Since the 1990s with the Clock Tower series, games have been interested in examining the use of sanity both as a mechanic and as a plot device. Many horror games have since adopted this Lovecraftian trope in various ways. I would like to take some time in examining the various tropes and approaches studios have used since then for interpreting the loss of sanity, while also postulating where it could go going forward.
In the subtitle I made a distinction between sanity as plot device and as a mechanic. That is because there are games that has the protagonist struggling with sanity that is not influenced by systemic consequence, instead being the result of progressing through the story as a way of building tension, or character development. Since Clock Tower used sanity as a mechanic, I will start from there.
Fear the Dark
Generally, when sanity is used as a mechanic it acts like a secondary health bar that is usually invisible to the player, using diegetic cues to inform the player of its status. Complete depletion of the sanity bar can result directly in death (Call of Cthulhu: Dark Corners of the Earth), or it debilitates player agency through restricting movement, vision or hearing (Clock Tower, Haunted Grounds, Amnesia: The Dark Descent, etc.). Two of the major elements that can drain your sanity are seeing or hearing the monster/enemy that will chase you, or staying in darkness for too long. In Amnesia: The Dark Descent, players are meant to hide to evade the monsters that roam the castle, and they are equipped with tinderboxes to light candles, and a lantern that has a finite (but refillable) amount of oil.
Paranoid, Abusive, Selfish or Irrational?
In the Darkest Dungeon, you send your party into dungeons with a finite number of torches, so tight resource management, and eliminating stress inducing enemies first in a fight are necessary for long term success. An interesting spin in this game is the use of a sanity “test” when a character has reached 100 stress (200 being a heart attack and death). There’s a small chance they can end up being virtuous, which reduces stress buildup and can provide buffs to heroes, but generally will end up indefinitely insane until returned to the Hamlet. These bouts of madness are generally represented in negative character traits that has the afflicted acting out against other party members, skipping their turn altogether or interacting with objects in the dungeon that are detrimental.
A quick note as well to mention the game with possibly the most extreme and meta interpretation of the mechanic, Eternal Darkness: Sanity’s Requiem. In this game your sanity is drained by eyeing the monsters for too long, and is reduced by hacking away at their corpse upon defeat. If your sanity meter got too low however, the game would start to play tricks directly on the player, such as: pretending to delete your save, cutting to a bluescreen, and making it seems like the TV had muted itself accidentally. While it is certainly interesting, the idea of targeting the player instead of the character does pose some interesting questions about immersion and tension.
In Outlast 2, you play an investigative journalist Blake who is doing a feature on a pregnant woman mysteriously found on the side of the road in Northern Arizona. As Blake makes his way through the wilderness, he starts to hear things, and sometimes when he picks up a document or re-watches a grizzly scene he has recorded, refers to a character named Jessica. Throughout the game as well you will suddenly end up in a school, whose clean and quiet atmosphere juxtaposes well with the rest of the game. What the player finds out over time is that these hallucinatory sections are Blake’s catholic school from his youth. You begin to unravel the story behind Jessica, resulting in a tragic self realization for Blake, leaving him completely broken by the end of the game.
Nothing in Outlast 2 is systemic in the way it handles the characters’ sanity. It’s a linear, curated experience where every hallucination or change in scenery is a conscious choice, meant to drive the mystery forward. Other games that follow similar structures are: Condemned: Criminal Origins, Layers of Fear and Blair Witch. With this approach you have much more creative freedom in how these events manifest, as you’re not bound in maintaining a cohesive system that has to account for all the different decisions players can take throughout the game. Sanity can have a personal value for the protagonist and can allow a deeper understanding through the manifestations of their psyche.
The main trade off is that the player is not longer interacting with their sanity in the same way. It is not a resource, and as such the effectiveness is based on emotional investment. From a game to game basis, this means that they run the risk of not communicating the relevancy of an event to their character, or even worse, failing to resonate with players at all.
A Variety of Insanity
There are of course games that have aspects from both approaches. In Amnesia the Dark Descent, while the result of sanity loss always manifests in the same way as you play the game, there will be sections where the game forces you to a crawl, and you begin to hear conversations in your head that provide exposition and insight into your character’s psychology.
Conversely, in Layers of Fear, all of the events you witness provide some insight into the character’s mind, the interactive portion stems from manipulating the environment based on where the player character is facing.
In a nutshell, an effective rendering of sanity in games as both an interactive element and a plot device is important for immersion and fulfillment once the story has concluded. It is crucial for the player to feel complicit in managing their protagonists’ sanity, while also becoming invested in that character’s psychology and story arc. In terms of how this can be handled in the future, games can start taking a look at the actual environments the characters are placed in, and how you can represent low sanity manifestations in a unique way for each setting. Other things to consider are where the player is at in their personal arc and self discovery, the “real” threats that the player faces, and also whether or not you even want a characters’ hallucinations to be a result of their own minds, or an external force that borders on the absurd.