Ninja Theory’s Hellblade: Senuas Sacrifice is a masterpiece. Never have psychotic experiences been replicated and animated in a way that players get a glimpse into what it is like to live with this severe disease of the mind. The designers collected their inspiration not from old mental asylum horror films but from real people who suffered from psychotic episodes. With the advice of Prof. Paul Fletcher from Cambridge University, the game’s depiction of psychosis is based on what it is actually like for a sufferer.
Everybody is different. Two people suffering from depression will not experience it in the exact same way. Not everyone who suffers from schizophrenia has the same experiences as Senua. But to a person who has never had a psychotic episode and is not keen on producing one with hallucinogenics, this might be a good place to start learning about psychosis.
Hearing things that are not there
A nameless voice greets us at the opening scene as Senua rows along the shore of Helheim. The narrator’s voice is not the only one – soon, others follow. Most of them are female. From the very beginning, there is also a male voice, though it seems to keep a low profile. The voices can be helpful, supportive, mocking and offending.
In psychiatry, we call that auditory hallucinations. They are by far the most common type of hallucinations when it comes to paranoid psychosis (=the modern term for schizophrenia), as hallucinations can be produced with all of the five senses. Frequent auditory experiences can be strange sounds like scratching, clicking, grinding or pretty much anything you hear on a daily basis, but which cannot be traced to a physical source. For example, you’re sitting on your couch and suddenly, you hear a metallic grinding noise right next to your ear. There is no way anything in your house can make this sound. Those auditory hallucinations are called acoasms and you can hear examples of them in the opening of “The Shining”.
Back to the voices. Voices in psychosis can be a mere murmuring or mumbling. Once the person understands what they are saying, there can be commenting voices or imperative voices. Commenting voices are just that, they comment on what the person is doing (“She is confused”, “She is scared”, “The door is open”). Imperative voices try to command the person on doing something. Best case: “Don’t give up”. Worst case: “Go kill yourself”. This is where the psychiatrist tries to make sure that the patient is safe from acting on suicidal commands.
During psychosis, you cannot simply tell the person to just ignore the voices, as they are part of their reality. Imperative voices that command them to harm themselves or others are terrifying. Sufferers can stand up to those voices for a long time, though it is extremely stressful.
Hearing voices is different from hearing one’s own thoughts. People can usually tell if they perceive the voices as belonging to them or being separate from them.
THIS SECTION CONTAINS MAJOR SPOILERS!!!
Some of the voices in Senua’s head are old companions for her. Luckily, some of them are supportive.
Then there is this one, deep, male voice haunting her. He reminds her of the spreading rot. He predicts that she will die in Hel. We see Senua constantly struggling against her inner antagonist. The game later makes the source of this voice very clear: Senua’s father has left his traces in her mind. As he was constantly belittling her, isolating her from others and pointing out her one big flaw: the darkness, which was the Celtic metaphor for mental illness. In contrast, Senua’s mother, who was living with psychosis herself, had a very different take on the darkness– it was a gift to be able to look beyond the veil. An aspect that is discussed today still, especially when we compare western psychiatry to shamanic traditions.
A psychologist who has been working with psychotic patients for many years has told me that often, patients associate the negative voices they hear with people in their lives who traumatized them. Trauma and psychosis are different psychiatric entities yet share many similarities. Many patients suffering from psychosis are trauma survivors.
To learn more about Trauma and PTSD, you might want to read my article on Junji Ito`s Tomie.
For Senua, discovering the root of her inner persecutor is a major step towards her victory over the darkness. The moment she understands that one of the monsters she struggles with came from a seed her father had planted in her, she is finally able to visualize it and kill it. What a nice metaphor for psychotherapy.
Hellblade gives us a good impression of how it is to have auditory hallucinations. The player can physically hear voices that are distinct from his own thoughts. They encourage him, comment on his actions or mock and belittle him. As some players reported major discomfort with those voices, we can imagine how hard it is for patients with psychosis who cannot just turn off the game. Sometimes the voices are connected to people from the patients’ life, as is the case for Senua, too.
About hearing voices: https://www.mentalhealth.org.uk/a-to-z/h/hearing-voices
Trauma and Psychosis: https://www.sciencedirect.com/science/article/pii/S0165178108002291