Dementia in diegesis

Signifying progressive loss of self in Dark Souls

Ruud Jacobs is an Assistant Professor in the Department of Communication Science at the University of Twente (the Netherlands). He researches the persuasive effects of serious games from a mediapsychological perspective. Follow the author on Twitter

Lieke Segerink is a Lecturer in Psychology at the Saxion University of Applied Science (the Netherlands). Her background is in cognitive neuropsychology, and she has worked in diagnostic teams at elderly care facilities that focus on dementia and rehabilitation after acquired brain injury.

Despite its reputation for being hard, Dark Souls (FromSoftware, 2011) might be described more fittingly as harsh. The original action role-playing game and its successors (FromSoftware, 2014, 2016) largely leave players in the dark on what to do and where to go. The worlds these games are set in seem to be oblivious to the player’s presence at best and deliberately inaccessible at worst. They offer little in the way of tutorials, players are often blindsided with traps and aggressive enemies, and the games’ few cutscenes are cryptic to the point of obtuseness for new players (Fahey, 2011). Indeed, players who reach the end credits for the first time – ecstatic as they may be to have made it through – often have no idea what it is their actions have accomplished in the grand scheme of things (Sullivan, 2016). This harshness is both a product and cause of the games’ melancholic atmosphere, which takes more than a little inspiration from real-world woes.

In this essay we will describe the ways in which the Dark Souls series’ visual and mechanical designs lean on symptoms and experiences of mental illness to signify a loss of self as a tragic theme. Although the series is frequently discussed in relation to depression (MacDonald & Killingsworth, 2016; Writing on Games, 2016), we posit that the games’ imagery and designs most closely fit dementia, which as a medical term describes an often progressive decline in mental abilities that nevertheless shows considerable overlap with depression (Alzheimer’s Association, 2018). Indeed, multiple blog posts and forum threads have touched upon how the game made players reflect on their personal experiences with Alzheimer’s disease (Hireling, 2014; Knee, 2018; Rowen, 2013). We will show how the games employ dementia-related imagery by examining their visual and narrative cues, as well as arguing how its overall design explicitly simulates loss of self to motivate players.

Visualizing the undead plight

Dark Souls’ opening narration speaks of an undead curse. The undead perpetually reanimate after dying, destined to eventually go hollow and lose what made them human. Although newly cursed undead are in possession of all their faculties, they slowly start to unravel. Rather than a shift between dichotomous states, ‘going hollow’ signifies a progressive degeneration. As Destructoid user Wrenchfarm describes (Rowen, 2013), this process is seen in different stages with NPCs in Lordran, the setting of the first game. New arrivals to this ‘land of ancient lords’ such as Griggs of Vinheim – a young undead sorcerer in search of his missing master – are ambitious and proactive, though they cannot always remember how they came to be there. Dark Souls II’s opening monologue indicates the same is true for that game’s setting, the kingdom of Drangleic: “one day, you will stand before its decrepit gate. Without really knowing why. Like a moth drawn to a flame” (FromSoftware, 2014). More senior denizens such as the Undead Female Merchant switch back and forth between paranoia and euphoria, alternately cursing the player and laughing away their grim surroundings. Severely hollowed NPCs do not speak and are often hostile to the player. Congregating in densely populated areas, such as the Undead Burg (in Dark Souls) and the High Wall of Lothric (in Dark Souls III), still gripping the swords they brandished as soldiers, they thrash around in mobs, grunting and screaming at the player, seemingly no longer in full control of their actions. Finally, there are hollows that lack even the will to attack (figure 1). Players venturing down from the first game’s central hub area into the drowned ruins of New Londo, for example, will find hollows sitting in huddles or alone, clutching their heads in agony, stuck in a cycle of purposeless motions, or curling up in the fetal position.

A non-hostile hollow found in Dark Souls III’s second area, the High Wall of Lothric.

A non-hostile hollow found in Dark Souls III’s second area, the High Wall of Lothric.

