HomeAll posts"Sick Heroes Explore representation of illness": PAX Australia

“Sick Heroes Explore representation of illness”: PAX Australia

One of my favorite features of PAX Australia is the panel stream. I attended a few panels this year and this one stands out in a crowd of professional panels. Academics and professionals, including a medical doctor, discuss disability and representation in computer games and broader society.

Below is my write-up based on notes so it is an incomplete account not a transcript. I’d love this panel and others like it to be recorded in full but this is the best I can do. If I’ve made errors, please let me know and I’ll make corrections. Please note: I’m not sure if the person I identified as ‘Vic’ is, in fact, Dakoda or a substitute.


Alayna Cole: Videogame Writer / Researcher / Journalist, University of the Sunshine Coast

Dakoda Barker: Researcher in Serious Games Development, University of the Sunshine Coast

Jane Cocks: Researcher of Psychology – Games and Stories / PhD Candidate, University of the Sunshine Coast

Jennifer Hazel: Psychiatrist / Founder of Prescription Pixel, Prescription Pixel

Katryna Starks: Lecturer in Serious Games, University of the Sunshine Coast

Alayna (moderator): We’re looking at representations of illness and disability and how they’re being erased from video games.

Vic: PhD topic. Injured his back, a spinal fracture and needs to walk with a cane. He’s 23 but feels older than he actually is at times.

Jane: PhD in psych & games, ways to use psych theory and practice to create interactive media to create positive change and improve health.

Katryna: Masters in using games to foster health promoting activities in dealing with chronic illness.

Jennifer: Medical doctor specializing in psychiatry. Runs website prescription pixel.com.

Representation is important

Alayna: Why is explicit accurate representation of chronic illness/disability in video games important? As soon as you start talking about diversity and equality, people start being vocal on social media, questioning the necessity and validity.

Katryna: Why is representation of [insert blank here] necessary? Because we exist. Representing people who exist is necessary. Seeing yourself is acknowledgement of your existence, that the world includes you. At the least it should be neutral if not positive.

Vic: Looking back at games I played when younger, the inclusion of chronic conditions isn’t too invisible. In Far Cry 2, the main character has malaria that comes back over and over again. I overlooked that when I first played the game, which is frustrating, but it was there.

Alayna: It’s not always positive either

Historically representation hasn’t come very far

Jennifer: Historically representation hasn’t come too far: we still have a division. between chronic illness and mental health. Shapes, sizes and colours of humans in art from centuries ago were as diverse as society. Representation should be as diverse as the community. The games industry has leant away from representation. Perhaps there’s a fear of misrepresenting tied with a fear of not selling. Specifically for the physical conditions, it’s important to ask if it’s well done, fair etc. If we had more chronic conditions in gaming, we’d be more educated.

Alayna: If 1 person produces one part and another produces another part of a condition, it builds a picture, increases representation and reduces responsibility.

If there is only one representation in a year and it’s crap, then it’s crap

Vic: If you’re only represented once and it’s crap, then it’s crap. But if you’re represented 100 times then 1 being crap isn’t so bad. When there are positive examples, those matter more than the negative ones. Finally getting to see yourself is huge.


Jane: It’s as much about educating people not in that situation to create understanding. Even a glimpse of what it’s like is an informative and educational experience

Alayna: The more we see it, the more it’s ok to talk about it. If you don’t have a cough when you call into work then that’s an issue. Mental health conditions need sick days too, need increased exposure through games.

Jane: Ether One puts you in the shoes of exploring dementia. [She mentioned another game I didn’t catch] is about depression. Benni Hill made Ether One.

How to end (or reinforce) stigma

Jennifer: Ending stigma starts with exposure and exploration, talking, asking, making it ok to be curious. If a child sees an obvious disability and asks, the child is crushed and told not to talk about it instead of explaining. That instills it in the next generation.

Alayna: Not everyone looks different either, which requires more education.

Demonizing mental illness

Jennifer: A lot of people are scared of mental illness. The public image of schizophrenia is bad, they’re demonized.

