How to Represent Mental Illness in Games

[Music] good morning welcome to gdc 2019 how you all doing give me a big yeah [Applause] that is a lot bigger than it's going to be in five days time i'm really impressed by your enthusiasm and thank you so much to coming to see this talk today it's something that's incredibly close to my heart something that i'm exceptionally passionate about us you will very much see over the next hour and thank you to gdc in the narrative summit for allowing me to talk about this it's something that i think is an incredibly important topic and i'm so thrilled that we're being given the platform to actually discuss these really really important issues with you and thank you to the developers whose games i showcase in a variety of videos in this talk um in particular corey barlog from santa monica studio who actually kind of sat down with me and talked about kratos from the god of war series so i was really really grateful

for that my name's dr jennifer hazel i've been a medical doctor for about eight years now i practiced in the uk and then i did emergency medicine in australia and last year i moved to new zealand and i've been practicing psychiatry for a few years now it's literally the most rewarding thing i've ever done in my life the absolute privilege of being able to help people who are at their most vulnerable when they've been shunned and had the doors shut and rejected by the rest of society is a fulfillment that i can't possibly describe and it brings me joy every day which is why i'm so passionate about this and it's also why i founded or co-founded checkpoint we're an international nonprofit organization that provides resources for the mental health of the gaming community we raise awareness we aim to reduce stigma which is a lot of what this talk is about and we actually create and distribute

mental health resources for people who are very vulnerable and in need and i just want to take a moment we are a new zealand organization and i just want to take a very brief moment to extend my extreme regret and sorrow for what has happened in christchurch over the last few days thank you for bearing with me while i got that out there um oh i've gone the wrong way excuse me uh i always put a content warning at the beginning of my talks uh we are obviously going to be speaking about mental illness over the next hour but that also includes themes of trauma and suicide which is very important to specifically raise if you actually need to get up and go or if you need to take a break put your headphones in whatever you need to do no one's going to call you out on it you are free to do whatever you need to do to keep yourself safe you're the most important person in the world and your health and safety is my absolute priority so don't feel anything negative about doing what you need to do to look after yourself

also there's some swearing in the videos i'll try and keep my swearing to a minimum sometimes on the fly it you know a little square will slip out but mostly it will just be in the video so again not as important as the the trigger warning but you know something that we need to raise and a couple of disclaimers please please please please please don't sue me i don't represent anything whatsoever except for myself and everything that i interpret with the videos and the characters in these video games we're about to see is my personal interpretation it's not anything that's been said by the developers themselves is literally just opinion and so we have to kind of make that clear mental illness is a legal term so i'm going to be using the colloquialism which is probably better described by the phrase mental health issues because mental illness in and as itself is in new zealand defined as a disorder of cognition volition perception or mood that

actually impairs someone's ability to think or make decisions in a way that can keep them safe or keep others safe and so they're the sorts of things we talk about in a legal term and the lines get a bit blurry so i just want to put that out there this is the colloquialism of the term mental illness and when i am with my clients at work i tend to function in a symptom-based formulation as opposed to diagnosis based so there's a kind of mixture of the two in here and what i mean by that is a good example is the word psychosis so someone can experience psychosis as part of a diagnosis of schizophrenia so psychosis being the symptom schizophrenia being the diagnosis but they could also have a psychotic depression or they could have a mania with psychotic features as a part of their bipolar affective disorder and so sometimes they'll say depression sometimes i'll say psychosis um that's not to say psychosis is the diagnosis it's just

easier for me to do it that way and also it makes it more human for the audience and for the you know the clients that i treat in my everyday life and of course this isn't medical advice if you're affected by anything that we talk about please do feel free to head to checkpointorg.com global where we have a variety of resources that are localized to different countries and cities all over the world and we've tried to be quite thorough there and there's also some that are worldwide resources so uh spoiler alert there are a few spoilers in here i have tried my absolute best to keep any spoilers for the first two hours of the game um a lot of these i reckon i get a free pass for the last of us has been out for like six years um you know life is strange as well uh god of war there's a very very small amount of it it's almost all the first bit and there's no big spoilers so people get sensitive about that stuff i just thought it was important to say

let's get started why is this important uh i tweeted the other day that i was gonna be doing this talk and i got a response um saying why why why are you doing this and it wasn't because they didn't think it was important it was because they were wondering what's the point in representing people's pain it's just gonna make it more real for them and i take that like absolutely i i understand but there are so many reasons to learn how to do this right depending on where you are wait which study you read somewhere between 25 and 50 of people will have a mental health issue at some point in their life that is somewhere between a quarter and half of the people in this room it might even be more it feels like a huge statistic to say half of us will have a mental health issue it feels disproportionate to what

