Insufficent Memory

I have an essay in the latest issue of gaming and history e-zine Memory Insufficient. This month's theme is the history of ecology in games and there are two other essays, both really strong and interesting pieces, alongside mine which look at the flaws in the concept of natural balance and at visions of post-apocalyptic futures and how they relate to climate disaster. I've written a quite post-modern piece about the Gaia hypothesis (sort of), which is in a very different register to most of what I write for this blog. If you have an interest in games and like how I write then hopefully you will also like that piece so please do check it out.

On the other hand, if you read my piece in Memory Insufficient and ended up here via the bio then hello, nice to see you, and please note that this blog is nowhere near as post-modern or structurally complex as that essay. You can find out more in the links above, but the short version is that I write about representations of mental health issues in gaming and talk about my own experiences of depression and how they relate to my experiences playing games. I did write a somewhat post-modern blog for a while called Things I Failed to Do which is generally quite bad but has a few nice entries in it.

Also, if you like post-modern, heavily structurally significant essays on pop culture though I would recommend reading Philip Sandifer's blog, or for specifically game related work his long-abandoned Nintendo Project. Sandifer has definitely been an influence for me; not only do I really enjoy his writing I am indebted to it for demonstrating how to do the encoding-meaning-in-structure technique well and for generally getting me keyed in to the idea of blogging to a structure as a way of keeping writing as I was coming to the natural end of my small press comics phase.

What Makes a Psychopath?

I came across an interesting paper via Mind Hacks recently on portrayals of psychopaths in cinema. It is something of a given that mental health is portrayed overwhelmingly negatively and inaccurately in the media, and that is something that I've talked about before on this blog. In this paper however, Leistedt and Linkowski were interested in looking at that depiction in a closer and more methodical fashion, analysing 126 film psychopaths against current criteria. Unfortunately the paper is locked as it has a wonderfully dry humour accentuated by the constraints academic language but the key points are summarised nicely in that Mind Hacks post.

It did get me to thinking about doing a similar exercise with games, although I have neither the time, resources nor the expertise to do a review of that scope. Again, as with most media, games have a real problem of labelling individuals as psychopathic when they actually aren't and so a great many members of our subject pool would be automatically disqualified. Even then there should be enough to make a survey, although I imagine that they would come mainly from the less-narratively heavy end of the spectrum than most people would expect.

Psychopathy is a funny old disorder in that it is beloved of melodrama and yet the more lurid the invocation the less likely it is to be accurate. Writers like the concept as an explanation for evil acts and yet by definition it has no moralistic explanatory power. In some ways it's fine if you want a villain to commit random violent acts to establish them as a psychopath (although it isn't really) as in many ways the term psychopath is one we use to get an intellectual handle on people who commit random violent acts (although this has been expanded). The problem arises when that label becomes established as a synonym for a certain kind of villain and then writers seeking greater sophistication but lacking the psychological awareness attempt to get into the mind of the character. I am absolutely all for better-rounded villains, but essentially as you provide (emotional) motivation you degrade the integrity of your original diagnosis: as one of the key aspects of psychopathy is invulnerability you cannot retain the right to call your villain a psychopath even as you make them vulnerable.

I'm talking a lot about villains here, but I'm doing so because Leistedt and Linkowski do so too. It is almost a given in their paper that it is always the villains who display psychopathic behaviour. Partly I think this is to do with the general sense in which  psychopathy has become a moralistic concept; its essential amorality being consistently read as immorality, and partly it is as they say that psychopathy lends villains danger and intrigue. I also think it is a function of genre expectations, in that when for instance an action film protagonist acts in ways that might in other contexts be considered as psychopathic we don't consider it to be so because they are acting in-genre and we recognise that and so parse their behaviour accordingly. In many of his films James Bond is almost certainly a psychopath, for example, and although this is sometimes made explicit and sometime lampshaded it is usually excused in a way that the psychopathy of the villains he meets is not. Meanwhile numerous films and heroes are based on the Bond model without even that complexity and with the assumption instead that their heroes are just acting heroically.

What does this mean for video games though? It would be easy to shrug and to say that a great many video game protagonists are psychopathic and that by extension they engage players in episodes of psychopathy; and a great many people do say this. It’s all there: the violence, the lack of empathy, the erratic and impulsive behaviour and the emotional invulnerability; I never once saw Mario shed a tear over the first goomba let alone the thousandth. These particular extracts from Liestedt and Linkowski particularly struck a cord with me, especially if you consider the perfect no-deaths playthrough of any particular game to be the canonical version of the events depicted.

"In these slasher films, psychopathic characters are generally unrealistic, accumulating many traits and characteristics, such as sadism, intelligence, and the ability to predict the plan that the future victims will use to escape."

