Since Grand Theft Auto and Mortal Kombat created a moral panic in the 1990s with their violent and irreverent style, the relationship between games and mental health has often been discussed. Still, it’s only in the last few years that games themselves have begun to address the subject in their stories.
Mind Scanners from Danish studio The Outer Zone is set in a dark and gloomy future with cyberpunk aesthetics and a dripping synthesizer soundtrack. Despite this, your job is not to shoot laser guns or hack computer terminals as is customary for the genre. Instead, you need to diagnose and treat mental disorders.
“The inspiration came from a visit in 2015 or there to a now closed psychiatric hospital in Ghent”reveals The Outer Zone founder Malte Burup. The hospital had turned into a museum [Dr Guislain Museum], and I was immediately fascinated by all these bizarre methods that used to be used to treat people. Methods that seem to be almost pure guesswork.”
The thought-provoking insight into 19th-century psychiatry, which often had little regard for the actual well-being of the patient, made the graphically trained game designer consider whether the experience could somehow be turned into a game. After releasing the interactive children’s book Sofus and the Moon Machine in 2016, he teamed up with programmer Rasmus Mølck Nilsson and began developing Mind Scanners. A game where you can experiment with the “alternative” mental treatment yourself.
“By playing as a psychiatrist, as a player you feel the consequences of the ethical dilemmas facing psychiatry and reflect on the challenges that will arise”, Burup explains.
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The developers of The Outer Zone don’t try to hide that they are inspired by Papers, Please. The 2012 indie hit put you in the shoes of an overworked border guard in a fictional Eastern Bloc country. By comparing documents such as passports and entry permits, you ultimately had to decide on the fate of people – would the citizen in question be allowed to cross the border or be refused entry?
In many ways, Mind Scanners is reminiscent of its source material. With the obvious difference that the Danish game is set in the future, and instead of judging whether a person is a law-abiding citizen or a spy, the player must decide whether they are suffering from a mental illness. And the game’s dilemmas don’t stop there, because you’re not just tasked with diagnosing your patients. You also have to heal them.
The psychiatric treatments are created using futuristic machines, each connected to a specific mini-game. You can use futuristic glasses to decode symbols in the patient’s eyes. Or you bombard their ears with a kind of rhythmic Morse code that you have to decipher. In many cases, the treatments are probably more insane than the patients. Something from the visit to the psychiatric hospital, Burup reveals:
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“In the Belgian museum there were weird devices everywhere. I walked around and thought ‘what the hell are those buttons on this weird machine from 1905 supposed to do?’ Like a kind of piano where you made five cats meow by putting thorns or nails in their paws, and apparently that was supposed to cure something. It was really weird, and I wanted to include that dimension. You weren’t supposed to just go through leafing through a report.’
Originally I envisioned Mind Scanners in the past. But that wouldn’t work because as a player you would just think you’re playing some kind of torture simulator.
Thanks to the mini-games, Mind Scanners can quickly become a hectic experience. You only have 200 seconds a day to complete your task, and during treatments the clock ticks constantly as confusing symbols dance around on the futuristic diagnostic equipment. As if this were not enough, you also need to balance the stress level of your patients. Your equipment is not gentle in any way and if you push the patient too much they may end up having a psychosis and losing their personality.
“Time constraints are rarely something you put into game design, as it often leads to unnecessary stress,” Burup explains. “But we wanted that feeling of stress. You will inevitably make mistakes, human errors, and it will affect the people in the game world. Your time then becomes a kind of resource. And that’s what we see in the real healthcare industry as well. under pressure for time and resources, and that leads to mistakes.’
While working conditions for psychiatrists and mental health workers have been heavily debated in recent years, there’s unfortunately not much you can do about it in the bleak Mind Scanners universe. Since you work for a totalitarian city-state called The Structure, there’s not much you can do to improve your working conditions. Especially since they’re holding your daughter hostage in a psychiatric clinic. What you can do is infiltrate the system from the inside. Perhaps with the help of the mysterious underground organization known as Moonrise. Or you can do your job properly and hope that the authorities will reward you.
