Analysis of the Stigmatization of Mental Illness in Video Games
Psychology
Terrence J. Chambers III
Thesis Advisor: Dr. Rebecca Regeth
HAB Member: Dr. Justin Hackett
Second Reader: Dr. Ryan Sittler
Librarian: Loring Prest
Keywords: mental, health, public, stigma, video games

Abstract
Video games often villainize mental illness as a means of explaining the behaviors of
villains and other characters in the game (Shapiro & Rotter, 2016). Thus, the goal of this
thesis is twofold: first, I analyzed a sample of 18 video games for their content
concerning the stigmatization of mental illness. Second, I will then propose two
alternative methods of presenting mental illness in video games: one method will be a
suggestion aimed at the elimination of mental health stigma from video game content so
that an alternative design to the current system is available. The second method is a
suggestion aimed at educating players of video games on mental health in an effort to
reduce mental health public stigma as a whole and improve knowledge about mental
illness so that facts are more widely available than myth using Patrick Corrigan’s
analyses on the different ways mental health public stigma can be confronted and reduc

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Introduction
The video game industry is an expansive network of technology companies and
independent developers that provide entertainment to millions of individuals, with some
estimates that as much as 97% of American children and adolescents play video games
daily (Granic, Lobel & Engels, 2014). The amount of content in video games is massive
and, at least in terms of plots and characters, contains as much variety as one might
expect from libraries full of books from hundreds of different authors. Like books, games
have intricate plots, dynamic heroes and villains, new fantasy worlds, dystopias, and
portrayals of modern, past or future societies. Video games also portray mental health in
a variety of ways, and, like other mediums that do this, can often inaccurately portray
mental illness throughout the progress of the game (Shapiro & Rotter, 2016). This
sometimes leads to the villainization of abnormal mental health in the games, and a
sample of such games will be presented in this thesis. Like other forms of media, video
games can frame how people think of particular aspects of society, including the
perpetuation of stigma (Quintero Johnson & Miller, 2016). In this case, video games can
affect people’s perceptions of mental health and lead to or confirm preexisting negative
or inaccurate views of the audience’s perception of mental health.
Video games portray mental health in multiple ways, from picking and choosing
different symptoms of mental illness to being outlandishly false and inaccurate in its
portrayal (Shapiro & Rotter, 2016). The characters that display these selected traits are
often villains, antagonists or alienated characters of some kind, which leads to a false and
villainizing portrayal of mental health to the audience playing or watching the game and
this perpetuates the stigmatization of mental health in society (Goodwin & Tajjudin,

MENTAL HEALTH STIGMA IN VIDEO GAMES

2016). This is an issue that has not changed over time, as this sample of games suggests
by using games developed as far back as 28 years ago. A select few examples more
accurately portray mental health, and these will be selected as examples moving in a
positive direction for the portrayal of mental health in video games. When video games
do portray mental illness, my analysis shows that it is often in a bad, inaccurate and
villainizing or alienating light, and this can lead to negative perceptions or
stigmatizations of mental health from the audience.

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Literature and Game Review
The Games
Grand Theft Auto V. Grand Theft Auto is a game series usually about conducting
criminal activity to bring your main character(s) to power as a criminal underboss of
some kind. The games rely a great deal on satire and often utilize it to make fun of certain
aspects of society, such as society’s addiction to technology, or a satirical presentation of
gun stores and gun culture. In this iteration of the series, the main characters are two
former bank robbers, Michael and Trevor, and Franklin, a person trying to make enough
money to live comfortably by almost any means. Each character has their own
personality and history (Rockstar Games, 2013).
Franklin comes from the city slums and has worked with gangs and as a
repossession worker for a car dealer. Michael is a retired bank robber that is trying to live
a comfortable life in the upper class part of town until his life gets derailed and he must
go back to his criminal ways. Trevor is a former bank robber that lives out of town and is
attempting to take over the crime businesses in the area through violence and killing. All
three work together to pull of heists, build a criminal empire and live a wealthy life on
top of violence and criminal behavior. The game is open-ended and gives the player their
choice of missions to complete, as well as some limited decision-making in how the story
will take place. Ultimately, there is a great deal of violence and the “heroes” of the story
are criminals that get away with their crimes. While in previous installments, it was
usually up to the player to go on civilian killing sprees, Trevor will do this on his own

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sometimes when the player is playing as a different character at that time (Rockstar
Games, 2013).
The Sims 3. In The Sims 3, the player creates and controls the lives of “sims,”
which are virtual people in a relatively open-world environment meant to fictitiously
simulate someone living a regular life. There is no game-set goal as you play other than
to help your sims live a fulfilled life or a miserable one. The player creates the sims
themselves and can select their traits and goals in life. The goal is simply to play through
a sim’s life with the ability to control up to 8 of them at a time in one household
(Electronic Arts, 2009).
Rimworld. Rimworld is a science-fiction sandbox survival game that places the
player in control of people attempting to survive a crashed spaceship on an unknown and
hostile planet. The goal of each playthrough is always the same: create and sustain a
colony of people on the planet and attempt to escape the planet before a group large
enough to destroy the player’s colony shows up and kills everyone. Each character,
known as pawns, comes with a diverse set of backgrounds and traits that make every
pawn unique and better or worse at particular skills (Ludeon Studios, 2013).
League of Legends. League of Legends is a massively multiplayer online battle
arena (MOBA), in which the player selects one of over a hundred champions to face off
against others in a battle arena that pits five players against five other players with each in
control of a champion of their own. The game boasts being the game with the most active
players participating in the game in the world. Each champion in League of Legends has
their own backstory, history and lore. This leads to interesting and diverse personalities
for each of the champions, ranging from kind and benevolent leaders to violent and

