Should game developers avoid triggering players’ PTSD?

This post might contain triggers due to discussions of PTSD.

Photograph of an orange sky with dark clouds covering the sun and a flock of birds flying away.

It’s nice on a blog like this to be able to see a trigger warning and then make an informed decision about whether or not to read on. Edge magazine doesn’t give you the same luxury, instead in this month’s issue plunging you feet first into a graphic description of the Lara Croft sexual assault scene right at the start of the article. It’s a writing strategy perhaps intended to intrigue the reader and make them want to read on. Instead it caused me to curse loudly on a crowded train and then angrily throw the magazine on the floor in a kind of post-traumatic hulk smash reflex.

I want to pose a question. It’s not something I want to attempt to answer on my own, but it’s something I want to talk about.

The discussion about rape in games took an interesting turn when someone very generously wrote a difficult and emotional post for The Escapist explaining to the unaware what it feels like to hear the rape discourse in and around games if you are a rape survivor suffering from PTSD.

The writer didn’t say that game developers should avoid triggering his PTSD, rather that there should be a greater awareness of what rape survival is like, and a greater sensitivity in the wider gaming community about possible harm caused to the invisible masses of survivors.

Still, it’s worth considering the question: should game developers – and other media producers for that matter – be more careful to avoid triggering PTSD in their audience?

Black and white photograph of Loch Cluanie in Scotland. The lake appears to be black. Huge boulders are piled up in the foreground. There is no vegetation. The sky is heavily overcast, and dark mountains loom on the horizon.

This isn’t just about offending some players, as the anonymous Escapist writer points out – triggers cause a person genuine pain and harm, not just for the duration of the initial response (panic attack, anxiety, depressive mood) but sometimes for days afterwards, as the trigger opens a Pandora’s box of fear, self-doubt and anger. Triggers send you to a black pit of molten tar deep inside your psyche; it’s a dark place that you usually manage to avoid, but the ground there is so sticky and rotten that once you enter, it can take a very long time to wade back out again.

It’s lucky that there are so many PTSD-aware writers online now critiquing games that sufferers are able to find fair warning before a game unexpectedly throws them into the tar pit. But it’s frustrating to learn that a game much-hyped for its cinematic storytelling achievements might make you feel unwell. Insensitive use of traumatic content limits access to cultural products to only those people privileged enough not to suffer from mental health risks.

Is this fair or right? If a game developer makes the decision to include triggering content, knowing that it will cause a portion of the audience significant distress and pain, can that ever be an ethical decision?

Well, maybe. I don’t believe it’s as simple as do-no-harm. Will Luton argued a while ago that games should be able to explore difficult topics, and that any obstruction of this is against creative freedom. I’m inclined to at least partly agree with him.

It’s not reasonable to expect someone to recognise and remove any and all content that could serve as a trigger. The majority of triggers are nobody’s fault. Nobody did anything wrong or meant any maliciousness, they just unknowingly pushed an emotional button and left another person in a terrible state. It could be a particular facial expression, as mentioned in the Escapist post, or it could be a scene that the writer considered to be tender and romantic or graphically inexplicit but the viewer reads in a different way. Sensitivity on the part of writers can only help to an extent.

Screenshot of Sansa Stark from Game of Thrones TV show. Close-up of her face as she looks deeply unhappy and troubled.

Also, a story can contain triggers and still be a worthwhile journey. Certain Game of Thrones scenes unquestionably contain triggers, but I’ve been pretty satisfied with the show for dealing intelligently with questions of aggression, consent and agency. Getting through certain episodes of the show can be extremely challenging, but in the end I felt like I experienced some catharsis, because the show makes an effort to give a complex and difficult account of survival.

A good rule of thumb may be to include trigger flags alongside other content warnings on games. But content warnings can be so vague and all-encompassing that if you were to allow them to filter your media consumption you’d have little left to play with.

Another thing I’ve been wondering about is how the unique qualities of video games affect this problem. If the entirely passive experience of watching Game of Thrones can deal complexly with traumatic issues, then there is far more scope for similar complexity and perhaps even authenticity in more interactive media. Maybe a medium that ordinarily gives the consumer an unprecedented level of agency can deal most intelligently with situations where agency and autonomy are cruelly and mercilessly taken away. Video games could even raise awareness by simulating in the player-character the physical effects of the same post-traumatic symptoms they have in the past callously triggered.