we know about the people around us if you think about the four closest people to you two of them will have a mental health issue at some point in their life and that seems baffling and it's because we don't talk about it and there's a reason we don't talk about it mental illness is extremely stigmatized surveys have shown that 25 of people would feel uneasy or fearful around someone with a mental illness and 46 of people excuse me believe that mental illness is an excuse for bad behavior so essentially what we're saying is that a significant proportion of the population think that half of the people in this room are badly behaved and scary no wonder we don't want to come out and say i've got a mental illness no wonder people are keeping this stuff deep down the fear of the stigma that they will be facing is huge they're scared that they're going to not get jobs that they're going to fail in their social lives that people are going to actively discriminate against them and worse still the people in this society who suffer a mental illness are 10

times more likely to be a victim of violent crime 10 times more likely that's ridiculous that's to me absolutely disgusting and it needs to stop these statistics are inherently linked to one another the violent crime is because we view as a society people are mentally ill or scary or badly behaved and therefore inhuman in some way that they're deserving of the mistreatment that they're receiving from the rest of society and so of course people aren't speaking up of course that 50 statistic is a surprise because people don't speak up they don't get help two-thirds of people will never seek medical professional help for their mental illness two-thirds so you've got fifty percent of people have a mental illness and two-thirds of those never get help for it whether that's because they don't want to actually say i'm suffering or whether they don't even want to like the stigma

is so bad they don't even want to acknowledge it within themselves that's huge we know that med like proper professional treatment helps even if it's just a professional saying you don't need pills here's a very brief course of self-help like a self-driven cbt or here's a social worker that can be an advocate for you even if it's a simple intervention we know that we can treat mental illness we can cure mental illness if you get professional help so why are people scared to get help they're scared they're going to get locked up in an asylum that they're going to put on medication that is going to change their personality that there's so many things that people believe inherently and they're scared of these things because they've seen them they've seen them in the movies they've seen them on tv and they've seen them in video games a thousand messages screaming at them constantly if you're mentally ill you're terrifying and you deserve to be put in a straight jacket locked up in an asylum

the key thrown away and say goodbye to everything you knew but it doesn't have to be that way we know for a fact we have studies that show that if you represent issues appropriately empathetically and realistically in media public perception improves people understand the issues better they're more empathetic for them that means that rates of violence decrease respect and sympathy increase and people are more likely to seek help so we're talking about the most vulnerable people in our society sometimes people that can't tell what's real and what isn't this is how we protect them when they can't protect themselves and it is our obligation to do that i believe and i assume that you agree as you are sitting here in this room so thank you for being on this journey with me and thank you for coming because you have the power right now and that's thrilling to me

so let's do this right and i would be pretty terrible if i came and talked to you about all this and didn't tell you how to do it that's why we're all here these guidelines um were made as an adaptation of the generic screen and stage guidelines from an organization in australia called mind frame they advised the media writers journalists how to talk about how to represent mental illness and they didn't have a games section so with their permission um i took the advice that they give to film and tv and i adapted it to make it more appropriate for game developers using what i know about game design and game development myself and because i'm a doctor and we make acronyms out of literally everything have you heard have you heard the acronym tla it means three-letter acronym so i made an acronym called lapses and

someone i didn't think of this this is not my best pun game was that someone on twitter was like ah this is when your lapses in judgment are a good thing i liked that a lot uh so lapses means language um i'm going to go through these very quickly because me talking at you doesn't actually prove anything i want to show you some videos and that's what we're all here to see but i'll go through them very quickly to kind of just give you an overview language is so important if you're the writer and it doesn't necessarily need to be the character dialogue it can be the narrator or even just the in-game text in any form get the language right and avoid getting it wrong and i know that sounds like they're the same thing but then they're not so we have a number of words in our everyday vocabulary that are quite loaded um psycho is my least favorite word in the entire world and if you take

one thing away from this talk never use the word psycho again please i will go on and on and on about this um psycho literally means nothing it could mean psychotic it could mean psychopath they're two different things i will talk about that at length later but if you use the word psycho you're essentially labeling anyone who is having a psychosis as being a psychopath and that is so dangerous because these people are incredibly vulnerable crazy is another good example i use crazy all the time crazy and nuts is just part of my vocabulary i'm trying to cut them out but you know it's i accidentally do it a lot of the time but it comes from the word crazed meaning out of control meaning unpredictable so in using that word you're actually implying that they're traits that these people have and words do have power and then you've got the using words right part and a good example for that is oh i'm so ocd i like everything neat

and that's just completely trivializing the experience of someone who actually suffers with obsessive-compulsive disorder because it's not just needing things neat it's an incredibly complex illness which involves a variety of different obsessive intrusive thoughts and then compulsive rituals um often in order to achieve things that are completely unrealistic and so it's really important when you are writing to just double check the language just literally just google it see what wikipedia says it's not something that has to be a real big time sink it's just something that's really important to just double check when language and representation is done accurately it helps the people in the audience to identify their own vulnerabilities so in seeing yourself or seeing a trait or a part of yourself portrayed in the game and particularly in games which is so immersive and so fantastically involving you're able to if you have this vulnerability identify

