What ‘Until Dawn’ teaches about mental health, and why it is important.

WARNING: SPOILERS FOR UNTIL DAWN (2014).

Until Dawn is a psychological horror game, with emphasis on the psychological part. This article will discuss what this game teaches its audience about mental health illnesses, and why this is important. Mental illness is shown primarily through the character of Josh Washington, the elder brother of twins Hannah and Beth Washington, who go missing at the beginning of the game. This game is broken up by therapy sessions, although it is not immediately apparent who the player is playing as during these sessions. Josh, also known as The Psycho, is the only character who is not able to be rescued at the end of the night; either dying or turning into a Wendigo.

The first appearance of Josh in Until Dawn was when he was unconscious, presumably from drinking too much alcohol. He is at the lodge with the others and is downstairs in the kitchen when the player first gets to move around as Beth. The second appearance is when the player starts noticing that something isn’t right.  In a cutscene, you see Josh in a video on Sam’s phone. It’s like a welcome back video, as the group is returning to the lodge one year after Hannah and Beth go missing. Josh is very clearly excited about this, but it is easy to get a gut feeling that something isn’t right with Josh, right from the beginning. He’s trying too hard. It’s almost like he is working too hard to be happy. Out of everyone in the group, Josh would have had it the hardest during the past year. He was the older brother of Hannah and Beth. He was likely held responsible for their disappearances by their parents because he was meant to be looking after his sisters while they were at the lodge. More importantly, Josh likely held himself responsible. If he hadn’t drunk so much alcohol that he passed out, he might have been able to prevent them from running off. He might have been able to comfort Hannah instead of her running off, which would have also prevented Beth running off. He might have been able to catch up to Hannah before Beth did, and therefore talk sense into her. Josh probably felt a lot of guilt regarding the situation, which is why this video is so off-putting. He seems overly happy, overly excited. There is something off, but it is challenging to work out what with the limited information available at the time.

Skipping forward a little bit, the big (immediate) issue that the group face during this horror night is The Psycho. He is the secondary antagonist that taunts the group, psychologically torturing each and every one of them. The group are led to believe that this guy is the one who killed Hannah and Beth a year ago, and now he was back to get the rest of them. His first kill is Josh, which makes the idea of this murderer being back for more even more likeable because the first person he goes after is Hannah and Beth’s older brother. Josh gets cut in half in front of Chris and Ashley. At this point, The Psycho is torturing Chris, making him pick between his best friend and love interest, and then just killing his best friend regardless. So, Josh is dead.

Until he isn’t, of course, because in a shocking turn of events, Josh is actually The Psycho. He means well, but his friends do not see it that way, probably because of the whole psychological torture process that Josh made them endure. Josh explains that he had a plan, that he was filming the entire thing and was going to upload it online to make the group famous. His friends were less than impressed at his plan, and at this point, the player realises that there is something psychologically wrong with Josh because he just tortured – and depending on how you play the game, caused the death of – the people who were meant to be his friends. It was all for some video that might not even go viral.

So, let us dig deeper into Josh’s head.

Remi Malek, who portrays Joshua through voice acting and motion capture, states that Josh’s original reason for inviting everyone back a year after the disappearance of Hannah and Beth is so that everyone could get a little bit of closure. His intentions were always good.

Looking at the psychiatric report that can be found by Sam, you can see that Josh has suffered from mental illness since he was a child. He had been on many different medications to treat the same thing- depression. Looking further down, it is shown that Josh was referred to Dr Hill as he was at risk of suicide after the disappearance of Hannah and Beth. He was put under observation and then treated with medications. Dr Hill believed that Josh needed a higher than the normal dose to see improvement. But there is a much bigger issue here that this game touches on quite well, and that is how medical professionals treat mental illness.  

This is not to say that medical professionals fail because of something on their behalf. The issue with mental illness is that no one knows how to treat it efficiently. People, especially children, in treatment (such as therapy) know that their treatment is not working, but feel they cannot speak out for two reasons. The first reason is that it is meant to work. Treatments such as CBT and antidepressants are intended to work and expected to work. When these treatments do not work, the patient is often left feeling like they are too sick for treatment. The second reason patients with mental illness do not feel able to speak out is because they are unable to offer an alternative. As a whole, people who are mentally ill do not know what kind of treatment or support that they need, similarly to people who are physically sick. They rely on professionals. With physical illness, the goal is typically to fix the symptoms. Some doctors treat mental illness this way as well, especially due to mental illness being linked to physical symptoms. However, this is also the route that antidepressants take. They balance out the chemicals in the brain, but at the end of the treatment, the patient still has depression.

