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Freemium Games as a Metaphor for Chronic Pain: The Lost Detective Finds Fibromyalgia
by Tabitha Carlson

Attempts to explain chronic pain, regardless of cause, can be difficult since pain varies from person to person and also mercifully tends to be forgotten once experienced. Yet a vocabulary of chronic pain is vital for those living it to give voice to their experience to seek help, compassion and awareness from healthcare and wellness providers, loved ones, and the general public.

Christine Miserandino’s "spoon theory," first published on butyoudontlooksick.com, has been frequently cited as a very helpful way to explain the energy limitations to those not experiencing chronic pain. Its key image -- "running out of spoons" -- has undoubted become a sort of shorthand in many households. The author herself has found it incredibly useful in her own family, with two members who can "run out of spoons." In no way is this paper suggesting a replacement of that powerful image.

Yet another surprising metaphor can be found readily accessible on Facebook on in the app store of your choice. Freemium games, those games that are offered for free for play with options for purchase, tend to rely on a set formula. However the game is structured, be it "lives" or some sort of "energy," it runs out as one plays and then one must "recharge" or buy additional lives/energy. If one chooses to not purchase anything, then the game is over for a period of time, usually two to three hours, until recharging occurs and the cycle may begin again. Certainly, this structure is set up for specific reasons. Game makers want, and need, players to buy boosters, energy, etc. to stay in business and make profits. The limiting of game play frustrates players ("just when it was getting good!" or "I almost had it!") and encourages purchases. By discouraging repetitive play, companies keep players coming back for weeks, months, years, instead of letting them master the game in one day and/or complain that there’s nothing new. For games with social media interfaces, most highly encourage players to invite all their friends to play and give each other lives/energy. Undoubtedly, some apps also use social mining to monetize their development efforts.

The two people in my family who are prone to run out of spoons also use freemium games as a coping tool for chronic pain. As an article focusing on the neuroscience of Candy Crush Saga notes, dopamine is released during successful gameplay (Smith). Candy Crush Saga has also adapted over the years that it has existed, ditching the clear narrative arc in episodes to simple images. Boosters are now more easily gained through a prize wheel daily and a "sugar track." These adaptations over time keep long-term players invested as well as bring back lapsed ones.

But it is a different game that so perfectly epitomizes the existence of chronic pain that it should perhaps be experienced just for that metaphor alone, regardless of its intended gameplay: Sherlock Holmes: Lost Detective. If one plays entirely for free, it is a consistently maddening, endlessly repetitive, and poorly designed game -- as a source of entertainment. As a method for understanding life with chronic pain, it is outstanding.

Understanding Energy Limitations

Energy in Lost Detective works in two different ways: lightning bolts and stars. Lightning bolts are the most basic energy measurement. These recharge over time, with each bolt requiring about two minutes to generate. A player may only have a maximum of ninety bolts at one time. Fifteen bolts are used to search a scene for hidden objects. The successful completion of that task, depending on time, earns a percentage of a star. Stars are then necessary to progress in the narrative.

A real experience a player can have is spending 90 bolts, a wait of three or more hours, to earn part of one star to move the story ahead. But playing six hidden object scenes is fun, right? Not when you have played them before and each round only takes sixteen seconds. Even if by some miracle stars are available to go forward in the narrative, unannounced bolts may be required at any time to explore for clues. Yes, lifting a shirt is work. Getting a piece of paper off the floor is work. Each motion gets taken from the bank.

Yet what it does allow someone to experience is the frustrating life of pain. Making any real progress is difficult and frustrating because there is always recharging after every action, no matter how minor. Days can go by and it seems like nothing happens. It is impossible to get a nice stretch and get it all done.

Brain Games

Playing hidden object games in the same scene over and over to earn enough stars to keep the narrative moving is maddening. Two different modes of gameplay pop up randomly to keep players interested: one version has the item names scrambled and the other challenges players to find the objects in the dark.

Welcome to the brain issues that can strike chronic pain sufferers. Because of pain medication, depression, “fibro fog,” migraine, and/or other issues, any day can bring its own mental challenges. Few people think of these effects of living with pain. Minds may work slower. Even mental tasks that seemed so easy before pain can change.

There is a bit of sloppiness in the text as well. There are typos here and there. When chronic pain occurs, things can no longer be perfect. Spelling may not work anymore, the words may not form, or a sentence may fall apart prematurely. Effort. Hard.

The Default is Male

Despite the fact that multiple surveys show that women are more likely to be casual gamers, the character representing the player is male (Levere). While this is usually easily ignored, there are several instances where the pronouns and artwork betray the makers’ assumption that all gamers are men. One doubts they are making a statement about the City of London’s dismal 22.5% proportion of female police officers, the lowest in the entire United Kingdom and Wales (Home Office). All investigating characters in Lost Detective are male. While the men may have their flaws, they are often represented with power and intelligence. Female characters are stereotypes: dancing girls, a nurse, an upset family member, a damsel in distress. Other forms of diversity (age, race, body shape, ability) are similarly difficult to find, but one has better luck in the mental hospital than the medical lab.

Gender cannot be underestimated when it comes to chronic pain. Women’s experience in chronic pain is interpreted differently and experienced differently than men’s. A 2014 survey found that 90% of women with chronic pain feel the healthcare system discriminates against female patients (Anson). Women can easily have their pain dismissed by a doctor, be told it’s “all in their head,” have important testing or medicine not prescribed, more frequently than men. The differences are biological as well. A 2015 study discovered that pain sensitivity is regulated differently in male and female mice (Costandi). This may have been known much earlier -- had anyone bothered to include female mice in their research.


Who Wins?

After making it through the game, with all its frustrations, there’s the giant existential question: why? When the game’s not fun anymore, why it is still played? When the game is utterly frustrating and ultimately painful, why continue on? Some players will need to know the answer; others will think they solved the case early on and stick with it just to prove themselves right. But after all of that, what does any of it matter?

And that is the biggest and worst lesson of chronic pain -- one that hopefully the player never gets far enough to ask.


Works Cited

Anson, Pat. “Women in Pain Report Significant Gender Bias.” National Pain Report. 12 Sep. 2014. Web. 24 Dec. 2015.

Candy Crush Saga. King. 2011. Web. Game. 24 Dec. 2015.

Costandi, Moheb. “Sex Divide Seen in Mechanism that Produces Persistent Pain.” Nature. 29 Jun. 2015. Web. 24 Dec. 2015.

Home Office. “Police Workforce, England and Wales: 31 March 2015.” UK.Gov. 16 July 2015. Web. 24 Dec. 2015.

Levere, Jane. “Mobile Gaming Stats: It's All About the Moms.” Campaign US. 15 July 2015. Web. 24 Dec. 2015.  

Miserandino, Christine. “The Spoon Theory.” But You Don’t Look Sick. 2015. Web. 24 Dec. 2015.  

Sherlock Holmes: Lost Detective. Facebook. 2014. Web. Game. 24 Dec. 2015.

Smith, Dana. “This is What Candy Crush Saga Does to Your Brain.” The Guardian. 1 Apr. 2014. Web. 24 Dec. 2015.