Hellblade Follows A Warrior Into The Underworld, But It’s On A Quest To Fight Real-World Prejudice

Psychosis in games and movies is usually an excuse for someone to get an axe in the face, but new game Hellblade is trying to help us understand how our minds actually work

We’re living at a time when suicide rates among men are increasing, rather than falling, and mental health issues are on the rise across the board. In England and Wales, at least, suicide is the leading cause of death in men aged 20-34, partly because of a reluctance to ask for help, due to shame. So something needs to be done to get more of us talking about mental health – but can a video game really help? After all, isn’t part of the problem trivialising mental health with labels like ‘psycho’ and ‘bonkers’?

Hellblade’s creators, Ninja Theory, describe the game as an ‘independent AAA production’, taking creative risks but applying blockbuster production values. It’s an ambitious claim. Then again, using the story of a traumatised Pictish warrior who believes she is entering the Norse Underworld, in order to help us understand how the brain actually works, and what happens in mental illness, is kind of ambitious too. So, Ninja Theory enlisted the help of both the professionals at the Wellcome Trust, and people who live with mental illness. RISING caught up with Paul Fletcher, psychiatrist and professor of health and neuroscience at Cambridge University, at the game’s London launch to find out how he collaborated on the design of a game which features hallucinations and voices inside the players’ heads…

RISING You use the phrase ‘alternate reality’ instead of ‘psychosis’ – why is that? PROFESSOR PAUL FLETCHER ‘Well, psychosis is a very contentious term and part of the problem is that a lot of people don't recognise that it's just a description. It's not a diagnosis. A diagnosis implies that there's a particular pathology that manifests in a certain way, there's a certain prognosis, but actually, you could have the features of psychosis for so many different reasons. If you have a fever or if you take a load of LSD or ketamine or if you're post-traumatic, sleep-deprived. Hallucination is a key feature of psychosis, so for me, it's a sign of a distressed brain. It's a brain that's not quite putting the pieces together in the way that everybody else is.’

RISING Hang on, are you saying that a healthy brain is closer to having psychotic features than we might like to admit to ourselves? PF ‘I think so, yes. I think one of the things that I've learnt over the course of time is that, we're all making up our reality. It's a constructive process, we're not passive recipients of the world out there. We're actually putting pieces together, trying them out, making predictions, refashioning them.’

We have to reassemble reality based on very ambiguous signals, and we don't often do a terrific job of it

RISING That sounds a bit hippified – if you get hit by a bus then it’s a bus, right? Is there an example of how a mind you would call healthy, is perceiving something other than objective reality? PF ‘The obvious example, and one reason why brain people are so fascinated by optical illusions is that's pretty much always a case of where your expectations override the actual objective reality. A good example of that is the hollow mask illusion - if there's a typical, plastic mask rotating in front of you, as the hollow side comes around, there's an expectation that kicks in which is that, faces don't stick in, they stick out. You can't help but see it as a face sticking out. Lots of other optical illusions are perspective based illusions. They're always a sign that your brain is deciding what should be there rather than allowing you to see what's actually there, and that's not a flaw.’

RISING Explain, as a scientist, how this process of piecing together reality normally works for all of us? PF ‘Our brain is encased within a skull which luckily, has some holes in it where nerve signals can get through and tell us about the state of the world out there. Heat; light; force; pressure; chemical composition. Those are the signals that we get but somehow, we have to construct that into a reality. We have to reassemble reality based on very ambiguous signals, and we don't often do a terrific job of it. It's a puzzle and what we do to help solve that puzzle is essentially, look at the picture on the box. We have our prior expectations about what should be there and we assemble our signals to fit those.’

RISING What happens when things go a bit wrong? PF ‘We have this delicate balance between what we know and expect, and what's coming in. The result of that negotiation is our perception of what's out there, what the world is. You can see with that model, how easy it is, even with the slightest shift, to spiral away into a very different reality that's populated by very different beliefs and perceptual experiences.’

