PROLOGUE

Video Games and Your Body

VIDEO GAMES ARE A MEDIUM DEFINED BY ABILITY.

Games require mental and physical dexterity to play, and they often involve immersive experiences that take our abilities to fantastic places. In games we can jump and climb and fly and run and fight in ways we never could in real life. And the ethos of accessibility that now pervades game design, an ethos of improving access to gaming for people with disabilities, further emphasizes the relationship between digital games and our abilities. This relationship has grown as video games have become a cultural mainstay and as critical conversations, activism, and policymaking have brought attention to disability and mental health. It is a relationship stemming from software, hardware, and culture, and I propose a term to describe this phenomenon: ability machines.

Video games are ability machines. Their core conceit is that they allow players to do things that would otherwise be impossible. Games test players’ physical and mental abilities through button presses, keyboard strokes, mouse clicks, and screen taps. The widespread adoption of accessibility options—subtitles, controller input remapping, assist modes, frequent save points, and so forth—has made more games playable by more players than ever, especially players with disabilities and mental health challenges. Games are an avenue to redefining our capabilities and demonstrating mastery of our bodies. As products of popular culture, video games are touchstones that continue to spark debates about disability, access, and mental health. Our bodies and abilities will, by necessity, evolve alongside video games as they continue to occupy a growing place in everyday life. We must account for that change, scrutinize it, influence it, and recognize that, in its matrix, nobody’s body is normal and accessibility benefits everyone.

A practical example of this phenomenon is Celeste (Extremely OK Games, 2018). Celeste is a side-scrolling platformer (a player who avoids hazards and jumps on platforms while navigating each level). It requires near pixel-perfect precision, quick reflexes, rapid button presses, and the patience to fail repeatedly when attempting a single maneuver. The game is difficult, even though its premise seems simple. In the game, players control a character named Madeline while she climbs a mountain, but “climb” makes it sound too straightforward. There are branching paths, puzzles, and difficult platforming that ask the player to fail repeatedly until they land that single jump or grab on to that impossible-to-reach ledge. Nearly every review of the game admits that it is “infuriatingly hard, even just within its first level.”¹ By almost any metric, Celeste should be a hallmark of mainstream game culture’s obsession of gatekeeping games through difficulty. There is nothing more alluring to some players than knowing that they are simply better than other people because they can beat a hard game. There is nothing more tempting to some hard-core gamers than to unite around super challenging games, the Dark Souls (FromSoftware, 2011) and the Cuphead (Studio MDHR, 2017) and the Super Meat Boy (Team Meat, 2010) type games. There is nothing more offensive to “true gamers” than easy modes! Simply do an internet search for the keywords “difficulty” or “easy mode” as they relate to the exhaustingly challenging game Sekiro: Shadows Die Twice (FromSoftware, 2019). The internet rage is too readily apparent.

Which is to say I was surprised to discover how accessible Celeste is, especially to people with disabilities. A primary feature of the game is its “assist mode,” a menu of options that allows players of almost any skill level to enjoy the game. In assist mode, players can do some or all of the following: adjust the game’s speed in order to reduce demands on reflexes and rapid button presses, turn on “infinite stamina” to allow Madeline to never lose her grip when climbing, enable the use of unlimited midair dashes in any direction, and make Madeline invincible to all hazards (see fig. Prologue.1). Admittedly, there are plenty of optional challenges to increase the difficulty for the most hard-core players, but in general, the game espouses a philosophy of accessibility. Celeste’s assist mode not only opens the game to players of varying skill levels but also allows players with various disabilities, both physical and cognitive, to enjoy the game.

Celeste is not only accessible in its gameplay, but it also welcomes players with mental illnesses in both its tone and story. The game’s hero, Madeline, faces regular anxiety attacks, has a history of depression, and deals with self-doubt stemming from her mental illnesses. One moment in the story even requires players to calm Madeline during an anxiety attack. The game’s tone is that of encouragement, self-love, acceptance, and the value of loving people who struggle with their mental health. While other games may often portray mental illness, they do so as either a horror trope or as a melodramatic story beat. It almost feels like the purpose of Celeste is to help people with mental health challenges feel empowered, welcome, seen, and loved.

Figure Prologue.1. Screenshot of the assist mode menu in Celeste. The image shows the large words “Assist Mode” followed by five settings that players can manipulate: game speed, infinite stamina, number of air dashes, dash assist, and invincibility. Screenshot by author.

Celeste, in its controls, gameplay, and story, is a game about our bodies and abilities. And it demonstrates what many games often hide: the tension between games and embodied skill. To quote Dara Ó Briain in his comedy special Craic Dealer, “Video games do a thing that no other industry does. You cannot be bad at watching a movie. You cannot be bad at listening to an album. But you can be bad at playing a video game. And the video game will punish you and deny you access to the rest of the video game. No other art form does this.”

Ó Briain exaggerates for the sake of the joke, but the underlying premise is worth considering. In less comedic words, video games tend to be “quite demanding in terms of motor, sensor, and mental skills . . . and often require mastering inflexible, quite complicated, input devices and techniques.”² They seem fundamentally opposed to accessibility and oftentimes unwelcoming to people with disabilities. But games have a nuanced and sometimes unexpected relationship to disability. Not only has accessible design increased in the last few years—both in terms of overall design philosophies and software options such as subtitle settings—but also people with disabilities can use games as a way of reimagining their disabilities and capabilities. As one player explained in an interview: “I do things that people with hands can’t even do.”³

On their surface, video games appear at odds with disability and mental illness given how physically and cognitively demanding they often are. This book’s purpose is to map the relationship between gaming, disability, and mental health. In broad terms, it aims to provide a vocabulary to describe the relationships between our bodies and interactive entertainment technology. And, at its most specific, this book will provide critical, feed-forward suggestions for what gaming can mean as culture continues to struggle with what our bodies are capable of being, whether they lie outside of hegemonic normalcy or not.

