Doubling Down: Flathead and the Neurobiology of Gambling

Over? Or under?

Content warning: this article discusses gambling, how it works within the brain, and contains mention of compulsive gambling (gambling addiction). Some of the imagery in this game (and the others made by the same creator) are disturbing in an uncanny fashion (especially concerning faces) which some people may find upsetting.

It’s the classic gambit: do you walk away with what you’ve got? Take the money and run? Or do you risk taking a loss for the chance of walking away with even more than you started with?

Gambling is so old that it predates written human history, and I’ll come right out and say it: I don’t understand its appeal as a recreational activity. Maybe I’m just too stingy to risk it with my money. Being a permalancer will do that to you, I suppose.

The only place I gamble is with fictional currency on everyone’s favorite childhood gambling website: Neopets dot com!!!!

But I do know that gambling holds an almost supernatural power. For the majority of people, gambling is a fun, somewhat glamorous way to spend an evening, score some NeoPoints, or get the skin or cosmetic you wanted for your favorite character in a video game. But for others, it becomes compulsive, all-consuming, and even pathological, resulting in catastrophic damage to interpersonal relationships, personal finances, and even so-called “deaths of despair.” Another reason I don’t understand the appeal, I suppose.

And yet, the power that gambling holds seems almost improbable in itself: how can something as unassuming as a slot machine or betting on your favorite sports team on an app lead people to lose their entire life savings? How can playing a little game of chance turn into a diagnosable addiction?

There has to be something almost intoxicating about gambling. There has to be something in its makeup to cause people to throw all self-preservation and logic to the wind. What’s in this thing that is so dangerous that it’s banned in many US states, entire countries, and in the codes of many world religions?

…And how can it be used in horror?

The Neurobiology of Gambling

As it turns out, the gigantic “supernatural power” of gambling ironically comes down to something almost imperceptibly small: neurotransmitters. For the unfamiliar, neurotransmitters are a class of chemicals within the brain and greater nervous system that act as messengers between special nerve cells called neurons.

This is a highly simplified diagram of how they work. Throwin’ it all the way back to high school biology class!

Each neuron “fires” the appropriate neurotransmitter across the synaptic cleft, the small distance between one neuron and the next. Once the neurotransmitter arrives in its associated receptor on the opposite side of the cleft, that marks “message received.” Then, the next neuron can “fire” the same neurotransmitter to pass the message forward like a baton in a relay race. This little network of chemicals and signals is the language of the human nervous system: both incredibly complex yet somewhat rudimentary at the same time. And it happens constantly.

And as advancements in technology and medical imaging allow us to have a better understanding of neurobiology, it’s become clear that the act of gambling ignites an absolute firestorm of neurotransmitters in the human brain. You know those memes about what modern food would kill a medieval peasant? That’s literally what modern gambling is doing to our nervous systems.

Because the nervous system is old. The common nervous system structure associated with bilaterian (symmetrical) mammals is believed to have developed during the Ediacaran Period, over 550 million years ago. A modern slot machine or sports betting app is virtually identical to that decadently-seasoned Dorito as far as our nervous systems are concerned.

Because for all our technology has advanced, our nervous systems are essentially running on pretty primitive hardware. This is why when you’re stressed out, opening an email might feel akin to facing down a hungry lion. The human nervous system is only able to speak in a language that was appropriate for our early ancestors who didn’t know what “influencers” were. God I wish that were me.

Not only is the “language” of the nervous system out of sync with our modern reality, the set number of neurotransmitters means that they are also speaking with a pretty limited vocabulary. However, don’t be lulled into thinking that “limited” is synonymous with “unsophisticated.” So let’s get acquainted with some of the key players of the neurotransmitter world so you can see what I mean.

Norepinephrine - Alertness

Norepinephrine (also called noradrenaline in some dialects of English) is a major player in the neurobiology of gambling. This neurotransmitter functions as an “activator” within the body, and is sometimes referred to colloquially as the “rage hormone.” Its levels rapidly increase during the fight-or-flight response, and it’s the primary neurotransmitter of the sympathetic nervous system: meaning it can control things like heart-rate, respiration, sweating, and muscle tightening. When you physically “feel” stressed? That’s norepinephrine, baby.

But norepinephrine isn’t a “bad” thing by any means. When you aren’t stressed and its levels are normalized, it’s what allows us to get up in the morning, focus in on school or work, and otherwise allow us to take care of business. Alertness can look like this, too. You need some level of alertness, otherwise activity in the brain decreases, leading to symptoms often associated with clinical depression.

Functional MRI (fMRI) imaging conducted by Yale indicated that in people with “problem gambling behaviors, there is both an increased presence of norepinephrine and its metabolites” (the things that breaks a neurotransmitter down over time). This could indicate that people who struggle with gambling feel the “rush” of this neurotransmitter - but are also subject to a much faster comedown than the general population. This could easily create a cycle wherein an individual feels like they are eternally chasing a norepinephrine high.

