Tori Foreman
Professor Saenz
Psychology 2301
14 November 2022
Ellie Williams: An Analysis of Posttraumatic Stress
Disorder Representation in The Last of Us
Ellie is one of the main characters in the video games The Last of Us, The Last of Us:
Left Behind, and The Last of Us Part II. Within the context of these games, Ellie shows
numerous significant signs of Post-Traumatic Stress Disorder, manifesting in different ways over
the span of approximately 4-5 years, at least. In this discussion of my thoughts of this
diagnosis, I will be covering topics including a summary of the events occurring across the
games that could have contributed to and lead to Ellie’s trauma, specific examples and
descriptions of some of these events that may not be elaborated on in the summary, the DSM-V
diagnostic criteria that Ellie meets specifically for PTSD, the “4 D’s” of diagnosing mental
disorders that are present within Ellie’s experiences, and my personal recommendation of a
treatment/recovery plan.
In order to fully explain why I think Ellie qualifies for a PTSD diagnosis, I first need to
give a summary of the games which will help paint a picture of the events leading to and
contributing to her overall trauma. In the world of The Last of Us, the United States has been
taken over by an outbreak of CBI, Cordyceps Brain Infection, for the last 20 or more years. The
CBI is a mutation of the Cordyceps fungus that is able to inhabit humans through either the
spread of bodily fluids from infected individuals (most often a bite) or through airborne spores.
Once exposed to the virus, individuals typically “turn”, or succumb to the infection, within two
days and go through various stages and severities of the virus over time. However, Ellie, age
14 at the time, finds out through a near-death experience in Boston that she is immune to this
virus. She is bitten along with her best friend, Riley, inside of an abandoned mall during the
events of The Last of Us: Left Behind, and comes to this conclusion of immunity when Riley
turns but she does not. Following this discovery, Ellie seeks the help of another friend of hers,
Marlene. Marlene is a member of an organization called the Fireflies, a group who protests
against the military and also looks for a cure for the CBI. When Marlene finds out Ellie is
immune to the virus, she attempts to get Ellie to other Fireflies who can possibly make a vaccine
from this discovery. However, she is unable to do so herself and instead enlists two smugglers,
Tess and Joel, for the job. Initially, the three were only meant to make a short trip across the
city. However, the Fireflies they intended to meet were not at this location, and this sends them
to another possible meetup point. In the process, Tess is infected and killed, leaving Joel and
Ellie to finish the mission alone. Now, for the best chance at a new lead, the two must travel to
yet another location: this time, it is Jackson, Wyoming, where Joel’s ex-Firefly younger brother,
Tommy, is thought to be living. During the trip to Wyoming, the two find themselves in Pittsburg
, and meet brother duo Henry and Sam. Though initially wary of each other, the four agree to
work together to rendezvous with a group Henry and Sam were meant to meet. However, in
their attempt to make it there, Sam is infected and winds up attacking Ellie. Henry kills Sam to
protect Ellie, then immediately commits suicide out of guilt. Joel and Ellie must once again
make the journey alone, Ellie not unaffected by what happened. After reaching Jackson and
Tommy, the two are sent to a university in Colorado. While at the university, Joel is ambushed
by a hunter and falls, being impaled through the abdomen with a piece of metal. Joel manages
to make it out alive with Ellie, but Ellie has to care for Joel for an undetermined amount of time
while he heals. At one point during this time period, when Ellie goes hunting for the two, she
encounters two men named David and James. David orders James to retrieve medicine for
Ellie in exchange for a deer she killed. In the meantime, David puts together that Ellie was
traveling with Joel who apparently killed a lot of his men. He winds up taking Ellie hostage, she
manages to escape, and David nearly kills Ellie in a very disturbing sequence. Joel came to her
rescue when he realized she was gone and the two made it out once again and continued
moving forward. Finally, after what seems to be many more months of travel and peril, Joel and
Ellie make it to St. Mary’s Hospital in Salt Lake City, Utah, where the Fireflies actually are.
