Calculating Infinity: Mental illness in Horror

At the root of any horror story, no matter how fantastical it may be, is a real human fear. From JAWS embodying our fear of the water to The Exorcist being everything we fear about what comes after death, horror is supposed to be about what scares us. The only trouble with that is unfortunately society often possesses irrational fears of anything that is different, or that which we do not immediately understand. Such is often the case with mental illness, arguably one of the biggest inspirations on the genre. All fears take shape in the unknown, but it is important to come to grips with and discern an irrational fear from the rest. Mental illness can be difficult to understand without having experienced it yourself, as it is demonized too often in the genre, and sympathetic portrayal is hard to come by.

*Be wary of heavy subject matter that may be potentially triggering. Also slight spoilers for The Evil Within and Silent Hill 2 below. *

There was a particular event that occurred almost exactly two years ago that changed my life forever. Unlike most life altering moments though, this one was not planned and was not stirred about by any particular actions. I was out driving with the plans to meet up with some friends, then suddenly I couldn’t hear out of my left ear. It was like that sensation, when a loud noise goes off close to you and all you can hear is a faint ringing. In this case however, there was no sort of loud noise that could have caused this. Shortly after the ringing began my heart began to beat at fast pace and with a large impact to every thump. I had no idea what was going on at the time, so I decided to turn in early for the evening. “It’s just something I need to shake off” I thought to myself as I tried to relax at home. Though despite my best efforts, whatever was happening to me did not go away, in fact it only got worse. Soon my whole body was going numb, cold, and I was pacing all around my apartment. I still had no idea what was going on, but at this point I had a guess:  It felt like I was dying.

Two ambulance trips, several talks with doctors, and about 4 days of agony turned out to be the products of a massive anxiety attack. Generally an anxiety attack is caused by a particular event, but it just happened in my case. Since then I’ve had to deal with this lingering beast that is anxiety as it comes and goes without warning. Before that initial event, I was fairly ignorant of what mental illness actually was and what it could do to a person. When you don’t suffer from a form of it, or have no experience with it through friends or family; it may seem like just some sort of vague notion. It’s like trying to calculate infinity.

Now the reason why I just went into all that detail about my personal life just now is so you know where I’m coming from for the rest of this piece. I have always been a fan of horror but after being diagnosed with anxiety it gave me some important perspective on how fiction, and in particular horror, has a tendency to portray the mentally ill in a very negative light. If you are a regular here on Rely On Horror, then you most assuredly know what I am referring to. Straight jackets, asylums, padded rooms, psychotic patients, mad doctors, bloody hospitals, and a myriad of other stereotypes regarding the mentally ill are staples of the genre. This sort of iconography is practically all we see from survival horror games that feature prominent themes of mental illness, and that’s not really a good thing.

Whether people want to admit it or not, fiction influences us in powerful ways and can subtly shape our opinions regarding virtually everything. While most people know that mental illness does not turn a person into a face eating zombie murderer like the enemies in Outlast, people may still derive a negative connotation from the experience. As I said earlier, you really can’t understand mental illness unless it has directly affected your life in some way through real world experiences. When I let a lot of my friends and family know that I had anxiety, most of them did not understand it at all. They suggested I was too stressed, that I was not positive enough, that I needed a better attitude, that I just need to relax more often, and that if I just decided to be happier that my condition would just go away. This was all even after I told them that the initial attack happened out of no where and even my doctors have no idea what happened. Now despite the somewhat hurtful response I received, I did not take any of it personally. After all, there was a time when I probably would have silently agreed with a lot of those suggestions. Heck, even though I have anxiety, I can’t pretend I know what people that suffer from depression, obsessive compulsive disorder, schizophrenia, and many other forms of mental illness must go through every day. I’m lucky enough to have friends that will listen to me when things get bad, but not everyone has that luxury. However, I can’t help but think that a lot of negative portrayal in media, particularly horror, has played a big part in why people are not more empathetic towards the mentally ill. It’s like that old saying: You may not have noticed, but your brain did.

