Hair of the Dog
Exploring the ethics and depiction of substance use in horror games, featuring "The Mortuary Assistant" and its developer, Brian Clarke.
Content Warnings: This article contains detailed discussion of addiction/substance use disorders, the opioid crisis, etc. Please be aware that this could be very upsetting if you or someone you know is in recovery.
This article also contains spoilers for The Mortuary Assistant (2022).
Overview
The expression “the hair of the dog” is often associated with alcohol consumption, but it’s a fallacy that can be applied to any habit-forming substance. The expression comes to us from an old wives’ tale associated with curing rabies, saying that placing a single hair of the rabid dog which bit you into the bite wound would be able to prevent rabies from taking hold. Of course, this is impossible, as rabies is one of the single most fatal illnesses known to mankind - but the concept of taking something from the very thing which hurt you as a “cure” has stuck. “Hair of the dog” might be another drink after a heavy night out to “cure” a hangover, or perhaps even stop withdrawals if a person partakes in a substance regularly. A moment of indulgence or escapism turns into always returning for that hair of the dog to prevent that devastating crash back to reality: it’s this feedback loop that becomes so dangerous.
Addiction, particularly that of opioids (such as heroin and narcotic painkillers), was officially declared a public health emergency in the United States by the Department of Health and Human Services in 2017. But according to many healthcare institutions, this was far too late. According to the CDC’s own data, more than a million Americans have died from some sort of drug overdose since 1999, yet the number of those deaths specifically attributed to opioids was a whopping ten times higher by the year 2021. Similarly by 2021’s data, overdoses involving opioids in general were responsible for the deaths of more than 80,000 people. A shocking 88% of those fatalities involved synthetic opioids like fentanyl which has infiltrated the market as it’s used as a cheap, powerful way to “cut” the product.
If you’re like me, you probably someone who has struggled with “Substance Use Disorder” (SUD - the official medical name for addiction) of some variety, whether that be drugs, alcohol, or even tobacco: if you haven’t struggled yourself. Yet despite how common this condition is, there’s something deeply taboo and stigmatized about its discussion, which can prevent a sufferer from getting help and thus result in worse outcomes.
A large body of research indicates that stigma is persistent, pervasive, and rooted in the belief that addiction is a personal choice reflecting a lack of willpower and a moral failing. Rates of stigma are extremely high both in the general public and within professions whose members interact with people with addiction, including the health care professions. Research demonstrates that stigma damages the health and well-being of people with substance use disorder and interferes with the quality of care they receive in clinical settings.
- Johns Hopkins University on “Reducing the Stigma of Addiction”
And it certainly doesn’t help when media outlets have been found to continually run sensationalist headlines which perpetuate stigma and fear surrounding those struggling with SUD and the substances that they use. This has gone to such an extreme that police officers have fainted when encountering synthetic opioids in the field, believed by healthcare professionals to be more a side effect of the moral panic surrounding the substance rather than the substance itself.
All this to say: us Americans in 2024 do not have a good relationship with substances, whether that be in our own lives, in the lives of our loved ones, or even in media.
That’s why, when the horror game The Mortuary Assistant (2022), developed by DarkStone Digital and published by Dread XP, explicitly included having a history of being in recovery from SUD as part of its narrative, I was intrigued. Horror as a genre is a way for us to confront that which is upsetting, othered, and taboo - so it felt like a golden opportunity to bear witness to this frightening aspect of so many people’s lives in a way that was both raw… and hopefully, compassionate.
I began to wonder if we as game developers, and artists/creators of media in general, might find a ethical framework by which we can display the reality of living with substance use disorder, while also not contributing to the stigma and sensationalism that tends to be coupled with it. I reached out to Brian Clarke, the primary developer of The Mortuary Assistant to ask him some questions about the protagonist of Rebecca, and he was kind enough to answer my questions about the inspiration, process, and reception surrounding this part of her story.
Meet Rebecca
Rebecca Owens is the protagonist of The Mortuary Assistant. She’s a young woman studying the mortuary arts who is nearly finished with her schooling, as she has become certified in embalming and has moved on to the internship/praxis phase. Her old professor, Raymond Delver, has offered her a job working for him at the River Hills Mortuary, and Rebecca has decided to accept.
But even before her foray into the mortuary world, Rebecca was no stranger to death. Her parents both struggled with addiction in her childhood, which would ultimately lead to her mother’s premature death via overdose. Through a traumatic flashback the player may see, we can assume that Rebecca was the one to have found her mother’s body. As is unfortunately consistent with the children of those struggling with addiction, Rebecca would go on to develop SUD herself as a young teen. Her father was able to secure his own recovery, but would perish in an accident years later when trying to rescue Rebecca from a perilous situation caused by her drug use. As she has had to bury both of her parents before even coming of age, we can understand why caring for the dead might be a deeply personal calling to her.