Dopamine - Reward

This neurotransmitter has caught a lot of flack on the internet in the past year or so, as it has been branded a key aspect of brainrot. Seriously, people are advocating for undergoing “dopamine fasts” (spoiler alert: that’s not real/they don’t work). But perhaps the trepidation around this neurotransmitter is somewhat warranted, because it is indeed quite powerful. Dopamine is colloquially known as the “reward hormone,” but that somewhat oversimplifies its many functions.

Sure, dopamine is grouped in with “pleasure chemicals,” but it’s got quite a few jobs! Rewards are an important aspect of the learning process, meaning that dopamine contributes towards the overall processing, learning, and memory capabilities of the brain. In fact, there’s evidence to suggest that schizophrenia and other psychotic disorders have a correlation with altered levels of dopamine. Additionally, dopamine appears to play an important role in movement and muscle control, as Parkinson’s disease is believed to be caused by a degeneration of dopamine secreting neurons.

That same study conducted by Yale indicated that in people with problem gambling behavior, dopamine levels are elevated - and it’s no real question why. When a person is within the “gameplay loop” of gambling, the anticipation of the outcome is a pure dopamine rush. That dopamine doesn’t just instantly disappear once they step away from the slot machine.

Serotonin - Impulse Control

Sometimes known as the “happy chemical,” serotonin is the workhorse of the neurobiology world. While it’s most commonly known for its capacity to regulate mood, it’s responsible for a complex variety of functions in the body: everything from regulating your digestive system, to blood clotting, appetite, sleep, and even sexual desire. She’s the MVP - and this is why SSRIs are some of the most commonly prescribed medications. They treat a lot of things!

But when it comes to gambling, serotonin is the sleeper-hit for a very important neurological function: impulse control. Most notably, serotonin is associated with behavioral inhibition, the process in which humans realize they shouldn’t do something because of a predictably poor outcome. Remember when I said I don’t understand the appeal of gambling because it never seems to lead anywhere good? That’s classic behavioral inhibition.

fMRI indicates that in people with problem gambling behaviors, this aspect of inhibition is, well, inhibited, due to lower serotonergic activity within the brain. Gambling appears to be able to quiet that little voice that says “hey, maybe it’s not a good idea to do this,” which is the key to both self-preservation and the ability to stop. It seems like serotonin is the reason why some people can get so hooked by the act of gambling: our brain’s built-in “off” switch has been disabled.

It’s at this point that you’re probably like: alright Anna, enough background on neurotransmitters, let’s cut to the good stuff.

So I’ll ask you one very important question…

Over? Or Under?

Surrealist 2024 indie-horror game Flathead by solo developer Tim Oxton, published by DreadXP, absolutely knocked it out of the park as far as neurotransmitters are concerned. Flathead has an incredibly simple gameplay loop under the hood, with a basic guessing game of probability dressed up to the indie-horror nines.

Akin to the demo for his upcoming similarly-surrealist horror title The Silkbulb Test, Oxton presents a deviously simple setup. You, the protagonist are placed into a chamber as if you are some kind of lab rat. A screen beside you instructs you to “pay what you owe,” and gives you a numerical standard of credits you need to meet. Essentially: this is the minimum threshold where you can “cash out” and get out of the chamber alive.

…Because oh yeah, if you lose too many times, a strange interdimensional creature comes to get you :)

To get these credits, you need to win rounds of the aforementioned “over or under” probability game facilitated by the analog console shown above. You’re shown a single number with a value from 1 to 20. Then, based on what the first number is, you have to guess if the second number will be greater or lesser in value - over or under.

That’s it. That’s the game.

You only have a few other switches at your disposal. The player can turn to their left and activate a cartoonish electric switch labeled “LIGHTS.” It allows the player to look behind them for only a few seconds to peek down a long hallway where something is lurking… and growing closer all the time… There’s also a small switch called “Make Your Own Luck,” which eliminates numbers on the board to help the player make their decision - but beware, the thing behind you approaches much more quickly when you use this option. And then there’s the Wheel of Fate - a strange alternate wheel that can give (or take) various boons: such as awarding credits, removing credits, giving you additional uses to the light box, etc.

Now all of this might sound confusing when laid out in text - so it might be better if you see a couple rounds for yourself to understand it.

Flathead’s Use of Casino Design Fundamentals… to Scare You?

Much like a slot machine, Flathead itself is delightfully tactile. From the levers to the big, chunky buttons, spinning wheels, and flashing lights - there’s no doubt that Flathead employs many of the same tools of the trade as casinos. The difference, of course, is that usually things aren’t going to eat you in a casino (unless you’re a member of the White Glove Society in New Vegas, I suppose).

