I’ve been partially deaf since the age five. Experiencing life with poor hearing is like playing an eternal guessing game. A lot of the time, you’re not quite sure what’s going on in any particular conversation, so you have to somehow tie what threads you have together and then roll with it. It creates a lot of awkward moments, and requires a lot of uncomfortable explanations. I’ve always been very self-conscious about my hearing, and rarely bring it up unless I absolutely have too: usually that’s when people think I’m ignoring them on purpose.

It often feels like I’m witnessing the world through a kind of filter, one that makes everything feel a little more distant. It’s difficult knowing that there’s always something I’m missing out on when it comes to hearing sounds, and because of this, I can never be truly certain of what’s going on around me.

This feeling of disassociation inevitably leaks over into my experience of playing video games. Exploring imaginary worlds is one of my greatest pleasures, and when it comes to games that have a narrative focus, which count for most of the games I play, not being able to fully hear audio means I can struggle to feel connected to what’s happening on screen. Much like many of my experiences of the real world, there’s still always this barrier between me and this world I’m supposed to be inhabiting, that I can never quite overcome.

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However, due to the wonders of Britain’s national health-care system (God save it), I was able to recently undergo an operation which has dramatically improved the hearing in my right ear. Being able to hear this well again has been an incredibly strange and enlightening experience. Every new discovery is both amazing and terrifying all at once; like finding out that you’ve had a helicopter rotor protruding from your back this whole time, and you’ve only now just noticed that it’s there.

By pure coincidence, I also happened to buy Hellblade: Senua’s Sacrifice days before the operation. Published and developed by the now independent studio Ninja Theory, Hellblade has received praise for how it uses sound design to authentically depict some aspects of psychosis (though the game's depiction overall has received some pointed criticism). I was still adjusting to my newly improved hearing at the time, and so it came as quite the shock when I first heard the voices inside Senua’s head. What came after was possibly one the most emotionally intense gaming experiences I’ve ever encountered: all thanks to one moment of complete happenstance.

Almost all of Hellblade’s audio was recorded using binaural microphones, which are designed to replicate the way we naturally hear by capturing sound as it moves around a set point (in the case of Hellblade, a foam model of a person’s head), and then re-playing those sounds around the listener's head in the exact same way. Which is also why players are required to wear headphones, because each individual sound needs to be played from its corresponding side for it work. I was almost entirely deaf in my right ear prior to my operation, which meant that whenever I used headphones, I had to entirely rely on my left ear to hear any of the audio. I had never been more aware of what I’d been missing out on when I had first heard those voices coming into my right ear.

Which is a very strange thing, because the spatial element of Hellblade’s sound design plays on the very idea of tricking your senses into imagining that the game’s audio is real. It’s like an inception complex, where the player is made to believe two levels of created realities; the game’s world, and the world projected by Senua’s psychosis. It was weird to play a game where the protagonist's condition directly affects the game’s audio, when own my poor hearing has made me perceive audio differently as well. When I realised this, I instantly felt a kinship with Senua, because I had experienced the world through my own strange filter, and knew some sense of the alienation that comes with that.

I recently spoke with Tameem Antoniades; lead creative director and writer for Hellblade. We discussed how the game’s sound design became a driving point for representing its key themes of social stigma and mental illness.

When I asked what drew Antoniades towards binaural sound design, he instantly recalled the conversations he and his research team had shared with a support group called ‘The Voice Collective”—a charity that helps people who experience the symptoms of psychosis. They had described how the voices they heard felt like they were physically there; moving around and changing directions. Antoniades was determined to authentically emulate the experience of psychosis in Hellblade, so the audio had to be recorded binaurally: “We thought it was important enough that we should go down that route, and try to encourage as many people as possible to play with headphones.”

Antoniades described psychosis as what happens when someone’s inner thoughts merge with their reality. There’s no firm line between ‘normal brain function’ and psychosis, simply a gradual shift towards believing that things like hallucinations and delusions are real: which is why many people who do experience psychosis do not necessarily believe they are suffering from a mental illness. Removing the damaging stigma many people have towards psychosis was one of Ninja Theory’s primary aims when making Hellblade. So by making the player experience the symptoms of psychosis that they could replicate (the hallucinations, hearing voices, etc….), they hoped that people would better empathise with those who do live with it.

Recognising that the voices Senua hears are "real" in Hellblade’s world, was something that I could better manage with my improved hearing. The immersion felt so much more effective now that I could take in every voice, and give them a physical presence. It was not enough for me to simply witness Senua’s struggle. I needed to be able feel those voices also harrying and encouraging me, in order to fully empathise with Senua's experiences.

When I mentioned how impressed I was that the voices in Hellblade consistently managed to invoke so much emotion, Antoniades described how much thought was put into ensuring that the voices would sound realistic. He discussed how he disliked the obsession that modern sound designers have with clean recording, because it prizes quality over authenticity. Which is why his lead sound designer, David Garcia, recorded in open spaces that allowed for plenty of movement: “If you hear anyone speak in real life, then you’re hearing [...] the physical movements in their breath as they move around [..] so we had the actors running around, and tumbling, and struggling with each other.”

I’m so used to settling for the most basic version of audio, that I was surprised by how much I had picked up whilst playing Hellblade. I remembered hearing exactly what Antoniades was describing as we were talking about it, and found it amazing that I could actually make that connection. It felt like I was part of a shared experience, of something that I’d always been unable to relate to and yet finally could.

Antoniades insisted on continuously changing out voice actors, so that audiences could imagine that each voice represented a different aspect of Senua’s personality. The voices do more than just depict Senua’s psychosis, they tell her story of grief and self-acceptance. Catching every stray comment and observation helped me to build an understanding of Senua’s character, one that I wouldn’t have had without hearing these things. So that when the time came for Senua’s story to reach its end, it had so much more of an impact because I’d been able to follow it all the way through. I hadn’t had to fill in the gaps in Hellblade’s story: I had understood every part of it.

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This newfound sense of understanding bled into my experience with the game’s combat, because audio is heavily featured there as well. In our interview, Antoniades described how he had to fight to fit Hellblade’s combat around its sound design:

It was a constant battle with the combat designer; he wanted the camera pulled out, I wanted it kept in. He was like: "How are you going to tell if you’re going to get hit from behind?" And I was like: "No, players have to rely on sound, and on the voices." "But what if people don’t listen to the voices?" "Well then you’re stuffed!" I said.

Here, Antoniades is referring to how players need to listen for audio cues during combat: such as the voices’ warnings, or the sounds made by your enemies. Awareness and positioning are both essential mechanics to master in order to survive combat encounters, which can get incredibly intense, especially during the last few hours of the game.

There's an uncomfortable irony here: in many ways, this design decision potentially excludes people with worse hearing than even myself: namely those who are entirely deaf. While for obvious reasons I have reservations about people possibly not being able to play because of an impairment or disability, I appreciate such an unconventional combat system and the way its function reinforces the game's themes.