TECHNOLOGY IN PSYCHIATRY
A review of the video game Hellblade: Senua’s Sacrifice and implications for psychiatry.
Dr. Edrei recently completed his Ph.D. at Tel-Aviv University and currently teaches a course on gaming that university. His publications on interactive storytelling, video games, and virtual narrative appear in Ctrl-Alt-Play (McFarland); A History of Evil in Pop Culture (ABC-CLIO); and a forthcoming book, Cityscapes of the Future (Brill). Dr. Packer is a psychiatrist and a frequent contributor to Psychiatric Times. She is the author of several books pertaining to psychiatry and popular culture.
Psychiatry and media have long been strange bedfellows. There are several reasons why. For one thing, psychoanalysis and cinema emerged within a year of one another as the 19th century ended. That chronological correspondence allowed each to influence or interact with the other and increased one another’s awareness of such turn-of-the-century innovations. Much attention has been showered on psychiatry’s representation in cinema.1-3
Video games now merit the attention of psychiatric practitioners as well as the public—and financial forecasters.1 Video games are currently three times as profitable as films. Earnings for youthful esports champions exceed their parents’ wildest expectations, according to the Wall Street Journal.4 The Entertainment Software Association (ESA) 2015 report notes that 42% of Americans (150 million people) devote at least three hours a week to video games.5 Over 91% of persons under age 17 years play video games regularly (and that number is increasing rather than decreasing). Yet over 55% of practicing psychiatrists are over age 55,6 making them less likely to have as much personal experience with video games as their younger patients, peers, or progeny, and making the profession in general in need of updated information on this medium.
When video games do attract the attention of psychiatrists, that attention often revolves around potential adverse effects of gaming7 or about premorbid psychopathology that predisposes persons to overuse video games.8 Occasionally, we hear about negative portrayals of psychiatric patients or practitioners in video games, such as Arkham Asylum (a spin-off of the Batman Universe and today’s top-grossing video game). Arkham revolves around a bedlam-like asylum for the “criminally insane,” where psychotic or simply sociopathic psychiatrists are committed to the very same institutions they administer and are locked in wards with murderous and often infamous mental patients (eg, the Joker, Penguin, Mad Hatter, the Riddler). We find allusions to video game addiction in American psychiatric literature, and rehabilitation programs for such addictions have popped up. This is especially true in South Korea, where nationwide high-speed internet connectivity is conducive to gaming.
DSM-5 failed to add this proposed diagnosis to the standard nosology but instead listed it as “a condition for further study.” Yet as of 2018, World Health Organization (WHO) broke with the American Psychiatric Association’s lead and is set to include “gaming disorder” in the updated and upcoming 11th International Classification of Disease (ICD-11).9
At a time when other novel forms of media are being touted for treatment of psychiatric disorders (such as virtual reality [VR] treatment for phobias), it may be useful to revisit a new breed of video games that may have value as teaching tools, if not necessarily as treatment tools.
Hellblade: Senua’s Sacrifice is one such example. Developed by Ninja Theory and published in August 2017, the game’s bombastic title belies its thoughtful, emotionally resonant narrative that stands out even in the age of increasingly cinematic game experiences. It relies on extensive neuroscience-related research for the project.
1. Packer S. Cinema’s Sinister Psychiatrists: From Caligari to Hannibal. Jefferson, NC: McFarland; 2012.
2. Packer S. Movies and the Modern Psyche. CT: Praeger; 2007.
3. Gabbard GO, Gabbard K. Psychiatry and the Cinema, Second Edition. Washington, DC: American Psychiatric Press, Inc.; 1999.
4. Needleman S. Video stars have fans, fortunes—and utterly baffled parents. The Wall Street Journal. January 4, 2018. https://www.wsj.com/articles/videogame-stars-have-fans-fortunesand-utterly-baffled-parents-1515085499. Accessed February 26, 2018.
5. More than 150 million Americans play video games [press release]. Washington, DC: Entertainment Software Association; April 14, 2015. http://www.theesa.com/article/150-million-americans-play-video-games. Accessed February 26, 2018.
6. Hawryluk M. Supply of psychiatrists shrinks. The Bulletin. August 11, 2016. www.bendbulletin.com/home/4557462-151/supply-of-psychiatrists-shrinks. Accessed February 26, 2018.
7. Young K. Video games: recreation or addiction? Psychiatric Times. April 20, 2015. http://www.psychiatrictimes.com/adhd/adhd-associated-video-game-addiction. Accessed February 26, 2018.
8. Fuerst ML. ADHD associated with video game addiction. Psychiatric Times. http://www.psychiatrictimes.com/adhd/adhd-associated-video-game-addiction. May 9, 2016. Accessed February 26, 2018.
9. Wakefield J. Gaming addiction classified as disorder by WHO. BBC News. January 2, 2018. http://www.bbc.com/news/technology-42541404. Accessed February 26, 2018.