In this book, I argue that video games are vital to understanding our bodies and abilities. Video games can help us imagine what our abilities mean, and they engage us physically, behaviorally, and cognitively to envision our agency beyond any limitations. At their most juvenile, this means games provide power fantasies. At their most profound, games fundamentally reshape cultural and personal conceptions of mental health, illness, disability, and accessibility. Video games are ability machines that produce a reimagined state of agency. To make this argument, I engage in a series of case studies to examine three aspects of ability machines: accessibility, game work such as in game streaming and development, and interactive portrayals of ability. Ultimately, I contend that we must look to interactive digital media as it pertains to the future of our bodies, and, if we do not include people of varying abilities and mental health in that vision, then we are excluding nearly all humans from that future: for there is no such thing as a “normal” body.

What Is Disability?

After I broke my elbow in a bicycle accident, and after the resulting surgery—involving a metal plate and seven screws permanently embedded in my arm—I am no longer able to fully extend my arm nor flex it. I have difficulty fastening the top button of my dress shirts, and anything involving sustained effort in that arm, such as supporting myself on a bicycle, is difficult or impossible. Even now, when typing this manuscript, I feel my elbow tightening and becoming sore. Do I have a disability? Why do I feel like I do not?

If you were to walk around a busy city street, asking random passersby what the word “disability” means, how do you think they would answer? Perhaps they would focus on movement and body control. Or maybe they would describe the use of accessibility tools such as wheelchairs or guide dogs. They might mention medical diagnoses. Some might begin saying the word “deformity” before quickly changing course. There is a chance that a few people would acknowledge “invisible” disabilities such as chronic pain, and certainly many people know loved ones with learning disabilities. But when it comes to the matter of teasing out the concept, it would probably not merit much thought from most people. But what is a disability, and what is not? Must it be medically diagnosed? In that case, does a disability simply not exist before a doctor enters the room? Is poor eyesight a disability, and, if so, why do so many people who wear contacts or eyeglasses not consider it a disability? When a pregnant person experiences a reduced yet temporary range of motion or consistent pain, is that a disability? Or must disabilities persist for the rest of a person’s life? The TV program Portlandia addressed this ambiguity in a season 6 episode: When the overexuberant couple Kath and Dave hurt their legs in a marathon race, they feel entitled to the legal protections afforded to people with disabilities. They form a support group for people with sunburns and other minor injuries in order to claim they have disabilities. Why does the joke work? Why do their injuries—sprained ankles, carpal tunnel syndrome, and so forth—feel like they are not disabilities?

At the foundation of this project lies the assertion that disability is not just physical or medical. In fact, disability is everything beyond medical diagnoses or physical abilities or cognitive difference. I have found it is best to explain it as a formula, but I tease out the details in the following paragraphs:

DISABILITY

=

THE PHYSICAL

+

THE SOCIAL

To shock my students when teaching this idea, I loudly proclaim that disability is socially constructed. And when they pull back from that idea—as they should, since they have seen or even experienced the very real physical side of disability—I mention a simple example. First, I ask my students, “How many of you wear eyeglasses or use contacts?” Approximately half the class raise their hands. I then ask, “How many of you would earnestly and confidently state to a stranger that your eyesight is a disability, and that you therefore have a disability?” The question gives students pause. I continue to push back on this issue: “Why not? It is most certainly medically diagnosed, you use accessibility tools in the form of eyeglasses or contacts, and without corrective surgery your level of eyesight will either remain as it is or even continue to deteriorate. Why is that not a disability?”

The answer, again, is that disability is social. Or, to put it more mildly, a disability is different from an impairment. The social model of disability emerged in the 1970s, initially suggesting that “impairment” is a useful word to describe the physical side of disability: the medical diagnosis, the differing cognitive ability, the embodied experience, and so on.⁴ The reduced motion in my left arm is an impairment. For many of my students, they experience an impairment in their eyesight. An impairment need not be validated through a medical diagnosis to exist: impairments come in many forms, and we all experience them. The physical side of disability—the impairment—includes medical diagnoses, physical limitations, cognitive differences, and any number of other very real embodied experiences.

DISABILITY

=

THE PHYSICAL

[Impairments and Diagnoses]

+

THE SOCIAL

However, the social side of the equation must exist for an impairment to become a disability. At its most crude, the social side of the equation can be summarized like this: a disability is not a disability until everyone sort of agrees that it is a disability. Or, more eloquently, disability is a social reaction to particular bodies.⁵ The factors that play into the social side of disability extend beyond societal agreement, and so what follows are some of the factors that play into a social model of disability. First, social discourses, or how we communicate about disability, define many of its parameters. For example, two of the case studies in this book examine how game news websites generally address disability and mental health. The types of stories chosen for publication and the language journalists employ to describe disability reflect general opinions about disability while also acting as thought leaders to influence how we think about the subject.