So many novels, games, and movies continuously retread the same old tired tropes (asylums, straight jackets, etc.) over and over again. When I was playing through The Evil Within, it was like I had reached a tipping point with my tolerance towards putting up with these portrayals. The entire game exacerbated all of the aforementioned tropes to an absurd degree. Several chapters in the game have you chasing after a patient that was experimented on by the game’s antagonist, while also fighting off people that have become infected with the crazy-nutcase-psycho-sickness trope. It was not anything I hadn’t seen before, but that’s just what bothered me–we’re doing this again?  There’s nothing inherently wrong with being initially wary of mental illness itself, after all nobody wants it. However, being fearful of people with mental illness is a different matter entirely. It’s largely an irrational fear that is exploited in fiction probably due to how easy it is to put a knife in an person’s hand and say “That dude wants to kill you, because he’s come down with crazy-nutcase-psycho-sickness you see!

The thing about being afraid of the mentally ill as opposed to say being afraid of something like drowning is that no one is hurt if you say you’re afraid to go swimming. As I said earlier, all horror stories have their roots in reality no matter how fantastical the monsters that inhabit them may be. Let’s go back to the movie JAWS for a moment so I can articulate this point fully. The shark in the movie represents our fear of the water, and the movie scared so many people because it tapped into a primal fear we have of how vulnerable we are when we enter the open ocean. Most people know that the shark itself is as much as much an exaggeration of real sharks as any other movie monster, but regardless the monster in that movie was not made at the expense of a large group of people. The thing about fearing mental illness and particularly making the mentally ill the enemy like so many games do though, is that it’s detrimental to those of us that have it. So many people come to associate mental health issues with these silly tropes exclusively. It makes me think back to when I was telling my friends and family about my anxiety, that a lot of them could not put together that it is a sickness no different from any physical ailment, and it didn’t turn me into an axe murderer that wanted to eat their faces. To them anxiety was just like a silly nervous thing you get before you write an exam, and not mental illness, ’cause only the “crazies” have that. Basically, what I’m saying is a game like The Evil Within perpetuates the stigma that the mentally ill are all dangerous and it muddles the truth as to what it actually is. So many people are afraid to get help with their conditions due to being labeled “crazy” by others, and as a result they may not get the help they so desperately need. Maybe they wouldn’t be afraid if more fiction was sympathetic to their ailments.

There is one instance that comes to mind though where a horror game featured prominent themes of mental illness and was inoffensive about it. That game being the survival horror classic Silent Hill 2, specifically with its supporting character Angela Orosco. You see, we are never explicitly told in the game what it is Angela suffers from, but simply through the interactions between her and the game’s protagonist James, we know it’s there. More importantly though, Silent Hill 2 does not demonize Angela’s ailments. The writers understood what mental illness is and what it can do to a person, and they wrote Angela in a sympathetic and understanding way. Regardless of her past and what it is that brought her to Silent Hill, only empathy is on display here. It would be pretty easy to take a character like Angela and exploit her ailments in a way to get a cheap scare in a horror game. At no point however did the writers do this, and for that I am forever grateful.

The thing about mental illness is most people are afraid to mention or even consider the possibility that they have it for fears of being associated with the negative connotations that come from fiction. So much of horror revels in the act of going for the low hanging fruit to mock, exploit, and stigmatize at the expense of the mentally ill. Much of what I have said here is probably heavy handed, but I think myself and many others would agree it is important to communicate to everyone. Art is far more powerful at shaping perception than many people realize, which is why demonizing the mentally ill is so troubling. We need less face-eating-crazy-screeching-patient enemy types and more characters like Angela Orosco. More importantly though, there just needs to be more understanding in regards to this subject. We may not be able to calculate infinity, but we can always be empathetic.

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  • Whitney Chavis

    So much this. Excellent article Kyle! BTW it’s really brave of you to talk about your own issues to help give perspective…epecially given the climate as of late.

