Content warning: the following article contains graphic allusions to abuse—and rape—and arcane psychiatric treatment procedures.
"I was not surprised when the asylums were closed," Angelo Lippi, a former head of social services at the Italian psychiatric hospital Zona Alta Val di Cecina, tells me. "From my first day on the job, I always felt that asylums were not the proper place to ensure adequate care that could help patients to return to their lives."
Situated in Volterra, a quaint mountaintop town in the Tuscany region of Italy, the Zona Alta Val di Cecina was once part of the now shuttered Ospedale Psichiatrico di Volterra asylum. Dubbed by locals as "the place of no return," thousands of patients were said to have been sent there for "treatment" prior to its closure in 1978, but were instead institutionalized indefinitely. Between 1970 and 2003, Lippi worked in the adjacent Zona Alta Val di Cecina in a social work role that was then still finding its place in society—particularly within the realms of psychiatric care.
"Working in Volterra allowed me to feel like a protagonist," adds Lippi. "Together with many others who believed in democracy, in rights, in overcoming therapy based only on internment and in finding more appropriate solutions for those who were wrongly admitted to asylums: children, alcoholics, epileptics, individuals with Down's syndrome, Parkinson's disease, Pellagra and more. Finding solutions for therapy and inclusion in society, and family life for those who had 'real' mental illness, could be envisaged. I was pleased and proud to have worked in Volterra, and with its director Carmelo Pellicanò in particular, who led these great battles for innovation."
Despite Lippi's admirable commitment to equality, mistreatment and malpractice in archaic institutions such as Volterra were often commonplace. After months of extensive research, relaying the atrocities that are said to have occurred within the asylum's grounds became independent video game developer LKA's raison d'etre. The resulting game, The Town of Light, marks the Florence-based studio's debut—it launched last year on PC, and came to PS4 and Xbox One in early June 2017. While it's a tremendously bleak and sobering venture, it's also one of a kind.
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"Our creative director, Luca Dalcò, was really touched by people around him who suffer from mental illness," the game's environmental artist Lorenzo Conticelli tells me. "It's really a common thing—people suffer from depression, for example, or alcoholism. He started his own research and found out that the [now closed] psychiatric hospital Volterra was really near our studio, and was one of the biggest in Europe.
"No one knows the story of this place, and we wanted to tell it. During our research we found these controversial, dark and sad topics and we didn't want to hide anything from the player—we decided to show everything that we found in our research. I feel this is the only way to approach these controversial topics if you want to do them justice, to treat them with respect and sensitivity and tell the truth of what happened."
Against the clichéd, dehumanizing interpretations of mental institutions the survival genre has and continues to pedal, The Town of Light goes in the opposite direction. By virtue of flashbacks driven by diary entries strewn around the game's lonely corridors, examination rooms and isolation chambers—all of which are modeled on the still-standing, real-life Volterra building—players learn the harrowing tale of Renée, a 16-year-old girl who, in 1938, was institutionalized.
Dubbed a "danger to herself and others," Renée spends much of her life held against her will, while continuously clashing with orderlies, nurses and doctors—both mentally and physically. One particularly distressing scene takes place in a changing room where patients have been stripped naked and left in the cold. One internee is seen screaming while lying on her side cowering beneath a wooden bench. Another scene sees Renée being forcibly given electroshock therapy, which Conticelli tells me was researched by watching live videos of inpatients going through the same barbaric procedure. One scene depicts Renée being raped.
It's in these moments where LKA's meticulous attention to detail accentuates the horror of its premise and setting. Renée's narrative is fictitious, yet was wholly inspired by reality—and while the vast majority of horror games take place beneath the cover of darkness, The Town of Light is set in the afternoon, where interminable beams of sunlight split the institution's vacuous, cobweb-covered floors.
