How Hellblade: Senua’s Sacrifice is still a great tool for explaining mental health

While Hellblade: Senua’s Sacrifice came out in 2017, I was only recently able to get my hands on it. The idea of gameplay experience requiring a headset and its portrayal of mental health intrigued me. I also believe mental health is still something that should be addressed, especially when this game is providing something most media doesn’t. A glimpse into psychosis that needs to be understood. The developers worked with neuroscientists, psychologists, and even people who deal with these kinds of conditions every day to help us see, even if it was just a little broad, what it was like.
There were many themes and concepts brought in so subtly by the creators of this game to highlight certain aspects of psychosis and other mental health that should be appreciated.
The furies aren’t your friends, are they?
You’re introduced to auditory hallucinations first, or rather, the “furies” that speak to her throughout the game. If you’re not used to hearing voices that aren’t your own, they’re actually nice at first. They tell you when an enemy is sneaking up behind you and they care if you fall in battle.
You get used to hearing them even while you’re walking around in the game or when you’re solving puzzles. For me, I was so used to hearing them that when I wasn’t, I didn’t know when they’d be coming back and it actually made me nervous. What was going to happen in the game? Did them going silent mean something bad was going to happen to me? They had become so much a part of my experience that I wanted them to come back.
As the game progresses, more voices are introduced and some of them are not friendly. They fed into the Senua’s guilt or laughing when things weren’t going well for her. Later battles would have a battle between the voices as well. Some were rooting for me and some were laughing at me. It sometimes made it hard to focus on the physical battle that was happening in front of me.
One of the voices will tell you stories from Norse mythology that added to the gameplay for me. I was always into lore in video games and it made her current environment more real to me.
The game introduced a new fear I haven’t experienced in a game before. Generally, I’ll play a horror game with trepidation because there will be a jump scare. With this game, I could see what horrors were waiting for me and even the voices were almost screaming that I should turn back before I died. My anxiety would skyrocket during these times because it wasn’t just me that was scared, it was also an external force whose motives I couldn’t understand.
Hearing those voices for the entire game helped me understand that it’s not black and white when you hear voices like this. While the game can’t catch everyone’s experiences with this, the developers were able to do it well enough that I had a minute glimpse into what it could be and my sympathy rose for people who deal with this every single day.
Things aren’t always what they seem to be.

Locked doors with runic symbols prevent Senua from progressing until she can make sense of the symbols. The game shows that to keep moving forward, you have to look at things differently like someone with Senua’s condition might. You can’t unlock the door until you find patterns in the world around her that match the outline of the symbol. One symbol that takes on the shape of a boxed infinity might be found by focusing on two trees with the branches intertwined. This can be frustrating at points in the game because you don’t quite understand how the patterns are formed and might walk around for a while making those patterns from anything and everything.
The anxiety that comes from that gives you an insight into how people in real life might experience situations like this. The need to form a pattern from something for their world to make sense. The developers choosing this to be the key to escaping reminds you that not everyone has the same thought processes. Sometimes, thinking a different way can also even be beautiful and enlightening.
Senua has to deal with literal illusions as well that she has to find alternate paths or ways of thinking to get through. Doorways that open up different worlds that seem more real than the last are great puzzles for someone like myself but also good visual ways to depict how very real something can appear to someone when it’s just in your head. It can be hard to see beyond what’s in front of you because of how real it seems to you.
Her own view of the world shifts throughout the game as well. Sometimes the world is full of color and is bright. Then it becomes almost too bright. She might be in the sunlight and move to another room and be met with dark shadows that have jagged edges. Visions of fire and death plague her causing her to not be able to stand still. She scans every room she’s in and winces at any changes that may happen in her environment.
Since I don’t experience this on a day to day basis, the only relatable thing that’s happened to me is getting a migraine. Lights and sounds are more present, they start to physically hurt you. It’s hard to get away from the triggers and medicine doesn’t work sometimes. You want the pain to stop but until the episode is over, the light seems to shine brighter and more invasive.
Even saying that though, I know that they are very different things. But knowing how bad a migraine is, seeing how psychosis can bring about visual hallucinations like this frightened me. In the game, I almost preferred the darkness because the light was too bright and it was like an illusion. Even without having these symptoms outside of the game, I was already forming patterns and safe pathways depending on the experiences in the game.
Anxiety, guilt, shame.
The game at the beginning warns that it deals with mental health and may not be suitable for everyone. If you start to play this game and experience negative emotions or reactions to the concepts, Ninja Theory also has a website where you can go to get help. I took that with a grain of salt but while playing this game, it did have moments where I was feeling very real symptoms of panic.
The game was able to show very real visual examples of what anxiety, depression, and psychosis can be for someone. There are times where you see your road ahead and even though the voices in your head are telling you that it’s a trap, that you’re unsafe- you venture on despite it because you don’t know if there’s actually danger ahead or if it’s just the voices saying that. My heart would pound during those moments because everything in your brain is telling you not to go that way, not to go towards the danger. In real life, anxiety is like that. There might not be a danger present but I’m fighting against every part of my body to keep going because the threat isn’t real. The game accurately portrays that idea even though it’s something that can be hard to put into words.
The same with guilt or shame. Growing up feeling like she was cursed or evil, she fought with those feelings her entire life. When you have mental health issues, it’s hard not to feel like you’re unwanted, or cursed. That you’ll bring everyone and anything down with you. It’s easy to see your illness as a darkness that is growing inside of you. Being reminded of the tragedy she’s been through and her dealing with her lover’s death were items in the game that really got to me. To have someone that loved you even though you felt so broken just to have them taken away is something that I imagine to be the worst event that could happen to someone. Dealing with feeling cursed, especially being mistreated by others, can leave you feeling like there’s nothing left.
This game depicts that perfectly. Senua’s anguish, her cries and pain can almost be felt by the player.
Does the game do more harm than good in making mental health issues known?
I didn’t love this game because of the game mechanics, I loved it because of the story it was telling and how it was fleshing out how psychosis can feel to certain people. Having any kind of mental health issues like anxiety, depression, schizophrenia isn’t as cut and dry as the media usually portrays it.
This means that when a company like Ninja Theory tries to put this in their game, they aren’t going to match everyone’s very specific ideas of what the condition might mean to them. I read some of the reviews after playing the game because I wanted to see how people felt with everything they did try to address in the game. Most were positive, they dealt with these things daily and it was hard to really explain to another person how they felt and this game gave them a way to explain some of it.
However, it was the negative reviews that really stuck with me because they were very angry about how their idea of mental health wasn’t addressed. It wasn’t because Ninja Theory didn’t do a good job of researching, it was because their specific edge case wasn’t addressed in the game. Why didn’t the creators show Senua with a mental breakdown unable to leave the house? Why didn’t they show her unable to do the simple things people with depression can’t do like going to the grocery store or take care of chores. I personally feel like they did a great job portraying the varying degrees of psychosis and any more would have taken away from the general idea. Her father also did keep her hidden away and isolated from the rest of the village which is definitely shown in her memories so that was addressed.
The setting is also in a location I don’t think most people could identify with which would have taken away from what the developers were trying to represent. The time period this was set in was also a time where science didn’t have an explanation for mental health. Demons, curses, and other things like witches were used to explain anyone that wasn’t normal. To this day, mental health is misunderstood. Too long has it been swept under the rug. Too long have people who have these conditions been seen as lesser than and misunderstood. I applaud the developers on making this attempt and I believe more games and other media need to address these issues in a more educational light than something that’s used to explain a murderer in a TV show.
I recommend this game and if there are other forms of media like it, definitely send it my way. This is something that can be addressed and we can better assist people getting the help they need.