Definition Of Insanity: Games & The Stigma Of Depression

The relationship between gaming and depression tend to only be addressed by sensational misinterpretation of studies by the mainstream press. RPS contributor David Owen set out to find out whether gaming can be linked to mental health, how games could better represent depression, and whether games themselves can be an effective means of helping those who suffer.

Far Cry 3 gives a definition for insanity. "Insanity is doing the exact same fucking thing over and over again, expecting shit to change."

You’re probably familiar with how madness manifests itself in the world of games. It’s that ill-defined brand of hyperbolic insanity that compels antagonists to shoot people in the face, hatch needlessly convoluted plots to take over/destroy the world, and maintain a socially unacceptable hairstyle. And this is not just a cheap dig at Far Cry 3, which rode a wave of promotion centred on insanity. It just happens to be the most recent example, in that every major character on Rook Island is unhinged in some capacity – we know this because of their propensity for murder, rape, and to hallucinate giant voodoo demons. At no point in any of this is a specific mental illness named. Far Cry 3 does not know the definition of insanity.

It’s not only games that risk the accusation of paraphrasing mental health issues for ease of narrative. Whenever any commercial entertainment media portrays insanity it leaves itself open to scrutiny. The reason for singling out gaming is that it's the medium with unrivalled access to, and relies on much of its revenue from, young people, where mental health figures are going through the roof. Most prevalent of these is depression. Mental health charity Young Minds claims that nearly 80,000 children and young people suffer from depression in the UK alone. This link has given rise to the question of whether gaming nurtures or causes depression in young people. Whether or not this is true is not the topic of this article, although out of necessity it will be touched upon along the way. This article will instead ask whether, blame-game aside, mainstream gaming has a responsibility to address spiralling youth depression figures.

There have been some attempts in mainstream games of recent years to depict depression authentically. Heavy Rain starred Ethan Mars, a bereaved father pushed to the brink of suicide. The Walking Dead game flirted with aspects of depression such as hopelessness, suicide, and the subsequent strain on relationships. But the very nature of depression means that these depictions could be considered flawed. Depression can be an illness that’s difficult to quantify or to rationalise with cause and effect. In fact, according to mental health experts, there might not be exterior stimuli for its onset. “Most depression starts in late adolescence,” says Laura Oates, a cognitive behavioural therapist at Harley Therapy in London. “There’s a genetic component to depression. If you’re going to get it then it’s unavoidable. The first time you get it, you’re unlikely to realise what’s happening. You’re not likely to know you’re getting depressed.”

Ethan Mars is depressed because his son is dead and he might be a schizophrenic serial killer. Characters in The Walking Dead are depressed because zombies ate their families. These are perfectly legitimate reasons to be depressed, but it's perhaps arguable that young gamers are unlikely to identify. So could such depictions cause young people to dismiss their symptoms because there is no such extreme problem in their own life? “Any depiction of depression that is stigmatising could make people embarrassed,” says Dr. Theresa Fleming of the University of Auckland, creator of gaming project SPARX. “Representation of challenging issues that we see around us impacts on how we understand and deal with those issues.” So it could be argued that the misinterpretation of depression and mental illness by games as something causal or violent could be considered harmful to affected young people.

Yet this doesn’t explain why games have previously been singled out for causing depression. There is sadly very little in the way of scientific data in the form of psychological studies on this issue, particularly relating specifically to young people. The only substantial study was conducted at Iowa State University by Dr. Douglas Gentle and a small team of fellow researchers. Entitled Pathological Video Game Use Among Youths: A Two-Year Longitudinal Study, the project monitored the gaming habits of school children in Singapore over the course of two years. It aimed to determine whether “pathological gaming” had an impact on the mental wellbeing of the children. The study defines “pathological gaming’ based on criteria such as subjects neglecting homework to play games, stealing money to purchase games, or gaming to escape problems or bad feelings. (Other researchers have summed up such behaviour related to gaming as “problematic use”.) And Gentle's results drew a direct line between heavy gaming and depression.