There are scientists and a surgeon there that determine they can in fact make a vaccine from
Ellie’s biological mutation of the virus. But in order to do so they would essentially have to kill
her, since the virus grows in the brain and there would be no way to retrieve the virus without
killing “the host,” according to the surgeon. Joel refuses to accept due to his bond with Ellie that
has grown throughout their time together. Joel was present for the earliest stages of the
outbreak, and his teenaged daughter, Sarah, was killed in an attempt to seek safety from the
Infected. Although Joel initially refused to allow himself to be close to or take on a fatherly role
for her, Ellie reminded him so much of Sarah, and this affects his judgement in the matter. So,
he kills all of the Fireflies in the hospital, including the surgeon and Marlene, takes Ellie, and
flees the hospital, returning to Tommy’s town in Jackson. In Jackson, Ellie asks Joel what
happened, so he makes up a lie that there are others like Ellie and the Fireflies have actually
stopped looking for a cure.
In The Last of Us Part II, Joel and Ellie, now 19, remain in the city in Jackson. Their
relationship is somewhat strained due to the events that took place in the first game. Though
Ellie never outright said it, it’s likely she didn’t believe Joel when he gave his explanation for
leaving the hospital. However, they seem to be trying to repair their relationship slowly. Tommy
and Joel are sent on a patrol, and Ellie and her girlfriend, Dina, are also sent on their own patrol.
When the girls find out from their friend Jesse that Tommy and Joel haven’t returned from their
patrol when they should have, the three all set out in different directions to search for them.
Ellie comes across a lodge and hears Joel screaming; she enters the lodge and is pinned down
by multiple people, finding Tommy to be incapacitated and Joel to be bloodied and beaten. She
had unfortunately walked in on Abby, the daughter of the Firefly surgeon Joel killed, with her
group of friends, exacting her revenge on Joel. Ellie can do nothing but watch and beg and cry
as Abby tortures and kills Joel. She is then knocked unconscious and later found by Dina and
Jesse, with Abby’s group gone. In the scene shown immediately after Dina finds Ellie, Ellie is
seen sitting in her bed essentially staring into space, quite possibly in a state of dissociation.
Someone knocks at the door, and it takes multiple rounds of knocking before she responds. It
Professor Saenz
Psychology 2301
14 November 2022
Ellie Williams: An Analysis of Posttraumatic Stress
Disorder Representation in The Last of Us
Ellie is one of the main characters in the video games The Last of Us, The Last of Us:
Left Behind, and The Last of Us Part II. Within the context of these games, Ellie shows
numerous significant signs of Post-Traumatic Stress Disorder, manifesting in different ways over
the span of approximately 4-5 years, at least. In this discussion of my thoughts of this
diagnosis, I will be covering topics including a summary of the events occurring across the
games that could have contributed to and lead to Ellie’s trauma, specific examples and
descriptions of some of these events that may not be elaborated on in the summary, the DSM-V
diagnostic criteria that Ellie meets specifically for PTSD, the “4 D’s” of diagnosing mental
disorders that are present within Ellie’s experiences, and my personal recommendation of a
treatment/recovery plan.
In order to fully explain why I think Ellie qualifies for a PTSD diagnosis, I first need to
give a summary of the games which will help paint a picture of the events leading to and
contributing to her overall trauma. In the world of The Last of Us, the United States has been
taken over by an outbreak of CBI, Cordyceps Brain Infection, for the last 20 or more years. The
CBI is a mutation of the Cordyceps fungus that is able to inhabit humans through either the
spread of bodily fluids from infected individuals (most often a bite) or through airborne spores.
