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A Different Life
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In this blog by Sin Fai Lam, Constantinos Panayi discusses
virtual reality to reduce anxiety and isolation of young patients,
his projects and hopes for the technology.
Admission into hospital for children can often be an
intimidating process. The potent mix of being in an unfamiliar
environment along with the uncertainties of the unknown can lead
fear and uncertainty. Furthermore, if children receive insufficient
information regarding the various procedures within the hospital,
they may experience elevated levels of anxiety 1.
In one particular area, attempts have been made to alleviate
this distress. Magnetic resonance imaging (MRI) scans can be
intimidating, due to the nature of the procedure with its loud
noises, large machine and relatively confined space. Some children
find it hard to tolerate such a procedure and this sometimes
necessitates the scan being conducted with the child under
sedation, which is not ideal. Therefore attempts have been made
either via mock MRI scanners2 or via virtual reality (VR)
mock-ups3, to help prepare children for the scan, with initial
evidence suggesting they have a benefit in reducing agitation and
I was fortunate to attend a Middlesex University end of year
showcase and was able to interview
Constantinos Panayi a 3D Environment Artist specialising in VR
Technology who was collaborating with Great Ormond Street Hospital
(GOSH) in developing a similar VR mock-up for them. The aim would
be to use VR to show the child the MRI procedure and in the process
help the child become aware and informed. In theory, this should be
a more informative experience than simply receiving a verbal
description of the procedure from healthcare staff. This in turn
would hopefully reduce the child's anxiety before the scan.
Constantinos explained his initial inspiration:
"I was initially stuck for ideas on what to do for my final year
project," he said, "however my teacher mentioned that his friend
had an MRI scan once, then I got thinking about showing an MRI
procedure in VR. I had spent many years in Great Ormond Street
Hospital and I remembered how stressful the whole experience was. I
had many MRIs and CT (computerised tomography) scans and I could
remember the noise and being alone in the room by yourself. It can
be quite daunting. I then decided to read up about MRI and to
research more on it. I was able to find information online and was
able to talk to the people in the hospital who agreed for me to
look at the machine."
Constantinos then developed and designed the VR model. He drew
inspiration from the video game "That Dragon, Cancer" and designed
the mock-up with a similar "low-poly" look to that game ("low-poly"
refers to 3D objects being constructed from a relatively low number
of polygons, which can result in objects having a clean, blocky
aesthetic; an intentional stylistic choice). He integrated
additional features to the VR model, such as having visual
stimulation like fish swimming within the model to allow greater
engagement for the child and to reduce the intimidation of the
entire process.
Discussion with Clare Simcock, the lead radiographer for GOSH,
also highlighted how the joint work between individuals with
different expertise helped to develop a more polished product.
Claire said "Constantinos approached us about this project and it
was something which we were interested in." She highlighted how the
team fed back regarding the technical aspects of the procedure as
well as regarding visual considerations. This included
considerations for younger children and children with special needs
and how they would interact with the environment. However she
did note that this project was still a work in progress and further
research is needed into the field.
Running concurrent with the MRI project, Constantinos was also
developing a VR simulation of one of the gardens within GOSH. The
idea being that patients would be sitting in the garden through the
use of VR and it would ,"come alive through the use of animals and
plants". Additionally, "reassuring and thoughtful letters that have
been written by former patients are brought to the table. A
narrative then reads them out to the patient."
Constantinos said "When I was a patient, I spent some time in
isolation. I remembered that as a patient, I was not allowed to go
out; I was not allowed to go outside. It can be very lonely. This
is a relaxing garden" and he hoped that patients experiencing it in
VR would help them feel less isolated, if only for a while.
I asked him whether he thought that children would be able to
engage with the VR models. He felt that the visual nature of VR can
appeal to young patients and he had seen children use it during his
demonstrations at shows. Through their feedback he found that they
felt happy and relaxed. Constantinos stated the ability to immerse
the child in the VR world was another important factor. "On one
occasion," he said, "the young child pointed out to their younger
sister 'look look at the fishes' whilst wearing the VR headset, and
the sister replied, 'but its not there, only you can see it.' The
smiles and their looks just made me feel it was worth it."
Constantinos continues to be actively involved in GOSH both as a
guide and as member of the GOSH Young People's Forum, which looks
at ways to make hospital life better for young patients. "I have
spent much of my childhood involved with GOSH," he said, "both as a
patient and a sibling of a patient. It's almost like it is my
second home and I am giving something back to improve patient
Overall, I find Constantinos project exciting on two different
levels. One aspect is the usage of technology to improve patient
experiences. The promise is that VR technology could potentially be
a non–pharmacological/low-risk method of reducing anxiety and
distress amongst children in hospital. However, what I think his
project highlights even more is the need for hospitals to engage
better with patient and relative groups in trying to improve
experiences within our services. Patients often have their own
unique experiences of healthcare services that clinicians may not
always be aware of. Projects like this help bridge that gap of
knowledge and allow us to work more collaboratively in achieving
desired outcomes.
References1. Wilson, Margaret E.,
B. S. N. Kimberly Carlson, and B. S. N. Laura Enenbach. "Children's
Experience of Hospitalization." The 18th International Nursing
Research Congress Focusing on Evidence-Based Practice. 2007.
2. de Bie, Henrica MA, et al. "Preparing children with a mock
scanner training protocol results in high quality structural and
functional MRI scans." European journal of pediatrics 169.9 (2010):
3. Liszio, Stefan, and Maic Masuch. "Virtual Reality MRI: Playful
Reduction of Children's Anxiety in MRI Exams." (2017).
Under the name @AutismFather, Stuart
Duncan shares his experiences of parenting an autistic child
and his opinions on "all things autism". He remembers Minecraft's
meteoric rise in 2012 not only as a dad playing the game with his
two children, but as someone connected via social media to many
other families with austistic kids. Initially, parents would share
that their child "would do nothing but play, watch and talk about
Minecraft". However, more serious frustrations emerged: parents
increasingly reported their children were being bullied while
playing Minecraft on public servers. Stuart responded by creating a
server where autistic children could meet up and play together
safely – and so Autcraft was born in 2013. We
spoke to Stuart about Autcraft and its potential lessons for other
gaming communities.
Minecraft is an absurdly successful 'sandbox' computer game with
over 144 million copies sold, making it the second best-selling
computer game of all time (behind Tetris). The gameplay is akin to
playing with Lego, but in a procedurally generated world full of
dangerous beasts. Generally, there are no explicit goals and
players are free to create as they wish.
The Autcraft server hosts online games of Minecraft, and players
must undergo an application process to be able to play on it. On
the server there is zero tolerance for bullying, swearing or
stealing, and a structured system exists for praising positive
behaviour. The server also uses plugins to ensure that structures
players have built can't be destroyed by other players. At its
core, Stuart and a team of admins ensure the community functions
effectively. Stuart feels that the diversity in the admin team is
one of the server's great strengths. Stuart himself brings a wealth
of lived experience to running the server as an austistic person
and as a parent of a autistic child, but he recognises that he
cannot relate to every situation, and so he relies on the diverse
admin team to better represent server users. The admin team include
parents of autistic children, some of whom are autistic
Team of Autcraft admins
Admins deal with various issues that arise, including reports of
real-world bullying and suicidal thoughts. The response is to try
and match up the player in question with someone they can relate
and talk to. Admins have often had similar experiences themselves,
plus other server users may be going through similar situations at
that moment in time. At the most fundamental level, Stuart says "we
just let them know that they're not alone… We're here for each
other and will support each other for as long as need be... we all
know how terrible it can feel sometimes and none of us want the
others to feel that same way." As an illustration of this, Stuart
remembers users who initially came to the server feeling suicidal
and are now helping others dealing with similar
Stuart aims to help players flourish by providing "an accepting
environment where they're not afraid to learn, grow and make
mistakes." He feels many servers focus on gaining a high volume of
users, to the detriment of fostering a supportive community. In an
online world where 'griefing' and verbal abuse are rife, Stuart
feels it is a shame that Autcraft is an "anomaly" with its
supportive ethos, and he hopes that the server can demonstrate to
others that it is possible to achieve large user numbers whilst
also working to lock out abusive behaviour.
Stuart describes a number of examples of Autcraft users
flourishing. He recently finished writing an employment reference
letter for one of Autcraft's teen players (who has the rank of
'Helper' within the game), and he recalls other players who have
obtained their first jobs following on from their experiences with
Autcraft. Parents often get in touch to say their children are
making friends at school after playing on the server and "learning
how to interact with others." And players themselves describe doing
things they never would have done before playing on Autcraft: "one
child said he helped an elderly lady with her groceries at her car
just because it's the type of thing we encourage players to do on
the server." The server also provides a supportive space for users
to develop, such as "the kids who sign onto the server and don't
say a word for months, but, once opened up, become so helpful that
they are rewarded with a rank and a position that allows them to
help people".
The "Autcraft Lodge"
It is not only autistic children and their families who are open
to the benefits of Autcraft. Researchers have taken an interest in
how the
server works as an assistive technology for youth with autism.
Stuart has also found that a significant number of players heard
about the server from a healthcare or education professional, which
he sees as an encouraging development from the perhaps traditional
attitude that video games are stultifying. Professionals appear to
be "open to the good that a server like Autcraft can do" and are
beginning to appreciate "the benefits of a community at play".
Stuart has been exposed to negativity and abusive behaviour
surrounding autism himself, but also second-hand through Autcraft,
as players share experiences of bullying on a scale he hadn't
anticipated. "It can feel like the world is still a very dark place
with a long way to go," he said. He has also found that autistic
people are struggling with issues such as sexuality and gender
identity which are not always well-recognised.
