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Psychological horror games and mental illness in indie horror games
How to write psychological horror? I’ve seen this question asked a lot when it comes to making psychological horror games and stories. I often ask myself this when writing stories while scouring media and books for vivid examples. Most portrayals of mental illness can be hit or miss. Yet, most indie horror games have stepped up to bat. This made me wonder which games handle mental illness best or at least well.
I embarked on a spine-tingling journey through indie horror games that do more than just scare. Some delve deep into the psychological struggles of mental illness through their gripping narratives and gameplay.
These games aren’t just about chills but also about understanding and perspective, peeling back the layers of mental illness with story-driven quests and haunted pixels. If you want my psychological horror, click here.
So, let’s step into the list of 10 indie horror games that assess mental illness.
1. The Town of Light

Description: Nestled in the hauntingly abandoned Volterra Psychiatric Hospital, The Town of Light takes players into the traumatic past of Renée, a former patient revisiting her old haunts.
Gameplay: Dive into the eerie halls of the Volterra Psychiatric Hospital as Renée, piecing together her history through environmental interactions and exploration, eschewing traditional gameplay mechanics like combat for a focus on narrative.
Portrayal of Mental Illness: As one of the psychological horror games based on a real location, this game does not shy away from depicting the harsh realities of historical mental health treatments, including electroshock therapy and isolation, which Renée and other characters in the game underwent. Through its historically accurate representation, it invites reflection on the inhuman treatments that were once commonplace and the lasting effects they have on individuals.
2. Hellblade: Senua’s Sacrifice

Description: Join Senua, a Celtic warrior, on a vision quest filled with symbolism from her psychotic episodes, crafted to mirror her mental state.
Gameplay: Though an AA game, made by an independent development team with AAA budget, it blends psychological horror, puzzle-solving, and melee combat well. It integrates gameplay with narrative, using auditory and visual hallucinations to influence both story and player actions.
Portrayal of Mental Illness: The game vividly simulates the experience of psychosis, including auditory hallucinations and visual delusions, making it a pivotal tool for understanding this condition. Its development involved collaboration with both neuroscientists and people who experience psychosis, ensuring an accurate and respectful depiction of the mental condition.
3. Neverending Nightmares

Description: Experience a looping nightmare that reflects the protagonist’s mental health struggles. Among psychological horror games, this one nails it.
Gameplay: This side-scrolling game focuses on evasion, using minimalistic interactions to emphasize the protagonist’s recurring nightmarish mental state.
Portrayal of Mental Illness: Inspired by the developer’s, Matt Gilgenbach, own experiences with depression and obsessive compulsive disorder (OCD), the game’s black-and-white sketchy visuals starkly represent the overwhelming and intrusive nature of these conditions, portraying a relentless mental battle that many can relate to.
4. Fran Bow

Description: After the tragic loss of her parents, young Fran Bow finds herself navigating disturbing alternate realities. It is almost reminiscent of Alice and Wonderland with the absurdities she encounters.
Gameplay: This point-and-click adventure involves solving puzzles within a bizarre, often disturbing environment to progress Fran’s unsettling story.
Portrayal of Mental Illness: The game uses its bizarre and often disturbing imagery to explore Fran’s trauma and mental illness. Each environment and character she encounters symbolically represents her inner turmoil and struggle with her mental state, encapsulating the confusing and often terrifying experience of her psychological condition.
5. An Outcry

Description: Set in a city mirroring the protagonist’s depressive state, An Outcry explores despair and isolation through its themes.
Gameplay: Explore a surreal city that shifts to mirror the protagonist’s depression, solving environmental puzzles that simulate psychological challenges.
Portrayal of Mental Illness: An Outcry uses its surreal and ever-changing urban landscape to depict the all-consuming nature of depression. The city’s oppressive atmosphere and the disjointed narrative reflect the protagonist’s battle with a reality distorted by mental illness.
6. SHUT IN

Description: This dark comedy portrays a protagonist with severe social anxiety and depression, trapped in their own home.
Gameplay: Simulate the claustrophobic experience of depression and anxiety through routine tasks and puzzles that represent mental barriers.
Portrayal of Mental Illness: SHUT IN cleverly represents the claustrophobic nature of depression and anxiety through gameplay mechanics that restrict the player’s movement and activities, mirroring the real-life limitations those with severe anxiety might feel.
7. OMORI

Description: OMORI switches between a vibrant fantasy world and a grim reality, exploring themes of denial and trauma.
Gameplay: Engage in turn-based combat and exploration across two contrasting worlds, with choices affecting the storyline and outcomes, reflecting the protagonist’s internal struggles.
Portrayal of Mental Illness: As one of the standout indie RPG horror games, OMORI deftly handles subjects of anxiety, depression, and trauma, with the dual-world mechanic serving as a metaphor for the protagonist’s escape from and eventual confrontation with his past and mental health issues.
8. The Piano

Description: In post-war Paris, a failed pianist uncovers dark mysteries surrounding his brothers’ deaths while grappling with his sanity.
Gameplay: Combine survival horror elements with a noir-style mystery, involving puzzle-solving and clue-gathering in a gloomy atmospheric setting.
Portrayal of Mental Illness: The Piano explores the psychological impact of trauma and guilt, weaving a complex narrative where reality is often indistinguishable from hallucination, highlighting the confusing and painful journey of those suffering from severe mental distress.
9. The Cat Lady

Description: Susan Ashworth, haunted by depression and suicidal thoughts, confronts her demons in a surreal world.
Gameplay: Navigate a narrative-driven adventure with interactions and puzzles that mirror Susan’s psychological battles.
Portrayal of Mental Illness: This game dives deep into themes of depression and suicide with unflinching honesty, using its narrative and visual style to explore the depths of Susan’s despair and her quest for redemption and hope amidst her psychological struggles.
10. Cry of Fear

Description: Navigate the bleak streets of a deserted city, embodying Simon, a young man battling severe depression.
Gameplay: Experience intense survival horror mechanics, psychological puzzles, and scenarios that reflect Simon’s mental state.
Portrayal of Mental Illness: The game is lauded for its raw depiction of depression and anxiety, marked by Simon’s intense feelings of despair. It uses horror elements to symbolize his psychological struggles, providing an emotional impact that leaves a lasting impression on players.
Closing Thoughts
Psychological Horror Games and their Impact
Through their immersive and thought-provoking depictions of mental illness, these indie horror games provide deep insights into the human psyche. They’re not just entertaining—they challenge players to understand mental health issues, marking them as essential tools for discussion within the gaming community.
So, which game’s portrayal of mental illness resonated with you the most? Was there a game not on this list that changed your perspective on mental illness? Share your thoughts and join the discussion below.

Nero lives in the United States, delving into indie horror to mainstream games. Armed with a psych degree and a passion for storytelling, he wrote stories and essays published online and in museum catalogs. Besides writing, he also likes sketching and tuning into rock music. Catch his latest posts or follow him across social media.