Second, portrayals of disability in entertainment media may technically be just another social discourse, but their prominence in culture merits unique consideration. These depictions often devolve into harmful stereotypes in movies, books, or television programs.⁶ Sharon Snyder and David Mitchell argue that “there are significant stakes in the humanities-based analysis of disability” because people with disabilities “must negotiate a finite repertoire of social meanings.”⁷ These portrayals, especially in entertainment media, provide a language for imagining what life with disability can mean, and thus depictions of real people or fictional characters with disabilities, for better or worse, informs the parameters for defining disability. For that reason, two of the case studies in this book target portrayals of disability and mental illness.

Third, the resources society provides to people with a variety of impairments greatly influence what people may consider disabilities. The reason I use the example of eyeglasses and contacts when I teach about disability is because they are one example of how proper social resources can fundamentally change the nature of disability: in a world without the technologies of eyeglasses or contacts, without affordable medical care for eyesight, and without the requirement to live with razor-sharp eyesight—think of a world where everybody has to pilot fighter jets—a moderate amount of eyesight loss can be essentially ignored in day-to-day life. For example, how many people do you interact with every day who use eyeglasses or contacts, and you do not notice or care? Conversely, imagine a world where nobody is required to use their legs to transport themselves, even if there exist no major impairments to most people’s legs: Would paralysis in the feet be considered a disability in that world? Most likely not. From my own experience, I once met a young man in Honduras who could not roll his r sounds, a fundamental part of speaking Spanish. His family lamented his speech impairment, while I imagined the number of native English speakers in the United States who might not be able to roll their r’s. In the United States, speaking English, this young man would not merit any special attention due to his speaking: his rhotic r’s would be perfectly normal. The resources and expectations that dictate day-to-day life provide a framework for distinguishing between impairments and disabilities, and two case studies about game streaming in this book will return to this topic.

Last, accessibility and accommodation structure disability. It is worth noting the difference between accessibility and accommodation: accommodations are typically legally mandated attempts to provide equality for people with disabilities, while accessibility describes those proactive measures that improve the lived experience of nearly everybody, including people with disabilities. An accommodation, for example, is a university-hired notetaker for a student who requires one due to a disability. An accessibility feature is when the professor turns on live subtitles for all people to read along with what the professor is saying: even those without hearing disabilities can benefit from the added clarity of seeing subtitles. The curb-cut effect is an oft-cited example of accessibility: the ramped sidewalks at road intersections benefit wheelchair users as well as other pedestrians. Issues of accessibility, especially as it applies to access to media, are hotly contested with a variety of opinions regarding how to approach the issue. But look to several chapters in this book that tackle accessibility for an expanded discussion of the subject.

DISABILTY

=

THE PHYSICAL

[Impairments and Diagnoses]

+

THE SOCIAL

[Discourses, Portrayals, Resources, and Accessibility]

These elements of disability are not exhaustive, and theorists have written at great lengths regarding these topics and much more. And so, to offer a few final thoughts on expanding how we think about disability, I turn to the field of disability media studies.

Elizabeth Ellcessor and Bill Kirkpatrick propose a unified yet interdisciplinary field in order to target issues of inclusion, production, portrayal, and other shared interests between media studies and disability studies researchers.⁸ Disability media studies relies on several key foundations, which I summarize here. The first is the social model of disability already discussed above. Second is the concept of a “normate” subject position or identity to give a vocabulary to the often invisible and unnamed “able-bodied” subjectivity that many people inhabit. Instead of calling people without disabilities or mental illnesses “normal,” Rosemarie Garland-Thompson suggests “normate.”⁹ The term acknowledges that nobody has a “normal” body and that normalcy is just as socially constructed as disability. The third key foundation of disability media studies is that lived experience is a valuable epistemological position for understanding disability.¹⁰ While disability is socially constructed, the lived experiences of people with disabilities are full of actual yet subjective manifestations of their disability, such as physical pain or encountering places that limit mobility.¹¹ And, to complement this idea, scholars should disclose their relationship to disability, a practice I employ throughout this book.¹² Fourth, popular culture, including entertainment media and journalism, is a resource for discussing the nature of disability. Mass media imagines disability through discourses and portrayals, and thus they are a tool to describe disability, for good or for ill. Video games would certainly qualify as mass media: by almost any metric they are one of the most popular media forms.¹³ Fifth, mixed methodologies, meaning a variety of research approaches and questions, better access and assess the meanings found in popular media and everyday life.¹⁴ Pioneered in the field of cultural studies, a mixed methodologies approach would suggest that scholars study “media texts not in relative isolation, but together with their industrial conditions of production, the social, political, and material contexts of their reception, and the active participation of audiences in producing meanings—all as interrelated phenomena.”¹⁵ This book takes a mixed methodological approach to its subject matter, engaging in a variety of research approaches including discourse analysis, design assessment, autoethnography, and grounded theory, among others.

What Is Normal?

The concept of “normal” is a social tool. As Michel Foucault wrote, “The judges of normality are present everywhere.”¹⁶ It categorizes some things as “regular” or “natural” or “expected,” while other things are “irregular” or “unnatural” or “unexpected.” Unfortunately, it is easy to wield this tool in harmful ways, even unintentionally. Normal often manifests as a means to manage power, exert control, maintain influence, or keep certain people out and other people in. The problem with “normal” is that it is not just descriptive in function but prescriptive as well. Other writers have eloquently addressed the idea of normalcy and its relationship to disability.¹⁷ And while I have already hinted at this issue in the previous section, the problem with normal merits a foundational summary here given that the central premise of this book rests upon a working knowledge of the relationship between normalcy and society.

