Hellblade and Recovery in Mental Health

Is Senua a good therapist?

by Graham Walker; Professional Psychotherapist and Video Game Lover

Tags: Psychotherapy/ voice hearing/ mental health

Mild/ moderate spoilers for Senua’s Saga: Hellblade II; trigger warnings for mildly psychologically distressing content

This week I was listening to the excellent videogame podcast ‘Something Rotten’ from Blake Hester and Jacob Geller*. They were discussing ‘Senua’s Saga: Hellblade II’ the latest game from the Xbox-owned developer Ninja Theory; a studio based less than two hours down the road from me.

Upfront, this is not a game I have played myself so I’m not going to go into details of something I don’t know about, but part of the podcast’s conversation got me thinking and is a good jumping off point.

The main discussion in the podcast I found interesting was their description of how the titular Senua must battle giants, but not by killing them… instead it is by empathising with them, helping to identify their core pain and resolving this with them. After doing this the giants are all better and no longer struggle to live well with the world around them (I mean, watching a playthrough online it seems that they actually die and are ‘at peace’ that way but you get the gist).

“I have to reach the eye of the storm”, Senua announces while walking through the giant’s mind, driving home the metaphor that reaching here will resolve their core pain.

It's powerful stuff! Really makes you think.

As a professional psychotherapist it makes me think “If it were that easy I would probably be out of a job!”

Cure through recognition and acceptance is a lovely trope. It can do a lot of heavy lifting in all sorts of stories across media; it creates lovely story arcs and resolutions with lots of juicy drama and none of the mess come the credits!

The question that it raises for me, though, and the one that I want to explore is: Does neutralising the ‘core pain’ resolve the overall pain, and issues it manifests day to day? Or to put it another way; can we go back in our heads and identify the root cause of mental distress to cure it?

To answer these questions we want to first look to understand a few ideas in psychology and mental health.

First, broadly speaking there is a difference between ‘chronic’ mental illness and ‘acute’ mental illness. Chronic mental health conditions are those that have no particular cure. You may get to a point where you feel you have ‘recovered’ wherein you feel that you can live well with your mental health condition, but you are still living with it and it can rear its head later down the road for you. Conditions like schizophrenia and bipolar disorder would fit into this category. For these conditions, medical and therapeutic intervention may help but will never rid you of the condition. They are long-term conditions that will need some level of consistent management in the same way something like diabetes might in physical health.

Then there are acute mental health conditions. These are conditions that you may have for weeks, months or even years but that can generally be seen as cured; you can be reasonably completely recovered from the condition and may not need to worry about it again. It might come back in the same way that you might get a chest infection again. There are things which might make it more likely to come back and you may even be slightly more susceptible to it in the future, but generally you’ve recovered. Depression and many anxiety disorders like OCD and PTSD fit into this category. There’s no guaranteed sure-fire way to cure them but in general they are treatable to a reasonable degree- the therapy I practice (Cognitive Behaviour Therapy) being one such way.

It turns out it's difficult to find still images which help to convey Senua’s psychosis, but here's one where she looks distressed at least

When we think back to Senua in the Hellblade franchise she would generally be seen as someone living with schizophrenia or similar psychotic chronic illness. In the first game of the franchise “Hellbalde: Senua’s Sacrifice” she herself has realisations and comes to terms with core pains but her psychosis persists (and perhaps so do other symptoms less obvious to the player). This seems to have some logic to it. Her illness seems chronic and so to see her continuing to live with such symptoms, albeit with them having less impact on her life is somewhat reasonable. There’s more to say on this certainly but that’s for another time and another blog.

The giants, however, don’t seem to be presented as having a chronic illness; they seem like they are struggling with depression (possibly with a mixed anxiety/ depression presentation) which has developmental roots in a past trauma. So acute difficulties, but difficulties that seem to have existed for the giant for many years; perhaps even decades or centuries.

The idea that we want to consider here is; would resolving this past trauma for the giant change the decades or centuries of difficult emotions, unhelpful thinking and bad habits built up during the 'depressive episode'?

Ivan Pavlov. Whats that? Yes, this is the picture from Wikipedia, why do you ask?

What do I mean by this? To explain this I want to talk about dogs for a while. Let’s think back to some early studies around the idea of ‘conditioning’. The wonderfully moustachioed Russian experimental neurologist Ivan Pavlov conducted studies to find out more about the relationship between memories, learning and responses.

One day, Pavlov decides to start feeding his dog in a slightly odd way. He tries creating an association for the dog between a bell ringing and the appearance of its dinner. Seeing the food makes the dog naturally start slobbering as it's body gets ready to receive food. The association of the bell and the food appearing becomes so second nature to the dog that it gets to the point where just the sound of the bell leads to the salivating response. The dog isn't thinking "oh boy, that bell means food, let's get nice and slobbery in my mouth so I'm ready for it". The body and unconscious brain just respond. Learning takes place in the brain and the body has become ‘conditioned’ to now naturally react.

