Beata Gubacsi reflects on Psychtech 2019: Mental Health and Digital Technology conference
Previous posts on Medical Humanities 2.0 have addressed the increasing interest in gaming and mental health as well as speculating possible trajectories of future research in healthcare and digital technologies, so I was really looking forward to attending Psychtech 2019: Mental Health and Digital Technology conference to learn more about on-going projects in the field. The conference took place on 22nd November at the Hamilton House in London where organisers Paul Gilluley, David Rigby and Peter MacRae welcomed the attendees.
The day began with Henrietta Bowden-Jones’s (@ArtScienceDoc) talk, providing a great and much needed overview of internet gaming disorder/gaming disorder, a term which has been grossly misunderstood and misrepresented in the media. She addressed the difficulties of determining how prevalent the issue is since there are “no common screening tools”. Bowden-Jones referred to “Toward a consensus definition of pathological video-gaming: a systematic review of psychometric assessment tools” (King et al 2013) which has identified problems regarding the lack of consensus over the classification and measurement of gaming disorder. She gave examples such as “inconsistent coverage of core addiction indicators”, varying “cut off points”, and “the lack of temporal dimension”, “untested or inconsistent latent structures” and “inadequate data on predictive validity.” She moved on to discuss the accepted definition for internet gaming disorder (IGD) as “persistent and recurrent use of the internet to engage in games, often with other players, leading to clinically significant impairment or distress indicated by the following in a 12 month period”: preoccupation, withdrawal symptoms, continued excessive use, deception, escapism, loss of relationships and professional/educational opportunities. The presentation also touched on the neurobiology of gaming disorder as well as the UK gaming industry and scene, and the treatment now available at the first NHS Gaming Disorder Clinic. Henrietta Bowden-Jones concluded the necessity of a gaming regulatory body, independent from the industry, open to public concerns, and employing psychologists – alongside age verifications and fines.
Following the exploration of the potentially harmful effects of digital technologies, Ross O’Brien’s presentation, “Virtual reality for mindfulness engagement, including the Grenfell Health and Wellbeing Service”, drew attention to more positive uses of digital technologies. He explained how Central and North West London NHS Foundation Trust began to reach out to people and start a discussion about mental health with the help of VR technology, leading to a much better understanding of the community’s needs as well as raising awareness of the services and resources available at the NHS. Both patients and staff benefited from the shared experience and the reestablishment of trust. In the wake of the Grenfell Tower disaster, VR Technology began to serve as a platform to help the community to deal with complex bereavement and trauma with VR memorials which can provide a more inclusive and personal environment. At the moment Ross O’Brien and his team are working on a series of short films approaching mental health in a non-traditional way, involving VR technology: the first film in the “VR Mindfulness” project is now available.
The first section of the day featured three parallel sessions: Johnny Chiodini’s “The facts behind the media concerns around Fortnite”, Johnny Downs‘s “Can we automate mental health assessments of children and their families?”, Tim Rogers’s “Social support technologies and the work of Big White Wall”. I attended Johnny Downs’s presentation which explored the various “informatics challenges to provide fair access to NHS CAMHS assessment, diagnoses and treatment.” The three areas addressed were “accurately identifying children at risk of psychiatric disorder”, “systematically collect assessment measures”, and how to make the current assessment practices more objective.
At midday Paul Fletcher began his informative and entertaining talk “Neurogamer: points of contact between game design and clinical neuroscience”, explaining that video games are great at “representing situations and challenging psychological processes in video games” because they are engaging. The engagement originates from “exploring and comprehending a new, ambiguous and uncertain world” simulating the challenge of understanding and coping with the real world. The player is allowed to immerse themselves into this environment, and share experiences with the protagonist: the player is actively participating in these and “choice, action, and learning become the key parts of the experience.” The core of the presentation focused on Hellblade: Senua’s Sacrifice (Ninja Theory, 2017), a collaborative project between Ninja Theory and the Wellcome Trust, to create a game that represents psychosis accurately. Paul Fletcher acted as expert consultant, and in his talk he explored how the different symptoms of psychosis appear in the game. He mentioned aspects of the sound design and voice acting, which were created with the help of voice hearers to create a realistic experience of intrusive, often violent, and sometimes caring voices. He emphasised the importance of how Senua sees the world: perspectives and colours are changing dynamically in the game, and Senua is aware of abstract connections in her environment – the player has to make these connections in order to proceed. (More on information is available in the Development Diaries.) Paul Fletcher ended his presentation with displaying positive feedback from people with mental illness who played Hellblade: Senua’s Sacrifice and found the experience overwhelmingly relevant and a real game changer in their mental health experience: not only because it represents their experience respectfully and accurately but also because it makes others understand the realities of living with psychosis. This, I believe, gave an even greater significance to the event itself: it showed the meaning and impact of research.