Stuart describes learning about the fears that can hold back
users in their daily lives, "the fear of being judged, teased,
mocked, bullied or even the fear of being alone… On Autcraft, I've
seen children sign on, totally in a panic at this new place with
new people and having to speak and worried about breaking things
and being punished… and I've seen those same children learn to let
all of that go and share their likes and dislikes, their dreams and
their heartaches with everyone else… I see children making friends
for the first time ever, I see them becoming interested in science
because some other child is making it sound like magic."
Autcraft players assemble
Stuart notes that Autcraft is becoming increasingly well known
as a positive group, and other things are changing for the autism
community. Autistic characters are being featured in television
programmes and awareness campaigns are increasing. Some Minecraft
servers now ban players for hate speech if they use the term
"autistic" as a form of insult. Stuart ultimately feels optimistic
that people are more open-minded to understanding autism.
Autcraft is a way of life for Stuart, which comes with long
hours and full-time dedication, which amounts to being "patient and
compassionate and understanding and positive each and every time"
he is needed. Looking to the future, Stuart is working on a
secondary server that will allow players to play in "Creative
Mode", with access to unlimited items and materials for
unrestricted building, as opposed to the more traditional mode
where players must first gather materials in order to build. If
funding were no obstacle (Autcraft relies entirely on donations),
Stuart's dream is to be able to offer Autcraft in other languages
and add servers in more locations.
Stuart Duncan, AKA AutismFather
As a veteran gamer, what does Stuart play when he's not working
on Autcraft? "I'll always love the open-world games that I can play
at my own speed. Zelda: Breath of the Wild, Watch Dogs, Assassin's
Creed, GTA…" He views video games as a way to relax and de-stress,
providing vital "me time", and he finds doing his own thing within
a game satisfying and freeing. "I can take my time and build at my
own speed. If I want action, I can go find that. If I want to fish,
I can do that too." For him, this is Minecraft's appeal, and
Autcraft simply takes this one step further by allowing this
freedom within a well-supported and structured environment.
More information on Autcraft is available through the
Authored by Fran Debell (Core trainee in psychiatry, South
London and Maudsley NHS Trust). Interview by Donald
Here at Gaming the Mind we particularly appreciate originality
in games, both in form and content. A firm favourite is Life is
Strange, with its rewind mechanic that allows experimentation
with social communication within a world that is admittedly
'strange', but also in many ways familiar and ordinary. Some games,
however, provoke emotions and reflections that allow us to
empathise with people experiencing lives that are very different to
our own. If this sounds a bit farfetched, try out the
decision-making mechanic in Papers, Please, where your
family's life and the lives of refugees are hanging on the choices
you make. Or try surviving the long days of This War of Mine, a
game about staying alive in a war zone as a civilian.
This War of Mine is about choices, prioritisation and risk
taking. It's about luck, discipline and planning, and it's about
not giving up. Now, if this sounds serious and not particularly
fun, well that's just how it's supposed to be. The game is bleak;
it fills you with hopelessness and is deeply depressing. In this
game about war, you're not the omnipotent hero; you're the little
person getting rained down upon. I'm not going to say it's
realistic, because thankfully I've never experienced war, but it's
a simulation of an experience that many civilians in war zones
endure. And it gets you in ways that a film couldn't, because
you're actively involved in creating the story and the outcome.
11 bit studios, who made the game, drew influence from
the 1992 Siege of Sarajevo, which lasted 1,425 days and led to
5,434 civilian deaths. They used first-person accounts from the
FAMA Collection, a media
project that collected oral histories from people caught up in the
conflict in former Yugoslavia, to create a realistic game world
with real-life challenges. This attention to authenticity, both
within the narrative and the gameplay itself, avoids what has
become known as "ludonarrative dissonance"– a critique particularly
aimed at war games that attempt to portray a moralistic view of the
horrors of war whilst ironically rewarding senseless violence.
As the player, you look into the cross-section of a bombed-out
house, with its dark basement, bare kitchen, rubble-strewn upper
floors and broken roof. You direct three characters by clicking on
objects to interact with, such as a cooker, a fridge or a bed.
After scavenging for resources, you can build things that help your
characters survive – a water filter; a radio; a weapon. In this
game, you can kill and be killed, and there are no extra lives.
This is no obscene undead pre-oedipal fantasy, as Slavoj Žižek
likes to call the immortality mechanic in video games. When your
character, who has a name, a face and a personality, dies, she's
not coming back. This game is about loss.
A cross-section view of the survivors' dwelling
War is hell; hell is other people. You'll find that you need the
help of others to survive this game. You'll need to learn to barter
with the random strangers who come to your door unannounced and
you'll need to learn to exploit your team members' strengths and
keep them strong, through cooking and sleeping and guile. The game
offers you the chance to play with a total of 12 different groups
of characters, with each group having different stories, starting
environments and resources. This leads to interesting variations in
tactics and choices. Each night, you get the opportunity to assign
your team members roles such as being a lookout for raiders, a
scavenger in the local area or the person who gets some precious
sleep. The scavenger missions involve directing your character
around unfamiliar buildings filled with dark spaces, bounty, and
strangers who are often homicidally unpleased to see you. You might
assign the most physically strong or fast character to venture into
the night, but even they require regular food, rest, and, if
injured, medical assistance.
Characters must care for themselves and each other
Mental health themes run throughout this game, as you would
expect from a game about war trauma. Loss is certainly a feature,
as are constant threat and fear. The game is clearly trying to give
the player the experience of living in an extreme environment where
bad things can happen on a daily basis and where you have very
little control over your life. A lot seems down to luck and the
game is often deeply unfair and mean. Some characters show
incredible levels of resilience whereas others don't.
Characters have moods which respond to various factors; for
example, their mood will deteriorate as they become involved in, or
are exposed to, traumatic events, witness suffering and death, or
endure hardships such as hunger, illness or injury. Eventually a
character can become depressed, and unable to engage in daily
activities; even those that aid self-preservation. It is possible
that characters may end their own lives if they remain in a
severely depressed state.
However, their mood can recover through actions such as engaging
in good deeds, eating well, sleeping well, and having access to
entertainment. Importantly, characters can console each other to
help improve mood, which highlights the importance of reaching out
to others when in need. A custom psychologist character is
especially skilled at consoling others, sending a clear message
about the importance of seeking the attention of mental health
services when unwell.
One character attempts to console another to help lift their
Of course, this presents a basic view of depression and
recovery. Consoling is depicted as simple conversations between
characters, with phrases such as "I'm here for you, if you need
me". It seems logical that in this crisis scenario, things such as
food and sleep could reduce stress, but depression and
post-traumatic stress can often present with sleep difficulty and
loss of appetite, so presenting these activities as generalisable
solutions to low mood or trauma in all contexts would be overly
simplistic and narrow. However, if taken as encouragement for
players to engage in self-care, and to seek help when needed, the
game's message rings true for our daily lives. If the game teaches
us one thing, it's that to survive we depend on mutual aid and
As I write this, a number of cities and towns remain under siege
and at war. This game is important because it makes it that bit
harder to forget what war does to people.
This War of Mine is
available for Windows, OS X, Linux, Android, iOS, PS4 and Xbox
One .
Authored by Stephen Kaar
When I sat down to speak to Michael Levall, the Swedish
main developer of Please Knock on My
Door, my first instinct was to tell him that I enjoyed the
game. On reflection, I wondered if 'enjoy' was the right term to
use for a game about depression. Levall saw this as an issue with
how games are typically perceived. "There are books that are not
supposed to be strictly fun," he said. "There are movies that deal
with very heavy things, and I feel games have this idea connected
to them that they are supposed to make you laugh, but I don't think
that's the case at all."
Michael Levall. Photo: Kristian Andersson/Commersen
Please Knock on My Door focuses on a fortnight in the
life of a character who experiences symptoms of depression. It's a
down-to-earth tale, with the player seeing the main character
through everyday tasks at work and at home. In portraying this, the
game shows how deepening depression can affect daily
Initially a prototype he had developed at university, Levall's
game was inspired by his own experiences. "I wanted to use the game
medium as someone else would use a diary. When you use a diary, you
write with the purpose of having a moment of reflection. I decided
to use game development for that same purpose."
He returned to the prototype three years ago to begin
development proper. The writing process for the game was stressful,
at times. "I would write late in the evening. I would prepare
myself mentally for an entire day just to get a couple of hours of
writing done. I have a ton of respect for the subject matter, which
means that I would rather release nothing than release a game that
deals with this poorly. So it was very important for me to make
sure all of the texts were serious, genuine and respectful to the
subject matter and to people who had similar experiences."
The scenarios within the game offer a candid view of the trials
someone with depression can face. "I had done the initial prototype
when I was depressed," Levall said. "That was a way for me to cope
and to deal with what I was going through. Many of the stories I
wrote for the game are actually taken from my own life." On top of
this true-to-life foundation, Levall elaborated with fictional
elements, as he "didn't want to create an autobiography in game
As a result of Levall's perspective, Please Knock on My
Door is a particular take on depression that won't necessarily
ring true to all people. "I felt there was some higher value in the
player being forced into this specific narrative that followed only
one person and their struggles. As long as there are parts of it
you can connect with, you can still empathise with the main
character." Levall resisted taking a broad view in order to
preserve the 'soul' of the game. "I don't think you can generalise
too much. If the game was entirely relatable to any other person,
would it still be personal?"
However the game resonates with players, Levall intends for the
game to have a wide appeal. "One core idea was that I wanted
someone who was depressed to be able to use the game as a catalyst
for discussion, essentially offering the game to a family member or
friend and going 'Hey, I can't explain what I'm going through, but
if you play this game, maybe you'll be able to understand, and we
can talk.'"