When I asked about this particular vocation for an otherwise pretty typical young lady like Rebecca, Clarke replied:
“Her desire to become a mortician stems from her feeling comfortable alone and was originally a step she took to move forward while still not fully dealing with her past. It is a more solitary career where the only people you really deal with are dead. It’s a stable step out of an unstable past while still staying withdrawn.”
“My goal was to have the character grow through the actions of the player so the endings would be more impactful as Rebecca has not only survived but become a better version of herself.”
By the time we begin the game, Rebecca has reached ten years of sobriety as is evident by the chip (a coin/token utilized by many 12-step programs that indicates how long a person has been sober/substance-free) that can be found in her apartment. This is a huge milestone, and from this we can already infer that Rebecca as a character is no stranger to hard work or facing the painful things in her own past, meaning that her potential for growth as a character has few limits. …But as tantalizing as a complete recovery may seem for story purposes, it doesn’t mean that she’ll ever be “over” the trauma which played a role in causing her to develop SUD in the first place. Some things, like trauma, have of more of a “you learn to manage/integrate it” sort of prognosis.
The Dual Intimacy of Death and Addiction
Perhaps one reason why people are often so loathe to discuss addiction/SUD is because of how deeply personal of a struggle it is. When we as a society can’t even manage to stomach the answer of “how’s it going” with anything other than “good", discussing the personal struggle between the psychological and physical that comes with addiction might feel completely beyond one’s grasp. Couple that with the general distaste for grappling with death and its looming sword of Damocles, and the Mortuary Assistant is a game that brings multiple societal taboos into the open in a way that is raw, harrowing, and yet oddly refreshing.
In the game, the player as Rebecca has the sacred duty of preparing and embalming various deceased persons prior to their burial. Their bodies are placid and uncanny, but the memento mori is tempered with the otherwise typical routine of work: such as clocking in, going down a checklist, and printing out paperwork.
The process is simultaneously very sterile and professional and very intimate: the player must drain each cadaver of their remaining blood, for example, or even wire their jaws shut. This kind of work would otherwise only be under the purview of someone like a surgeon - so few people are ever granted that kind of access to someone’s body, especially in such a vulnerable state. To be reminded that at the end of the line, our very bodies may be entrusted to some stranger is somehow disquieting.
And when supernatural things begin to occur in the funeral home when it was just supposed to be Rebecca and the bodies of the deceased? …Even more disquieting. In The Mortuary Assistant, that which is otherwise very private, becomes the main focus of the story through Rebecca.
“It’s also a very intimate game. The game is really Rebecca and the demon. This led me to push the idea that the main character needed a very difficult and unsettling past for the demon to exploit. Something that would allow for unsettling imagery and situations as well as a glimpse into why Rebecca may have chosen the path she has. The game is, essentially, all about the protagonist.”
Yeah. You read that right. A demon.
According to Abrahamic demonology, particularly that of the anonymously-published 17th century work The Lesser Key of Solomon, demonic entities may exploit or feed off of highly emotionally charged individuals in order to manifest. And as Rebecca tries to figure out what the heck is going on within this funeral home, it becomes very apparent that there is some element of demonic possession at play. Part of the gameplay requires identifying the demon that is attempting to manifest and which of the bodies it has attached itself to. Rebecca will need to follow all the given steps properly to cast the demon out. …Something tells me this wasn’t exactly within the initial job description. I wonder if she gets hazard pay?
Furthermore, typical Christian scripture and the writings of St. Augustine indicates that demons can begin to possess an individual without that person’s consent or even awareness. The way that demonic possession is able to “sneak up” on someone dovetails with conditions such as SUD, which may develop so slowly that the afflicted and their loved ones may not be able to understand what is going on until the addiction has already been formed. This parallel was not lost on Clarke:
“Drug addiction became a natural progression for me when writing her character because of the parallels I began to see through what I was creating for the possession process in the game. At first, Rebecca isn’t even aware it’s happening to her. She's being told it's happening, she knows it’s bad, she can tell something is different but she mostly ignores it until it’s influenced her so much that she isn’t even aware her choices aren't fully her own. Eventually, she is faced with either allowing it to go beyond her control or to take the new tools she’s gained and grow beyond it as she did with drugs. In the end, she isn’t really over it but rather learns to live with it. She’s not cured, she's stronger.”
This continuous nature of recovery is echoed throughout the various endings, wherein Rebecca feels called to continue her work (both as a mortuary assistant and now as a demon-hunter). We as the player have gotten a deeply intimate look at Rebecca’s life and her struggles alongside the sleeping dead - and as we resurface at daybreak alongside her, we know she is now even more equipped with tools to forge a new path ahead. But of course, it will never be easy.
