JMIR Publications

ABSTRACT

Background:

Video game playing is a daily activity for many youths that replaces other media forms (e.g., TV watching) and serves as an important source of knowledge, with the potential to impact their attitudes and behaviors. Researchers are concerned about the impact of video gaming on youth (e.g., for promoting prosocial or antisocial behaviour). Studies have also begun to explore players’ experience of gameplay and video game messages about violence, sexism, and racism; however, little is known about the impact of commercial video games in the sharing/shaping of knowledge and/or messages about mental illness.

Objective:

This study aims to review and examine messages about, and representations of mental illness, especially psychosis, and its context of care in commercial video games.

Methods:

On Steam (a popular PC gaming platform), we performed keyword searches on games made available between January 2016 to June 2017. A total of 789 games were identified and reviewed to assess whether their game content was related to mental illness. At the end of the screening phase, a total of 100 games were retained.

Results:

We used a game elements framework (characters, game environment/atmosphere, goals, etc.) to describe and then unpack messages about mental health and illness in video games. The majority of the games we reviewed (97%) portray mental illness in negative, partial, misleading, and problematic ways (e.g., associating it with violence, scary, insanity, hopelessness, etc.). Furthermore, some games portrayed mental illness as manifestations or consequences of supernatural phenomena or paranormal experiences. As mental illness was often associated with mystery, unpredictable, and as an obscure illness; its treatment was also associated with uncertainties, as game characters with mental illness had to undergo “experiment treatment” to get better. Unfortunately, little or no hope for recovery was present in the identified video games, where mental illness was often presented as ongoing straggle as well as endless battle with their mind and themselves.

Conclusions:

The game elements of a large number of commercial video games included mental illness, about which many perpetuated well-known stereotypes and prejudices. We discuss the key findings further in relation current evidence on the impact of media portrayals of mental illness and stigma; the ability of serious video games, to promote alternative messages around mental illness and clinical practices. Future research is needed to investigate the impact that such messages have on players and to explore the role that video games can play in fostering alternative messages to reduce stigma associated with mental illness.