Anxiety Disorders and the Great Escape Video Games Can Provide

Paris in the autumn. The final months of the year, at the end of a millennium. The city holds many memories for me. Of cafés. Of music. Of love. And of anxiety disorders.

Clowns are scary enough, George Stobbart thought to himself. Never mind those with a penchant for murder. The explosion had ripped a hole in the otherwise peaceful Parisian cul-de-sac, now showered in broken glass and upturned tables and charred golden leaves. The café-cum-crime scene was now a smoldering shell, and as George pulled himself up and dusted himself off, the stench from the melting plastic-coated canopy at his feet scalded his nostrils.

Miraculously, a copy of the national newspaper had survived the blast, just yards away. George picked it up, read the headlines, and placed it back on the ground. He picked it up, read the headlines, and placed it back on the ground. He read the headlines, and placed it back on the ground.

George could see the bistro's waitress through the gaping hole that once housed the building's windows, slumped over a booth, seemingly unconscious. He knew he should help her, but walking towards the door's threshold was merely a formality. His brain knew this. He knew this. Turning in the opposite direction, he wandered towards the adjacent alleyway.

A small black cat pounced from within a trash can before darting up the street. George peered inside the bin, and sat the lid back in place. He turned away, turned back, lifted the lid and looked inside again. Nothing new. Down the road, he could see an odd-looking mustachioed policeman walking toward the wreckage, just beyond some road works. He thought it best to wait it out here, out of sight. But not before checking the trash can again.

Revolution Software's 90s point-and-click classic Broken Sword suddenly plays out very differently against the backdrop of mental illness. Here is an adventure game that requires so much investigation, so much interaction, now made impossible by re-imagining the lead character with anxiety disorders.

With obsessive compulsive disorder, protagonist Stobbart struggles to pinpoint exactly which items he must use or disregard in order to progress, obsessing over trivial interplay; a crippling social anxiety complex (approximately 24 percent of adults diagnosed with obsessive compulsive disorder receive an additional diagnosis of social anxiety disorder) makes interacting with others exponentially more challenging. Here, by assuming these conditions, the game can go no further than as outlined above. In essence, the escapism that video games facilitate on a daily basis can be seen here in the starkest of examples; true testament to the medium's transformative powers. And they can also transport us into the worlds of others.

For Matt Gilgenbach, OCD makes developing video games particularly challenging. Games development requires not only time and patience, but also assertiveness, as designing a game can be a long, drawn-out process, whereby making big decisions is often common course. Even for veterans of the trade, this operation can be fairly onerous—even more so if you harbor an obsessive disposition.

Under the banner of 24 Caret Games, Gilgenbach released his first independent title in 2012, Retro/Grade, a hybrid rhythm/side-scrolling shooter. Having spent an extensive four years in development—and having swallowed all of his savings—much rested on the shoulders of Gilgenbach's independent debut, particularly given his meticulous nature and impeccable standards.

The trailer for Retro/Grade

"I think I stole this quote from movies," he says, "but I would say it's even more true in games: You never really finish a game; you just stop working on it. There are so many things where you can just do a deep dive and spend so much time getting every aspect of the characters or the elements right.

"While I'm trying very hard to not nitpick, it's still sometimes very frustrating to some of my artists, because eventually, rather than saying, 'Oh, you did a good job—I'm happy with the asset,' I just sort of have to say, 'OK, I don't care anymore—we've worked on this enough.' For them, working for me—wanting to hear that they're doing a good a job—it's difficult to just hear me simply say, 'OK, no, I'm just washing my hands of it.'"

Retro/Grade would go on to become somewhat of a critical darling, but would more or less bomb commercially. As a rhythm-cum-shooter title, Gilgenbach had hoped to harness the waning—but once recognized—enthusiasm for music games such as Guitar Hero, and capitalize on the fact that many users within this spectrum would already own its increasingly redundant guitar controller. Gilgenbach acknowledges that being picky about the details—stating he was "terrified" when it came to finally releasing the game into the world—and ultimately missing the window of opportunity regarding rhythm games were the most likely the main reasons for failure.

