Critical Compilation - Mental Health/Illness

It took a long time and a lot of work to name it as trauma, and even more work, still ongoing, to understand how I could keep it from destroying my life.
/.../
I want to say people who loved me asked me to get help, or that I had some kind of breakthrough that I couldn’t spend the rest of my life that way, but that’s not what happened. What actually happened is that I played Bioshock Infinite.
/.../
for all the things it gets wrong — and it’s so, so many things — it gets so many things right about trauma.
/.../

Until the core physical experience of trauma — feeling scared stiff, frozen in fear or collapsing and going numb — unwinds and transforms, one remains stuck, a captive of one’s own entwined fear and helplessness. The… perception of seemingly unbearable experiences leads us to avoid and deny them, to tighten up against them and then split off from them. Resorting to these “defenses” is, however, like drinking salt water to quench extreme thirst. Booker’s split comes at a pivotal baptism scene, implied to take place directly after Wounded Knee although with no sign of the battle in sight. It’s here, the game tells us, that one version of Booker decides to become Comstock, washing himself clean of his sins, putting the past behind him, and eventually going on to create the floating white theocracy of Columbia. Yet Booker-as-Comstock is repression, stagnation, Peter Levine’s avoidance and denial; he deals with his trauma by powerfully and absolutely pretending it never happened.

That’s the salvific promise of the game’s understanding of baptismal doctrine; but the past, it goes on to show, cannot be wiped away. Columbia is Comstock’s monument to everything he won’t deal with, a testament to the all-saving power of staying stuck and the bandage on the unbindable wound of his actions. With Columbia he can write a new story about Wounded Knee, about the Boxer Rebellion, about the False Shepherd and the Lamb and the future and himself. With Columbia he can pretend that everything is fine.

/.../
Having a wife and a family could have been the coming back to life Booker needed, but instead, when it ends in tragedy, he turned to the violent, ugly life of the Pinkertons. Peter Levine writes, “Humans… reterrorize themselves out of their (misplaced) fear of their own intense sensations and emotions… [making] the process of exiting immobility fearful and potentially violent.”² Or, as Comstock tells Booker, “It always ends in blood.” Unlike Comstock, Booker’s efforts are at least kinetic. He dives headfirst into the person he was, trying to solve his problems through the actions that caused them in the first place. Columbia was made for him by him, or another version of him. It is a playground for every one of his maladaptive coping strategies and a place where he can spin his wheels under the guise of getting better while simply rehashing the same old things. It ends in blood because he brings it, because he can’t bring anything else.
/.../

When it does go wrong, Columbia is Booker’s ideal therapy room. In this floating city, everything that wrecks his life on the ground leads to success. Non-Columbia Booker clearly has a drinking problem, but in Columbia drinking makes him healthier. Non-Columbia Booker is pretty broke, if the losing gambling receipts in his room are any indication, but in Columbia people toss their riches in the trash; money is easy to come by and easy to spend. At the Good Time Club in Finkton, a powerful stranger offers Booker the job of head of security and forces him to “audition” for the role, according to the club’s marquee, through a series of increasingly difficult wave battles. To me, this is Booker auditioning for the role of himself, a chance to indulge in all the violent impulses that lived in his heart through Wounded Knee and the Pinkertons and to be lauded and praised for them. His annoyance and his determination to just do the job that brought him to Columbia are all lies. There’s no way he isn’t enjoying it, because it all makes sense; it feeds back in on itself, re-traumatizing him, trapping him in that endless loop. He drags Elizabeth into it too, helping her deal with her dead mother through the same audition format: a series of wave battles with her ghost to prove herself worthy of the dead woman’s love.
/.../

As I played through the end of Infinite and the game made its strange sense of Booker’s story, I understood what I had been doing to myself more clearly than any website or pastel-covered self-help book had been able to point out. I saw how I’d let my past define me, how I constantly ran it over in my mind, refusing to try a new door, a new way, refusing to let anything else in. If people had done bad things to me I couldn’t make them stop by doing bad things to myself. Just as Booker couldn’t end the cycle of bloodshed with more bloodshed. Just as Comstock couldn’t end denial with more denial. Booker’s looping timeline showed me my own and pointed to the thing I seemed to most fear and yet most want: that I’d be dead inside forever, because even though it was terrible, at least I knew it was safe. When Booker decides to step away from that, to let his past drown him at the baptism, to submit fully to the weight of everything that happened… well. We don’t quite know if it breaks the cycle, but at least it’s something new.