To begin, Foucault provides a useful foundation for any discussion about normalcy in his book Discipline and Punish.¹⁸ While the primary question of the book concerns the rise of prisons as a social institution, its broader exploration is of normalization. And when it comes to how societies make “the normal,” there is one driving morality in modern culture: discipline. Discipline appears and migrates to wherever it is needed in society, so to speak, and these disciplinary techniques “like all forms of power—operate on our bodies.”¹⁹ Imagine a school that requires students to follow certain rules when moving between classes or traversing the hallways. Persons in power may be able to observe some students, and therefore enforce those rules, but only in a relatively small part of the school’s physical space. To mitigate this limitation, students are enlisted to act as monitors to report improper behavior, thus spreading observation to nearly every corner of the building and during every moment of the school day. Disobedience is thus reported, and the offending students receive their punishments since “at the heart of all disciplinary systems functions a small penal mechanism.”²⁰ Punishment, at its very core, is “corrective.”²¹ All parts of our bodies undergo correction through systems of discipline and punishment, from their attitudes to their habits and instincts, and thus societies create “normal” denizens. Even our limbs, our eyesight, and other parts of our bodies enter this matrix of discipline. Foucault called this biopower “a distinctly modern form of power that involves the subjugation of bodies and control of populations through the regulation of life rather than the threat of death.”²² Imagine a student who cannot properly hear the teacher due to an undiagnosed hearing disability: they may receive medical interventions, yes, but also a regimen to follow regarding hearing aid maintenance and where to sit in class and who to speak with to receive updated lecture notes and so on. If they do not follow those prescriptions, as observed by anybody in power, they would certainly be “punished” in the corrective form of the word.

It may be useful to imagine discipline and punishment—as social functions to create normalcy in denizens—not as reactions to disobedience but as purposive attempts to create conformity. And in this process, especially in institutions such as the military, employment, school, hospitals, and such, people are summarized as “case histories”: criminal records, academic transcripts, résumés or CVs, letters of recommendation, among others, to document how successful these institutions have been in correcting people into normalcy. These systems produce “more or less normal subjects—individuals with certain life experiences, personal identities, self-concepts, emotional responses, bundles of habits and beliefs, and so forth,” as Ladelle McWhorter summarizes.²³

Disability and mental illness enter the conversation as the outliers to the normal, as abnormal subjects or what Foucault calls “residual.”²⁴ Disciplinary institutions, like those mentioned above, must always face the “external frontier of the abnormal.”²⁵ In other words, they “come up against those who cannot be classified, those who escape supervision, those who cannot enter the system of distribution, in short, the residual, the irreducible, the unclassifiable, the unassimilable.”²⁶ In terms of disability and mental health, this confrontation of the residual often occurs in a child’s schooling: a child who cannot assimilate, cannot be corrected properly, physically or behaviorally, is therefore transformed into “the residue of the feebleminded or mentally defective child.”²⁷ And thus entirely new institutions crop up that concern themselves with the disciplinary residue: “Since there are feeble-minded, that is to say, individuals inaccessible to school discipline, schools for the feeble-minded will be created, and then schools for those who are inaccessible to schools for the feeble-minded.”²⁸ And children who institutions dub as delinquents or criminals will follow a similar path: residual programs and other programs for children who do not properly conform to those residual programs. It is turtles all the way down. McWhorter offers a fantastic summary of the entire issue: “We live in a normalizing society, [Foucault] contends, a society that insists on normality, all the while generating new forms of abnormality. We live in a society where abnormality is feared, where abnormal individuals are often considered sick and dangerous and legitimately subject to all sorts of constraints, and where normal people work very hard to avoid getting labeled abnormal because we all know what happens to those who do.”²⁹ Our societies create the normal as well as the abnormal, and these institutions make it so that people with disabilities or mental illnesses cannot, by definition, fit inside the suffocating bubble of normalcy.

This is how media matters: media reflects cultural norms while also creating them. Or, as Lennard Davis argues, “The problem is the way normalcy is constructed to create the ‘problem’ of the disabled person.”³⁰ If normal is the problem, one way that this problem emerges is through the normalizing power of mass media portrayals. Depictions of people with disabilities, in both entertainment and news media, often rely on harmful tropes that paint a picture of disability as scary, utterly different, and wrong, “an absolute state of otherness that is opposed to a standard, normative body.”³¹ Similarly, media portrayals of mental illnesses also tend to be quite poor. Entertainment media is rife with stigmatizing depictions of mental illness, often making mental illness a justification for villainy or violence.³² Otto Wahl also finds that news media presents people with mental illnesses as dangerous, all the while more positive portrayals of mental illness are practically nonexistent.³³ More surprising is Wahl’s finding that these negative portrayals of mental illness affect public opinion, often translating into policies that unfairly impact people with mental illnesses.³⁴ Heather Stuart reiterates these findings: not only are media representations of mental illness overwhelmingly negative, but they also lead to an overall reduction in help-seeking behaviors, self-esteem, general recovery, and medication adherence.³⁵

Inaccurate representations of disability and mental illness create a false dichotomy between what is “normal” and what is supposedly the abnormality of disability. Harmful or inaccurate portrayals not only situate disability or mental illness as abnormal or wrong, but media also gives us a shared language to understand ourselves and our identities. In other words, people with disabilities or mental illnesses often do not have the most helpful selection of portrayals to “negotiate” their “repertoire of social meanings.”³⁶

