By Elizabeth Ballou

Have you ever played a game about an eating disorder? Unless you’re an indie game aficionado, the answer is probably “no.” Yes, more game developers are starting to tackle the subject of mental health, but eating disorders like anorexia, bulimia, and binge eating remain mostly unexplored subjects.

Shrinking Pains, a 2018 visual novel by Australian indie team Bedtime Phobias, is an exception. Gabriella Lowgren, a communications manager and the writer behind Shrinking Pains, based the story on her own experiences with disordered eating. Bedtime Phobias – comprised of Lowgren, Daniel Elston, Jaris Rener, and Kirsten Yiannis – released Shrinking Pains for free on Steam last year. Since then, the game has been downloaded over 50,000 times, a rare feat for a free game.

Indie games have a long history of taking more impactful narrative risks than big-budget studios. While AAA studios have to worry about conservative fans’ reactions, indie writers aren’t hampered by the same concerns. When small studios create expressive games that succeed, those signals travel up to the indie world’s larger cousins. Take Gone Home, an game centered around a queer romance. Gone Home became a sleeper hit in 2013. Since then, big-budget franchises from Dragon Age to Overwatch to Life is Strange have featured queer relationships.

The same could happen with narratives about eating disorders, especially since Lowgren was invited to GDC 2019 in order to speak on a panel called “Stories that Haunt and Heal: Mental Health and Game Narrative.” In between the mad dash to panels and networking events, I sat down with her in away-from-the-fray Yerba Buena Gardens to discuss making a semi-autobiographical game based on mental health issues.

Elizabeth Ballou: How do you make a game about personal trauma?

Gabriella Lowgren: I’ve been asked that a lot after releasing this game. And the reality is not everyone can do it. I think some people, even years after, are still very deeply affected by trauma. I think that comes down to how bad the trauma is and personality types and access to therapy. It can be really hard to write a narrative that has a lot of parallels to their own experience without being autobiographical. Or it can be a really cathartic way to take those issues and then put them on another character. Even though it is dealing with the same things, there’s that little bit of separation. t’s not reliving a personal experience too many times.

EB: So creating an avatar and then having the avatar experience it.

GL: That can be a really, really good tool. I think that’s probably the safest way in general to do it. It’s also good for people to understand that if they release something [personal], people will know that forever about them. That is hard as well.When I released Shrinking Pains, it was like, “Okay, do I want to come clean about this? It gives my game more credibility, and it is a semi-autobiographical experience. But at the same time, I have to step up and let people know about the worst part of me. The most awful thing that I did to myself, everyone will know about and I will have to be open to discussing with people forever.”

It had good points too. It made me a lot more accountable for my recovery, and I feel like I recovered quicker because I had to be so accountable.

EB: That’s one of the things that fascinated me the most about your talk. It sounded like your recovery went better because you were making a game.

GL: Less so the making of the game than the releasing and then seeing the people playing it and reaching out to me.I was like, “Oh, there are risks now. I have to be better at this. I can’t do this to myself again. I have to be responsible, not just for me but for the people that are reaching out to me and asking, ‘Does it get better?'”

EB: That seems like a lot of pressure.

GL: Yeah, really, but I thrive under pressure. The game has had more than 50,000 plays now.

EB: That  points to this larger trend of people playing serious games that are not necessarily fun, but they teach you something and they put you in the shoes of another person.

GL: I’m so passionate about that. Games [are] art and art can be that experience for empathy building. It can be really harrowing.It doesn’t have to be fun to be valuable. It can do a lot of good as long as the issue is not exploited. I think that we’re seeing a big movement to want that within games, and serious games and even moving into interactive experiences. But I still think Shrinking Pains is a videogame.

EB: I would never say that Shrinking Pains is not a game. I don’t have any patience for people who split hairs about what is and is not a game.

GL: I definitely had people say, “It’s not a game.” And I’m like, “It’s a visual novel; it is a game!” And they’re like, “You just click and stuff.” I’m like, “Research what videogames are!” We’re seeing a lot of genre pushing and form pushing. It’s very exciting.

EB: Are there other games that served as inspirations to you while you were making Shrinking Pains?

GL: A title that comes to mind is That Dragon, Cancer. It was very effective and really moved me. It was a horrible experience, but it was so good. So important. Also, Depression Quest is a great example.

I played another game which is about an eating disorder, more of an interactive fiction kind of game called Mangia. It was very autobiographical. I wanted to take experiences and make it semi-autobiographical so that that people of all different gender expressions and ethnicities and body types would be able to play [my] game and identify with it.

An eating disorder isn’t picky. It could be anyone. You never know who is suffering an eating disorder, for the most part. In a few extreme cases, you look at someone and you’re like, “Oh.” But most people do not look like that, and I wanted to make that really clear.

