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Pain is necessary for human survival. It warns us when we’re in danger of injuring ourselves and alerts us when our bodies sustain damage. People born without the ability to sense pain, a condition known as congenital analgesia, have a severely reduced lifespan. As children, they bite pieces off their tongues and suffer cornea damage from pieces of grit they can’t feel. Broken bones and infections remain untreated for long periods. They scald themselves with hot water. Their brains have no sensory connection to the flesh they’re putting in danger – in this instance, they’re just like videogame players.

One of the difficulties in designing games is communicating information to the player with a reduced range of senses. While players can see and hear the same things as their character, they don’t share the visceral sense of touch. Partially, this is a good thing, since it encourages the player to take risks they never would if they shared nerve sensations with their character – running through fire, for instance – but it also means designers have to find creative ways of communicating pain, injury, and physical strain in order to influence player behavior. This leads to a blend of art, game mechanics and neuroscience that you’ve probably never noticed consciously – though it was pulling your brain’s strings the whole time.

Originally, videogames represented character health mathematically. The classic Life Bar is literally a graph that tracks the extent of a character’s injuries. Whether it’s Street Fighter‘s brightly-colored meters, the iconic hearts from the Zelda series, or even hit points expressed as a fraction, the point is to quickly explain to the player how close they are to death. Hit points and health bars are the perfect tools for games that involve strategic play and husbanding resources. They’re important for RPGs because they allow a player to calculate the risk and reward of using certain stat-boosting items. Fighting games need them to accurately communicate which player is winning at any given moment. However, the problem with statistical representations of character health is that they don’t convey a sense of character immersion or narrative. In most health systems, a character that’s near death will look and act the same as if they have full health – a fact that depersonalizes the pain and injuries they suffer by boiling it down to numbers and graphs. By this measure, players aren’t so much inhabiting the characters as they are controlling them.

Expressing pain and injury became more common when games started exploring the first-person perspective. After all, if a player sees what a character sees, shouldn’t they also feel what the character feels? At its most basic level, designers communicate this using visual and auditory clues. Doom is an early example. In addition to a health meter, Doom gave players a picture of their character’s face. Each time the Marine took damage, he grunted in pain and his portrait became bloodier. What started as a simple nosebleed eventually become blood from the eyes, cheeks, and hairline. When the Marine died, he died with a scream. Fast forward to today’s FPSs and we find that these visual and auditory cues that originally supplemented the health bar have now replaced it. Run-and-gun action titles like Call of Duty opt for the regenerating health system because it both cuts down on the HUD and keeps the game fast and frenetic. Instead, the red mist and draining colors they use to indicate injury – not to mention tinnitus from grenade concussion -transmit the same message that real-life pain does: Get out of the line of fire. What these games lose in health bars, inventory management, and med-kit hunts they make up for in a more lifelike HUD and quick-time pacing. Essentially, regenerating health simulates pain but never actual injury.

Horror and tactical games, on the other hand, are willing to slow the pacing though injuries and healing systems, since these can be powerful tools to influence player behavior or create a sense of dread. Metal Gear Solid 3: Snake Eater had its neon green healing menu, where the player had to treat injuries in the field as part of an inventory management mini-game. Broken bones required splints and bandages. Open wounds called for disinfecting, staunching and bandaging. Players that failed to treat Snake’s wounds had to deal with a reduced health bar. The player’s limited medical resources ultimately directed their approach to combat – while you certainly could take patrols head-on, doing so quickly ate through your bandages and splints, reinforcing the tactical, stealthy approach the series made famous. Call of Cthulhu: Dark Corners of the Earth used a similar injury system, but instead of enforcing a play style, the broken limbs and gashes served to enhance the game’s sense of anxiety. Call of Cthulhu‘s Jack Walters is fragile for a videogame protagonist, even one from the survival horror genre. A Tommy gun or Deep One’s claw could maul multiple body parts of his body, not only damaging his health but hampering gameplay. Broken arms kept Jack from being able to aim straight, or in extreme circumstances, even lift his weapon. Snapped legs reduced his movement to a lope or a crawl. Untreated cuts to his chest and head would eventually cause Jack to bleed out. After a gunfight, a wounded Jack might stumble hundreds of yards searching for medical supplies only to drop to the floor dead of blood loss. Also, while players controlled medical treatments through a menu, Jack applied the sutures and bandages in real time, meaning healing during combat was a desperation move.

These design choices had a striking effect: Call of Cthulhu made me terrified of firefights. Not only were they dangerous because I was always outnumbered, but even a lone Innsmouth townsperson could tear me up so bad that, even if I survived, the next encounter could easily finish me off. (And that’s before you hit the actual monsters, and assuming you even had a gun – for the first third of the game you’re unarmed.) All this reinforces Jack’s helplessness in the face of forces much more powerful than him, leaving him with few options but to run and hide. This type of healing system can also create emergent narratives, as overcoming untreated injuries and fighting against the breakdown of your own body becomes as much a struggle as facing enemies. But in addition to this, the game really made you feel Jack’s injuries.