Despite these results, Dr. Gentle believes it would be an oversimplification to say that gaming directly causes depression. “Depression and pathological gaming seem to be truly co-morbid,” he tells me. “Where they make each other worse.” Subjects turned to gaming to escape their feelings of depression instead of seeking help. When it didn’t work they simply gamed more, so both issues deepened.

Laura Oates talks me through how cognitive behavioural therapy works, which, when combined with anti-depressant medication, is considered the best treatment for depression. It essentially encourages patients to tackle depression by altering their thoughts, feelings, behaviour, and physiology. “If you’re lying still and gaming, you’re not going to feel better. How could you change your behaviour? What could you be doing with your body to make you feel better?” As Dr. Gentile’s study shows, turning to games might prevent young people from making these vital changes. Oates continues, “Any compulsive behaviour like gaming is known as self-medication. It may not be terribly helpful.” As for how games approach the subject itself, Oates believes that “games could do more to remove the stigma” of depression.

So if young people are turning to games when they feel depressed, should developers be doing more to address the issue? Those I speak to are open-minded yet sceptical. “I think gaming, like any pastime, needs to be consumed responsibly,” says Karl Hilton, managing director of Crytek UK. “As an industry we need to always be aware of the content of our games and who we are making them for. After that it’s up to the people who buy games to decide what is right for them.”

He admits that his non-committal answer is due to being uninformed on the issue. The difficulty here stems from the question of how capable an individual is to make the right decisions regarding their gaming habits if a mental health issue has not yet been diagnosed.

Andrew Eades, CEO of Relentless Software in Brighton, also acknowledges that he is unaware of evidence that links gaming with depression. He’s keen to defend against such accusations. “I’m an advocate of playing games. I think the positives outweigh the negatives. My children get a great amount of joy out of playing games.” Yet he also concedes that, “If there’s evidence that shows games are affecting susceptible teenagers, then [developers] should be man enough to admit that and deal with it.”

It is immediately difficult to see how games could tackle the issue of depression. But it’s not uncharted territory. Unsurprisingly, it’s the indie sphere that’s set about exploring mental illnesses. Tourette’s Quest by Lars Doucet tries to capture the experience of living with Tourette’s syndrome. The player controls a yellow smiley face, and must manage its stress levels as they explore dungeons. Enemies are docile, but get more difficult to evade or confront as stress levels grow, and symptoms of Tourette’s are exhibited.

Daniel Benmurgui’s Today I Die is an independent browser game designed to represent how it feels to suffer from depression. On a single screen, it asks the player to rescue a girl from being dragged underwater by fighting off maleficent creatures, uncovering secrets, and piecing together poetry. It’s a simple and elegant concept, and a deliberately abstract experience. After all, depression could be considered an abstract illness.

SPARX is a much bigger project, and takes a different approach entirely. Designed by a team at the University of Auckland, the project aimed to develop a game that would help young people to deal with symptoms of depression in the real world. It takes the form of a fantasy-adventure game that packages elements of therapy inside puzzles and challenges. The player is responsible for defeating the darkness and gloom that has descended upon the world. Results showed that those who played SPARX found it to be at least as effective, if not more so, than traditional counselling. I asked Dr. Fleming, who worked on the project as a PhD student, why this was the case. “It’s a whole lot of things. You have the therapy content, but the user also has a whole lot more control in the programme than many young people experience in counselling. [We] have the ability to use games and visuals to communicate ideas rather than relying quite so much on talking.”

The stigma of embarrassment around mental illness could make it difficult for young people to seek help by traditional means, so they instead try to block it out by gaming. “A [traditional] game can easily bring your mood up for a little while,” says Fleming, “but they can’t change how you deal with issues in your life.” SPARX might be the first step towards changing this, but it was never conceived of as a mainstream title. While Fleming hopes that it can be made readily available on PC and Mac, it could only ever serve as a means of alternative therapy. Each mission begins with a mood-monitoring questionnaire, and there is an in-game guide who explains how lessons learned within the game can be applied to real life. “You wouldn’t play SPARX for fun,” concludes Dr. Fleming.

