A journey through childhood grief: Sketchbook Games x Dr Caitlin Hitchcock

A collaboration between a games studio and a clinical psychologist demonstrates the benefits of research expertise for both story and structure.

'A potent, powerful experience'

As part of our work at Wellcome before our spin-out, we funded Sketchbook Games to make Lost Words: Beyond the Page. The game follows budding author Izzy as she discovers her creative powers through the pages of a journal gifted to her by her grandmother – and how that creativity helps her deal with her grief when her grandmother is taken seriously ill.

The game won UKIE UK’s Game of the Show at Gamescon 2017 among numerous other awards, and on its official release in April 2021, the Washington Post praised the game’s visual style which they said gives it an ‘undeniable charge’. Polygon said ‘Even just a sentence across a page manages to evoke something deep’ while Eurogamer described it as ‘a potent, powerful experience.’

Building the collaboration

Mark Backler, founder and Creative Director at Sketchbook Games and Rihanna Pratchett, the game’s writer, worked with academic expert Dr Caitlin Hitchcock, a clinical psychologist and senior researcher at the MRC Cognition and Brain Sciences Unit at the University of Cambridge to create an authentic portrayal of childhood grief – and used what they learned about therapeutic techniques to shape the very structure of the game.

Caitlin says: ‘Mark approached me after he became aware of my research on memory and posttraumatic stress in young people. He felt that my research would provide a good scientific grounding for elements of the game.’

Mark adds: ‘With a topic like grief you want to make sure that you cover it in the right way and that it’s helpful – as well as being exceptionally moving it’s ultimately a good experience for the player.’

He said the development team were surprised by the extent to which working with an academic expert shaped their creation of the game.

‘You would think it would just be little things here and there but actually learning about compassionate image theory was something the whole game was structured around, it shaped the entire experience,’ he said.

For Mark, the motivation to work with an academic expert – which Wellcome’s funding made possible – lay in his desire to ensure his game went beyond its narrative and had the potential to help people.

‘We like making narrative games that have a positive impact,’ he said. ‘We got lots of feedback on social media that said playing the game helped them deal with losing their loved one. It’s always very moving to hear that the game has made a difference.’

While Caitlin had worked with artists on spoken word pieces and short films, this was her first experience of collaborating with a games development company, but she says what drove her was the prospect of sharing her work with a new audience in a different way.

‘Video games represent a unique opportunity to bring research to a wide audience, and enable them to interact with and engage in our research,’ she said. ‘I was excited to contribute to something which might educate and support the user, while also entertaining them.’

Although not a gamer herself, she says ‘I learnt a lot about the potential of this industry for reaching audiences I might not otherwise engage.

‘It also prompted me to think more deeply about how I could take the science I use to improve treatment of mental health disorders, and disseminate it in avenues outside of ‘therapy’. These alternate avenues might reach more people, integrate more sympathetically into everyday life, and still educate or yield a positive benefit for mental health.’

The game is beautiful and very moving, and I never thought I could contribute to such an impactful experience. The feedback and reviews from users is phenomenal – it has touched so many people, and I don’t think I truly appreciated the power of video games to promote positive change

Dr Caitlin Hitchcock

Learning from challenges

Mark says the main challenge was in navigating the uncertainty around how audiences would react to this alternative approach.

‘We had to ask, do people even want this kind of game?,’ he said. ‘For instance, the story and game mechanics support each other. You learn more by doing, which makes it a more powerful experience.’

For Caitlin, the challenges lay in ensuring her research was accurately represented without losing any of the enjoyable aspects of the game.

She says: ‘For example, following the experience of a traumatic event, individuals may have difficulty retrieving memories of specific events, which promotes poor mental health. Increasing the retrieval of specific event memories is related to improvement in mental health.

‘Using the diary element of the game, we were able to prompt retrieval of specific event memories in a way that was engaging, and fit in with the narrative of the video game.’

Tackling these challenges led to a learning about how to communicate research that Caitlin wanted to share with her fellow academics: ‘We use very specific language in research and are required to be quite narrow in our conclusions, but we need to consider how we can convey our key messages in a way that is more approachable to other industries.

‘The different perspectives that the team bought to my research was extremely valuable. I now think more broadly about the implementation value of my research, beyond improving mental health treatments, and consider non-traditional ways that I can ensure that my research achieves real world impact.’

Mark adds: ‘It’s definitely worth doing because it gives you something to structure things about and a way to check things – the last thing you want is to make a game about a real world topic and then realise you’ve covered it in a way that would have a negative impact.’

Mark is now using a similar approach on his next game – and he is also drawing on the experiences of people with lived experience of mental health challenges.

He says: ‘Speaking with people with lived experience as well as researchers gives you the best chance of making a really powerful game and creating the best experience you can for players.’

Got an idea for cross-sector collaboration? Apply for funding now