it in the character that you're playing as that's a really powerful tool to promote help seeking so if you want to represent a character's mental illness accurately ask ask professionals ask people with lived experience do the research and it goes hand in hand with not perpetuating stereotypes which i'll talk about in a little bit purpose why are you doing it why are you including mental illness in your game no one wants the 50 gazillion horror game that's sitting on this island because someone decided one day that asylums were scary you can and should represent mental illness i'm not in any way saying don't do it but there is a way to do it correctly and a way to do it for the right reasons and those reasons are things like character development making characters that are real that you can relate to sympathize with that the player feels like they're actually going on a journey with because they can see parts of

themselves or their friends or their loved ones in this this digital person things like uh driving plot motivations and conflict in the game the person that is representing mental illness doesn't need to be perfect or a saint everybody makes mistakes i was going to say the f-word then um and i said i wouldn't swear everybody makes mistakes and a good person can do a bad thing and that might be because they're experiencing a mental illness the point is that you're using it for a reason to drive something and obviously what i would consider to be the most important reason to represent mental illness is if you're actually trying to raise awareness and reduce stigma for that mental health issue stereotypes tend to fall into three different trees there's stereotypes of fear and exclusion i.e mental mentally ill people are scary authoritarianism which is mentally ill people are not able to make their own decisions and

thus we must make decisions for them and sorry stereotypes of benevolence uh which is mentally ill people are childlike and must be taken care of be aware when you're writing am i falling into one of these trees of the stereotype and how can i avoid doing that show empathy and it doesn't again it doesn't need to be someone that's a saint you can have a good person that does bad stuff they don't need to be 100 empathetic all the time and maybe you could even use their mental illness or part of that as the reason that you're empathizing with them and support is a huge one uh life is strange did this really well they actually had in the game a list of external resources that you could go to if you were experiencing a mental health issue because those themes are used so much in the game but it doesn't need to be as oblique as that it doesn't need to be this big obvious signposted mental health stuff like you know when there's a terrible story on the news and they're like if you've been affected by this issue use

your call lifeline it's good to do that and you know please do if you want to we've actually had a couple of games direct to checkpoint which is really cool because it's a gamers charity so that's something to consider but it also could just be behavioural modelling it could be a character who is experiencing something and then that character says okay i probably need help and then goes to get it so you as the developer don't need to kind of break the fourth wall by speaking directly to the player you can have the character or those around the character speak to the player through the game we're going to move on to some specifics which is the bulk of the talk what i'll be doing for you know roughly the next half an hour uh breaking down specific symptoms and conditions that commonly associated or our mental illnesses explaining the myths that are associated with each uh and the reality of the situation and then showing some video games that have done each of them particularly well uh i actually don't go through substance

abuse and addiction um i should have took that out i apologize uh because the talk was too long depression one of the most common mental health conditions that we as a society society excuse me face and also one that is incredibly misrepresented a lot of the time many people believe that depression is just feeling sad i'm a bit down today and i might be a bit down a day next week actually depression is a pervasive state of mind that can last consistently for weeks months or years someone with depression is most commonly describing to me as their doctor not as feeling sad but feeling nothing and that is incredibly distressing to them they feel apathetic they can't enjoy anything anymore even the things that were their best hobbies in the world they're just like i just

just don't have fun doing this they can't concentrate their memory is shot they're not motivated and they're not motivated to improve their situation either and that's a really challenging thing to overcome and the physical symptoms are almost never represented these people usually when they're experiencing depression when they eat too much or not eat enough one of the really worrying signs is when people start losing weight and they're not even trying to it's just falling off them they might not be able to sleep or sleep too much and we have a very classical symptom of depression which we call early morning waking which is people that will wake up without an alarm at like four o'clock in the morning and then they're like well what do i do with my day now i want to bust this thing about antidepressants i actually don't like the name antidepressants because that's not really what they're designed to do but there are a group of drugs that treat depression therefore we call them antidepressants and that they make you feel numb and they change your personality and of course if you believe that you're not going to go out and try

them right if even if that's the one thing that's going to take you from being depressed to being functional again if you feel like they're just not going to do anything for you and in fact going to harm you you're not going to try them but all medications have side effects there is not medication in the world that does not have a potential side effect and in fact most people don't get any whatsoever and if they do get one and it's not very good you just go back to the doctor and the doctor says ah sorry about that let's try this different drug instead and it's a growing and a collaborative journey that you could take together so that's something that again i'll talk about drugs later but it's something that's really important depression is not a sign of weakness of course you don't necessarily have had to experience the trauma or a negative event in your life to become depressed you could be doing the best you could be as my australian friends say living your best life and still have an episode of depression because it's a biological illness that happens within the neurotransmitters of your brain and there's nothing that you can do about that