"Psychopaths in films generally possess a number of standard characteristics that are not necessarily as common among real-life psychopaths, ... The traditional “Hollywood psychopath,” generally found before 2000, is likely to exhibit some or all of the following traits ... (ii) a somewhat vain, stylish, almost “cat-like” demeanor; ... (iv) a calm, calculating and always-in-control attitude; and (v) unrealistic, exceptional skill at killing people, especially with blades or household objects (sometimes overpowering multiple assailants with superior armament). These traits, especially in combination, are generally not present in real psychopaths."

So yes, we could say that video games make us inhabit the lives and minds of psychopaths and blunt our capacity to feel in the process but I think that that would be both grossly unfair, to players, game characters and psychopaths alike. the key sentence in those extracts is the last. As I mentioned a few paragraphs ago this is more a question of genre; these characters are not psychopaths within the rules of the world that they live in. To say 'why aren't video game characters more like real humans?' is to miss the point that they fundamentally aren't real humans but are artistic representations of humans instead. The reason I don't feel it as jarringly out of character for Lara Croft to kill hundreds of grunts but feel sad about her dead mate is the same reason I don't feel it is jarringly out of character for Arnie to kill hundreds of grunts in Commando but feel sad about his dead mate. The art, unless you're in a movement like Dogme 95 where verisimilitude is paramount, is in negotiating between abstractions and representations to create something that feels true rather than merely is true. And sometimes that involves building a jigsaw puzzle of different registers and genre tropes to create a bigger and more vibrant picture that maybe has to gloss over some of the details.

The other problem I have with that analysis is that it is particularly teenage in it’s level of insight, especially as it usually comes alongside an assumption that most players are passive consumers in this situation allowing their minds to be dangerously warped by desensitising media. I say teenage because it's sort of this idea that you are the only one who can see the truth and who was affected a certain way by a certain piece of work. It ignores the internal life of others who may not have the inclination or the vocabulary to express themselves, assuming that if feelings or responses are not being talked about then they must not exist.

Video games are getting technically more competent and so are looking at broadening the emotional register of their characters in-game, but to assume that that is happening in parallel with a broadening of emotional register in players is demonstrably false because human emotional evolution is not tied to graphical processing capabilities; I was having emotional responses to games, and questioning the thoughtlessly violent nature of their protagonists, 20 years ago and I am no-one special. I don't mean to say that there aren't plenty of people wilfully missing the point or interacting with a given work purely on the surface level at any given time, myself included. But, my default position is to assume that the way any given person feels about a work of art is much more complicated than the way that they talk about it.

Psychology and in particular anthropology have historically suffered from a version of this fallacy which has left a legacy of popular belief in the emotional simplicity of both sub-cultures within and external cultures to the western education system from which they draw their explanatory framework. Which actually, neatly, brings us full circle to the initial problem with labelling people psychopaths: which is that it can easily fall prey to the same instinct to ignore internal lives and pathologise solely on the basis of external actions. Which is not to say that the concept of the psychopath is without use or validity, but that it's usage in media is certainly fraught with problems.

Liestedt and Linkowski (2013) Psychopathy and the Cinema: Fact or Fiction? Link

Getting Shot At In All My Guises

I'm used to being shot at in games. I'm intimate with it, with the experience of viewing myself through the sights of a gun, with depressing a trigger that brings release and relief from being and wholeness for both the bullet and the me the bullet interrupts. Being subject and object holds no fear for me, as whichever is destroyed I know that I will continue. I remember my sister complaining that her boyfriend sat around in front of her just playing games where he shot Germans without realising that it might upset her but I knew the problem was deeper than that. We're always killing someone in games, it's just something I learned to be down with because I like playing them. Killing myself, or at least my great grand parents, on a regular basis just made things a whole lot more honest. It humanised everything else I've ever killed.

Of course, we don't really kill Germans in our computer games any more, if we ever did. As the atrocities fade into history, the stock Nazi villains that populated early shooters have developed an armour of camp and irrelevance. Too many other players have caught up with me and can see themselves, or someone like them, in the ordinary soldiers. Duty now calls upon you to kill brown people instead, for the most part, (the rhetoric of culpability remains, shorn of any shred of the justificatory logic it might have held) so I've been dodging that particular bullet for a number of years. Except that they aren't people at all, they're Terrorists, who are like Nazis but without the sexy uniforms. They're an ideology wrapped up in flesh for you to try to wipe out: you can't shoot an idea, but maybe if you can trap it in a fragile mind you have a chance of deleting it once and for all. Every repeated instance.

