I have Tourette's Syndrome and Narcolepsy. A couple years ago I made a game about those, and it mostly sucked. The recent 7 Day Roguelike game jame inspired me to make a new version that mostly doesn't suck.
You can play it right here in your web browser. There's some discussion below, it doesn't really matter whether you read it before or after playing the game.
Years ago, the first version of Tourette Quest got an insane amount of media coverage relative to the tiny amount of work I put into it -- and that scared the heck out of me. I knew people were being drawn in mostly for the concept, but the substance wasn't delivering. And even worse, the messages people were drawing from it were not what I was trying to get across. I was failing to communicate.
This time, I think I've done a better job.
So, some quick background on the conditions for those who aren't familiar with them. If you are, feel free to skip this part.
Tourette's Syndrome is a neurological disorder where patients exhibit a variety of involuntary, automatic and compelled behaviors, often called "tics." On the vocal side these can range from simple grunts and coughs to involuntary utterances of sounds, words, songs, even complete sentences. On the physical side, tics encompass everything from twitches, blinks, and facial grimaces all the way to extreme, violent movements capable of injuring both the Tourette's patient and those around them. My particular case is "moderate" -- I can live a mostly normal life -- but it's definitely on the severe end of that "moderate." Some of you might be familiar with Tourette's as seen on TV: involuntary cursing, a symptom known as Coprolalia. Sensationalized as it is, this is totally a real thing, and I do in fact have this symptom myself, though it's not the one that's most prevalent in my day to day life.
I also have Narcolepsy, a neurological disorder I like to describe as "being in an abusive relationship with sleep." Like Tourette's, Narcolepsy is a collection of comorbid symptoms rather than just one specific ailment. Also like Tourette's, there is a "TV Narcolepsy" which reduces the entire disorder to just one symptom -- the famous "Sleep attacks", which cause the narcolpetic patient to spontaneously fall asleep in the middle of the day, like this adorable little fella:
Media sensationalism aside, sleep attacks are also a real thing. I don't have them personally, but I have something very similar -- Cataplexy. Cataplexy is a narcoleptic symptom which to outside observers might as well be a sleep attack, except that for it's duration I'm actually fully conscious, but unable to move or speak. Cataplexy can also manifest in a partial form where it only takes down part of your body (an arm, your legs, etc). However, it's distinct from actual paralysis, going numb, or losing consciousness -- you still have full feeling, just without the ability to move.
To an outside observer, these conditions produce seemingly random behavior that's hard to understand. However, I have a front row seat to the internal experience, and that's what I've been trying to model in Tourette Quest.
The basic design schtick is a game where your character is not fully in control of their body -- tourette's and narcolepsy symptoms can interrupt what you're trying to do and make you do other things instead, putting you in dangerous situations or just frustrating your attempts to accomplish otherwise simple tasks.
Last time, I modeled my prototype after classic Zelda games, which was a mistake for two reasons: first, real time controls make it hard to differentiate the disruptive effects of symptoms from simply bad controls. Second, that game format had all these little gameplay details to get right (collision detection, free movement, enemy AI, animation, etc) that constantly distracted me from focusing on the most interesting part of my game -- symptoms.
7DRL turned out to be exactly what I needed -- there's no genre more stripped-down in terms of visuals and presentation than a classic Roguelike, and the 7-day time pressure was just enough time to explore the idea, but not enough to let me get sidetracked with unnecessary features and systems.
A final note before we look at the new game -- as fond as I am of procedural rhetoric, I think it's easy to forget that games are not necessarily all that great a medium for communication. Dare I say it -- games actually kind of suck at this. Compared to say, an essay, video games are not very accessible -- at minimum they require electricity, expensive equipment, and input devices, not to mention all the intellectual baggage like familiarity with historical gameplay conventions. I do think there's some really unique things you can only do with games, but the audience is always going to be limited, it's super easy to get bogged down in stupid stuff like collision detection rather than the actual rhetorical bits, and the ambiguous nature of visual symbolism and the way your mechanics actually play out make it super easy to accidentally slather your video game with all sorts of unintentional messages.
All that said, on to the game.
TouretteQuest is a simple Roguelike/Roguelite/Procedural Death Labyrinth/Russian bagel where your character has Tourette's Syndrome and Narcolepsy. On every floor of the procedurally generated dungeon, you will gain a new Tourette's or Narcolepsy symptom. Encounter a monster and a JRPG battle system akin to Dragon Quest pops up:
Your character has three vital stats: HP (hearts), MP (stars), and Stress (asterisks). The higher your stress, the more likely you are to exhibit a symptom. The first symptom you start out with is "general tics," which manifest as compelled actions. You can see one in the above screenshot, colored in yellow, with two exclamation marks.
