Communications of the ACM
Video Games Provide Outlet for Empathy, Dialogue, and Increased Self-Awareness, Designer Says
"Our games are not for everyone. You've got to be ready for them and open to experience something that's not just entertainment," says Doris Rusch, creative director of DePaul's Deep Games Lab.
Credit: Jeff Carrion / DePaul University
Video games can be used for more than just entertainment, they can also help raise awareness for mental illness and diseases, says Doris C. Rusch, an associate professor of game design in DePaul University's School of Design.
A DePaul faculty member since 2011, Rusch has helped create games such as "Blood Myth," which examines living with sickle cell anemia; "Soteria" and "Zombie Yoga" about anxiety; and "Perfection," a game that addresses the eating disorder anorexia nervosa. Her current project aims to help players understand the mechanisms and emotional dimensions of emotional abuse in intimate partner relationships. Rusch is the creative director for DePaul's Deep Games Lab, and in 2017, she won the 2017 Audience Choice Award for "Soteria VR" at the Innovations in Psychiatry and Behavioral Health: Virtual Reality and Behavior Change conference at Stanford University.
In this Q&A, Rusch explains why this medium is so important, the process for creating a game, how games can be an avenue for healing and what she hopes her games will accomplish once released.
Q: Why is it important to you and the other researchers and developers in the Deep Games Lab to create games for more than just entertainment?
A: Games are the cultural medium of our century and we should use it for something. It's great to have things that just entertain you, but there's so much more they can do for you, so why not? Our games make one point and can really help conversation, dialogue, and empathy. I think that's totally worth doing.
Q: All of your games use metaphors to help explain a disease or condition. Why is that the best approach?
A: I wouldn't necessarily claim that it's the best approach, but here are the reasons I tend to embrace metaphors for my projects: One is to get people through the door, it's the sugar coat that hooks them and eases them into a difficult subject. The other is you truly cannot depict deeper messages about how something very abstract like loyalty or trust works if you don't use a metaphor to make it concrete. Otherwise, you're telling a story and using examples, but you're not getting at the systemic aspects of these concepts, and that's where games excel. Arguably, games are intrinsically metaphorical and play is metaphorical because it always represents something else. So for example, if we play house, it's kind of a metaphor for being in a family household and everything that comes with growing up and living together.
Q: What's your process for creating a game?
A: The process depends on whether I pick a subject that I already have some personal experience with or whether a client or stakeholder brings a subject to me. If it's personal, coming up with a metaphor is a very natural process. The experience is already on my mind and to make sense of it, I'm playing around with metaphors and systems all the time. What does it feel like? How does it work? Images tend to just bubble to the surface that illuminate salient aspects of the experience. Then I go from there and explore the image further.
I also use structural elements of games to get a grip on a concept. What's the goal, the win/lose state, the conflict? Sometimes there is no goal. Or no win state. That tells you something about the kind of system you're modeling. As an example, making games about bipolar disorder or attention deficit disorder, there is no clear "win state" as the illness can't be beaten, only managed. But eating disorder—as a more addiction-based issue—can have a win state.
When I make a game about a subject that is brought to me, I spend a lot of time talking to various experts, primarily people with lived experience of the issue, but also doctors, family members, friends and others. I'm trying to get as much of an understanding as possible about "what it's like" and the implications of the issue for personal life and social context before I even think about a game or mechanics. Throughout the design process, there is a lot of playtesting that involves subject matter experts. Especially when I make a game on a subject I don't have lived experience with. I want to make sure those who do feel as accurately represented as possible.
Q: Can games be a key to healing?
A: It has to be done very deliberately, very intentionally, and very mindfully. It's not going to solve all the problems. I think what is incredibly important to keep in mind is you can't change anyone ever—and you shouldn't—without them wanting to change. Change happens when both parties are ready, when there's a sender and a receiver and they come together in a meaningful "meeting of the minds." There is a game and a player that come together at the right time and that game does something, ignites a desire for change in the player. Maybe it does something years later and we don't even know, we don't even remember what caused that initial spark of transformation.
It's very comparable to how good books and movies work. Only we wouldn't dream of asking for measurable change in regards to those media. When I was a 13, I read J.D. Salinger's "Catcher in the Rye." I don't remember filling out a questionnaire about how much more understood I felt in my teenage angst. But that book changed me forever. I hope games can get away from being instrumentalized and pushed in the corner of having to produce measurable outcomes, just because they deal with themes of the human experience. I think the key to transformation is emotional resonance, not imposing some formula for change on the player.
Q: What's your hope for a game once it's created?
A: My main hope is that people who might benefit from them in one way or another play my games. I know our games are not for everyone, and that they are not for every mood. You've got to be ready for them and open to experience something that's not just entertainment. The target audience varies from game to game, of course.
For example, "Elude," a game about depression, was specifically designed to facilitate dialogue and increase understanding between people with lived experience of depression and their friends and relatives. It's the dialogue that will deepen the experience and complete the game's purpose. The game in and of itself is only a conversation starter. "Soteria," a game about anxiety, was mostly made for people with anxiety disorder to promote readiness to embrace being unsafe and uncertain. However, you don't need to have an anxiety disorder to benefit from the experience in some way. We all have things we shy away from or don't feel comfortable with. So, the actual audience for it is broader than those the game was originally designed for.
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