Unpacking the stigma of mental illness in The Town of Light

Overpopulated and understaffed, Ospedale Psichiatrico di Volterra represents the very worst in 20th century psychiatric practice. The Italian hospital, built in 1887, was founded to be a place of gentle respite, a self-sustaining village for occupational therapy where patients would grow crops, raise livestock, make and mend clothes and learn trades.

In the early years, Volterra had a ‘no restraint’ policy; its residents would not be manhandled. In time the asylum’s population grew to more than six thousand. As staff became overwhelmed, the tone of the treatment shifted. 

Many of its occupants were treated with experimental, personality-withering electroshock therapy. Historical records show that patients were tied to their beds, lobotomized and placed in diabetic comas. There were outbreaks of malaria. Incoming letters from family members were hidden and left opened. You could be sent to Volterra for alcoholism, for being embroiled in some public scandal, or for homosexuality.

The asylum became known as ‘the place of no return’ as patients were often forcefully kept on site beyond their treatment term. Then, in 1978, the Italian government closed down Volterra. The hospital was summarily abandoned and left to decay – an institution twice made a horror cliché: first as a place of psychological malpractice, now as a place of ghostly desertion.

The actual abandoned asylum. via Eleonora Castagnozzi/Medavia.co.uk

“Volterra was a place of detention, not cure, where society dumped everyone that it disliked,” says Luca Dalco, creative director at LKA, an independent Italian studio whose debut game, The Town of Light, is set in the mental hospital. “Whoever was admitted there lost their human rights; they became like a human who is viewed as inhuman by society.”

Volterra’s practices are appalling, but not entirely unfamiliar. The stigma of mental illness has, in the past few decades, shifted valuably. But television, film and video games routinely revisit the historical horrors of the sanatorium. Wikipedia has a page dedicated to video games set in psychiatric hospitals. Asylum Jam takes place every year in an effort to encourage game-makers to avoid the clichés of the setting. Dalco and his team, however, are eager to point out that The Town of Light is anything but a hackneyed horror game. It has been born, not out of voyeuristic interest, but, rather, personal experience.

“Like many others I’ve seen people near me fall in the dark void of depression,” says Dalco, whose background is in theatre. “I’ve experienced times in my life where I have been exposed to the suffering that psychic disease involves.”

Dalco was conducting research a few years ago on an unrelated project when something he read prompted the idea for making a game about mental illness and how mental institutions used to operate in the past. “In this way it’s come partly from my past experience, and partly because I have found games to be an extremely powerful medium in which to tell stories.”

The game, which launches on PC next week and Xbox One later this year, follows the story of Renee, a fictional 16-year-old girl who, in 1938, was sent to Volterra for being, as the authorities put it, a danger to herself and to others. The game revolves around finding Renee’s memories, exploring areas where she used to live inside the asylum and solving puzzles in order to understand what she went through.

“Asylums are a common location in videogames," says Dalco. “But for us the location is not just an excuse to have a place to fill with paranormal activities or zombies. Rather it’s somewhere we can understand the many lives that are affected by mental illness and the old way those institutions use to treat people back in the forties.”

In researching the story, Dalco and the team read scores of historical documents and research publications. “We had access to a huge number of videos, documents, interviews and direct witness accounts from former doctors, nurses and patients,” he says. “But beyond the historical research, we spent a lot of time imagining what the protagonist could feel in this place. We built up her story in a detailed way, producing hundreds of pages of background material as part of our design process. We wanted to create empathy within the team for her. Renee became like a real person during the development of the game. It became moving, working on the story of a girl whom we knew that we couldn’t save.”

Verisimilitude was crucial for Dalco and the team, who collaborated with Gilberto di Petta, a psychiatrist and president of the Italian society of phenomenological psychopathology. “In literature and movies ‘madness’ is often portrayed as a genius deeply rooted with criminality,” says di Petta. “Psychiatrists, meanwhile, are depicted as sick and strange. Almost all movies contribute to the stigma that mental health patients and practitioners face daily. While The Town of Light is a game, it has an incredible and valuable historic fidelity. The atmosphere, the architecture and the historical practices are recreated with both respect and tremendous attention to detail. It could help normalize the topic, and make it easier to talk about.”

It’s a worthy goal, and yet, detractors might argue that exploring the topic via the inhumane practices of a historical asylum could reinforce stigmas, rather than unravel them. “The decision to use a real location is to increase the immersion in the game,” says Dalco. “Visiting a non-fictional place that you can read about in books or on the internet contributes to feeling like being a part of something real, something that exists. This is consistent with the message we want to communicate with the game: mental illness is tragically real and its dimensions are far larger than what people normally think."

He points out that one percent of the worldwide population suffers the symptoms of schizophrenia. "The suffering and desperation connects us to the stories of the people who lived in Volterra," he says. "Mental illness can put people in an incredibly difficult condition, and if this were not bad enough, mental institutions have contributed to make all even more unacceptable and inhumane.”

The Town of Light isn’t the only recent or forthcoming videogame to address the topic. Life is Strange touched upon mental illness, while Hellblade, a forthcoming game from Ninja Theory, features a protagonist who suffers from psychosis. Dalco thinks that this is not only indicative of the unique perspective the medium can bring to the subject, but also thanks to the democratization of game making.

“I believe the trend is connected to the indie scene,” he says. “New tools have facilitated a creative renaissance in the medium. Traditional publishers needs to create a sustainable business model to maintain high production values and constant revenue streaming, and some topics could have been seen as too risky. In future we will see more games that will cover ‘unusual’ topics. It can only be a good thing.”