“Have you seen A Beautiful Mind?”

“I love that movie.”

“Would you be scared of him?”


“Well then…”

Alayna: Some games almost go out of their way to avoid engaging with issues but there are so many people living with these things.

Invisible by omission

Katryna: A lot of games de facto erase conditions by not including them in crowd diversity. How many times have you walked down the street and not even seen people with disabilities in the crowd? That is one small step because those people exist so they should exist in the world. It’s a small way of adding diversity and character.

Jennifer: I hadn’t noticed and that signifies how big a problem it is.

Alayna: The obvious excuse is character models: if they’re all standing up, that’s a lot easier. It is an excuse. It’s not a good enough excuse.

PTSD in Tomb Raider

Vic: How many played the Tomb Raider reboot? Lara is not quite white and she’s a woman so she’s our shiny example of representation. She should have PTSD but she doesn’t. In a psychiatrist’s office, she’s tapping her foot. She doesn’t have PTSD, she’s anxious to explore more tombs. She could have had PTSD and that would have been ok. They’ve missed the point of making a human character instead of a robot instead of putting so much effort into making her hair flow.

Jennifer: She’s displaying several symptoms of PTSD but some director says “No, she doesn’t have PTSD”. The comics overtly say she has PTSD, it’s written on the page. I’d like to think everyone has the best intentions and he just didn’t want to say she had it but he got quite a backlash.

Alayna: There are so many people who would acknowledge Lara as a hero even with PTSD. There are so many games where it’s all ok, no problem, we’ll just get straight back on the battlefield. Anyone with military experience would laugh at that because it’s absurd.

Jennifer: You don’t have to sit and watch Nathan Drake have a cup of tea but it’d be nice for him to have a rest to acknowledge that what he did today sucked.

Alayna: Misrepresentation?

Jennifer: With regards to the villains: ALWAYS BRITISH.

Audience member: Centuries of colonialization.


Plans for a panel next year: British people in video games.

Psychiatric hospitals are not your horror setting

Jennifer: Can you stop using psychiatric hospitals as setting for horror games? I love working there, I love my patients, I’m regularly bored, it’s not a horror story.

Audience member: People find mental health issues scary so they’re afraid of hospitals.

Another: It makes people scared of seeking help.

Vic: RPG heroes get neuroses from doing awful crap. How do crazy creepy asylum with bars, how does that make people better? I don’t know who was thinking that was a good idea to imply all conditions can be fixed in a week by going to a creepy hospital.

Alayna: Some things can’t be fixed. I’ve learnt to manage it; I still have days where that comes back. It’s not something that goes away.

Vic: It’s just an obstacle.

Suicidal ideology is not a puzzle to solve

Katryna: If someone is suicidal, it is NOT a puzzle to solve. Mass Effect 2: pick the right responses to save them. It misrepresents in two ways. There are professional people that can help them. It is possible to save them but it’s not because of the correct responses. When a suicide happens, the people left behind feel responsible, unlike with cancer. It is not an effective game mechanic. Especially for people are going through it. It is not a puzzle.

Jennifer: I completely agree. Please include mental health in games but not as a puzzle you can fix. If the person is safe today, it doesn’t mean they’ll be safe tomorrow. They live with this every day. Slowly they might get better. There is no all or nothing moment.

Alayna: These things don’t get fixed, they get lived with.

Vic: The Phantom Pain is a reference to a chronic condition. Venom snake is a protagonist who doesn’t say much. Cut scene: bionic arm doesn’t work, it might take getting used to but then he’s fine from the end of the cut scene. “His missing arm hurts with the phantom pain of his lost comrades”. But he doesn’t talk about literal pain or challenges, it’s an angsty metaphor that should be PTSD. It is trash in terms of representation. Metal Gear Solid 4: a character had a similar medical condition. In the Avengers, I was Thor. From that point onwards, my back has been crap.

Audience: Do you feel Thor?

Groans, laughter, applause.

