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Senua from Hellblade: Senua’s Sacrifice Steam

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What Hellblade: Senua’s Sacrifice gets wrong about mental illness

This action game tries to show what psychosis is like but ends up invalidating real experiences

“Would you give up the beautiful world that you and only you can see just to be rid of your nightmares?” asks Dillion.

Dillion is the sole point of protagonist Senua’s quest into Hel, the man that Hellblade: Senua’s Sacrifice sets up as the person who understands her better than anyone ever has or could. Her light in darkness. And here he is invalidating not only her mental illness, but her desire to seek wellness. It’s part of the well-intentioned neurotypical sentiment that permeates this game, invalidating the experiences of people with mental illness even as it seeks to promote understanding.

[Warning: The following piece contains spoilers for Hellblade: Senua’s Sacrifice.]

Hellblade: Senua’s Sacrifice begins with a warning screen about its “representations of psychosis.” It cautions players who have had similar experiences to take care when playing and provides a website (hellbladehelp.info) with contact information for helplines. This warning comes with showy mention of the professionals and individuals consulted in the game’s making. The whole thing is written in a skeletal, serious and severe typeface, posed against a black background. The first minute of Senua’s Sacrifice is an odd mixture of sincerity, preciousness and confusion. It’s Grimdark 2.0, the well-meaning grimdark with a diversity and inclusion initiative.

But it left me holding a bag full of questions. I couldn’t tell if I was being pandered to, postured at or just being used. I didn’t know who this game was for. Perhaps I should have listened to the warning and begged Sony for a refund, citing “I’m severely mentally ill, and the game says I probably shouldn’t play.” I’d be lying if I didn’t admit that cynicism crept through me like Senua’s black rot. Despite it all, I have never wanted to be proved wrong by a game more than I have with Hellblade: Senua’s Sacrifice.

Ninja Theory

The representation of mental illness in video games is fraught, often irresponsible and fundamentally non-existent outside of indie developers. Reviewers (albeit with no stated history of psychotic mental illness) have praised Hellblade’s sensitivity and insightfulness. Even friends with mental illness said the game resonated with them — that this was the “AAA Depression Quest” the games industry has been waiting for.

In all fairness, this is the first instance I know of in which a game studio contacted mental health professionals and people living with mental illness for its game about mental illness. It’s also not set in a haunted sanitarium and the stench of Howard Phillips Lovecraft is nowhere in sight. It was with Ninja Theory’s willingness to “do the work” in mind (and the lack of an apparent Sanity Meter) that I started up Hellblade — eager to embark on a journey through psychosis with a tortured but persistent Pictish lady.

The research shows in the game. While playing I saw the gamut of symptomatology classically associated with psychosis and was alternately guided, taunted and upbraided by auditory hallucinations (which the game calls “the Others” and are credited as “Furies”). Senua hallucinates glowing runes, with colors and light that are either amplified or dimmed. Her head darts furtively back-and-forth, scanning for the danger that hushed, faraway voices and perhaps imagined movements might portend. Fire spontaneously erupts from buildings as Senua’s focus shifts between this reality and another. Hyper-vigilance, auditory and visual hallucinations, flashbacks, agitation, intrusive thoughts, delusions — all the classic hallmarks of psychosis are brought to bear in Hellblade.

I made my way through a beautifully crafted, decrepit Viking landscape of wooden villages, sacrificed corpses and smoky black Viking demons — what I’d come to learn were manifestations of the trauma Senua experienced shortly before the game began. This particular psychotic episode is fueled by two triggering events: the slaughter of her village and boyfriend, Dillion, and the stories that a mentally ill mystic, Druth, has told her about the Norsemen. Druth can sometimes act as a guide, but his primary purpose is to inject Norse mythology into the game. I found myself largely ignoring these moments because they had little bearing on Senua’s present realities.

Ninja Theory

Her realities are more outwardly presented via Hellblade’s puzzles, which involve using an aspect of her mental illness to “see things differently.” They’re about finding connection and patterns where none really exist. It’s a creative psychological process called pareidolia, and it’s something we all engage in. It’s believed that people with psychosis are more adept at this kind of creative process and involuntarily engage in it more frequently.