  • Ahmad Al-Hamily

    I’m in agreement that people will always assosciate mental disorder to something negative because that’s what they’ve come to know from all sorts of media including video games.

    I’ve also been to to the psychiatric hospital once to treat a disorder that led me to stutter due to tremendous amount of stress.

    When you see people, men and women, screaming from the top of their lungs, it would scare anyone but it also should teach a valuable lesson. A mental disorder/ disease is like any physical ailment that requires various treatment.

    I’m pretty sure every single human being suffers from some sort of disorder which may or may not require going to the “shrink”.

    As for the entertainment industry, I won’t hold my breath and wait for something that will educate the masses on mental illness.

    Bottom line, depression doesn’t equal mass murderer.
    Thanks for writing this article friend.

  • Sess

    Well said. I struggle with a mental illness myself, and it’s truly impossible for anyone else to understand what I’m going through. Plus my mother has anxiety, and although I can’t possibly know what people with it go through, I can certainly relate in some way. It makes Silent Hill 2 such a fantastic beautiful piece of art because of its fair portrayal of the human mind. Those who do not suffer personally from an illness may not be able to capture the entire beauty of SH2.

    • CasuallyDressed

      That should’ve been the tagline on the game box.

      “Silent Hill 2: You’ll only really enjoy it if you’re a head case”

      • Sess

        I played the game before I became a head case and it was my favorite by far ever since. Playing it again after progressing as an adult and experiencing more of the world’s harsh realities has brought out even more to appreciate about the work.

  • Anubis

    I think that the best medicine against any kind of irrational fear or hatred is education. Education all the way through all ages. Mental illness should be explained clearly at a young age to as much people as possible, as well as the importance of medical research that is working towards solving mental health problems, which has and will continue to help many people around the world.

    I disagree with your point that games like The Evil Within are perpetuating these stigmas. I think ignorance is the thing that actually perpetuates them. We should try to change that, like we’ve changed in a big way when it comes to other topics, like homosexuality, for example. And we didn’t change that stigma because we had lots of awesome gay characters in games (we still don’t have that), it has been changing by a consistent and prolongued social effort educating people on why gay people are undeniably humans that deserve to be treated like humans. As a result of that, I’m sure that today a game portraying gays like monsters would be severely, and justly opposed.

    Now, when you say that whether we want to admit it or not, fiction influences in powerful ways that can shape our opinions about everything, I think you’re going too far. It’s a serious assertion, because if you’re telling me that I’m actually being influenced to change my opinions without noticing, I should be worried about that actually happening. I certainly wouldn’t like to become a murderer or a violent husband or something like that.

    But I have one big reason why I can’t actually fear that possibility: my 25 years of gaming have not caused me to become more violent, or hateful, or homophobic, or fearful of mentally ill people.

    In fact, I’d say that I’m now far less inclined to be any of those things, and not because I played games with characters that showed me how to do so, but in part because I’ve had real life experiences with many different people that have suffered differnte kinds of abuse, and I have developed empathy towards many different groups of people.

    And I would say that games can help educate people. There have been games that had the intention to help people understand things like child abuse, homosexuality, etc. I’m not against those games. It’s great that they exist, and developers should feel encouraged to continue those efforts. Entertainment doesn’t need to be just stupid vacuous fun, just as it doesn’t need to be just education and scientific facts.

    And in the end, I think the developers of The Evil Within could have very easily placed a big, obvious disclaimer saying “remember this is just some ridiculous fiction, real mental health issues are a serious business and you can get more information about them here and here”.

    Please excuse any mistakes I made. English is not my native language.

  • Andy

    Nice article. I don’t wanna get personal either but I have anxiety, depression, OCD, adult ADD etc. I have had it all my life. But I’m 26 and I have just started noticing that I had anxiety when I was 21. I know what it’s like and it’s not fun at all.

    • ariessiren

      As long as you get help, therapy and meds You should be okay. Most people refuse meds and it’s Really difficult too be around them . Millions of people have these disorders and don’t address them. Kudos for coming forward.

