Welcome to the Young Academics Workshop

Mental illnesses have long since been an integral part of popular culture. As a field of interdiscourse (Link 1996, 50), popular culture picks up on scientific findings, social norms and ideals and the respective othering of the mentally ill as deviants. Digital games are no exception to this. Their constructions of mental illnesses range from stigmatising tropes in horror psychiatries to attempts of (self-)empowerment in autopathographic games. As the focus when analysing digital games and mental health has for a long time primarily rested upon potential media effects, the intricate and increasingly diversified constructions of mental illness within the game texts have largely flown under the radar. While the construction of mental illness in other forms of mass media, such as television or movies, has been studied and criticised with increasing persistence since the 1990s,1 there are few quantitative and qualitative studies that primarily focus on constructions of mental health in digital games. Drawing from a currently ongoing PhD project as well as previous conjunct research, we are working on a typology with the goal to make constructions of mental illness in digital games accessible for analysis. Based on individual interpretations, i.e. deep readings, of games such as The Sims 4 (Maxis 2014), Amnesia: Dark Descent (Frictional Games 2010), Outlast (Red Barrels 2013), Depression Quest (Zoë Quinn, Patrick Lindsey, Isaac Schankler 2013), The Town of Light (LKA 2016), and Hellblade: Senua’s Sacrifice (Ninja Theory 2017) we wish to propose six types and elaborate upon their relevance in our talk: (1) quantification, (2) objectification, (3) subjectification, (4) somatic externalisation, (5) spatial externalisation and (6) actional externalisation. These categories are not exclusive and in itself interconnected. In this context, we understand illnesses in games as “functional disruptions” (Görgen 2017), as productive elements serving a narrative and ludic structure. Our goal in mind is to reach an overarching understanding of how the construction of mental illness in digital games works and to which degree it ties in with medical epistemology, social discourse and popular culture in a broad sense.

The portrayal of the mental health and state of videogame characters has a long history, from gamified sanity meters, to more recent, mature approaches that explore the experiences of neuroatypical individuals in a responsible and instructive manner. This evolution brings about several questions regarding the portrayal of the mental state of an entity lacking autonomy, found predominantly under player control. For a genuine portrayal of matters concerning mental health, characters must surpass their role of mechanical and informational conduits and assume autonomy within the mechanical layer of the game, as doing so will not only individualize them within the context of the game’s heterocosm, but also in the game situation (Eskelinen, 2001). To gage the possibility of this metamorphosis, I have qualitatively analysed the video game The Missing: J.J. Macfield and the island of memories (White Owls Inc., 2018) guided by the proposal made by Actor-Network Theory that non-humans can exert an undirected agency over the status quo (Latour, 2008, p. 70-86). It follows that both sources of direct and indirect action as well as modifiers, enablers, and constrainers of action have been coded and examined. The resulting analysis grants an overview of the diffusion of action control through the network enabling both the analysis of the centrality of participants in the diffusion of agency, as well as the roles that the player character takes in the game situation. Through the study, the emergence of the player character as a parallel agent, functioning alongside the player, in the player-game relationship becomes discernable as we witness J.J. accepting herself, and assuming control over herself, and away from external sources. Within the game situation, this translates to taking control over a central mechanic, regeneration, which has so far been under the player’s control. With this, her understanding of her mental state, and retaking of control is contextualized in her emergence as an individual, not only within the bounds of the game heterocosm, but also within the game situation.

While the success of JRPG PERSONA 5 (2016) may surely be attributed to its densely packed socio-political commentary on contemporary issues within Japan, it also portrays the struggles of high schoolers who are dealing with mental health. This begins with the protagonist who is falsely accused of a crime and bullied at his new school, leading to classmates who are mentally and sexually abused by their teacher, culminating into a suicide attempt by one of the victims. In addition to the story, the game eventually introduces the spatial exploration of mental illness. Although one half of the game is typically set in modern-day Tokyo, the other half takes place in what the game calls the ‘metaverse’ with conquerable ‘palaces’, a physical manifestation of mental corruption. The protagonist’s party usually target corrupt people in power and their palaces with the goal of changing their mental state. One exception in the series of targeted palaces is that of teenager Futaba Sakura, whose palace is not as much of a manifestation of corruption, but one created through self-destructive desires. The palace is a spatial representation of her mental state and as the party advances, her depression as well as suicidal thoughts are revealed. The palaces of the metaverse can be understood as ‘mindspaces’. Although the term has had a wide application in literature studies particularly within the science fiction and fantasy genre (Slusser and Rabkin 1989), mindspaces have become popularised in films such as INCEPTION (2010) or the television series SHERLOCK (2010-2017). However, they are understood as cognitive spatial constructs. Borrowing from film and television studies then, the focus will lie on cognitive spaces, or “Erinnerungsräume” (Beil 2010) in Persona 5. This project seeks to widen the scope of research for interactive spaces that includes mental and cognitive aspects of game design.

