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Neverending Nightmares: Videogaming as Therapy

Neverending Nightmares is a video game which aims to give players a sense of what it’s like to live with mental illness. It was created by indie developer Infinitap Games and draws inspiration from it’s creative director, Matt Gilgenbach’s personal struggle with obsessive compulsive disorder and depression, which was at it’s worst in 2003.
“I felt this horrible feeling where I looked forward in my life and I could see no way to escape the misery. I felt like the only relief I would ever get would be through death.”

Concept artwork
Concept artwork from Neverending Nightmares c/o: Infinitap Games

In Neverending Nightmares, you take on the role of Thomas, who wakes up from a nightmare in a lunatic asylum, only to find that he is still dreaming. The nightmares, which play out on most gaming platforms including PlayStation and PC, range from the discovery of teeth and eyeballs in a sink to Thomas unzipping a vein in his forearm, a recurring thought that plagued Mr. Gilgenbach for years.

Mr. Gilgenbach believes that many people define OCD as a condition that involves checking or repeating rituals, but his own experience was different.
“Negative emotions lead to self-deprecating thoughts which evolve into powerful images of hurting oneself” is how Mr. Gilgenbach describes the cycle, for which the mental torture is often eased with pain.
“Once I stapled my arm which felt really weird but I think to some extent, the idea is that physical pain is very immediate, and almost distracts you from the emotional pain. The physical pain is much easier to deal with.”

A decade later the 33-year-old would share his torment in Neverending Nightmares, a video game that brings his recurring thoughts of self-mutilation to life.
“It’s not a fun, enjoyable experience – it’s a difficult experience. Those people that have an open mind, and are interested in games as art, I think they can potentially get a lot out of it. But I also wanted to show people who suffer from mental illness that they’re not alone” Mr. Gilgenbach says from his townhouse in North Hills, LA, which doubles as Infinitap’s office.

Inmate concept artwork
Inmate concept artwork from Neverending Nightmares c/o: Infinitap Games

The International OCD Foundation says between three and four million people in the U.S. suffer from OCD. It blames the mainstream media for the public’s lack of understanding of the disorder, in particular TV shows that make light of how OCD manifests itself externally, without detailing the internal struggle.
“OCD is about this chronic, intense anxiety that’s going on internally for someone, where they’re having thoughts and images that just won’t shut off. It’s like a running horror movie, that’s constantly running through your mind” says Jeff Szymanski, Ph.D., a clinical psychologist and Executive Director of the IOCDF, who says that while there are a lot of documentaries and apps focusing on OCD, he’s never seen a video game that approaches the subject.
“I like the way that he (Mr. Gilgenbach) titled it Neverending Nightmares and I like how he’s saying “this is what it feels like in my head.” I think that’s a better way to help people understand what OCD is, rather than they’re turning lights on and off or they’re unlocking and locking their locks over and over again.”

Dr. Szymanski says that almost everyone has odd or strange thoughts and images that come to mind, but OCD sufferers can’t turn them off.
“Most of us just dismiss them, “Oh, isn’t that weird. I’m walking along the street and I had an image of a car jumping the kerb and hitting me, or hitting the person next to me. Isn’t it strange that my mind just threw that image up?” and you keep walking. But if you have OCD you start to think “Oh my goodness, why did I have that thought? And now that I’ve had that thought is it more likely that that’s going to happen? And do I need to do something to protect myself or this other person?” So they get caught and stuck in that thought process, rather than if you don’t have OCD you just shrug it off and keep moving.”

The West Wing (1963)
The West Wing (1963) by Edward Gorey c/o: The Edward Gorey Charitable Trust

Stylistically the video game looks like an animated pen-and-ink sketch from the early nineteenth century, an art style that Mr. Gilgenbach says represents the bleakness of mental illness, and was inspired by artist Edward Gorey, who’s characteristic drawings often depict unsettling scenes in Victorian and Edwardian life.
“I wanted it to be autobiographical from the standpoint of the emotional feelings. Obviously I don’t live in a Victorian mansion, but I wanted to create an atmosphere where there’s no escape from the nightmares. That when you die, you wake back up again – you don’t ever get a reprieve.”

And while thousands of drawings were needed to bring Neverending Nightmares to life, it’s the dark, ambient soundtrack that Mr. Gilgenbach says is his favourite part of the game, which elevates the experience into a kind of pressure pushing you.
“Instead of just walking through hallways, you are walking through this horrible, oppressive, atmospheric world that nears what I felt with depression and OCD.”