§

Mental illness in fiction is often used as a way to strip individuals of their humanity and, in doing so, reflects a cultural fear of what happens when we, too, descend. The horror of Eternal Darkness therefore lies not in the monsters your character must fight, but in the long-term impact of encountering those monsters.
/.../
While Eternal Darkness explores the descent into madness and casts insanity as something to be avoided at all costs, Psychonauts takes a more comprehensive view.
/.../
the game does not equate “mentally healthy” with being neurotypical in a direct fashion, nor does it tie competency to lack of mental illness or past trauma. Not only does pretty much every camper training to become a Psychonaut have traits that code for a mental illness—two happy campers are plotting suicide in attempt to gain more powers, a boy wears a tinfoil hat to avoid making things explode, and another child has extreme hydrophobia—but so do some of the camp instructors. Even characters that don’t have obvious coding, such as Raz, are shown to be wrestling with a deeper issue of one kind or another. For Raz to “fix” an issue obviously associated with a mental illness or help to resolve feelings over a past trauma, the person must be afflicted by it on some level; he does not assume particular eccentricities are a problem in the absence of related distress.
/.../
If Eternal Darkness is a game that speaks to “normal” people’s fear of going insane, Psychonauts is one that delves deeper into what being mentally healthy actually means. Eternal Darkness assumes it is impossible to see terrible things without going mad; Psychonauts largely assumes you’ve gone through something terrible, but recognizes the impact of that on your psyche is dependent on how you handle it and how your mental landscape looks otherwise.

§

I was taken aback by the idea of having a conversation with someone who my mind immediately identified as another enemy. Another body to add to my ever-increasing count in the game. But instead, here I was, talking and trying to coerce information out of someone who was clearly an intelligent being. This seemingly mundane occurrence of gently subverting the horror genre’s traditional Othering of its enemies into flawed but complex portrayals was one of the many achievements of Troika’s Vampire: The Masquerade – Bloodlines.
/.../
Games, particularly the ones that rely on having the players commit violent acts, have a poor reputation of stigmatizing mental illnesses through a negative portrayal, often equating people with such illnesses to monsters.
/.../
One common way the horror genre antagonizes those with mental health issues is by depicting them as exhibiting violent, psychopathic behaviour that threatens the safety of the player character. The endangerment of the player’s own well-being in the virtual world is a condition many action-based horror games use in order to justify the violent actions the player is then encouraged to commit towards the disabled bodies.
/.../
However, Othering goes beyond the problematic representation of enemies. Mechanics like sanity meters are commonly used in games like Eternal Darkness: Sanity’s Requiem to describe the mental state of the player character.  If the meter is filled to its maximum, it would generally result in the player character going “insane” and trigger a fail state. This mechanisation is deeply problematic, as on top of reinforcing existing stereotypes about a group of people, it further deepens the stigma surrounding them by misrepresentation. One of the most common misconceptions perpetuated by the stigmatizing mechanics of horror games is the false notion that mental illnesses lead to criminally violent behaviour.
/.../
By establishing a setting which treats characters with mental illnesses with respect, Bloodlines tries to humanize key Malkavian non-player characters, and communicate empathy to the player.
/.../
Bloodlines is a strange and fascinating game on several levels. This is apparent already in the character creation scene. One of the six possible clans the players can role-play as, the Malkavians, are a group of vampires who suffer from a variety of mental illnesses including hallucination and schizophrenia. However, within Kindred — the colloquial term for the community of Vampires in the game’s universe — they are respected and treated as equals, and are often regarded as seers and oracles. Even within the Camarilla, the ruling body of the Kindred, Malkavians are given an equal seat of power, and thus represented fairly. By establishing a setting which treats characters with mental illnesses with respect, Bloodlines tries to humanize key Malkavian non-player characters, and communicate empathy to the player. Bloodlines consciously avoids this negative stereotyping by carefully portraying every Malkavian NPC you meet during the course of the game as non-aggressive.
/.../
dissociative identity disorder (DID). Bloodlines deals with this issue in an interesting way by utilizing the same approach it does with Malkavians. It treats them as who they are, first and foremost — humans. This can be seen with how the game deals with The Twins.
/.../
Both Therese and Jeanette are respected by other NPCs in the Bloodlines world and it presents an example of the game providing a safe space in its universe to the Malkavians. Seeing the world treat Malkavians like Therese/Jeanette with respect acts as a deterrent for the player to Other them for their mental illnesses. Bloodlines, by adding a personal background to the characters, humanizes them and makes it easier for player to empathize with them. By foregrounding their humanity, Bloodlines allows Therese/Jeanette’s character to evolve without forcing stereotypes pertaining to their condition. However, it doesn’t fully evade the problematic aspects of the representation of Malkavians. By presenting their personality traits as eccentric and mystical, it creates a stereotype which reduces every Malkavian to that specific set of characteristics.
/.../
Bloodlines’ ambition comes to the fore when the you as a player choose a Malkavian character to be your protagonist. Unlike other clans, a Malkavian Player Character (PC) has a largely different script and they often speak in convoluted and vague dialogues to other characters. These dialogues have a vague tone which may be cryptic and opaque to a first-time player. However, what’s interesting to note is that these very dialogues are designed to serve as foreshadowing to a player on a repeat playthrough of the game. Many of them subtly hint at major revelations well before they are actually scripted to occur in the game’s plot.
/.../
By doing that, Bloodlines also implies that while words of someone suffering from mental illnesses are often relegated to ramblings by society, they may contain wisdom that may require a deeper understanding. It still can be seen as a form of Othering, but without much of the negative connotations that stigmatize people with mental illnesses. The kind of understanding, which in the context of the game, that only players who have experienced the game would have.
/.../
while representing Malkavians as non-violent eccentrics subverts expectations established by horror tropes, that does not necessarily make them more relatable. Or do the methods Bloodlines employs fetishize characteristics we associate with people having mental conditions? It’s worth asking if representation in media always runs the risk of objectification on some level, no matter how nuanced it might be.

