Until Dawn and Mental Health

Until Dawn developed by Supermassive Games.

Mental health is a common a theme tackled in the horror genre. It is common that the main antagonist suffers from some form of mental illness and does terrible things to the protagonists. Famous examples include Michael Myers, a homicidal escaped psychiatric patient, from Halloween, the murderer Norman Bates, who suffers from dissociative identity disorder, from Psycho, and the character of Sweet Tooth, from the Twisted Metal games, is also depicted as an escaped psychiatric patient. It is also not uncommon to have a mental health institution as a main setting. The video game Outlast is set in a mental institution and the Baltimore State Hospital For The Criminally Insane is a setting for Silence of the Lambs. The issue of mental health is easily addressed by the horror genre because it relies on human psyche in order to illicit a response. This genre only succeeds because it feeds off of human fears and desires, and both of which originate in the mind. Sadly, the over saturation of negative portrayals involving suffers of mental illness, usually in this genre, have created a stigma around mental health issues. The horror genre relies on the concept of fear and we have been conditioned to fear mental illness and its surrounding issues.

The 2015 horror game Until Dawn, developed by Supermassive Games, seemingly follows the well-known trope of mental illness in its genre. However, the game creates sympathy for a character who suffers from mental health issues by not making the character truly evil, like the common trope, or the main major antagonist. The game follows the horror genre formula, but it also slightly changes the common perception of mental illness if the player is able to piece all the clues given by the game together.


Josh is one of the original eight protagonists.

The character of Josh, portrayed by Rami Malek, is revealed early in the game as one of the game’s eight protagonists. He is the older brother of Hannah and Beth, who had disappeared a year prior to the main events of the game. He is initially described as thoughtful, loving and complex. As the game continues he is revealed to be the antagonistic Psycho. During the reveal of the Psycho’s identity, Chris, another one of the eight protagonists and Josh’s best friend, will state “well he’s definitely off his meds.” This would be the player’s first indication of Josh’s mental state if they had failed to escape the Psycho while playing as Sam, the heroine of the story, earlier in the game. The real details of Josh’s mental state can only be acquired if Sam escapes the Psycho and finds the Psycho’s lair.

The Psycho’s lair contains the key items of Josh’s cellphone and the Psychiatric report. Josh’s cellphone contains a conversation between Josh and his Psychiatrist in which the Psychiatrist advises Josh against moving forward with an unspecified plan of revenge. The conversation also includes this important exchange:

Dr. Hill: Please, pick up your phone. I’m getting worried.
Dr. Hill: Are you still taking your meds?
Josh: im fine
Dr. Hill: It’s very dangerous to stop taking your drugs mid course Josh.

This information reveals that Josh is off his medication, as Chris would suggest later on in the game. However, the Psychiatric report contains the most vital information in regards to Josh’s mental condition.

Josh's cellphone.
Josh’s cellphone.

The report reveals that Josh has been on medication for almost a decade and he has been prescribed various anti-depressant medications including Fluoxetine, Amitriptyline, Duloxetine, and Phenelzine. It also reveals that the medication wasn’t working as planned and that Josh had begun taking increased doses. All of these drugs focus around the neurotransmitter serotonin. Serotonin is thought to play a role in depression, and has been touted by the media as the cause of depression. However, the link between serotonin and depression has been researched, debunked, supported, and theorized for years. It is a simple explanation for the complex issue of depression. The debate between the link between serotonin and depression continues to this day, but the most common antidepressant medications prescribed are SSRI ( selective serotonin reuptake inhibitor) drugs. The drugs that are prescribed to Josh fall under this category. Sadly, Josh’s actions do not align with the symptoms of depression. Between the drugs not working and Josh’s symptoms it suggests that Josh was misdiagnosed. 

Josh's Psychiatric report.
Josh’s Psychiatric report.

The illness that Josh most likely suffered from is psychotic depression (different than non-psychotic depression and requires different treatment) and/or schizophrenia. His symptoms fit the criteria for both mental illness’ in accordance with the Diagnostic and Statistical Manual of Mental Disorders. Psychotic depression is a subtype of major depression and occurs when the person suffers some form of psychosis (delusions, hallucinations, and other breaks with reality) during a major depressive episode (“Psychotic Depression”). Those who suffer from psychotic depression usually take a combination of antidepressants and antipsychotic medications. Psychotic depression can be difficult to distinguish from schizophrenia, but the key differential feature between the two is that psychotic depression requires mood symptoms to be present. Those who suffer from schizophrenia suffer from psychosis but do not need to be in a depressive state to have symptoms. Late adolescence and early adulthood is the usual age for onset (“Schizophrenia Facts and Statistics”). It is not known if Josh’s hallucinations only occurred during a depressed state, it is most likely that he suffered from untreated schizophrenia.