How the story goes is entirely up to you. Mind Scanners has different endings and reacts not only to your choices during the story, but also to the outcome of your treatments. The Outer Zone chose the structure so that your choices felt consistent. It should matter whether you mistreated your patients or not. But the open narrative structure also proved a major challenge for the small developer, reveals Nilsson, who handled most of the heavy coding:
“We had a pretty reasonable schedule that we kind of managed to stick to. But the story, all the choices and different branches, was probably what ended up going the most over time and budget. We went back and changed a lot things to really create that sense of the game, responsive to how you treat the patients and the choices you make along the way.”
Burup adds: “You may not see all the work we’ve done in a single playthrough. But you can feel it when you play. Whatever you do, you feel there’s a consequence.”
While games like the depressing Hellblade: Senua’s Sacrifice and the angst-ridden teen drama Life is Strange have somewhat paved the way, it can still be a somewhat touchy subject to pixelate sanity and fun gameplay. Gaming sometimes has a habit of downplaying serious topics. For example, think about how war is treated in games like Battlefield or Call of Duty. On the other hand, as an interactive medium it can sometimes bring you too close for comfort. Like in the aforementioned Papers, Please, where you’re not just watching or reading about an inhumane bureaucracy – you’re actually part of it.
Considerations like these were something The Outer Zone thought long and hard about. “I originally envisioned Mind Scanners in the past”, reveals Burup. “But that wouldn’t work, because it’s now common knowledge that none of the treatments back then really worked. As a player you would just think: you’re playing some kind of torture simulator.”
The ethical aspects ultimately influenced the art and tone of the game as well. “I wanted the game to be high resolution with realistic 2D graphics. But I kind of moved away from the dark and gloomy to something lighter and more colorful with a low resolution style. To make it feel like you’re playing a game on it was play. The darkness is now a bit more confined to the text. What we want to do is point out problems on a societal scale. We didn’t want to point the finger at real individuals.”
What I really like about this studio is that the inspiration is part game, part all sorts of other things. With Death Howl, we once again draw inspiration from specific games. But also shamanism, the collective unconscious and many other ideas.
Because of this, at first glance, Mind Scanners might seem like an old Nintendo game with its pixelated graphics and chiptune-inspired soundtrack. However, the universe is still very bleak and the audiovisual side is heavily inspired by classic sci-fi film. Especially Blade Runner, and specifically the complicated Voight-Kampff machine, but also the satirical and slightly over-the-top style of David Cronenberg and Paul Verhoeven’s 80s classics like Videodrome and RoboCop.
“We were very inspired by this kind of sci-fi social satire”explains Burup, who, in addition to doing most of the writing, also drew the graphics and composed the soundtrack. “[In die films] everything feels a bit fake or gameshow-esque. Almost like a video game, actually. They have a kind of rigid, mechanical and also playful universe. And at the same time they provide insightful social commentary.”
With decent sales on PC and later releases for Xbox and Nintendo Switch, it seemed obvious that The Outer Zone’s next project should be set in the Mind Scanners universe or at least build on the same mechanics. However, that is not the case.
The Copenhagen studio is currently working on Death Howl. A card game in the vein of Slay The Spire with elements of tactical RPGs and an open world that the player can freely explore between battles. The setting is a magical and spiritual version of the Stone Age in which you play as the young woman named Ro. But the story is ultimately secondary, the developer explains. It’s the gameplay that matters.
“What I really like about this studio is that the inspiration is part game, part all sorts of other things”says Lasse Sommer, the studio’s third and newest member. “Like Mind Scanners that combine Papers, Please with the thoughts and musings about visiting a psychiatric hospital. With Death Howl we once again draw inspiration from specific games. But also shamanism, the collective unconscious and many other ideas.”
From the future to the distant past. From a narrative experience to gameplay-first. The Outer Zone aren’t afraid to explore new ideas and we’re excited to learn more about their upcoming game as development progresses.