(But ideologies don't work like that anyway. They are external to the minds that they touch upon and change, like the protagonist in Geist they are unaffected by the death of the host. Execution and war become punishment; punishment for every German's culpability in the holocaust whether they were a Nazi or not. It's a ritual, but one that's hidden from the player - referencing the one reason the war was worth prosecuting would fundamentally spoil the fun of prosecuting it again and again and again. My favourite, personalised, example of the disinterest displayed in the true horror of Nazism is Call of Duty's General Heinrich Amsel. In a game that slavishly recreates the weapons that mechanised death no-one researched the names of the villains. Heinrich Amsel would never have fought for the Nazis, he would have been obliterated by them, because Amsel is a German-Jewish surname. So it goes.)

This is all a preamble to what was to be my main point but maybe isn't any more: why I don't feel that there's anything wrong when I gun down the mentally ill in games. I mean, I do think that there's something wrong, something massively wrong, it's just that I'm used to it. I can't always feel the disgust that I know I probably should. I'm far too used to it.

The mentally ill make for good villains, across all media in fact. You see, we just don't stop, we don't know how. We can't listen to reason, so the question of the appropriateness of force is taken away from you, the protagonist. We make things easy as well, because ultimately, we want to die. Not the clean, pure death urge of the hero either, who stakes his life on the promise of a better world; we just want to be put out of our misery.

It's bullshit, of course. Stigmatising bullshit at that, coming from the same root formulation of moral innateness that allows us to bomb civilians because they look like our enemies and fuelled by a desire to have new villains as uncontroversially evil as the Nazis until recently have been able to be. But I've seen it again and again. Its in the cutscene where a defeated enemy attacks again, justifying the final blow. It's on the choice tree that pops up when an antagonist's eyes clear, reason returns and he begs for an end; and I've provided it. In horror games where the horror is that your mind may not be your own so you obliterate any evidence of what you may become. The mad are both cause and victim of the evil that threatens you.

Even cures are worthless, the popular anti-psych message about medication is that it turns you into a zombie: unfeeling and unaffected; effectively unable to contribute in a meaningful way any more. And, well, the good thing about zombies is how fun they are to kill, how many you can wade through without any feeling of remorse. They are better off dead; both the victim and the cause of the evil that threatens you.

It should stop, though. We need to be able to tell the difference between madness and malice. We need to be able to show the difference between madness and malice, because ideologies spread in a way that madness doesn't. But the secret I know is that we'll always need enemies to populate our fantasies of opposition, and my complicity in this narrative power structure is as unavoidable as my complicity in global inequality. But then, if there's one thing I've learnt from my ancestry it's that an awareness and acceptance of your past is vital for the work of doing things better in the future.

A Little bit of Housekeeping

First up, I'd like to point out the tabs at the top of the page. Yesterday I set up a new one to go alongside the Further Reading page as a resource listing Games that feature madness either mechanically or thematically. I intend to keep adding to both these lists and will gladly take suggestions for titles I've missed. The games page doesn't have links because primarily because choosing a definitive resource on each title seems somewhat too subjective, but again I'd be willing to put something in if enough people shout.

Secondly, it's in the further reading tab, but if you found my take on Depression Quest interesting then you might also like this take by The Orts. I don't agree with everything it says, especially the slight anti-psychiatry stance that seems to push the, in my mind false, dichotomy between treating mental distress as illness and treating it as a part of your inviolable self. But it does say a lot of stuff that I agree with, and that I would say myself, and it does so more eloquently and more academically than I'm capable of.

Thirdly, the latest issue of the as-always excellent Memory Insufficient is on Disability and Games History. Of the three essays two are primarily focused on issues of mental health, while the third encompasses it in its overview of disability as a concept, and so the issue will be of particular interest to anyone who reads this blog. A couple of confessions: editor Zoya Street's article on sanity rules in D&D does reference this blog, and I did intend to write a piece for this issue but couldn't get an angle I was happy with sorted out in time for the deadline.

(I was planning on taking a look at how the merit and flaw system popularised in the World of Darkness games deals with disability by both quantifying it but also systematically compensating for it by allowing players to buy unrelated bonuses but I didn't get much father than 'that's really quite reductive' which is pretty un-interesting really, because roleplaying rules literally are attempts to reduce complex realities into a system.)

I have a few brief responses to the articles in the issue which I'll lay out here. I though it was interesting that in general all the essays worked within a conceptual framework in which the DSM and psychiatry are essentially synonymous. This is a common position and a useful shorthand, especially for some of the points being made about medicalization and normativity but, as I discussed here, I think things are more complicated than that and I sometimes worry that this shorthand can become a self-limiting axiom. I don't think this impacts on what the articles have to say in any significant sense, and I may also be reading it in wrongly, but I think as a critical position it might be worth bearing in mind.