All the behaviors of characters that are going hollow as well as the advancing nature of the illness reflect often-seen forms of dementia, such as Alzheimer’s disease. In a review of symptoms of dementia, Cereijeira, Lagarto, and Mukaetova-Ladinska (2012) note that the condition includes disturbances to psychological, perceptual, and motor skills. Individuals can start experiencing memory issues, as recollections of different times in life fade in varying patterns. For example, Alzheimer’s disease causes recent memories to fade while those of one’s formative years endure the longest (Hou, Miller, & Kramer, 2005). People diagnosed with dementia often alternate between apathetic and euphoric states and can easily become paranoid as gaps in their recollection cause confusion. Behavioral symptoms center around restless, agitated motions that include wandering around and performing rote behaviors over and over. The aggressive stage in the hollowing process has its real-world counterpart in the frustrated, emotional outbursts often seen in people with dementia, although most are nonviolent. Dementia lowers inhibitions, so the war-torn landscapes in which hollows find themselves could evoke defensive or aggressive behaviors. Moreover, all behaviors portrayed by hollows are indications of severe pain according to the Pain Assessment Checklist for Seniors with Limited Ability to Communicate (PACSLAC), which is used in care facilities to gauge quality of life of patients who can no longer express themselves verbally (Eritz & Hadjistavropoulos, 2011). The scale ranges from changes in the eyes, restlessness, and refusing to move as indicators of physical discomfort to more severe signs such as guarding a sore area, going limp, and assuming a fetal position.

Seeing nonviolent hollows is especially striking, as it underscores the fact that they are not the player’s enemy. Their minds are going, and we do not need the PACSLAC to recognize their deep anguish. Dark Souls II elaborates on this with the dramatic arc of Lucatiel of Mirrah. A proud warrior, she came to Drangleic after hearing of ways to stave off her own hollowing. Players find her resting near bonfires in different areas of the world over the course of a playthrough as she scours the land searching for her brother. After several encounters, Lucatiel reveals her fear of going hollow: “I’ve found my thoughts growing hazy. My memories are fading, oldest first. The curse is doing its work upon me. I am frightened… terribly so” (FromSoftware, 2014). Later, she explicitly acknowledges her ultimate fear:

Loss frightens me no end. Loss of memory, loss of self. […] I don’t want to die, I want to exist. […] Sometimes, I feel obsessed… with this insignificant thing called ‘self’. But even so, I am compelled to preserve it. Am I wrong to feel so? Surely you’d do the same, in my shoes? Maybe we’re all cursed… from the moment we’re born… (FromSoftware, 2014)

In their final encounter, Lucatiel begs the protagonist to remember her name before she disappears, presumably having gone fully hollow. Along with many (though not all) of the other NPCs in these worlds, Lucatiel was aware of her deterioration. Although dementia often induces anosognosia – the lack of self- and disease-awareness (Migliorelli et al., 1995) displayed by several other hollow NPCs throughout the series – even individuals with advanced dementia often have fleeting lucid moments where they evince a deep understanding of fighting a losing battle.

World-building loss of self

Far from being just tragic window-dressing, the undead curse also affects the series’ gameplay and narrative designs. Awakening in a strange land as the Chosen Undead, Bearer of the Curse, or Ashen One, the protagonists of Dark Souls I, II, and III all start their adventures undead and in varying stages of going hollow. Regardless of players’ efforts with the character creation menu before the game begins, player characters all start as a desiccated corpse with only vague, confusing references to a forgotten previous life (such as the opening narration to Dark Souls II that was mentioned before). Early in each game, players come upon a consumable resource that can be used to counteract the weathering effects of going hollow. This item is called ‘Humanity’ in Dark Souls I (and ‘Human Effigy’ and ‘Ember’ in the sequels, see figure 2). These items’ names and descriptions strongly imply that going hollow causes one to lose one’s humanity, equating effects of dementia with loss of what makes one human – a message that can be read as ableist and potentially harmful. Its effects are impermanent, staving off hollowing but not negating the curse itself. Although it is not possible to lose a player character to hollowing, the in-game effects of the hollowing mechanic consist of aesthetic changes and a handful of gameplay consequences (a smaller pool of health points and reduced multiplayer connectivity, among others) that motivate the player to hold onto their humanity.

Items counteracting effects of the undead curse across Dark Souls I, II, and III. From left to right: Humanity (DSI), Human Effigy (DSII), Ember (DSIII). Despite the shift towards a fire theme in the third game, the three items have comparable shapes.

Items counteracting effects of the undead curse across Dark Souls I, II, and III. From left to right: Humanity (DSI), Human Effigy (DSII), Ember (DSIII). Despite the shift towards a fire theme in the third game, the three items have comparable shapes.

