Keywords

1 Introduction

Human-Computer Interaction (HCI) research traditionally has focused on making artefacts more usable [1]. However, in the cases where negative experiences are to be conveyed, making the system less accessible to the interactor could become a design choice that help communicate the “right” negative experience. Indeed, Halbert and Nathan suggest that it might even be inappropriate to engineer a positive experience where the context calls for a negative one [8]. To depict what it may be like to live with chronic pain and have movement limitations that may impede the sufferer from fulfilling social obligations, we devised a game-like environment. In this environment, the interactor has to bake a cake for their grandchild while going through episodes of pain that limit her movement.

AS IF features an avatar—an elderly woman who has chronic pain and is struggling with daily tasks. Through embodied interactions and audio recordings, the narrative exposes the thoughts of this avatar in ways that are often invisible. These thoughts are captured from the perspective of a chronic pain patient and are intended to reveal what it may mean to try to do seemingly simple tasks while living with a condition that limits one’s ability to perform them. In this extended abstract, we discuss the design decisions we have made to facilitate a disabling experience and how such frustrating interactions are vital in communicating a corporeal experience that is inherently frustrating. We will argue that it may be necessary to abandon practices that foster positive interactor experiences to devise an experience that may be negative yet vital to conveying the right kind of insight and provide a reflective space (Fig. 1).

Fig. 1.
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The avatar in the virtual world mimics what the interactor does in the physical world. The red ball represents an object in the game world which the interactor needs to touch with the avatar’s hands. (Color figure online)

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1.1 Chronic Pain

Where nociceptive pain exists when actual tissue damage occurs or in the event of a threat, chronic pain may exist without any damage or visible injury. A widely used definition of Chronic Pain is pain that lasts more than a year [15]. A 2011 survey conducted in Canada showed that 18.9% of the adult population had chronic pain, more frequently found in older adults and females compared to males [14]. Affecting almost 1 in 5 of the adult population, chances are that most of us will experience CP ourselves or are close to someone who may be living with chronic pain. Because chronic pain is often invisible, is not well understood, and is termed “the silent epidemic” [11]. Because patients suffer from social stigma [5] it is essential to understand how this condition burdens the patient to create a supportive environment.

Although the aspect of pain itself is a dominant problem, it is not the only one side of the problem. Chronic pain interrupts behavior, interferes with functioning and negatively affects the quality of life [9].

The cause of and cure for chronic pain are unknown; however, the complexity of this condition is recognized by the biopsychosocial approaches that pain clinicians and health researchers have adopted [5]. For example, patients often also suffer from sequelae such as insomnia, depression, anxiety, cognitive impairment, decreasing mobility and social isolation [5]. Further, may affect a person’s sense of self: patients compare “who they are now” to “who they have become” as the result of their degenerative condition, and often feel alienated from their body and themselves [11]. Moreover, patients face stigma from those who are unfamiliar with chronic pain, doubt its existence or feel helpless—from friends, co-workers and family to health care workers. Therefore, successful management of chronic pain requires more than only managing the sensation of pain, but requires multifaceted approaches in treatment as well as advocacy in educating the public.

AS IF provides an environment where the general public can “walk in the shoes” of a chronic pain patient – albeit briefly – to gain insight into what it may be like to live with similar constraints in a virtual environment.

1.2 Perspective Taking

Perspective taking refers to the individual going beyond their typically egocentric view of the world in order to consider a different point of view [12]. It is vital for the community – be it healthcare workers or relatives of the patient – to understand the unique and multiple difficulties that patients struggle with. In invisible illnesses like chronic pain, patients feel as if their close ones and even their doctors do not believe them [5]. Therefore, to foster empathy and a more understanding environment for the patients, perspective taking exercises might help.

1.3 Perspective Taking in Serious Games

Serious games are a category of applications that does not merely entertain but addresses real world problems such as raising awareness about a certain cause or issue, giving a more bearable context for painful physical rehabilitation or eliciting behavioral change. In the case of “games for change,” the goal is to persuade, change or form an attitude or simply raise awareness regarding social issues [13].

Games often feature an avatar which the players control and experience the world through. This makes them a useful tool for showing interactors unique perspectives they might not have considered before. Traditionally in perspective taking studies the participant is merely asked to imagine themselves as the model they are briefly shown [6]. In the context of Immersive Virtual Environments (IVE), Groom suggests that viewing oneself embodied as an avatar is more visceral than simply imagining, resulting in greater understanding [6].

