Video games have gone through a bit of a rough patch recently; not only has gaming disorder now been classified as a mental health condition by the World Health Organization (WHO), Trump’s also been putting the blame on video games for school shootings. But let’s give video games some slack. After all, they’re no longer just about violent gun battles, robberies and whatnot. In fact, the V&A’s recent exhibition presented video games as one of today’s most important design disciplines, as they begin to tackle the most current, crucial and intricate aspects of humanity, just like any other artform.

The themes covered in video games are broadening to represent a wider range of human experiences, including highly sensitive topics such as eating disorders, anxiety and depression. Simultaneously, as games are researched more in depth, we are also gaining more experience in this mass gaming phenomenon that has swept over the world. With this growth of knowledge and insights into the field, let’s explore how video games can in fact be a form of self-help and contribute to dealing with mental health issues – both for players and for creators.

Learning how to play the right way

No one can deny the fact that extreme gameplay has led to a number of tragic outcomes. And due to the addictive nature of games, this is certainly not a subject to be taken lightly. It’s no surprise that people enjoy playing video games so much – especially as recent findings show that what goes on in our brains while playing, is the exact opposite of our neurological activity during times of depression. The regions of our brains that are stimulated when playing, are in fact under-stimulated when clinically depressed. The question is: how can we use this knowledge to our advantage and play effectively, joyfully and responsively?

Game designer, researcher and future forecaster, Jane McGonigal, believes we can harness the positive effects games have on us to alter our brain state and mood. The trick is to practice self-control and set a timer when playing, so that we can then get back to our real lives with this improved sense of wellbeing. “If you’re trying to calm your mind and body and return to the world with more mindfulness, 20 minutes is the amount of gameplay time that’s recommended,” Jane McGonigal explains on the WNYC Studios podcast. “If you’re just trying to stop an anxiety attack or if you’re ruminating on thoughts that make you really upset, or maybe you’re replaying a conversation or something traumatic that happened, ten minutes is recommended for that. Ten minutes is also recommended for squashing cravings.” For this purpose, she suggests puzzle-like games, such as Tetris. But just like taking painkillers, you have to try it out and see what works best for you in terms of types of games and timings.

Tetris Effect video game
A frame from Tetris Effect.

Once finding the game that works for you when feeling down, you can try analyzing your choice. “We can infer how we’re feeling from what games we feel like playing, even if the emotions or issues haven’t actually come apparent to us yet,” says video games journalist and video producer, Johnny Chiodini, in his YouTube series, Low Batteries. Making the right game choice could also play a part. Often, in periods of depression, people may find themselves having difficulty doing even the most basic of tasks. These circumstances may call for the types of games that give you frequent and small victories, marked by receiving trophies or achievements, along with oddly satisfying noises. If you think about it, it’s not so different to ticking things off your ‘to do’ list. There’s nothing better than including one or two simple tasks on your list that you know you can achieve fairly easily.

Putting our thoughts and conscious minds to rest while playing certainly has its benefits, offering us a somewhat meditative state. On the other hand, it can become addictive. Johnny Chiodini stresses the importance of self-regulation, adding, “There’s a fine line to tread between temporary escapism and flat-out denial. While sometimes games can provide a much needed release, we can in turn begin to rely on them too much.” And if you think about it, this may not be too different than other forms of meds, only that for video games, we don’t usually get a prescription.

Games that directly deal with mental health issues

Other than using responsible and self-aware gameplay to help us organize our thoughts, or voyage into another world when we’re feeling down, there are games that directly address themes of mental health. More of these have been released recently, which is not surprising, as the world of video games is rapidly developing and creators are using it as a medium of self-expression, just like any other form of art.

When executed accurately and sensitively, video games offer a powerful medium through which to portray these complex issues. This can be achieved thanks to the incorporation of a plot, relatable characters or simply the fact that the player is fully immersed in the game and able to make active decisions, as opposed to being a spectator like in books or movies. Through engaging with games that deal with topics of mental health and seeing characters experiencing what the player may be feeling, players can perhaps gain a better understanding of what they, or their friends or family, are going through.