I have to admit that I've never played with the rules from Unearthed Arcana, so as far as I was aware the only sanity system in D&D was that developed for Ravenloft. I will have to read into it some more. In some ways that just goes to show how large D&D is as an entity, as well as the scope of its ambition as a system. (Are there any sanity rules for the explicitly universal systems like GURPS or Rifts/Palladium? There must be, although I've only ever read the core rulebooks for either of those.)

Zoya Street's take on D&D is probably harsher than mine, I was quite pleased to be described as 'even-handed' as I sometimes worry I get too polemical, but I suppose my problem is that I've always thought D&D to be self-evidently a terrible system. That's not to say I don't enjoy it as a game, just that in some ways that enjoyment was hard won and involved a lot of ignoring the really stupid bits. The article also reminded me of the tribalism in RPG circles, where people are wedded not only to systems, but to the primacy of those systems' representational models.

D&D, and AD&D especially, is never going to describe anything realistically, or allow you to play or explore any concepts in a realistic manner, because as a project it is about imposing the D&D mathematical model onto those concepts and not the other way around. While this is not to say that it shouldn't be called out for doing so, which is something Street does very well, I suppose my position is that it can only be understood in the light of this dynamic. One day James Wallis will finally publish FRUP and I'll be able to point at it and go 'look, this is what you have done - this is the world your slavish rules-lawyering has implied.' Until then you'll just have to take my word for it.

And finally, I recently wrote a piece for The Ontological Geek about horror in roleplaying games. I looked at where horror is located and how game systems, including sanity systems, can mediate and generate that horror. It isn't strictly about mental illness but I hope that my rule-happy readers will find it interesting. The Ontological Geek is running a horror month at the minute and I heartily recommend having a look at what is coming out of that.

Depression Quest and the Physicality of Mental Illness

Trigger warning, this is about depression in quite a visceral sense.

I know what it feels like to be depressed from my own past experience. As much as anything that means I have an understanding of the physiological effects as well as the mental, which can be important because, as a mental illness, it is often discussed in purely mental terms. 

But those physical effects can be horrible, almost indescribably so. It isn't just the lethargy and the headaches, in some manner similar to the experience of a bad cold, but the curious fear that accompanies them. Colds come and then they go, following a familiar and understandable self-limiting pattern. They are grim and they can vary in severity but they make sense and have an end that can be anticipated while the physical symptoms of depression merely persist. And the longer they persist the more the anxiety over that persistence becomes a physical thing in itself; a gnawing in the gut that feels like maybe you ate something wrong and oh god what if you might get sick for real and...

I imagine that this is similar to many other chronic illnesses, which I am aware have the capacity to feedback into mental illness. I also am certain that other mental illnesses have their own set of physical symptoms which I have never felt and will probably never know. It is interesting that I am better able to imagine the mental state of someone with mania than I am the physical feeling of it and it fascinates me, in part because the physicality of my own depression is a huge part of the way I understand it.

I said I know what it feels like to be depressed because what I realise is that I don't know what it feels like to become depressed. I can imagine that it must be terrifying on that purely physical level because there's no frame of reference for why your body suddenly feels the way that it does - it can be terrifying for me and I know that it's coming and that it will, eventually, pass.

Those games which do model mental illness seem for the most part to be focused on its onset - on the shift-point between sanity and madness. Once the illnesses are contracted, and they are contracted, imposed into the sanctity of a character's  mental cradle by the agencies in the external world, they become modifiers on play rather than lived and vital experiences. Or worse, they signify the end of playability.

But mental illnesses are progressive, not binary. Those acquired later in life do not snap into being, fully-formed in the sufferer's mind, but are wrought out of experience and predisposition. Of course, to make a secret list of the illnesses your character might develop would be a curious exercise, and to roll your winnings on the genetic lottery on a random table at the point of phenotype expression is functionally, if not teleologically, the same action as rolling at birth.

It makes me wonder what a game would have to do to actually embody the experience of being mad - to genuinely get at at the phsysicality of it without resorting to glitch or distortion, to showing things which aren't there when it's already in a world that isn't there and anyway can't we just get over the idea that hallucination is the be-all and end-all of being mad?

One game which makes a stab at this is Depression Quest. It's a good stab, and I like the core idea of having, in a choose-your-own-adventure, greyed-out choices. It says that the core of being depressed is knowing that there are things you could do, but nevertheless being unable to do them. Unfortunately the rest of it lets it down.