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destructive criminals with no care for authority and no regard for the lives of others (Riot
Games, 2009).
FarCry 3. In this game, players take on the role of Jason Brody, an American on
vacation with his brother and friends on a tropical island that are captured by pirates and
find themselves embroiled in a conflict for dominance between the pirates and the local
population that leaves Jason’s brother dead at the hands of one of the game’s villains,
Vaas Montenegro (Ubisoft, 2012).
Resident Evil franchise. The Resident Evil series of games focus primarily on
incidents of zombie outbreaks all over the modern world in the game universe. The
games are generally survival-horror with some action games in more recent years. Full
game synopses will not be necessary for each one, as most characters will be in multiple
games with a few exceptions. Most of the games follow a similar arc for the conflict:
There is an outbreak of some kind and the protagonists of each game must put a stop to it
or escape with their lives. In most of the games, as well as the original cause of the first
outbreak in the first game, the fictional pharmaceutical giant, Umbrella Inc., developed
the biological weapons (often shortened to bioweapons) that created the horrors of the
games in the first place.
Resident Evil: Code: Veronica. In Code: Veronica, the player plays the game as
two protagonists: Claire and Chris Redfield, siblings that are both veteran survivors of
zombie outbreak incidents. In Claire’s mission to find her brother, she runs afoul of
Umbrella and is imprisoned on an island used for the training of Umbrella’s private
military. A zombie incident occurs here, and she must survive these horrors while also

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facing off against the villain, Alfred Ashford and later his sister, Alexia Ashford
(Capcom, 2000).
Resident Evil 5. In one of the more actionized games in the franchise, players
play as Chris Redfield and Sheva Alomar as the duo investigates reports of bioweapon
experiments in Africa. Here they find evidence that Albert Wesker, the series villain and
Chris’ rival, is attempting to release a biological weapon on a global scale that would kill
most of humankind and leave him the ruler of what remained (Capcom, 2009).
Resident Evil 7. This most recent installment of the series has players take on the
role of Ethan, a regular person caught in an irregular situation, as he searches for his
missing girlfriend in Louisiana. Ethan must survive a house of horrors while fighting off
members of a family afflicted with a biological weapon that prevents them from dying
(Capcom, 2017).
The Evil Within. This game is a difficult one to describe. The player controls
Sebastian Castellanos, a detective sent to investigate a report at a local asylum for mental
illnesses. What he finds there are experiments being conducted on patients as well as a
great deal of supernatural elements that make the player and the protagonist question
their own sanity. The game is presented through the perspective of an unreliable narrator
that may be suffering from audio and visual hallucinations. The villain, Ruvik, appears
often and twists the player character’s reality on a whim, leaving them confused and
disoriented often. All characters throughout the game suffer in different ways as the game
progresses (Bethesda Softworks, 2015).
Elder Scrolls IV: Oblivion. In this installment of the Elder Scrolls series by
Bethesda Softworks, the player plays as a character known popularly as the Hero of

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Kvatch. This name is selected as a general way of talking about the protagonist of this
game by the players, as the player character him or herself is created entirely by the
player: their race, their looks, how old they are, if they are male or female, and their traits
are all selected by the player. The game is set up as an open-world role-playing-game, in
which the player chooses the role of their character with a certain degree of freedom in
their choice of abilities and actions they can take throughout the game. The story of the
game is that you escape from imprisonment and vow to help fulfill the emperor’s last
dying wish: to make sure his son ascends the throne and prevents the gates of Oblivion, a
separate realm controlled by a powerful being known as a Daedra, from opening and
destroying their world. Yet, as previously mentioned, the game is an open-world format
with hundreds of other quests. There are many interesting characters to meet, and one
very large expansion to the game to focuses entirely on insanity: the Shivering Isles DLC,
in the realms of Madness (Bethesda Softworks, 2006).
Elder Scrolls IV: Shivering Isles expansion. This game-sized expansion places the
player character in the role of the champion of Sheogorath, the Prince of Madness, and
deserves particular mention since its goal is very different from the base game from
which the expansion comes. The goal of the expansion is for the player to succeed the
Prince of Madness and stop the Greymarch, an event that leads to the destruction of the
realms of Madness every era by the Prince of Order, Jyggalag. Again, the game has a
focus on its open-world elements and side quests the player can undertake to explore and
further understand the expansion and additional realm (Bethesda Softworks, 2006).
Dragon Age II. In this installment in Bioware’s popular RPG series, the
protagonist is Hawke, a person whose family is fleeing the Blight, an event in which

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creatures known as Darkspawn attempt to destroy human civilization. The character
creation itself follows a similar format to many open-world RPGs: The player decides the
character’s looks, temperament, decisions in dialogue and combat style. Hawke and
his/her family escapes the Darkspawn to the city of Kirkwall. This is where most of the
game takes place with a branching main storyline that can have a couple of different
outcomes based on player choice, although one thing always remains the same: A war is
started between mages and their handlers, the Templars. The player must decide whether
or not to side with Templars against mages or mages against Templars with a heavy
emphasis on prior decision-making affecting how others feel about the protagonist and
whether or not they will support him or her at this point. Throughout the course of the
game, the player character meets characters of diverse backgrounds and races and can
have many of them in his or her party as combatants and companions in their adventure
(Bioware, 2011).
Fallout franchise. There are a great number of Fallout games to discuss. All of
the games in the series are open-world RPGs, in which the player character can go almost
wherever they want at the start of the game. The player also creates the characters in each
game: they decide the sex of the character, the character’s traits and perks, and their
relevant skills from an extensive list of options ranging from combat skills to dialogue
and stealth skills. In the later installments of the series, the player also decides what the
character looks like. Each game takes place a certain time after 22 October, 2077, which
marks the end of the Great War that destroyed modern civilization in a nuclear holocaust.
Each game has its own story and goals for the player to complete with a focus on the
open-world and freedom of choice elements present in many Bethesda RPGs.