Vic: Seeing old snake I felt that abstractly. It was the first time I felt part of me had been represented in a video game (Metal Gear 4). That was awesome. Old Snake’s condition has parallels to a real-life condition.

Jennifer: It’s incredibly rare.

Vic: You guys know it more than me. I know the back pain. Wanted to have a bit of a cry about the bad representation.

Jennifer: It really annoyed me about the phantom pain.

Alayna: He explicitly says “It’s fine, I don’t hurt, I just…” why call it Phantom Pain if it isn’t phantom pain?

Jennifer: I want to believe everyone means well…

Alayna: I wish.


Alayna: Depression Quest had a lot of positives.

Jennifer: Max Pain 3: PTSD, alcoholism; not a nice guy but good representation.

Jane: The kid also wants to save the dad. The desire to want to save someone in a chronic situation.

Jennifer: Gone home: great representation of gender.

Queer representation is my thesis

Alayna: I identify as bisexual. Anyone identifying as non-normative experience is questioning. Others don’t have to think about it. I’m constantly noticing when represented and when not. Queer rep is my thesis. The number of trans people with mental illness, non-binary with mental illness; questioning self, being mistreated, connects. The link between inability to do things considered normal and mental illness is unmistakable.

Jennifer: Cloud is a wonderful representation of weakness and humility. He struggles then comes through the other side. I found it really powerful that he goes through this journey to discover that he’s not who I thought he was.

Audience: Is there a risk in putting disabilities in crowd like in GTA then making them more vulnerable?

Katryna: LA Noir involves investigating murders but you don’t have to murder people with disabilities. Dreamfall Chapters has a lot of people on the street. Anything that has a city scene. Not everyone is in danger.

Alayna: Equal opportunity to be killed.

Audience: Why is it important to represent accurately?

Jennifer: There’s representing accurately and representing at all.

Vic: There’s a level of unrealistic representation that we accept but the repercussions are there. We can’t accept being thrown in as an afterthought; it’s not good enough. “I know a black guy so I’m not racist” isn’t good enough. I can’t jump as high as I used to any more but Mario can always jump just as high.

Alayna: Some people think “Change sucks, I like my games, keep your hands off them”. We’re aiming at producing more games with diversity, with new ideas, new prototypes. It means also having games with realistic characters represented with chronic conditions in our world.

Katryna: I’ve seen eons of discussions on boob physics. Why not have people in chairs? I don’t care about boob physics but if someone has a cane and they move properly, that will have more of an impact on people feeling unrepresented.

Audience: I work in mental health, reducing labeling. Do you need to define diagnosis in a game?

Jennifer: I personally don’t like labels but if you have a mental health condition and you want to get medication on PBS you need the label. I don’t like it but that’s the way it works.

Alayna: I don’t think labels are vital for games. Recognizing the back pain is a symptom of a condition. Having the symptoms without the label can help more people feel represented.

Katrina: There’s something you can show. Prescriptions, scheduling conflicts etc.

Vic: We can be heroes in our own stories or we can be side characters in other’s stories. Those things are there but they don’t have to be dramatic.

Audience: A child on a bus asks why the man’s hand is funny. Mum replies, maybe he lost it in an accident. “Oh, like in HTTD”. How do you put conditions in games?

Vic: Here’s a controversial opinion: games don’t have to be fun. Challenge perceptions. Games that aren’t fun can still affect you and be a memorable experience. It’s still worthwhile.

Alayna: Games can be fun with chronic conditions. This person can have back pain, mental health issues, etcetera and still have fun. You can have fun and have a condition.

Katryna: Beyond Eyes goes through the world as a blind girl. The Sims made a character like her, went to work, exercised (a little), played games and ate. Couldn’t get her social meter up. The Sims was kind of like a coach. Seeing the missing link helped by highlighting a problem. She’s used that to build her life.

Shortly after this the panel wrapped up because we were out of time. If this interested you, you might like this panel on disability in computer games.

Nalini is an award-winning writer and artist as well as managing editor of Dark Matter Zine.


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