      • killer89

        Meds soften up your head, and take your mind away more than the illness.

        “The thing about mental illness is most people are afraid to mention or even consider the possibility that they have it ….”

        People either joke about it or pity. Having hard time on figuring out which is worse.

      • Andy

        Thank you.

  • Mimi

    Excellent article! I was bothered by the same things with The Evil Within, and so many indie games that rely entirely upon the scary hospital/crazy killer tropes.
    Apart from mental illnesses like anxiety and depression, stories in every genre that feature characters who are implied (often not stated directly) to have autism or some form of neurodivergence treat those characters fairly badly. Leslie (from Evil Within), for example, is never developed past being a plot device for the protagonist to chase throughout the game. He doesn’t even have much of a personality beyond the surface traits of his vaguely-stated mental illness. It’s another example of badly constructed inclusion of mental illness that’s only there to support lazy writing.

    Thanks for writing this! We need more discussion about these issues, to be sure.

  • Hayley Jackson

    Not to dig up an old phrase, but people fear what they don’t understand.
    Long has the battle been against stigmatizing words and portrayals, but
    it’s futile. There will always be stigma attached to mental illness,
    just as there is to differing races, differing genders, differing sexualities and so on. It’s generally human nature to not accept what
    you can’t possibly imagine, and it’s pretty much impossible to imagine
    having a mental illness if you don’t experience one. I studied mental
    health and nursing at university and a lot of the courses contained ways
    of fighting stigma and ensuring unconditional positive regard. After my
    graduation, I had a whole new outlook on not just mental illness, but
    life in general.

    I’m also really glad about Angela in Silent Hill 2 because for once she
    wasn’t a completely unstable person who just wanted to hurt James. She
    was confused, vulnerable, suffering and incredibly jaded to the goings
    on in the town and you actually WANTED to make sure she was okay. You didn’t run from her in fear. Angela herself seemed to suffer some kind of post-traumatic disorder from the abuse her father did to her, or so it’s hinted at. And that’s very important as well, as it has its own

    The most important thing to remember is that in most cases, mental illness sufferers are, indeed, suffering. They struggle with their experiences and have the tough choice of dealing with symptoms or taking medication that has numerous side-effects, or also seeing a therapist which in itself makes people think “oh my god he/she sees a therapist? I wonder what’s wrong with them”. And there’s our key word. “Wrong.” It’s incorrect to say that, but again, there’s the stigma. It’s everywhere.

    Thank you for this article. It was a great read.

    • ariessiren

      So true. Unless you study it or have experienced it, it really is hard to understand and have empathy. The portrayals in games have not been kind that’s for sure

      • Hayley Jackson

        Indeed, and it saddens me that many games and movies fuel the fire by including “psycho” characters in their plots and such. I love horror games, even if they have this element in them, but I’m very aware of when mental illness is abused as a scare tool. I studied it, but I also experience it, which is why I studied it in the first place. I would love to collaborate with someone working on a horror project on how to portray mental illness but sadly I don’t think anyone would ever be interested in “fair treatment”, because the general public want the gritty, messy and terrifying side of it all. That’s what sells.