The afternoon session began with Pete Etchells’ “Behavioural effects of games” which provided insight into the realities of some of the longest standing “damaging myths” concerning video games – just as informative and daring as Henrietta Bowden-Jones’ presentation on internet gaming disorder. Etchells was exploring why we play video games and how video games can affect us. He began with the question “do video games make people violent?” to which the answer was “yes, sort of, but there is more to it.” He explained the difficulties of measuring aggression and the problems of this creates with examples. Without a unified framework, studies tend to show different results. He moved on to talk about the benefits of video games, and how playing is more than entertainment. For instance, Sea Hero Quest, a mobile gaming app designed to collect data for dementia research, pointing out that gaming is a useful, multifaceted tool.
The second section of parallel sessions included Sebastian Barker’s “Supporting homeless individuals to crowdfund new career opportunities”, Dennis Chan’s “Virtual Reality in the early detection of dementia” and Anna Hollinrake’s fantastically animated presentation “Video games as engines for empathy”. As it is always the case with parallel panels it was a difficult to choose but I attended the latter which in many ways was an interesting juxtaposition to the previous topic presented by Etchells. Anna Hollinrake, artist, illustrator and BAFTA Breakthrough Brit, was talking about “non-traditional play”. According to Rico Albe’s Gentle Game manifesto developers should “make games about decisions that make your life better. Happy decisions.” Gentle games are not based on victory or win conditions: they are comforting, community focused, avoid conflicts and focus on emotionally meaningful interactions. Anna explained the importance of empathy, connection and companionship in Thatgamecompany’s Journey (2012). The slow pace and relaxing atmosphere of these type games are not only sources of escapist entertainment but also that of self-discovery. She explored how these types of video games are especially significant for young queer people dealing with the anxieties of self-acceptance and coming out as it is shown, for instance, in the indie game, Gone Home (Annapurna, 2013).
The last session consisted of three parallel talks again: Max Davie’s “Square eyes, bad vibes – screen time put into context”, Miriam Fornells-Ambrojo’s “AVATAR therapy for voices: Embodying the Disembodied” and last but not least David Zandle’s “Loot boxes and beyond: The potentials for harm in the convergence of video games and gambling”. In this final section, I attended Miriam Fornell-Ambrojo’s talk on the most fascinating Avatar Therapy. Miriam Fornells-Ambrojo began with a brief overview of the essential characteristics of auditory hallucinations, then introduced the project illustrating it with short videos. She explained in detail the process of creating avatars, a virtual representation of the disembodied voice, with great customisability of voice qualities as well as facial expression. Once the avatar is created, “under direction from therapists, patients are encouraged to challenge the voice and allow it to come gradually under the patient’s control.” (Video available) She concluded that while further research is needed to explore some of the challenges of the avatar therapy (the ideal length of sessions, training etc.), the client feedback are positive. Hopefully, in the future this technology can become instrumental in helping clients with voice hearing experiences by gradually building up confidence to engage with the intrusive presence effectively.
It was clear that Psytech 2019 and similar events signal a paradigm shift not only in how video games and other forms of digital technology are regarded in healthcare, medicine and medical humanities. Throughout the day a great range of potentials in gaming has been recognised from research data collection to therapeutic purposes and even diagnostics. Several speakers identified the amount of work that needs to be done to work out the theoretical background of these various applications of game design and gameplay as well as policies accompanying these new practices. Good news is that the exponentially growing interest in the field guarantees that we will witness massive breakthroughs in the next couple of years. I will certainly look forward to attend the next conference to learn more.