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Fallout 2. In the second game in the series, the player creates and plays the role of
the Chosen One, a member of a primitive tribe on the verge of starvation in the year
2241, in norhern California. The goal of the story is to find the rumored Garden of Eden
Creation Kit (GECK), which is said to have the ability to create an abundance of
vegetation and life so that the tribe can survive. As the game continues, the player
character’s tribe is targeted and destroyed by a militant group known as the Enclave,
which is a group representing a twisted version of the United States government almost
two hundred years after the collapse of all organized governments in a nuclear war. Like
many open-world RPGs already mentioned, this game and others in the series have a
diverse and extensive number of characters to meet and interact with throughout the
course of the game (Interplay Entertainment, 1998).
Fallout 3. In this installment, the player character creates and plays as the Lone
Wanderer, a 19 year-old man or woman that is forced to leave the safety of their Vault,
Vault 101, a shelter originally created before the nuclear war as a means of preserving
human life on Earth, in order to find their father in a radiation-infested Washington D.C.
200 years after the bombs have fallen. Once again, the player character finds himself or
herself in conflict with the Enclave and is sent on a path of revenge when the Enclave
kills the player character’s father. The core story is focused on destroying the Enclave’s
presence in Washington D.C. while also helping another group, the Brotherhood of Steel,
finish a project to create radiation-free water for the citizens of the ruined city (Bethesda
Softworks, 2008).
Fallout: New Vegas. As the name suggests, this installment in the series takes
place in the Mojave desert around Las Vegas, four years after the events of Fallout 3. The

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player takes the role of the Courier, a character with an unknown and ambiguous past that
is ambushed and left for dead due to an item the character is carrying at the beginning of
the game. The core story of the game starts as a revenge story, but then focuses on a war
for control of Hoover dam due to it being the largest producer of power in the entire
region. There are four possible factions fighting for control of the dam: The New
California Republic, a group known as Caesar's Legion, Mr. House’s faction and a
possible independent faction with the Courier as the leader. Through player choice, the
Courier can side with any of these factions and change the end of the game (Bethesda
Softworks, 2010).
Fallout 4. Taking place ten years after the events of Fallout 3, in the
Commonwealth, a place in and around Boston, the player takes on the role of the Lone
Survivor. The Lone Survivor is, as the name states, the only survivor of Vault 111, an
experimental cryogenics facility. The player character was alive at the time the bombs
fell in 2077, but has been cryogenically frozen until 2287 (Bethesda Softworks, 2014).
The game features an open world and a core storyline originally focused on
finding the character’s son and getting revenge for the murder of the player character’s
spouse, but the story continues beyond this and becomes a war for control of the
Commonwealth between four factions: The Brotherhood of Steel, the Railroad, the
Institute and the Minutemen. Each faction stands for a different cause with their own
beliefs and visions for the future of the commonwealth.
Depression Quest. Depression Quest is a first-person text-based game focused on
player choice. The player must make decisions to improve their condition throughout the

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game and is intended to help people better understand depression (The Quinnspiracy,
2013).
Hellblade. An upcoming game, Hellblade is going to be a fantasy action game
about Senua, a girl whose tribe is murdered by marauding vikings. Many details about the
game are currently unknown because it is still in development, but the team developing
the game has released some details about the main character and that she is suffering
from schizoaffective disorder (Ninja Theory, 2017).
The Literature
“Implicit Bias toward People with Mental Illness: A Systematic Literature
Review.” Jayci Robb and Jeff Stone’s analysis of 19 different studies about the implicit
and explicit attitudes towards people with mental illnesses focuses on answering the
question, “Have there been significant studies focusing on implicit attitudes towards
mental illness, and are there effective strategies to combat these attitudes?” What they
found is that there needs to be greater research on this particular area, and that they have
found no effective strategies in their search to combat this area of concern, as the current
methods, personal contact and interventions, have been found to be insignificant in
battling the implicit biases against people with mental illness (Robb & Stone, 2016).
“The Benefits of Playing Video Games.” Among the arguments that video
games promote violence and social isolation are some articles such as this that argue the
benefit that video games can provide. Among these are numerous cognitive, motivational
and social benefits that include interaction with new people and friends, effectively
elevating one’s emotional state through the use of puzzle games, and greater problemsolving skills compared to many non-gamers. The authors of this article recognize the

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potential harm that games can also do to a person’s self-esteem and levels of aggression,
but insist that, like many other leisure activities in everyday life, video games have the
potential for good as well as bad (Granic, Lobel & Engels, 2014).
“Internalized Stigma of Mental Illness: Changes and Associations with
Treatment Outcomes.” As the name suggests, this article discusses internalized stigma
by people that suffer from mental illness. The article brings up a concerning point for
treatment of people with mental illness: that internal stigma (their personal negative
stereotypes associated with their mental illness) reduces the effectiveness of treatment
and may even lead the person to avoid treatment altogether. The goal of this study was to
analyze the effectiveness of short-term treatment plans in battling this internal stigma,
and the authors found that these short-term plans showed a significant reduction in one’s
internal stigma about mental illness, and that this reduction was associated with the
person being more responsive to the treatment altogether (Pearl, Forgeard, Rifkin, Beard
& Björgvinsson, 2017).
“Perceived Primal Threat of Mental Illness and Recovery: The Mediating
Role of Self-Stigma and Self-Empowerment.” This article pursued a connection
between primal threat (the threat to one’s survival needs and feelings of belonging) and
recovery from mental illness. Previous literature states that as the threat increases,
recovery decreases and vice versa. The findings by this study were consistent with this
view, and it was also found that participants’ degree of primal threat was also positively
correlated with sense of self-stigma and their negative associations with their mental
illness. The authors also noted that stressful stimuli could also activate primal threat in