Making the main character gaze out of the window brings
emphasis to his isolation
Central to the game is the main character's "mental fortitude",
a measure that isn't explicitly explained, but might be thought of
as a summary value of the character's mood, energy, motivation and
confidence. As this value decreases, the player becomes less able
to engage in certain actions. The first actions to become
unfeasible involve communicating with others. As the mental
fortitude continues to dwindle, even simpler tasks become
impossible to complete. "I wanted to convey that when things are
going your way, you're able to deal with things and talk to people
about how you're feeling, but when your mental state declines, all
your effort goes into, for example, being able to do the
Almost every action in the game has either a positive or
negative effect on the mental fortitude value. "It is a way to make
the player explore how their actions affect the mind state of the
character," said Levall. "If you don't eat, if you don't sleep
well, if you don't talk to people, that's going to have its effect
on you."
Some actions can have different effects in the short term
compared to their eventual long term effect, as Levall explained:
"I made that to show that some things can make you feel worse at
the moment, but they can have positive effects in the long run. For
instance, facing difficult thoughts or talking to people about
difficult things; those might be difficult to do, and might make
you feel worse in the moment, but can increase your mental state
going forward. In the opposite way, if you use games as escapism,
or watch TV shows to avoid dealing with life, that might make you
feel better for the moment, but in the long run that's only going
to bring you down."
Television is a momentary comfort, but can invite negative
thoughts and ruminations
Levall is open about the fact the game stacks the odds against
the player. Maintaining mental fortitude is difficult, and all the
more difficult when you can't do things that might be helpful, such
as reaching out to others. "I wanted players to always feel the
weight of every choice," he said. "I get the sense that most people
feel like there's something that they could do, but they simply
can't figure out what that thing is, which to me is one of the
central emotions when you are depressed. You feel like there should
be something for you to do, like you should be able to deal with
this, you should be able to snap out of it, but it's just
The main character bounces back and forth from home to work, but
as depression creeps in, it becomes difficult to maintain this
routine. At home, it is up to you to pass the time, which can be
hard when there is little your character wants to do. "One thing I
felt was a common thread for people with depression, and that
resonated strongly with me, was that hobbies stopped being fun or
interesting. For me, that meant playing games in the evening wasn't
something I did for fun, it was something I did to pass time,
because I wasn't tired enough to go to sleep. I wanted that to be
part of the game."
If passing time is hard, equally hard is keeping to time. You
need to leave for work in the morning, but with a growing tendency
to oversleep, and a morning routine that can take longer than
anticipated, chances are you'll eventually show up late to the
office. "In the game, you don't get to decide how long actions are
going to take you," said Levall, "because you don't sit down to
watch TV and decide exactly how many minutes you're going to spend
there. Of course that has implications during the morning ritual,
like do you have time to eat? What kind of food should you make? Do
you have time to shower? Should you just take a quick shower? That
information on timing isn't there; it's all hidden. I wanted to
capture the sense that you merely push the character in certain
directions, but you're never in complete control, just like you're
never in complete control in reality, either."
It shouldn't come as surprise that things begin to spiral out of
control, both at work and at home. If you are used to feeling
rewarded by games, this might be tough to take. "It was actually
very difficult to write in a way that the player wouldn't just get
frustrated," said Levall. "How do you write a character that has
weaknesses that don't come off as frustrating for the player?
Usually that's a no-no as far as games go; you want the player to
feel powerful and in control."
The game creates an excellent tension between the mindsets of
the player and the character they are playing as. For example, it
may seem obvious to the player that the character should cook and
eat a comforting meal, but that may be beyond the character's
capability. Similarly, at work, the player may notice social
support is available that the character isn't able to appreciate.
"In this case, I had to write characters that would give enough
hints so that the player would know 'Okay, these characters care'.
They try to reach out to the main character, however they still
have to be obtuse enough for it to make sense that the main
character, in the state they are in, would not be able to
understand or would not have the energy to pick up on it."
Cooking, eating, and washing up are daily chores that become
harder to maintain
As the game draws to a conclusion, things become increasingly
desperate for the main character and their ability to cope. How
things turn out depend on the player's choices, with three possible
endings. There are no 'good' or 'bad' outcomes, with all endings
operating on what Levall labels a greyscale. Of course, one outcome
is worse than the others, and I had to ask Levall about this.
"Personally," he replied, "I didn't want it to be too obvious a
thing. Think: what could be the most horrendous thing to happen in
response to depression? Of course, suicide comes to mind. I didn't
want people to expect that to happen, and for me to just give in to
those expectations. But, at the same time, if I didn't deal with
that, would I still be doing the theme justice? I decided to keep
it in, but with my own twist to it. I feel like the most important
thing is to be honest and upfront with players, so that someone who
does not want to be subjected to that would not be shocked. I
wanted to be very upfront with players about what this game is, so
that they don't expect this game to be something else."
Such themes can be distressing, but Levall wants players to see
the hope in each ending. "I never wanted to leave the player in a
dark place, so I usually tell people to not stop playing once they
start. The second week pushes the player very far down, but I
wanted to leave the player with an idea that things get better.
That was very important to me. I feel some responsibility as a
creator that if someone who is depressed plays my game, I don't
want to leave them feeling like everything is hopeless, so it was
very important for me to make sure all of the endings had some kind
of positive connotation to them."
Like many games that tackle the subject of depression, the
prospect of seeking medical attention is not covered. While
Please Knock on My Door touches on themes of recovery,
Levall is clear that he wasn't producing a guide on how to get
better. "I'm not a psychiatrist, so I don't feel comfortable
talking in those terms," he said. "All I could do was to try and
offer an individual perspective and hopefully add something
valuable to the overall discussion about mental illness. I can't
say for sure if someone who is depressed would gain something from
playing this; I have heard from people that the game was able to
strike a chord with them. In the end, I made it more as
entertainment than as a tool, but I feel entertainment has a strong
place in our culture for dealing with difficult themes and making
them more available and approachable to people."
While Levall is keen for Please Knock on My Door to
contribute to the conversation on mental illness, he recognises
that encouraging people to play it remains a hurdle, once again
striking on the idea that games should be only for enjoyment. "One
of the bigger challenges has been to convince people that the game
is actually worth their time. As it is a commercial product, people
are choosing between this and whatever other game is made for them
to feel happy. So it can be a bit of a rough sell. The way I try to
frame it is that this game won't simply last two hours and be over;
hopefully it will give you some kind of a takeaway that you can
then bring with you during the rest of your life. I feel it has
been able to do that, at least for some people."
Please Knock on My Door
is currently available for Windows.
Authored by Sachin Shah
Sea Hero Quest (SHQ) is a free game available on Android and
iOS, which collects data on how players navigate its wayfinding
tasks and then uses this data as part of dementia research.
Amazingly, it has translated 73 years' worth of gaming activity
from 2.7 million players into the "largest dementia study in
history", and so I was excited to speak to Dr Hugo
Spiers (Reader in Cognitive Neuroscience, University College
London Institute of Behavioural Neuroscience), who is leading this
The game tasks the player with navigating in a boat using simple
left/right controls. Data from players will show how well they use
spatial navigation, and on a larger scale will show how spatial
navigation ability differs across various demographics, including
across ages. With this vast bank of general population data, the
team are taking the first step in developing a tool to detect signs
of dementia, by understanding what normal spatial navigation
behaviour is, and what is pathological.
The initial levels of SHQ feel more like tutorials. These levels
serve a purpose within the study, explains Dr Spiers: "We're not
tapping into the brain areas that you need to find your way... you
are just going to a visible target and that allows us to
effectively measure how fluent you are with these types of video
games." A seasoned player would reach the target faster than a
gaming novice. This allows the team to understand how experience
with gaming impacts on the player's navigation skill, and to
account for this in their analysis.
The team can use mathematical modelling to assume everyone is
bad at videogames, "and you still see a decline... just the
steepness of the slope is much shallower because they start off
performing badly in their early age group; they're already poor
navigators, but it's exactly the same relationship between age and
performance, it's just the angle of the slope has changed because
your starting point is different."
There are plans to trial the game with an orienteering team, to
see how their performance in the game relates to real-world
performance. "It might show that there are certain levels that
seemingly, for some reason or another, allow you to predict the
best navigation performance in the real world. Or certain bits of
those levels in breaking them down." This will help the team in
honing a more precise diagnostic tool.
The team have already presented preliminary findings; perhaps
most notable is that spatial navigation ability as captured by the
game appears to deteriorate with age from the early 20s onwards.
These findings were based on two month's analysis of a set of
levels that tested the player's ability to know which direction
they had travelled from. There are more findings to come as the
team sets to work analysing data on how the players actually
navigated around the wayfinding levels. "As soon as you go to the
tracking in the main wayfinding levels, we have a 500 millisecond
resolution of where people were and what direction they were
facing," Dr Spiers notes. "It allows you to look at their choices
in the topological network of paths; it allows you to look at how
much they are deviating from the optimal path."
Yes, there are people in the general population who happen to be
bad navigators. But the wayfinding levels should give enough
navigation data to tease out specific differences in navigation
ability which may indicate deterioration due to dementia.
"Something we have from the clinical literature is that people with
dementia are more likely to just keep going forward than to take a
left or right turn," says Dr Spiers. "It might be that you have
healthy bad navigators who just make lots of bad choices. But then
you maybe have someone who's got early stage Alzheimer's dementia,
and they literally just go forward into the wall and they don't
deviate in their path… the way they move is very different,
Dr Spiers notes that most cognitive exams for dementia that have
a lot of precision are language-based, which makes it hard to
equate them across countries. "Plus, the clinicians I speak to
aren't really convinced that Alzheimer's dementia is a verbal
memory problem… patients are actually quite good at verbal memory,
early on in the disease. But they get lost: that's why they
typically come in to the clinic."