Mental Health, Illness, and Disability

While disability and mental illness share many similarities in how mass media portray them—mostly as something scary or villainous—there appear to be a vast number of other similarities that marry the two concepts in this book. However, a primary limitation of this project is that there exists no unified term to describe corporeal otherness—insofar as it relates to our bodies’ abilities—that also overtly includes mental health and illness. Using separate terms—“disability” and “mental health/illness”—has the unintended effect of differentiating between them when it appears they have a great deal in common. Of course, there exists codified mental disabilities, learning disabilities, and behavioral disabilities, but it should be noted that mental health merits inclusion in a project on disability. Examples abound in which mental health and mental illness become indistinguishable from disability. For instance, in the United States, significant mental illness is justification for the government to provide disability services and support. And colleges and universities in the United States offer disability accommodations for people with diagnosed mental illnesses such as chronic depression and anxiety, making no distinction between those conditions and other disabilities that merit accommodation. But I cannot simply refer to all mental health challenges or mental illnesses as “disabilities.” The terms, and how people commonly use them, preclude that: someone with a severe yet isolated and recoverable bout of depression would certainly not claim they have a disability.

My decision to include mental health and mental illness in this project stems from what culture expects of our bodies in terms of abilities. For example, there exists an unspoken expectation that “normal” bodies should be able to use their fingers to comfortably operate a smartphone, even though plenty of people have difficulties using smartphones as currently designed, including those with physical or cognitive disabilities. Similarly, there exists an unspoken expectation that “normal” bodies should be able to wake up by 6:30 in the morning to get ready for work, perform their work obligations without issue, and energetically enjoy their free time at home afterward. But that is not the reality of people with severe depression or anxiety. Those unspoken cultural expectations of “normal” bodies intimately tie disability to mental health and mental illness. There is an unmistakable similarity to how mental illness seems to separate people into an unofficial group, a group with bodies that culture considers “abnormal.” And it is a specific type of “abnormal”: it is the “abnormal” of health and function and physicality, the same “abnormal” wherein disability resides. While our conception of mental illness continues to function separately from the term “disability,” they both exist in the same sphere. Still, the tension between mental illness and disability is why I separate them in each of my case studies: there still exist unique characteristics between those phenomena to merit individualized study. At the core of it all, the question remains the same for both: How do video games matter to people whose abilities—both mental and physical, if there is any real difference between the two—exist outside cultural expectations of ability?

For the remainder of the book, when I am addressing the subject matter at its broadest—including mental health—I will often simply write “disability” and trust that the reader understands the implicit differences between disability and mental illness.

How Do Video Games Matter to Disability?

Digital games have evolved from relatively simple arcade pastimes to a fundamental part of everyday life. Video games exist in nearly every cross section of society: they are in living rooms and on smartphones, in cars during road trips, and on the train during the morning commute. A keen eye can even spot them in the sacred halls of a church wherein bored parishioners pass the time on their phones. Simply put, video games are a massively popular form of media that exists in the everyday lives of people of all ages. Of all game players in the United States: 21 percent are under eighteen, 38 percent are between eighteen and thirty-four, 26 percent are thirty-five to fifty-four, 9 percent are fifty-five to sixty-four, and 6 percent are sixty-five or older. Of all Americans, 75 percent “have at least one video game player in their household.”³⁷ Of the approximately 214.4 million Americans who play video games, 41 percent of those players are women and 59 percent are men. The video games industry is both massively popular and profitable. For the past ten years, “the video game industry has earned more money than Hollywood and the music industry combined.”³⁸ The United States has surpassed China as the largest gaming market in the world.³⁹ To put these numbers into perspective, the highest grossing movie of all time, at the time of writing, was Avatar with $2.92 billion. But Grand Theft Auto 5 (Rockstar North, 2013) has grossed over $6 billion, over twice what Avatar made.⁴⁰

Researchers and journalists have taken note of gaming’s place in culture, and there are a plethora of gaming news sites and a burgeoning, interdisciplinary academic field of game studies in colleges and universities across the globe. So, what does game studies research have to say about disability? There exists a primary concern with how video games may function as medical interventions for people with disabilities. As examples, look to the work of Oana Balan, Alin Moldoveanu, and Florica Moldoveanu who describe how audio-based games may help people with blindness improve tasks that require navigating spaces.⁴¹ Or look to Pamela Kato’s work on improving physical performance or Karen Stendal’s research on how games can aid in rehabilitation and increased feelings of empowerment for people with disabilities.⁴² Researchers are particularly interested in how video games may help students with learning disabilities.⁴³ Regarding mental health, a similar focus on the medical or pathological remains a consistent feature in games research. For instance, some research suggests that games may act as a non-pharmacological intervention for people with dementia, military veterans, and people who may have anxiety, insecurity, and depression.⁴⁴ Many scholars have researched gaming behaviors, compulsion, and addiction: some pathologize gaming while others offer a more nuanced discussion of the matter. For instance, see the excellent work by Soonhwa Seok and Boaventura DaCosta or Sukkyung You, Euikyung Kim, and Donguk Lee regarding the correlations between gaming habits and some negative social behaviors.⁴⁵ However, Kelly Bergstrom argues against alarmist notions of gaming addiction, and work by Trent Bax and additionally Alex Golub and Kate Lingley offer compelling reasons to avoid diagnosing compulsive gaming.⁴⁶

While a medical approach to studying video games and disability is certainly beneficial, they are not the be all and end all of how games matter to disability and mental health. Instead, as this book argues, games are fundamentally changing what disability means, both to those with disabilities and to culture at large. In this vein, some game studies research addresses how video games have portrayed disability and mental illness, which is a topic I return to—and more fully address—later in this book.⁴⁷ That discussion only just begins to answer the larger questions in this project: How do video games matter to disability and mental illness? How do video games change what disability and mental illness mean? How does the physical nature of video games inform our understanding of mental and physical ability? How is the games industry changing to meet the demand for more accessibility? And ultimately, how do video games alter the nature of our abilities? What does ability mean in the age of video games? To answer these questions, my goal is to map a variety of locations in video game culture regarding disability and mental health. And that map can best be understood when viewing games as ability machines.