Again, I don’t want to propose an answer to this problem. I’d rather have a discussion about it. But I’m left wondering if maybe the key question when dealing with traumatic content that could cause people pain is, ‘is it worth it?’ Does the triggering content in question achieve enough that it is worth paying the price of hurting people?

About Zoya

Zoya is a freelance writer and historian. Their particular interest is in video games: design, history, and how virtual worlds are inseparable from real-world social and economic networks. Zoya has written a book about the Dreamcast, is Editor of Memory Insufficient games history e-zine, and Deputy Editor at Gamesbrief.
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26 Responses to Should game developers avoid triggering players’ PTSD?

  1. prezzey says:

    One of the issues is that literally anything can be a trigger, so how do you decide what to warn for? Pick the most common ones?

    Also, in video-game-related discussion I usually only see trigger warnings for content that’s hypothesized to be triggering for women, but not for men, based on gender stereotypes. So there are warnings for rape, but no warnings for graphic war scenes (even though there are more and more women who are war veterans).

    • Zoya says:

      That definitely is an issue. I think some things are more obviously going to trigger, such as depicting events that traumatise.

      I don’t agree that rape triggers only affect women, but I completely see your point that graphic violence triggers are rarely labelled. And they should be. For content creators, I imagine that similar questions ought to be asked about war violence – does the content add enough depth to be worth hurting people?

      • prezzey says:

        “I don’t agree that rape triggers only affect women”

        That’s why I said gender stereotypes.

      • prezzey says:

        Oh sheesh I just scrolled up and now I think my comment looks really brusque. I should’ve added a smiley or something… Sorry, it wasn’t intended to be brusque. I think your post is interesting and discusses a very important issue, so I’d rather not scare you away from writing more! :]

    • Rakaziel says:

      Graphic war scenes or otherwise potentially triggering amounts of gore, mutilation and explosions are something the game usually tells you about before, often even advertises them. As such games like that are comparably easy to recognize and thus avoid.

      With rape it is a different matter, as it is more often something the player gets thrown into halfway through the game or when the developers wanted a cheap character motivation right out of the box.
      There is already a sexual content warning label pictogram, so going into detail whether rape is included or not would not require much extra work on the side of the publishers.

      The better solution, albeit requiring more work, would be to have an “exclude potentially triggering content” option in the options menu. It would only require a bit of programming and alternate cutscenes and dialogues without the triggering content.

      • Trodamus says:

        Given the subjective nature of triggers and the wide variety of emotional trauma that may produce them, such an option seems impractical.

        Rather, as mentioned below, a more generalized warning at the beginning of the game would be more suitable (as Silent Hill used to provide).

        “This game contains scenes which contain violence, abduction, murder and cruelty.” Or something.

  2. Alex says:

    Welcome, Zoya, and thank you for this thoughtful post.

    I think having content warnings, in general, is a pretty basic thing most people can do that can help someone decide what they can or want to try to handle at that moment. At least then no one is completely blindsided.

    I also agree that games can and should try to tackle difficult subjects, but it should be done in a mature way, and those that use, say, rape in a sensationalist or exploitative way should be harshly criticized.

    • prezzey says:

      Coming to think of it (I completely forgot about this when writing my first comment -.-; ), both PEGI and ESRB ratings already include content descriptors, though their accuracy is another matter…

      • Zoya says:

        PEGI and ESRB ratings are helpful for screening content for kids – which is what they were designed to do – but as such they tend to focus on how *explicit* the depiction is, rather than, say, whether the sexual relationship depicted is manipulative and abusive. The Lara Croft discussions show that *inexplicit* scenes that would not necessarily contribute to a high PEGI rating can be extremely distressing because of their tone.

        • Ermoss says:

          There doesn’t appear to be a content descriptor for non-sexually-explicit coercion, but the ESRB does indeed have a content descriptor specific to sexual violence. They also have short synopses of the games they rate, (TW: sex, prostitution) including a reasonably detailed description of any attributes they consider problematic. I’m not familiar with PEGI, but I assume they operate similarly.

    • Zoya says:

      Thanks for the encouragement!

  3. Eric says:

    I think in a more aware world perhaps we could have the option in games to skip scenes. I believe it was a CoD game that let you skip “No Russian” because of how graphic the mission played out. Why not let players just skip over the whole suggested sexual violence bit in Laura Croft? “This Scene contains triggers would you like to skip it?” That kind of places some control in the players hands letting them delve into it with the knowledge that things will get rough, or just skip it and have worry less.

