I can be stabbed, poisoned, and fall from a balcony, but still, in Dark Souls, the so-called toughest of the tough games, I can run, dodge, and fight. The health bar may run low—ostensibly, I can be "near death"—but to look at my character, you wouldn't know I was hurt. Same goes for the Uncharted, Assassin's Creed, Grand Theft Auto, and Call of Duty series. In fact, in almost every video game, no matter how badly my character is allegedly hurt, he moves and functions as if perfectly healthy. John Marston might get shot in the gut, but he can still run and aim his pistol as usual.
It's ludicrous and unfair to expect games to adhere, wholesale, to the rules of reality. Health systems in games are a flourish, an example of artistic license—personally, I doubt I would enjoy a shooting game wherein every time I was hit, I had to wait six months until I could play again. But there is a mid-point, a way of depicting health more faithfully that, rather than making games less enjoyable, accords them depth and intrigue. Health bars, which truncate all the nuances of physical injury into cold, basic graphics, are a reductive way of representing a character's status. To get a fuller sense of physical pain in games, characters need to be shown to be hurt—they need to limp, double over, and bleed.
When Max Payne staggers his way through the stadium mission in Max Payne 3, or crawls away from the burning offices of Fabricas-Branco, one can feel his pain. And Max Payne 3 is a game about Max's pain. He sweats, he swears, he bleeds—his physical deterioration matches perfectly the game itself, which gradually becomes more violent, more difficult, and more of an ordeal for the player.
Similarly, in this year's Layers of Fear, as the character hobbles around on a visible limp, the player gets a sense of his life. Through trying to complete his masterpiece, he has lost his child, his wife, his mind, and of course, his leg. He is a profoundly damaged character, and by illustrating clearly his physical ailment, the game makers encourage players to understand his mental suffering, also.
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Not that explicit physical injury need always reflect greater narrative themes. Being wounded—physically wounded—during a combat encounter, for me at least, makes that combat encounter more exciting. I adore the sequence at the end of the autumn section in The Last of Us, where Joel has been impaled on the metal rod and must struggle his way through the encroaching bandits. His wobbling aim and jagged movement create tension, a sense of being there.
When your character is overtly at death's door, rather than performing normally, fights become urgent and frightening. And that's something video games regularly fail to achieve. When combat and killing has become so blasé in games, adding a hint of desperation—insinuating to the player that mistakes can legitimately hurt the character, and that one more may kill him—lends a much needed sense of consequence.
I'd like to say that DayZ, Rust, and the Fallout series, "survival based" games where gunshots make characters limp or slowly bleed to death lest treated, are more effective at conveying medical emergency and the nuances of treatment. But they're very mechanical, very cold. The wounds may have different names, but the act of treating them is still the same: apply item to character. Similarly, Darkest Dungeon and Amnesia: The Dark Descent, games that attempt to illustrate not just physical but mental health deterioration, treat the human mind as a simple machine that can be simply repaired.
A character in Darkest Dungeon may become "hopeless" or "paranoid," but these emotions, broad and complex in real life, are remedied by simply returning a character to the home world and letting him rest—for the players at least, they are combated with a single, universal medicine. Likewise, "insanity" in Amnesia is cured by turning the character's eyes away from whatever horror or monster originally caused it.
Treatment for mental health is especially variable. There's an enormous range of traumas that can contribute to a person's depression, anxiety, or personality disorder, and huge variety of drugs and therapies: A game where something as idiosyncratic as a person's "paranoia" can be remedied the same way as another person's "hopelessness" strikes me as tokenistic, as using "status effects," the same as Final Fantasy's "poisoned" or "berserk," only with deliberately more adulterated names intended for cheap shock value. Also, these games represent mental health using physical, visual markers. Insanity is depicted in Amnesia by the player's screen becoming increasingly distorted. In Darkest Dungeon, when a character crosses an invisible threshold between healthy and "hopeless," the game signifies it with a pop up.
Mental health problems, rarely, are distinguished visually—a person may appear fine, but inside be depressed, anxious, or otherwise mentally ill. More commonly, mental health problems are described using words and speech. The majority of therapies, rather than simply showing a psychologist something upon one's body, involve talking the problem through. Almost by their nature, mental health issues belie visual recognition. Yet video games, seemingly from a desire to be taken seriously and deal with serious topics, yet unwilling or unable to do justice to these topics in their entirety, treat mental illness in the same way as physical pain. In Darkest Dungeon and Amnesia, mental health problems occur in an instant. In the next, they are remedied, completely.
More faithful to the nature of mental illness is Jasper Byrne's Lone Survivor, wherein the character, rather than a flashing bar or a list of status effects, explains his mental well-being through words. "I'm tired," he will say. "I can't go on much more." Pills can be taken, but their effects are undetermined. There is no bar to refill, no screen distortion to dissipate—taking tablets for your character's mental problems, in Lone Survivor, is much more akin to treating mental health in reality. You have to try, wait, and determine by yourself whether there is any improvement.
Advocating for more "realism" from video games is petulant and meaningless: These are creative works, licensed to use flourishes and metaphor. But contrary to what seem to be the accepted standards, more nuanced representation of physical and mental health problems could make video games more exciting. A shootout, once your character is visibly near death, becomes more tense. A horror game, when you are implicitly aware that your character is on the verge of collapse, but unsure of when it might occur, is much more unnerving.
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