The Last of Us episode 6 is punctuated by Joel suffering from panic attacks - something that doesn't ever happen in the games - and the creators have explained in-depth why they made the change.
Now, before we explain any further, here's your *spoiler warning* for The Last of Us episodes 5 and 6. If you aren't caught up, turn back now so we don't ruin anything for you.
In The Last of Us HBO podcast, hosted by video game Joel actor Troy Baker, co-creators Neil Druckmann and Craig Mazin explain that Joel's panic attacks are directly connected to the tragic events of episode 5.
As if there's any possible way you've forgotten what happened to brothers Sam (Keivonn Woodard) and Henry (Lamar Johnson) in The Last of Us episode 5, here's a very brief recap: Sam is bitten and infected during a struggle with a horde of infected and is killed by Henry, who then turns his gun on himself to Joel and Ellie's horror. Pretty grim stuff.
Well, in episode 6, we see Joel clutching at his chest and struggling to steady his breathing a couple of times throughout the episode. And while there are about a million very solid reasons for someone to be experiencing severe anxiety in the world of The Last of Us, Druckmann and Mazin have confirmed that Joel's panic attacks are specifically about Sam and Henry and how their deaths impacted his confidence in his ability to keep Ellie safe.
"We wanted to explore the impact of what's happened to Joel in the wake of Henry and Sam, despite time having passed significantly and it's shown when he exits the cabin and seizes his chest," the duo said (thanks, Collider).
"What's happening is Joel is having a panic attack and he doesn't know why. It's your body telling you that you're in terrible danger but you don't understand why. This episode is about Joel coming to terms with how terrified he is that she's going to die and it's going to be his fault. If you've been paying attention, you'll see as many times Joel has helped her, he's failed her. And those are the things he dwells on. Like a lot of us, if you have core trauma the way Joel does, the things you do well are discounted but you will magnify your failures and tragedies until they threaten to subsume you."
In case you needed any more justification for this relatively minor diversion from the games, you should know a little detail in The Last of Us Part 1 actually made Joel's condition canon.