Ninja Theory's Tameem Antoniades discusses how past games have exacerbated the stigma around conditions like schizophrenia – and how his new game will change this

‘It’s devastating to some people, beautiful to others’: Exploring mental illness in Hellblade

Hellblade is an oddity.

From a casual glance at the screenshots, it’s an action game set in medieval times with a fantasy twist that sees players fighting demons. And to an extent, that’s true.

But the real cause for interest in Ninja Theory’s new IP is its exploration of mental illness. The story revolves around Senoa, a warrior that suffers from traumatic events during a brutal conflict and the aforementioned fantasy elements are in fact hallucinations and the effects of a worsening mental condition.

It’s more than just a narrative hook or gimmick. The team has been working with renowned psychologists and neuroscientists, as well as patient groups, to extensively research how this condition affects people and then demonstrate that to players through the medium of video games.

It’s a prime example of the latest wave of developers tackling more sensitive issues in their titles, which you can read more about in our Special Feature here. We caught up with Ninja Theory’s chief creative director Tameem Antoniades to find out more about this ambitious project.

Why choose to depict mental illness and trauma in Hellblade? It’s not something covered regularly by video games.
I know what you mean. Should games tackle serious issues? For me, that not even a question. I don’t think books and films should have a free pass to tackle difficult issues while games don’t. If you’re serious about games as a medium, there is no defensible argument in my opinion that it shouldn’t be tackling serious topics. That doesn’t mean that all games need to tackle serious issues, of course, but games need to have the diversity to tackle any subject.

I pick subjects that interest me. When you’re working on a game for two or three years, you’ve got to do something you care about. This is something I have a deep interest in. I reckon most of us, if not all of us, have been touched by mental illness directly or indirectly at some point in our lives. I believe one per cent of people in the world suffer from schizophrenia. In the US, 40 per cent of people have some form of serious mental health issue in their lives.

Another aspect that I’m interested in is fantasy, creativity and where those things come from – our brain’s capacity to invent, create imagery and simulation of worlds. The more I looked into things like psychotic mental illness, the more I realised that what people experience is an extension of what we all experience. We’re constantly dreaming, hallucinating, creating a world around us. The more you look into the science of it, the more you realise how little of what we see and experience is real.

This gives us the opportunity to create a fantasy that isn’t based on tropes of literature like Lord of the Rings and so forth. It gives an opportunity to create a fantasy based on direct, real experiences. Which is why we’re working with a psychiatrist and neuroscientist from Cambridge University. We’ve also just started meeting with patient groups, called service users, who have previously had, been diagnosed with or still are diagnosed with schizophrenia. It’s to get an idea of what they hear, see, and feel.

The game isn’t a mental illness simulator. It’s actually the story of a warrior who happens to suffer greatly from her condition.

Is it important to make that differentiation, that this is not a mental illness simulation?
Yes, because the subject stands out. It’s interesting because of that, partly, and people pick up on that, but this is a Ninja Theory game, just like Heavenly Sword, Enslaved or DMC. It’s about creating a vivid world and creating a character journey through that world. It’s just a little more grounded. 

The game isn’t a mental illness simulator. It’s actually the story of a warrior who happens to suffer greatly from her condition.

How do you balance the gameplay and the exploration of mental illness? Presumably if you make it too game-y, it undermines what you’re trying to do.
We’re trying to create a compelling, interesting character to experience the world through her eyes. I think you do that when you play any game with a good character; if you play Uncharted, you’re experience the world through Drake’s world view and you become involved with that. 

What I am interested in doing is representing Senoa’s point of view on worlds and the challenges she has to face. There are real challenges she has to face: she’s a warrior, and there’s a war, she has to fight through it. But the inner struggle has been very particular to her and it affects everything in the world, everything she experiences and sees. The fact that what she sees is filtered through her brain doesn’t fundamentally change the hero’s journey. It’s still her journey and it’s still, hopefully, compelling and exciting.

I don’t feel that a subject like mental illness, as universal as it is, necessarily has to be treated with kid gloves, put into the shadows and hidden away from view. This is something that is very real, very lucid, very vivid. It’s devastating to some people and beautiful to others, which is a side you don’t often hear. And it can be brutal, it can be nightmarish and some people describe it as a living hell. When I realised that, I realised it’s immensely powerful.