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regular individuals and decrease one’s opinion of their subjective health (Zhang, Mak &
Chan, 2017).
“Addressing Public Stigma and Disparities Among Persons with Mental
Illness: The Role of Federal Policy.” As the title suggests, this article discusses the role
of federal policy in the perpetuation of public stigma towards mental illness, as well as
how federal policy has attempted to correct this issue. It mentions that while protections
are in place for members of this group, these protections are not uniform and do not
protect certain subgroups. It also discusses the effectiveness of federal policy in
regulating personal stigma towards mental illness, which is minimal. It concludes that the
current system is inadequate in providing protection for the population of those suffering
from mental illness, and that a comprehensive system of education, contact and federal
regulations aimed at reducing stigma will be much more effective in reducing people’s
personal stigma towards mental illness (Cummings, Lucas & Druss, 2013).
“Primary Care, Behavioral Health, and Public Health: Partners in Reducing
Mental Health Stigma.” This article discusses reforms that could help with the
reduction of mental health stigma as well as identifying possible concerns earlier than the
current system allows by integrating mental and behavioral health into primary care. This
integrated approach could help in reducing stigma for seeking aid as well as possibly
screen for major mental or behavioral health concerns in patients to a primary care
provider. However, the article also informs that the process is expensive and time
consuming, and that the current model of primary care cannot support this integration
(Shim & Rust, 2013).

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“Resolving Mental Illness Stigma: Should We Seek Normalcy or Solidarity?”
Patrick Corrigan’s article discusses two strategies for combating the stigma surrounding
mental illness: normalcy, the strategy of downplaying the difference between individuals
suffering from mental illness, and solidarity, the strategy of celebrating the differences
and standing by those people that are different regardless of that difference so as to help
them and provide them with the support and understanding necessary to aid them. The
second strategy is similar to the common stance for homosexuality in the western world
and has proven to be highly effective in this case (Corrigan, 2016).
“Erasing the Stigma: Where Science Meets Advocacy.” Corrigan and Kosyluk
identify multiple vehicles and processes necessary for confronting public stigma towards
mental illness, as well as the risks and benefits of using each one. The authors’ goal was
to inform the reader that not all strategies for reducing public stigma are effective at all
times, and some may even harm the intended outcome (Corrigan & Kosyluk, 2013).
“When Women ‘Snap’: The Use of Mental Illness to Contextualize Women’s
Acts of Violence in Contemporary Popular Media.” This article discusses the use of
mental illness by different media as a means of explaining behavior. It does this by using
examples from film and news media and criticizes the media in perpetuating stigma
towards mental illness in its coverage of this particular subject (Quintero Johnson &
Miller, 2016).
Diagnostic and Statistical Manual of Mental Disorders Fifth Edition: DSM-5.
The DSM-5, published by the American Psychiatric Association, contains details for all
of the current accepted mental health disorders recognized by that association through an
extensive research and vetting process. It includes symptoms, necessary conditions,

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background and statistics about each of these disorders and will be used extensively
throughout this thesis when discussing characters and conditions from the games
(American Psychiatric Association, 2013).
Mental Health Stigma in the United States
As mentioned in various sources included in this thesis, there is a general public
stigma concerning mental health in the United States and elsewhere (Cummings, Lucas &
Druss, 2013). The public stigma towards mental health includes common beliefs that
those suffering from mental disorders are dangerous and should be avoided, and that
people with mental disorders are uncontrollable and violent. Of course, the stigma
changes slightly depending on the disorder, but the general public opinion is that people
suffering from many of the mental disorders to be discussed are dangerous individuals
with little to no self-control (Cummings, Lucas & Druss, 2013). The stigma is so
widespread in the United States that legislation has been necessary to reduce the
discrimination related to it. Cummings, Lucas & Druss (2013) discuss three pieces of
legislation passed recently that attempted to reduce this stigma: The Mental Health Parity
and Addiction Equity Act of 2008, the Patient Protection and Affordable Care Act of
2010, and Individuals with Disabilities in Education Act. All three pieces of legislation
were aimed at reducing discrimination associated with mental health stigma, but as the
authors point out, these protections are not uniform, and these laws simply do not change
people’s attitudes concerning mental illness.
These laws are made even more ineffective when local and state legislation
appears to run counter to federal legislation by imposing restrictions on people with
mental illness. Wolf and Rosen (2015) discuss state and local legal responses to many of

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these violent tragedies in their article. Legislation after events like the Newtown school
shooting specifically target people diagnosed with a mental disorder and prevent them
from purchasing certain firearms when most violent crimes are not perpetrated by this
population of individuals. The authors write, “The truth is that individuals falling into the
category of ‘mentally ill’ only account for a small fraction of all violent conduct. Simply
having a mental illness is not a strong predictor of future violence” (Wolf and Rosen,
2015, p. 853). The authors also say that, “people assume those with mental illnesses are
more prone to violence than those without these issues” (Wolf and Rosen, 2015, p. 853).
Yet with the news coverage these events get mixed with where news outlets place the
blame, the stigma persists through attempts to help eliminate or lessen its effects.
Even when this stigma is not openly presented, studies show that implicit bias
remains. Robb and Stone (2016) found that while a great amount of research has been
conducted on eliminating explicit (externalized) bias against mental illness, less has been
conducted on implicit bias. The authors also say that current methods “do not
significantly improve implicit attitudes” (Robb & Stone, 2016, p. 10), meaning the
current methods used by researchers and professionals to reduce overall stigma towards
mental health and mental illness are ineffective at improving internal attitudes and beliefs
in this subject.
Effects of Mental Health Stigma
This stigma does harms on many fronts. First, it affects the attitude of the general
public towards those that suffer from mental illness. People become avoidant of people
with mental health problems, treat them differently ranging from being openly hostile to
pitying and tend to fear them. With public stigma also comes internalizing stigma for