This means that if you don't choose it, Tourette's Syndrome will punish you by elevating your stress. However, if you do choose it, it will reduce your stress. What I'm trying to communicate here is how the compulsion to tic feels from the inside. Tics are "involuntary" but it's more complicated than that -- technically speaking, at some point the patient does make a "choice" to give in and let the tic happen, but it's done under duress. A common way of describing it is like a sneeze -- it's inevitable, but you have some power to redirect it and very occasionally you can suppress it entirely, but it will usually re-emerge anyway (A fart is another pretty good example). You might have some control over when and where, but it's coming out one way or another.
As for Narcolepsy, you have the added threat that as the symptoms escalate you could have some of your actions randomly greyed out (partial cataplexy) or miss an entire turn (full cataplexy).
Tics can come out nigh-automatically, even when you thought you were going to be able to "suppress" it a little longer. One of the many ways I model this is by making the cursor immediately jump to any compelled choices when you open that menu. It's very easy to double-tap enter and do the tic rather than what you actually wanted.
At first this isn't super bad because it just means occasionally choosing a random move, which might have even been the one you wanted. But in later levels you'll gain new symptoms, such as "verbal tics", which infects your command menu with useless actions like "cough" and "grunt," and are particularly susceptible to being compelled. And I do model coprolalia too, though in a very simplistic way. When you gain that symptom you learn a new spell - "Curse" - which consumes MP and damages the player. You do NOT want to cast that spell if you can avoid it, but the combination of stress and other symptoms might force you to, one way or another.
On later levels you'll develop the worst symptom, which I call "chaos." When you've got chaos, all your menu choices will randomly shuffle, at a speed proportionate to your stress level. You're still "free" to choose whatever you want, but you've got to chase it down and catch it in real time. The only actions spared from shuffling are compelled tics, which will stay safely put, glowing bright yellow, calmly insisting that you just give in and do it already.
In play testing I've found that when players are fully in the throes of chaos, choosing a compelled tic command several turns in a row is "helpful" because it reduces their stress with each outburst, giving them a shot at recovering. Granted, this still exposes you for several turns to whatever the enemy wants to do (and whatever Tourette's makes you do to yourself). If you get to this bad place, you find yourself ruled by a cloud of symptoms that all rush out of you like angry bees until you collapse in an exhausted heap.
This is the heart of what it feels like to be a Tourette's patient. You've got disruptive, annoying, sometimes offensive and even dangerous behavior flying out of you, and you're not responsible for it, but you're forced to be somewhat complicit in it happening anyway, and this leaves you with some extremely weird feelings no matter how well you understand the condition and how supportive your friends and family are. If you ever know someone with Tourette's who is constantly apologizing after having tics, this is why. A "choice" that wasn't really a choice was made.
Players should quickly realize that the true enemy here is stress and that the battle is internal.
And that's what I'm really trying to communicate -- there's an invisible resource war going on. It's quite similar to Spoon Theory, often used to describe e.g. chronic pain disorders.
People who knew me in high school who meet me now often say, "wow, your tics have really cleared up!" And you know, for some people, Tourette's Syndrome actually does clear up later in life and the symptoms basically go away forever. I still have them, though, so when you see me "tic free" you're just seeing me on a good day, and if you're seeing me in public at an event or something I did a lot of prep work to get myself there, and I'll have a price to pay for it in recovery time afterwards.
I've carefully sculpted a very controlled and safe environment for myself. Put me back in a pressure cooker and all my tics will come back full force.
Let's talk about the game again real quick.
As you progress through Tourette Quest, you'll do typical procedural dungeon crawling stuff -- try to find the exit, fight and/or avoid monsters, collect treasure.
To win, you have to manage your stress -- if it maxes out, your symptoms will dictate nearly every move and while you're wrestling control back from yourself the monsters will pound you into submission.
As a quick aside -- the monsters don't represent an oppressive society or mean teachers or bullies or employers or anything like that. To be sure, I've had my fair share of um, extremely unpleasant experiences with people not understanding or not being willing to understand my conditions, but for this particular project I wanted to focus on the internal struggle. The monsters and the dungeon are just there to provide the proper framework to give the mechanics some meaning. This time around, I specifically made them as goofy and non-sequitur as possible, deliberately picking non-anthropomorphic things without faces or eyes.
The best strategy is patience and risk management. Don't take unecessary risks. To facilitate this, all the doors are labeled with a little icon that indicates what you will find inside. An imp face indicates there's monsters, a diamond indicates treasure, and an exclamation mark indicates both. The exit room is clearly labeled "EXIT." The monsters will get stronger on later levels, so you'll need to seek out treasure to build yourself up, up, but every single monster encounter will increase your stress, as will running away. Striking the right balance is the key to winning the game.
I'm happy with this prototype. It's not perfect, it's probably got bugs and some issues where it's communicating something other than I'm intending to, but I feel it gets the point across in the simplest and most direct way possible. Stripping out all the real-time action elements from the original game, and focusing just on what I could get done in 7 days, was a huge help.
Now that it's done I've got all sorts of ideas for how I can expand it, but I'm in no particular hurry. I'll probably revisit this after I finish Defender's Quest II.