and it doesn't require medication to treat you can also use psychotherapy and lifestyle treatment options so we can't be just fitting everybody into this one thing of depressed drugs depressed drugs there's actually a variety of things that you can do and so i'm just gonna and i'm desperately hoping that the sound works so you might know in study valley that you're a farmer and there's a number of non-playable characters in the village and they all have an arc you can romance and marry many of them as well and shane's arc as what's indicated here um includes that he is suffering from what i perceive as a depressive illness it makes him relatable it makes him realistic as you're playing through the game excuse me um

what i'll try and do is just speak very very quickly then because i can't pause so by this point in the game you've actually built up a relationship with shane um i think this is the first meeting and he's exhibiting some real significant symptoms [Music] and later you see him here surrounded by tins of beer and you really feel for him he's literally crying on this cliffside and encouraging you to support and help him

he's experiencing suicidal ideation i think that's pretty clear from what's happening which is a common feature of depression and importantly he asks for help he says to the player i really need you to take me to the hospital coincidentally the doctor is another romantic choice and i like that we're not dictating to shane what he needs to do at this point it's a suggestion that's appropriately labeled

i'm so sorry anxiety another incredibly common mental illness or mental health issue i should say that is very regularly misinterpreted lots of people think it's just having panic attacks or that someone who has anxiety is an emotionally uh sensitive or shy person when in fact anxiety disorders are real i have one um you wouldn't know it because i'm standing up here talking to hundreds of people um but actually people with anxiety disorders often overcompensate quite a lot um and they will come across as extroverted as that outgoing

um and sometimes can be a bit irritable at times and the reason for that is that they're constantly in a state of fight or flight their body is telling them you need to get out you need to run you need to go and they don't have the mental capacity to actually process information at an acceptable rate so there's about a gazillion things firing and they're not really able to kind of really see what's happening and that's in an episode of acute anxiety whereas a lot of people who have anxiety disorders uh go a long time without experiencing anxiety they feel completely normal gad what i've written there is generalized anxiety disorder that's what i have which is feeling very worried all the time about everything there's also things like social phobia and specific phobias and they used to include ocd and ptsd in the anxiety disorders but they now have their own sections of the diagnostic manual um interestingly whenever i see anxiety

sorry presented on screen people are prescribed sedatives like valium valium isn't going to actually take away anxiety it will make you feel a little bit calmer for the moment but the treatment of choice is high-dose antidepressants this is the best thing i've ever seen anyone play celeste [Music] i just want to point out that um on the top left of the gondola is a little purple head character that is an actual physical manifestation of the main character's mental health issues and it's something that comes up again and again throughout the game and is actually used as a powerful mechanic motivator and it's a very very emotional driven story [Music]

[Music] so obviously she's having a panic attack [Music] he labels it immediately the language is incredibly appropriate it is what's happening i also like the way that the environmental storytelling is explaining to you what madeline's experiencing by showing these kind of tendrils coming into the side and the music is also communicating an experience to you without actually having to say to the player what's happening now when i didn't play it was too hard for me but my other half did and when he played this and i saw this i was like pause this game this is amazing the game teaches the player how to cope with a panic attack

using a breathing exercise it includes it in the game's mechanic in an intricate way and gives the player transferable skills that can be used in their real life that is exceptional amazing amazing amazing work this is how you do this correctly we're moving on to psychosis i would like you to repeat after me psychosis and psychopathy are not the same thing thank you psychosis is a series of symptoms that describe a detachment from reality people who are experiencing psychosis can have hallucinations delusions thought disorder and a lack of insight hallucinations can be of any modality it's not just hearing things which is

the most common and it's often not seeing things either in fact if someone was seeing things i would think they probably had an organic problem within their brain such as a dementia hallucinations as i say can be of any modality often they're hearing voices but you can hear other stuff too explosions music some people feel things under their skin like worms is the classic one some people smell things poison gas is one that i hear pretty commonly and they're not able to tell that these things aren't real even if you challenge it they still think it's real and that's part of the illness itself a delusion is different from a hallucination because a delusion is a fixed false belief classic example i'm an alien you could put me through a ct scanner cut off a bit of my body dissect it and say look you are clearly a human being and i still am like no the aliens made me look like that that's a delusion it's fixed it's false

it's unshakable uh thought disorder is the the classic um you know when you're thinking there's a sentence in your mind if that sentence was to become muddled about or you were to jump very quickly from one unrelated sentence to another and you don't know this is happening so your perception of the world around you and how you're actually thinking and processing information is impaired you obviously are not able to experience reality and make reasonable decisions about the reality that you're experiencing and the nature of psychosis is you don't know that that's happening and you believe that what's happening to you is the true reality and that everyone else is lying essentially it makes it really tricky to treat also makes these people so so vulnerable they are so vulnerable they just don't know what's going on and they need looking after they need help they do not need to be told that they're evil that they're psychopaths that they are going to kill people that is not the case at all and doing so is