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people with mental illnesses. When a person with a mental disorder agrees with and
accepts the public stigma towards mental illness, they internalize these attitudes and feel
similarly about themselves. Zhang, Mak and Chan (2017) write that self-stigma/
internalized stigma damages the recovery process of someone with a mental illness, and
may cause primal threat, which is a perceived threat to one’s well-being and belonging in
the world. The authors say that the recovery process is made extremely difficult or
impossible with the presence of self-stigma, as the people take on an attitude of
helplessness and may even make the situation worse. Shim and Rust (2013) write that
public stigma surrounding mental illness also prevents those suffering from behavioral
health problems and substance abuse from seeking help for fear of being stigmatized and
treated differently by peers and colleagues. Clearly, the perpetuation of this negative
stigma towards mental illness has far-reaching negative effects that can make a bad
situation much worse.
How Video Games Perpetuate Mental Health Stigma
With these effects in mind, it becomes clear that many video games perpetuate
this stigma. This is done in multiple ways. As discussed in this thesis, there are a number
of examples in video games where mental illness is used as a way to explain a villain’s
actions. There are also games that use mental illness as “set dressing,” in which the
setting and most of the people involved are affected in some way. Other games use
mental illness as a way for the player and characters to feel bad for those that appear to be
suffering under their conditions, yet this is still a perpetuation of a different kind of
stigma that results in pity rather than empathy for the individual. Very few games

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recognize the stigma being perpetuated in some way and attempt to do something to
combat it.
Analysis of Mental Health Stigma in Video Games
All but two of the games selected for this analysis are or were commercially
successful and are widely popular in at least the United States, as this is an analysis
concerning the stigma in the United States and not elsewhere. Characters will be analyzed
according to the DSM-5 criteria and then discussed in terms of the stigma of mental
health. It is important to note that for most characters present in the following games, the
player is given only a brief snapshot of that character’s life. Many diagnoses would
require a great deal more information than what is present in the games. However, this
does not make the analysis and discussion of stigma any less important: Game developers
design these characters in such a way as to get the response from the player that “The
villain from X game is just crazy,” which leads to the perpetuation of mental health
stigma. Organization of this section will be based upon the disorders reflected in the
games rather than game-by-game.
Schizophrenia Spectrum Disorders
Schizophrenia spectrum and other psychotic disorders are characterized by
abnormalities in one or more of five domains: “delusions, hallucinations, disorganized
thinking (speech), grossly disorganized or abnormal motor behavior (including catatonia)
and negative symptoms” (American Psychiatric Association, 2013, p. 87). Schizophrenia
and associated disorders are complex and heavily researched disorders that are commonly
utilized in video games for villains or alienated persons in society.

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Fallout 3. Psychotic symptoms associated with Schizophrenia and its related
disorders are ever-present in the post-apocalyptic game series. This can be related to the
fact that almost all individuals in the games have suffered from constant radiation
exposure throughout their lives, but the actions undertaken by some of these individuals
still perpetuate the stigma that people suffering from this spectrum of disorders are
dangerous and need to be avoided. This is particularly evident in Fallout 3. The player
character can encounter an individual that speaks with lines that make no sense:
“Hungry… hungry… so hungry. What? No. I’m not hungry. The worm is hungry.
Hungry for me, for you, and for fire” (Bethesda Softworks, 2008). He goes on to say,
“Trees! So many trees! To the north! But be careful… the trees… are deadly, and the
trees too will be consumed in the belly of the great fat worm!” (Bethesda Softworks,
2008) as well as “The sun will rise in the north! No! The northwest! For forty-four days
and sixty-seven nights!” (Bethesda Softworks, 2008). His speech is clearly disorganized,
and he may also be hallucinating.
Because of how brief the encounter is, the closest DSM-5 disorder to his actions is
brief psychotic disorder, but this is the furthest the analysis can go concerning the mental
health of the individual, as the player character is not able to find out if the person has
been taking any substances to cause this psychotic episode. If the player character
approaches him, he will kill himself and the player character with explosives, indicating
that people with these symptoms are violent and unpredictable, when in reality these
individuals are only more likely to commit suicide than harm others (American
Psychiatric Association, 2013).

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Dragon Age II. In Dragon Age II, the player character and his/her party are sent
to find and capture a criminal by the name of Kelder, who preys on elven girls and kills
them. When you finally meet Kelder, he says, “She [The elf girl] had no right to be so
perfect, so beautiful. The demons said that she had to be taught a lesson” (Bioware,
2011). Demons are a very real threat to the mind in the series, which would eliminate any
questions of a schizophrenia spectrum disorder. But if a mage is in the party, it will be
revealed that there are no demons plaguing Kelder. Once again, a man suffering from
hallucinations is presented as violent and unpredictable, and the player character is given
the option of killing Kelder or handing him over to authorities. If he is handed over to the
authorities, it is later revealed that he “was mad” (Bioware, 2011).
The Evil Within. Perhaps the game in this analysis that perpetuates mental illness
stigma the most, The Evil Within uses symptoms of schizophrenia spectrum disorders to
make the entire game. This is a common theme for horror games. The player character
and many others in the game suffer from auditory and visual hallucinations throughout
the course of the entire game, leading one character to take violent action against a close
friend. Leslie, a character that comes from an asylum for the mentally ill, speaks
incoherently for much of the game and has frequent episodes of disorganized behavior.
Due to his long-term stay at a mental hospital, it can be assumed that these features are
longstanding for Leslie (Bethesda Softworks, 2014). Leslie is an enigma to the main
character and the player of the game for much of the story, and he is set apart from other
characters as odd or disturbing.
The perpetuation of stigma towards schizophrenia is a particularly major issue. As
a category of mental disorders with clearly visible symptoms, these individuals are easily