Really, it's doomed from the name onwards. The idea that depression is a quest already suggests that it has a win-condition, that no matter how many times the authors tell you that it is something you must learn to live with fundamentally they view it as something that can be beaten. And that it can be beaten by the sufferer. For some people that may be the case, but unfortunately the game clearly isn't talking about an isolated episode of depression as experienced by an otherwise healthy person, it's talking about the chronic kind. The kind I've got. The kind that isn't a game.

It's odd for me to say that because, perhaps unsurprisingly, I've gamified my own depression. When I was sixteen, and heavily self-harming, I sat in a park at night somewhere near Three Bridges and I made a deal with myself that if I was to commit suicide then I would have lost the game I was playing. I didn't know what the win condition was back then, I still don't, but that was a clear loss. It helped. It gave me a point of power and control and it's kept me going. But some of the worst mistakes I've made have been to, even unconsciously, project that system onto other suffering people, because it has seriously fucked up my relationship with them.

That's the problem with systems. Unlike events, for which you can disclaim universality, systems imply their applicability to all situations. Depression Quest allows that it doesn't describe every depressed person's experience, but it implies that it models it. Ignoring the use of static and glitch as signifiers, they may be tired but they are at least uncontroversially deployed, the first thing you notice when you load up the game, especially if you are used to playing games, are the three gauges at the bottom of the screen. Again, suddenly, there's a win condition, and it's when those gauges say the right things.

It almost doesn't matter that those gauges represent a hopelessly proscriptive view of what depression is and how it should be managed. The fact that they are there at all is enough to imply that failure in this game of coping is the fault of the player, the very thinking the game aims to subvert with it's greyed-out choices. It isn't the case that you can't try these options because you are unwell, it's because you rejected meds and meds always help. If you'd gone to the therapist you'd get to have sex with your girlfriend and enjoy it, but you didn't, so fuck you. You're just not thinking about your illness in the right way, because if you were you'd know how to fix it.

I should be clear, I think medication is wonderful if you get the right stuff, but because we don't know exactly how these illnesses work it is always a compromise. I think therapy can be an incredibly useful tool, but it can also become a very expensive sideshow, even more addictive than the supposed addictiveness of the drugs, and again it depends on so many factors I can't even begin to explain them here.

I stated earlier that I wondered what a game that truly embodied the experience of being mad was like but I'm not sure I actually want to know. I was imagining things like haptic feedback on controllers that flooded your limbs with dull current. Characters that controlled sluggishly, like you were pushing them through treacle. All those similes we employ, writ large on the screen. The thing is, I'm not sure I want to know, really. I wanted to love Depression Quest's core mechanic, but I ended up hating the execution. 

I still think that the best expressions of what it is to be depressed come through in Douglas Adams' adventure games. It's in the loneliness of Starship Titanic or the sheer bloody-minded hostility of the world in Hitch-hiker, but the systems of those games are not the vehicle for that expression. I want someone to show me a system that works as well as that, and I admire that people are trying, but I can't not point it out when those noble failures look like propagating further harm.

On Categorisations and Diagnoses

Welcome to another brief theory post, or at least as brief as I can make it. This time I’m looking at some of the theory and debate surrounding both the use of and the very existence of, diagnostic labels in mental health. Taken along with these two other theory posts this should constitute a very basic grounding in my approach. In addition, there are links to further reading and resources in the tabs at the top of the page, although it doesn't constitute a complete beginner's overview.

We're used to the idea of mental illness as a set of discrete conditions, any of which a person will either have or not have at any given point in their life. Alongside this there is the perception that, in the main, what arguments there are in psychiatry are over whether these individual conditions actually constitute illnesses rather than states of healthy being that happen to differ from current societal norms. Perhaps the most famous example here would be the classification of homosexuality, eventually removed in its entirety from the DSM in 1986 after spending 6 years in limbo as a disorder only if you didn't want to be gay. As much as anything the process by which this was changed highlights many of the difficulties inherent in attempting to systematise scientifically within a culturally created, political space.

In addition to these major reversals, non-academics may also be aware of the process of shifting boundaries and diagnoses within conditions as our knowledge of them is increasingly refined. Often this aspect of science is hidden in popular culture in favour of the twin fallacies of 'scientific fact' and the idea of science-as-discovery. Science as it is actually done is about teams of people gradually refining concepts through falsification, rather than individuals generating knowledge through genius and insight, but the shadow of logical positivism looms large over our culture. In spite of this, an example of this kind of change and refinement within mental health that more people might be aware of, as it has surfaced into popular understanding, is the move from the term 'manic-depression' to the more nuanced 'bipolar disorder', slotting it into a larger structure of understanding about mood and mood disorders.