actively damaging these people in society and we just need to stop doing it uh psychosis is not a split personality that's a misnomer because the etymology of the word skits is it means split but it's just a coincidence and latin and we're really bad at medicine at naming things accurately and the vast majority of my clients who experience psychosis live in their homes they have jobs they have kids and a family and they live a very functional life and they are not all locked up now before i play this video it's a game called hellblade senua's sacrifice it is my game of the decade these developers showed me what my patients have been experiencing over the last 11 years without without me leaving my living room i put on a headset and i played this game and i got the most overwhelming experience i was literally in tears i just i can't

believe that this is what it is and it's just incredible the way that they use the sound design the environmental storytelling even the mechanics everything is unified to display what psychosis is how it feels what it's like and they did it by asking doctors and people who have had psychosis they worked closely with them and they actually represented their experiences in this game and it is one of the most powerful experiences i've ever seen uh if you didn't hear that was are you scared you should be scared thank you

you see how the hallucinations flipped from second to third person that's a common experience often the hallucinations aren't saying anything derogatory they're just thinking about what you're doing the darkness does not bargain it does not reason it is wrong and now it has taken hold she is such a likable character strong and vulnerable at the same time she's incredible until there is nothing left of her [Applause] now i just want to clarify very briefly what this is this black rock suffering will have been for nothing i believe there's a delusion of nihilism which means she believes her insides are dying

it's a common feature of psychotic depression and not only did they put it in to represent her experience they actually made it part of the game mechanic so every time you die the black rock grows and if it overcomes your entire body there's a perma-death or allegedly there's a perma-death mechanic and i put this scene in as just a bit of contrast to show the various sides of this person this character that they represented they showed her vulnerability her strength they also showed her her human side her beauty challenging this really pervasive stereotype that psychotic people are evil by showing her experience of the world in such a glorified wonderful way and obviously i really like this game could you tell

trauma and post-traumatic stress disorder something experienced by many many many people and not just because they are war veterans it can be any form of trauma which can be a loss or a grief of a loved one can also be vicarious trauma which is you weren't even there but you've heard or seen what happened and are therefore traumatized by it the unifying factor is there have to have been a threat to life or safety having ptsd is not just lacking resilience the strongest amongst us can experience this and there are many contributing factors that we're still trying to understand invalidating someone's trauma by saying that they're just weak or not resilient

is incredibly damaging and stops people from being able to process and move on by sticking them in this kind of vortex of self-doubt people with ptsd and trauma responses are not violent unpredictable or psychotic they actually present with a variety of symptoms that usually include hyper vigilance which is being constantly on the alert for everything around you all the time flashbacks of the traumatic event and nightmares which don't necessarily need to be about the traumatic event they could just be nightmares about anything but they are pervasive and continuous they might become irritable they might become emotionally detached i've got two games here if you need to like go for the god of war i understand now

so there was a clear move here i assume to use environmental storytelling to communicate kratos experience of his past trauma he is looking at his deceased wife right now not not a glimmer of emotion on his face the story is being told by the environment by the music by the relationship between him and his songs which way in the direction of deer this game isn't really about kratos it's about the relationship with his son this way and the reason that they're able to look at kratos kratos's trauma is to exemplify that relationship what are you doing now as guard is up obviously that's a massive overreaction for what's just happened and this kid's

mums just died so holy fire when i tell you to fire i'm sorry do not be sorry be better such a good line follow me why help us again this is a really artful way of communicating minor maybe i see more of myself than you that i'm willing to admit maybe maybe by helping you i'll make up for a lifetime of mistakes we're using an npc to communicate kratos is psychology this is a little bit of a spoiler sorry cover your eyes and ears for 30 seconds if you're bothered

so he's having flashbacks because of the lightning very common big bang big flash your brain goes into hyper alert mode re-experiencing the trauma get out of my head [Music] quick apology for this next clip one of the uh words comes down out of sync with the dark bit also it's my favorite game of all time

just fyi [Music] you mumble in your sleep experiencing nightmares of course i hate bad dreams yeah me too what do you want from me admit that you wanted to get rid of me the whole time tommy knows this area well i'm sorry i trust him better than i trust myself stop with the [ __ ] what are you so afraid of that i'm gonna end up like sam i can't get infected i can take care of myself how many close calls have we had well we seem to be doing all right so far and now you'll be doing even better with tommy

the interesting thing here is because ellie reminds him so much of his daughter he's literally trying to get rid of her to avoid reliving his past trauma um if you didn't know john's daughter dies at the beginning of the game you are treading awesome mighty thin eyes here i'm sorry about your daughter joel but i have lost people too you have no idea what loss so yeah this is another example of how he's not actually traumatized by the zombie apocalypse he's throwing ties by his daughter has either died or left me everyone [ __ ] except for you so don't tell me that i would be safer with someone else because the truth is that would just be more scary [Music] you're right

