Hellblade Creates Empathy for Mental Illness Through Game Design

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

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.

Tagged with Analyses, Hellblade: Senua's Sacrifice, Ninja Theory, PC, PlayStation 4.

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