Digital Culture & AudioVisual Challenges

Summary
The paper explores the capacity of game mechanics to facilitate the understanding of people suffering from major depressive disorder and to create an environment for cognitive, emotional and compassionate empathy [1]. To this end, four mini-games showcasing everyday struggles in the life of a patient were designed and developed [3]. In contrast to the stereotypically negative portrayal of mental illness in video games [4,5], this work approaches the topic based on principles set by empathy games [2] and aims to offer insight into the challenges patients are confronted with to non-familiar audiences. Each mini-game addresses another feature of the selected disorders, namely: (i) symptom of clinophilia, (ii) symptom of fatigue, (iii) social interaction distress and (iv) stress-induced thinking process.

Objectives
The presented work aims to explore the degree to which symptoms of major depressive disorder can be translated into game mechanics. The work is based on relevant literature and examines the hypothesis that games can be used for communicating symptoms of such disorders by designing a video game and putting it to the assessment of patients who have experienced such disorders. The main objective is served by a complimentary goal, which is the development of a prototype video game that is used to present the symptoms of the mental disorder, as well as exam its effectiveness and subsequently the proposed hypothesis. To this end, an interdisciplinary team was initially created to set the criteria to be met by the game “Another Day, Another…”. The criteria, which focus on the symptoms of depressive disorder, are based theoretically and empirically on psychiatry and computer science that specializes in the process of game development. The ultimate goal of the game is to be implemented as an educational resource for psychoeducation and to be used in different contexts so that end users can understand and empathize with the person experiencing depression.

Method
The method employed for the completion of the work’s objectives consists of: (i) the research for major depressive disorder and the stigmatized, negative portrayal of mental illness in video games as a whole, (ii) an overview of pre-existing video games that touch upon the selected mental disorder, with special attention on the category of empathy games, (iii) the design and development of four mini-games, each addressing a different facet of the selected mental disorder, implemented in the narrative frame of a patient’s diary and finally (iv) play-testing and user-based evaluation by patients and potential players, to establish the game’s efficacy and to what degree it has been achieved.

Conclusion
This work takes on the hypothesis that games can be utilized for communicating the symptoms of major depressive disorder and presents a case of translating such an experience into game mechanics. For the fulfillment of the objectives, a set of four mini-games are designed and developed into a prototype video game, based on the symptoms of major depressive disorder, in the narrative frame of a patient’s diary. This approach aims to deliver a psychoeducational intervention in the aforementioned mental disorder in an empathetic light to non-familiar audiences. Future work includes the advancement of the narrative frame, the employment of participatory design through interviewing patients and the enhancement of the player experience through expressive game graphics.

References
[1] American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders (DSM-5) - Fifth Edition, American Psychiatric Association, Arlington, VA, 2013. doi:10.1176/appi.books.9780890425596.
[2] J. Belman, and M. Flanagan, Designing Games To Foster Empathy, Cogn. Technol. 14 (2010) 5–15.
[3] K. Dunlap, Representation of Mental Illness in Video Games, in: Proc. 2018 Connect. Learn. Summit, Massachusetts Inst. Technol. August 1-3, 2018, Carnegie Mellon University: ETC Press, Pittsburgh, PA, 2018: pp. 77–86.
[4] M. Ferrari, S. V. McIlwaine, G. Jordan, J.L. Shah, S. Lal, and S.N. Iyer, Gaming With Stigma: Analysis of Messages About Mental Illnesses in Video Games, JMIR Ment. Heal. 6 (2019) e12418. doi:10.2196/12418.
[5] S. Shapiro, and M. Rotter, Graphic Depictions: Portrayals of Mental Illness in Video Games, J. Forensic Sci. 61 (2016) 1592–1595. doi:10.1111/1556-4029.13214.