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Nupur Goenka (based on an interview with Dr. Rachel Kowert)

AFK, trying to unpack mental health in video games

6 minutes read

June 24,2021

The rapidly growing gamer community has millions of people worldwide with diversity across age, race, gender, sexual orientation, and backgrounds. It begs the question, what will we find if we unpack the mental health narrative in this space?

I sat down with Dr. Rachel Kowert to discuss the recent trends in research around mental health and video games. Dr. Kowert is a research psychologist, Research Director of Take This, and science content creator Psychgeist ( Here are some insights from the conversation.

Sensationalised media and myths about gamer violence

Over the past 50 years, video games have become a sensationalised scapegoat for individuals exhibiting violent behaviour and are often conflated with mental health conditions, sexism, addiction, and toxic culture. Even today, concerns about the impact of violent video games on long term mental health issues and aggression continue, especially since younger generations have begun to join the gaming world. However, to put it simply: there is no scientific evidence linking violent video games with aggression and violent crime. Several other myths have been debunked many times over as well. There is a gap between reality and perception at a time when, more than ever before, we need to look at mental health in the gaming world and have a much more nuanced discussion.

Death Race was one of the earliest games that sparked controversy and incited general moral panic after its release in 1976. The game was a driving simulator where players could earn points using their on-screen cars to 'run over and kill' gremlins. There was an immediate controversy that Death Race made players use their cars as 'weapons' to run people over. A few years later, the release of Mortal Kombat kept the debate going. The game became particularly famous for its gory fatality endings that included beheadings and disembowelments. And of course, we have to mention Grand Theft Auto. This video game continues to create controversy and outrage even today as players participate in a wide range of criminal behaviour.

Hundreds of scientific studies have evaluated the relationship between violent video game play and aggression. Of these, many have reported small, short-term increases in aggression following exposure to violent video games. While this may sound like a reason to sound the alarm, it is important to note that these increases are typically measured only within the first few minutes following violent video game play. There is also no evidence to suggest that these short-term rises have any long-term impact on a player's level of aggression or mental health.

Mental Health in game design 

Let's also consider that video games can provide interactive and enriching opportunities to learn about mental health and well-being, especially since independent games have become even more prevalent and are a dominant media form with millions of players across the globe. While several games have come under scrutiny for either misrepresenting mental health or conflating mental illness with violence, the community has recently seen several games that show a positive development in their considerations for game design. For example, just within the last year, games like Celeste, Gris, and Sea of Solitude tell mental health stories in nuanced and accurate ways. Hellblade: Senua's Sacrifice is also lauded for its mental health storytelling and portrayal of Schizophrenia. Many people who have played this game have reported that it gave them a new perspective on what this mental health condition is like for those living with it, increasing the ability to empathise rather than stigmatise.

The discussion about the portrayal of mental health in games is unique compared to other mass media because apart from characters and stories, it's also about game mechanics and in-game decisions where people are actively involved in play. By being immersed in an interactive world, players find themselves in an 'active learning' situation rather than passively retaining information. And this can be a potent tool if used well.   

For designers, it's crucial to avoid tropes and stereotypes. How mental health is portrayed within media matters and games are no exception. Setting a game in an "insane asylum" to make people scared further reinforces negative stereotypes about mental illness and those suffering from mental health challenges. We have seen that misrepresentation of mental health in games can increase stereotyping, deepen stigma, and even reduce help-seeking behaviour.

Gamer culture, toxic behaviour, and dark participation 

While we consider the design and construct of games, it is equally important to understand and discuss the cultural movement of gamers. As it has evolved over time, gamer culture is now often cited as 'toxic'. It describes a movement based on exclusion rather than inclusion with players hiding behind anonymous gamer identities. Dark participation is an umbrella term that encapsulates "deviant" online behaviours in games - what others often call toxicity or toxic behaviour. The behaviours that fall under this umbrella, such as trash-talking, harassment, griefing, hate raiding, and doxxing, can have a detrimental impact on a players mental well-being for both the short (increased distress) and long-term (PTSD). This culture refers to the perpetuation and normalisation of these behaviours within gaming communities.

Games are meant to be fun and playful activities for everyone. However, dark participation and toxic gamer culture fuelled by verbal and behavioural abuse within these communities have created a space that is the opposite of welcoming. A study by the ADL in 2019 found that 1 in 10 players reported depressive or suicidal thoughts resulting from harassment in online multiplayer games. While these statistics are shocking, and it can be challenging to change group norms once established, it is still a solvable problem if we work both top-down and bottom-up.

One way to combat this toxic culture is for the video game industry to make reporting tools much more effective to increase accountability. We must also have stronger community guidelines to create a safe space for everyone and encourage better industry collaboration between researchers to collectively understand and combat toxic behaviour. Even then, we have to do our part as a community as gamers. It's important to stand up to harassment when you see it rather than ignore verbal abuse or add to the toxicity with similar comments. We must be the active ally; if you see something, say something.

And, finally… 

The world of gamers and gaming culture is complex and constantly evolving. Unfortunately, many people who aren't in this movement tend to view it through biased eyes because of stereotyping in pop culture and sensationalised media. However, if we look closely, we can find many opportunities to create a stronger narrative for mental health in the community. We need to look past the stigma and myths to stop perpetuating and normalising misleading reports. We have to get creative with game design and leverage their interactive nature to make powerful stories and learning opportunities. And finally, we cannot sit back and accept toxic culture when there is something we can do about it. This is a global community with millions of people connected to each other, and the opportunity we have before us is massive.

Written By
Nupur Goenka (based on an interview with Dr. Rachel Kowert)

Rachel Kowert, Ph.D is the research director of Take This ( and science content creator Psychgeist ( She is an internationally recognized speaker and author on a range of topics relating to the uses and effects of digital games, including its impact on physical, social, and psychological well-being. She has published several books and scientific articles relating to the psychology of games and, more recently, the relationship between games and mental health specifically. One of her most recent books, A Parent’s Guide to Video Games, won an INDIES award in the science category. For more information about Rachel and her work, visit her website at

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