1.4 Simulated Disability

While AS IF portrays the struggle of a Chronic Pain patient, physical limitations that the illness brings may very well apply to a variety of conditions. From an HCI standpoint, the problem that needs to be mediated by the system and experienced by the interactor is analogous to many other ailments. Any range-of-motion reducing condition, be it chronic or acute creates a constraint for the person that may limit their day-to-day activities. Even seemingly easy and mundane tasks such as cooking or doing groceries may become difficult to perform, and can lower one’s quality of life. The invisibility and changes in behavior can also easily be misunderstood. Charmaz, for example, describes a case where a middle aged woman’s inability to prepare meals quickly and her overall slow movement caused her spouse irritation; he attributed her slowness to her attitude towards him [3].

Simulated disability exercises have been employed to help non-disabled populations improve attitudes towards a disability and improve their understanding and knowledge of specific handicaps by simulating the disability in real life with physical constraints [6]. By providing an embodied insight into what it is like to be disabled, a more understanding and supportive social environment may be fostered. Thus, we employed a simulated disability approach by introducing constraints on the avatar; this, in turn, creates a handicap for the interactor by limiting their ability to interact with the game world. See Fig. 2.

Fig. 2.
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Even though the interactor reaches far enough to touch the object in the gameworld, the avatar stops synchronizing her movements perfectly and the interactor fails to complete the task, causing frustration.

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2 Uncomfortable HCI

Most of HCI research is focused on making interactions more “natural,” fluid and effective. This is understandable since a majority of computer applications aim to elicit positive or productive experiences. In our case, however, to convey an experience that is in essence not-fluid and, not positive, our system had to reflect the frustrating nature of the limitations we are mimicking. Benford suggests that distorting the balance of control by making the user give up or conversely have an unusual degree of agency creates discomfort through control [1]. Similarly, in AS IF, we continually change how much the interactor has control over the avatar, not only to create discomfort and dissonance, but as a way to embody the perspective of the avatar, who simultaneously talks about how frustrating her limitations can be which creates an uncomfortable closeness, creating another level of discomfort as Benford proposes [1].

2.1 Frustrating the Interactor

AS IF employs bodily interaction with the system. The avatar mimics the interactor’s actions with the help of a 3D camera that can detect and map the interactor’s movements onto the avatar. While the avatar mimics the interactor’s actions in the virtual environment, the interactor is tasked with making a virtual cake which can be done by controlling the avatar’s upper body with her own to interact with objects in the game world.

The making of the cake is divided into a number of steps and to progress, the interactor has to complete a connect-the-dots puzzle that signifies the task. For instance, to put the cake in the oven, the interactor connects the dots by reaching them with her hands and trace the shape of an oven or place candles on the completed cake by tracing a candle. As the interactor completes each task we trigger voice-over narrations hinting on what to the in the next step as well as setting the tone with the patients’ voice.

Prior research suggests that removing agency from the player may elicit feelings of anger and helplessness [2]. In the case of embodied interaction where the interactor’s body is the instrument through which she interacts with the world, removing agency partially problematizes the body for the interactor. By merely not mapping the actions perfectly but in a limited way, the system can still be interacted by the interactor but the completion of the tasks have now become immensely more difficult.

Leder points to the taken-for-granted absence of the body in the nature of our experience; yet pain doesn’t let our body disappear, but dys-appear, or appear in a “bad”, “ill” way. With pain, a dys-representation of our body becomes central to the experience at hand [10].

When agency is disrupted, the interactor feels a dissonance with their body and the avatar, as if the avatar has gone beyond being a representation but a dys-representation. Merely gazing at a sculpture that depicts a body under distress results in felt activation of the muscles that mimic the sculpture [4]. We propose that embodying an avatar that is constrained and distressed the users can have an experiential understanding.

3 Conclusions

To convey an experience that has an unpleasant, negative nature – like illness or grief – and to render visible certain constraints through interaction, instead of designing for usability we may at times have to turn to designing more uncomfortable experiences through non-ideal interactions. AS IF aims to convey what it feels like to not be able to complete seemingly easy physical tasks by systematically robbing the interactor of her agency. Not translating the interactor’s actions to the virtual world like the interactor expects in the game, creates frustration by rendering the interactor not as effective as they were before the simulated disability was induced on the avatar.

Embodied interaction affords the interactor the metaphorical shoes of the avatar for them to walk in. By unfairly removing the agency from the user causes them frustration since it is now harder to complete the objective, we deliberately make progress difficult for the user in order to convey a difficult experience.

Our preliminary study showed that our participants were frustrated with the interaction but this seemed to give them a better understanding of the context, resulting in increased willingness to help patients with chronic pain. Even though the experience was described to be frustrating and negative, the participants had left with newfound understanding and sympathy for the avatar’s character.