RISING So how can a video game help us understand this? PF ‘As a matter of fact, I long had a belief that video games are an incredible forum in which to explore how we come to terms with reality, because you're placed in this setting about which you know very little, and you have to explore it, probe it and somehow assemble the pieces in order to solve the game, solve the quest.’

RISING By working with people who have experienced mental illness, Ninja Theory have tried to show what it’s like as a human, to go through it in Hellblade – how successful have they been? PF ‘I think they've been extraordinarily accurate in how they've tried to represent those experiences, whether it's the voices or the visions or the way in which the character puts the world together, or the way in which the environment alters mood, experience and action. They've also done so in a way that acknowledges that this is not just a list of symptoms. That's not what psychosis or altered reality is. It's not just a voice here and a vision there, it's a whole integrated experience of a different reality, and as a consequence of that, I think the person they've created in it is truly a hero – I think that is really anti-stigmatising in itself.’

I see psychosis as an exaggeration of normal function rather than some broken brain

RISING What about hearing voices in your head? We all have an internal monologue, but we call that our own and we can control it, even though thoughts often pop into your head, from nowhere... PF ‘Yes, one theory about why people have hallucinations is that, they get those thoughts and they can't distinguish them from something that's outside. I think there's good evidence that you can turn noise into meaning. That's what our brain really wants to do all the time; find the pattern in the noise. If you play somebody a burst of white noise and you tell them that, hidden in there is a clip of a song, they just have to push a button every time they hear that clip, you tell them what the song is, they'll listen and listen and every so often, they'll push the button. Actually, it's not there. Their brain is expecting it and fashioning the noise into that.’

RISING So interpreting the signals that our brain receives from reality is a creative process? PF ‘Yes, I think so. My feeling is that, in some cases, people who are prone to psychosis actually have a big advantage under certain circumstances – they're very good at bringing out the pattern using what they already know or believe. Which is great if the pattern is there. If it's not, then they're seeing things that aren't there. I see it as an exaggeration of normal function rather than some broken brain.’

RISING You’ve said that popular culture often uses psychosis and mental illness as a lazy excuse for violence – Hellblade is violent but it’s super-immersive so does that make it a more empathic experience? PF ‘I really sense that, all of the stuff that's around the energy bars and sanity bars that appear in some games – Eternal Darkness had a sanity bar and as it went down, your behaviour became more erratic – those all anchor you to something outside the game, don't they? Whereas, if they're not there, this is all you've got, you have to fully embed yourself in what's going on there. I can't help but think that must improve the empathy with the character.’

RISING So does this help the player think about mental illness without being either patronising or fearful? PF ‘Yes, I would quite like people to finish playing the game and think, she wasn't mentally ill. “That felt normal!” Well, not normal, but that was frightening and mind-blowing or whatever, but understandable, I think that's it: comprehensible.’

Everybody has that fear of sitting next to the person on the bus who is responding to the voices

RISING Do you hope that by making psychosis understandable all of us can overcome our fear of it? PF ‘Yes, everybody has that fear of sitting next to the person on the bus who is responding to the voices, and you quickly lose that fear when you start to think: “Actually, they are real voices to them, and to them it's an external reality.”’

RISING The recent high-profile suicides of men have shown isolation can strike anyone, anywhere – what would be your advice to someone feeling like they need help, but are suspicious of psychiatrists like you? PF ‘The most awful thing is increasing isolation and the sense that it's just you and nobody else has ever experienced this. My feeling is that, finding someone to talk to is step number one. I think psychiatry has a horrible history of compulsion, but I think nowadays, you're much more likely to find sympathy, respect and sensitivity. My advice would be: make some contact with someone.’

WHAT NEXT? Watch the atmospheric trailer for Hellblade’s intense, immersive experience, made all the more convincing by next-level motion capture and face mapping tech…

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