Inmate concept artwork
Inmate concept artwork from Neverending Nightmares c/o: Infinitap Games

Dr. Szymanski, who’s also a Clinical Instructor in Psychology at Harvard Medical School, says in OCD, obsessive thoughts take many forms including the threat of contamination or not practicing one’s religion correctly and offending God. But for OCD sufferers who have thoughts of violent or sexual imagery, Dr. Szymanski says Neverending Nightmares will be an anxiety provoking experience, which he says is a form of treatment, called cognitive behavioural therapy, which has proven to be effective in treating OCD.
“If you have violent thoughts, play this video game and don’t do your compulsive behaviour. What people with OCD find is when they stop doing the avoidant and compulsive behaviour when they’re feeling anxious in the presence of these obsessions and these images, then their anxiety and distress starts to go down on its own. And they break that cycle.“

It’s a theory that has paid off for Mr. Gilgenbach, who at the start of the project, which began in December 2012, was worried that it would be difficult to dredge up his thoughts of self-mutilation and look at them in a game, but he says that he’s found the experience strangely therapeutic.
“I’ve found that by opening my head, taking them out, and putting them on screen, the images lost a lot of power. They were still things that over ten years later were difficult for me, but now that they’re part of the game, I can point to them on the screen and say ‘this is an intrusive thought’”

Bubbling below the surface of a video game industry that’s dominated by big money developers like Ubisoft, Activision Blizzard and Electronic Arts is a huge indie scene, in which game developers often self-publish. And while it’s not usually as lucrative, it does mean that creators retain control of their work and can approach subjects rarely picked up by AAA studios.

Indie developers publish on platforms like Steam, an online market place for PC, Mac and Linux games, which as of February 2015, has 125-million active accounts. By submitting information, screenshots and video of their games to ‘Steam Greenlight,’ developers tap into a community which leaves feedback on the developer’s pitch – which then helps determine whether a game is selected for distribution.

Another publishing avenue is Humble Bundle, where indie developers can sell their game as part of a collection or “bundle” of independently developed titles.

Funding for Neverending Nightmares came from a variety of sources including a Kickstarter campaign which raised $106,000 and participation in the ‘Free the Games Fund’, an initiative which gives money to developers who kickstarted their games, in exchange for bringing it to the Ouya micro-console exclusively for the first six months.

So far Infinitap Games has distributed more than 100,000 units of Neverending Nightmares – about 40,000 of those through the Steam platform and 60,000 through Humble Bundle says Mr. Gilgenbach, who’s quick to point out that while Humble Bundle opportunities moved a lot of units, “you certainly don’t get paid as much.”

Concept artwork
Concept artwork from Neverending Nightmares c/o: Infinitap Games

But it’s the feedback from those who suffer from mental illness that Mr. Gilgenbach finds most rewarding. In an email published on Infinitap’s blog, an unnamed OCD sufferer writes
“I was so amazed by how well you captured how I felt with OCD that it almost scared me how similar it felt when watching the main character in the game.”
The anonymous sufferer, who stumbled upon a video of YouTube legend PewDiePie playing ‘Never-ending Nightmares’ goes on to say
“For a while I struggled with explaining to people just what I was feeling and then this game comes along and I am just thankful for doing something like this. I have been looking for something that I could hold onto, something that I could relate to and now I’m not as scared and now I’m not as sad. Thank you very much.”

Dr. Szymanski believes any way in which someone explains OCD, that talks about the internal experience of OCD is a much better way to educate people about what OCD is
“People with OCD are not doing this because they want to. It’s not an eccentricity, it’s not a personality quirk. They don’t like these behaviours. They’re doing them because if you saw what’s going on inside you’d be doing this too. And ‘Never-ending Nightmares’ does do a good job of, “here’s what the inside of my head looks like.”

Mr. Gilgenbach has now reached a happier point in his life. He has a baby son and enjoys married life but says that mental illness remains a part of him, which is why he didn’t give Neverending Nightmares a Hollywood finale, opting instead for multiple endings which are meant to be more thought provoking than resolving.
“I wanted it to continue to be bleak, to show that this journey is still going on and that the nightmares are never-ending, although the game is definitely ending.”