In 2019, ‘gaming addiction’ was officially recognised as a disease by the World Health Organisation (WHO). This followed the WHO’s landmark vote in 2018 for the inclusion of ‘gaming disorder’ as an official condition.

How does the WHO define a ‘gaming disorder’? The key criteria is that the behavioural pattern “must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning”. Such an impairment would be visibly portrayed, at the minumum, over a 12-month period.

Of course, there are detractors to WHO’s move. They also question the validity of its definition.

However, the reality is that an increasingly larger number of gamers, professional or otherwise, are seeking treatment for mental health issues. In Singapore alone, a counsellor from the Institute of Mental Health’s National Addictions Management Service (NAMS) shared that more than a 100 people sought treatment for gaming problems over a 5 year period (between 2012 – 2017). The majority of these were of secondary school age (between 13 and 16 years old). This data was corroborated by the findings from Touch Youth Intervention.

More disconcertingly, the youngest patient was merely 10 years old.

The problem is evident. The nuances of gaming disorders need to be understood if effective solutions were to be implemented.

The editorial consists of two parts. In the second part, the editorial analyses the impact that gaming has in cultivating these disorders and the possible mitigating solutions. In this current part the writer will focus on the nature of the industry, the depiction of mental health disorders in games, and how they are perceived, as well as the implications on a gamer’s mental health.

Despite the increased spotlight, mental illness is a constant trope in gaming.

Insanity, PTSD, depression and narcissism are the most commonly played cards in the media but they’re far from the only ones. Mental illness, in games, are almost always treated with the finesse of a blunt object.

Almost always, it’s ignored or dismissed as a quirk – the mad scientist is insane because he just is. His feelings of rage and being beaten down by society? Just his own doing for being a bad person.

So what if he’s driven insane? All the more reason for him to be locked up like the villain that he is. Why care about the reasons he got to be that way?

Arguably, the industry is one that lends itself to mental illness.

Jobs are volatile, toxic communities can make developers’ (or social media managers) live a living hell and crunch time (where teams are forced to work unholy hours a week to meet release dates) all contribute to the deterioration of mental well-being.

Perhaps this is a reason why mental health is so unaddressed in gaming. The industry has become so desensitised to it that it’s become a fact of life for a portion of the gaming community.

The issue isn’t the representation of the varied illnesses one can suffer. Rather, the issue is that they’re almost always portrayed as something of a character trait.

There are different famous (and infamous) game characters who suffer from some sort of mental illness.

This includes the likes of Siegfried Schtauffen (SoulCalibur series), Balrog/Vega (Street Fighter), Harry Mason (Silent Hill), Goro Majima (Yakuza), and even the badass Solid Snake (Metal Gear Solid). There are many, many more characters like them.

Mental issues also come in many forms though depression (usually from grief or regret) and PTSD are the ones most commonly shown in games.

Yet, there’s an underlying common theme with them all – none of those afflicted seek help because games (like movies) think that mental illness is quirky or charming and gives a character depth.

Developers need to realise that gamers idolise game characters and see themselves in them when they realise they suffer from the same thing. Idol worship isn’t just relegated to rock or movie stars. That’s why cosplay is so popular; you get to be the character, not just playing as the character.

That’s why, when a character is created with mental illness, it’s not only important to address it, but to also show that getting treatment for it is not perceived as being less manly, or even stupid.

Take for example, Solid Snake.

While it’s not explicitly stated, it’s strongly hinted that Snake suffers from PTSD. How many times has the fate of the world fallen upon him? Even one time can be a heavy burden to shoulder.

So how does Snake go about treating his condition? He doesn’t.

He’s definitely aware of it (he’s a veteran) but takes no medication or goes to therapy. He just lives with it like it’s a natural thing to do, until the next crisis comes along.

It might seem macho, even noble, in fiction…especially if you subscribe to patriacrchal ideals. Don’t bother anybody else with your issues, suck it up and quit being a baby about it. It plays into the strong, quiet but determined manly man stereotype. The ideal man, in the eyes of society.

In reality, it merely encourages people suffering from identical issues to do the same thing. After all, if Snake can take it, I can take it too. Doing less would be unthinkable. Sometimes, human agency to do the right thing, is over-rated.

There are slivers of hope that hint that some in the industry are aware of the need for games to do more to highlight mental issues.

Hellblade offers great insight into the minds of those suffering from mental maladies.

It shows how sickness isn’t always physical (though mental ones can manifest physically too) and how those suffering might not even know how to cope with what they’re going through

The game doesn’t couch its message behind anything; it’s in your face and relentless in trying to make you understand how it feels like to suffer with a mental illness.

Likewise, Persona 5 deserves some praise too. While the game doesn’t revolve around mental issues like Hellblade, there’s one particular segment that should stand out to anybody who’s ever played the game.

It concerns Futaba Sakura.

In the game, she was wrongly blamed by most of her relatives for the death of her mother (courtesy of a forged suicide note). That trauma changes Futaba so much that she becomes a recluse, choosing to forgo any sort of social interaction other than through her adopted father.

Obviously, Futaba’s PTSD (thinking about her mother’s death makes her panic) and depression are a major issue in her story arc and they’re only resolved when the Phantom Thieves (the Persona 5 protagonists) show their support and help her work through her issues.

While life isn’t as clear-cut as that, the message Persona 5 delivers is still noteworthy in itself – with support and help, anything can be overcome. You don’t have to go through everything solo.

Other games should at least acknowledge this in some way.

This effort should not get in the way of a good narrative. Such messages can be emplaced in the game’s credits or options as a way for people to find the help they need. It’s easy to say Google is just a step away, but for some people, taking that first step, admitting that they have a problem is the hardest thing they’ll probably ever do in life.

Games usually have epilepsy warnings and other health advisories. Why not include the same for mental health too? With today’s integrated consoles and PCs, it shouldn’t be an issue to have built-in browser links that’ll take you to places to get the help you need.

So, why hasn’t it been done?

Until the social stigma of mental illness has been thoroughly erased, this blatant feigned ignorance will continue. If you see no evil, there can be no evil, right?

After all, it’s much easier to repress and pretend nothing is wrong (until things reach a boiling point) than reaching out for help, especially if you’re alone.

So what’s the point of this editorial?

To say to gamers out there that it is NOT a shame to ask for help if you’re suffering from mental illness. Even if you think you might, it’s still ok to look for help. There are no judgments, most people won’t think any less of you. Those that do, you don’t need their toxicity in your life.

If you’re feeling depressed, suicidal, have PTSD or any other mental condition, don’t just keep it in cause that’s what Solid Snake would do.

Incidentally, if you do need help, check out Take This. It’s a site gamers and those in the industry can go to for assistance.

Be a better man/woman. Seek assistance and show that you can be better.

That said, there’s a flip side to the coin too – gaming is also a contributor towards mental health issues. This will be explored in greater detail in part two of this editorial.

Sal's been in the industry since the early 2000s. He's written for a ton of gaming and tech publications including Playworks, Hardwarezone, HWM and GameAxis. Recently, Sal served as a juror for the Indie Game Awards at Taipei Game Show 2020. A geek and hardcore gamer, Sal will play everything, on any platform.