§

As a therapist, I’d like to say that every group session I’ve done with young people goes great. Unfortunately, the truth is that some sessions are marked less by epiphanies and more by blank stares, fighting, and crayon-eating. The main difference? Whether the day’s topic actually resonates with the group.
/.../
Instead of tearing up the floorboards and replacing all of our current analogies with gaming references, I suggest that we recognise video games as a font for cases where kids have already encountered (and often triumphed over) real-world issues. Mario Kart wasn’t just a thing that those kids knew — it was a place where they felt anger and betrayal. It confronted them with the fact that their friends don’t always support them. For those kids, a reference to Mario Kart was an acknowledgement of these complex experiences.
/.../
There was a pause as the boys mulled these questions over. One boy disagreed. He started to tell me how the situations were nothing alike, when another boy leapt to his feet. “I’m stuck, and I don’t know what to do,” he proclaimed. “But there could be something, I just haven’t thought of it. There’s no CPS wiki. But there could be.” That’s the power of gaming analogies. I didn’t have to sell them on changing their perspective or altering their behaviors. They found their own way in, using examples that were relevant in a context that was meaningful to them. Minecraft provided real experiences of being stuck and having to wait. Minecraft provided real alternatives to “think of all the people you’d like to threaten.” The boys had already encountered their current problem. What’s more, they’d already triumphed.

§

tension between the potential freedom afforded by games and the baggage that cannot be outrun is especially pronounced in games about anxiety and depression. How do you try on new identities when an emotional condition tinges everything? Is anxiety one of the things players leave behind or a part of real life that bleeds into games?
/.../
There is no shortage of games about anxiety and depression. The past year and a half has seen an explosion of small, personal games, all of which sought to address this subject in their own way.
/.../
I don’t want to be happier. I’d gladly settle for that, but it’s not a real goal. Instead, I only wish for a bit more perspective, just enough to get through the day with a minimum of fuss. The same is needed from videogames: A little more perspective on what they can and cannot tell us about others or ourselves. As in other media forms, anxiety and depression aren’t signs of artistic seriousness—you can be a serious artist or author without these afflictions—but they are challenges that should be taken seriously. We now have enough games to form a group therapy session and hope some greater context comes of the exercise. That context is needed—it is one of the few areas in which I am confident of not being alone.