Does Dr. Fleming think a major mainstream game could offer legitimate therapy? “Maybe an MMO or RPG of some kind, featuring a character that depicts depression,” she says. “Just seeing an authentic depiction in a game could help a young person recognise their own problems. By seeking positive change in the game, it could encourage them to do the same in real life.”

Laura Oates agrees. “We encourage [patients] to exhibit behaviour of someone they’d like to be similar to. Mainstream games could offer a positive role model.”

Like Andrew Eades, Dr. Fleming is reluctant to place blame directly on gaming. “It’s no different to any other compelling activity. Doing one thing too much will stop you from doing other things. Not becoming depressed is about having a balance of everything in your life.”

MMOs are of course the genre most often vilified as a modern day Pied Piper. They have the potential for endless play, and can offer up ever greater rewards for every hour invested. I ask Simon Bradbury, founder of Firefly Studios, if MMOs risk upsetting the balance needed to keep young people healthy. The studio develops the Stronghold series, and has recently launched an online version.

“MMOs can be a retreat from the world, but escapism is not necessarily a bad thing,” says Bradbury. “If one of our players wants to spend a few hours every day in our online rendition of medieval England then I think that’s a healthy thing. It’s about balance... not hours of grinding.”

Toward the end of 2008 my own sister Christina, who has suffered depression from a young age, experienced a particularly low period. “I began playing Fallout 3 because I needed a distraction. I didn’t think it would help because I was having trouble focusing on anything for very long. I ended up playing it for 14 hours a day for about 3 weeks.” This might be considered unhealthy - some might want to categorise it as "pathological gaming" - but for Christina it was crucial for getting through the day. “It got me out of bed in the morning. Becoming so involved in the storyline and the tasks gave me a reason to keep on going, and it was so far removed from real life that it made me feel better.”

Rather than inadvertently deepening her depression, the mood lift Christina experienced as a result of these long gaming sessions made her feel better prepared to deal with the real world. “Towards the end of that three week period I felt better, so I played less and took the opportunity while I was feeling more productive to spend short periods of time tackling my issues and doing everyday tasks. I think I just needed some time out.”

Discussing her situation with Dr. Gentile, he stresses the importance of defining “pathological gaming”. “It’s not defined by how much time is spent doing it. It’s defined by whether the gaming is dysfunctional – that is, it’s damaging other areas of life. In this case gaming may have actually been helpful. But if over a longer time she couldn’t get back to her job, family, friends, school, etc., and just kept gaming, then that would be evidence that it has become a problem.”

Christina agrees, and insists upon a healthy balance. “There’s a fine line between escapism and avoidance, and I think you have to know where that line is and not cross it.”

It appears then that some mainstream games at least can offer indirect therapy for those suffering depression. Yet arguably this alone isn’t enough to absolve them of the responsibility to do more. All of the gamers I spoke to had had their condition diagnosed long before they found that gaming could be a comfort to them. With the difficulties inherent in recognising depression, it is likely the case that many young people are unaware that they have a serious medical condition, leaving them unprepared to draw that crucial line between escapism and avoidance. If mainstream games already hold the potential to be mildly therapeutic, surely more could be done to help young people recognise the condition, or encourage those that already do to seek help, therefore fulfilling that therapeutic potential to the utmost.

Whether games do cause depression in young people will remain a controversial topic until a great deal more research is done. In the mean time, it remains incredibly unlikely that mainstream developers and publishers will take steps to tackle the issue - flamboyantly crazed bad guys needn’t be looking to expand their range just yet. “We all have a responsibility,” insists Relentless's Andrew Eades. “As members of society we should be looking out for [depression] and not dismissing it because it’s inconvenient.”

Gamers allow games into our lives like no other form of entertainment. We let them in even when we’re at our lowest ebb. They are therefore in a unique position to affect our lives, and, in an issue that spans all media, it could be games that take the first step to lead the way forwards.

If you have concerns or questions about depression, or think you would benefit from talking to someone about it, you can call Mind in the UK on 0300 123 3393.