Pitfalls
Of course, when it comes to the moment-to-moment story beats of depicting substance use, there are certainly ethical questions that come into play. For example: how explicit should depictions of this be? While some of this is moderated by various content boards such as the ESRB, explicit depictions of substance and its paraphernalia could be triggering to those who are currently experiencing or in recovery from SUD, or to those who have a family member who is. To depict substance use also runs the risk of glamorizing it, which is especially dangerous when it comes to younger, more impressionable audiences.
Yet simultaneously, the 2018 VICE documentary series Dopesick Nation was praised because of its unglamorous, explicit depictions of the front lines of the opioid crisis in the United States, particularly in Florida. Dopesick Nation approaches those with addiction with compassion and empathy, and it shines a light on the many intersecting issues with the opioid crisis, including homelessness, human trafficking, trauma, and organized crime.
The Mortuary Assistant is able to do so similarly, showing the casualties and collateral of a life of substance use through the environments Rebecca envisions in her flashbacks. The player may see abandoned houses and the interiors of hospitals, yet the game shows little of individuals actively partaking in substances of any kind. In The Mortuary Assistant this is very effective, but I’m not sure it would have been as effective in media such as Dopesick Nation. This kind of depiction is likely heavily contingent on a case-by-case basis.
It feels to me that there is a delicate balance that must be struck in terms of both authenticity and sensitivity. I did a considerable amount of research to see if any sort of framework or guidelines were already existing, perhaps from nonprofits or even professional consultants - but unfortunately came up empty-handed.
One of the other risks for characters who engage with substance use is that they may be ultimately reduced to the confines of their condition. Having characterization be mostly comprised of details about a character’s past can play into stereotypes that people with addictions are their diagnosis. Clarke commented on this as well, saying:
“I think I would have liked to give a bit more insight into Rebecca as an individual in the present day. I feel I establish the core beats that matter for a game the length of Mortuary Assistant but there is so much focus on her past and trauma that there is only so much character building in the present. Even some small things around her apartment with more personal info. Maybe I can add it in some DLC.”
While I have no concrete solutions for any of these pitfalls, I hope that games like The Mortuary Assistant can start conversations within the gaming sphere. I’d love to see the inclusion of sensitivity consultants and even see games from those recovering from substance use disorders themselves. Much like all other arts, games can really help us understand what’s going on inside our own minds by putting it down on paper (or in this case, a screen).
As Always: Personal Stories Drive Game Narrative
For game developers, the games we make aren’t merely the byproduct of our dayjob or the equivalent of some sort of fancy toy: they are often driven by deeply personal inspirations. Much like professional artists (of which I would argue game developers are a subset, but I digress), devs are often influenced by what they may be experiencing in their personal lives and the world around them. This often (consciously or not) finds its way into design.
“A lot of Rebecca’s story and the story of addiction in general isn’t so much about the drugs themselves but the past that led to making the choices of escape. I have had personal experiences with depression…that have informed a lot of my choices not only in the story of Mortuary Assistant but my writing in general.”
Similarly, I might not be writing this article if I didn’t feel an emotional connection to the topics addressed in The Mortuary Assistant. Having had loved ones who struggled with substance use has made SUD a presence in my life. When you love someone who is either actively struggling with, or is in recovery from an addiction, you can feel so helpless. But recovery is possible, and there’s an entire community of people and resources out there dedicated to it.
So I was curious what players were saying, as I was certain that others likely found some element of connection with Rebecca. Clarke said that the response to this element of her story has been “rather surprising.”
“There have been people who have reached out who have recovered and said that Rebecca’s story really meant something to them. I’ve also had those who have lost loved ones who have said they felt a connection with Rebecca and her father. That the alternate ending with her father really meant something to them. It’s surreal. It means the world to me to know that something you created from nothing resonates with people. It’s a luxury I never imagined I’d be fortunate enough to experience.”
At the end of it all, humans are creatures wired for connection. We just want to know that we are not alone in the world - in our joys and in our struggles. And horror can take something which is considered taboo or even shameful and thrust it into the spotlight. When we are able to detangle it from expectation, judgment, and tradition, we may realize that at the heart of this spooky story is none other than a beating heart. A deeply human core which whispers: we were never truly alone to begin with.
Thank you for reading another installment of Resident Anna. This one is very personal to me, and I hope that games continue to have thoughtful discussions about these sorts of topics.
I’d like to give a huge thank you to Brian Clarke of DarkStone Digital and Dread XP for letting me interview him for this article. Please go check out The Mortuary Assistant!
If you or someone you know is struggling with substance use you are not alone. There is help available to you. If you are in the United States, you can contact the Substance Abuse and Mental Health Services Administration (SAMHSA) for free, confidential information about your options and finding treatment/resources. Their National Helpline is in services 24/7, 365 in both English and Spanish. If you are reading from outside the United States, similar resources may be available to you.
You matter.
Talk to you soon. <3