Gaming as a research toolI had
made it to level 40 of the game by the time I had spoken to Dr
Spiers. With around 30 minutes of game time clocked, the game told
me I had contributed two days' worth of research data to the
project. This was quite astonishing to me. Dr Spiers explained how
this was the case. "We optimised the game in a way we hadn't done
before to collect this this really detailed trajectory data, so you
couldn't normally use the trajectory at that level, every 500
milliseconds. It wouldn't be that meaningful in a small sample, but
because you're contributing to a very large sample it means every
500 milliseconds we're getting very useful information from you.
But if you were coming to the lab… to do this in the lab setting is
just ridiculous; it's not possible."
Dr Spiers considered how other fields of mental health research
could benefit from this form of study. Movement monitoring may
prove useful for people with recurrent depression. For example,
someone with severe depression is less likely to leave their house.
But before they reach that stage, there may be more subtle changes
that could be picked up. "The patterns in which they move through
the space around their community before they stop leaving home
might be predictive of a future onset of severe depression. So
there's potential in data on that which would be interesting to
look at."
While SHQ isn't looking at players' real-life movements, the
team is learning a lot about how they can analyse trajectories,
which is the bulk of data they get from the game. "People vary
enormously in what routes they take and it's quite possible we
could explore how people with depression change the way they move
within the game."
When it came to designing the game, Dr Spiers found the team
having to compromise between gaming and science. He's pleased the
game has received generally positive reviews on the app stores. "I
thought if we'd not achieved that, it'd be a disaster because the
fun game component does relate back to the science: if it's not a
fun game, you're not going to get 2 million people playing it."
There were also compromises made in the game design in order to
fit the needs of the experiment. "If it had been a raw experiment,
if someone was coming into my lab, they would have spent five
minutes filling out a load of demographic questions. If you'd
started the game online with five minutes of demographic questions,
our sample size would be a thousand, because nobody would want to
sit and answer a load of personal questions about their life before
they get into the game, it doesn't work like that on the app
store." Instead, the game asks only nine demographic questions
about the player. "As a scientist, we needed to really work hard to
get the best questions into the game. But we always knew it had to
be done carefully, as a compromise, asking 9 rather than 90
Dr Spiers foresees a rise in the use of games in research and
gamifying experimental data input. "It is really good… It's not
typically seen to be worth it, whereas every experiment I make in
my lab, I try to gamify it, so it is engaging, because I believe
that you want people at their optimally engaged for your
experiment… There's some experiments where I think it's just not
going to be worth it. But I think in things that we're interested
in (navigating environments), you do want to bring people up to a
situation that they're familiar with: which is generally
With millions of people playing video games in their free time,
there is clearly great potential here for gathering data on playing
activity for cognitive behavioural research, from players who agree
to participate in such research. As SHQ has shown, the data
acquired can be huge and detailed, which can provide new insights
into population behaviour. It also lowers the barrier for people to
take part in research, making it easy for people to participate
from their own gaming devices. With the study involving SHQ already
showing fascinating preliminary findings ahead of deeper data
analysis, the field of gamified behavioural research seems to hold
a very exciting future.
Sea Hero Quest is part of a research project that is a
collaboration between Alzheimer's Research UK, University College
London, University of East Anglia, and the UK game development team
Authored by Sachin Shah
Recently a targeted advertisement for a video game came across
my Facebook feed. Usually, most games I'm told to buy, to my shame,
are Candy Crush and their ilk. This advert, however, was
slightly different, featuring a behind-the-scenes glimpse of a
game; the video was titled "Myth and Madness".
A game that dealt with 'madness' as a theme? I watched the video
with trepidation, worried that the game would resort to the
"villainous lunacy" trope so often seen in entertainment media.
However, after watching it, I felt that the video game developers
were not merely paying lip-service to the issue of mental illness,
but had invested time and energy into researching it.
The game was called Hellblade: Senua's
Sacrifice. Hellblade is an action-adventure game
that tells a story of a Celtic warrior named Senua, who is on a
vision quest to retrieve the soul of her sacrificed lover. The
story is told from the viewpoint of Senua, who experiences
psychosis in the form of hallucinations and delusions.
With Senua as the protagonist, the game promises a "strong
character story"
I was fortunate enough to be able to interview Dominic Matthews
from Hellblade's development team Ninja Theory (where he
holds the enviable title of "Product Development Ninja"), about
Hellblade and the psychiatric themes the game would
Ninja Theory have a good reputation for developing well-rounded,
aesthetically-pleasing, action-heavy games. Their reboot of the
Devil May Cry series (retitled to DmC: Devil May
Cry) critiqued modern consumerist culture, whilst their
previous game Enslaved: Odyssey to the West was praised
for its mature narrative. Hellblade is Ninja Theory's
first step in creating a game as an independent developer, free
from mighty-publisher constraints.
Dominic described how Ninja Theory chose to cover mental illness
as a theme. "This is our first independent game, so we have been
fortunate to find ourselves in a position where we are able to make
a game that we can control creatively. Without creative
restriction, we wanted to do something unique and special, and
that's how we came across this topic." The prospect of covering
mental illness had clearly struck a chord with the developers.
"Although it is not something we talk about overtly, this is a
subject that is close to a lot of people in the team. We felt that
it would be a great opportunity to make a video game and tell a
compelling story, which we can develop."
Dominic stressed that the purpose of Hellblade, a work
of entertainment, "isn't primarily about raising awareness or
necessarily being educational." However, within this entertainment
medium, Ninja Theory have the opportunity to deliver a strong
social message. "I think there is a lot of stigma attached to
psychosis and to mental health difficulties. Exposure will
ultimately lead to understanding. And the understanding will lead
to destigmatisation."
Brutal combat, a hallmark of Ninja Theory games, is of
course present
Through their development process, Ninja Theory became involved
with the Wellcome Trust. The Trust has a team dedicated to
supporting entertainment and art projects that engage a wide
audience on scientific themes, and has supported the
Hellblade project through their Public Engagement Fund.
"So we first met them," Dominic explained, "and started discussing
the project. We first got the development grant which was something
that helped us to put together the concept, and now we are partners
in co-production, so they have a financial grant into the project
and that grant is helping us both deliver the game and make sure
the scientific theme, in our case psychosis, is portrayed in an
accurate manner." Through the Trust, the developers were linked up
with mental health service users as well as clinicians, including
Paul Fletcher, Professor of Health Neuroscience at Cambridge
University. "Through that, we have been able to make this link
through art and its creative side and the scientific community and
the service user community."
Our discussion moved to how mental illness had been portrayed
within video games in the past. "I think games have not always done
a great job of tackling sensitive subjects," said Dominic. "There
is a whole number of areas where games have tried to tackle mental
health. Sometimes they can reduce experiences of psychosis into
gameplay mechanics; games with a 'sanity meter', which goes up and
down. That is a very mechanical way of representing psychosis, and
people's perception of psychosis is very binary: 'there is me and
there is the person with psychosis'. Instead, what we have learnt
through our work with Professor Fletcher and the Wellcome Trust is
that psychosis is based in how we all perceive the world, the way
we perceive our own reality, and how we all have different
interpretations of our reality. What we are trying to do in
Hellblade is present our character in a very truthful
manner. I think in the past games have not necessarily done
Eternal Darkness (2002) used a 'sanity meter' as a blunt
measure, with depleted 'sanity' resulting in
Ninja Theory is actively trying to move away from a mechanical
representation of mental illness. "We created fantasy games for the
last fifteen years, and in many ways Hellblade is the
same. In the case of this game, the fantasy is the creation of
Senua's mind. So I think what people will experience in the game
would be a unique experience that would have root in people's real
experience of psychosis and the scientific foundations behind it.
It is part of the story; it is part of the character. Just like how
we are our own characters, she is another character who happens to
experience psychosis."
Considering the way mental illness has been portrayed in video
games up to this point, naturally there are concerns about how the
concept can be reduced to a gimmick within narratives. "Mental
illness is very much essential to the game," Dominic reassures. "It
is a story about a character on a journey; a quest where she
happens to experience psychosis. So it is very embedded into the
game; it is not something that is a twist at the end. It is
something we are very upfront about. As the player, you will
experience the world just as Senua does. You will experience the
world through the visions and the voices that she hears, as well as
other unique experiences."
I wondered about the balance of creativity and clinical-accuracy
in this game, and whether there had been any compromise in either
direction. "We have worked with the academia and people who have
experienced psychosis," said Dominic, "and a wide range of
different people who may just hear voices or people who may have
unique beliefs which dominate their lives. It has always been
important for us to do our research in the subjects we are
portraying. But I think that working with Professor Fletcher and
Professor Fernyhough (Charles Fernyhough, Professor of Psychology
at the University of Durham) allowed us to understand the latest
scientific thinking regarding psychosis and exactly how it
manifests, and then we tried to represent that in the game. I think
a lot of game developers, when they think of collaboration with
science, they might think that science could restrict their
creativity, but in actual fact it enriched our creativity. So many
concepts, ideas, and experiences that people have come across are
in the game, and it is much more compelling because of that
The links that Ninja Theory made were useful beyond the bounds
of professional game development. "On a personal level," said
Dominic, "and for many other people on the team, having the
opportunity to not only speak to people who are experts in this
field, but people who actually have these experiences, it has
actually been very, very valuable. And it is something which we
would like a lot of people to do: to sit down, and speak, and to
Dominic expanded on the team's experience
working with service users and clinicians. "We were very up
front about the mental health part of the game when talking to
clinicians and groups, but we really didn't know what the reaction
would be, because historically video games tackling subjects about
this have not been great. But we had a lot of support. Working with
the service users has been fantastic. They have been very
supportive and I think they enjoyed the experience of working with
us in trying to manifest some of the things that they
"It has been great to talk to them,
hear about the things they experience, to then translate that into
the game world and show it back to them and see their reactions.