Ability Machines

Machines make things. The word “machine” inspires visions of industrial-grade conveyor belts, metal presses, and larger-than-life tools that whir, spin, and slam to produce the constructed world around us. And this imagery makes the word a powerful metaphor for making, specifically a metaphor for media. Much like industrial machines, media constructs the world around us. News media provides us with a tinted window through which to view our societies. Entertainment mass media produce worldviews, values, and verisimilitudes. Media machines do not make metal contraptions or buildings or gadgets. Media machines make perspectives. They interact with our minds to produce, and reproduce, systems of thought.

Roger Ebert, the acclaimed movie critic, famously promoted movies as a type of machine in a speech in 2005. He said:

For me, the movies are like a machine that generates empathy. If it’s a great movie, it lets you understand a little bit more about what it’s like to be a different gender, a different race, a different age, a different economic class, a different nationality, a different profession, different hopes, aspirations, dreams and fears. It helps us to identify with the people who are sharing this journey with us. And that, to me, is the most noble thing that good movies can do and it’s a reason to encourage them and to support them and to go to them.⁴⁸

Regardless of the validity of the claim, Ebert cemented the metaphor of movies as empathy machines, and that quote has spread among cinephiles for a good reason. It describes the product of movie watching, whether it is accurate or not. It sees movies as a machine that produces human perspectives. And doesn’t the phrase feel just right? Movies are empathy machines. And even if they do not successfully produce empathy, they invite us to investigate movies for how they fulfill that purpose.

I call video games ability machines for similar reasons. I claim that video games change how we understand our abilities. And both games and games culture invite us to investigate how games produce new perspectives on our abilities. These abilities are not limited to physical movement: cognitive disabilities, mental illnesses and health, and all aspects of our abilities fall under these new perspectives.

The term stems from various concepts related to disability and game development. First, the word “machine” draws from disability’s long-standing relationship with emerging technologies, such as accessibility equipment.⁴⁹ Second, Jesse Schell calls some games “story machines.”⁵⁰ He writes in his book The Art of Game Design about how games allow players to generate their own stories through open decision-making, interactivity, personal struggle, and emotional investment. The term “story machines” is a useful lens through which to investigate the product of playing games. Third, the related term “state machine” is used both in mathematics and game development. Specifically in game design, a state machine separates actions a game character can perform and places the character in distinct states depending on the context. It is the difference between a character being in combat mode versus climbing mode. Developers want to allow players to change how they interact with the game depending on which state the game exists in, and thus state machines organize that process.

Ability machines, as a term, is a lens through which we can view gaming as a cultural phenomenon. And my goal with this lens is to focus attention on ability. When a game forces a player to change how they normally manipulate their fingers, that is an ability machine. When gaming news reconstructs what accessibility means, that is an ability machine. When a game includes more and better-designed accessibility settings to include a wider array of abilities, that is an ability machine. When streaming gameplay alters how a person with disabilities views their disabled identity, that is an ability machine. When game development affects the mental health of workers, that is an ability machine. When the act of making a game helps a person work through personal trauma, that is an ability machine. When games produce interactive depictions of people with disabilities or mental illnesses, that is an ability machine. This perspective, or this idea of ability machines, is not the answer to everything games do. But everything games do can indeed be examined through the lens of ability.

The Structure of This Book

The case studies in this book do not account for every aspect of gaming as a phenomenon: that would be a never-ending project well outside the scope of a single volume. Instead, I have chosen several areas that I consider key to understanding what video games mean to our abilities and bodies: accessibility in games, game work such as in streaming or development, and interactive portrayals of ability. My hope is that, when read as a whole, they act as a foundation for how researchers, journalists, and even game makers think about disability. Throughout the chapters I will return to the concept of games as ability machines, or software and hardware that produce a reimagined state of our bodies’ agency.

The book is divided into three sections, each consisting of case studies exploring that specific area of ability machines. The first section is titled “Accessing Ability,” and it includes case studies about how accessibility in video games expands cultural conceptions of ability. The second section is “Producing Ability,” and it delves into how games operate as ability machines in game development and live streaming. “Depicting Ability” is the final section, and it consists of two case studies about games’ use of ability—through interactivity—to portray ability. Many of the chapters refer to my previously completed research: and while those who have read my past work will find that the chapters review some of that material, they will also find additional insights as I push beyond my previous findings to address the subject at large.

Before each chapter, I include an interview with an expert, advocate, or industry insider. Many of these interviewees have disabilities, and all of them love video games. These interviews include disability advocates, accessibility consultants, game designers, and one mental health professional. The intent behind including these interviews is to relate the research material to the conversations already taking place among prominent individuals in games culture.