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noticed and public stigma is a major concern. People with this category of mental
disorder often become socially withdrawn and suffer from feelings of helplessness and
depression (American Psychiatric Association, 2013).
Paranoid Personality Disorder
In short terms, paranoid personality disorder is “a pattern of distrust and
suspiciousness such that others’ motives are interpreted as malevolent” (American
Psychiatric Association, 2013, p. 645). Oftentimes, characters that display paranoid
personality disorder in video games are alienated or presented as odd or quirky to the
player.
Grand Theft Auto V. Multiple characters display this. Lester, an acquaintance of
the main characters of the game, is excessively secretive and constantly suspicious of
others. He shuts himself in his home and rarely leaves, and believes that others only
intend him harm. People with paranoid personality disorder also tend to hold extreme
grudges for insults and slights (American Psychiatric Association, 2013), and some of the
missions the player can do for Lester include killing people who appear to have done this
to him in some way. In many ways, Trevor displays this as well. He believes that the
government is always out to get him and others, and trusts very few people (Rockstar
Games, 2013).
The Elder Scrolls IV: Oblivion. In the Shivering Isles, the duchess of Dementia,
Syl, displays long-term paranoia and suspects that everyone around her wants to kill her
and take her throne. She orders the player character on a chase to uncover a loose plot
and kill those involved (Bethesda Softworks, 2006). Of course, while Syl is always this

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paranoid, it is worth noting that there was indeed a plot to kill her and that, in this one
case, her paranoia was accurate.
Dragon Age II. Anders, a member of the main character’s party, also displays this
with a much greater timeline. The in-game codex entry about Anders can say, “The past
three years has seen Anders cross the edge from moodiness to open paranoia” (Bioware,
2011). Anders, a mage devoted to freeing mages from Templars, becomes extremely
paranoid that people may be trying to kill him or inform on him to the Templars.
These examples stigmatize people suffering from paranoid personality disorder as
crazy shut-ins that will kill anyone they think would bring them harm or slight them in
some way. Not only do these examples harm public opinion of individuals with this
disorder; it can also reinforce the beliefs a person with this disorder may have about
others.
Antisocial Personality Disorder
According to the DSM-5, a person with antisocial personality disorder must
display a “pervasive pattern of disregard for and violation of the rights of others,
occurring since age 15 years” (American Psychiatric Association, 2013, p. 659). They
must be at least 18 years old, have evidence of conduct disorder in their childhood, and
the behavior must not occur exclusively during the course of schizophrenia or bipolar
disorder. The person in question must also display at least three of the following traits:
“failure to conform to social norms in respect to lawful behaviors… deceitfulness…
impulsivity… irritability and aggressiveness… reckless disregard for safety of self or
others… consistent irresponsibility… [or] lack of remorse, as indicated by being
indifferent to or rationalizing having hurt, mistreated, or stolen from another” (American

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Psychiatric Association, 2013, p. 659). Often, when someone thinks of what a psychopath
or sociopath is like, this is the disorder closest to those thoughts.
FarCry 3. Vaas Montenegro is a textbook example of antisocial personality
disorder. He has no regard for human life and kills the main character’s brother in front
of him. He is impulsive, easily irritated and is a pirate that traffics drugs and people
(Ubisoft, 2012).
Resident Evil franchise. Multiple villains in the entire franchise display this.
Alfred Ashford, from Resident Evil: Code: Veronica cares little for ethics, experiments
on members of his own family with deadly viruses, and houses prisoners for the sole
purpose of torturing them (Capcom, 2000). Albert Wesker, the main villain of the series,
displays this particularly well in Resident Evil 5 when he rationalizes infecting the entire
world with a virus that will transform individuals into better beings while also killing any
who are too weak (Capcom, 2009). Lucas Baker, in Resident Evil 7, enjoys setting up
traps for people to kill them, is easily irritated, feels no remorse for his actions, and
constantly lies to the player character. Through notes found throughout the game, it
becomes evident that he has been doing this to people since he was a child (Capcom,
2017).
League of Legends. There are multiple examples in one of the most popular
multiplayer games in the world. Jhin is a champion whose backstory informs the reader
that he rationalizes his killing as an artwork. He hates when things are not perfect in his
own way, and becomes easily irritated and aggressive when he is interrupted during his
“work.” Jinx is a criminal with no regard for authority or the safety of herself or others.

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She is impulsive and violent, with her most notable line being, “Rules were made to be
broken. Like buildings. Or people” (Riot Games, 2009).
Rimworld. Players may find their colonies of pawns with many different traits
that define the personalities of the colonists. One such trait is called “psychopath.” The
trait description says that the individual feels nothing when prisoners are killed or sold
into slavery, and their mood is unaffected by witnessing the deaths of others. They also
get no mood change when speaking to other people. “Normal” pawns are all affected by
these events, but pawns with the psychopath trait are not (Ludeon Studios, 2012).
The Evil Within. Ruvik, the villain of the game, has no regard for authority or the
lives of others. As a researcher at a mental hospital, he unethically experiments on
patients like Leslie, with his rationale as, “These vermin? These microbes? They’re mine
to do with as I please” (Bethesda Softworks, 2014). It is also revealed that Ruvik murders
his father, and he is described by another character as “a serial killer masquerading
around as a scientist” (Bethesda Softworks, 2014).
Fallout franchise. The Fallout series is full of examples of multiple disorders. In
terms of antisocial personality disorder, there are examples from multiple games. In
Fallout 2, Frank Horrigan appears to have this. Although a mutated human exposed to
radiation like everyone else, Horrigan believes himself superior and rationalizes his
killing of others as their being inferior and mutated. He is impulsive, angers easily, and
cares little for the lives of others or even himself in combat (Interplay Entertainment,
1998). In Fallout: New Vegas, the faction known as the Fiends embody this as a theme.
Their leader rationalizes that if they can take it from someone else, then it is theirs by
right. Their leader, and the faction as a whole, has no regard for the authority of the only