And with a lot of things we tried, they said 'Yes, yes,' that's
very close to their experience. I think it has been a very
fantastic collaboration. Also, I think having the opportunity to
talk to us about those experiences is a different context for them.
This isn't a clinical context talking about these things, this is a
context of creating entertainment."
Senua must undergo a journey as
the game progresses
I often find, when mental illness is
depicted in media, that there is not enough emphasis on the types
of help available, and people with mental illness can be shown as
suffering with no means of support and no route to recovery. I
wondered how Hellblade would portray the main character
managing her experiences. Dominic noted that the game has a
historical setting (so presumably effective treatments don't yet
exist in this world), but he also stressed that we can expect Senua
to progress along with the story. "I don't want to give too much
away, but it is not only a journey with Senua, but also a journey
with her experiences. It is a difficult journey, but it is a
journey of understanding."
With Hellblade, the developers
Ninja Theory are taking a bold step into independent games
development without the backing of a large publisher. Dominic was
excited about this prospect. "If we were creating this game as a
big blockbuster title, we wouldn't be creating this game the same
way we are, with this collaboration with the scientific community
that we're working with. We get to create the game we want and get
to grasp interesting opportunities. There is a lot riding on this
game for us because we want this game to be the first of many... so
there are risks there for us but we are definitely enjoying this
Dominic's team feels well placed to deliver a meaningful
representation of psychosis to players. "Our aim with the
combination of technology and creativity is to try to make it feel
as close to the real experiences as we possibly can. It is a
compelling thing, and I think when you lay on top of it that this
is something that people live their lives with, we have the
opportunity to help people understand a bit more."
The film industry has produced works of entertainment that take
steps to promoting understanding of mental illness, and this could
potentially be a role within the video games industry. The initial
groundwork of involving service users in the development process
shows that Ninja Theory have taken a more inclusive approach to
incorporating the experiences of psychosis that many people in
society have. It suggests that we may be looking forward to a more
subtle and accurate depiction of mental illness, and I am looking
forward to seeing the outcome upon the game's release.
Authored by Sin Fai Lam
Hellblade: Senua's
Sacrifice releases on August 8th for PlayStation 4 and
No man is an island,
entire of itself;
every man is a piece of the continent,
a part of the main.
John Donne
No man is an island,
entire of itself;
every man is a piece of the continent,
a part of the main.
John Donne
However for some children, this may not often feel the case.
Children with physical disabilities may face limitations in their
interactions with peers (Stevens et al, 1996). Reduced access
to participation is often not only due to differences in functional
skills, but may also be due to limitations imposed by the physical
and social environment (Law et al, 2007).
SpecialEffect is a charity which looks to address this issue
when it comes to participation in gaming. Mark Saville, who acts as
communication support for the team, was kind enough to offer his
time for an interview, so I could find out more about the charity's
Mark set out the aim of SpecialEffect: "To help people of all
ages with physical disabilities enjoy videogames. To play video
games on a level playing field with everyone else. So, for those
with a physical disability to join in with their family and friends
as effectively as possible."
I was curious about the origin of this service. Mark told me
about SpecialEffect's founder and CEO, Dr Mick Donegan (an
Associate Senior Research Fellow at SMARTlab, University College,
Dublin, and Adjunct Professor in the Department of Assistive Design
at OCAD University, Ontario), who ten years ago was working for
another charity in which he was helping severely disabled children
with their communication. "The parents would come and say
their children can communicate at school, but what happens when
they leave? What quality of life do they have on the weekends
on evenings? This was a time when video games were on the rise.
Games provided a perfect platform for people with disabilities to
join in."
Mark returned to the concept of levelling the playing field. "I
think we are looking at children who don't have the ability to run
around and play like other children do. And, you know, the online
version of football—FIFA, for example—comes along and they can't
play that either. They are missing out twice with their friends.
The aim of the charity is to at least pull back one of those and
make it possible. And by doing that, the impact is incredible. The
inclusion, the raising of quality of life, is just
The way SpecialEffect 'pulls back' is by modifying the hardware
required to play computers games, in order to increase their
accessibility. I was fortunate enough to trial some of their
technology at Rezzed, a gaming convention in London, and was able
to see the different modifications to gaming controllers which help
people with disabilities engage with games. However, the
question remained whether it would allow somebody with a physical
disability to play on the aforementioned 'level playing field'.
Images courtesy of SpecialEffect
Mark acknowledged that there are a lot of variables influencing
whether the charity is able to help somebody. "For example, a
parent or a child might come to us, and the young person is saying
'Look, I have muscular dystrophy and I have weakness in my fingers
but I really want to play Call of Duty.' And so we say 'Okay, we
will go along and look at your specific abilities even down to the
millimetre of movement you have and we will see whether there is
some way, be it through joysticks, switches or eye gaze, and we
will try and find some way for you to play Call of Duty.' So that
is the primary aim. And that is what I mean by levelling the
playing field. We will do our utmost to make that happen."
Mark recognises that sometimes it is a case of managing
expectations. "Especially sometimes we find we are working with
people who may have a condition which may be advancing. We will try
to keep them playing as long as we can but we may have to progress
to other games as time goes on."
He also highlighted the difficulties in the practicalities in
creating bespoke controllers for video games. "Making a general
controller for accessibility for all games isn't possible, even
within a particular disability. If you look at cerebral palsy for
example, every single person has different difficulties: their
muscle spasm might mean they spasm inwards or outwards. There are
various levels. It is therefore impossible to create a generic
controller and say, 'there you go.'"
This means that each controller made via SpecialEffect is
customised for the child requesting it. This is, as Mark puts it,
"the one-to-one approach." This in turn requires a
multidisciplinary team being involved, such as technologists and
occupational therapists going out to visit people. "They are
amazing to watch," Mark said, "to see them working with people to
produce something custom. It could be something as simple as an
adapted one-handed joystick for some people who may have a problem
with one hand. If it is somebody with a spinal injury, we might be
thinking of a chin joystick combined with a voice control in
combination with a couple of head switches on the head rest. There
is a huge range of technology which includes pulse switches and eye
blink switches. So we are kind of mixing and matching and creating.
Sometimes we have to pull a controller apart and put holes into it
and modify it in a way which makes it easier for somebody. It
really is horses for courses."
Mark described the benefit the work has had not only for the
children involved, but also for the carers as well. "The impact we
are finding is not just obviously fun: we are finding that
especially with people with severe disabilities, if we enable them
to gain three or four hours in a stretch, we are giving a lot of
respite time to their carers. We are also giving those people a
chance to be anonymous online and interact at the same level with
the people they are playing. They may well be beating people online
and those people have no idea this person has got a disability. It
is a big thing." This impact is seen through the positive feedback
the charity receives. "I was talking to a parent the other day, a
parent we had helped, who said, 'Thank you, as a father, for making
me feel so much better that my daughter is enjoying herself.' And
it had never struck me, before."
These accessibility modifications can also have a role in
physical rehabilitation. "We may find an occupational therapist is
referring someone who needs some kind of hand exercises, and for
us, operating a joystick to play a game is a good repetitive hand
exercise for a young child. It is a win-win. We are finding new
positive impacts every day. But mainly it is still about
Discussion turned to the future of SpecialEffect. "First and
foremost, we want to still be doing what we are doing now because
the nature of disability is never going to change. There is always
going to be a huge range of disabilities displaying in different
ways and we will always need to produce custom controls. But what
we are also doing is working with game developers as well, to look
at ways in which they want to make their games more accessible to
people. 10 years, who knows? But I can assure you we will still be
helping people."
The referral pathway for SpecialEffect is completely open.
Anybody with a physical disability or their parents/carers can
contact the team directly (a contact
form is available). "We don't charge," said Mark,
"because we are dealing with young people and families who are
facing enough pressures financially, or otherwise. The last thing
we want to do is say 'Would you like to play games? I'm sorry that
is going to cost you a few hundred pounds.'"
To me, the charity seems a worthwhile cause, increasing social
inclusion within an often overlooked group in society. In
most fields of psychiatry, in particular in liaison and CAMHS, we
often see individuals with physical disabilities which may limit
their ability to engage in what is viewed as "normal" activity
among their peers. This increases their sense of isolation and
distress as they feel more disconnected from those around them.
This loneliness is associated with increase rates of depression and
suicidal feelings (Schinka et al, 2012), while strong social
networks play important protective roles against depression
(Santini et al, 2015). With The Pew Internet Study (Lenhart et al,
2008) previously recognising that video games are becoming an
almost universal pastime in society and that they are part of
normal social engagement, reducing the barriers for people with
disabilities to engage may be beneficial not only for their social
interaction, but their mental health as well.
SpecialEffect is a registered UK-based charity. Coverage of
this charity on this blog does not constitute its endorsement or
recommendation by the College.
Law M, Petrenchik T, King G, et al (2007) Perceived
environmental barriers to recreational, community, and school
participation for children and youth with physical disabilities.
Archives of Physical Medicine and Rehabilitation,
88: 1636–1642. [abstract]
Lenhart A, Kahne J, Middaugh E, et al. (2008) Teens, Video Games
and Civics. Pew Internet & American Life Project.
Santini Z, Koyanagi A, Tyrovolas S, et al (2015) The association
between social relationships and depression: a systematic review.
Journal of Affective Disorders, 175:
53–65. [abstract]
Schinka K, Van Dulmen M, Bossarte R, et al (2012) Association
between loneliness and suicidality during middle childhood and
adolescence: longitudinal effects and the role of demographic
characteristics. The Journal of Psychology,
146: 105–118. [abstract]
Stevens S, Steele C, Jutai J, et al (1996) Adolescents with
physical disabilities: some psychosocial aspects of health.