Nonetheless, the whole experience had drained Gilgenbach on every level. Emotionally, physically, financially and mentally. He'd sunk £45,000 ($70,000) of his own money into Retro/Grade's development, paying for artists and attending events. He'd borrowed more on top of that from his parents. There was no pay cheque for four years. Worse still, he just couldn't comprehend how or why the game had racked up top scores across the board, yet offered little financial return. To this day, Gilgenbach admits just how difficult it is for him to reconcile the game's lack of success. At the time, he came close to turning his back on everything.

"I thought about quitting game development altogether, not just independent game development," he says. "Independent game development is very challenging and it's very stressful. But there's a great reward for that. Perhaps not a ton of financial rewards—I don't think there are many indie game developers that are really making the big bucks—but I think it's more about it being creatively fulfilling, being able to make the games you want to make. That's why I'm indie, but it's definitely tough. I didn't really have any good ideas for what else I could do, but I did think about giving up game development altogether."

It was during this time that Gilgenbach slipped into depression. He found it difficult to communicate how he was feeling—a symptom largely consistent with the illness—further compounded by his pre-existing OCD. Verbal communication was out of the question, and after struggling to write about where he stood emotionally, he turned his hand toward interactive means. In his mind, a horror game was born; one that would depict the horrors of mental illness, as far as he understood it. That game would become  ​Neverending Nightmares.

By largely doing everything the opposite way around from Retro/Grade, Gilgenbach and his newly formed Infinitap Games team set about outlining a fixed schedule and, crucially, a fixed budget. This time, Gilgenbach would acknowledge the challenges that his OCD forced upon the development studio, and was thus better able to organize a work plan. Helped along by a successful Kickstarter campaign, Neverending Nightmares would release on time, minus an overly extensive development cycle. Perhaps most importantly, Gilgenbach would release Neverending Nightmares into the world "without getting the details perfect."

Naturally, this was a big step. And what Neverending Nightmares portrayed would extend to a period in Gilgenbach's life to which he refers to as "rock bottom"—where things couldn't get any worse, before getting continually worse still. Most interestingly, he notes this time as one that could, and arguably should, have been his happiest—at least as far as outside, common-minded perception is concerned.

"The interesting thing about mental illness is that you can't point to any specific thing and say, 'This is why this is or was bad,'" he says. "I don't have a good answer—I was at college and, in terms of outward appearances, I was one of the best students in the computer science program, getting As in all my classes. On the outside there was nothing wrong with me. It was just over time, the way my mind worked had just become so terrible, to the point that I was really my own worst enemy.

"I could be doing something that I really enjoy, and then my mind would turn against me and I'd start thinking about what a terrible person I was, or there was a lot of self-abusive language—in my mind I would say all these nasty things to myself, or I'd have these horrible thoughts of self-injury."

The trailer for Neverending Nightmares

Gilgenbach admits that some of these thoughts are still with him, but are now more manageable. Making Neverending Nightmares was overall a therapeutic experience, and although within the bounds of the game's animated style, these visions of self-harm do feature quite prominently. By getting these intrusive thoughts down and into a game, however, Gilgenbach feels they in turn lost their power.

Since release at the end of September, Infinitap has been inundated with emails and messages from players praising Neverending Nightmares for its portrayal of mental illness and how it has affected them, or how they are able to relate their own circumstances to the game. Gilgenbach himself has been on a very interesting—if, at times, very dark—journey. But he's come out on top. Video games have provided that much needed outlet of escape against some very challenging personal, yet clearly relatable, circumstances. I ask him if there needs to be more of a conversation had about mental illness in video games.

"I think there should be a conversation in general," he says. "There's such a stigma associated with mental illness and it makes it more challenging for people who suffer. If I tell people I have asthma, then people are like, 'Oh, whatever, I guess you can't run really far.'

"But if you tell people you have OCD and depression, then you get funny looks. People don't understand it, and may be like, 'Oh, cheer up,' or just, 'Get over it.' They don't understand that it's part of your being and it's a constant battle and a constant struggle and it's never going to go away."

Neverending Nightmares is out now, via Steam and for Ouya.

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