you're not my daughter [Music] and i sure as hell ain't your dad literally the entire game is driven by this drama we are going our separate ways all right one more borderline personality disorder one of the most common mental health issues we see as a society the evidence suggests that between seven and ten percent of the population has a personality disorder and borderline is the most common personality disorder of which there are actually ten um which are i like this game schizotypal schizoid paranoid borderline anti-social histrionic narcissistic avoidant obsessive compulsive and dependent

come on i need a round of applause for that as i say borderline's really really common um it's experienced by a significant proportion of the population and because it's poorly understood it's misdiagnosed regularly usually as bipolar disorder and the reason for that is they're both characterized by mood swings but the mood swings that are associated with borderline go like this all day every day and with bipolar disorder you'll get a manic phase which will last for several weeks and a depressive phase which can last for several months and in between these people are normal or we call normal's a terrible word i shouldn't have said that but they're what we say euthymic they're some they're sitting somewhere between the two mood states whereas a person with borderline does not experience that normalcy for very long they're constantly going up and down we call that effective instability they are not super able to respond to their

perceived threats in the environment so when they think that there is a threat coming and it's usually a threat of abandonment because of an early trauma that they experienced they react in a way that seems to others to be a bit too much they go a bit over the top whether that be with rage or with kind of reaching out and desperately requesting love and affection they don't they're not able to regulate those big powerful emotions as well as someone that doesn't have this disorder and they can't help that they they can't control that they don't want to be like that it's incredibly distressing for them and these people are the ones that i see very often because they just can't take this chaotic lifestyle anymore and they really want to be different they seem to often be attention seeking because they occasionally will engage in things like deliberate self-harm

but actually they're asking for help they really really want help they just don't know how to ask for it because they're vulnerable they've been early they've been traumatized early in their life and they're just not able to interact in a way that's effective or functional it's an incredibly treatable condition and if we were better at representing it better at diagnosing it that more people would get the treatment that they need they would cease their levels of distress and be able to live a normal functional life this is something we really need to get right it's the last video you can't keep blaming me and everybody for everything and it's chloe that i think has borderline personality disorder not max i blame somebody otherwise it's all my fault [ __ ] that so she has a very classical black or white thinking pattern here there's no area of gray it's either her full or not her fault and there's no

wiggle room there that's a really distressing way to see she was banging that pig frank [ __ ] lied to my face max people are often ideated or denigrated so that means they're either perfect or terrible anybody again and that's held with faith until they don't even you and you can see that chloe is emotionally lashing out at max because she perceived that max abandoned her at some point you know what it's like to wait for your father to come home when you're a kid and he never does no of course not but i was with you that day it was just a terrible accident and what we're showing here is that there's a reason that chloe has this disorder even though she's lashing out and being quite inappropriate and hurtful towards max we can see [Music]

us and now one of them showed that you were gonna leave when i needed you most a very clear display of her frantic fear of abandonment [ __ ] cameras i show her with such vulnerability here even though she's angry and all by herself she's she somehow seems small and and needing of protection she's a very very likable relatable character again environmental storytelling the music says more than any words could

there's some others that i really want to quickly want to go over i actually spoke a little bit more about bipolar affective disorder before but big mood states manic impulsive um not sleeping too much energy for weeks normal for a bit depressed for months dissociative identity disorder excuse me used to be called split personality most psychiatrists agree that split personality doesn't exist and that we call it this specific diagnosis because this different identity is a form of yourself that you're so dissociated from yourself that you're actually identifying as a different person it's really rare and anti-social personality disorder this is what psychopathy is anti-social personality disorder is a type some type of personality disorder for people that do not empathize with other members of society they show very little respect for authority and don't believe that authority should apply to them

and they're hugely over-represented in the prison population psychopaths are a version of an anti-social personality disorder where they also want to harm others and because they don't necessarily care about others they are much more inclined to do that they know what they are doing they know it is wrong they can tell the difference between right and wrong they are based in reality and they choose to do it anyway that's a bad person someone who is psychotic does not know that what they are doing is wrong or they do know that it's wrong but their reality is so skewed that they can't actually tell what they're doing and a very last slide of my very specific gripes stop putting wheelchairs and mental health wards we don't need them these people are walking around and talking and they don't need to be in a wheelchair stop it

there's so many wheelchairs there doesn't need to be wheelchairs asylums don't exist anymore but what the modern equivalent of mental health ward they're not scary they're really really boring most of the time i've worked in them for years you'd be amazed at how mundane it is not not all psychiatric not all psychiatrists are british i'm a very bad example [Music] but they don't have to be evil and they don't have to be english in fact some psychiatrists are really quite small and unintimidating please get the medication right talked about this heaps earlier but all you have to do is go on google for like five seconds and you'll you'll get what you need it really helps people in signposting to the appropriate treatments and yes we still use electroconvulsive therapy yes we do regularly it's really really effective for certain conditions particularly when