Journal of Adolescent Health, 19:
157–164. [abstract]
Within the medical community, there often are those of us who
dream of venturing into other fields of interest, but due to a
multitude of reasons, we are unable to take the first step. We were
pleased to speak to one of the founders of the game development
studio BioWare, Dr Augustine Yip, who did take that step and as a
qualified doctor branched out into game development before
returning to medicine full time. Dr Yip, who is currently working
as a family physician in Calgary, Canada, kindly gave us a candid
insight into what his life was like as a game developer, his
personal views of computer gaming in general, and his transition
back into medicine.
BioWare is a video game developer that was founded in 1994 by
Ray Muzyka, Greg Zeschuk, and Augustine Yip, three doctors who had
recently graduated together from the University of Alberta's
medical school. The three had met in while studying Medicine and
had collaborated on software for use within the medical field.
After forming BioWare, they made their big break with the game
Baldur's Gate, released in 1998. From there, BioWare moved from
strength to strength, developing critically acclaimed games such as
Star Wars: Knights of the Old Republic, Dragon Age and Mass Effect.
Dr Yip however, had made the decision to leave BioWare in 1998.
The impact of BioWare on the video gaming world was not only
through its Infinity Game Engine, which was used for other computer
role-playing games (CRPGS), but also through its impact upon the
narrative and structure of future CRPGs. Concepts that are taken
for granted in CRPGs today, such as character relationships and
engaging storylines, were greatly developed and refined within
Baldur's Gate.
Regarding Baldur's Gate, Dr Yip said "We were really, really
proud with the storytelling and the idea that you can actually
adventure. Other games tried to do it, but this was our attempt to
have Dungeons and Dragons (D&D) role-playing on the computer."
D&D is traditionally a tabletop role-playing game, though the
system and its fantasy worlds have also appeared in novels and
video games. "A non-linear storyline that allowed you to explore
everything else: it was a real point of pride."
The path in game development was not smooth, however, with
occasional discrepancies between the game publisher's expectations
and BioWare's vision. "I helped create the graphical user
interface, and that is a special point of pride for me. The
producer--the publisher--they were called Interplay. They wanted a
'Warcraft 2'-like interface and we had to explain, sort of
vehemently, that this is not that type of game. This is a
roleplaying game and it is Dungeons and Dragons."
It is often asked how a fledgling developer obtained the rights
to develop a D&D game. "Well here is the actual story," Dr Yip
explained. "For Baldur's Gate, we made a demo of the game and we
called it 'Battleground: Infinity' and it was supposed to be
different mythologies versus each other, such as Norse mythology
versus Roman mythology versus Aztec mythology versus Chinese
mythology; that kind of thing. That was the demo that we brought to
Interplay. And Interplay had this Forgotten Realms license which
was sitting dormant and was about to be lost." Forgotten Realms is
a popular D&D setting, which has been licensed for further use
in media such as novels and video games.
"(Interplay) said 'Yeah, we like the engine but we don't want
the mythologies; we want to make the Forgotten Realms games.' We
were such geeks, having played the old D&D games with the dice
and everything, and of course we just jumped all over it. So they
carved out a small point in time in Forgotten Realms for us."
How did his life as a game developer impact on his decision to
return to medicine? "The journey was good. It was. But business and
software development is all consuming, even more than medical
"To be blunt, we just, we were just exhausted. Game development
was 18-hour days, no exercise, poor nutrition, literally pizzas and
coke for breakfast lunch and supper. You are basically locked in
windowless rooms with 50 other geeks playing games and talking
about games all the time. I am an avid but uncoordinated sportsman;
I play tennis, ski, badminton and golf and everything else. I just
knew that I couldn't keep doing this."
Another influence on Dr Yip's decision to leave BioWare was when
his wife, fellow family physician Monica, and he were expecting
their first child. "Though the games were doing well, we thought
'You know what, I'd rather live a comfortable life than one filled
with nothing but computer screens, geeks and rooms.'"
Dr Yip feels the role of video games has changed significantly
over the years. "Well, I mean they are so huge now, they are such a
gigantic industry. I feel that--having had three kids and putting
them through soccer, skiing, golf and everything else--I don't have
anything against video games, but there is a whole world of real
games, sports, skills and musical instruments. You know that these
things matter as well. Being an excellent player for soccer games,
or, whatever, any big shooter games; I am not sure that those
skills would necessarily be transferable to anything else. But
being able to play an instrument or reading physical literature
could be more important to a person in a long run. I have no issue
with gaming in general. It is just the amount of it."
We moved our discussion onto the existence of gaming addiction
and its introduction in the DSM V. "Easily could be, easily could
be," Dr Yip said. "I mean, gambling addiction… you can argue
gambling in small amounts is okay, but gambling in large amounts
can affect family and lifestyles. So, easily, gaming could be in
the DSM classification. You can have Facebook DSM classified, and
Youtube DSM classified, and everything. But gaming, for sure."
On returning back to medicine after his time in BioWare, Dr Yip
reflected on his career and whether he enjoyed the decision he
made. "Oh, very much so. I have been at it for twenty years now. I
have seen babies grow into adults. I have seen a generation of
grandparents pass on. It has been an honour and privilege. I mean,
in 22 years you can imagine the changes in therapy. My wife
actually has actually branched off into psychotherapy and I have
developed an appreciation of psychotherapy and its power. I have no
regrets. It is funny, I have done a few of these interviews
probably every two, three, four years and a lot of the interviews
centre around 'Do you regret leaving the gaming sector,' and I say
'No, I don't even think about it at all.' It is not that I am
avoiding it; it just doesn't even cross my mind.
"The computer world is so random, so much hard work so poorly
paid, and basically only the top producers and developers make the
big money. I mean, it was a blast, but honestly, it was for the
person young, unmarried, no obligation, total freedom to work
insane hours and with a high metabolism for carbs."
Drawing the interview to a close with Dr Augustine, who was
returning to pick up his children from hockey, I thanked him for
helping us on this article about doctors and gaming, and he left
with "Doctors formerly in gaming… It was a long time ago."
Following the interview, I thought upon the changes within the
video games especially with regards to its reflection of the
psyche. Talking to a trailblazer who developed a video game where
attempts were made to move away from one dimensional place holder
characters, to thinking about games today that are more confident
and able to reflect the emotions which come with living; there is
now a recognition within the gaming community that games which
emphasise the complexity in human interaction within an engaging
narrative is just as important as nuts-and-bolts game play.
However, on a more personal level, Dr Yip's story allowed me to
reflect on how this person had explored his various passions and
had come to a decision on the one he most wished to follow. Perhaps
there should be more flexibility for us in exploring alternative
career pathways, as opposed to the streamlined production factory
that medicine can sometimes feel like. That way, we may have a
better sense of contentment in the choices we make, instead of
feeling of "what may have been".
Max, an Autistic Journey (MAJ) is a roleplaying game
for Windows, which has you take on the role of Max, a ten-year-old
boy with a diagnosis of Autism Spectrum Disorder (ASD).
It allows you to experience one day in Max's life, showing a
flavour of the challenges he faces both at home and school. Battles
within the game are fantastical in nature and stem from Max's
imagination, and the monsters he fights represent the stresses Max
is experiencing. MAJ is notable in that it was developed by the
real life Max's father, Stéphane Cantin. Having played through and
very much enjoyed MAJ, I was keen to contact Stéphane and learn
Donald: MAJ is a very personal work. What made
you decide to create this?
Stéphane: I was playing a wonderful game called
"To The Moon"
from Freebird Games and Max came to me and watched me play.
Then, out of the blue, he said: "Papa, I'd like to make a video
game like this someday…" And the light turned on in my head! I
started asking him about what he would do and it evolved into Max,
an Autistic Journey.
Donald: What did you hope people would get out
of playing MAJ?
Stéphane: I wanted to use the video game format
to illustrate some of the challenges that Max has to go through. If
that helps some people better understand what a ten year old boy
with an Autism Spectrum Disorder could go through in a typical day,
and in a fun way as well, then that's a goal I can definitely aim
for. I don't think a game about ASD had ever been made before, so I
thought that could be a great personal challenge to take on. I
never wanted to explain autism; that's not the point. It's such a
vast and complex spectrum, with so many facets… That being said,
some people might recognise some of the situations that Max goes
through in the game and get a better understanding. Judging is easy
when you don't understand the reason behind a behaviour…
Donald: I love the turns of phrase used by Max
in the game, such as "In fact..." How much of the real Max
has gone into this game?
Stéphane: Thank you! A lot of Max's quirky
expressions went into the game. Our family is French Canadian and
our first language is French. So I translated things like "En
fait…" into "In fact…" The conversation between Adam
and Max about the Mario princesses actually happened! I was
listening to them like a fly on the wall and absolutely loved
Donald: MAJ uses the art motif of the
puzzle piece, which I understand originates from the original
National Autism Society (NAS) logo and was felt to represent autism
as a 'puzzling' condition. Some have expressed a desire to move
away from this image and the ideas it represents. What are your
thoughts on this?
Stéphane: That's a really good question! I had
no idea when I started the game that the puzzle piece was somewhat
controversial to some people. In Canada, it's an accepted and
recognised symbol for ASD that we see pretty much everywhere. I
fully understand and respect that some people have a problem with
"the missing piece" interpretation and that it suggests that people
with an ASD are "incomplete" in some way or another. I personally
see it more as a positive and constructive symbol, something
challenging, yes, but also incredibly rewarding! All of the puzzle
pieces represent every day victories to me.
Donald: Computer games are unique in that
they are an active medium. How do you feel MAJ benefited from being
a computer game rather than any other medium?