Near the end of the game the player gets to witness the hallucinations that Josh suffers from as he goes through major withdrawal. Josh sees grotesque versions of his sisters who taunt him. He sees a giant pig head that wants to consume him. The scene plays out in a confusing and disturbing way, and the player sees what Josh has to live through. This scene serves as the tragedy that is Josh’s mental health and his treatment.

The character of Josh can be interpreted in two different ways. The first way is the stereotypical portrayal of a person with mental illness who causes harm to those near them. This common interpretation perpetrates the belief that those suffering from mental illness are dangerous and cannot be helped. It is this portrayal of mental illness in media that creates the damaging stigma that surrounds real life suffers of mental illness.

The second interpretation, which can only be achieved by examining all the pieces of evidence provided by the game, is that Josh is a tragic figure. He is a victim of the failures of the mental health care system. Josh was consistently misdiagnosed and he suffered tremendously for it. Josh, albeit a fictional character, is a representation of the very real issue of misdiagnosis in the mental health field. With this interpretation the game could be seen as an urging to not push aside and hide mental illness, but instead try to improve the mental health system and improve the care for mental illness sufferers.

Unhappy ending

Until Dawn can be interpreted as a message that current mental health care system is flawed and that issues surrounding mental health need to be readdressed. In this aspect that game breaks away from the trope that mental illness is the equivalent of evil. This is also enhanced by not having the character who suffers from mental illness as the main antagonist. However, the game’s ending for Josh perpetrates another sad trope associated with mental illness: there is no happy ending.

Josh is attacked by Hannah.
Josh is attacked by Hannah.

The game ends with Josh dying at the hands of Hannah’s Wendigo or turning into a malevolent Wendigo himself. The game was never meant to be anything but a homage to the teen-slasher genre, but with slight and important details in regards to Josh’s diagnosis the game deviated from the common black and white portrayal of mental illness in the horror genre, and could be used as a catalyst for discussion. The game could have taken the opportunity to give Josh the chance at a fulfilling life, but instead made him the only one of the eight protagonists in the game who cannot be saved. The mental illness sufferer cannot be saved. It is a message that is portrayed in media all the time and Until Dawn does nothing to contradict the message. It is unfortunate that the creators of Until Dawn took this approach to Josh’s character, especially after leaving numerous evidence that Josh simply needed proper help. Perhaps Josh’s outcome was to reinforce the idea of him as a tragic victim, but the approach, sadly, appropriated a common theme in media portrayal about mental illness.

Josh turns into a Wendigo.
Josh turns into a Wendigo.

Until Dawn is an interesting game to analyze in regards to mental health because it breaks away from a common horror trope in portraying a mental health sufferer as not being the big bad, but rather a tragic figure who was failed by those who swore to help him, but the game also reinforces the idea that a mental health sufferer cannot have a happy ending. Until Dawn is a game that never set out to revolutionize the tropes of the horror genre, the creators considered it as a homage to horror cliches, but it begs the question as to what if the game had? 

Works Cited

  1. Burnett, Andrea. “Schizophrenia”. Psychology 385. Medicine Hat College, Medicine Hat. November 2014. Lecture.
  2. American Psychiatric Association. Diagnostic and Statistical
    Manual of Mental Disorders: DSM-5. 5th ed. Arlington: American Psychiatric Association, 2013. Print.
  3. “Psychotic Depression.” WebMD. WebMD, January 2014. Web. 3 March 2016.
  4. “Schizophrenia Facts and Statistics.” Schizophrenia.com. The Internet Mental Health Initiative. Web. 3 March 2016.

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  1. This game is great. It’s nice to see Agent Beef Hydrastick, Cheerleader and Mr.Robot Anderson in one game.

  2. Definitely one of the best Quantic Dream-style walking simulators I’ve ever played. I actually liked most of the characters (Emily and Mike can get out, though) and enjoyed the monsters a lot, but there is still a fair amount of bad horror movie stuff in it. The beginning prank especially is super cartoonish — 30-something-year-old actors playing high schoolers, talking the way exactly no high schooler has ever talked and playing a prank that’s grotesquely cruel to the point of unbelievable. Maybe because, again, they all look like they’re 35 and should know better.