    Yeah it adds a bit to develop time, but as games become closer and closer to reality, I think it’d be nice. We can always fast forward in movies, it’d be nice to do the same in gaming.

    • Zoya says:

      I think trigger warnings would really help, but they need to give some idea of *what* they trigger if players can make a decision about whether to skip. I hope that just the consideration of ‘Oh, we should include space for a trigger warning if we’re going to do this’ might also lead to thinking about ‘what would this entire experience be like if that part of the scene had made me feel horribly anxious?’ Perhaps sometimes they’ll decide that’s okay, sometimes they’ll decide to change the pacing and how the scene is resolved to bring that anxiety around into something empowering, and sometimes they might decide not to include the triggering content after all.

    • Rakaziel says:

      I think it would be better to include a “automatically skip triggering content” option in the options menu (though of course an “ask before each scene” option can also be included, programming wise it would be easy). The advantage of this is that no “skip this scene” window popping up would not break the immersion, and would not cause part of your brain to worry about what the triggering scene would look like, which would also lead to fear.
      An even more sophisticated solution would be to include alternate dialogue and cutscenes without the triggering content, which again would break less immersion.

  4. Amanda Lange says:

    The Silent Hill games often begin with a screen that says “Some parts of this game may be considered violent or cruel.” I think if you bought the game, you’d probably already know that, but it’s not amiss. A warning is good, but games shouldn’t be afraid to explore potentially triggering content.

    An interesting thread I stumbled on once was people complaining about spiders in games (specifically, Skyrim). Some people are so phobic of spiders (or other creatures) that they feel they can’t play a game that depicts them, or have to mod them out in some fashion. That really got me to thinking that it’s pretty hard as a developer to be entirely sure what will be triggering for your players.

    • Zoya says:

      Is there a Skyrim mod for arachnophobics? That’s awesome.

    • Trodamus says:

      I think a general warning at the outset is more appropriate than in-game warnings or toggle-able options to omit such scenes. Triggers are subjective and based on a variety of experiences, so having an option to remove them would obviously not include every possible trigger.

  5. Timmy_Mac614 says:

    Potential solution: Is there a website that identifies games with potential triggers that could be promoted as a PTSD sufferer resource? Kind of like you can find games with local multiplayer or LGBT themes. If a website exists, it would be great if Borderhouse Blog promoted it as well as passed the website along to the major gaming sites to promote it.

  6. Jellie says:

    Timmy_Mac614: I was just going to ask/suggest the same solution.

    Triple-A studios swallowing the time and expense of researching, designing, and developing interfaces and affordances for skipping or showing alternate content seems extremely unlikely, especially considering the incredibly wide range of content that can trigger trauma-related panic and anxiety in any given human. Even if they did, the solution is problematic: As Rakaziel said, the warning itself could be a trigger as immersion is broken and the player is forced to make a decision, ponder the implications of that choice, wonder what the content might be, etc. I’m feeling a little woozy just typing about it.

    I think externalizing warnings on a Web site is a sensible and relatively inexpensive solution, and we don’t have to wait for the studios to do it.

    As someone who loves games, TV, and movies who is triggered by content that shows up with some regularity, I struggle to make informed, cautious decisions about what I watch and play. There are some obvious franchises I’ll never be able to participate in comfortably and can easily avoid, but there is always the chance of being caught off-guard with something that seems safe–to Zoya’s point about intriguing the reader and playing to the privileged masses who find those things provocative but not personally harmful. And I think it will get worse, not better–but that’s a whole other debate.

    I just want to know how to protect myself now, while still enjoying games! A site that published critical analysis of potentially triggering content in games (and other media) would be amazing.

    • Alex says:

      I can’t remember what the name is, but there is a website that actually catalogs potentially triggering content in movies (WRT sexual harassment and sexual violence specifically). It seemed particularly useful for cases that aren’t explicit and thus don’t show up in ratings… for example, the site warned about the scene in Harry Potter and the Goblet of Fire where Harry is in the bath and Moaning Myrtle harasses him. The scene is played like a joke, but it’s actually harassment, and potentially triggering. I remember thinking that a site like that for games would be very helpful (although of course it would be quite a lot of work). Wish I could remember what the site is called!