  • Lucas Rivarola

    Kyle, this is an amazing article.
    I’ve seen what you talk about first hand. There’s a homeless old man that roams around the train station in my city from time to time. I’m not sure what exactly is the name of his illness, but he just wanders around, trying to talk to people, but he can’t form words. He just mumbles things. Sometimes he just shouts to the air. Sometimes he’s just sitting on a bench and then suddenly he stands up and starts screaming.
    Of course, you can see the fear in people’s eyes. For some reason, they all seem to think that the man is going to hurt them. You can see them getting away from him, avoiding him. I can’t understand what’s going on in his head, but I’m completely sure that he doesn’t feel good when everyone’s trying to avoid him. That’s why I don’t do it. Hell, I even offer him something to eat or drink when I can. I talked to some of the station workers and they told me that people from stores around the station usually feed him and that he sleeps in a park. No one apparently knew his name, let alone if the man had any family.
    I understand if some people are afraid because they always see “crazy people who kill normal people” in movies and stuff, but he’s still a person. There’s people out there who do worse things and they are seemingly sane.
    I agree with you so much when you say that fiction shapes our perception that I’m inclined to mention (because that’s how serious I get when I talk about this :P) the other genre that’s guilty in making us have misleading thoughts about mental illness: comedy.
    Horror wants us to fear people with mental illness, but comedy wants us to think it’s not a big deal. There’s people afraid of the old man, but there’s also people who laugh when they see him screaming things that don’t resemble words.
    Hell, I’ve even seen people from my own family laughing after my grandma got alzheimer. I can’t begin to understand why they thought it was funny when she had no idea who she was talking to. My grandma died without knowing who I was, and that was no joke. But hey, that’s what happens in TV, old people forget stuff and it leads to funny situations, right?!
    So yeah, to sum up (because this is a pretty long comment already :P) your article is great and I agree with what you say. This portrayal of mental illness leads to misinformation, and misinformation leads to situations like those I talked about. And that shouldn’t happen, because people with mental illness are still people.

    • Ahmad Al-Hamily

      That’s true. Avoiding the problem by either depicting it as evil or insignificant is another problem that should be addressed.

  • Milan Mitic

    Much regards to you Kyle and the rest of the crew at Rely on Horror. I am a horror fiction/cinematography/games fan I tend not to comment much on the forums/blogs but I find this topic very interesting and inspirational that I couldn’t resist to share my views with you. My apologies for a lengthy reply.

    What is fear? Why do we feel fear in the first place? The answer is quite simple really, it’s because we are concerned about our survival and our well-being, we want good for us and our body and not to suffer, we worry whether we will be hurt physically or mentally or even killed. This is where our survival instinct kicks in. Thus, fear is a part of who we are, a part of our nature.

    Fear is one of the most basic human emotions, it is a necessary component for our survival as a species and a way for us to feel ‘alive’ and in touch with the primal aspect of our inner self. That being the case, it is clear why horror as a genre keeps on living and permeating all levels of society. While there are so many aspects or manifestations of fear, it all inevitably boils down to just one underlying primal fear – the fear of the unknown, of the alien.

    Just think about it: people fear of what they don’t know or don’t understand. We have many instances of this all around us in everyday life: we’d choose a brand of food we are familiar with rather than a novel one, we feel anxious in important situations in our life, we feel anxious before a school exam because we aren’t sure what will happen, we don’t feel just as comfortable in the presence of people we don’t know at all as opposed to the feeling we have in the company of people we know well, we fear (or at least have a kind of discomfort or dread) of the darkness at night (imagine walking alone down a deserted alley or through a graveyard – though it may be exhilarating for some people for sure; also, a myriad of successful movies and video games exploited precisely this kind of fear in people, which is not a bad thing, and, of course, there is no harm in exploiting this kind of fear, i.e. nobody gets hurt, as opposed to some other manifestations of fear, but I’ll come back to that in a moment), we are all afraid of solitude and isolation (what are solitary confinements for?), we are all afraid of dying because of the unknown that comes after it, afraid of unfamiliar and sly animals… afraid of mental illness as we maybe know too little about it and it feels so alien in nature.

    Therefore, video games, being the most recent, most advanced and most powerful medium of human expression, are really at the forefront of influencing any society, so their task and the task of their creators as trailblazers in this respect is much more challenging and dangerous. They doubtlessly could lead to people having a very negative and damaging attitude to things. Let’s not forget that movies and other popular media shape human consciousness quite much as well.