The first two chapters address how accessibility in video games fundamentally defines abilities. Chapter 1 investigates gaming journalism for how it communicates about disability and accessibility. Games journalism websites are plentiful, popular, and prosperous, and they cover every aspect of gaming, including e-sports, popular streamers, design, hardware, sales, emerging phenomena, game reviews, and the games industry. Games journalism exists at the center of game culture because it both reflects trends or opinions as well as directs game culture as thought leaders. Journalism is discourse: a matrix of communication that constructs culture while it attempts to describe it. Chapter 1 investigates disability and accessibility through a discourse analysis of articles from gaming news websites. It showcases how we write, talk, and culturally engage with the ideas of “disability” and “accessibility” and how changing these conversations is essential to unlocking games’ ability to improve people’s lives. The study targets how journalism contributes to understandings of accessibility and disability in gaming, specifically addressing six themes: gamers with disabilities, portraying disability, game design, game controllers, generalizing accessibility, and advocacy. These themes reveal several prominent attitudes regarding disability and accessibility in gaming culture, including a tendency toward self-congratulation instead of self-reflection on the challenges faced by people with disabilities. Games journalism tends to fetishize and tokenize gamers with disabilities while also describing the act of “raising awareness” as an adequate level of advocacy. Despite the other prevailing attitudes, there still exists in these discourses a desire to provide practical solutions to improve the lives of people with disabilities.

Chapter 2 continues this conversation by examining how games actually approach accessibility in design. Game design is at the core of all gaming phenomena because design choices dictate the possible range of experiences for players, and design therefore changes what video games, and gaming culture, can mean. The chapter asks how games can improve their design regarding accessibility in order to extend the reach of gaming to the greatest number of people. Video games are ability machines in that through innovative interactive design they can allow people of all abilities can play them. I describe research that evaluates a large number of games for their accessibility, and the results highlight design pitfalls and innovations in four key areas: auditory, visual, motor, and difficulty accessibility. I advocate for what I call the ground floor of accessibility for video games, meaning the lowest possible expectation we should apply to gaming accessibility.

The next three chapters in the “Producing Ability” section uncover the myriad ways that ability machines extend beyond gameplay and into streaming and game development. Chapter 3 investigates the strategies video game streamers with disabilities employ to navigate their identity as gamers and as persons with disabilities. The study examines video interviews and mini-documentaries featuring streamers with disabilities, and it reveals how these specific streamers establish their identities as both people with disabilities and as gamers. The streamers go to great lengths to establish themselves as “legitimate” gamers while also explaining how video games influence how they see themselves as people with disabilities. The chapter sheds light on the ongoing mutual creation and transformation of gaming and disability identities on the internet. I also examine the role of streaming as a gaming practice that extends identities and abilities online, well beyond the scope of simply playing games at home.

Chapter 4 investigates how game work, specifically streaming and game development, relates to an industry-wide mental health crisis. It first looks at the physical and emotional strain of game streaming, how game streaming is a form of emotional labor, and some of the tragic consequences of the mental health crisis streaming has created. The chapter continues by focusing on the gaming industry and how prominently crunch time, burnout, and other work-related issues regarding mental health appear in games journalism. The chapter presents a discourse analysis of eighty-three articles from four popular video game news websites. The findings reveal seven themes for how games journalism addresses mental health and illness, but special attention is paid to how the articles describe the notions of burnout and crunch time, or the expectation to work overwhelming hours to finish a game near its deadline. The chapter relates how these work practices relate to mental health and illness. The findings are stark: over half of the articles showcase issues of game character portrayals while only seven of the articles described burnout and crunch time as being related to issues of mental health. The analysis suggests that there exists an overemphasis on both celebrating and critiquing video game portrayals of mental illness and an underemphasis on advocacy and work-related issues in the games industry. The chapter then extends these ideas through a discussion of games industry practices, what can be changed in the industry, and what some companies are doing to combat burnout and crunch time.

Chapter 5 examines the game design process itself. Just as game streaming exists as an extension of gameplay, so does the act of making games. And the chapter explains how the game design process extends the role of games as ability machines by providing a game-based avenue to understand and communicate about mental health. The chapter is an autoethnography of my experience designing a game based on issues of mental health and illness. It builds on previous work on the theory of reparative game design to argue how the process of designing games, especially empathy games, is a worthy extension of how games act as ability machines: they can offer healing by providing a means of communicating to others who have had similar experiences.⁵¹ While empathy games may fail at inducing empathy, they provide a voice and community to people with mental illnesses through the act of designing the games.

The book’s final two chapters, in the section “Depicting Ability,” examine depictions of mental health and disability in video games, specifically targeting how games present an ability-focused avenue to portraying characters. In other words, interactivity and other features specific to video games portray disability and mental illness differently than any other medium, and understanding how games use “ability” (specifically interactivity) to showcase “ability” (specifically disability and mental illness) is essential to grasping how games operate as ability machines. Chapter 6 discusses the primary methods of interactively—not just narratively—portraying disability in games in order to discover how they can reimagine disability in a digital realm where almost anything seems possible. My focus on interactive design, not simply character portrayals, is what sets it apart from other research on depicting disability. Video games require physical interaction by players, and therefore players may feel a sense of agency in the game world. That agency is ability. The chapter specifically examines a small number of games in order to perform in-depth design analysis and that analysis reveals shortcomings and innovations in how games can invigorate notions of disability in culture.

Chapter 7 follows suit with a comparable study of mental illness portrayals in video games. The analysis offers an evaluation of how video games might improve in how they depict mental illness, with the chapter specifically identifying how these games use audiovisual styles, control systems, game goals, and interactive design. After summarizing the research, the chapter addresses additional interactive design choices for how they can improve games as ability machines.

I conclude the book with an epilogue. I synthesize the findings in the previous seven case studies to tease out the implications of video games as ability machines. Given the feed-forward nature of many of the chapters—pointing toward how culture, media, and theory can improve in the future—the conclusion provides guiding questions for game producers, journalists, and researchers as we continue to reevaluate how we think about video games, our bodies, and the nature of ability.