Let’s take a further look at Josh’s medical records. Joshua had been seeking treatment since 2006, when he would have been 10 or 11. He was a child. He was also put on antidepressants around this time. Antidepressants are typically not used in children or teenagers (below the age of 18) due to the risk of suicide or self-harm that may be caused by the medication for this group age. However, exceptions are made after the patient has already tried therapies (such as CBT) and have been unresponsive. The question that needs to be asked is: was Josh under some kind of therapy before he was put on antidepressants when he was a child? The short answer is, we do not know. However, it is unlikely. He was referred to Jeremy Harris on 11th June 2006. He was then put on antidepressants on the 18th June 2006, just a week later. It is improbable that in this time, they tried some kind of therapy and decided that Josh was unresponsive to the treatment. According to ABC News, one in ten Americans over the age of twelve are taking antidepressants. Yet, less than one-third of these patients are seeing a mental health professional, such as a psychiatrist or therapist.

The problem with taking antidepressants without some kind of therapy is that it does not solve the problem, it just hinders the symptoms to make depression easier to cope with. Let’s put this in a physical condition situation. Let’s imagine you have a headache. You take a pain killer (paracetamol, for example), and the pain goes away for a little bit. This is a repeated occurrence. You go to the doctor because you’ve had this headache almost non-stop for a few months by this point. It’s easy to tell that there is something else wrong. Something is causing those headaches. Paracetamol is not enough to fix the cause of the issue. Similarly, antidepressants are not enough to fix depression. It merely suppresses the symptoms of depression. This can be fine for people who are having depressive episodes, but depression itself is not that easy to solve. It is an illness. It is not just going to pass by.

Depression is often caused by (as well as other things, including genetics) environmental factors. This is why therapy is so vital to the recovery of those patients who have depression. While undergoing therapy, patients are able to establish a different way of thinking about negative situations in their lives, as well as being able to express how they are feeling about these situations (that being said, there are many types of therapies that work in different ways). It helps to heal the problem rather than suppressing the symptoms like antidepressants.

Next, let’s talk about why some people would want to go on antidepressants and the symptoms of depression itself. This will help us better understand Josh’s situation. Depression is not just being sad all of the time. More than that, it is feeling numb. It’s not feeling anything, despite knowing that you are meant to. It is looking at your parents and saying “I love you” because that is what you are expected to do, not because you feel that way. There sometimes comes a point when you have depression that days blur into each other, you sleep through most things, you are constantly sick, and you isolate yourself. The physical symptoms of depression include insomnia, headaches, and stomach aches. These things, although happen to everyone, can be debilitating. For example, having a headache for every day for a month will eventually lead to symptoms such as nausea. Insomnia, or struggling to sleep in general, can worsen the mood of someone, making them more irritable. However, it can also shorten someone’s concentration, making them less likely to be able to do their daily tasks up to their usual standard. Experiencing just one of these symptoms every day for a long time can be worrying, but also frustrating as it does get in the way of everyday life. If the doctors put Josh on antidepressants a mere week after first being seen regarding mental illness, it would be wise to assume that Josh had more than one symptom, and was experiencing them quite severely. As for therapy, Josh may have experienced therapy alongside taking his medication.

However, the most likely answer is that he was put on a waitlist for some kind of therapy and while waiting, the medical professionals thought that it would be best to attempt to reduce Josh’s symptoms to help him handle day to day life a little better. Unfortunately, a child suffering from depression is not uncommon; rather, the opposite. Medical professions should act forcefully when treating a child with depression due to the high risk of suicide. Children are often more pressed with the ideologies of social groups, school work, and growing up in general. As adults, it is easy to forget how hard all these things were at the time because they seem easy to deal with in adulthood. However, for a child dealing with depression, dealing with social pressures is extremely difficult. Adults often dismiss the feelings of children who are struggling, as they feel like they had gone through the same thing and what they are going through is small in comparison to real-world problems. They often forget that children do not have to deal with real-world issues, and therefore they have nothing to compare this negative situation to. It may feel like the end of the world to them, and depression can cause these thoughts to turn suicidal. This is why it is so important for doctors to put children in therapy. However, this creates an issue in terms of waiting lists. There are not enough therapists around to have sessions with all the children that need it. In America and other places without free healthcare, there is also the worry of cost. Parents are sometimes hesitant to send their children to therapy as it costs significantly more than medication, and they often do not understand that their child needs therapy. The most likely case for Joshua, as stated above, is that he was put on a waitlist during this time, and his antidepressant medication is merely to help with the symptoms.

So far, the main topic of this post has been focused on Joshua’s psychiatric report. Next, the discussion is momentarily directed to the therapy sessions that break up the game a little. The player plays through these sessions as Josh, as he talks to Dr Hill about the game that he intends to play on his friends. Dr Hill questions the root of Josh’s anxieties, asks which friend he likes least and most; overall, it seems pretty basic. It is evident that this is the way that the game finds out what you are scared of, and which characters you like least or most. It is a horror game. It is meant to make the player uncomfortable. However, the main thing that needs to be addressed here is that the therapy sessions are not advanced enough to be helpful, due to the short amount of time that they take up. This reflects how many people find therapy unhelpful for (typically) one or two reasons. One being the lack of time spent there, and the other being that what the therapist directs the conversation to is irrelevant to the problems at hand. Both of these issues will be addressed.

