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Can videogames help us understand mental disorders? Certainly an alarming amount of commercial games use generalized "insanity" as a trope, but usually just as an opportunity for wild level design. It's easy enough to list off examples of madness in the games we play: the whispers and disorienting camera angles of Eternal Darkness, Batman's gas-induced hallucinations in Arkham Asylum, the weird inner mindscapes of Psychonauts. Text adventures like Andrew Plotkin's Shade are even more adept at warping perception to devastating effect. But is there any connection to be made beyond the merely aesthetic? Does the interactive element of a videogame lead us to think about mental illness in a useful way, or can it only sensationalize and exploit?
When it comes to mental illness, commercial videogames generally stick to the same generic myths common in other forms of media, particularly film.
What used to be known as Alternate or Multiple Personality Disorder and is now called Dissociative Identity Disorder has been misunderstood almost since its first diagnosis, often getting confused with schizophrenia. This is largely due to semantics: The word "schizophrenia" literally means "split mind," but the split is with associations, not personalities. Schizophrenics may have delusions or hallucinations but do not have multiple identities. In popular culture, DID is sometimes similarly misconstrued. Real people with this disorder have often been psychologically fractured by some serious trauma and require these different personalities to accomplish the life of a whole one - they do not switch between fully formed identities. True cases are rare and often misdiagnosed, and the disorder itself is not entirely understood or even acknowledged by some doctors (it doesn't help the believers that Shirley Mason, the real-life subject of the book Sybil which popularized the subject and the disorder, was recently revealed to have lied about her condition).
When it comes to mental illness, commercial videogames generally stick to the same generic myths common in other forms of media, particularly film. American McGee's Alice and its sequel use a sort of vague idea of madness as a plot point, taking place largely in a corrupted vision of Lewis Carroll's Wonderland. In this version of the story, Alice is the survivor of a fire that claimed her family and Wonderland is not just an escape but a representation of her ever-changing mental state. The grotesque creatures she encounters embody aspects of her own personality, and frequently harken back to the helplessness she feels while hospitalized. The most obvious example of this comes in Alice's fight with the Jabberwock, who here is an incarnation of her self-hatred and guilt. In an arena reminiscent of her old burning house, the horrifically gaunt semi-mechanical creature paces around menacingly while blaming her for her parents' deaths. Through it all Alice's condition is not specified (though how could it be?), and despite the symbolism, it's hard to say we get much out of this in the end other than vague ideas about "facing yourself." There is food for thought here, but ultimately Alice's true personality remains an enigma, her trauma little more than an engine for the plot, and the player never really deals with her struggle outside of those scant sequences.
But some games are more ambitious. A prime example is the infamous Deadly Premonition, the bizarre cult horror/Twin Peaks-inspired thing that features an FBI agent with an alternate personality as its protagonist. Throughout the game, Agent Francis York Morgan refers to someone he calls "Zach" for help. The player assumes this role, acting as the benevolent voice in York's head. When York asks Zach for guidance or tells Zach to look at something, it is the player he's talking to and the player who responds. But later, as York confronts the game's grotesque final villain, he realizes that he, York, really is Zach, and that witnessing the death of his parents at an early age caused him to split in order to cope. With this realization, the player loses their own identity, which is no more secure than York's. Yet, even though we are no longer really Zach or York, we must be someone, as we can still control the character onscreen. The game forces us to consider the implications of dissociation firsthand in a way no other medium could.
Suda51's psychedelic, cel-shaded cult classic Killer7 seems, at first, to be wholly exploitative, full as it is of in-your-face violence, disturbing images and unsettling black humor. Wheelchair-bound assassin Harman Smith exhibits something called "multifoliate personae phenomenon" (according to the game's supplementary materials) that allows him to absorb the souls of the dead and switch between them at will. These different characters make up the Smith "family," who are called upon to take out different targets in a world dangerously close to nuclear destruction. Throughout the course of the game's complicated, surreal narrative, the player swaps between these personae like the different attachments of a Swiss Army knife, picking the right Smith for the right job: Kevin Smith (no relation) can turn invisible, Kaede Smith can open barriers with her blood, and Dan Smith has a special, super-powerful Demon Shot. This seems to play into the inaccurate idea of split personalities giving the possessor powers, as if each break were to bring with it something new and useful.