Notes

1. Burton, “So I Tried . . . Celeste,” para. 3.

2. Grammenos, Savidi, and Stephanidis, “Designing Universally Accessible Games,” 2.

3. Handi the Gamer Counter-Strike Twitch Player // 60 Second Docs. 2017. 60 Second Docs. https://www.youtube.com/watch?v=-W_U0ditU90.

4. Priestly, Finkelstein, and Davis, “Fundamental Principles of Disability.”

5. See Shakespeare, “The Social Model of Disability” and Corker and Shakespeare, Disability/Postmodernity.

6. See Barnes, Disabling Imagery and the Media; Norden, The Cinema of Isolation; and Garland-Thompson, “Seeing the Disabled.”

7. Snyder and Mitchell, Cultural Locations of Disability, 168–169.

8. Ellcessor and Kirkpatrick, Disability Media Studies.

9. Garland-Thompson, Extraordinary Bodies.

10. Charlton, Nothing about Us without Us.

11. Wendell, The Rejected Body.

12. See O’Toole, “Disclosing Our Relationships to Disabilities” and Linton, Claiming Disability.

13. “2020 Essential Facts: About the Video Game Industry.” 2020. Entertainment Software Association, http://www.theESA.com. https://www.theesa.com/esa-research/2020-essential-facts-about-the-video-game-industry.

14. See D’Acci, “Cultural Studies, Television Studies, and the Crisis in the Humanities”; du Gay et al., Doing Cultural Studies; and Johnson, “What Is Cultural Studies Anyway?”

15. Ellcessor, Hagood, and Kirkpatrick, “Introduction,” 14.

16. Foucault, Discipline and Punish, 304.

17. See Davis, “Constructing Normalcy”; McRuer, “Compulsory Able-Bodiedness and Queer/Disabled Existence”; Davis, The End of Normal.

18. Foucault, Discipline and Punish.

19. McWhorter, Racism and Sexual Oppression in Anglo-America, 46.

20. Foucault, Discipline and Punish, 177.

21. McWhorter, Racism and Sexual Oppression in Anglo-America, 48.

22. Brown, Regulating Aversion, 26.

23. McWhorter, Racism and Sexual Oppression in Anglo-America, 50.

24. Foucault, Psychiatric Power.

25. Foucault, Discipline and Punish, 183.

26. Foucault, Psychiatric Power, 53.

27. McWhorter, Racism and Sexual Oppression in Anglo-America, 50.

28. Foucault, Psychiatric Power, 54.

29. McWhorter, Racism and Sexual Oppression in Anglo-America, 51.

30. Davis, Enforcing Normalcy, 24.

31. Snyder, Brueggemann, and Garland-Thompson, “Introduction,” 2; see also Barnes, Disabling Imagery and the Media; Norden, The Cinema of Isolation; Garland-Thompson, “Seeing the Disabled.”

32. See Diefenbach, “The Portrayals of Mental Illness on Prime-Time Television” and Wahl, “Depictions of Mental Illness in Children’s Media.”

33. Wahl, “News Media Portrayal of Mental Illness.”

34. Wahl, Media Madness.

35. Stuart, “Media Portrayal of Mental Illness and Its Treatments.”

36. Snyder and Mitchell, Cultural Locations of Disability, 169.

37. “2020 Essential Facts: About the Video Game Industry.” 2020. Entertainment Software Association. www.theESA.com. https://www.theesa.com/esa-research/2020-essential-facts-about-the-video-game-industry.

38. Mitic, “Video Game Industry Revenue Set for Another Record-Breaking Year.”

39. Global Games Market Report. 2010. Newzoo, https://resources.newzoo.com/hubfs/Reports/2019_Free_Global_Game_Market_Report.pdf.

40. Clark and Lynch, “The 10 Highest-Grossing Movies of All Time, Including ‘Avengers: Endgame.’”

41. Balan, Moldoveanu, and Moldoveanu, “Navigational Audio Games.”

42. See Kato, “Video Games in Health Care” and Stendal, “How Do People with Disability Use and Experience Virtual Worlds and ICT.”

43. See Marino et al., “UDL in the Middle School Science Classroom” and Marino and Beecher, “Conceptualizing RTI in 21st-Century Secondary Science Classrooms.”

44. See Cutler, Hicks, and Innes, “Does Digital Gaming Enable Healthy Aging for Community-Dwelling People with Dementia?”; Banks and Cole, “Diversion Drives and Superlative Soldiers.”; and Griebel, “Self-Portrayal in a Simulated Life.”

45. See Seok and DaCosta, “Problematic Mobile Gameplay among the World’s Most Intense Players” and You, Kim, and Lee, “Virtually Real.”

46. See Bergstrom, “Temporary Break or Permanent Departure?”; Bax, “‘Internet Gaming Disorder’ in China”; and Golub and Lingley, “Just Like the Qing Empire.”

47. See Carr, “Methodology, Representation, and Games”; Carr, “Ability, Disability and Dead Space”; Derby, “Virtual Realities”; Banks, Mejia, and Adams, 100 Greatest Video Game Characters; and Dunlap and Kowert, “Mental Health in 3D.”

48. Rogerebert.com, “Video: Roger Ebert on Empathy.”

49. Roulstone, Disability and Technology.

50. Schell, The Art of Game Design.

51. Stone, “Time and Reparative Game Design.”