Perhaps that’s true. I spent hours struggling to solve environmental matching puzzles in this game; seeing the specific rune’s shape everywhere I turned and matching it up perfectly only for the game to conclude it wasn’t the specific shape I needed. My partner (who is also mentally ill) would point out others I’d missed, always to the same negative result. Were we making connections that simply didn’t exist? Or was this a deliberate act by the designers? We’ll likely never know. The game doesn’t address what the puzzles consider fraudulent semiotic connections. If it’s a deliberate attempt to mimic the pareidolic capabilities of someone with psychosis for a neurotypical audience, it’s not communicated. Like with many of the other puzzles in Hellblade, it felt like I was being deliberately undermined — that my own mental illness was being explained to me by an inexperienced outsider. Having to embrace Senua’s reality, as Ninja Theory’s puzzles demanded, meant having to give up my lived experiences as a mentally ill person to occupy a perspective that felt inauthentic.

The second zone I went to after defeating the fire god was the home of Valravn, a trickster deity whose area is a forested labyrinth of dead ends that aren’t actually dead ends. The puzzles here involve getting to vantage points and realigning Senua’s perception of the space to uncover the passageways that were there all along. I stopped and wondered about how many times in my own life my mental illness has aided me. No intrusive thought has ever saved me from harm or given me direction. Visual hallucinations have only been horrifying or mundane. Flashbacks have never offered profound insight. Perhaps my hyper-vigilance has kept me from danger; it’s also made me lash out at perceived but unrealized threats. I’m not even dissociating through the process of writing this article (that would have at least removed me from the anxieties of writing). I’m certain my mental illness has never benefitted me or society (a claim Ninja Theory co-founder Tameem Antoniades muses on at the end of a documentary feature included in Hellblade). I’m not some mystical aberration helping the world progress; I’m just a girl trying to live as best I can.

And it was here that I began to fully realize just how this game invalidates the experiences of people with mental illness at nearly every turn.

Senua’s journey is a typical hero’s quest. According to the aforementioned documentary, Hellblade was originally conceived as a straightforward heroic adventure game in a world made from illusions. A young warrior is thrust into a reality she doesn’t understand and accepts the call to action. She ventures into the underworld, accompanied by a sage and other helpers, and reconciles with her father by killing him. Embracing her new fate and self, she’s ready to return to the material world. This takes place all in the span of an afternoon. Even as allegory, this isn’t how mental illness works. Thrusting real mental illness symptomatology into a game that didn’t begin with it in mind feels tacky.

Hellblade’s hero, Senua, travels down a river Ninja Theory

Playing through Hellblade was torturous. I’d manage parts of chapters before having to abandon it for a walk around the block. Many reviewers, while praising the game, have used words like “tense” and “stressful” to describe it. For me, a game like Dark Souls is tense and stressful. Hellblade is something different entirely. I screamed and shouted. I went through a series of symptoms (dissociation, derealization, panic attacks, acute hypervigilance, unshakable feelings of dread). I even long-threaded on Twitter ... a lot. I nearly quit the game every other chapter. I watched as the black rot crept up Senua’s arm as I died repeatedly, getting hung up on bad geometry. All of which brings me to what was initially the most controversial aspect of this game for many reviewers — death, or rather, permadeath.

In an early set-piece moment, Senua falls in battle against an endless horde of spooky vikings. It’s unavoidable. The game needs you to die so it can introduce the concept of permadeath. Senua will die in her quest, repeatedly. Those deaths only do one thing: spread the darkness eating away at Senua. Eventually that darkness will grow from her hand to her head and she will be lost forever. Many people with mental illness struggle with feelings of dying, fearing that their next bad experience will end them, even launching into suicidal ideation and actions. In Hellblade, this is a bad metaphor, handled poorly.

It’s also a flat-out lie. There is no permadeath. You’ll see the black rot crawl up Senua’s arm, but it resets every time. It’s a deliberate move by Ninja Theory to artificially increase tension, to raise the stakes in a game already in love with its psychological horrors. Manipulations are common in media. But this feels wrong.