  7. KA101 says:

    OK, is up for sale. That was the site I recalled. :-(E>

    I’m aware of the proliferation of trigger warnings. Shakesville had to restrict their use because people were warning for things that didn’t deserve warning, and thus trivializing the TW. (I was part of the problem–directly encouraged people to use TWs [“when in doubt, use TWs”] during the Penny Arcade TW debacle. Guilty. :-(E> )

    TW for torture, CIA

    A lesser-known graphic-adventure game called Spycraft had the player as a CIA agent.

    It included capturing an independent agent and interrogating her. This could be accomplished either through doctoring a photograph to convince her that her SO (also an independent agent) had been captured, or through torture. I haven’t a clue what the torture was like, because the installer gave an option to lock the torture out. And I’ve taken that option each time.

    IIRC, the lockout removed the option to use or explore the torture room (entering it gives a Windows popup: “Bullpen has been locked out.”, and all you can do is leave the room), as well as having the ingame e-mail briefing on it never happen. It comes up as a threat in the photo conversation, but I haven’t tried issuing that threat and have no desire to do so if I reinstall the game.

    Unfortunately, I don’t trigger on torture. Not sure how problematic an installer-based option would be compared to an in-game option–but the in-game option does seem like something that could be re-enabled if someone wanted to be *nasty*.

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  9. Amanda says:

    I know I’m a little late to this, but I have to weigh in on this because it is something that i thought about earlier.

    Gore and violence, while upsetting, are not as personal as something as rape. Video games have, many times, shown some unnamed or third person character being rescued from a rape attempt, or even dealt with the after effect. TV shows deal with rape often, as you mentioned in Game of Thrones. I have never been raped, but the idea of getting raped is very upsetting to me. I am constantly aware of my surroundings so that things like that are less likely to happen to me. (I honestly thought I was going to vomit when they were slaughtering the children being a very new mother at the time the show aired. I even knew it was coming because I have read the books.)

    The problem I have most with Lara Croft being raped, is that Tomb Raider, in my anecdotal experience, is far more popular among women than men. While men do get raped it is still a crime that is overwhelmingly perpetrated against women by men. I believe the statistics are that 1 in 6 women will be raped in their life time. Also, the player is playing as Lara Croft. You are, essentially, Lara Croft while you are playing. I don’t know about you, but as a woman, I like playing a strong, capable woman. I imagine that is what draws so many women gamers to the game in the first place. I think it is extremely insensitive to set up a rape scene where a person you are supposed to be pretending to be (hence the whole “roleplaying” experiece) almost getting raped and you having to fend them off when so many players are women, and arguably 1 in 6 have been raped and the rest are worried that they might become that 1 just to make *male* gamers feel *protective* of the character they are supposed to be.

    Some women might find it empowering, but I can assure you that they are not getting *my* money if that is the route they decide to go, and I suggest everyone who feels strongly enough about respecting women and the players who desire a strong women to play as not buy the game and show them just how disgusting this sort of thing is. I also hope men don’t buy the game either to show their support.

    Gore and violence are one thing, but as a person who lives in a military town and is surrounded by soldiers who have had 2-3 tours in the middle east already, I can honestly say that war games seem to be their greatest pleasure, not something that distresses them, and those that are distressed can just as easily not play them and have plenty of other games to choose from.

    I don’t see why they have to ruin one of the few strong female characters for so many female gamers.

  10. DStecks says:

    I think the best solution is a comprehensive content warning at the start of the game, before the studio idents or anything. And it’s not like there isn’t a precedent for this, TV shows have viewer discretion advisories. The problem with this, though, is that if there’s no demo, you won’t know it contains triggering content until you’ve already bought the game. A website identifying triggering content in games would be an excellent resource.

    Interrupting gameplay with content warnings is a terrible solution, it shatters immersion, and will inevitably fail some portion of the userbase, due to the impossibility of predicting every possible trigger. A blanket warning would have the same issue, but at least the player would be aware that trigger content exists in the game, even if it isn’t their specific trigger, and will exercize caution. Whereas if you’re depending on a real-time warning, the player might not expect anything until it’s too late.

    Allowing the player to skip triggering content raises the question of why it was included in the first place, if it can be safely skipped. Potentially triggering content is generally pretty heavy stuff, like rape for example. If you’ve included something like rape in your game, and it isn’t completely vital to the story, it’s probably being used exploitatively.

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