Recently, John Wolfe made some thoughtful comments regarding the villianization of people with mental health problems. We would like to expound on the problem John pointed out and discuss why this is a problem and what can be done against it.
One US study reports that nearly half of the respondents reported at least one life-time disorder and nearly 30% reported at least one 12 month disorder (Kessler et al., 1994). That means, almost half the population has a history of mental illness. Depression, Obsessive Compulsive Disorder and Schizophrenia along with numerous ones more uncommonly heard of are included under this umbrella. This means there is a wide spectrum of mental health problems in a large portion of our society.
There has been an increase in perceived dangerousness of people with mental health issues from 1950-1996 (Link and Phelan, 1999). With the misinformation and misrepresentation that has been going on, it is safe to assume this trend has not slowed on the last decades. Stout et al.(2004), in their overview of portrayal of mental illness in the media, found a consistent misrepresentation, exaggeration and misinformation of mental health problems. Two outstanding conclusions were that the portrayal of mental health patients implied that they were dangerous and they should be avoided (ibid). Movies, newspapers and video games all feature characters with mental health issues. When the authors present these characters as hostile and dangerous, it perpetuates the misrepresentation of both the patients and the nature of the mental illness. In terms of writing for games, it is a cheap way of having an encounter that is unpredictably violent. Consequences of these misrepresentations however create real life problems for people with mental illness.
Stigma towards mental health problems, harm the sufferers in many ways. People with mental health problems have harder time finding housing or getting good jobs due to the prejudice from their communities (Corrigan, 2004). People who suffer from these problems may help seeking help, afraid of facing stigma and prejudice. In cases with self-harm and suicidal behavior (two very different things) creating a barrier for getting help contributes to the morbidity of these illnesses.
Most of the time, I do not think the developers put much thought into what the images they create may mean. I am willing to bet the “insane” can be interchangeably used with “zombie”, “nazi”, “goblin” in some games and it would not make a difference regarding the gameplay. And if it is in for the the story, I hope they do better research regarding what they are portraying. You can’t stretch the definition of an illness to fit your gameplay without doing injustice to a bunch of people who do suffer from said disease and do not display the symptoms you made up to make it scarier.
What can be done?
Corrigan and Pen (1999) suggest a 3 step approach. Protest, education and contact. Merely protesting may help diminish stigma but is not enough to change the attitude towards a more constructive one. Content creators like game-developers, movie-makers and authors can educate their audiences. While stopping using such tropes would help in not perpetuating the problem, portraying mental health illness in a more sensible and informed context may help educate the audiences. After a change in attitude, contact with people with mental health problems may become a non-problem as the audience now is less expectant of violent behavior from the person with mental illness.
- If you are in the audience, protest if you feel you are being served misrepresentations.
- If you are a content creator, put more thought and sensitivity into what you are communicating.
We do think there is a place for mental health problems in games, the question is are we as developers willing to put more thought into our characters and stories they tell. And are we as the consumer willing to suspend our disbelief so much that we buy what is on the screen without a question and let it shape our opinions without having our own lived experiences with these subjects.
References:
Corrigan, P. W., & Penn, D. L. (1999). Lessons from social psychology on discrediting psychiatric stigma. American Psychologist, 54, 765–776.
Corrigan, P. (2004). How Stigma Interferes With Mental Health Care. American Psychologist, 59(7), 614–625. https://doi.org/10.1037/0003-066X.59.7.614
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. B., Hughes, M., Eshleman, S., … Kendler, K. S. (1994). Lifetime and 12-Month Prevalence of DSM-III-R Psychiatric Disorders in the United States: Results From the National Comorbidity Survey. Archives of General Psychiatry, 51(1), 8–19. https://doi.org/10.1001/archpsyc.1994.03950010008002
Link, B. G., Phelan, J. C., Bresnahan, M., Stueve, A., & Pescosolido, B. A. (1999). Public conceptions of mental illness: labels, causes, dangerousness, and social distance. American Journal of Public Health, 89(9), 1328–1333.
Stout, P. A., Villegas, J., & Jennings, N. A. (2004). Images of Mental Illness in the Media: Identifying Gaps in the Research. Schizophrenia Bulletin, 30(3), 543–561. https://doi.org/10.1093/oxfordjournals.schbul.a007099
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