This categorical method is however a relatively new way of thinking about madness, which as surviving uses of the word attest, has long been a much more amorphous concept. This is not to say that historically we had no concept of differences in the ways in which people could be mad, just that previous systems tended to view madness as a monolithic constant, the sufferers of which displayed various symptoms depending on circumstance and constitution. In other words, it was the fact that you were mad that was first and foremost of importance, and the manner in which you were so that was secondary. The big shift therefore was to separate madness into madnesses, i.e. to treat individual illnesses or conditions as distinct on a conceptual level. Henceforth, it was not enough to consider someone as mad and then to discern the cause and quality of their madness, but rather a case of studying symptoms and gauging whether they were sufficient to diagnose a specific disorder.

The concept of diagnosis is an important one, because as madness has shifted into mental illness, (and as an important part of this work has been an attempt to shift it from a predominantly moral to a corporeal judgement) there has been a shift from the dismissal of those afflicted and their ostracising from society* towards the desire of the unwell to have their specific illnesses recognised and, in a more general sense, a desire for legitimacy. (This could also be understood as a shift in the perception of the mad from objects to subjects.)

Diagnosis is both an emotional and a practical need. As an example, In the USA where access to medicine is controlled by insurance companies the DSM is** in many cases the arbiter of that access. Medicine on an industrial scale is necessarily bureaucratic. Even without this people often find it easier to cope with a problem that they can name than they can with one that is unknown, while it is easier to prove to others that what you are suffering from is real when you can point to it in a book. Despite this, the case remains that many people still regard mental illnesses as not really real illnesses - or that they should be possible to defeat with strength of mind alone.

I mentioned in the previous paragraph that the DSM, the American Psychiatric Association's Diagnostic and Statistical Manual, has become, in a very practical way, the arbiter of what is and isn't an illness. As is often the way with such tools, through use and convention it has also become for many people the underpinning of the thing it describes rather than a schema for understanding it, emulating the manner in which some people approach dictionaries, positioning them as controllers of rather than guides to, language. This mechanism of social construction of truth can be difficult to pare away from any actual underlying truth that may or may not exist in reality. Especially as the methodology behind it, as delineated by Kraeplin in the 1880s, was originally directed at classification, at finding the thing as it is rather than the thing as it appears to be and can be usefully dealt with. (The methodology is also one which has a currently high cultural capital for generating truth, even when misapplied - it seems very scientific, because it is logical, but logic requires true premises to produce truth and those are not always easy to evaluate.)

There are then two main oppositional positions to the heavily diagnostic, discrete conditions, model that from the aforementioned position currently dominates psychiatry. First are the anti-psychiatrists, the most prominent of whom include RD Laing and Thomas Szasz. Although they do so from often differing positions anti-psychiatrists argue in general against the very idea of mental illness, and more specifically against the various measures (drug therapy and incarceration primarily) employed by psychiatry to treat them. There are a great many flavours of anti-psychiatry, from new-age types, magicians, natural living adherents, Scientologists, anti-pharmaceutical campaigners and the 'common-sense' argument to Laing's stress of the beauty of and Szasz's stress of the autonomy of all minds. The arguments here are varied but tend to resolve down to a defence of the sanctity of minds qua minds - i.e. that to say what is normal or correct behaviour or functioning for a mind and crucially what is abnormal is an act of supreme arrogance.

There are certainly serious arguments in favour of these views, especially with regards to the medicalisation of things like homosexuality, and the way in which certain drug companies have behaved incredibly unethically when it comes to treatments that may not actually work or that have required new diagnoses in order to be prescribed. In addition there is the muddying factor of psychoanalysis, which is a system that deliberately works by making normal functions abnormal. Psychoanalysis was heavily influential on psychology and psychiatry for a relatively short, but very public period and the fact that many people conflate psychoanalysis with psychiatry I think overstates the (already present, but not overwhelmingly so) tendency of the latter to medicalise things that are actually in the realm of normal behaviour.

The other dissenting position is in some ways similar to the earlier conception of madness I discussed briefly at the beginning (in that it views madness as a set of interrelated states which we can fall into and out of over the course of our lives), while in others it differs significantly. It, in essence, holds that mental illness is real; is disruptive to people; is measurable both physiologically and psychologically; and is demonstrably a functioning of the mind outside of identifiable norms. However, in addition it holds that it is subjectively experienced and crucially is located on a series of overlapping spectra and is an emergent property of the interaction between mind, physiology and environment.

It is from this sort of position that techniques like Cognitive Behavioural Therapy stem, which attempt to treat the mind as a psychological instead of a physiological entity, and as a tool rather than as the person concurrent with that mind. Although that is not to say that an approach like this would rule out the kind of therapies disavowed by anti-psychiatrists the focus would rather be on treating symptoms rather than the conditions of orthodox diagnosis. A current move by one version of this position towards orthodoxy is described by this article, detailing the US National Institute for Mental Health's proposals for a replacement to the DSM, the RDoC.