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Many games depict pain or use pain-like mechanics – but some do more. A select few manage to bridge the physical divide and actually make the player feel their character’s injuries through human empathy. It’s no secret that humans feel the pain of others psychologically. That’s why men wince when they see someone hit in the groin or a whole stadium groans when a running back takes a bad hit. For the same reason, we generally don’t like to see pictures of bodily harm. Scientific research has found some evidence so support the idea that seeing injuries in others can provoke mental reactions or even physical sensations in a viewer. In 2009 a University of Birmingham study found that one-third of participants reported feeling physical sensations like tingling, aching, or sharp pains when shown images and video of people injured or in pain. Afterward, a neuroimaging study confirmed that the pain matrix in these responders’ brains lit up upon seeing the imagery, with activity focused in the areas of the brain involving sensory perception. (People who didn’t feel response pain mostly reacted with the emotional portions of their brain.) This may be the work of “mirror neurons,” a fairly new type of neuron that scientists have confirmed in macaque monkeys and theorize may occur in humans as well. To oversimplify, mirror neurons may be what helps animals learn through mimicry and react at a gut level to the emotions of others. For example, if you’re watching a basketball game, the exertions of the athletes might fire neurons in your brain consistent with aerobic exercise, causing your heart to beat faster in excitement. Alternately, if you see someone pick up a teacup it may light up the same areas of the brain you’d use to pick up a teacup yourself. It’s by this type of injury and pain association – which artists have employed intuitively for centuries – that certain games can reach out and touch the player.

What made Call of Cthulhu‘s injuries so shocking wasn’t the gameplay consequences of injury, but the sound effects that communicated them. For example, on one playthrough I was exploring a fish processing plant, searching for a first aid kit I’d seen while climbing around the catwalks. That’s when I heard the gargling voice of an Innsmouth thug behind me. As I wheeled around, his shotgun literally cut me down at the knees. Jack dropped. I swore, sighted my revolver and drilled the cultist through the skull. The healing menu confirmed what I feared: two broken legs, no splints, no bandages. I was twenty yards from the first aid kit. Jack walked slow and heavy, almost a crawl. With each step, I heard Jack’s shattered bones crunch and grind against each other. He grunted and practically whimpered. It set my teeth on edge, and I resorted to giving him a shot of morphine – which I’d avoided, fearing addiction – to bring him through the last stretch. Call of Cthulhu uses audio to a pretty unnerving effect generally. You’ll hear otherworldly voices whispering to you as you lose sanity and Jack muttering arcane knowledge he shouldn’t know, but none of that bothered me as much as the sheer awfulness of that 45 seconds I spent hobbling toward the medkit on shattered femurs.

In contrast, Far Cry 3 communicates Jason Brody’s pain visually. Animal attacks are the most direct example, particularly sharks and crocodiles that latch onto Jason’s arms. Here, the developers accomplish pain transference mostly through shock- you usually don’t see the animal coming, and when violent imagery suddenly fills the screen it transfers the trauma of the attack straight to the player’s brain. Car crashes are similarly brutal, as Jason gets forced up against the wheel and his arms splay across the dashboard. But, for my money, it’s Far Cry‘s grotesque healing animations that really bring the pain. A one-bar healing might include re-setting a dislocated thumb or hand, but it only gets worse from there. Jason pulls nails out of his arm, enormous shards of glass and shrapnel from his hands, and in the most graphic examples, he digs bullets out of his arm with a scalpel, a stick, or his teeth. Each action induces spurts of blood and the sound of popping bones and squelching flesh. The painful imagery of this healing system serves to illustrate the impact Jason’s behavior is having on his own body, with his lack of reaction suggesting that he doesn’t fully understand the reality of his situation. Despite killing hundreds of pirates, getting shot, and burning half a tropical island, Jason Brody remains what he was when he arrived – an idiotic tourist who sees Rook Island as his playground. However, it’s worth mentioning that these healing animations are also a holdover from the game’s more serious predecessor, Far Cry 2, which had twice as many impromptu treatments that were even nastier. Either way, they work. The only time I feel connected to Jason as a character is when he pops his joints back in place like a Jacob’s ladder. Jason Brody is a contemptible person, but everyone can relate to a human being in pain.

Recent advancements in game technology have tried to bridge the physical gap between the player and their avatar. Efforts such as the Wii, Kinect, and Move have largely failed, as have the more exotic products, like vests that simulate being shot. However, those who attempt to link our physical bodies to our virtual bodies are forgetting that corporeal sensations don’t reside in our hands and feet, but in our brains. We don’t need feedback tools or accelerometers to connect with our virtual selves. Humans are social creatures that naturally want to connect with others – what we need are good design decisions made with humanity’s capacity for empathy and mirroring in mind. Ultimately we don’t play games with our hands, we play them with our brains.

Robert Rath is a freelance writer, novelist, and researcher based in Austin, Texas. You can follow his exploits at RobWritesPulp.com or on Twitter at @RobWritesPulp.

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