Caregiver Fantasy

One of the key things that videogame stories offer is approval. To some extent all media does this; but in videogames player identification with protagonists is a lot stronger, and more active participation is required – and needs to be motivated. As a result, the kinds of approval on offer in videogames are often much more blatant in their delivery.

I’ve written before about this, mostly with respect to masculine power-fantasy. The power-fantasy hero is strong, taciturn, highly competent, deeply serious, reliant on nobody. He is emotionally inexpressive: when the stoic mask drops, it’s mostly to express anger or (more often) contempt. He can be loved for doing good or feared for doing evil, but this is less important than the fact that he’s shown as having the power to choose, and to do it on his own terms. But none of his choices carry weight, because none of them can change him. He can slaughter thousands without the hecatomb ever affecting his feelings.

Two women seated on a couch: one looks sad, and the other touches her hand in support.People in indie games talk a lot about diametric alternatives to the status quo, so you hear a lot of discussion about the opposite of gun-butch, individualist-mastery power fantasy: games about interpersonal dynamics, femme-coded activities and aesthetics, tend-and-befriend, and so on. A recurring theme is games about care, community, intimacy, therapy. Which is all to the good! But these aren’t novel or unexplored spaces in games, for all that they’re more prominent in hobbyist and indie works than in headline-grabbing AAA. And, just like power-fantasy, they’re themes that exist to feed particular urges, to the point where the primacy of the urge often distorts the world around it.

I talked (rather too much) about narrative delivery in Heart’s Medicine: Time to Heal a while back, but I had to split out quite a lot of what I wanted to talk about for the sake of focus. To quickly recap, it follows a couple of genres: the Diner Dash-style time-management career game, and the medical-care minigame.

I’m mostly going to be talking about medical-care minigames, but the time-management part is relevant. This is a frame in which the most valuable career skills aren’t about education, craft, innate talent, knowledge, charisma, privilege or connections: they’re about being quick on your feet, short-term memory, diligence, setting rapid priorities. Multitasking. In this world, being a waitress isn’t a dead-end job that you take to make ends meet: it’s the best possible apprenticeship for becoming a surgeon or CEO. This is a close neighbour to power fantasy, but it’s an egalitarian one: you’re good at your job and are praised for it, but you’re not The Best At Waitress, not the genius doctor who towers above her peers. (If that was the deal, it would not be subtle about it.) This is a fantasy about a world where, regardless of what you want, dutiful persistence suffices. Where power-fantasy is entangled with the myth of Exceptional Talent Inevitably Rises to the Top, this relies on the partner myth of Work Hard and Believe In Yourself And Everything Will Be OK.

The main Character Issue of the protagonist, Allison Heart, is that she’s kind of a doormat. At times the game’s moral seems to be that since she’s a doormat, she should put her head down and do the work and be the best damn doormat she can be, and that this will eventually lead to her earning love and respect. When she stands up for something, it’s always on behalf of a patient or co-worker, never herself; and standing up usually involves her taking on extra risk or work on top of her regular duties, rather than demanding anything of anyone else. For a story that goes out of its way to suggest high drama, it’s really averse to interpersonal conflict.

One of the major forms of feminist analysis of sexism in work deals with how women are constantly expected to take on additional kinds of labour: “leaning in” and adapting their personalities to male-default settings, educating men, providing comfort and reassurance. At the game’s beginning, Allison is robbed of something she has earned: there’s a mix-up and a prestigious internship in Surgery is taken by a more assertive male intern. The head of surgery declines to put any effort into sort the mess out, and so Allison gets knocked down to the general ward; most of the game is spent earning back something she has already earned. Allison is absolutely frustrated about it; it’s the frame for her Character Problem.

But here’s the thing, here’s the fantasy: Allison does put in the extra work, whenever she’s asked to. And in the game, that strategy works – in fact, is guaranteed to work. The deal offered sucks, but it’s an honest deal. Allison gets the professional rewards she expected, plus everybody loves and respects her and sees her as deeply caring. Work twice as hard, keep your head down, and you’ll get the career plus nobody – literally nobody, not one person in the world – will think you’re a bitch.


On the whole, Time to Heal’s depiction of medicine is clean and cosy and bloodless, in line with its glossy, smooth-edged casual-game world. But there are elements that don’t quite fit with this, especially in the mid- to late-game. In Physiology you sometimes have to realign bones, together with flinch-inducing crepitus noises. In Radiology you might have to scan for blood-clots. In Surgery you vacuum up bright green goop from the inside of organs. These are still presented in a bright, cheerful style, but it’s still an odd contrast. Medicine is messy and it’s hard to entirely avoid that in medical minigames. The juxtaposition of the two genres put me in mind of… well, it kind of put me in mind of Pregnant Elsa Foot Check-Up. (I know, I know. Bear with me a moment.)