So there you have it - very briefly and grossly oversimplified, the three(ish) main positions on what madness actually is and the axes on which they differ. Crucially, they don't necessarily need to be mutually exclusive, at least on certain dimensions. It is for example entirely possible for a rigid diagnostic system to be both empowering and limiting at once, just as it is possible for certain functions or behaviours of the mind to be acceptable and normal for one person, but destructive and unpleasant for another. (I tend towards the third position personally, which is probably apparent in the way this post is written, as I believe it to be a more integrated approach.)

As a general bit of housekeeping, I will be referring to these concepts and positions a fair bit in future posts. The main point to take away however is that while on an everyday level we feel happy to refer to psychiatric disorders in a very definitive way, similar to how we refer to physical conditions, and while this may in fact be a necessary part of talking about, socially constructing and understanding these concepts, it is entirely possible that it is more complicated than all that. In addition, people's positions on the status of diagnosis can be political, philosophical and sociological as much as they can be a scientific opinion, while the science itself is still far from consensus.

* Foucault, in Madness and Civilisation, talks a lot about the way madness and leprosy were conceptually similar, with the idea of asylums for the mentally ill developing from established mechanisms for dealing with lepers.

** Or was, as other diagnostic manuals are gaining traction in use.

A Journey to the Inside of your Mind

The dream sequence is one of those perennial media techniques that creators seem to think doesn't look as lazy to consumers as it actually is. They're wrong, of course, and most savvy audience members are able to spot the fake-out a mile off. This isn't to say that they can't be artfully created, or cleverly integrated into the texture of the plot, just that as a general rule they aren't. I'd blame magic realism except I like it too much to do so, but I suspect that at least part of the problem is that more conventionally structured works often look upon its techniques with a hungry eye and a lack of understanding. Sharks attracted by the scent of bloody metaphor leaking into the fathomless ocean of prose.

In general, a dream sequence doesn't have to signify mental unrest or madness. Yet one of the primary cinematic languages of dreams is derived in main from the techniques of portraying visually a disturbed mind, first delineated in The Cabinet of Doctor Caligari with it's unnatural camera angles and impossible geometries. In turn this has further informed cultural constructions of madness, which already had a reputation for being a dream-like state in which the mad were trapped and unable to awake, generating an idea of madness as a predominantly visual, or at least sensual, experience. Still, in the majority of fictional forms dreams have for a much longer time been a place of revelation - a way of advancing the plot by disguising exposition as mystical insight. And then disguising it further by making it all rather symbolic.

This needs to be handled with care of course; as with anything which takes agency away from characters it can end up stopping you from caring about those characters. The single worst plotline it is possible to write is the one which starts with the protagonist having a dream compelling them to action and ends in a deus ex machina*. But, we can't argue too much with the classics, because really vision quests are as old as religion and they're not really what I wanted to look at here.

Within games you do get the occasional bit of expositionary dreaming, but in many ways this is just another flavour of the endless task of getting the player(s) on to the next bit of action. As with all cut scenes, flavour text or DM rail-roading it can be done in a more or less satisfactory way, but it lies firmly within the imposed narration of the game rather than the shared space created during play.  What I'm more interested in just now is something that is unique to the way games work, and how this affects depictions of dream worlds.

Games are heavily predicated on player agency. I know that there are arguments about how much agency players actually have (especially in video games where there are technical limits imposed on action) or should have (in the case of heavily narrative games), but there are very few games which still manage to be games and don't at least allow the player some choice over what to do. Dreams, on the other hand are most notable for the lack of agency we experience when we are caught up in them. It's true that some people claim to be able to lucid dream** but they're basically just a bit better at having fantasies than the rest of us in my opinion.

That's not everyone's opinion though, and there is a strong faction arguing that the dream-world is a real place, or semi-real, or something coherent at least; a place where actions can have consequences, where rules, even if not the normal rules, can apply and where, just maybe, causes can have effects outside of the dream itself. The mechanism of this might be one of many; the dream being part of the larger spirit world is the classic model, but Freudian, and then Jungian, psychoanalysis has added a version with the veneer of scientific respectability to the lexicon, however unwarranted that respectability may be.

the Psychoanalytic model is worth studying here for another reason, namely to start answering the question you may have been asking; why are we talking about dreams in a blog interested in mental illness? the short answer is that a common misconception about madness, and a common depiction of it (as hinted at earlier), is that it is a waking dream. The experience of madness is often equated with that of dreaming, focusing on the supposed lack of structure and causality experienced in the two states. This is despite the fact that in madness if anything is irrational it is the subject while in a dream irrationality lies within the objects and surroundings. Psychoanalysis only compounds this by suggesting that the contents of dreams are important signifiers of waking dysfunction, and that the key to treating and healing that dysfunction can be found within those dreams.