While keeping this in mind, now think of the person with a phobia of dogs (not Pavlov’s dogs, just dogs in general). The person with this phobia is walking down the street and they see someone walking their dog and coming towards them. Even before they think about it their body starts responding, generating physical sensations of fear; the chest tightens, the pulse quickens, the stomach drops. They have the thought “oh god! That dog is going to bite me if I walk past them!”. The idea feels very real to the person and so they choose to cross the road to get some space between them and their feared canine attacker. The dog passes and relief washes over the person;  they think, perhaps quite consciously, “thank goodness I crossed the road otherwise the dog would have bitten me”; the head learns that crossing the road stops the bad thing from happening and that avoiding things that feel scary feels good (i.e. a wave of relief feels better than a wave of terror). The brain gets conditioned to avoid the feared stimulus. The person is also robbed of the likely contradictory experiential evidence that perhaps not all dogos will chomp you as you pass by.

Perhaps James Sunderland (Silent Hill 2) had a legitimate reason to fear dogs. He works it out you could say… in some endings…

Now, if I was to sit down with a person and explore where this fear came from (perhaps they were bitten by a dog, or perhaps Pavlov rang a bell as they entered a room and a dog mistook them for food) would they stop feeling scared and crossing the road straightaway? Absolutely not! Why would they? The behaviour and response both on a conscious and unconscious level is learned; the sight of the dog will still stimulate conditioned fear and the prediction that the dog will bite will still be intact.

Ok, let’s think of a person this time who was verbally abused as a child. Their parents shouted at them, called them vile names, told them that they were stupid, a failure and everything was always their fault. Over the years they become anxious in situations where they are open to judgment from mentors and seniors, so in school they get anxious about their grades, fearing the worst. At college/ university they are scared of presentations due to a fear their lecturers will criticise them. This fear makes them tense and on edge; they feel like they are going to be sick and they can hardly breathe.

They get through this just about and now as an adult 30 years later, they are a teacher; one day they are told that their supervisor is coming later that day to assess the quality of one of their lessons. Just the idea of this brings back memories of being screamed at by their parents and being told how awful they are as a human. The all too familiar feelings of shame and fear come back. Their chest tightens so badly that they gasp for air and their stomach flips to the point where they fear that they might vomit there and then. They are not even in the situation and the response is so palpable as to almost disable them right where they stand.

Now let's say - through therapy- we identify the reason; we map it out and make complete sense of why it is going on for them. We do this in such a way that it gives them a new perspective of why they can feel as awful as they can now in situations of judgment. They get it. They can accept this new truth about themselves, their past and the world. Are they all better? At peace with themselves and their life? Are they cured? No. Absolutely not. Perhaps they can have a little more self-compassion or self-acceptance. Or, perhaps they can be more aware of why certain thoughts and behaviours bubble up for them and maybe can even stop some of that in the moment. But, those habitual thoughts, physical responses and behaviours are still all there and can be triggered and activated, just like a dog salivating at the sound of a bell ringing.

Thinking this approach gets results is a little bit like a firefighter going into a burning building and pointing to a faulty plug socket and saying "there's your problem; glad we could help" as the fire rages around them. You would say "great, but actually please put out this fire engulfing my house! What caused it doesn’t matter to me right now". The fire of mental health still rages on even after the source has been identified.

Old habits die hard. Even just seeing a cigarette dispenser might be enough to trigger that sense of desire and craving in us

A final thought on this idea before wrapping up. Think about any bad habits you may have had or still have; say smoking or drinking too much, eating too much or even maybe just biting your nails. How long did it take to try and stop that? How easy was it? If I told you "ah, you only smoke as you were socially anxious and you started this to help you fit in" would that magically help you break the habit? Or if you reduce it but then you meet up with some friends at a pub and they are smoking, do you suddenly get a desire to smoke again? For some, perhaps not, but for many that association and habit will come back hard either in desire, action, or likely both. Habits are hard to break. Even ones we don't like. Even ones that lead to us hurting ourselves or those around us. Understanding how these habits developed can be a helpful step on a journey of recovery, but it is far from the one and only step.

And so, as I think back on the giants Senua frees from their mental anguish I cannot help but squirm a little inside as this trope of resolution of internal pain and conflict plays out. It is not that easy. It is a hard task that takes time, effort and a willingness to confront pain.

“Touch my hand, Senua, and I’ll be sorted!”… Oh giant, how naive!

But then what is the message of this blog? That we shouldn’t even bother trying to sort this stuff out as it is too hard? No, far from it.

My first point is that I hope that videogames and media in general in the future stop relying on such ‘quick-win’ narratives; yes, it might help the story fit the space it’s been given but it is so far from reflective of an accurate depiction I don’t find it helpful; particularly in a game series which tries so hard to depict mental health accurately in so many other ways**.

And secondly, if you are struggling then do get help. The journey to recovery can be long, difficult and perhaps even painful at times. But, with good support and hard work it is possible to get there and I would strongly encourage everyone to seek support (such as- but not only- psychotherapy) if they think they would benefit. Knowing that it is hard work going into the process is arming yourself; you will be more mentally prepared for what lies ahead. We might not be able to heal ourselves as quickly as Senua can a giant, but we can do it and it is worth doing; for ourselves, for those we love and those we will love in the future.

That’s how I feel about this. You might feel different and that is OK.

Feel free to share how your thoughts about this in the comments section below.

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* Something Rotten Podcast - YouTube

** A 'fun' (to me at least) little aside. I recently attended some training on voice hearing and psychotic experiences. The trainers had specially produced some audio clips to convey to the group what the experience of voice hearing was like. They played some very evocative audioclips and when I looked at the slides it was noted that these clips were created by none other than Ninja theory, the developer of the Hellblade games! These guys are so good at what they do that it is seen as good enough to help with the training of mental health professionals and therapists!