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Changing mental health depictions in games

Developers say the industry is getting better at incorporating real conditions into their stories, but more progress is needed

Today is World Mental Health Day, so it's a particularly appropriate time for the inaugural edition of The International Games Summit on Mental Health Awareness (TIGS for short). The two-day event kicked off yesterday with a series of panels, including one moderated by Scott C. Jones.

Mental health in games is a focus for Jones, whose podcast, Heavily Pixelated, tells people's stories of how games helped them through difficult times in their lives. Jones' podcast and TIGS itself are fairly recent efforts, and they reflect a burgeoning understanding of the importance of mental health, both in this industry and society at large.

Three of the four panelists were developers whose own projects prominently feature mental health concerns. 2Dogs CEO and creative director Ken Hall is working on Destiny's Sword, a strategy-combat MMO where players manage the human consequences of their troops' combat experiences including addiction, depression, and PTSD. Kristopher Poulin-Thibault recently released Looking Back, a JRPG about the personal struggles he experienced in pursuit of his doctoral thesis. Embreate's Scott Nihil this week launched Wittle, a project that took comedians' personal stories of depression and adapted them into web-based games. Finally, Dr. Kelli Dunlap of iThrive Games Foundation offered her own expertise.

A recurring theme of the panel was that the industry is improving how it handles mental health topics in games, but there is still a need for improvement.

Destiny's Sword will try to show the personal consequences of combat

Destiny's Sword will try to show the personal consequences of combat

"We clearly see in the entertainment industry mental health being used purely on the principles of major psychotic breaks, and usually homicidal ones," Hall said. "What I'd like to see, and what I think we're seeing nowadays, is a lot more nuance in the spectrum of how we present mental health -- that it's not always debilitating, or that it's not always even negatively presented, or that people find sometimes their characteristics give them strength and advantages in their daily existence, like awarenesses or empathies that [the characteristics] led them to."

"We've really tried to normalize the fact that everybody has some aspect of mental health issues. There really is no such thing as a zero line, somebody who has no [issues]"

Ken Hall

Hall said the key is to make sure that mental health is not the thing that defines a character, but simply one extra trait that plays a part in shaping who they are. That's been a point of focus for him when working on Destiny's Sword.

"We've really tried to normalize the fact that everybody has some aspect of mental health issues," Hall said. "There really is no such thing as a zero line, somebody who has no [issues]. We're all dealing with some aspect of this so we can all bring that awareness and empathy to the characters, to ourselves, our friends. And that hopefully transcends the game and gives us some strategies to interact with people in the real world too."

Dunlap agreed that things in the industry are trending better, but said developers still trot out problematic stereotypes of mental illness from time to time.

"I think about Far Cry 3, which is not that old a game, and you see Vaas Montenegro," Dunlap said. "He basically does the Joker thing of 'You want to know I got these scars' type of deal, and that's his entire motivation. Everything from Kefka to Vaas, that's who they are."

She added, "I personally find that a little bit lazy, like let's do some character development here. It's not that a villain can't have a mental illness, and it's not that a villain has to be totally evil. It's that characters that are engaging tend to be actual representations; they tend to be deep, to have personalities, to have layers to them where if you took one away, there would still be something there.

"It's not that a villain can't have a mental illness, and it's not that a villain has to be totally evil. It's that characters that are engaging tend to be actual representations"

Dr. Kelli Dunlap

"With Kefka, if you took away his mental illness, his psychopathy, there would be nothing left. Having characters that are deeply flawed makes some of the best heroes and some of the best villains. And we're definitely getting more of that now than we have in the past. The medium's maturing, and I'm glad to see it happening."

Nihil agreed, pointing out that the shift has been happening not just on the developer side but also among the people playing games.

"When I talk to people that don't play games or are more into watching movies, that's something they've come to expect from cinema," he said. "For a much longer period of time, we expect these grand performances and if the characters don't feel real, if the story doesn't feel like it's based on some kind of truth, then people are going to trash the film."

He said that games criticism is increasingly adopting that approach and insisting on characters that aren't hollow, one-dimensional stereotypes, adding the industry is better for it.

Poulin-Thibault said he also enjoys the shift away from black-and-white subject matter, as it's a move that lends itself particularly well to better depictions of mental health.

"Games are more metaphorical and figurative," he said. "They don't need to be explicit, having one boss fight to beat. Especially with mental health, I think it's important to not always put things into neat boxes but just look at the character, one who may or may not have a mental health issue, and that's who you are and who you have to embody."

Looking Back follows a doctoral student named Kris struggling to finish his thesis

Looking Back follows a doctoral student named Kris struggling to finish his thesis

For all the talk of progress, Jones asked the panel about lingering stigma associated with mental health, and whether grappling with the subject in a thoughtful, deliberate way might hurt a game's commercial prospects still.

"There is a stigma," Hall acknowledged. "There is a concern. 'How can listening to that be fun? How can playing that be fun? How can that be a positive experience? Is it too close to home?' I definitely think there are going to be some trailblazers, and you're certainly one of them. But that's what it takes.

"The more of us that do this, the more of us that create things that examine all these different aspects, the more normalized talking about it becomes, then the easier it becomes to have that conversation."

Dunlap agreed, but was careful to point out that games can depict mental illness responsibly without making it the sole focus of the project. Such an approach can be particularly effective in getting people to learn about issues without them needing to first decide that's something they want to go learn about.

"Hellblade is a fantastic example," Dunlap said of the Ninja Theory game. "It's not a game about mental illness. That [would be] your educational games-for-change, which are fine and wonderful, but they're not at this point ready to change the world because they're small, and they're going to preach to the converted. A game like Hellblade has broader appeal because they're not hitting you over the head with, 'This is mental illness, you should be nice about it.'"

Dunlap added that she wants to see more games address mental illness in ways big and small, even if it's just having a character take their meds every day (with no gameplay effect or "sanity meter," she notes) because it's "just a normal thing over half the population does every day for mental health reasons."

She also had one particular handling of mental health she'd like to see developers abandon entirely.

"I would be so relieved if horror games would just never, ever use insane asylums ever again," Dunlap said. "Have you ever had your character wake up in a psychiatric hospital and have something good happen? No, you haven't, because it's cultural shorthand for 'Be afraid.'"

Poulin-Thibault offered "an optimistic note" to close the panel.

"I think there is more and more variety in how mental health is being depicted," he said. "If we keep going, it's just going to be better and better. I think it was the same with gender 20 years ago. There were very few female protagonists, and nowadays there are more and more [to the point] where it's not about a female protagonist, but a protagonist that happens to be female. Sure, it affects the way some events happen or her outlook on the world, but this is not the defining trait of the protagonist. It's the same with sexualities, with mental health. It's about having a diversity of characters and characters that have a diversity of traits within themselves, and I think we're going in that direction more and more."

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