Madness is constructed as being trapped in the dream, then, and clearly something must be trapping us, either an external force or an aspect of ourselves. Well, if there is something trapping us then clearly we need to face it and defeat it, for the alternative is either coma and death or, well, madness. Or at least such a perfect facsimile of madness that to an external observer there is no need to distinguish and the one can quietly replace the other. This is an important point about cultural constructions of madness, actually, as it is one of the mechanisms by which the mad can be blamed for being mad: it may not be their fault for being trapped in the dream, or the spirit world or whatever, but it is if they lack the strength to escape; in fact it's just the old willpower 'try not being depressed' canard but with a spiritualist or psychoanalytic flavour depending on taste.

Hence, the video game playable dream sequence, where the protagonist journeys to the centre if their dream and slays the evil that lurks their using the exact same moveset they posess in the waking world. I hate playable dream sequences***. In addition to the sense that you achieve nothing, because it's a step removed even from the game world, I've always felt that dream sequences really highlight the lack of options available to the player as well as the limits of the technology representing those options. It's all very well to tell me that I'm in an imaginary space where anything can happen, where the rules are different and dream logic applies, but when that resolves down to the same gameplay as every other segment then it's hard to maintain any suspension of disbelief.

Oh, how do I hate you? let me list the ways. [Spoilers]. The big daddy of them all has to be Dragon Age: Origins, purely for length. You fall asleep and navigate the fade, which is an extended sequence of door based puzzles and smashing things with your sword. Bonus points go for meeting people in the fade who have given up because they aren't strong enough - those guys need to buck up yeah? We all have problems. The thing I found really odd about this section is that it hints that in the fade willpower is important, much more so than physical strength, but all challenges were still resolved with the same stats as before. There was such scope for making the mage of the party a badass while turning the fighter into a wimp, but it was completely ignored. The rules are completely different, and yet somehow completely the same.

The two Batman Arkham games have dream sequences as well, as you might expect in a game heavily invested in concepts of madness and institutionalisation. When Scarecrow gets to you in Arkham Asylum the whole world collapses into a morass of shifting geography which has the potential to be much more than it is. I can buy the idea that Batman has just the right tools to traverse the physical locations in Arkham, part of Batman's legend is that he is always prepared, even down to carrying shark repellent bat-spray, but the idea that Scarecrow creates a shattered mental geography that is yet designed for the same tools again felt like a disappointment. Not to mention the skeleton warriors who act suspiciously like the thugs in the rest of the game (although it is suggested in the final sequence that Batman is actually fighting inmates, I don't recall that in the previous segments). The one good thing I do have to say about those sequences is the way Batman defeats Scarecrow is to my mind perfect: by shining the bat-signal in his face, effectively asserting his own madness over that of the Scarecrow’s.

I didn't get too far into American McGee's Alice when I did play it, but as a game which takes place entirely within the mind of its protagonist I think it highlights a lot of the problems I've discussed. It repeatedly tries to tell you that the world is shifting, illogical and doesn't make sense, and yet it has to make sense in order to be playable. In fact, it makes the exact same boring, linear sense as any other FPS, being a series of combats linked by corridors. That these corridors look different is no matter, because they function exactly the same as any other game's.

I could go on, or cite more examples, but really I think that's the crux of my point: this isn't a dream, and this isn't madness, it's just a palette swap, a different location. to my mind, the best dream worlds in games are not the ones which try to be about the look of the world, but the ones which use it for narrative power instead. The Legend of Zelda: Link's Awakening springs immediately to mind here. Yes, he defeats the evil at the centre of the dream by hitting it with a sword, but the strangeness of the dream itself is revealed slowly, not hammered down your throat. It is also, notably, a story about self discovery rather than one about the oppression of the mind. And I crucially think that that is the most important step to making dreams fun again, and rescuing them from Freud's pathologising; dreaming is ultimately part of our mental processes for understanding the world, not a hidden well of all the worst things that have ever happened to us. they can be fun or they can be horrible or they can be just weird, but they are natural, and that is the most important thing.

*And then they wake up and it was all a dream anyway.

**I once made myself have the same dream two nights in a row, I died at the end both times and woke up shattered so I don't really know why I bothered.

*** I love a good narrative dream sequence though, I'm not going to lie. Inception, for instance, is a thoroughly stupid but beautiful movie.