Stéphane: I wholeheartedly agree with your
statement! I made this game so that, to some extent, the player
would get to experience the everyday challenges that Max has to
face, sometimes. Reading about it or watching a video will give you
some information, but actually playing it, fighting with your
rising anger or anxiety, makes it much more tangible to me.
Donald: Were you worried how people might
react to it? What has the response been like?
Stéphane: Worried? Yes, definitely… Sadly,
Autism is often used in a very derogatory manner and I was ready to
face some "trolling". My great publisher John Kaiser III at
GPAC Games and I did get a
lot of insulting comments and we dealt with them accordingly.
However, what was really surprising to me was how much and how fast
the fan community took care of a lot of the trolls and made sure
that the whole experience remained as positive as it could be!
That's what I focused on. We received so many positive comments,
personal stories of parents of children with an ASD who found some
comfort in playing Max, or even adults with an ASD who shared their
experience with us. I shielded Max from the negativity but I also
showed him the amazing support and love that we received!
Donald: What did you learn from the
process of creating this game?
Stéphane: Making games is hard! Seriously,
aside from learning about the technical stuff, I mostly learned
that there are amazing people in this world! It might sound a bit
corny, but the support that I received really made it all
worthwhile! It took Max and me about 15 months to get to our final
product. It has truly been a labour of love over many nights and
weekends. It brought me so much closer to my kids and they blew me
away time and again with their imagination and involvement with
this project! There were many more highs than lows!
Donald: Early on in MAJ, there is a mini-game involving
vaccinations, following which the game points out the importance of
getting immunised. Given the controversial media coverage from 1998
onwards that the MMR vaccine might be linked with autism (exhaustive
research has since provided very strong evidence that there is
no such link), is this not somewhat provocative?
Stéphane: Yes, absolutely! It's my
'tongue-in-cheek' jab at anti-vaxxers. I believe in science… It's
time to get rid of all these falsities and the agents that spread
Donald: What does Max make of starring in
his own game? I note you made sure to include his siblings!
Stéphane: That's a great question! I made this
game with Max, as well as Jean-Michel, Elisabeth and Charles, to
simply have a whole lot of fun discovering what a day in a life can
be like sometimes for this ten-year-old boy who has an Autism
Spectrum Disorder. I could very easily say that Max loved it and
voilà, that'd be that. But it goes deeper as Max uses the game as a
tool in his everyday interactions! That blew me away the first few
times I noticed it. Let's say we just sat down and discussed a
scene together (I wanted to get his insight constantly throughout
the process, of course). Then, I would create the scene and show it
to him. He would play the game, comment on it and then, a week
later, he would come back from school and say: "Today, I did
like the Max in the game does! I closed my eyes and I took 3 deep
breaths. Phew! Then I was Ok. No need to get angry…" and he
sings the "Victory" sound from the game. I had to pick up my jaw
off the floor…
Donald: What do you think is the next big thing
in computer gaming?
Stéphane: I'm not an expert at all, but just
from my own experience, I see a lot of gamers looking for nostalgia
and finding it in retro-style games. With the availability of
software like RPG Maker, Game Maker Studio and Unity, to name a
few, it's become much easier for a lot of indie developers to
create great quality games! The retro-style seems to be very
popular, especially with more seasoned gamers like myself.
Donald: What are your plans for the
future now?
Stéphane: Ideally, I would love to make
downloadable content for MAJ, as well as a whole new game. For now,
I'm just so grateful for all the love and support that the game has
received! Thank you so very much to everyone and please, let's
raise awareness about the challenges of Autism Spectrum
Donald: Thank you very much for taking the time
to talk to me Stéphane, I really look forward to hearing about your
next project.
Find out more about Max, an Autistic
Authored By Donald Servant
When the MindTech Healthcare Technology
Co-operative tweeted about Champions of the
Shenga, we were intrigued. It's an 'emotionally responsive
game' which rewards players for regulating their emotions. In this
game, it pays to keep your cool while playing. Thus the developers
hope it will help train players in mindfulness techniques.
Mindfulness is a meditative activity that originates in Buddhist
practice. It helps a person notice what they are sensing and
thinking, and how they are reacting to it, in a non-judgemental
way. This allows the person to be more aware of such feelings, and
enables them to react differently, in more constructive ways. There
is growing research into mindfulness-based therapies, and current
evidence supports the use of mindfulness-based cognitive therapy
for prevention of relapse in people who are currently well but have
experienced three or more previous episodes of depression.
Champions of the Shenga will use a Bluetooth sensor to
detect the players' heart rate and claims to use heart rate
variability (HRV) as a measure of the players' stress and anxiety.
The game itself is a card duelling game with a fantasy theme, and
can be played against players across the world. A player is more
powerful within the game if they are able to utilise diaphragmatic
breathing exercises in order to raise their HRV, which the game
understands as a measure of reduced stress. The game asks players
to 'gather magic power' through controlled, focused breathing.
Simon Fox, the Design Director of BfB Labs gave us more
information about their upcoming game.
Champions of the Shengha is a card duelling game that
senses your emotions. Players step into the role of would-be
Champion engaged in magical duels - casting spells, summoning
creatures and deploying their best strategy in order to achieve
victory. In order to conjure magic players do what they imagine a
real spellcaster might - focus their mind and body as measured
using our wearable sensor. Our players must adopt and learn key
emotional regulation strategies evaluated using heart rate variance
data streamed live while they play.
Our game teaches players the kind of skills which sit at the
core of philosophies like mindfulness, or even therapies such as
Cognitive Behavioural Therapy.
The idea that the physiological response of our bodies to
external stressors can be observed consciously in the crucible of
our cognition. That we can forge a little space between our
immediate autonomic response to a situation and our conscious
behaviours. This is interesting stuff! As a designer I feel lucky
to be engaging with these kinds of problems.
We wanted the player's tribal allegiances to underscore the
games' pedagogic content. In the future we will deploy expansion
packs which contain series' of missions including 'in-fiction'
pedagogic content designed to teach players the value of embracing
and experiencing challenging emotions.
We hope so!
Building consciously around impact is a new sort of challenge
for a games designer. You might begin designing a game around a
cool story or character your players would want to engage with, or
an interesting set of rules. We begin with a measurable change we
want to make to a user's life.
To do this you need both designers and researchers on your team,
and you need to let both do their job. Letting your games designers
be playful with the subject area and technology, while ensuring you
are designing around measurable impact is a big challenge.
Games drive intense engagement when they work. They are
inherently pedagogic systems which immerse their users in a new
world with new rules - rules which must urgently be learned to
succeed. The motivations for play are very interesting - it's an
active learning state in which players adopt a lusory attitude in
which we will accept and adapt to new norms. Our ability to explore
the system of a game, to master those rules or to share that
experience with others may one of several core motivators. That
play is motivated intrinsically by its own value makes it a great
candidate for teaching skills or creating interventions to which
participants adhere.
Games design and good design in general seeks to engage a very
deep understanding of its user and make that understanding
fundamental to the creation of an artefact. Most psychological
health interventions still come from a rather didactic place. I
foresee a future where more effective interventions are designed -
interventions which adapt themselves to their user, changing their
mode as the user progresses. I foresee interventions which engage
deeply with their users rather than being imposed upon them. I
foresee a scalability driven by ubiquitous technology that allows
many more people access to effective services than currently enjoy
this privilege.
Board games are a fantastic way to get involved in games design.
The cost of entry is low and it's easy to try new things! You can
totally rebuild a board game in an afternoon. Compare that to video
games where the cost of an iteration can be a team of people
working for 2 weeks or more.
I enjoyed Pandemic a great deal. Suburbia is
also very nicely designed. I personally like games which are about
communicating so things like Resistance and
Werewolf are great fun for me. I'm also a big geek so card
games like Netrunner tickle my strategy bone.
I've splashed out on a VR headset for my home (cf. big geek) and
the last thing I played on it was a surreal comedy adventure called
Check out our website!
If you don't have an account please
Click here to Register
You can follow Gaming the Mind on Twitter: @gamingthemind
First game ever played?
Double Dragon on the PC
What game made an impact on you?
Indiana Jones and the Fate of Atlantis – for making me wish to
become an archaeologist… though I failed miserably in the
Where are you now?
On a train getting querying stares as I WhatsApp these
James Pond on the Amiga
Doom – the first game I played in which a digital 3D world
started to feel real
Sat in a café in Camberwell eating falafel.
Super Mario Bros on the NES
Undertale - beautiful music and a vivid cast of characters that
the game made me care about.
Sitting in a café in Camberwell eating chicken shawarma with
Stephen and Sachin.
Captain Planet and the Planeteers on the Amiga
Shadow of the Colossus - a game that made me question my
murderous actions
Help, I'm trapped in an infinity machine.
Reference on this blog series to any
specific commercial product, service, manufacturer, company, or
trademark does not constitute its endorsement or recommendation by
the College.


text:
New York State Department of Environmental Conservation
The New York State Department of Environmental Conservation (DEC) was created to conserve, improve and protect New York's natural resources and environment and to prevent, abate and control water, land and air pollution, in order to enhance the health, safety and welfare of the people of the state and their overall economic and social well-being. DEC's goal is to achieve environmental quality, public health, economic prosperity and social well-being, including environmental justice and the empowerment of individuals to participate in environmental decisions that affect their lives. Visit the NYS DEC on the web at http://www.dec.ny.gov/

subset: commoncrawl


text:
For Max Spevack, chair of the Fedora board, the upcoming release of Fedora 7 represents the answer to that question. Often dismissed as a beta release for Red Hat Enterprise Linux (RHEL), the Fedora community is now trying to reposition the GNU/Linux distribution as a leading community distribution through the merger of its repositories, and through opening up its build process to increase community involvement.