    It would be fun to see some more games in this style tackling different horror subgenres or homaging different creators. An old-fashioned haunted house movie, an early noughties J-horror throwback, something gooey and gross and Cronenberg-y…

    • Lexzie

      I have to admit that Ashley was my least favourite character of the bunch. I agree, I would love a game that tackled different horror sub genres. I enjoyed Until Dawn, but I always wonder how the game would have turned out if the developers didn’t stay within the confinements of the already established “teen slasher” genre.

  3. This article makes me want to revisit this game.

  4. Emily Deibler

    This article turned out great! I like the examples you gave in the beginning of other horror films and games that use mental institutions and mental illnesses as background. A few days ago, I spoke to someone about how now it seems like newer horror films are using monsters as metaphors for internal struggles. (The Babadook=unresolved post-partum depression remaining because of grief and severe trauma.)

    Excellent work writing about an important topic.

    • Lexzie

      Thank you so much!

      I also never thought about that metaphor in Babadook. I am going to have to pay close attention to the horror films that come out now to see the monsters=metaphors.
      I simply love that metaphor in the horror genre because it reminds so much of classic Silent Hill games.

  5. this game would have been better if they made you the killer, and instead of quick time events and a making choices kinda game, they could have let you just hunt the teens down a kill them any brutal way you can.

  6. This is definitely in my top 5 most favorite games of all time.

  7. This is pretty much an interactive teen ¨horror¨movies from late 80s/early 90s that uhmm…. were not scary at all…Wanna play a TRUE HORROR GAME ? Outlast is your game.

  8. My only real annoyance was that there were two potential character deaths where avoiding them was really counter-intuitive and chancy, and it was pretty clear that the game “expected” you to have them get killed – if they live, they basically disappear from the game and main plot until the very end, one of them only about one-third into the game.

  9. This game was awesome.

  10. Tying mental illness to psychotic horror and violence is problematic. Instead the pointless violence and mayhem should be perpetrated only by people whom the game painstakingly demonstrates are perfectly normal and completely free from any condition found in the DSM.

    It won’t make any sense, of course, but that’s a small price to pay to make sure that the primary purpose of all art is to advance SJW politics.

    • Lexzie

      I understand what you are trying to say, but I have to respectfully disagree with your sentiment. I get the sarcasm and I understand why you would come up with that response in regards to this article.
      I would just like to see a person suffering from mental illness survive and be a functioning human being in society as a portrayal in media more often.

  11. Tayna Healey

    I’ve been watching some Let’s Plays of this. Need to try it.

  12. My interest in this went from non-existant to mildly curious when I read Rami Malek was in this.

  13. IMO the greatest point and click game ever made.

  14. I’m enjoying the hell out of Until Dawn, and I can see myself playing it again once every few months just to see what other outcomes I can come up with (especially around Halloween time).

    It is exactly the kind of game that the unholy mess Beyond Two Souls should have been.

  15. This looks so freaking cool. Thank you for the analysis.

  16. ChristelleMarie Chua

    I loved the game, but also found that the lack of redemption for Josh was really unfortunate. I’m glad they gave us a glimpse at how scary it could be to live in his head — that, truly, to me, was the horror story. However, like you said, it is important to show that those who suffer from mental illness can have happy, fulfilling lives. I saw this parallel in another decision making game, Life is Strange, where the mentally ill character, Nathan, cannot be saved.

    Really great and conclusive article. Thanks for this.

  17. Jacque Venus Tobias

    Mental health is always a topic that needs to be brought to the conversation. Your article section on the complexities of Josh were great. I am not familiar with this game; yet, I can empathize with the situations.

  18. This game is great and, most importantly, doesn’t overstay its welcome. I finished it in a couple days and was eager to replay. It’s also a good game to play with friends who are actually in the same room with you, which is a rarity these days.

  19. I hate that this is an exclusive

    • Yeah, I know… I don’t really need another game system clogging up my entertainment center, but I really want to play this. It’s similar with the Wii U and Super Mario Maker.

      Not that I’m upset that Nintendo isn’t releasing a Mario game on the Xbox or anything. You have a damn handheld system that it’d be perfect for!