The physical design of gambling spaces has implications in the psychology and neurobiology of gambling, too. In fact, the design principles most commonly associated with modern casinos were written by a former gambling addict. No, I’m not making this up.

Rather than recover and fight the predatory gambling industry, Bill Friedman (who fascinatingly does not have a Wikipedia page…) instead chose to study the methods casinos use to hook patrons. He’d then go on to then become a casino manager and consultant. …Not what I’d do, but the guy got results.

Here are some of the psychological tricks The House plays… and Flathead uses.

Disorienting Spaces

Whereas casinos might be of labyrinthine construction with no windows to keep you disoriented to trap you into staying longer, Flathead follows this design principle’s lead. The primary room where the gameplay occurs is almost devoid of an interior, with nothing but shadows and the console in front of you. It’s impossible to know where you are, what time of day it is, or even how long you have been in there. In casinos they want you to stay, but all the players of Flathead want to do is leave.

Even in transition moments when you experience a camera pan or zoom-out, the console is really all there is… except for that long hallway behind you, of course. :)

The Machines Are The Decor

Used in combination with the above, there are no real decorations or art within casinos, as the machines are meant to be the sole thing for patrons to engage with. Flathead similarly embraces this… except for the four TV screens to the player’s left which show the face of the lady from The Silkbulb Test as she displays uncanny facial expressions (which is kinda her whole deal as far as I can tell).

Sensory Overload

Flashing lights, spinning wheels… if you’ve ever been overwhelmed at the concept of a casino, know that this is deliberate. Overstimulation is meant to disorient and otherwise exhaust an individual mentally, which might lower their inhibitions… and of course cause them to stay and gamble longer. Flathead uses this sparingly, but it’s such a stark contrast with the otherwise empty expanse of the game that when you do get a brief whimsical glimpse of flashing lights or spinning wheels… it almost feels like it’s mocking you. This was supposed to be fun, right? :)

And stop LOOKING AT ME LIKE THAT

But there’s one other grand trick that Flathead uses to really scare its audience.

Doubling Down

Flathead really thrives on a concept derived from the game of blackjack: doubling down. At a blackjack table, doubling down means that you are doubling your initial bet (but you can only draw one extra card). But instead of doubling down on cards and chips, Flathead succeeds in doubling down on certain neural pathways, intensifying the reaction from the player.

Remember our friend norepinephrine? The “alertness” neurotransmitter? You may have noticed that beneath it’s “profile” above, I name-dropped a connected system that we frequently discuss on Resident Anna: the fight-or-flight response.

Because norepinephrine’s primary function is that of activation, it’s heavily implicated in both excitement and terror - all domain of the fight-or-flight response/the sympathetic nervous system. Just look at all of those reactions in the diagram above: those are all norepinephrine-controlled!

There’s a peculiar adage that I’ve heard from various health professionals in the past, that “anxiety and excitement are the same word in different fonts” as far as the nervous system is concerned. Since both are communicated through the sympathetic nervous system via the same neurotransmitter, it can sometimes be difficult for our minds parse the difference between the two. Nervousness and excitement feel very similar somatically, and it’s the emotional information from the frontal lobe and contextual stimuli from the world around us that help us infer which of these two emotions we’re experiencing.

But with Flathead, the mixture of these sensations is the point. The player is designed to feel both simultaneously: the excitement of gambling… and the fear of a horror game where something is creeping up in that long hallway behind you. Flathead is doubling down on the effects of norepinephrine within the player, heightening the intensity of its excitatory and anxiety-inducing features in a way that I’m not sure would be as successful if either element had existed in isolation. Throw in some uncanny facial expressions in there and you’re golden!

The connection between anxiety and excitement is ancient but has only become understood in recent decades. Making a horror game that capitalizes off of this connection is nothing short of genius from a psychological perspective, essentially making the player’s own nervous system an extension of the game. And the general strangeness of the experience has me left with even more questions. Just what is that entity behind us? Who’s running this weird laboratory? And why does that Silkbulb Test lady keep making weird faces at me?

Truthfully, I’m really looking forward to the future of Oxton’s work in both a stylistic and design capacity. Because if he’s shown he can do one thing, it’s always have an ace up his sleeve.

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Thanks for tuning in to another Resident Anna. This one was pretty neuroscience heavy compared to last month’s more opinion and culture-based article, so I hope you found it interesting!

If you or someone you know has a gambling problem, just know that there is help. The National Problem Gambling Hotline is available here in the United States for anyone who wants to take the first step getting help. They can connect you to local resources to assist you in starting your journey. Their website also contains educational information about compulsive gambling, questionnaires, and links to additional resources. Compulsive gambling is real behavioral addiction and can (and should!) be treated as such. Resources are out there and you are worth it.

Catch ya in the next one!