In 2017, I was a young journalist – I’d barely spent more than a year at NRC as a trainee. The game Hellblade, with its themes about mental health, struck me in a deeply personal way– and I had not yet learned that chatting about such things with journalistic colleagues will quickly get you sent to an editor to pitch a story about it.
The story was pitched, and I reached out to Ninja Theory to ask if they had anyone on hand willing to speak to me about the game’s mental health themes. To my absolute surprise, creative director Tameem Antoniades took time out of his day to do so.
Snippets of this interview would later become part of a large two-page spread about Hellblade and other games that try to approach mental health themes realistically and sensitively. They did not quite capture the interview itself, something I have since regretted (though at the time, there was simply not enough space to facilitate more of it). The interview has pretty much lived in my head rent-free since then, much like the game itself does.
I have no idea whether this holds up to my young-journalist-nostalgia-colored memories of it, but I’ve finally decided to put the whole thing online.
Len: So I guess my first question is also the one that you’ve probably answered a couple of times, which is why did you decide to tackle this subject matter?
Tameem: „I think there’s a couple of reasons. One is because our history is in making fantasy games, and I wanted to make another fantasy game, but I also wanted it to be more grounded. Because most fantasy is based on Lord of the Rings and stuff like that.
And I thought, well, where does Lord of the Rings come from? It comes from the mind of JRR Tolkien and his experience as an officer in the First World War. I think the themes of his experience come through in that story. That indicated to me that fantasy comes from the mind. And so I thought, well, if we explore the mythos of old stories, like Beowulf or the Divine Comedy, and it may be that they’re not just made up stories, not just works of fiction, but maybe they’re the lived experience of people. In the same way that people who have psychosis, or just general, artists and dreamers see the world differently.
On the one hand, I wanted to understand how do people with psychosis, or who have been diagnosed as schizophrenic see the world because they’re clearly trying to interact with a world that the rest of us don’t see. What would that be like? And the more I looked into it, the more I read forums about psychosis and schizophrenia and saw simulations of what people experienced, the more I was just really astounded and shocked by just how vivid and horrible it was.
I felt the medium of games was actually a really good medium for exploring that because in games, you become that person and you see the world as we want you to see it. I’ve known people that have experienced severe bouts of mental illness and it’s just so common. I think it touches all of us at some point in our lives. It’s as common as physical illness in a way we just don’t recognize. So I thought, exploring the mind is a great subject. Games are a great medium for it.”
So do you feel that this subject is something that you might be able to experience or explore in a different way with games than with a movie or a TV show?
„We’ve got this label of games, which I think doesn’t fully describe what the medium can do. I mean, what we call games, is creating alternate digital realities. We can make these digital realities analogous to people’s real experiences. The power of it is that you can be fully immersed in these worlds and participate in it.
Books and films are better in many ways at telling stories than games. But there’s something else about games in that you live in an experience, you don’t watch. Someone will become that person in that world, if you can immerse the player correctly. And if you’ve managed to do that, it’s a revelation.”
I’ve had my own struggles with fear and self-esteem issues, I have friends who have experienced deep depression. And even though Hellblade is about psychosis, it seems to touch on a lot of these things. There are moments in the game where she communicates in a way that I recognize from my friends when they were depressed or the insecurities that they deal with. How did you decide to give this shape?
„During development, we spoke to a lot of people, people who have recovered from severe psychotic mental illness, people that are still within it. We consulted over two years with Professor Paul Fletcher, who’s a psychiatrist and professor of health neuros, a neuroscientist in Cambridge University.
So we went really deep into the subject to really understand it, and to talk to lots of different people who have these experiences, some of whom, by the way, do not consider themselves mentally ill. We met a few voice-hearers who reject the notion that they’re mentally ill just because they hear voices, which was also interesting.
I think what psychosis is, is an extreme. But we all sit on a spectrum towards this extreme. There is no clear line where you go, this person is normal and this person is psychotic. It’s a spectrum. So the fact that the themes resonate with a lot of people is not surprising to me, because all we’re showing is an exaggeration of the truth. The truth of how our brain works, how we perceive things, how we fool ourselves, how we’re not as in control as we think we are, and how we deny our own mental torture.
