DR: Three factors converged to inspire Elude. I had just presented a game on substance abuse (Akrasia) at the Games 4 Health conference in Boston. A child psychiatrist (Atilla Ceranoglu) was in the audience. He approached me afterward and said, "That's cool, let's make a game together!" I was going through a rough time myself and an acquaintance had recently committed suicide (a suicide he had announced on Facebook). All of this happened at the same time and so it seemed obvious to make a game that helped communicate to friends and relatives of people with depression what it's like to help fight stigma and promote support.

MB: Is the game successful at helping players to empathize with someone who's depressed, and how do you know?

DR: We tested the game a lot when we developed it, making sure we got it in front of friends and relatives of people with depression. Afterwards, it was picked up by many self-help blogs where friends and relatives could access it. I still receive emails from people from all over the world (including Thailand, Singapore, Europe and the U.S.) who played the game and want to share their experiences. It has also been used in nursing education by Barb Harris at DePaul University.

My evidence is anecdotal but based on a wide player base. What I heard consistently from players who don't suffer from depression themselves was, "I felt like I didn't have a choice. All of a sudden, when those vines came after me and dragged me down, I was helpless. I couldn't do anything!" They say this with a realization that depression is not a character weakness. The loss of agency is very real. Often, friends and relatives of people with depression experience tremendous anger and frustration that their loved ones can't "pull themselves together." Understanding that it doesn't feel like that's an option is key to a better dialogue and more empathic relationship.

MB: What's unique about trying to understand depression by playing Elude, as opposed to, for example, reading about someone's personal experience with the condition?

DR: Elude uses games' capacity for embodied learning. Players submit to the rules of the gameworld, which model the inner landscape of someone with depression. "What it feels like" becomes the law in this world, as real as gravity. As the player, it is your happiness that is now constrained, your agency. Sinking deeper and deeper into the quicksand of despair is your reality. That's what other media cannot portray.

Elude creates this sensation by first modeling happiness, letting the player soar higher and higher through a sunny sky using leaves and flower petals as footholds. Then it slows and drags the player down through the tree canopy and into the darkness, modeling the loss of capacity for happiness in a tangible way. And there is no way to just "try harder" to break out of this stuck place because the rules of the game—following the lived reality of depression—don't permit it.

I came to feel that the game should focus on this part of the experience, and not on the healing part. I wanted people who don't necessarily "get" depression to just sit with it for 5 minutes and allow it to be. People often want to "fix" the person with depression, but that devalues their experience and underscores that "something's wrong with you," so wrong that we can't even talk about it. Sometimes, being able to talk about it, accepting it the way it is, is crucial to establish a dialogue and relationship that is productive for change. That's why Elude focuses on conveying what it's like without offering a solution.

MB: What is your process for designing a game meant to inspire empathy in the player?

DR: I first need to understand deeply the reality that the game should model. I do a lot of background research. For Elude, I drew on my own experiences with depression but also did a ton of complementary reading to get a broader picture of what it felt like to others. I read William Styron's "Darkness Visible" and Julia Kristeva's "Black Sun." It was not a happy year! I also dug through a lot of clinical literature provided by Atilla Ceranoglu and we discussed his expert perspective on the issue. I had in-depth conversations with people who'd experienced depression, my subject matter experts (SMEs). I looked for metaphors in the language they used because our inner worlds are abstract and we often draw on metaphor to make them concrete.

Sometimes, I co-design with SMEs. We might make every design decision together, or I might derive a preliminary metaphor/rule system from SMEs' reports, prototype a game, and then let my SMEs play it and give feedback, on which I iterate.

The SMEs' feedback is essential but not the only factor in the design process. If the goal is for the game to convey to people without lived experience "what it's like," I also playtest with those people. They need to get it. If the experience the game models is too idiosyncratic, the metaphor too obscure, I have to find a way—with the SME—to make it more relatable. I firmly believe that everything can be made relatable. We are all, after all, humans. Our experiences may vary (sometimes A LOT), but we all carry everything within us. We just need some ways of accessing this deep, dormant understanding of the whole range of the human condition.

MB: When your goal for a game is to inspire empathy, how does that affect your design choices? I'm especially curious about the decisions around the main character, who appears to be a teenage boy.

DR: We could have just as well designed the main character to be a teenage girl and if we had had the time, we would have done both and let players choose. But we thought: it's a game. Teenagers play games. Teenagers often struggle with depression. So, if we make a game, our target audience is probably friends and relatives of teenage boys with depression who play games and use them to self-express, relate, explore. It made sense for the topic and the audience. We thought parents might be able to see their child in the character and other players might be able to see themselves. But yes, having a female version would have been good, too.

MB: What else do players need to do or know outside of this game to enhance their empathy for someone with depression? Why is the game alone not enough?

DR: The game is a good starting point, but its purpose is to foster dialogue. Nothing beats real, human interaction. Often this interaction needs a little nudge. We hope Elude can be this nudge by offering a shared experience that can then get people talking about it. The game can also help those with depression to "feel felt." I heard this often from players who have firsthand experience with depression. They know the designer gets it. Someone gets it. They are not alone. But then this needs to spread to their friends and family and possibly even strangers.

MB: Why should game developers design for empathy, and how can they do it better?

DR: Games are great media to enable embodied experiences because players learn through consequences of their actions and can experience inner worlds by submitting to their realities. It's extremely powerful to see life through someone else's eyes (at least salient aspects of it and for the time of the game). But it all starts with listening, with being truly open to the experience the game aims to convey. It is easy to project and assume, and when you do that, what the game depicts has little to do with "what it's like" for the single mother, the refugee, the person with an eating disorder, or the teenager who thinks she's just no good at math because math is not for girls.

Design approaches should be participatory, including people with the actual, lived experience as experts. To design for empathy, you need to have empathy yourself first. You need to make room for the reality of others and make it your job to understand it as fully as possible. It's a great "no-ego" exercise. And this leaks into other areas of life, too. Making a lot of empathy games is a powerful way to adopt empathy as a permanent mindset. I think creating empathy games so more people can play them and learn something from them is important, but it would be just as important for people to learn how to design empathy games themselves.