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organized government in the area, the New California Republic, and all are impulsive and
irresponsible, including intense drug and alcohol abuse (Bethesda Softworks, 2010). In
Fallout 4, the player character can meet Pickman, a man who kills raiders without
remorse. Like Jhin from League of Legends, Pickman creates art from his victims. He has
a disregard for his own safety in his mission. His actions are usually forgiven by the
player character, as Pickman only targets raiders, which prey on others (Bethesda
Softworks, 2015).
Grand Theft Auto V. Trevor appears to have elements of antisocial personality
disorder. Trevor clearly has no regard for the well-being of others. He is extremely
impulsive, very irritable and aggressive, and cares little for social norms. The player can
change to his perspective during gameplay and sometimes find him killing police officers
in a gunfight or drunk and naked in the middle of the desert (Rockstar Games, 2013).
Antisocial personality disorder, or just villainous? Antisocial personality
disorder traits are commonly used in video games as a means of defining a villainous
character. People may argue that this is coincidence: Many of the traits associated with
antisocial personality disorder are also traits people associate with villains: lack of
remorse, aggressiveness, reckless disregard for safety of others and a disrespect for
authority are all things “bad” people might do. The concern for stigma here is not
necessarily in the alike traits of the villains and the disorder, but in the delivery of the
character. Oftentimes, these characters are presented as being like this without much
background or justification. They are simply this way because that is who they are. If
someone were to ask a player of Grand Theft Auto V why Trevor acted the way he did,
they might just say “that’s because he’s crazy.” This is what perpetuates the stigma in

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question. The label of “crazy” or “insane” is applied to many disorders, and thus the
stigma that people suffering from mental illness are dangerous and unpredictable is
perpetuated further. In the uninformed mind, there may not be a distinction between
Trevor’s “crazy” and Leslie’s “crazy” even though one is violent and the other is not. So,
while some of these traits may overlap with what society considers to be villainous, the
delivery of the characters by the designers results in furthering this stigma.
Bipolar I Disorder
In shortened terms, all that is needed for bipolar I disorder is one manic episode in
which one’s mood is extremely, abnormally and persistently elevated for at least one
week, with symptoms of grandiosity, decreased need for sleep, racing thoughts, extreme
talkativeness, distractibility or excessive involvement in risk-taking activities are noted
with the severity causing impairment in daily life (American Psychiatric Association,
2013). Characters that show these symptoms are usually portrayed as irrational,
aggressive risk takers.
Grand Theft Auto V. As Michael speaks with his psychiatrist, he reveals that he
may sometimes fit in this category: “One moment I’m calm, the next I’m crazy”
(Rockstar Games, 2013). Trevor may also suffer from manic episodes during his
rampages, as he becomes extremely talkative, feels (and is) nearly invincible, and
engages in violent risk-taking behaviors.
Elder Scrolls IV: Oblivion. Sheogorath is the embodiment of this disorder. He is
the Prince of Madness, and his speech indicates that his thoughts change quickly when he
says “Now get going. Before I change my mind. Or my mind changes me” (Bethesda
Softworks, 2006). In Sheogorath’s realm, one of the provinces is known as Mania, and

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the people here are meant to embody this idea of risk-taking and irrationality (Bethesda
Softworks, 2006).
The Sims 3.Within the Sims 3 is a trait called “insane.” This trait makes Sims act
in irrational ways, wear and do bizarre things like rummaging through trash or acting like
an animal, and act as a nuisance or joke to other Sims. While clearly intended as a joke
and bit of fun to make the player’s Sims act oddly, it is an insult to people who must cope
with their mental illness (Electronic Arts, 2009).
Once again, video games stigmatize traits of a mental disorder and harm the
image of those actually dealing with these illnesses. These games paint people with these
traits as violent, impulsive and disorganized. Yet the reality is that individuals with
Bipolar I tend to commit self-harm instead, and may account for up to “one-quarter of all
completed suicides” (American Psychiatric Association, 2013, p. 131).
Are Video Games a Nuisance to Society that Perpetuate Negative Stereotypes?
Absolutely not. While a number of video games perpetuate stigma associated with
mental illness and drug abuse, there are benefits to playing video games. Even violent
games like Grand Theft Auto V (2013) have shown benefits for those that play them,
including benefits to attention allocation, visual processing and mental rotation abilities
(Granic, Lobel & Engels, 2013). Data shows that these skill improvements may even be
comparable to formal courses aimed at improving the same or similar skills (as cited in
Granic, Lobel & Engels 2013). In the same article, the authors provide evidence that
video games benefit players by improving social interaction (in multiplayer games such
as World of Warcraft), motivation through engagement with games, and reduction in
anxiety and stress through games with short-term investments like Bejeweled (Granic,

