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.

To mention Killer7 in the same article as an actual psychological disorder seems woefully inappropriate. Yet the killers are all limited in different ways. Each has only one real weapon: Kaede is stuck with her sniper scope and automatic pistol. Kevin is good with throwing knives but useless against large groups of enemies. The burly luchador Mask de Smith is armed with twin grenade launchers but is imprecise and cumbersome. As opposed to the more typical FPS hero, who can switch from a rifle to a rocket launcher with ease, these characters are all fragments of one protagonist. They are not an army. In the world of their genre they barely add up to the capabilities of one person.

We may not gain any real understanding of Dissociative Identity Disorder from playing games like this, but we are encouraged to understand.

The goal of most DID treatment is unification, meaning the incorporation of all of the patient’s extant identities into a whole. The International Society for the Study of Trauma and Dissociation has specific guidelines on their website that detail the treatment process. Usually, there are three “phases”: establishing safety, confronting the patient’s memories, and merging identities together. The guidelines describe it this way: “Integrating traumatic memories refers to bringing together aspects of traumatic experience that have been previously dissociated from one another … Integration also means that the patient achieves an adult cognitive awareness of his or her role and that of others in the events.”

The climactic mission of Killer7 takes the group to a school and former training ground for young government assassins. Here the smooth, white-suited “cleaner” persona, Garcian, who normally handles all of the group’s business arrangements and revives fallen Smiths, discovers that he is in fact the host, and that he killed all of the others, including Harman, years ago when he had a different name. This involves a series of flashbacks showing each of the group getting murdered, traumas Garcian has suppressed and is now revisiting. In a chilling moment, the game forces the player to control each of the Killer 7 as a series of grinning, invulnerable shadowy enemies leap off of the stage in the school gym and destroy them one by one. None of the squad’s attacks are any good. The player is helpless, forced to watch as each character is overtaken and dissipates into the air.

Stripped of all his defenses, Garcian must climb to the rooftop of the building alone in order to face his target, who is not a mangled grotesque, but a young, confused boy with a third eye, which he shoots off. Dropping to his knees, covered in blood, Garcian finally opens the long metal briefcase he’s always carrying and discovers all of his team’s weapons inside. He is the core persona, the one who did all the work: the briefcase works as a neat little symbol for the multitudes he once contained. He has rejoined with all of his previous parts and is left as one individual, combining the others into a coherent whole. As with Alice, the ultimate goal is assimilation, and the journey leads back to himself.

Needless to say, Killer7 does not intend to provide a realistic portrait of DID (it doesn’t even intend to provide a realistic portrait of the human anatomy). “Multifoliate Personae Phenomenon” is not real and might not even be a disorder. Deadly Premonition makes no claims to medical accuracy. But these games do dramatize identity and consciousness from the perspective of the mentally ill and (however accidentally) mimic clinical approaches to such conditions. We may not gain any real understanding of DID from playing games like this, but we are encouraged to understand. We are asked to consider what life with multiple personalities might be like. That’s an important distinction, though it may not seem like it: It’s the difference between empathy and a cheap thrill.

Andy Hughes is a blogger, gamer, pontificator, expounder, and general poor person hailing from Boston Massachusetts. He is co-editor of the hip new gaming blog Item Crisis and can be reached at [email protected].

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