Princess Elsa, with exposed pregnant stomach, raises one horribly-injured foot towards you.Medical minigames are not a new thing that Heart’s Medicine invented; they’re a fairly well-established genre. There are tons of Flash games aimed at pre-adolescent girls which rotate around looking after a patient. Pregnant Elsa Foot Check-Up is not even slightly unique: many of the genre feature Frozen characters, and pregnancy is a really common theme. They’re horrible, in the specific way that things appear horrible when they have been very closely targeted at a very specific kink, when something is hyperspecialised to scratch a very specific itch and gives zero shits about anything else. (The foot check-up is less disturbing than the one where pregnant Elsa’s face is covered in bruises; she looks as though she’s been savagely beaten, but she’s still giving the player an adoring smile.) Some subset of pre-teen girls really, really want Elsa from Frozen to be pregnant and injured so that they can intimately look after her and bask in her gratitude.

Now, this is obviously a cheaper and cruder piece of work than Heart’s Medicine, and much more obvious about the buttons it’s pushing. But they’re essentially the same buttons. It really looks like fetish, but I think that’s just how things look when a work is born in the gravity-well of a singular need. Complicated art is incommensurate: it tugs on lots of different desires, holding them in tension in a rich, interesting ecosystem. One-function art, art where a single desire swamps everything like kudzu, tend to end up strongly resembling kink, even if they’re not really anything to do with sex.

That’s the extreme end of care-fantasy, where everything in the world is warped to one end. Let’s look at something that handles things a little more delicately.

Cover art for A Mortician's Tale

A Mortician’s Tale is a much more indie-styled game than Time to Heal. It has a more abstract, less glossy-pretty style, based around low-poly Unity 3D; however, with its soft-midtone palette and cute-bobblehead character design, it’s still a clearly femme aesthetic. It has Things to Say and it tends to say them directly, in textdumps. But it’s fundamentally rooted in the tradition of medical caregiver games, both mechanically and in terms of its motivating fantasy. Mortician’s Tale is about respecting the wishes of the dead, about offering care to their families. You offer care through sensitivity to people’s preferences, and through diligent, repetitive work.

Mortician's Tale screenshot: a woman's corpse, partially covered with a sheet, and embalming tools

I played Mortician’s Tale with my partner Jacqueline, who has worked with corpses in various capacities and has, in fact, done an embalming; she was impressed by the game’s accuracy, but she did point out that in the real world there’d be a lot less modest sheet-coverage. This slight distortion is in line with the work’s aims. Frequently, in videogames, death means indignity, reduction to a pile of loot and a ludicrous ragdoll, or to skull decor. Tale wants to avoid the corpse becoming grotesque spectacle, sexualisation or humour; the signalled care of the author informs the care of the player.

And, to a great extent, it’s a work about silence. Charlie listens, but does not speak. (Sensitivity, here, isn’t just about being nice: it involves reading up on things in advance, doing your research.) The most we see of her inner self is through emails from her friend Jen – we don’t see the originals that Jen is replying to. Tale‘s overarching plot is a resistance story: the mom-and-pop funeral parlour that Charlie works for is taken over by a big corporation, which prioritizes profit over care and respect and demands its employees do likewise. Charlie ultimately leaves to found her own green funeral business, but this all takes place in elision; it is not expressed mechanically, and only the aftermath is shown. The precise part that you’d conventionally expect to be the core of the game – the fantasy of growing a small business – is totally absent. It’s a piece about mood rather than agency, and about ethics rather than personality.

(And also, I felt, the tiniest thread of desiring self-obliteration, of asking nothing for yourself and existing only for the sake of others. I worried about Charlie. I’ve seen that before.)

One of the most powerful moments in Tale is at the memorial for a homeless man. The funeral-industry corp has acquired a contract to cremate unclaimed bodies, so to them he’s just revenue. There’s nobody at the funeral: where normally you’d have a room full of mourners, there’s an empty room with an urn in it. You know nothing about this person but their corpse – and this distinctly not a forensic-science game where corpses are puzzles rich in information to tease out. You’re the only person who cares, but your care is insignificant.