Panel 1 - Representation

Short break

A report from the World Economic Forum (2019) stated loneliness as the third societal stressor in the world, which is on the rise particularly in the West. This psychological strain, which was recently classified as harmful as smoking 15 cigarettes a day and more dangerous than obesity (CIGNA, 2018), can also increase the risk of depression and other mental disorders, which can lead to increased severity of the condition due to negative impacts on physical, mental and social health (Cacioppo et al. 2002; Hawkley et al. 2003). Digital technology, specifically mental health apps (MHapps), has been viewed as promising solutions, however, little evidence on this topic reveals uncertainty around how technological solutions impact individual well-being. This work aims to investigate how a gamified social mobile app can reduce the social isolation and loneliness of young adults by bringing them into an online community of local users who will be able to communicate and help each other both online and in real life based on their geolocation. Furthermore, as little work has focused on digital apps to reduce loneliness, this project also proposes to describe and discuss the design process of the app Gratitude (Web and mobile), which its first version is being developed following a set of recommendations for designing high-efficacy mental health mobile apps (Chandrashekar, 2018; Bakker et al. 2016), gamification for mental health (Fleming et al. 2017) and loneliness reduction interventions (Masi et al. 2011). By considering these guidelines, the app also aims to create social opportunities and improve users' social skills through a quest-based gamified system in order to encourage conversations and develop empathy. The problem identification, the design process of low and high-fidelity prototypes and the methods to evaluate usability and the processes of peer evaluation will be presented.

In this years’ talk, I want to introduce the benefits and possibilities of using digital fiction for narrative-driven games, especially its usage in the project “Writing New Bodies: Critical Co-design for 21st Century Digital-born Bibliotherapy”. This project addresses body image concerns and consequent psychological problems young women and women identified individuals are facing every day. The goal of “Writing New Bodies” is to develop a narrative-based, interactive story game application that can be used as an intervention method in therapy for body image issues. Digital fiction is an interactive form of storytelling and it only exists in its digital form (Bell et al. 2018, Ensslin et al. 2019, Bell et al. 2010). While some digital fictions are text-based, such as Depression Quest, there are 3D digital fictions such as Wallpaper or Inkubus that are multimodal in their nature (Ensslin et al. 2019). Overall, digital fictions are highly suitable for game developers who want to design narrative-driven projects. This is because they can provide a platform to deal with difficult topics (depression, suicide, body image issues) in an artistically appropriate and matter sensitive way. “Writing New Bodies” is a digital fiction app built in cooperative co-design iterations dealing with such a sensitive topic. First, I will explain what digital fictions are. Second, to point out how digital fiction games can be used in therapy, I will introduce the methodology of the “Writing New Bodies” project and bibliotherapy as one of its intended usage options. Finally, I will conclude by giving an outlook for further research.

Since the 1990’s researchers have been developing virtual reality systems to treat phobias. This form of exposure therapy proved to be quite successful and raised the question which other anxiety- and mental health disorders could be treated with VR. Looking at the current research on game therapy, virtual reality systems are used frequently to enhance the psycho- therapeutic effect of therapy games. But what exactly does VR add to the success? In the Young Academics Workshop, I want to explore the way virtual reality systems for mental health therapy can positively affect the therapeutic process. Looking at a brief history of the use of VR in the mental health sector, I want to further investigate the advantages and disadvantages of this tool regarding game therapy.

Panel 2 - Design

Lunch break

The Jugendschutzgesetz (JuSchG, youth protection law) allows for an exception of the otherwise strict restraints on censorship in Germany. The responsible authorities maintain a list – often simply called the “Index” – with media that, in their estimation, are harmful to the healthy development of children (JuSchG §15 Art. 2 Nr. 5, §18 Satz 1). Media on this list must not be made available to children in any way, be advertised or sold openly. Reviewing the decisions on games of the Bundesprüfstelle für jugendgefährdende Schriften (BPjS, the federal inspection authority for youth corrupting publications) of the 1980s uncovers how political, religious and elitist opinions shape what is considered harmful to the mental health of children and how the power to rule what is deemed harmful can have repercussions on the image of a medium. Politically charged games, for example Raid over Moscow, do not seem to have an impact on the psychology of children that differs from other games of the time, but the BPjS still deemed them to cause cramps, anger, aggressive behaviour, nervousness, difficulty in concentration and headaches (cf. Mühlbauer 2010). The decisions of the BPjS represent the relationship between games and the government as well as the political parties involved at that time. Studying the index therefore can provide a contextualizing overview of the relationship of politics and games as well as stigmata of games as mental health hazards.