All the scenes with Dr Hill take roughly 20 minutes, perhaps a bit longer or shorter depending on how quickly you answer the questions. There are 10 Chapters in Until Dawn. Each chapter takes roughly an hour, depending on how you play the game. Twenty minutes for ten chapters mean 2 minutes for each chapter (approximately). This is 2 minutes with a character that is meant to be helping you through the game. This is a refreshingly realistic aspect of the game, although exaggerated. The majority of patients seeing a therapist see them either once a week, or once every two weeks. This changes depending on different things, such as the patient’s financial situation, the patient’s and therapist’s availability, and if the therapist thinks the patient needs more or less time.

Taking the best-case scenario of the majority, the once a week arrangement, that means that the patient would be seeing their therapist for one or two hours out of 168 hours. That means that a lot is going on in the patient’s life that will probably not get discussed due to more pressing issues. Despite Josh’s therapy sessions in Until Dawn being hallucinations, it is still a good insight as to how therapy works. In the prologue, Dr Hill asks you how you feel about a scarecrow image. He asks if it makes you uncomfortable, would you want to stay in the place, even if it was haunted, those types of questions. They seem irrelevant, but they’re not. This allows the therapist to understand how the patient thinks more.

The second session, at the end of the first chapter, is a lot more direct. The game gives the player a choice of two things, and the player is asked which scares them the most out of the two. According to Dr Hill, it is to understand the root of anxieties. However, remembering that the patient in question here is Joshua, it becomes clearer what is going on. Josh does not have anxiety. He has depression. Therefore, these questions are meaningless and a waste of time to him. This is not helping him get better as he does not need help with his anxiety. He has 1-2 hours to talk about what is making him depressed (likely the disappearance of his younger sisters at this point), but his therapist would rather ask him about what scares him. Not what makes him sad or angry or upset. Not why he is depressed. But what scares him. This is something that is entirely irrelevant to Josh’s situation. This aspect of the game teaches players that therapy sessions for those who need it are short and sometimes unhelpful.

Now, the main event. Josh’s hallucination in Chapter 10. This particular part of the game is terrifying yet refreshingly realistic. This hallucination helps the player understand a little bit more about why Josh did what he did. It becomes very evident that Joshua is not well. Hallucinations can happen to anyone, on any scale. However, it is highly suggested that Joshua suffers from a mental illness called schizophrenia. This is not his imagination; it is not him being tired; it is a mental illness that affects a lot of people. As someone who has psychosis, I saw this scene and felt reassured that the Until Dawn team did their research. I hallucinate daily, and it does get that bad, and it is that scary, even if you deal with it every day.

Joshua is terrified in this scene, and it is heartbreaking to watch.  Joshua needs help. One thing that is often pointed out on the internet is that depression was not Josh’s biggest problem, but schizophrenia was; that he should have been on medication for schizophrenia instead of depression. However, antipsychotics have a lot of side effects, and they are often more severe than antidepressants. There is also the issue of since Josh has been on antidepressants for so long, there may be side effects to him coming off them and starting a new medication. Of course, he could have taken both antipsychotic and antidepressant; however, mixing these two drugs may not always be beneficial. The point also needs to be made that Josh had been on several different antidepressants. They all have different side effects, and it is important for antidepressants to get into your system to have a stable effect. If there is a lack of stability in terms of antidepressants, there is a risk of there being a negative reaction if the antipsychotics are also taken. It is also important to remember that schizophrenia can develop slowly, and often in the teenage years. Josh was already being seen by a mental health professional at this time, and we know this because of his psychiatric report. It is sometimes complicated for medical professionals to pick up on new symptoms that a current patient is developing, even more so due to it developing during the teenage years. Josh is 20 during the game. Some people still count this as being a teenager; however, with the recent events of the disappearance of Hannah and Beth, it would be understandable if the doctors wanted to focus on his depression, rather than looking into new symptoms.

In conclusion, Until Dawn teaches the player a lot about mental illness and how it affects the person who is struggling with it. The scene in which Joshua has a hallucination, you can see how scared he is. It is not clear as to if Joshua has experienced this before, but regardless, it shows that even people who (potentially) have this happen every day can still be scared. Joshua’s changes in medication show that nothing is set in stone. In regards to how quickly Joshua was put on medication, it shows that therapy is not always an option at first and that sometimes it is better to treat the symptoms of mental illness rather than not treating it at all. It was likely difficult to diagnose Joshua with schizophrenia due to both the age he was when he started getting medical treatment. Because of the age, his symptoms likely first started- his teenage years. After the disappearance of Hannah and Beth, it would be understandable for the doctors to focus on Joshua’s depression. Above everything else, Until Dawn teaches the player that mental illness is a scary thing to go through and that treatment is not as simple as just going to therapy or just taking medication; it teaches the player that people with mental illness need help, because they are not okay, which seems obvious but due to stigma surrounding mental illness, it is not.

And why is this so important? Because this game is scarily realistic in terms of Joshua’s mental health. This stuff happens to real people on a daily basis. Mistreatment and misunderstanding lead to patient’s mental illnesses becoming worse; however, that is somehow unavoidable. We know Josh is getting treatment, yet his mental health is still extremely hindered due to misunderstanding and mistreatment.

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