someone's life is at imminent risk if someone is catatonic they're not able to move eat or drink they will die in a few days dct works for them we anesthetize we give them a general anaesthetic and we use a muscle relaxant it's not scary it's not one flew over the cuckoo's nest this is an effective treatment please stop demonizing it or obviously none of no one here is demonizing it but please don't i think that's really important when we represent mental illness even talking about mental illness it is a trigger even being in this room is a trigger it might bring up stuff for you look after yourself look after each other have a mental health protocol in your studio ask a professional ask me you're here because you want to do good thank you so much for that you're here because you want to change people's lives you want to save lives you want to change the world you are so cool i love you look after yourselves and let us help you do that

thank you so much for coming how much time have we got for questions few minutes huh about five minutes sweet i didn't overrun this is the first time i've ever done that um hello hi uh i'm working on a game that focuses on the physical challenge of having a chronic illness how can we represent the realities of some illnesses like taking a lot of medication without turning it into a stereotype sorry could you repeat the first sentence okay i'm working on a game that focuses on physical uh the physical challenges of having chronic illnesses so how can we represent the realities of some of these illnesses without turning that into a stereotype sure ask them um literally ask find the people who are experiencing what you

um are working on talk to them ask them obviously ask their permission if you're struggling to find them go to your local mental health facilities try not speak to the person that's in charge there there's usually advocacy groups who are very very keen to get people involved in community service work like that so these people really do want to talk about what they've gone through they're fed up of seeing the same old [ __ ] on the telly representing their illness they want it to be done right and they're going to be so grateful that you're actually willing to take the time to listen to their story so please talk to them thank you uh hi so this is hard to talk about about two years ago a friend of mine committed suicide i'm so sorry thank you and since then i've i've i may not be the best person because of that to say this but i have a really

really strong feelings in terms of game design of never ever ever make your player talk somebody off the ledge because don't do not do that just simply do not ever do that i can i just very that's very that's an extremely emotional thing for me and for part of that i partly to that i want to say thank you for not citing that part of life as strange as being good because i personally really don't think it is and i really also [ __ ] hate doki doki literature club for doing the same goddamn thing but even worse um do as a professional what are your thoughts and feelings about that because last night my friend lou and i were talking and we sort of about these things we kind of came to the conclusion that is a topic really we both felt is really only suitable or okay for an educational game so what are your thoughts on that yeah look i think that's fair enough it's not something i consider the specific scenario of um and i like the way you phrased it talking i'm off the ledge um it's something that is an

art that i've spent the last 11 years learning how to do uh and i i i would not say that i'm i'm perfect or that i really know how to do it um or that anyone in fact does because sometimes we do have to put people in locked wards to to protect them and therefore that means that the people around them are not going to be 100 sufficient at talking them down because what's going on there is a process that isn't rational it's a process that isn't going to be adherent to logic um and so for example a good example is when someone's incredibly suicidal if someone is genuinely considering their own life at that point they usually feel like they are a burden on those who love them they genuinely feel like they're worthless they have no worth and to tell them no you you have worth your we love you can actually sometimes make them feel worse so it's it's a very

difficult situation to to try and navigate um i would say that if you are going to do it in your game um that's a choice for the game developer but ask people who know what they're talking about so that they can advise best practice thank you you're welcome hi hi there um i i watched an interview years ago on tv that gave me the impression that anxiety and psychopathy are mutually exclusive i was wondering is that true absolutely not and anxiety and psychopath anxiety and psychopathy or psychosis psychopathy no i would say that they're capable of being anxious the same as everyone else they're just anxious about different things usually i see odd that's it yeah interesting hello hi um yeah so other hellblade's angular sacrifice is interesting that they actually brought in like professionals and patients to work on like doing it right do you know any organizations that

actually work on helping mental health professionals collaborate with game developers or the same organization okay um or if there's any organizations that help do funding or grants uh for games that are focusing on mental health um the the grants that i've seen almost exclusively by health organizations so i think ninja theory got quite a lot of funding maybe not ninja theory i don't want to say the incorrect thing i know that there was funding from a uk health organization involved so that's who i would go to we can't help with that one unfortunately if you can figure out how how that works please let me know and does checkpoint work uh like across different nations or is it just localized like new zealand and britain and stuff no we're an international organization we have people on the ground in australia new zealand and the uk we have a couple of people on the ground in the us as well but because most of our work comes from