Life is Strange video game
Max and Chloe in the car, a frame from Life is Strange, developed by DONTNOD Entertainment.

One such game is Life is Strange, in which you follow the story of teenage best friends, Max and Chloe. As the plot unfolds throughout the games’ five episodes, you become intertwined in their relationship, and are also faced with themes of depression and suicide. Johnny Chiodini explains how the game tackles these topics with great sensitivity, pointing out that there’s a packet of fluoxetine (the most commonly subscribed medication for depression and anxiety) on the scene and “no one makes a fuss about it. Finding someone’s medication can be a really difficult moment because it’s inadvertently asking someone to share something that can be intensely private and your own reaction to that discovery can mean a lot,” Johnny elaborates. Another nice and thoughtful touch is that the Life is Strange website itself includes links to organizations around the world that help deal with mental health.

Life is Strange video game
Max’s room, a frame from Life is Strange, developed by DONTNOD Entertainment.

A much less complex game, but one that also addresses anxiety, is indie game Hiding Spot. The aim here is simply to help the main character get away for a bit, by moving furniture around an office space and helping them create a quiet spot in which they can isolate themselves and calm down from the stressful world outside. The mundane, yet manageable action of moving furniture, is a little like that achievable task on your ‘to do’ list. Engrossing yourself in this act and putting your focus on it, can help you free your thoughts from the, at times, overwhelming reality.

Hiding Spot indie video game
The main character of Hiding Spot.

Knife Sisters is an additional game that deals with mental health issues – this time in the form of a graphic novel that covers poignant and often painful themes of peer pressure, manipulation and obsession. It encourages you to explore complex emotions, through intense romantic relationships and dialogue between characters. This kind of game invites you to temporarily “live through” other characters, as you encounter scenes and situations that you may relate to in your real life. In turn, this roleplay can help and encourage you to see things from an alternative, more distant perspective – a technique used in psychodrama. The game will be released in 2019 – keep your eyes open for it.

Knife Sisters video game
A frame from Knife Sisters.

Video game creation as a form of self-help

It’s not just playing video games that can be beneficial in dealing with mental health. Many games are also born out of a certain struggle, or simply the need to express oneself. One example is Path Out, a game that tells the autobiographical story of Abdullah Karam, a Syrian refugee living in Austria. A dark sense of humor accompanies the grave subject and plot, as you discover the story of the main character’s escape from Syria. Abdullah himself acts as a narrator occasionally, as he appears in the corner of the screen, reminding us that this is a real, painful and personal story.

Path Out video game by Causa Creations
A frame from Path Out, by Causa Creations.

That Dragon, Cancer is another game that was developed as a direct response to tragic circumstances. This beautifully sensitive, emotional and highly imaginative game tells the tale of a young boy’s four-year fight against cancer, and the experiences him and his family go through, described on the website as “a journey of hope in the shadow of death.” Ryan and Amy Green, the creators of the game, based the game on their experience with their son, Joel. In Amy’s TED talk, she says “We made a video game that’s hard to play. But that feels just right to me, because the hardest moments of our lives change us, more than any goal we could ever accomplish.” She continues to explain how she felt even more drawn to work on the game, after the night that their son passed away. “The possibility of sharing Joel’s life through our video game – it was something I couldn’t resist. I started writing more, I sat in on our team’s design meetings, I added more ideas and I helped direct scenes,” says Amy. “I discovered that creating a video game is telling a story, but with an entirely new vocabulary.”

That Dragon, Cancer video game
A frame from That Dragon, Cancer.

It seems game design offers a medium that is both an excellent artistic outlet for self-expression, and also an opportunity to disconnect from the outer world, possibly immersing yourself in a world that either understands you or simply enables you to put your conscious mind to rest for a while. However, it’s also important to play responsibly and use the platform in a positive way with regulation and self-awareness.