waving mental health justification. Instead, the design elements Ninja Theory incorporates are just stepping stones to creating a genuine sense of empathy for Senua and her struggles. And that might be Ninja Theory's real coup.

This article may contain links to online retail stores. If you click on one and buy the product we may receive a small commission. For more information, go here.

Comments 10

  • Avatar for chaoticBeat #1 chaoticBeat 11 months ago
    Wow, what a great article. After reading a couple reviews, this game was starting to be more on my radar and this article is pushing me over. I wasn't planning on playing Hellblade, and it's just out of that impulse buy range for me ($5-20), but I work in the mental health field and this sounds like something I want to experience and support.
    Sign in to Reply
  • Avatar for benjaminlu86 #2 benjaminlu86 11 months ago
    Interesting to hear about this. This game wasn't really on my radar so I didn't follow any of the coverage. One of the traps of portrayals of mental illness in games is presenting the possibility of mastery over the illness through force of will (i.e. mastery of game systems), whereas that's not something that really happens in real life except in very rare cases. This is the flip side to the demonization of mental illness problem, where people are unreasonably expected to "just get over" their illness because mental problems aren't real problems.

    Would you say that Hellblade falls into this trap or does it stay sensitive to that as well?
    Sign in to Reply
  • Avatar for VotesForCows #3 VotesForCows 11 months ago
    @benjaminlu86 That's a great question. Though from what Matt says, it sounds like management is the key in this game. I used to have a sever panic disorder, and I remember when I had some CBT for it the therapist asked me whether I'd prefer to just get rid of it, or learn how to deal with it whenever it happened. Of course the latter was the more powerful and useful aim over time.

    Looking forward to playing this game anyway.
    Sign in to Reply
  • Avatar for The-Challenger #4 The-Challenger 11 months ago
    At least it sounds interesting in theory. I remember reading Death's Head II a long time ago, and on the first page of the first issue they clearly convoy all the voices he hears, something like 600 people randomly chattering at once. As for Senua, since she's isn't a killer cyborg I expect the impact will be far more meaningful...hopefully.
    Sign in to Reply
  • Avatar for usgmattkim #5 usgmattkim 11 months ago
    @benjaminlu86 Yeah that's the great thing about this game. Ninja Theory translates mental illness symptoms into its design, but they're not obstacles to overcome because they can't be beaten. But your relationship with them changes over the course of the game.
    Sign in to Reply
  • Avatar for benjaminlu86 #6 benjaminlu86 11 months ago
    @usgmattkim Alright good to hear. I'll have to check this one out.
    Sign in to Reply
  • Avatar for Nuclear-Vomit #7 Nuclear-Vomit 11 months ago
    @kubisztal $30 is not much considering that I took the Wife and Kid to Red Lobster. My Wife received a $40 gift card she's been wanting to used it for 3 months or so... I kept stalling, but we went two days ago. She had the NY Strip and RockLobster Tail, I had the "Fresh" Fish Alaskan Salmon. We also had some 2 beers and something from the kids menu.

    Anyway, the Bill after the gift card was around $48 or so... More than the cost of this game. For $48 We both got a bland meal, devoid of any decent flavor. It's purpose was to just fill you up and then remind you why you should never step foot in this place again. Why must we receive giftcards to such crappy places.... It was a trap, devious but, ever inviting.

    Now the game, I started it last night around 12 am. In the first 5 seconds, I can tell you that it is a much better value than Red Lobster. The graphics so good, for a moment I thought I was watching a real live person on screen. But as Setsuna paddles onward, I see that I am playing a game.

    I look forward to finding out who did this to everyone and make them pay. They took so much time and effort to hang corpses and impale them. Must have taken them all week to do this! My friends are whispering in my head urging me to turn around... But, I don't listen. I can't. They all will pay... starting today.
    Sign in to Reply
  • Avatar for chaoticBeat #8 chaoticBeat 11 months ago
    @kubisztal Please don't copy me, ad-bot.
    Sign in to Reply
  • Avatar for pubg #9 pubg 10 months ago
    The game's intensity fosters adrenaline peaks, usually at the matche's beginnig and end: At the start, the player must find nutrients quickly and survive the actual opponents nearby. After that, the intensity will vary with regards Playerunknown's Battlegrounds to the encounters but will top at eatch one. More often than not, the match ends with an encounter, wether the gamer wins or not. Thus, the participant will end the match by using an adrenaline optimum witch will incite him to restart a fresh one.
    Sign in to Reply
  • Avatar for andi88 #10 andi88 7 months ago
    This is must be improved, it is good for us.
    by kriteria logo baikEdited December 2017 by andi88
    Sign in to Reply