When you hear about people’s experiences, such as people who have a voice shouting in their ear all day and night, you wonder how you could cope with that. It puts it into perspective. Or there are people who see a demon in their bedroom staring at them, and its as vivid as anything, as real as you and I seem to each other. How would you react if you saw that, and if someone told you it’s not real? What difference does it make to you?

For us, mental illness is usually used in games as a plot twist – ‘oh, look, none of this was real’. The reason I’m comfortable bringing it to the forefront is that I don’t think it matters whether you feel it’s real or not. For Senoa it is real, and you have to deal with that, no matter what. I think that’s an interesting way to present things.

So do you think there are things games can do to present the reality of these issues that books and films can’t?
I do. That was, in part, the epiphany for me. I was reading about it, both about the user’s point of view and more scientific perspectives, and I saw some videos that have tried to represent it. It’s powerful stuff, but in a game you embody your character, you see things visually and aurally, which is a big part of the experience for a lot of people, and you accept the world for what it is. You don’t question the world you inhabit in a good game; it’s just there, you follow the rules and you make your decisions based on those rules. 

This is effectively a very powerful medium for representing those kinds of experiences, and the team wants to get deeper into what mental illness is like. We met with a patient group recently, we showed them our vertical slice, and they told us what they see and feel, what they thought matched their experiences and what seemed a little off. Right now, we’re doing a lot of prototyping work to simulate more accurately or more closely their direct experience, and then we’re showing that to them again. We’ll be doing this over the course of the year, talking to various, diverse groups of people. 

There’s no universal definition of how this affects people, but there are common traits and I think we can try and get close to that. I think there’s a power there, a power for the story. 

I think the fact that it’s in 700AD rather than the modern day can benefit the game because you don’t immediately think ‘well, she should just snap out of it’, or ‘just go and a see a doctor’. You just have to live with the world that’s presented to you – it drops prejudices and barriers.

I don’t feel that a subject like mental illness necessarily has to be treated with kid gloves, hidden away from view. This is something that is very real, very lucid, very vivid. It’s devastating to some people and beautiful to others, which is a side you don’t often hear. 

What have you learned through your research for this game? What have you taken away from it?
It’s quite stark speaking to the patients when they tell you they walk into a room and see bodies hanging off the ceiling. Sometimes they can deal with it, but sometimes they try and rescue them, and this can happen at any time of the day and night. That hits you. It feels like there’s a responsibility to respect the subject.

That’s frightening but the encouragement we get from them and Paul Fletcher, the psychiatrist from the Wellcome Trust, has been a good reason to really jump in and pursue this properly, to not be afraid of dealing with this subject. They see an opportunity to have their story and their viewpoint represented in some way. 

Different people’s experiences are very different. I’ve had people tell me I shouldn’t treat this with kid gloves because the experiences are so brutal, we need to show how brutal it is. Whereas when you talk to someone who hasn’t experienced these things directly, there’s this impression that it should be implied or not talked about so openly. That has a negative effect on sufferers.

According to a lot of the people I’ve talked to, a lot of the suffering comes from the isolation and the stigma, rather from the direct experience itself. It comes from the social isolation that results from it. It’s not a hopeless situation: people get treated, recover and learn to live with it. It’s not a hopeless condition and I think once people understand that, the fear goes away.

 The main thing I want to do is create a really compelling story about a warrior that happens to have serious mental issues because of the violence that’s inflicted on her. That’s really what this is about. 

Are you concerned about backlash against introducing serious topics to a typically core game?
We’re not out to hurt people. I don’t think this is a subject that has been treated right in films and games.

A lot of the stigma around mental illness comes from the portrayals of things like schizophrenia, which has been extremely negative in some video games. Some titles imply that you need to be afraid of people with schizophrenia because they’re portrayed as violent. That’s not helpful, because people who suffer from psychosis are often the victims of violence.

With the research we’re doing and the people we’re talking to. I’m comfortable that Hellblade won’t be as damaging as those things.

The fact that we’re doing this on an extremely low budget means that we only need to sell to people who are interested in what we’re creating. We have no interest in changing people’s minds: if they don’t want to play this kind of game, there’s a thing called freedom of choice. We’re very comfortable with that. 

We’ve had some people get in touch expressing concern, people who have suffered from this. I personally respond to them, tell them what we’re doing and how we’re doing it. But more importantly, we listen to them, take on board what they’re saying and, if possible, involve them.

We’re not stonewalling anyone that has concerns. Even if people disagree with what we’re doing, I think it’s good for us to engage and understand why we disagree, and respect each other’s point of view.

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