And so that’s the idea that runs deeply through the game: that denying your own darkness makes it stronger. I think it’s a universal human existential condition that we live with our deepest fears plaguing us and tormenting us all the time. It’s just that in the case of psychosis, people literally hear voices and literally see these demons.”
It feels like you’ve managed to externalize some of the things that people with different mental mental illnesses might suffer through by using these voices.
„We worked very closely with people who hear voices. We chose to use a binaural microphone, which gives you a real really good sense of what it feels like to hear voices because the voices are– you know, everyone’s experiences are unique, but in general, they’re very fragmented, very evasive. They can be positive and negative. And they appear to be people around you.
And they’re unrelenting. They don’t go by. So we put that in the game, which was a bit of a risk, because you’re playing this for eight hours with incessant voices. But it’s what people experience.”
What was very interesting about the voices is that when I went into the game, I found them annoying. And at the end of the game, there’s this moment where they go away. And I found myself really missing them.
„That’s exactly what people who hear voices say to us. The people who have learned to live with their voices say that they would never want to be without them. Which is interesting. I think it’s interesting that you felt that as well.
A lot of people have felt that, that they sort of feel a bit empty once they’ve gone after they finished playing the game. And it feels strange that they don’t have this commentary with them. They sort of internalize the voices and they become a part of them.”
One moment that felt very true to life for me is when you walk into this room, you have all of these chimes that were there for previous puzzles, but suddenly, there’s thousands of them. And there’s this real moment where it seems like the game is simulating a clear sense of overstimulation. Was that a deliberate choice?
„Most of the set pieces in the game are based on what people have told us and on research papers that we’ve been given. I think people don’t realize just how literal these experiences are. I spoke to one girl who has a screaming voice in her head 24 hours a day. When she takes medication, all it does is make it sound like the voices are outside of her room, trying to smash the doors and windows in. These are very literal experiences.
Perception can break apart and shatter in various different ways, almost hallucinatory ways. So we tried to just give a taste of some of those experiences. And I think that’s why it hits home. I think that’s why, even though people may not have had these experiences themselves, there’s an underlying nuggets of truth that feels real, because it’s sort of innate in us. We sort of instinctively know when something feels true.”
In preparation for this interview, I read responses to the game from people who have much worse issues than anyone I’ve ever known. They say that it almost feels as if there are lessons in the game on how to cope with these experiences. Was that something you thought about as you were creating the story?
„What Senua goes through is very extreme. And it’s set in a mythical time. So it’s got myths and the concept of curses and darkness and everything wrapped around that historical setting. But I do think of it as a modern story. The stigma is very much real today. Our medicine and treatments for mental health issues are not very advanced, compared to where physical medicine is.
But there is hope. I’ve met quite a few people that have come out the other side, and they come out stronger. They feel they feel like their experiences are part of them in a very significant way. And they’ve changed as people because of them. Now they help others get through those experiences.
Often what helps is just having people that are close to you, that understand, and can help you to recognize that you can be trapped in various thought patterns that are very destructive. That there are ways to confront them and step outside of those patterns. It’s not just medicine, it’s talk therapy, there’s talking to people that have been through it themselves. I think there’s lots of help out there.
We’ve included a page, a website, in the game so that people can reach out for help in whatever country they’re in. Psychosis not a hopeless condition. And I think part of what makes it so devastating is that people who experience it, keep it to themselves. They believe that it is hopeless, and they just spiral down into the hole, not realizing that there are people out there that can help, and that there is a way out. So yeah, there are moments of hope there.”
So you’ve had a lot of conversations with experts and people who have actually suffered from these conditions to do this. What has surprised you most along the way?
„I think one thing that surprised me was– I met these two young teenagers who hear voices. And in no way shape or form, would they describe themselves as mentally ill. I would have to agree. There’s the fact that they hear voices, sure, but they understand that their voices aren’t physically there. Yet knowing that doesn’t make them go away.
So they just accepted that these characters exist in their life, they see them as friends, they wouldn’t want to be without them. They reject any notion that they’re ill. And I see this, and I’ve seen this come up with other people as well who have vivid hallucinations– they may have had severely negative hallucinations, but they also have incredibly beautiful ones. And they wouldn’t give up one for the other. They wouldn’t want to lose their ability to experience the beauty just so that they can get rid of the negative ones.”
