Citizen Sleeper: Chronic Illness as Game of Chance
How can videogames help explain chronic illnesses? Citizen Sleeper succeeds by using gambling mechanics like dice.
Explaining chronic illness in a game without sounding boring, annoying, or at worst both, can be extremely difficult. Citizen Sleeper and Citizen Sleeper 2: Starward Vector by Fellow Traveler and Jump Over The Age, however, have attempted to solve both problems. In both parts of the series, you play a Sleeper, i.e. a copy of a human person who has committed to a big corporation. Perhaps they are in an induced sleep on a ship that is supposed to be building a colony far away. Or they are paying with the abilities of their new body, which is then obliged to do difficult labour. With planned obsolescence they intend to keep this sleeper under control – after all, you don’t want to lose your workforce.
The impossibility of reliable planning
The problem posed in the first Citizen Sleeper: You play an escaped sleeper who regularly needs medication to maintain their bodily functions. With every daily cycle that passes and even with strenuous activities, your own state of health deteriorates. This influences the opportunities you are given, which are represented by a maximum of five dice you can roll each day. A dice result of 6 gives you a 100% chance of passing an action if you use it. These actions can be work that secures your livelihood or interactions with people. A die with a 1 still gives you a 50% chance of a neutral result, but an equally high chance of a negative result. The 1-dice would therefore not be used for a particularly difficult task, e.g. risky physical work, because failure here can have a direct impact on your physical condition.
In such a case the health bar above the dice shrinks and can only be restored through expensive measures such as medication or repairs. If it does not reach the last die, it will fail in the next cycle, which means you can only perform four possible actions instead of five. Increasing exhaustion means that the sleeper has fewer and fewer options. This system is very reminiscent of the Spoon Theory, which chronically ill people use to describe how they cope with everyday life. You wake up with a small number of spoons that represent your energy available for the day. Every action requires at least one spoon, no matter how easy it seems. The spoons get used up very quickly and no further activities can be undertaken. How many spoons you have available can vary from day to day and, as in the game, is influenced by numerous factors. These cannot always be predicted. Similar to the simulated Citizen Sleeper, there is always a factor of pure chance and gambling involved. Sometimes your health deteriorates as a result of the simplest actions because you don’t have enough spoons (or dots on your dice) – so the probability of a negative result increases. Sometimes, however, you can complete many difficult tasks in one day because you happen to have rolled a high number.
Another factor that contributes to health in the game and in life is the energy supply, i.e. food intake. In Citizen Sleeper, this is displayed as a bar below the dice, which can be filled up by eating. Food can either be earned by using a die or money, for which the corresponding work must be invested beforehand. If this value drops too far and cannot be balanced out, it permanently drags down the body’s condition. It can only be restored with a very expensive drug, which the sleeper can occasionally buy on the black market for a while, so there is always some amount of uncertainty. Will you still be able to get it? Can you even afford it? And if so, when is the right time to use it? Is the loss of one cube enough to reinvest or is it better to wait until things get ‘really’ bad? Since there is not always a real treatment, it is very similar to the handling of many chronic illnesses.
Stress resistance
In Citizen Sleeper 2: Starward Vector, this part of the decision is omitted. The new Sleeper has found a way to circumvent the planned obsolescence by rebooting. The health bar is replaced by ‘stress’ points. The Sleeper and the companions have an individual number of points that indicate their stress resistance. For every action that fails due to a low number of points, there is a chance that it will trigger stress in the person who caused it. The stress points accumulate and ensure that dice are damaged and therefore no longer usable, as with the constitution bar in the first game. Increased stress has an effect on the dice. While the rather negligible one-dice can be damaged at the beginning, the higher dice numbers, which are urgently needed for actions, are at stake later on. If you are at a station, you can use a die to reduce the stress load, but during an away mission this is not possible. You then have to make do with fewer dice, which increases the need to use the poorer ones, especially under time pressure, which in turn increases stress if you fail. If the stress bar is full, the character in question breaks down completely and cannot continue working.
Game mechanics to explain chronic illness
This is similar to severe post-exertional malaise – also known as crash – which has become known due to Chronic Fatigue Syndrome or ME/CFS, an extreme consequence of Covid or other viral illnesses. Stress of any kind can lead to a worsening of symptoms, which can either restrict those affected slightly or, in extreme cases, permanently impair them. This would be even more aptly illustrated by the combination of the two Citizen Sleeper mechanics: the unpredictable damage to the dice caused by stress in addition to the constitution bar, which indicates the permanent deterioration of daily options.
However, to keep the gameplay entertaining, one of the mechanics is sufficient and can possibly improve the understanding of chronic disease management. A random mechanic with dice is generally known and therefore easier to understand than a daily changing and random number of spoons. With the spoon theory, it would be possible to use six out of ten spoons in a day for a particularly strenuous activity, using the other four for cooking and eating food, for example, and doing nothing else. However, some of these efforts are only possible for chronically ill people on very good days, which the cube model illustrates much more clearly, as a small number of dots on that day can be used for a particularly strenuous activity. The factors of physical condition and stress as bars that damage cubes, are easier to imagine and to recall as an image. The concept of planned obsolescence also symbolizes the need to constantly struggle maintaining a physical and mental condition that is not necessarily good, but at least acceptable.
The Spoon Theory is now a widespread concept, and those affected often refer to themselves as ‘spoonies’. When communicating about such illnesses, it nevertheless makes sense to look for further and more widely applicable models that can help those affected to explain their condition to those around them and express their needs with fewer words and little energy.
This article was first published in German: Citizen Sleeper: Chronische Erkrankungen als Glücksspiel