Escapism is usually defined as avoidance of the real. Digital games are conducive to escapism because they take place in a temporally and spatially bounded virtual space that is separated from the real. Moreover, games contain artificial conflicts and actions that have no effect on real life. Digital games are also available on a broad range of devices (i.e. desktop, mobile, VR), making them an easily accessible platform for escapism in daily life. Consequently, escapism is one of the most common reasons for playing digital games. However, escapism generally has a negative connotation. Escapism was found to be associated with negative outcomes such as problematic use and excessive gaming. Nevertheless, games can also be beneficial depending on how escapism is operationalized. For instance, research shows that mental disengagement via video games was shown to provide recovery experiences such that it helps players to decrease their stress levels and provide relaxation after stressful activities (e.g. work). Escapism can also act as a mood management strategy, as people tend to play games to avoid negative mood states and induce positive mood states. Similarly, escapism in games can be beneficial for practicing emotion regulation strategies. Finally, games can also provide a healthy form of coping strategy for some players. In short, escapism can have both negative and positive consequences, depending on how it is defined. Consequently, it is important to demarcate what constitutes a healthy escapism versus subversive escapism.

This presentation illustrates mixed-method empirical analyses of trauma-themed independent games, to support theorizing dynamics among embodiment, multimodality, and meaning-making in designing digital games for mental health. Multimodality explores how communication involves combining various expressive resources effectively, such as visuals, language, sound, music, and haptics. In digital gameplay, meaning traverses technical materiality, bodies, and worlds (Keogh 2018). This emphasizes how the body crucially constitutes the mind, meaning, and communication, as substantially explored in embodied cognition (Gallagher 2015); and the importance to expand approaches in the humanities to examine affects in media encounters (Genosko 2016). In this presentation, I discuss findings from an ongoing research on games that engage such phenomena as loss, grief, war, and mental illness, with the illustrative case of Nevermind (Flying Mollusk 2016) – a psychological thriller featuring motifs of psychological trauma and biofeedback sensitivity to foster player mindfulness and mood management. Motivating my research is the aim to explore how digital games can constructively engage with mental health by cohering gameplay mechanics, narrative motifs, multimodal aesthetics, and forms of interpretive and affective difficulty (Jagoda 2018). Analyses combine player experiments (with affect-sensing equipment) and corpus-based game analyses, to triangulate embodied data and fine-grained multimodal patterns. Latest endeavors in multimodality research emphasize interdisciplinary, empirical work and intrinsic contributions of embodied responses to meaning (Bateman 2019; Bateman, Wildfeuer, and Hiippala 2017). In this regard, my analyses correlate multimodal patterns and players’ affective responses at significant gameplay moments, in relation to higher-order design strategies. Specifically, discussion details how Nevermind, and selected games from my corpora, experiment with player agency, witnessing and complicity, as well as ludonarrative dissonance; while eliciting diverse, complex effects, such as calm, relief, alienation, unease, and anxiety. Guiding this presentation is the aim to motivate game designs and research that explore mental health and resilience beyond gamification.

Panel 3 - Effects

Short break

Depression and anxiety are the most frequently diagnosed mental health problems, leading to devastating long-term outcomes that affect a huge proportion of children and adolescents across the globe. Effective prevention programs that show more than a small effect size and that do not stigmatize, condescend to, and bore children, are urgently needed. Our research program focuses on developing evidence-based games that promote emotional resilience through training skills while youth are immersed in games they love to play. We prioritize design and art, integrate developmental science and principles of behavioral change, and systematically test our gaming interventions with large-scale randomized controlled trials. In this talk I will: (a) describe the cross-disciplinary framework we use to develop mobile and virtual reality games that integrate biofeedback and evidence-based game mechanics, (b) present data from a series of randomized controlled trials that evaluate games that use biofeedback at their core (e.g., EEG neurofeedback, heart rate); and (c) introduce a roadmap to the next five years of programmatic studies in biofeedback games, emphasizing how our design and research methodology can help establish a validated toolbox of mechanics relevant to a wide range of interventions and mental health domains.