Even though FromSoftware did not go so far as to model the moment-to-moment psychological experience of the player going hollow, the design of the games – especially the way information is presented to players – evokes confusion regarding the player character’s narrative motivations. The cryptic narration and comparative lack of handholding that set the first game apart (Fahey, 2011) are evidence of more than just a sadistic streak; these devices are used for deliberately incomplete world building. New players stepping into the games’ worlds without having pored over lore analyses (e.g. VaatiVidya’s videos) are left to piece together their character’s motivations from vague instructions to ‘ring the bells of awakening’, or ‘return the lords of cinder to their rightful thrones’. Snippets of information are also presented through the descriptions for items and weapons in the games’ menus. Lastly, players can leave each other brief messages such as ‘look down, wretch’, composed like fridge poetry magnets from a pool of verbs and nouns. Although this information might make the moment-to-moment gameplay a little easier, it is too scattered to help players understand the narrative as a whole. As a result, new players find themselves in a world they do not understand, surrounded by individuals who are equally confused and grasping for meaning. In this way, the obfuscated messaging mimics loss of self and undermines player agency. This carries through to the series’ multiple endings. Just as how Spec Ops: The Line (Yager Development, 2012) is known for using perceptual blind spots to push players to commit violent atrocities in the heat of the moment (Keogh, 2012), the way players interpret Dark Souls’ endings (as described by VaatiVidya, 2013) depends on what they have learned about the games’ worlds and their hegemonic structures – though even the most lore-hungry players can only guess what each ending means.

Pathologizing tragedy

The Dark Souls games are not the first to reference mental illness for dramatic effect, nor the first to link it to gameplay and narrative elements. They do differ in one key respect from games that have been recognized for their attempts to do so (for better or worse). Prior discussions of mental illness in gaming have focused predominantly on representation and portrayal. Shapiro and Rotter (2016) searched through wiki webpages of high-profile games to determine if mental illness tropes often used in other media have made their way into games. They found that people with mental illnesses are almost invariably presented as dangerous, violent obstacles to player progression or even as principal antagonists. Dunlap (2018) proposed a framework that differentiates between non-essential representation and deeper, more authentic depictions that are woven into a game’s plot. Lastly, a recent special issue of First Person Scholar on mental illness and disabilities in games (Jerreat-Poole, 2018) included discussions of how the portrayal of madness impacts gameplay in high-profile titles such as Hellblade: Senua’s Sacrifice (Stang, 2018) and The Sims 4 (Doell, 2018). Crucially, by being based on wiki search terms, character descriptions, and terms used in gameplay, these works are concerned with clearly telegraphed mental illness. When following the strategy of Shapiro and Rotter (2016) and entering their search terms on the series-spanning Dark Souls fandom wiki, a few hits indeed point to characters that the game’s text and fan descriptions refer to as ‘psychopaths’, ‘depressed’, ‘delusional’, ‘paranoid’, and ‘insane’. However, the term ‘dementia’ is used just once on the wiki as a fan muses about the origins of Merchant Hag Melentia’s name – an NPC in Dark Souls II who in fact seems to be in better control of her mental faculties than characters like Lucatiel of Mirrah. Dark Souls’ use of the thematic and worldbuilding elements discussed above are not part of an explicit discussion of mental illness. Dementia is not referenced for the sake of the illness itself. Instead, these elements are intended to contribute to the overall theme of loss and decay. Well-known symptoms and striking imagery of dementia personalize the experience of loss. Although this means Dark Souls’ representation of dementia is three-dimensional in Dunlap’s (2018) framework – the illness is crucial to the plot and reflects authentic experiences – in this sense, FromSoftware has pathologized the tragic themes the series is known for.

As far as we are aware, FromSoftware have not mentioned dementia in any communications regarding the series. Nevertheless, the series has sparked some discussion and reflection among its player base. Players have connected their Dark Souls gameplay experiences with the effects of dementia on their loved ones in several articles (Rowen, 2013; Knee, 2018) and a Reddit thread. In the latter, the thread’s creator even describes how recognizing this thematic link made them prefer one of the games’ endings over others, indicating that putting an end to the undead curse would be “the merciful thing to do” (Hireling, 2014). Of course, games as complex as the Souls series do not boil down to one theme or interpretation over all others. It has given some players struggling with depression a new perspective on their illness (MacDonald & Killingsworth, 2016; Writing on Games, 2016) and others the strength to weather painful and difficult periods in their lives (Allen, 2014). All of these meanings can be derived from the series’ worldbuilding, narrative design, and informational architecture. Dark Souls is harsh in terms of gameplay, but it also demonstrates that there can be empathy and healing even in our darkest times.



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