There were a few [videogames] I played that were made by some friends back in Australia, that were about the trans experiences and the internal conflict and struggle of somebody who wants to transition but is feeling lot of social pressure. I found those sort of works really inspiring because they help someone understand even a little bit what that [experience] looks like, what that feels like and how difficult that is.

EB: So it sounds like you’re saying that there are two primary reasons why making games like Shrinking Pains can be good. One is because it can be therapeutic to be honest about your experiences, and then the other is that it invites other people to come in and experience what you have experienced.

GL: Absolutely. It’s a really useful tool for people to have an insight into what that’s like, and to build empathy and understanding of a mental illness that is very misunderstood. Anorexia specifically is seen as this fluffy teenage girls’ disease, as an exercise in vanity. The reality is that it isn’t an exercise in vanity, it’s an exercise in choosing every day to get closer to dying. It’s not just about wanting to look nice, it’s self-destruction.

I got a lot of messages being like, “I feel really seen, I feel connected, because [Shrinking Pains] wasn’t an idealized or romanticized depiction of an eating order. It’s really real and gross and it is exactly what I went through.” And there’s value in being seen and feeling less alone. A big part of mental illness is feeling isolated and that no one else goes through what you go through.

EB: One of the things that you mention that interests me is that people think about eating disorders as something that teenage girls suffer through, and not really anyone else. That you outgrow an eating disorder. And I was wondering what advice you might have to teenage girls, or to any teenage creators, who may be going through the first cycle of disordered eating.

GL: I think that something that’s really important in to realize is that recovering looks different for everyone, and your recovery will not look like someone else’s. It will not be in a pretty little box. You are never fully recovered, unfortunately, once it’s in you, those thoughts don’t go away completely. You formed neural pathways, you’ve formed patterns of behavior, you formed opinions of yourself which are very hard to shift. It’s okay to acknowledge that and to be, for the rest of your life, 99% [recovered]. That counts as a recovery.

You’re not defective or defunct if you can’t ever eliminate this thought pattern. It’s just having the thought pattern and then actively choosing to feed yourself and prioritize yourself. You may have cycles and you may relapse, but it doesn’t make you any less worthy of living. It’s okay to understand that it’s going to be different for everyone. Just be proud of the progress that you make. Someone might be like, “Oh, I recovered in six months!” And it’s like, “That’s fantastic, but not very realistic for most people.”

EB: What about teenagers who might be approaching making a game for the first time? What advice would you have for them?

GL: Don’t be afraid. There is a growing market for this. There are people that want to know about your experiences, if you feel comfortable sharing them. It also makes the world a more empathetic place. You’re doing a kindness when you release this content, sometimes because other people that have gone through what you go through resonate with [your game]. You’ll make their lives better or you’ll be able to use it to educate others. That’s really cool!

Making games can be a little bit scary and there’s a whole a lot of elements to it, but at the end of the day you should be making games for two reasons: because it’s fun and you love it, and because you have something you want to say and videogames are the best way to say it.

EB: Do you have any recommendations for specific tools?

GL: Yes! Games are hard because I can sit down as a writer and write a book. But you can’t do that with a videogame because you’ve got visuals, sound all that sort of stuff. But! You can make Twine games and that totally counts as a game. Start playing with Twine, make some little branching narratives, tell a story where players make choices. Give them some agency so they feel like they’re directly experiencing it. I think Twine is a really nice place to start.

EB: Is Twine what you used for Shrinking Pains?

GL: I made Shrinking Pains in Unity. But I have made lots of branching dialogue and narrative stuff in Twine. It’s really easy, and it’s fun, and there’s very little programming you need to do unless you want to dive into [programming for Twine].

If you have friends who also want to make games that have different skills, get together and work collaboratively! You don’t have to have a lot of those really high-end skills yet, which you have to study for.

EB: I’m doing that right now [as a grad student at NYU]. A lot of what I’m learning is just a lot of people being like, “Making games is really hard! Sound is hard! Art is hard! Writing is hard!”

GL: Yes, and I think a nice place to start is visual novels. You can get free software like Twine or Ren’Py and a whole bunch of free packaged assets. You put [the free assets] in and make a visual novel. You can do a lot of that yourself.

EB: Any final words for people making games based on their own experiences?

GL: I just want to encourage people to make serious games. They make the world a more empathetic, loving place. I really want to encourage women to do that. We are under-represented in terms of our gender ratio. But when you make games about personal experiences, you help broaden people’s understandings of what it means to be human. That’s beautiful.

Elizabeth Ballou is a New York Videogame Critics Circle intern/contributing writer who’s part of the MFA program at NYU’s Game Center. Follow her on Twitter: @lizbetballou.