The darkened room’s thick, expectant silence is broken by the wind howling and your own heart’s uneven beating. Your fingers firmly clench the game controller in an attempt to lead a character through this broken world of darkness and despair. Fear, in its simplest form, is the raw, instinctive response to danger. It is not just something we have learned to use, but also something we look for in the dim light of mediated content.
The video game industry has emerged as an important testing ground for this pursuit of fear. Modern horror game developers have created immersive experiences by blending narratives focused on extreme trauma, crippling anxiety, and other mental illnesses.
However, it can be challenging to distinguish between entertainment and education when the “monsters” we come across represent real people with clinical conditions. The way these games visually convey mental suffering does more than just provide a scare; they possess the power to reshape public perception and redefine the very language we use to discuss real-world mental health issues.
Running through a foggy forest
The horror genre has been notoriously criticized for exaggerated and stereotypical representations of mental health. It often sacrifices accurate and empathetic depictions for narrative storytelling and thrills, contributing to the stigmatized public perceptions of mental health.
A common mental illness depicted in horror games is schizophrenia, which has been stigmatized through violence. “They… create characters that are really violent [and] very aggressive…and that’s not really [the] reality, ” shares Filipe Tomé, a PhD student and game researcher from the Interactive Technologies Institute and the University of Beira Interior in Portugal.
Perpetuating cliché tropes is another practice that further dehumanizes mental illnesses. “If you are schizophrenic, [people think] you are crazy [and] there is no hope for you… or if you have depression, you are sad all the time,” Tomé expounds. The use of these tropes can mislead the public that people with mental illnesses are dangerous and fearsome, rather than individuals who require help and empathy. Thus, due diligence and proper considerations for the portrayal of mental health must be observed. “Horror really makes us explore the full depth of our emotions… through horror, you can really show and convey how horrifying sometimes mental illnesses are,” Tomé explains.
Forming the narrative
When incorporating themes of mental health in horror games, a careful balance between narrative and game elements is required. Developers must ensure experiences where psychological symptoms are integrated. For Tomé, this requires a mix of sound design and narrative to provoke a response or emotion. Many games utilize this to apply author H.P. Lovecraft’s principle of the “fear of the unknown, ” which Tomé echoed, admitting “Horror works best when you are not expecting it.”
Characters also require specific storytelling techniques to sell the narrative. “It [requires the] principle of storytelling: show, don’t tell… you can’t [always] explicitly say [things],” Tomé explains. This ensures that the game remains immersive while still eliciting fear and dread. An anonymous gamer mentions that the feeling of isolation and usage of effective sound design—such as silence to add tension—hooks them into these games.
However, it is worth noting that depicting mental illnesses can be difficult since these topics have to be handled with sensitivity and appropriate severity. As Tomé states, “It’s really tough to portray these mental illnesses in a game, because you can’t just drop a monologue… sometimes, you use cutscenes to slow down the action… [and balance] the story.”
While game elements and design must be balanced, Tomé also points out the essence of extensive research when incorporating mental health themes. Understanding various symptoms, causes, and life experiences can help improve their portrayal in these games. This not only makes a game immersive, but it also helps deepen the understanding of psychological horror. “To feel what the characters feel… adds to the tension and overall horror of the experience,” the gamer mentions.
Horrifying yet empathetic
Recent games have made efforts to improve awareness of mental health themes through available resources and content warnings. However, awareness alone does not provide players with the opportunity to genuinely understand these conditions. With that, Tomé lauds games which place players in the characters’ shoes. He argues that this allows them to empathize with the intricacies of mental illnesses not just through cutscenes, but through first-person experience.
He particularly brought up the 2017 release Hellblade: Senua’s Sacrifice, which was developed with the help of psychiatrists and individuals diagnosed with psychosis. Part of its gameplay replicates the title character’s psychosis by carefully blending in voices and imagery distortions. These discomforting scenes are augmented by counter-mechanisms, such as the voice of Senua’s husband, which helps her calm down in the narrative while also subtly calming down the player controlling her.
Horror games that intricately incorporate themes of mental illnesses are the reason psychological horror games have returned to the forefront of the gaming scene, Tomé stresses. As society has become more open to mental health conversations in recent years, he underscores the continued need for well-researched storylines in developing psychological horror games. “You can’t just say that the character has anxiety or depression through dialogue,” he retorts. “At the end of the day, we are creating characters that are the mirror of ourselves… so we need to understand how they think, how they act, [and] how they move.”
While the thrill of a horror game makes one’s blood run cold, the stories it tells can leave lasting imprints on a player. It is proof that a significant health matter and a genre characterized by dread can both be redefined in the social conversation by proper representations.
This article was published in The LaSallian‘s January 2026 issue. To read more, visit bit.ly/TLSJan2026.
