My post on games to increase mental health awareness led to an fascinating chat on twitter with @betabetic, focusing on whether the example I linked to (Depression Quest) actually *is* a game. In particular, @betabetic raised the question of whether, to qualify as a ‘game’, something needs to be fun. I think it’d be fair to say that role playing the life of someone with severe depression probably doesn’t count as fun in the usual sense (and if you do find it fun, I’m not sure I want to keep talking to you…). However, I’d argue it can still be an immersive and engaging experience, perhaps more akin to reading a challenging novel or watching a heart breaking film. It’s not quite right to say we ‘enjoy’ those experiences, but we do find them rewarding and appealing.
I take @betabetic’s point though, that a key aspect of a game is that you want to play it. I can imagine if something like Depression Quest was used in training for practitioners then it might be a case that you *have* to do it, but in the majority of cases there won’t be an external pressure forcing someone to play. If we want people to engage with voluntarily, then we need to think more about what motivates them. In fact, one of the biggest drivers for wanting to import game principles into health care is the idea that it will help motivate and engage patients, so working out what makes someone want to play a game is really the key point.
@betabetic then directed me to Marc LeBlanc’s 8 kinds of fun framework:
Sensation: Game as sense-pleasure
Fantasy: Game as make-believe
Narrative: Game as unfolding story
Challenge: Game as obstacle course
Fellowship: Game as social framework
Discovery: Game as uncharted territory
Expression: Game as soap box
Submission: Game as mindless pastime
Looking at this framework, it’s perhaps easier to see how these types of ‘fun’ could be achieved in games about mental health – for example, if games promoted expression by letting players talk about how they’re feeling, if they supported fellowship by letting players link up with other people, or by employing an interesting narrative to take the player through a story.
A while ago I had a twitter conversation about the need to think beyond just the idea of challenges or competition when thinking about gamification. These seem to be the aspects that health programmes have focused on so far, for example having people log their weight loss or time spent exercising and giving them rewards for reaching certain milestones, or letting them see how they compare to other people so they can compete to earn a higher ranking.Beyond these competitive aspects, I think there are lessons about aesthetics, pleasure, storytelling and socialising with others, all of which could be useful in designing games about mental health. @MarkOneinFour pointed out that the success of health apps like Zombies, Run! are down to people actually wanting to use them – the physical health benefits, for example motivating people to go running more often, are almost the side effect of the person’s desire to play the game. The 8 kinds of fun framework might help us build games about mental health that people genuinely enjoy playing. (There are other frameworks of fun that could be used too – for example 4 Keys To Fun by XEODesigns.)
Beyond games to raise awareness or understanding of mental health awareness, gamification could also have a lot to tell us about how to deliver therapies for mental health problems. A GP colleague of mine likes to point out that we often talk about the work of doing therapy – perhaps we should we think about the play? Could we exploit gamification principles to develop treatments that people actually want to do, rather than only being something they feel they have to do to get better?
Doing some further reading, I came across other emotions that game designers talk about, including ‘fiero’ – the fist bump to the air feeling of successfully overcoming a challenge, and ‘naches’ from the Yiddish word meaning pride or gratification, especially vicariously (for example helping someone out and then seeing them succeed). I wonder if we could engineer online therapies to include these kind of motivators as well? Furthermore, could this be a way of not only motivating people to engage with a therapy, but of providing games that have therapeutic value in themselves, through providing positive and rewarding experiences? I’d love to hear your thoughts.
PS. On a side note, it’s worth pointing out that @betabetic is a great source of info about this because she herself has worked on designing games to support training and education. This is a really neat example of how patients or service users can bring their own professional or personal expertise to discussions about treatment, not just their experience as people receiving health care. In practice, patients who try to get involved in research or improvement sometimes report feeling that they are only allowed to be a patient, and not treated as peers or colleagues who encouraged to bring their broader knowledge and skills to the table (something that @MarkOneinFour has termed ‘being beneficiared)’.