According to Spevack, these changes are already bringing concrete benefits to Fedora for the average user. And, in the process, Spevack hopes that no one will ever confuse Fedora and RHEL ever again.
"It's been very obvious to those of us who work on Fedora that the best way to think about [the relation between Fedora and RHEL] is that Fedora represents the upstream that Red Hat builds a lot of its products off of," says Spevack. "For those who build products based on Fedora or RHEL, it represents an upstream for them as well." Red Hat, Spevack suggests, has shifted from being "Fedora's sponsor" to being "Fedora's biggest customer," and Fedora from being a farm-team to a community in its own right.
"What we have been trying to do," Spevack continues, "is to step back and answer the question, 'How can we change the way that Fedora is built, so that developers who want to use Fedora can find it as useful and open as possible?' The idea is that if you've got developers who have an easy time using Fedora, they will produce really cool stuff that end users will want."
The Merging of Repositories
Historically, Fedora packages have been stored in two repositories. The original repository was Fedora Core, consisting largely of the software bundled in RHEL. Fedora community members could submit bugs and patches, but they would have to wait for a Red Hat employee to check their work into the source code repository, then wait for the Red Hat build system to produce a new package.
"It was a bottleneck," Spevack says, "And that is why Fedora Extras was created two years ago: to alleviate that problem." Unlike Fedora Core, Extras was accessible to programmers in the community. It rapidly became over twice the size of Core. Moreover, its guidelines for how a program should be packaged and where files should be installed on the system made for such consistency that the process of adding new software to the repository was no longer affected by the idiosyncrasies of individual programmers, so that other package maintainers could take over if a maintainer quit or was unavailable.
"Fedora Extras became, without a doubt, the most successful piece of the project," in Spevack's judgement. In fact, Extra's packaging guidelines were so thorough that they replaced those used for Core. Now, with the merger of the two repositories a few weeks ago, Spevack hopes that the bottleneck represented by Core will be replaced by the flexibility and openness that has made Extras such a success. As a sign of this change, the distribution has also recently changed its name from Fedora Core to simply Fedora.
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text:
- Description
Vegan Deli's 'Shroom "biltong" is a delicious mushroom based, vegan-friendly alternative to this traditional South African snack. Eat it straight from the packet, or sprinkle in salads, on your vegan pizza, or in your stir fry. Be warned, it's more-ish!
No artificial flavours, colours or preservatives. Packaged in a compostable bag. (Due to natural ingredients, batches may vary in colour slightly.)
Please allow 5 - 7working days' for back ordered items while Vegan Deli brews up your biltong!
All Vegan Deli's products are manufactured and packaged by vegans in a dedicated vegan kitchen that uses nuts, soy, and gluten.
- Mushroom,
- Vinegar,
- Organic Tamari Sauce (contains Soy),
- Olive Oil,
- Spices (whole and ground),
- Salt.
Storage & Use:
Store in a cool, dry place. Use once opened. (Don't forget to compost the bag once empty!)
For Wholesale Enquiries, please visit Vegan Deli's Wholesale Application page.


text:
Pop superstar Madonna caused commotion at the University of Michigan on Wednesday (21Nov13) when she accompanied her daughter Lourdes to the campus to check out the school's facilities.
The Material Girl hitmaker tried to keep a low profile as the 17 year old was given a tour of the singer's alma mater by a musical theater student, but word of the Queen of Pop's presence in Ann Arbor quickly spread.
Student Lindsey Meekhof tells People.com, "There was a lot of excitement. (Madonna's) daughter was learning about our musical theater program. Someone announced to my choir class Madonna was in the building, and choir wasn't productive anymore after that.
"People that weren't music school students were all over the area. Madonna tried to keep the attention on her daughter but... people were everywhere."
Madonna only studied at the University of Michigan for a brief period before quitting to pursue her pop dreams in New York, but she has made no secret of her desire for Lourdes to attend her old college.
Last year (12), she said, "I want my daughter to go to school there. I keep telling her, Ann Arbor is an awesome place."
Lourdes, Madonna's daughter with her former personal trainer Carlos Leon, has already proved her acting and singing credentials after taking on the role of Betty Rizzo in a production of Grease at LaGuardia High School in New York. Stockard Channing portrayed the character in the 1978 film.


text:
Earlier this yea, Laura Jennings sat opposite Bill Gates as a member of Microsoft Corp.'s Business Leadership Team, the company's elite, eight-person decision-making squad. Now, the former VP of worldwide strategic planning-who oversaw Microsoft's b-to-b investment strategy-has left the familiar confines of the Redmond, Wash., campus for Boston-based Atlas Venture, whose West Coast expansion she is leading as senior principal.
In a recent interview with BtoB, Jennings spoke of her transition from a software and Internet company to a venture capital firm, the relevance of her experience to start-ups, and her desire to continue doing business with Microsoft. [Jennings did not guarantee Atlas would work with Microsoft on joint ventures. But Microsoft has a long history of funding and getting involved with the current projects of former executives.]
BtoB: You're charged with opening a Seattle office for Atlas Venture. Isn't there enough venture capital competition in that city already?
Jennings: No, actually. Seattle is still a great opportunity. There's a large engineering talent pool coming from Microsoft, Amazon.com Inc. and even The Boeing Co. and the University of Washington. What you have now in Seattle are some local VC firms, and you have a lot of investment coming in from the Bay Area, like Kleiner Perkins Caufield & Byers. But you haven't seen the likes of a major firm like Atlas Venture, with both international contacts and a local presence. [Atlas has more than $1.6 billion in committed capital, and has offices in Boston; Menlo Park, Calif.; Munich; Amsterdam; Paris; and London. Its investments are split evenly between the U.S. and Europe.] I looked at a lot of venture capital firms before I did this. We can leverage our contacts internationally to help firms locally. And I think that my having that global perspective, and bringing it to portfolio companies' board meetings, is a big help.
BtoB: Can you leverage your Microsoft experience for Atlas?
Jennings: I worked directly for [Microsoft President-CEO] Steve Ballmer, and handled a lot of our b-to-b business development investments-for example, VerticalNet Inc. My background there is 12 years, going back to my Exchange days. [Among Jennings' positions at Microsoft was general manager of Exchange product lines, VP-Microsoft Network, and senior director-marketing and business development for advanced consumer technology.] I have an entrepreneurial background in all these positions. I'm a start-up person. When Microsoft looked at b-to-b, the rules were entirely different. Microsoft's investments were not just about returns, but for other strategic reasons. Now, I'm in VC, and looking at investments from a pure return sense.
BtoB: What is your impression of Microsoft now that you've left?
Jennings: Microsoft is a terrific company. Ballmer will be an incredible leader there for the next couple of years, which will be very interesting years for Microsoft. But for me it was time to go. Twelve years is a long time to be at the same company.
At Microsoft I was taking start-up ideas, taking an idea and watching it grow from the inside. Now, I felt that I could have more of an effect on the outside. But I intend to keep a good relationship with Microsoft.


text:
Is Ibuprofen Bad for My Heart? What You Need to Know About NSAIDs
Dr. Sharon Orrange - July 16, 2015
Update July 2015: The FDA is strengthening the existing black box warning on all prescription and over-the-counter NSAIDs. The current warning has been in place since 2005, but based on a recent review, the labeling will be updated with new information and stronger language. You should know that there is greater risk at higher doses, and there may be an increased risk of heart attack or stroke as early as the first weeks of use. See More
Dropped by Insurance: Will Your Pain Prescriptions Be Covered in 2014?
Roni Shye - November 20, 2013
Express Scripts and Caremark have removed certain medications from their formulary starting in January 2014. These companies handle prescription benefits for more than 200 million Americans, so your prescription coverage will likely be changing in the new year.
We're reviewing which prescriptions will no longer be covered and the suggested alternatives to give you a better picture of your options. Listed below are some changes to the pain med coverage from each formulary that might affect you:
Removed medication: Flector patches || Suggested Alternative: diclofenac, meloxicam, or naproxen
The convenient Flector patch will be an excluded medication as of 2014. See More


text:
Bank holding companies saw a dip in wealth management income in the first three quarters of 2012, a new study says.
They earned $89.74 billion in wealth management income through the first nine months of 2012, down 2.7% from the same period in 2011, according to a study released Wednesday by consulting firms Michael White Associates and Investment Professionals. The report was based on data from over 7,100 banks and thrifts and their holding companies.
Income from investment advisory services dropped sharply in the first nine months of 2012, but a rise in brokerage and trust income made up much of the difference. Investment advisory and banking fees fell 12%, to $32.62 billion, but securities brokerage fees and commissions rose 20%, to $33.34 billion, and income from fiduciary activities rose 1%, to $25.53 billion.
"As an industry, investment advisory and banking activities decreased in the first nine months of 2012 compared to 2011, thereby taking overall wealth management revenues down. However, the other components of wealth management showed positive growth," said Investment Professionals President Jay McAnelly in the news release.
Among large banks, Morgan Stanley (MS) earned the most from its wealth management operations, followed by JPMorgan Chase (JPM). Among companies with between $1 billion and $10 billion of total assets, Stifel Financial in Missouri earned the most, followed by Wedbush Bank in California. First Command Financial Services in Texas led companies with between $500 million and $1 billion of assets, and the Haverford Trust in Pennsylvania led the small banks.
Among the biggest banks, investment advisory income represented a larger proportion of total wealth management income, while smaller banks relied more heavily on fiduciary services and securities brokerage commissions and fees, the study said.
Based in San Antonio, Investment Professionals helps community banks develop investment programs. Michael White Associates is a consulting and research firm based in Radnor, Pa.
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