"The whole game uses light as a metaphor. You can hide in the dark, but you can't hide in the light, you can't escape the light," Conticelli explains. "The title and storyline for The Town of Light came from the diary of a schizophrenic girl who remembered, in an altered state, that she saw this brilliant bright light that filled her mind. We decided to use this for the game. We tried to create this contrast—from the outside it seems like a normal day, then you take this journey inside which is at times really dark. I think the environment and the structure helps to keep the dark inside.
"When the script was finished, Luca met some with some psychologists, psychiatrists, and social workers, to get their opinions on what he had written. They all assured him The Town of Light was close to how it was. They gave him more background information, too—such as the smells inside the asylum. It's impossible to represent this in-game, obviously, but it helped us design the game world from an atmospheric point of view."
Liaising with professionals helped LKA underscore The Town of Light's controversial horror with sensitivity, which in turn helped them eschew vulgarity, says Conticelli. "It's easy to misuse imagery," he says, "to use the wrong imagery, to use the wrong words."
One such professional—psychiatrist Giampaolo di Piazza of the Toscana Centro, and vice president of the Italian Society for Phenomenological Psychopathology—helped LKA understand that while the unscrupulous and immoral treatment of patients is of course condemnable, many practitioners and psychiatrists stood vehemently against the ways in which asylums operated.
Di Piazza notes these outmoded institutions were progressively dismantled over time, which is something reflected in-game by way of nurses who write to the Volterra director to denounce in-house sexual abuses, those who actually treat patients with care and compassion, and the first doctor treating Renée who is said to be "a victim of the therapeutic shortcomings of the medicine of the time."
Balancing this with the darkest stretches of The Town of Light's composition, however, makes the entire development process, somewhat understandably, both difficult and demanding.
"It's really tough," Conticelli admits. "Especially when you see some pictures or video from the early '40s and you have to recreate what you saw. This is disturbing, and you have to be as detailed as possible in order to do it correctly. I think it's also tough from a writing point of view."
In previous installments of this column we've explored how the horror genre has a tendency to mishandle issues of mental health, but that there are some games out there which have the capacity to do so with nuance. I've argued in the past that issues of mental health can be scary, but it's how this is presented to players that's key to wholesome interpretation.
In The Town of Light, the asylum itself is the horror—but not in an unempathetic Outlast, Sanitarium or BioShock Infinite sort of way, where we're forced to assume mental illness is scary. Underpinned by facts, and by real-life stories, The Town of Light instead leverages a human connection in relaying its horror: where players may not be immediately familiar with Renée's story, but where they can equally appreciate the hardship and terror wrought by these institutions' antiquated practices and procedures. In doing so, injustice is as much a vehicle for horror against everything Renée goes through.
Given their basis in fact, much of what The Town of Light projects can be tied to our understanding (or misunderstanding) of mental illness today. Speaking to wider societal perceptions of mental illness, di Piazza says there is still much to be done to dissolve preconceptions surrounding patients with mental suffering: "Even though [French psychiatrist Jean-Étienne Dominique] Esquirol suggested as early as 1838 that aggression does not represent the nuclear and pathognomonic [a sign or symptom] element of psychic disturbances, there is a tendency, due to ignorance, to approach the psychiatric patient with a caricatured and stigmatizing description of a person potentially dangerous to themselves or others.
"Psychiatry—born with [Jean-Baptiste] Pussin and [Phillipe] Pinel's bold gesture to free the insane from the chains at Bicêtre in 1793—and psychology are still two young disciplines that within a little more than two centuries have shed new light not only on madness but also on human beings in general. There is still a long way to go, but if we look to see the journey behind us, we can gain some confidence to limit or altogether avoid the errors of the past."
And Conticelli argues that there's no better vehicle than video games for communicating sensitive subject matter such as issues of mental health—not to mention navigating said ignorance.
"Using video games to tell these stories is really important because, when playing, you are not passive," he continues. "When you're watching a movie or reading a book you are, but when you are in the first person, you have to choose your different paths based on what you've learned up to that point. In The Town of Light, your decisions are based on how you explore the asylum and there are no bad choices based only on what you think. Games are amazing for this type of thing, and can help players internalize their messages better than any other medium."