Part of that feeling comes from how deliberate the lie is. The rot is mentioned by characters in the game, but the consequences of permadeath that accompany the rot are explained via a non-diegetic splash of text from the developer. The lie is injected by an external authority who has agency over not only Senua, but the player. It’s a manipulation that’s only purpose is psychological destabilization. Even though I can see the well-meaning intentions behind this trick, in a game about the debilitating consequences of abuse and mental illness, it’s an extremely inconsiderate trespass.

In some ways, I feel for Ninja Theory. Attempting to construct a sensitive lesson plan for a neurotypical audience about mental illness is difficult. A less cynical version of me wants to applaud the development team for trying to make a compelling, didactic game. Their depiction of the auditory and visual aspects of mental illness are solid in many ways, even if impressionistic. Hellblade comes close to showing how trauma can impact and incite episodes of severe mental illness. Still, in my most genial of moods, I can’t help but feel like this hurts more than it could possibly help.

Hellblade: Senua's Sacrifice image 1024 Ninja Theory

Mental illness doesn’t exist in a vacuum. A person’s mental illness is inextricable from their social context. While the developers understand that mental illness is interpreted differently based on social context, they fail to illustrate those experiences within society. The closest we get to seeing Senua exist with other people is in flashbacks to conversations with Dillion or the trauma of her father’s extensive abuse. She never has to go to the store for milk. She’s not struggling with losing her job because she had a flashback in a meeting. Paramedics and cops never break down her door because she didn’t answer phone calls from her friends and family for a week. We never go with Senua to the Social Security administration offices as she’s denied support because they’ve deemed her not disabled enough. Senua’s village is wiped out before our quest begins. The ending reveals she never goes anywhere.

It’s because of this lack of social context that Hellblade communicates (perhaps unintentionally) the harmful idea that mental illness “is all in her head.” It presumes a world where people with mental illness exist wholly divorced from their societies. This wasn’t true in the 9th century and it certainly isn’t true now. People with mental illness have to live among other people. That’s a colossal part of what makes living with mental illness a struggle. To remove that context for narrative and gameplay reasons undercuts any desire from the developers to be sensitive or didactic.

There’s a saying in the autistic community: “If you’ve met one person with autism, then you’ve met one person with autism.” This could also be said of mental illness. Despite 60-plus years of attempted codification by the American Psychiatric Association, no two experiences are exactly alike, even within single diagnoses or symptom sets. While Hellblade attempts to locate its depiction of mental illness wholly within Senua, she isn’t a person. Senua’s a gamified symptom set; a collection of harvested delusions turned into set pieces and a backstory sketched out exclusively by her relationship to her parents, a mystical Captain Jack Sparrow and a thoughtless boyfriend. She’s a case where “getting it right” took precedence over making it real.

We need games with broader appeal that have a sensitive, nuanced handling of mental illness. We need games that present people living with mental illness as real and valid people. But we also need those games to handle mental illness as it is, not as allegory. Hellblade isn’t going to make talking about mental illness less “taboo.” This kind of game isn’t going to help destigmatize mental illness, or progress the typically-ignored reality that mental illness is more diverse and complicated than experiencing delusions and hallucinations.

Ninja Theory’s decision to gather feedback from people with mental illness and mental health professionals was good. There are still questions I’d like to ask the developer. What in its opinion has Hellblade achieved for people living with psychosis and other mental illness? Does it feel as if Hellblade has contributed to improving the quality of life, of broader understanding of these conditions? Or has it simply illustrated symptoms society already associates with psychosis?

We need games that aren’t just illustrative of known (and often wrong) concepts; games that do more than strive to get it right and stumble. We need games for mentally ill people. We need games that don’t leave us wondering if our identities have been used against us or for the entertainment of others. We need games that, even if they are not specifically for us, treat us as human beings. We need these diverse characters (and the marginalized people they represent) to be treated with respect and love as fully realized individuals. We need games that seek to understand, and not just simulate. As my experience with Hellblade: Senua’s Sacrifice illustrates, caring more about nailing the technical specifics can be just as invalidating as not caring at all.


Dia Lacina is a queer Native trans woman who spends too much time tweeting and not enough writing about video games and photographing mannequins.