Mortician’s Tale is careful not to overpraise the player; a technique it employs a lot is indirect praise. In games we’re very accustomed to doing a favour for someone and receiving their effusive gratitude; it starts to feel contrived, insipid. When gratitude is expressed off-camera, as it were, and reaches you only through a third party, it feels less like crude gratification. Similarly, it doesn’t overplay your complicity in manipulative corporate upselling; it’s there, and you damn well understand that it goes completely against your character’s principles, and it lets you sit with that understanding. But in the context of a genre that’s usually about being dutiful, about the security of knowing that to be dutiful is to do good, it’s striking that the conflict is between doing your job diligently and doing the right thing. It does its emotional work by offering the fantasy and then posing an existential threat to it.

A black male nurse is saying to Allison: "You care more than anyone and that's what is going to make you an amazing doctor."

love it when black people tell me how much I care

Time to Heal is a lot more videogamey about its praise. The emotional payoff that Time to Heal is offering is a player-character who cares so much that her care is completely beyond doubt: NPCs mostly exist to affirm her care, either by needing it or praising it. And this is not allowed to conflict with duty: Allison’s care is always about going above and beyond her duties, rather than rejecting them to do something more important. Time and again, in mechanics and narrative, the game says that to care is to do extra work on top of normal duty.

This comes most to the fore in her relationship with Daniel, the first love interest of the plot. By contrast to jocular, butch Mason, Daniel is strongly coded as the Soft Boy, struggling with administration of a new hospital wing and Feelings about his unloving father. Daniel’s first plot beat is pharmaceutical addiction – to the point where the pharmacy is running short of medications, endangering patient lives, because he’s stealing so many. Allison investigates this; when her initial attempts fail, Daniel makes her feel awful for not trusting him. Then when he’s discovered, Allison, without batting an eye, helps him cover it up and secretly go cold turkey. (The game doesn’t stress the risk she’s taking here.) This kind of sets the tone for the pseudo-romance; throughout, Daniel is self-centred, distant and needs caring for after severely fucking up, Allison sacrifices and blames herself and does as she’s told, and the important thing we’re intended to get from this is that Allison is a Good and Caring person. Whether Daniel deserves this is not at issue.

Game power-fantasy tends to focus on the immediate, even at the expense of contradictions at the larger scale.  Bioshock‘s ending plays around with this tension – you’re constantly enacting power through brutal violence and Moral Choice Dilemmas, but someone’s constantly telling you what to do; the freedom and power that Rapture is selling is illusory. Similarly, caregiver-fantasy tends to focus on the immediate sensation of caregiving, even when the immediate appearance of care contributes to the problem. Mortician’s Tale engages with this; Time to Heal never does. Daniel’s purpose is to be a mess is so that Allison can loyally take care of him.


A final example. Let’s consider Time to Heal‘s Joe, the ambulance driver.

Joe’s role is to be the Good Boyfriend to Sophia, head of ER. Everything Joe does is there to paint him as a Good Boyfriend: he is romantic, friendly, has a sunny disposition and a sense of humour. Unlike Daniel and Mason, there’s nothing wrong with Joe, no Character Issue. If there was any doubt that his narrative role is Good Boyfriend – he’s good with kids. Joe is intended to be sculpted out of purest Husband Material. 

Joe carries around lollipops. Partly this is because Good with Kids, but also Joe’s reasoning is that it’s always nice to promise yourself tiny rewards to brighten your day.

And when Allison accomplishes a breakthrough on a difficult case, Joe thinks, hey, I know what’s an appropriate way to acknowledge the success of my co-worker, a grown-ass woman:

Joe offers a lollipop to Allison, saying "I normally don't do this on good days, but I think you've deserved one of these...". Allison looks coyly pleased. Sophia is in the background.

but daddy your girlfriend will see

You know, subtext-not-subtext, because she’s been a good girl.

Joe’s driving the ambulance, with Allison in the back trying to save Daniel’s life, when it crashes. Joe’s trapped inside; the ambulance is nose-down in water and also on fire, while Daniel is thrown free but bleeding out. Daniel tells Allison to save Joe; Joe tells her to save Daniel. Allison, instead of taking incident command of the damn situation as she ought to as the only professional left standing, dithers between their instructions before saving Daniel. It’s a tense, challenging situation and Allison is rightly proud when she stops Daniel from bleeding out. Here’s her reaction:

Allison kneels over a prone Daniel. "I DID IT!" She stands and turns. "JOE, I actually did it!"

But Joe is dead, and thus unavailable to validate her success.

Aaand then at the funeral there is… this, intended as a touching moment of comfort between Allison and Sophia:

Allison and Sophia stand beside Joe's grave, in black funeral clothes; Sofia's face is streaked with tears. Allison offers Sofia a lollipop.

You could write this whole weird sequence off as an unfortunate example of kink-blindness, but I think that would miss something important about why this got weird. Joe and his lollipops are not, I think, meant to be about kink. But they’re scratching a very similar itch.

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