  20. Interesting take on mental health..though not sure how I feel about this game tying into schizophrenia.

  21. Love the jumpscares in this game. It’s just so hilarious due to all the randomness. Look, there’s an otter coming out of the TV box!

  22. MattyMayham

    Really good article! While playing the game myself I grew to like Josh and did my best to save him, of course without success. Your article ends with the idea that this video game could have challenged the accepted view of people with mental health issues are without hope. This medium of video game grows stronger everyday with the stories they tell and make you experience, and there getting better at making people take the lessons they teach into our real lives and think for a moment ‘why couldn’t I save him’. Perhaps by portraying the end in that way in a fictional environment they make us ask, and in the end change. This game could have ended with josh’s happy ending, but I find that the more painful endings reach deeper, and perhaps show more meaning. Thank you for your time and efforts.

    • Lexzie

      I agree with you in the assumption that painful endings reach deeper. Many of my favourite stories don’t end with a stereotypical happy ending. However, I sometimes need a happy ending in order to have hope. My biggest gripe was that I can’t seem to recall a tale where the mentally ill main character gets a happy ending. I think there needs to be a better balance in portrayals of “happy” and “unhappy” endings, however I totally understand that the “unhappy” portrayal leads to more discussion of change.
      Thanks for the comment!

  23. I’ve been meaning to look into this game and now I think I will!

  24. Colin Cobb

    I work in mental health and I agree that portraying the mentally ill as evil is extremely destructive. People are terrified when they should be attempting to help them, or at least helping them get help.

  25. Great article I played this game I acctially played a few days ago and I loved the mental health issue trying to bring it to light

  26. LondonFog

    Until Dawn was a solid game and I totally agree that it was sad that Josh didn’t have a happy ending. After all that boy went through that’s all I as a player wanted to give him.

  27. I found Josh to be a tragic figure but I never really though about him from a mental illness perspective. Definitely makes me rethink the significance of him becoming a Wendigo at the end; I mean it struck me as odd when it happened but now that I see it as a mental health stereotype it seems a bit more like a cheap cop-out. Oh well, at least they did attempt to make him seem tragic instead of a straight up evil murderer like most games.

    • The funny thing is, Josh is one of the only two characters that can not do something that can kill another person.
      Josh and Jessica (and Chris, but he can ‘technically’ kill Ashley, or at least he thinks he does.)

  28. I watched a Let’s Play of this a while back and haven’t really thought of it since, and this article has got me thinking about it more in-depth. It’s interesting that the first (and possibly most) Wendigos were psychiatric patients getting experimental treatment. Initially I had been annoyed at the portrayal of people with mental illnesses as literal monsters, but I’ve realized that this is more a Frankenstein situation: the real monster is the doctor using psychiatric patients to experiment with potentially dangerous drugs. While more barbaric, this is similar to how Josh, and many others, are treated in the medical world: slap a title on their illness, throw some drugs at them, and hope for the best. i think the real moral here is that mistreatment and misdiagnosis does more harm than good, and leads to a complete failure from the medical system. In this case, the failure led to turning people suffering with mental illness into monsters. In this way, I think that Josh had to have the same outcome as the other patients — either becoming a Wendigo or being eaten by one. It’s a tragic case of doing the same thing and expecting different results.

    On a slightly more optimistic side, I think as much as the player wants to help Josh, if you had been able to it would promote the belief that another person can save you from your mental illness. Which is a trope that desperately needs to be dropped from film and literature. As much as you can encourage someone to seek treatment, they have to take the first step to recovery, otherwise it won’t work out. Outsiders cannot save you from mental illness, you have to save yourself. Josh had stopped taking his medication and was ignoring his psychiatrist, at that point he really didn’t want to be helped. If he had survived, his parents would most likely put him back into treatment, and he would probably ignore it again.

  29. The exact point of the game(i think) is, that it’s a game ALL about choice. But Josh had no choice. Schizophrenia(or Psychotic Depression) is in the genes, and he had no choice getting the illness in the first place. He had NO choice, when they pulled a prank, that would kill his two sisters, since he was pasted out. He had no choice, when the system diagnosed him with the wrong disorder.
    And even in death he had NO choice.
    I think Until Dawn is a metaphor about mental illness. The Wendigos are the illness. It shows no mercy, tries to hit you when you least expect it and it gives you no where to escape.

    When you think of it that way, it is(to me) the most scary horrorgame in the world.

  30. I’d like to play the game! Sounds good!

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