That reminds me– one of the most beautiful and yet uncharacteristic moments in the game is when you look back on Senua and her lover Dillion, and their history together. What was your thinking with that scene?
„In that scene I wanted to show just how beautiful it can be, that sensory experience. And how much somebody can mean to you in a moment. Of course it doesn’t last long in the game and it goes very dark very quickly but that switch, that idea that things can go very quickly from very positive to very dark is something that people told us about. That’s when it hurts the most for them.
When it comes unexpectedly and everything comes crashing down… that was a very deliberate moment to make you feel that if you can see it coming, you can cope with it, but when you can’t see it coming, that’s when it’s devastating.”
I feel like I’ve seen an attempt to do mental health issues like this in indie games before. But not so much in AAA-games.
„You know, it being self funded and sitting between indie and AAA, I would say meant that what we couldn’t do is just make an AAA-game but smaller, you know, because that would not be interesting. It had to have something that we usually don’t get in AAA-games. So it’s more like an indie game, but the production values are AAA.
That’s why we call it Indie AAA, and the price is much lower, accordingly. To do a game like this in the AAA-space, it wouldn’t work. I’d never attempt to do a game like this about mental health in the AAA space, no way. I couldn’t face it if the publisher puts it in front of focus groups and the focus group says that they want more action, and then undermine the theme to make it more commercial. I think it would just not work.
And it would undermine the theme, it would undermine the help that we’ve been getting from mental health experts.”
It definitely feels like you tailored every aspect of the game, including the gameplay, to be specifically about the experience.
„Yes, to the point where we’ve undermined the gameplay as well, to the point where there’s no tutorial, no HUD, there’s this pattern matching experience that throws you into the deep end and darkness, to no progression… there’s so many things we’ve just thrown away, because they’re immersion breakers, and they’re all things that you have to do in an AAA game, because the AAA game has to sell 3 million to break even.
It’s like making pop music. You know, it’s fine if you’re Rihanna, and want to make pop music. But if you’re Tom Waits, you don’t want to do that. So I think that there needs to be a space for people that want to make interesting independent experiences. Like there is in film and music.
So this was an attempt to do that. And I’m glad it’s worked out. It’s selling really well. The reviews are great. But it’s not about reviews for this game. It’s about whether people it touches people. And on that front, I think it’s been wildly successful. Which we couldn’t be more happy about.”
This article actually came to be because I told a colleague, who doesn’t play games, about this game and why it moved me. She told me I needed to write about it. And I realized she was right: this is something that I need to explore. Why is this? Like, why does this game touch people?
„I think we got into it. We started this game as a game. And the more we learned, the less of a game it became, the more it became an experiential journey, more like a vision quest. This is because of the feedback that people gave us. One girl who suffers from severe psychosis outright told us: don’t make it feel like a game. She was right. And I think that’s why it works.
I think that’s why people who don’t play games would probably be able to play it and understand it. I’m actually quite taken aback by by the response to this game. I really didn’t think it would be– I didn’t really think the response would be so wide ranging from mental health organizations to games press to players to scientific journals. Like Professor Paul who worked with us, he’s using our games to help teach now. I really thought that this would be like, an interesting indie game for some people. I didn’t expect it to move people across such a wide ranging sphere.”
You made me cry like a baby.
„When I made the game, I was trying to be objective and detach myself from emotion, which I did. Until the very end, when it was just done… then I cried like a baby for a few days.
I, I… I kind of feel a lot of people who played the game or who were involved in making the game feel the same. You don’t just magic emotion, you’ve– you’ve got to feel it when you’re making it.”
Do you think that’s what made it work?
„Yeah. I think… People were attracted to this project and came on board because of their own issues or those of people they knew. So the theme itself attracted, I think, the right people with the right way of thinking, who weren’t because it’s a job. Who wanted to be free to discuss the themes and the details of it, and the mechanics of how we make it work.
It’s been quite a cathartic experience for a lot of people, including the actress, Melina Juergens, who had never acted before. She was a video editor. She’s suffered, she’s suffered greatly, and she’s happy to admit that. She was the heart and soul of it, and she– her performance was genuine. It was not pretending.
It took her a long time to get into the right mood. You know, we would pause for half an hour or an hour or two, so that she can get to the right place. And then she played the scene. Afterwards, she’d be exhausted. But it was cathartic as well.”