§

One 2013 review from the American Psychological Association found that strategy videogames enhanced problem-solving skills in young children, and had the potential to increase “emotional resilience” in daily life. In-game failures aren’t a dead end for children, the report argues; rather, when presented with a conflict, young players create coping mechanisms that help them advance through the game. In real life, investing energy into everyday life can be an overwhelming experience for gamers with mood disorders. The sheer abundance of negative thoughts and feelings from depression can make the outside world feel too complex to handle. However, videogames are designed with a solution in mind for the player to achieve. They present an interactive space for the player to overcome conflicts without any real world consequences for failing. In gaming, we tend to believe, there’s no such thing as a permanent loss — just restarting.
/.../
XCOM also lets players choose Easy or Normal difficulty options for a much more manageable experience. In most situations, in-game risk has been diminished to the point where players simply have to use cover and prioritize enemy targets in order to win missions. So as the player learns the game’s mechanics at their own pace, they can also become more confident in their abilities to succeed, and subsequently move onto the harder difficulty levels. This is particularly important for players with depression or anxiety, who might have a low threshold for in-game challenge. Afterwards, they can take on the harder difficulty levels.
/.../
Take one article review published in the American Journal of Play, “Video Games: Play That Can Do Serious Good.” According to the authors, action, puzzle, and strategy videogames enhanced logical and visual information processing capabilities for their players. Extended time playing the strategy game Rise of Nations, for instance, improved “task switching, working memory, and abstract reasoning” among individuals suffering from age-related cognitive declines. Likewise, action and puzzle videogames improved players’ ability to prioritize decisions and quickly switch between tasks. Alongside cognitive therapy, videogames help the brain operate more efficiently while observing and understanding information. Hard data also shows that videogames can improve cognitive functioning, diminish the effects of depression and anxiety disorders, and can even be designed for therapeutic purposes. According to TIME, the cognitive behavioral therapy videogame SPARX successfully helped 44% of players completely overcome their depression, with 66% experiencing decreased depression symptoms after playing the game. Likewise, in a recent study at Michigan State University, researchers found that their shape-identification videogame “improved concentration and lessened anxiety for the anxious participants [who played the game].” Associate professor of psychology Dr. Jason Moser even concluded there was a potential to open a new market specifically for videogame therapy.
/.../
However, videogames are not a saving grace from mental illnesses. Overuse presents real barriers for behavioral therapy, and relying on a videogame for personal happiness can develop addictive habits in players. Without healthy boundaries and proper health care, mental illnesses can fester under gaming addictions.

§

The spinning blades are no more nonsensical than the chainsaw wielding maniac. Neither belongs in a mental institution,but they do belong in a campy/creepy game environment. The fact that the place purports to be some kind of madhouse probably won’t matter very much to what little narrative there might be. It’s wallpaper to act as a backdrop for bludgeoning and butchery. It could as easily be a carnival full of insane clowns or an abandoned hotel full of insane bellboys, or an insurance office full of insane filing clerks.
/.../
Earlier today, I had a peculiar reaction to the footage of The Evil Within that oozed through the clogged pipes of the interweb from the Eurogamer Expo and directly onto my screen. As Craig pointed out, the spinny-blade room is so daft that it’s immediately rendered non-threatening. Finding such a machine in a mental institution raises logistical questions rather than the hairs on the back of my neck.
/.../
at their best, games can implicate us in ways that traditionally observed media cannot and turn the screw an extra few degrees. However, games can also fill their corridors and torture chambers with the mad, and make otherness and illness things to defeat or to hide from rather than to engage with. That’s much less imaginative, much less empathic and, most damning of all in a creative industry, much less interesting.

§

This, we are made to understand, is how you become a heroine, a tomb raider. Our lead characters have to be hard, and while we accept a male hero with a five o'clock shadow and a bad attitude generally unquestioned, a woman seems to need a reason to be hard. Something had to have been done to her.
/.../
When you want to make a woman into a hero, you hurt her first. When you want to make a man into a hero, you hurt… also a woman first.
/.../
"Sherlock Holmes gets to be brilliant, solitary, abrasive, Bohemian, whimsical, brave, sad, manipulative, neurotic, vain, untidy, fastidious, artistic, courteous, rude, a polymath genius. Female characters get to be Strong." Further, we seem to have problematic ideas of how women become Strong -- men break them, we assume.
/.../
Abstracted ideas about post-traumatic stress disorder or the catch-all "mental health issues" are common in games -- apparently the logic is if we're trying to advance narratives in action games, we need to find nuanced rationales for why we're killing so many people with aplomb.

§

The mentally ill make for good villains, across all media in fact. You see, we just don't stop, we don't know how. We can't listen to reason, so the question of the appropriateness of force is taken away from you, the protagonist. We make things easy as well, because ultimately, we want to die. Not the clean, pure death urge of the hero either, who stakes his life on the promise of a better world; we just want to be put out of our misery.
/.../
We need to be able to show the difference between madness and malice, because ideologies spread in a way that madness doesn't.

§

This is why Depression Quest is not simply an “empathy game” that MAKES you understand depression, and why it is something more valuable.

§

Errant Signal - Actual Sunlight + Depression Quest (Spoilers)

§

I wanted to start from one simple word, one that is used by marketing departments and journalists alike; it pervades reviews, previews, the lexicon of indie games and it trickled down to gamers themselves. The word ‘addictive’. Gaming is, as far as I know, the only community in which the word addictive is considered a positive.
[This piece is really personal and hit home for me, even if my story with depression is quite different and has made me play less and not more games for the last ten years (but before that, yep, had me playing Baldur's Gate 2 constantly for three months).
§

A visual novel about a group therapy session for final girls.