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THERE ARE NUMEROUS FAR-REACHING studies that have shown the therapeutic benefits of videogames for people with certain mental illnesses, variously giving people a sense of control where previously there was none, counteracting the effects of PTSD, helping mitigate trauma and teaching empathy, but the portrayal of mental illness has only really been taken seriously of late. A staple of many horror themed games has been the concept of sanity. Not the most subtle take on mental illness and trauma to be sure – sanity meters degrade and the character goes from being sane to a gibbering wreck. The 2002 Nintendo GameCube game, Eternal Darkness: Sanity’s Requiem is credited as being the first game to feature a full sanitymeter.Thisgreen bar at the bottom of thescreendepleted upon being seen byanenemy, encountering some thing horrifying or taking damage,and could be replenished by using a finishing move on an enemy or using restorative magic. When the sanity meter got low, a number of visual or auditory effects could occur, some subtle, some character-based and some meta-textual, aimed at the player and not the character. Some of the effects included random audio cues,increasing the volume of ambient sound effects and lowering thatof dialogue, random whisper sand screams. While these effects were both ground-breaking and intensely effective in 2002, the fourth-wall breaking sanity effects that came into effect at low sanitywere even more effective as they simulated errors with GameCube itself, the TV the game was being played on or even gave the game the semblance of sentience. One sanity effect had the screen flash and go to black with a bright few pixels in the middle, emulating the look of a faulty CRT TV. Another threw up error saying the console had failed to read a corrupted sector of memory and was deleting your save game. Yet another would detect save data from other games on memory cards in the console, and comment on those games, making it seem like it “knew” which other games you had been playing.More recently, the indie Rogue-like hit, Darkest Dungeon explored the effects of trauma on the psyche and how that trauma can effect group dynamics. The game itself is a side-scrolling, procedurally generated RPG/dungeon crawler in which players explore the endless dungeons beneath a family estate. It’s darkly humorous in approach, but also surprisingly nuanced when it comes to how different kinds of trauma manifest in party members. Exploring the endless dungeon teeming with traps and monsters is a stressful affair. Running out of torches increases stress, as does not having enough food or drink. Taking damage adds to stress as well. When one of the party members reaches a stress threshold they gain a traumatic effect. These effects vary due to the characters themselves and the cause of the stress, but can manifest in many ways. Cowards might flee to the rear ranks, changing the way combat has to be played. Narcissistsmay do nothing but try and protect themselves to the detriment of the party.Kleptomaniacs might steal all dropped loot, making it harder to progress or reduce the stress of other party members. Also, not all mental illnesses are presented as being negative and can actually have positive gameplay effects.For its 2017 hit Hellblade: Senua’s Sacrifice, developer Ninja Theory worked closely with Paul Fletcher, professor of health neuroscience at the University ofCambridge to improve the depiction of schizoaffective disorder. Maincharacter Senua suffers from schizoaffective disorder after her tribe is killed by Viking raiders. The game is viewed through Senua’s eyes, soNinjaTheoryhas gone to great pains to ensure that the common traits of the disorder – visual and auditory hallucinations, paranoia and scattered thoughts – are presented in the most realistic way possible. One of the key techniques used is binaural audio design. Best experienced with headphones, the voices that constantly plague Senua dance around and chatter from all directions, like flies with dark messages of failure and denial. The fact that Hellblade is at heart a combat game with a heroine who has suffered a psychotic break is still a little troubling when it comes to portrayals of mental illness, but the fact that mental illness has gone from a green bar and madness to a nuanced take on schizoaffective disorder in 15 years, shows that videogames - far from inducing or amplifying mental illness - may just be the best medium through which to understand it.