Healthy or sick? Mind Scanners confronts the dilemmas of psychiatric treatment

Ever since Grand Theft Auto and Mortal Kombat created a moral panic in the 1990s with their violent and irreverent style, the relationship between games and mental health has often been discussed. Yet it is only in the last few years that games themselves have begun to address the topic in their stories.

Mind Scanners by Danish studio The Outer Zone is set in a dark and gloomy future with cyberpunk aesthetics and a dripping synth soundtrack. Nevertheless, your job is not to shoot laser guns or hack computer terminals as is common for the genre. Instead, you must diagnose and treat mental disorders.

“The inspiration came from a visit in 2015 or thereabouts to a now-closed psychiatric hospital in Ghent.”, reveals the founder of The Outer Zone, Malte Burup. “The hospital had turned into a museum [Dr Guislain Museum], and I was immediately fascinated by all these bizarre methods used to treat people. Methods that seemed to be almost pure conjecture.”

The thought-provoking insight into 19th-century psychiatry, which often had little regard for the patient’s actual well-being, made the graphically trained game designer consider whether the experience could somehow be turned into a game. After releasing the interactive children’s book Sofus and the Moon Machine in 2016, he collaborated with programmer Rasmus Mølck Nilsson and began developing Mind Scanners. A game where you get to experiment with the “alternative” mental treatment yourself.

“By playing as a psychiatrist, as a player you feel the consequences of the ethical dilemmas psychiatry faces and reflect on the challenges that will arise.” explains Burup.

Mind Scanners
The man you are examining has wires attached to his face. On the screen in front of you pulse strange symbols, looking almost like labyrinthine QR codes. Is the patient insane? Or sane? It’s up to you to decide. With a single push of a button.

The developers of The Outer Zone don’t try to hide the fact that they were inspired by Papers, Please. The 2012 indie hit placed you in the shoes of an overworked border guard in a fictional Eastern Bloc country. Comparing documents such as passports and entry permits, you ultimately had to decide people’s fate – would the citizen in question be allowed to cross the border or denied entry?

In many ways, Mind Scanners is reminiscent of the source material. With the obvious difference that the Danish game is set in the future, and the player, instead of judging whether a person is a law-abiding citizen or a spy, must decide whether he suffers from a mental disorder. And the game’s dilemmas don’t stop here, because you’re not just tasked with diagnosing your patients. You also have to cure them.

Psychiatric treatments are made using futuristic machines, each connected to a specific mini-game. You can use futuristic glasses to decode symbols in the patient’s eyes. Or you bombard their ears with some sort of rhythmic Morse code, which you must decipher. In many cases, the treatments are probably more insane than the patients. Something from the psychiatric hospital visit, Burup reveals:

“In the Belgian museum there were weird machines everywhere. I walked around and thought ‘what on earth are those buttons on this weird machine from 1905 supposed to do?’ For example, a kind of piano where you made five cats meow by putting thorns or nails in their legs, and apparently that was supposed to cure something. It was very weird, and I wanted to include that dimension. It wasn’t about just flipping through a report.’

Originally I envisioned Mind Scanners in the past. But that wouldn’t work, because as a player you would just think you were playing some kind of torture simulator.

Thanks to the mini-games, Mind Scanners can quickly become a frantic experience. You only have 200 seconds per day to complete your task, and during treatments the clock is constantly ticking while confusing symbols dance around on the futuristic diagnostic equipment. As if this were not enough, you must also balance your patients’ stress levels. Your equipment is in no way gentle, and if you push the patient too much, they may end up having psychosis and losing their personality.

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“Time constraints are rarely something you include in game design because it often leads to unnecessary stress.” explains Burup. “But we wanted that sense of stress. You will inevitably make mistakes, human mistakes, and it will affect people in the game world. Your time then becomes a kind of resource. And that’s also what we see in the real healthcare industry. Employees are under pressure for time and resources, and that leads to mistakes.’

Mind Scanners
Mind Scanners won the award for Best Narrative at the Danish Game Awards in 2022.

Although working conditions for psychiatrists and mental health workers have been heavily debated in recent years, unfortunately there is not much you can do about it in the bleak universe of Mind Scanners. Since you work for a totalitarian city-state called The Structure, there’s not much you can do to improve your working conditions. Especially since they are holding your daughter hostage in a psychiatric clinic. What you can do, however, is infiltrate the system from the inside. Perhaps with the help of the mysterious underground organization known as Moonrise. Or you can do your job properly and hope that the authorities will reward you.