Once exposed to the virus, individuals typically “turn”, or succumb to the infection, within two
days and go through various stages and severities of the virus over time. However, Ellie, age
14 at the time, finds out through a near-death experience in Boston that she is immune to this
virus. She is bitten along with her best friend, Riley, inside of an abandoned mall during the
events of The Last of Us: Left Behind, and comes to this conclusion of immunity when Riley
turns but she does not. Following this discovery, Ellie seeks the help of another friend of hers,
Marlene. Marlene is a member of an organization called the Fireflies, a group who protests
against the military and also looks for a cure for the CBI. When Marlene finds out Ellie is
immune to the virus, she attempts to get Ellie to other Fireflies who can possibly make a vaccine
from this discovery. However, she is unable to do so herself and instead enlists two smugglers,
Tess and Joel, for the job. Initially, the three were only meant to make a short trip across the
city. However, the Fireflies they intended to meet were not at this location, and this sends them
to another possible meetup point. In the process, Tess is infected and killed, leaving Joel and
Ellie to finish the mission alone. Now, for the best chance at a new lead, the two must travel to
yet another location: this time, it is Jackson, Wyoming, where Joel’s ex-Firefly younger brother,
Tommy, is thought to be living. During the trip to Wyoming, the two find themselves in Pittsburg
, and meet brother duo Henry and Sam. Though initially wary of each other, the four agree to
work together to rendezvous with a group Henry and Sam were meant to meet. However, in
their attempt to make it there, Sam is infected and winds up attacking Ellie. Henry kills Sam to
protect Ellie, then immediately commits suicide out of guilt. Joel and Ellie must once again
make the journey alone, Ellie not unaffected by what happened. After reaching Jackson and
Tommy, the two are sent to a university in Colorado. While at the university, Joel is ambushed
by a hunter and falls, being impaled through the abdomen with a piece of metal. Joel manages
to make it out alive with Ellie, but Ellie has to care for Joel for an undetermined amount of time
while he heals. At one point during this time period, when Ellie goes hunting for the two, she
encounters two men named David and James. David orders James to retrieve medicine for
Ellie in exchange for a deer she killed. In the meantime, David puts together that Ellie was
traveling with Joel who apparently killed a lot of his men. He winds up taking Ellie hostage, she
manages to escape, and David nearly kills Ellie in a very disturbing sequence. Joel came to her
rescue when he realized she was gone and the two made it out once again and continued
moving forward. Finally, after what seems to be many more months of travel and peril, Joel and
Ellie make it to St. Mary’s Hospital in Salt Lake City, Utah, where the Fireflies actually are.
There are scientists and a surgeon there that determine they can in fact make a vaccine from
Ellie’s biological mutation of the virus. But in order to do so they would essentially have to kill
her, since the virus grows in the brain and there would be no way to retrieve the virus without
killing “the host,” according to the surgeon. Joel refuses to accept due to his bond with Ellie that
has grown throughout their time together. Joel was present for the earliest stages of the
outbreak, and his teenaged daughter, Sarah, was killed in an attempt to seek safety from the
Infected. Although Joel initially refused to allow himself to be close to or take on a fatherly role
for her, Ellie reminded him so much of Sarah, and this affects his judgement in the matter. So,
he kills all of the Fireflies in the hospital, including the surgeon and Marlene, takes Ellie, and
flees the hospital, returning to Tommy’s town in Jackson. In Jackson, Ellie asks Joel what
happened, so he makes up a lie that there are others like Ellie and the Fireflies have actually
stopped looking for a cure.
In The Last of Us Part II, Joel and Ellie, now 19, remain in the city in Jackson. Their
relationship is somewhat strained due to the events that took place in the first game. Though
Ellie never outright said it, it’s likely she didn’t believe Joel when he gave his explanation for
leaving the hospital. However, they seem to be trying to repair their relationship slowly. Tommy
and Joel are sent on a patrol, and Ellie and her girlfriend, Dina, are also sent on their own patrol.
When the girls find out from their friend Jesse that Tommy and Joel haven’t returned from their
patrol when they should have, the three all set out in different directions to search for them.
Ellie comes across a lodge and hears Joel screaming; she enters the lodge and is pinned down
by multiple people, finding Tommy to be incapacitated and Joel to be bloodied and beaten. She
had unfortunately walked in on Abby, the daughter of the Firefly surgeon Joel killed, with her
group of friends, exacting her revenge on Joel. Ellie can do nothing but watch and beg and cry
as Abby tortures and kills Joel. She is then knocked unconscious and later found by Dina and
Jesse, with Abby’s group gone. In the scene shown immediately after Dina finds Ellie, Ellie is
seen sitting in her bed essentially staring into space, quite possibly in a state of dissociation.
Someone knocks at the door, and it takes multiple rounds of knocking before she responds. It