digital and online interaction it makes it much easier there's no barriers anymore and that sort of thing so cool thank you get in touch there's heaps of business cards here and flyers that have the um summary of the lapses acronym at the front so come and help yourselves there's heaps and i don't want to take them home with me uh hi thank you so much for talking to everyone about this it's such important stuff um and on the subject of hellblade so i love the game so much it's so interesting and it's so metal but um there was one criticism i read from a sufferer of psychosis which was really interesting and talking about how they sometimes the voices in the game are actually helping yes they'll say things like i don't know watch out things like that and it was one criticism that from this um sufferer of psychosis that my voices are never helpful this is not an experience like this there is no upside to the things i experience and so when you're in

when you're making a game there has to be a way to proceed there has to be a way to get forward usually and so like have you encountered many of these examples where the kind of reality of the mental illnesses and sometimes the inescapable nature of them kind of conflicts with absolutely absolutely like think about the people that you will meet at gdc everyone has an intricately different personality everyone is completely unique and therefore so are the things that affect our minds our mental our experiences of mental health are going to be completely unique to us and if you're going to represent them in a game you i don't think it's possible to actually represent the experiences of every individual what the goal i think should be is to raise awareness that will reach as many as possible and reduce harm to those it doesn't reach if

that makes sense so that finding the balance if it's one person that said that hellblade they didn't relate to you know that that seems like a really sad distressing situation for that person that their voices are never never positive and unfortunately it's a common one but the people that they spoke to did have that experience and i i've heard that often um particularly with people that have schizophrenias sometimes their voices aren't derogatory and they're not nice they're just literally like saying what you're doing um like jenny walked to the other side of the podium jenny spoke to the audience it would be so distracting and annoying to have that happen all the time but you can't you can't represent everyone's experience simultaneously maximize benefit minimise harm thank you very much the bottom line thank you um hi hi fantastic talk um thank you in

uh god of war i remember if i remember correctly in the trailer we had that the same scene where um uh atreus uh shoots at the deer and uh kratos is saying no don't do that i believe there's a game mechanic that got cut eventually where you had to control your anger do do you think that it would have been uh appropriate to to to leave that in uh yeah i think there would have been i mean obviously i haven't seen it um but i think that would have been appropriate and would have been powerful i also understand the limitations of game development and sometimes you can work for four months on a feature and then have it cut and it doesn't make it in and that's just the way the cookie crumbles so yeah it would have been cool and certainly when i spoke to corey that was actually one of the things that he he specifically mentioned was was kratos journey of actually being able to control his impulsive rage responses um and that impacted the relationship with his son um because he was always always

trying to do that so yeah it would have been interesting uh it's it's a shame it is what it is i guess thank you thank you hello just wanted to say i love your talk and i really think this is an important conversation to have thank you i'm currently interested in making a storyline about a person who's going into people's minds and helping people with their illnesses and i know that there are people in the world like you say that end up using like derogatory terms or the wrong kind of terminology for people with illnesses and it's something that we should try to avoid in games but i'll be honest i actually am guilty of this myself and it's something i'm still trying to work on but it does slip out from time to time i'm interested in actually including it into a game but not as to like support it but to point out that there are people in the world that does this and it is absolutely we should condone and i was wondering if that would be okay to include yeah look i think i think blanket censorship is ridiculous um

because you you're not communic in if you just censor something you're not communicating to the people that use that language why it's inappropriate um and so i think what you've just described there of using using it but framing it in a way that isn't actually promoting it so you can for example we put people that kill in our games all the time right like there's a primary mechanic it's killing other people but we're not necessarily saying it's a good thing to do um and often that the people who are doing that are quite um demonized and that's obviously the correct way of approaching it so i would use that sort of analog if if it was me but feel free to get in touch i'd love to talk more about that because i think that's a really interesting topic actually um thank you thank you awesome um any more questions if not thank you again so much it's been an absolute pleasure um

hello um yeah we've got flyers i've got business cards uh and we have one more question hey um i have autism uh high functioning and one of the things that i've kind of noticed with mental illnesses and gaming is that they all tend to be a lot of tragedies and i'm like where are the positive stories that's my thing i'm just kind of like you know a little bit like what the hell i mean all games have conflict right that's why they why we play them because oh yeah overcome the conflict i think a good example is celeste there's no real tragedy there she's trying to get to the top of a mountain and that the whole thing is a metaphor for her journey with her mental health issues and she actually gets to the top of the mountain and i don't want to spoil it but the end is amazing so if you want to give it oh i'm totally not you know saying that

they shouldn't have conflict i'm just saying why do most of them end in tragedy because like you know with god of war i think it's like a human condition right yes that's a game that's clearly about you know a tragic aspect and it continues to get darker and darker and darker and it doesn't really let up i haven't finished it i am so sad for you sorry about that no no that's okay i thought it was funny um i think i think it's the human condition we show stories about the deepest parts of our psyche and often that is tragedy and yeah it is tragedy but i also see a lot of you know people who persevere um actively within that community so yeah do i have an answer for that i'm afraid we'll keep on tracking yeah that's that makes a lot of sense um well yeah i also love the talk i had a good time thank you you're cool

all right i'll be around for a little bit