Healthy or sick? Mind Scanners faces you with the dilemmas of psychiatric treatments

Ever since Grand Theft Auto and Mortal Kombat created a moral panic with their violent and irreverent style back in the 1990s, the relationship between games and mental health has often been discussed. Yet, it's only in the last couple of years that games themselves have started to treat the subject in their narratives.

Mind Scanners from Danish studio The Outer Zone is set in a dark and gloomy future with cyberpunk aesthetics and a dripping synthesizer soundtrack. Despite this, your job isn't to shoot with laser pistols nor hack computer terminals as is usual for the genre. Instead you must diagnose and treat mental disorders.

"The inspiration came from a visit back in 2015 or there about to a now closed psychiatric hospital in Gent," reveals the founder of The Outer Zone, Malte Burup. "The hospital had been turned into a museum [Dr Guislain Museum], and I was immediately fascinated by all these bizarre methods that were used to treat people back in the days. Methods that almost seem to be pure conjecture."

The thought-provoking insight into 19th century psychiatry, that often held little regard for the actual wellbeing of the patient, made the graphically-educated game designer ponder whether the experience could somehow be turned into a game. After having released the interactive children's book Sofus and the Moon Machine back in 2016, he teamed up with programmer Rasmus Mølck Nilsson and started the development of Mind Scanners. A game where you get to experiment with the "alternative" mental treatment yourselves.

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

The developers from The Outer Zone don't try to hide the fact that they have been inspired by Papers, Please. The indie hit from 2012 placed you in the shoes of an overworked borderguard in a fictitious Eastern Bloc country. By comparing documents such as passports and entry permits you ultimately got to decide people's fate - would the citizen in question be allowed to cross the border or denied entry?

In many aspects, Mind Scanners is reminiscent of its 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 they are suffering from a mental condition. And the game's dilemmas doesn't stop here, as you are not only tasked with diagnosing your patients. You must also cure them.

The psychiatric treatments are made with the help of futuristic machines, each one connected to a specific mini game. You might use a futuristic pair of goggles to decode symbols in the patient's eyes. Or you might bombarde their ears with a sort of rhythmic Morse code, you'll have to decipher. In many cases, the treatments are probably more insane than the patients. Something drawn from the visit to the psychiatric hospital, reveals Burup:

"In the Belgian museum there were weird devices everywhere. I walked around and thought 'just what the hell are these buttons on this weird machine from 1905 supposed to do?' For example, a sort of piano where you had five cats meowing by putting thorns or nails in their paws, and apparently that was supposed to cure something. It was very weird, and I wanted to include that dimension. You weren't just supposed to leaf through a rapport."

Originally I had envisioned Mind Scanners as taking place 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 hectic experience. You only have 200 seconds per day in which to accomplish your task, and during treatments the clock is constantly ticking while confusing symbols dance around on the futuristic diagnostic equipment. As if this wasn't enough, you'll also have to balance the stress level of your patients. Your equipment is in no way gentle, and if you push the patient too much they might end up getting a psychosis and losing their personality.

"Time constraints are rarely something you include in game design, as it often leads to unnecessary stress," explains Burup. "But we wanted that feeling of stress. You will inevitably make mistakes, human errors, and it will affect the people in the game world. Your time then becomes a sort of resource. And that's also what we see in the real health care sector. Employees are pressed for time and resources, and that leads to mistakes."

While the working conditions for psychiatrists and mental health personnel has been heavily discussed in recent years, unfortunately there isn't a whole lot to be done about it in the bleak universe of Mind Scanners. As you are working for a totalitarian city state called The Structure there isn't much you can do in terms of improving your work conditions. Especially since they are holding your daughter hostage in a mental clinic. What you can do, is infiltrate the system from the inside. Maybe with the help of the mysterious underground organisation known as Moonrise. Or you can duly do your job, and hope the authorities will reward you.

How the story goes is completely up to you. Mind Scanners has several different endings and react, not only to your choices during the story, but also to the result of your treatments. The Outer Zone chose the structure, so that your choices felt consequential. 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 handled most of the heavy coding:

"We had a fairly 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 in order to really nail that feeling of the game reacting to how you treat the patients and the choices you make along the way."

Burup adds: "You might not see all the work we have done during a single playthrough. But you can feel it when you play. Whatever you do, you can feel that there is a consequence."

While games like the depressive Hellblade: Senua's Sacrifice and the angsty teenage 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 trivialising serious topics. Case in point, just think about how war is handled in games such as Battlefield or Call of Duty. On the other hand, as an interactive medium it might sometimes also put you too close for comfort. As in the previously mentioned Papers, Please, where you not only watch or read about an inhuman bureaucracy - you are actually a part of it.

Considerations such as these were something that The Outer Zone thought long and hard about. "Originally I had envisioned Mind Scanners as taking place in the past," reveals Burup. "But that wouldn't work, as it's common knowledge now that none of the treatments from back then actually worked. As a player you would just think, you were playing some kind of torture simulator."

The ethical aspects also ended up influencing the game's art and tone. "I had wanted the game to be in high resolution with realistic 2D graphics. But I kind of moved away from the dark and bleak towards something lighter and more colorful with a low-res style. To give the feeling that you were playing a game. The darkness is now a bit more confined to the text. What we want to do is pointing at problems on a societal scale. We didn't want to point fingers at any real individuals."

What I really like about this studio is that the inspiration is part game, part all kinds of other stuff. With Death Howl we are once again drawing inspiration from specific games. But also shamanism, the collective unconsciousness and many other ideas.

Because of this, Mind Scanners might at first glance seem like an old Nintendo game with its pixelated graphics and chiptune-inspired soundtrack. The universe is still very bleak though, and the audiovisual side has been heavily inspired by classical sci-fi film. Most of all 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 80s classics such as Videodrome and RoboCop.

"We were very inspired by this kind of sci-fi social satire," explains Burup who, besides doing most of the writing, also drew the graphics and composed the soundtrack. "[In those movies] everything feels a bit fake or gameshow-like. Almost like a video game, actually. They have a sort of stiff, mechanical and also playful universe. And at the same time, they provide insightful social commentary."

With decent sales on PC and later 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 isn't the case though.

At the moment the Copenhagen-based studio 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 explore freely between battles. The setting is a magical and spiritual version of the Stone Age where you play as the young woman named Ro. But the story is ultimately secondary, explains the developer. It's the gameplay that's in focus.

"What I really like about this studio is that the inspiration is part game, part all kinds of other stuff," tells Lasse Sommer, the studio's third and newest member. "As with Mind Scanners that combine Papers, Please with the thoughts and musings about the visit to a psychiatric hospital. With Death Howl we are once again drawing inspiration from specific games. But also shamanism, the collective unconsciousness and many other ideas."

From the future to the ancient past. From a narrative driven 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 the development comes along.