Could Games Improve Their Depictions of Mental Health By Ditching Their Sanity Meters?


We know games tend to drop the ball when it comes to portraying mental health issues, but how can they do better? Research is a good place to start, but as Ed Smith writes for VICE, if we really want to get the most out of toying with a character’s mental health, we need to stop worrying so much about mechanics.

For one thing, hit points and sanity meters are universally awful at portraying pain:

I can be stabbed, poisoned, and fall from a balcony, but still, in Dark Souls, the so-called toughest of the tough games, I can run, dodge, and fight. The health bar may run low—ostensibly, I can be “near death”—but to look at my character, you wouldn’t know I was hurt.

I’d like to say that DayZ, Rust, and the Fallout series, “survival based” games where gunshots make characters limp or slowly bleed to death lest treated, are more effective at conveying medical emergency and the nuances of treatment. But they’re very mechanical, very cold. The wounds may have different names, but the act of treating them is still the same: apply item to character. Similarly, Darkest Dungeon and Amnesia: The Dark Descent, games that attempt to illustrate not just physical but mental health deterioration, treat the human mind as a simple machine that can be simply repaired.


Smith argues that mental health and physical health could both be treated more realistically to make the player really grasp what their characters are going through. Physical injuries can be shown, and mental health issues can be communicated.

More faithful to the nature of mental illness is Jasper Byrne’s Lone Survivor, wherein the character, rather than a flashing bar or a list of status effects, explains his mental well-being through words. “I’m tired,” he will say. “I can’t go on much more.” Pills can be taken, but their effects are undetermined. There is no bar to refill, no screen distortion to dissipate—taking tablets for your character’s mental problems, in Lone Survivor, is much more akin to treating mental health in reality. You have to try, wait, and determine by yourself whether there is any improvement.


Sometimes mechanics are the right choice, of course–Darkest Dungeon is as much about managing numbers as it is about Lovecraftian flavor, after all. But in a narrative-focused game, it might be time to consider putting away the sanity meter in exchange for traits that aren’t so easy to track–or so easy to fix.

Help us give hope at events around the world. Support Take This on Patreon!