We all get stressed out from time to time. Most people live busy lives, balancing jobs, friends, and family, while still trying to keep on top of all their financial worries. And yet, no matter how much stress we feel, we still don’t want to talk openly about the more serious issues that stress often leads to.  It’s crazy. A friend of mine recently hit the nail on the head in a post on her Facebook page.

“Mental health issues are nothing to be ashamed of.”

It seems so obvious. It shouldn’t need to be said. And yet, there’s still a stigma attached to them. People are afraid, or embarrassed to seek out the help they need, because they fear demonization, or ridicule. This is a dangerous trend that needs to stop. Research has shown that roughly one in five American adults will suffer from some form of mental health issue each year. In the UK, rates of depression and anxiety among teenagers have increased by 70 per cent in the past 25 years. Lives are being unnecessarily lost. How many of these could be saved if we could just talk more openly about these issues?

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Pop culture often leads to people discussing social issues more freely, providing a platform for open dialogue on topics that are difficult for us to bring up in everyday conversation. We see a film or play a game featuring a mentally ill character, and when we discuss the film, we get on to the topic of mental health by proxy. Unfortunately, depictions mental health issues in the media are often less than stellar, often failing to take the empathetic, careful approach necessary when confronting these highly complicated issues.

Enter Darkest Dungeon, the long awaited roguelike RPG, showing other games exactly how it should be done. The concept is simple enough. You send a party of four heroes into a dungeon dripping in Lovecraftian horror influence, and try to keep them alive. What sets this apart from most games, is its brilliant handling of stress, and the impact it has upon mental health.

Reliance on the concept of “insanity” is a horrible cliché in the horror genre. Most horror games take a ham-fisted, borderline insulting view on sanity, turning all forms of mental illness into a homogenous blur in which the same tired tropes are wheeled out time and time again. Your vision becomes blurry, you begin to hallucinate, and/or you start hurting yourself. You’ve gone crazy. Yawn.

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Instead, Darkest Dungeon takes a more nuanced view on mental health, focusing on the nature of stress and how it affects the human psyche. The game recognises the stressful nature of the situations you’re putting your characters through, and responds to this by filling a simple 0-100 meter. When one of your characters is attacked, their meter goes up a little. If the meter reaches 100, then the game responds by afflicting the character with a negative “quirk” at the end of the mission.

Here’s why the stress meter is great. It’s a simple, but effective way of showing that stress is something that affects everyone. We all react to it in one way or another. Some of us crack under the pressure, or develop issues that we need help fighting off. By showing stress in this way, Darkest Dungeon shows that mental health issues aren’t wrong, or weird, or embarrassing. They’re something that requires patience, and understanding to fight off.

Why should featuring bulimia in a video game be so strange?

At first glance, this may all sound like a cheap gimmick. On paper, it sounds like the developer is trivialising mental health issues. Fill up the stress meter too high, and – ding, ding, ding! – you unlock PTSD! It’s a trap Darkest Dungeon could so easily have fallen into. But in practise, it hasn’t panned out that way at all, largely because the developer has tackled mental health with confidence.

Characters can develop serious real world health issues, including bulimia, alcoholism, and even sex addiction. Touching on an issue like bulimia is a brave move for a video game. So many developers would shy away from featuring an issue like this for fear of causing offense. And yet, why should featuring bulimia in a video game be so strange? Eating disorders are a real thing that affect many people simply because they don’t want to talk openly about their problems. By openly incorporating mental health issues in the gameplay, Darkest Dungeon actually makes it easier to speak about these issues in real life.

The game doesn’t feel the need to make a song and dance about its inclusion of mental health. A bulimic character doesn’t start wildly vomiting every few paces. A masochistic character doesn’t start violently hacking at their own wrists in an attempt to self-harm. Sex addicts don’t start randomly dry humping everything that moves. Representation is the first step on the path to creating open dialogue about these topics, and Darkest Dungeon does it in just the right way. The issues are represented without exaggeration. The focus is placed on the characters, rather than the illness they’re suffering from.

Often, games place emphasis on the illness rather than focusing on the character themselves. Pop culture is literally teaching us to fear mental illness. How many times have you played a game, or seen a film in which the villain’s motivation is summarised as “because they’re crazy,”? Chances are, it’s a lot. Too many, in fact.


Of course, Darkest Dungeon isn’t the first game to confidently tackle the issue of mental health. The adventure game, Actual Sunlight, features a protagonist suffering with severe depression. His interactions and thoughts are affected by his depression, reflecting just how much influence mental health issues can have on the lives of the sufferer. At the same time, it isn’t used as a gimmick. The issue is handled with sensitivity.

Just last month, I reviewed I’ve Been Late, a short game about the struggle of living with severe anxiety. There’s no “anxiety meter” which once filled, leads to your character running away crying in some kind of horrible, exaggerated portrayal of mental health. You simply play through a collection of brief scenarios, in which you are unable to interact with any of the other inhabitants of the game world. The aim isn’t to avoid anxiety at all costs. Your aim is to simply experience these emotions, and understand the ways in which people learn to work past them.

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More games need to take this kind of confident but nuanced approach to portraying mental conditions. When these issues are handled in the right way, games can be a real positive force in the fight against mental health issues. There need to be more games like Darkest Dungeon, having the confidence to address these issues as everyday things rather than using them as tired clichés that only serve to reinforce the stigma that is unnecessarily attached to mental health issues.

As long as pop culture continues to demonize these kind of problems with tired, disdainful portrayals, people will continue burying their heads in the sand, rather than seeking help. I shouldn’t have to say this, but if you’re struggling in any way, talk to someone – a friend, a family member, a doctor. Anyone.

Remember, mental health issues are nothing to be ashamed of.

About The Author


As a composer and video game enthusiast, Philip has spent years searching for a way to combine his passions for both music and gaming. Then, one day, he figured he could just write about them. He loves to over-analyse the way music helps to shape the player's emotional response in a game. He also loves to criticise bad control schemes, because... Well, they just get on his nerves.

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