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Lobel & Engels). Regardless of the intentional or unintentional perpetuation of stigma
and negative stereotypes surrounding mental illness, video games are beneficial. The
concern is therefore not “what should we do about games?” but “what should games do
about mental health stigma?” Rather than perpetuate these ideas, video games can take
alternative paths.
Recommendations for Eliminating Stigma in Video Games
Below are my recommendations for helping prevent the perpetuation of mental
health stigma in video games. There has been a great deal of research on mental health
stigma and how to help eliminate public stigma through multiple techniques proposed by
Patrick Corrigan and others. Corrigan and Kosyluk (2013) outline the different ways
people can confront mental illness stigma and attempt to change public opinion on the
subject, and it will be the basis for my recommendations for eliminating mental illness
stigma.
Eliminating and Combating Stigma in Video Games
A great deal of the stigma from the video games mentioned throughout this
analysis is present because of shallow character design. Many of the characters
mentioned are not given backstories, or the rationale in the backstory only confirms the
already-existing idea that the character in question is somehow insane. If a designer can
get the idea to the player that a character is crazy, violent and needs to be stopped, then
further explanation for the character’s actions is unnecessary. Then, the player can simply
get to the “good” parts of games, like fighting and exploring rather than thinking about
why a villain may want to destroy the world. A simple fix to this in future games would
be to provide a greater focus on character development. An example is Hellblade:

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Senua’s Sacrifice. Senua suffers from schizoaffective disorder after losing her family and
friends to a viking raid. Like schizophrenia, schizoaffective disorder includes delusions
or hallucinations as well as a manic or major depressive episode (American Psychiatric
Association, 2013). The team provides basis for the disorder in the character’s backstory,
but stigma may still be a concern due to the violent nature of the game (Ninja Theory,
2017). However, this is still a step forward that the game industry could use to set a
precedent for handling characters with mental illness: greater character development and
rationale for character actions may lead less to blaming some nameless insanity for the
character’s inherent fault, and instead lead to the identification of the context surrounding
the character’s actions.
Alternatively, game designers can change how characters with mental illness are
presented in their games. Corrigan (2016) outlines two ways in which this can be done in
society, and I have applied it to video games here. Two ways to approach eliminating
mental illness stigma are through normalcy and solidarity. In the normalcy view,
differences are reframed to be less striking and facts are used to counter myths. Corrigan
writes that the strategy works well in the beyondblue campaign in Australia, and that it
allows the people there to better recognize the illnesses and understand the benefits of
treatment (2016). This is actually utilized in one game I was able to find: Depression
Quest. This text-based game allows players to identify actions that will benefit a person
suffering from depression and also help them recognize the illness in a person. It educates
the player while also helping increase understanding and reduce stigma surrounding the
illness (The Quinnspiracy, 2013).

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Corrigan (2016) also discusses another approach: solidarity. In this approach, the
difference is celebrated in a word. Promoting solidarity means standing by these
individuals regardless of their mental illness and supporting them through hard times.
Similar to supporting someone for “coming out” as a member of the LGBTQ community,
it is understanding them and being there for them even though they are different. Identity
with peers and social groups allows persons with mental disorders to experience less
harm to self-esteem and recovery by internalized stigma (Corrigan, 2016). Video game
developers can utilize this technique in a number of ways by designing a character with a
mental illness and providing the player character the ability to support and aid that person
in some way and allow the player to see that person improve in terms of their self-esteem
and personal abilities. A representative example of this method can, again, be found in
Depression Quest. The player character must make choices throughout the game to
improve the life of a person suffering from depression, which provides an interactive
platform in which that player sees a distinct improvement in the character’s mental
wellbeing (The Quinnspiracy, 2013).
In another study, Corrigan and Kosyluk (2013) contrast various strategies
commonly used in erasing public mental illness stigma. The three processes are protest,
education and contact, with two vehicles of transmitting these processes: media and in
person. The original research with these vehicles and processes was originally conducted
to reduce intergroup prejudice with in-person contact being the most effective strategy for
effectively reducing prejudice and, later, mental illness stigma. The process of contact
can also be utilized in gaming. Corrigan and Kosyluk (2013) say that in-person contact
has the most impact, and this is not possible with video games as the medium. Yet video

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games have the potential to be effective in erasing stigma through the interactiveness of
the game itself. To return to a different article, “Game designers are wizards of
engagement” (Granic, Lobel & Engels, 2013, p. 70). Because of the engaging and
interactive nature of video games, the games themselves have the potential to be an
effective medium at contact with mental illness to dispel myth and reduce public stigma.
Conclusion
Video games have the capacity to perpetuate mental health stigma or confirm preexisting negative stereotypes about persons with mental disorders. As evidenced in my
analysis, many popular video games utilize mental illness as a tool for defining villains or
alienating characters throughout the game. This leads to a perpetuation of an already
serious public stigma that harms the image of people with mental disorders and may even
prevent them from trying to seek help for their disorder, or harm their ability to cope or
recover from a mental illness.
Yet video games also have the capacity to turn this around. With a change in
game design, games can help reframe public opinion concerning mental illness and help
people realize that the difference between a person with a mental disorder and someone
without is less striking than one might think. With a change in character design, a villain
may not be defined by how crazy or insane they seem, and may even help people dig
deeper when it comes to what motivates a person’s actions. Video games even have the
potential to help reduce public stigma by educating those that play the games on these
disorders without villainizing them, and also provided a virtual and interactive contact
zone in which players can better come to an understanding and empathize with persons
suffering from mental illnesses. As the video game industry currently stands, it is

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perpetuating a negative view of people with mental illnesses and only adding fuel to the
fire that is mental health public stigma. However, this stance, intentional or unintentional,
can be changed. Some progress is evident, and further progress can happen in the near
future towards a gaming industry that not only eliminates mental health stigma from the
games, but can be used as a method to educate and reduce mental health stigma in the
United States and elsewhere.

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