How the story goes is entirely up to you. Mind Scanners has several endings and reacts not only to your choices during the story, but also to the outcome of your treatments. The Outer Zone chose the structure so that your choices felt like consistency. It should matter whether you mistreated your patients or not. But the open narrative structure also proved a big challenge for the small developer, reveals Nilsson, who did most of the heavy coding:

“We had a pretty reasonable schedule that we pretty much managed to stick to. But the story, all the choices and different branches, was probably what ended up going the most over time and budget. We often went back and changed things to really create that feel of the game, reacting to how you treat the patients and the choices you make along the way.”

Burup adds: “You may not see all the work we did during a single playthrough. But you do feel it when you play. Whatever you do, you feel there’s a consequence.”

Although games like the depressing Hellblade: Senua’s Sacrifice and the angsty teen drama Life is Strange have somewhat paved the way, it can still be a somewhat touchy subject to turn mental health into pixels and fun gameplay. Gaming sometimes has a habit of trivializing serious topics. For example, consider how war is treated in games like Battlefield or Call of Duty. On the other hand, as an interactive medium, it can sometimes bring you too close for comfort. As in the aforementioned Papers, Please, where you don’t just watch or read about an inhumane bureaucracy – you actually become part of it.

Considerations like these were something The Outer Zone thought long and hard about. “Originally I envisioned Mind Scanners in the past, reveals Burup. “But that wouldn’t work, because it’s now common knowledge that none of the treatments back then really worked. As a player, you would just think: you’re playing a kind of torture simulator.”

The ethical aspects eventually influenced the art and tone of the game as well. “I wanted the game to be in high resolution with realistic 2D graphics. But I kind of moved away from the dark and gloomy to something lighter and more colorful with a low-resolution style. To give the feeling that you were playing a game. The darkness is now a little more limited to the text. What we wanted to do is point to problems on a societal scale. We didn’t want to point fingers at real individuals.”

What I really like about this studio is that the inspiration is partly game, partly all kinds of other things. With Death Howl, we’re again taking inspiration from specific games. But also shamanism, the collective unconscious and many other ideas.

Because of this, Mind Scanners may at first glance seem like an old Nintendo game with its pixelated graphics and chiptune-inspired soundtrack. However, the universe is still very bleak and the audiovisual side is heavily inspired by classic sci-fi film. Especially Blade Runner, and specifically the intricate Voight-Kampff machine, but also the satirical and slightly over-the-top style of David Cronenberg and Paul Verhoeven’s 1980s classics like Videodrome and RoboCop.

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“We were very inspired by this kind of sci-fi social satire.”, explains Burup, who, in addition to most of the writing, also drew the graphics and composed the soundtrack. “[In die films] everything feels a little fake or game show-like. Almost like a video game, actually. They have a kind of rigid, mechanical and also playful universe. And at the same time, they provide insightful social commentary.”

Mind Scanners
Game Designer and founder of The Outer Zone Malte Burup plays the studio’s upcoming game, Death Howl.

With decent sales on PC and subsequent releases for Xbox and Nintendo Switch, it seemed obvious that The Outer Zone’s next project should be set in the Mind Scanners universe or at least build on the same mechanics. That, however, is not the case.

Currently, the studio in Copenhagen is working on Death Howl. A card game in the vein of Slay The Spire with elements from tactical RPGs and an open world that the player can freely explore between battles. The setting is a magical and spiritual version of the Stone Age in which you play as the young woman named Ro. But the story is ultimately secondary, the developer explains. It is the gameplay that takes center stage.

“What I really like about this studio is that the inspiration is partly game, partly all kinds of other things.”, says Lasse Sommer, the third and newest member of the studio. “As with Mind Scanners which combines Papers, Please with the thoughts and musings of visiting a mental hospital. With Death Howl, we are again taking inspiration from specific games. But also shamanism, the collective unconscious and many other ideas.”

From the future to the distant past. From a narrative experience to gameplay-first. The Outer Zone are not afraid to explore new ideas and we are excited to learn more about their upcoming game as development progresses.

Mind Scanners
Lasse Sommer is the newest member of The Outer Zone.

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