    Now, you’ve mentioned JAWS. I really like those movies and many other similar ones for that matter (e.g. Anaconda). Those movies haven’t influenced me in any negative way and I haven’t noticed any kind of infamy fashioned in them. Still, I’ve got to say I’m well-informed about sharks, snakes and many other animal species. However, not everyone is as well-informed as I am on this matter (not to say I know everything there is to know on the matter, in fact it’s far from it). Still, you’d be surprised how little people know about animals. Having seen some reports, I am appalled, to say the least. Many ‘dangerous’ animal species are near extinction. Many countries worldwide have no restrictions whatsoever to the hunting of wolves, sharks, snakes, many big cat species etc. yet they strictly protect some non-aggressive non-human-threatening species of animals even if they are not in a direct danger of becoming extinct. I’ll just say that the number of sharks in the world oceans keeps dwindling dangerously as I speak, and that has nothing to do with climate changes. It has all to do with incessant hunting. The portrayal of sharks as dangerous, sneaky and irrational animals without any beneficial role in the animal kingdom has led to the present state of things. “We shouldn’t fear them, we are the most advanced species on this Earth, instead let us make them fear us or they shall be annihilated!” seems to be the motto.

    Much of this applies to mentally ill people as well. However, here I want to make a clear distinction between two types of disorders of the human brain. Near my hometown there are two sanatoriums: one is for ‘psychotic’ patients (individuals with severe mental illness affecting the whole personality – meaning they are aggressive and dangerous to society), the other is for mentally ill patients (individuals with mental health problems who are NOT dangerous to society, but still with serious health issues requiring them to be hospitalized). If people knew and understood clearly the distinction between these two types of disorders, many of the prejudices and condemnations of the mentally ill wouldn’t even exist. However, we all know this is not the case.

    To sum it all up: People must and should be educated on the topics they seem they are not familiar with. And I think it should be the obligation and responsibility of any individual media product to do that. Focusing on games, I don’t find it problematic that they try to invoke fear in people by using the mental illness with which people are not very familiar with, what I find problematic is the fact that few games explain what these disorders really are, thus demystifying them and explaining to people they are not something unexplainable, dangerous or a thing to be feared of. If a developer have put something into their video game, they should make it clear that it is there strictly for entertainment purposes and that it is not applicable to the real-world situations. That way the consumer would not get a wrong idea about the things depicted in the game.

  • Henrikm

    yeah indeed heavy stuff I cant begin to comment it as I never experienced it myself or someone close.

    However what is your take on for example Killer 7.

    There well we have a old guy with a split personality 7 of them and there its handled in a way its both comical and entertaining.

    Is that stigmatic in similar way as said games mentioned here our is it a bit reedeming?
    As its not potrayed as something bad rather its better too have 7 personalties in this case.

    or is it Stigmatic in a way aswell.

    I like the mental ilness themes but can agree on the article that is often used to portray something bad or something that one tried to forget and eventually surfaces to haunt you in the end.

  • Hellen

    I too have social anxiety, more precisely a personality disorder related to it. And you’re right, if you mention “personality disorder”, people cruelly think you’re hypochondriac or, if you actually say the psychotherapist told you that, they think what you so eloquently described:

    “To them anxiety was just like a silly nervous thing you get before you write an exam, and not mental illness, ’cause only the “crazies” have that.”

    And so it’s always your own fault, you’re just being silly, a loser, making problems out of thin air, fishing for excuses of being a failure, etc. Or in case of depression (I have it as concurrent disorder): “Haha, just clean the dishes in the kitchen and you’ll feel good”, “you’re just fishing for excuses for your passivity”, “you’re a lazy bum, an empty shell”. Those things said by most loved ones really hurt. And I’ve heard similar stories from others, people are crumbling totally, barely surviving on medication and they face nothing but slander and derision from their families. All based on total ignorance.

    So in my opinion, ignorance is the problem. There’s no public knowledge of anything like “illness of emotion”, or “ilness of self-perception” (which social anxiety majorly is, a fundamentally distorted view of self, unfixable by trying to think differently of it). There is only public knowledge of “illness of rationality”, like shizophrenia.

    Honestly, I don’t know whose friends and relatives actually think that depression or anxiety means you’re crazy or pity you, but I’d take such demonization any day over ignorance, laughing your issues off, and unfair demands to fix yourself with the force of will.


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