Video games as a medium are more powerful than they get the credit for. As gamers, we aren’t just seeing and listening but actively participating. We actively decide and live the lives of our protagonists. In doing so, we feel a lot more strongly about them, for better or worse. It’s an incredible tool to develop or encourage empathy, teach skills, and tell a story.
And there are some game developers out there who seek to challenge us, to make us think of our relationship with everyone around us. It’s a hard but admirable task, one Calathea Game Studio took with Inner Ashes.
Chronic and degenerative illnesses aren’t uncommon, unfortunately. It’s a horrible side effect of life. While they are all cruel, illnesses like dementia and Alzheimer’s are brutal because they steal your identity and your knowledge of how to function. We talked to Inner Ashes’ Game Designer Jose Montano and Producer Rebeca Muñoz Bernal to understand how and why they decided to embrace a game that revolved around Alzheimer’s. To understand what they had to consider to do this disease justice while still making a fun and evocative game.
Responses have been lightly edited for length and clarity.
How would you describe Inner Ashes?
Rebeca: The game is a first-person narrative adventure where you play as Henry, who just received a letter from his daughter Enid. Henry has been diagnosed with Alzheimer’s and does not remember why he has been separated (estranged) from his daughter. Or since when. He does not remember anything at all? So he will use this letter and a gift that came with the letter to try to remember.
So Alzheimer’s is a tricky topic to have a conversation about. What inspired you to develop a game about this topic and have the protagonist be the one who is dealing with the disease?
Jose: We did not actually start with Alzheimer’s. We started development with the goal of creating a first-person puzzle game. Then we started to think of how we could differentiate from other games. We thought about creating something with two realities where we could have some puzzles about reflexes. As we followed the idea of ‘two realities’ and that became bigger, at some point, something clicked in our heads. Alright, realities, what could it be when somebody’s here and then the next second, they aren’t here?
It might look like someone with Alzheimer’s. And in my case and the other colleagues from the design department, at the beginning, we all had someone close to us that suffered from this illness. In my case, it was my grandma. So we said why not? Why don’t we try to make the illness a little bit more visible? Let’s make it more visible in media like video games, which is not usually used for these kinds of things, right?
Considering that this comes from a personal space, with a difficult topic, the game itself feels very hopeful even if it is a little sad. What was the reason behind that decision?
Jose: When we were thinking about how we can deal with the topic within Inner Ashes, there were two options for us. For us, it’s okay, the topic is tough enough. We can try to soften the rest a little bit or we can go for a precise and tough, straightforward method to represent what’s going on.
We decided to go for the first approach, to be a little bit softer with the narrative and art of the game. Part of it was that we weren’t really confident about presenting it in a brutal and realistic way. We also wanted a gentler approach for the players. Those that are dealing with this disease already get sad and emotional. And others will have no context. A softer, gentler version is easier to deal with than the harsh realities.
How will players get to experience the degenerative nature of Alzheimer’s in Inner Ashes?
Rebeca: So we try to represent, within each of our levels, the different symptoms of Alzheimer’s. One thing that we have learned during the development process, is that Alzheimer’s is degenerative as you mentioned. But it does not have phases or steps. Each person will experience the disease in a different manner. Some of them will experience some symptoms and others will experience different ones, or maybe the same symptoms in a different order.
With Inner Ashes’ level design, we have represented some symptoms that a person may or may not have. And the order in which you explore them, within our levels, may not be the same as some of the players’ experiences. We have used Henry’s house as a way to track the physical impact of the disease. As we mentioned, we have two different worlds, the real one being Henry’s house. As you play through the game, the House changes. We use it as a marker to show how the disease affects Henry’s real life.
Jose: The other world of Inner Ashes is the islands. They are marked for the mental part of the disease, while the House represents the physical part of the disease. These differences are something that we learned during development. We’ve been working with specialists from the University to try and get insights on how this disease works and progresses. To learn as much as we can so that we can represent it correctly. It was through their guidance that we learned that we were missing out on representing some physical symptoms of Alzheimer’s.
For example, they might forget how to do things that they’ve been doing their whole life. So we use the house for these kinds of symptoms and the memory islands for more mental-related symptoms.
What was the most important element you had to keep in mind when crafting the gameplay experience? So that the player can feel Henry’s struggle?
Jose: That’s a great question. I’d say that we had like 2 main narrative pillars for Inner Ashes. One is the elements related to Alzheimer’s disease and the other one is the relationship between a father and his daughter. Every time we had to make a design decision, we had to keep in mind both of these topics. When we want the player to feel like Henry was struggling, we needed to decide if he was struggling because of Alzheimer’s disease or if he is struggling due to the relationship at that moment.
Depending on that, we would decide on our design and mechanics. I cannot tell you much more because I’ll be giving out spoilers. But yeah, we have those two things in mind and we try to understand how our main character and our player should feel and use that as a guide.
Rebeca: And I would say that all the elements of the game contribute to that. So not only the mechanics but also the scenarios, the music, the voices, etc. So all of them.
What were the challenges in creating the narrative and the world of Inner Ashes?
Jose: The most important challenge for me was to treat the disease respectfully. To try to read and try to learn, as I mentioned, as much as we can. The other challenge was understanding a father-daughter relationship. For me, as a man, that’s quite difficult, but thankfully I had some female colleagues that were able to drive that a little bit better than myself. Another challenge was to decide the game structure.
In Inner Ashes, we are representing someone that has Alzheimer’s, as a result of which, his life has been limited in many ways. So we cannot make Henry go everywhere we needed or wanted him to go. So we first had to decide where the game was going to take place. We can assume that thanks to these restrictions, he’s going to be at home. So part of the game is at home.
But then we decided to add the Islands because we realized that even if he is at home, he might be somewhere else, in his head. In his imagination or his inner world. I’d say he’s experimenting with different things to help process what is happening to him. This helped us create our settings.
Once we made the decision, we decided that each island would represent one symptom. Then we began to build, keeping in mind how we want the player to feel. We went island by island, deciding what was going to happen narratively and thus what should the mood be. Then we add to that with the art, the music, the sound effects, and even the voice acting. They all represent this progression, this degeneration through the game. We don’t tell the player that this is a degenerative disease, we have tried to show it.
You have created this large gorgeous world to represent Henry’s imagination and life. Within all this detail, what is something small that you hope the player will notice or interact with?
Jose: Something small? Let’s just say that there’s a small lock in Henry’s living room. It’s something he can interact with. Just keep interacting with it. I’d say that this is something that I want the players to notice.
Rebeca: I always say that every person that plays the game, will feel different and notice different things, even some things that we have not thought about.
(Interviewer note: The Inner Ashes team has slipped in a little wooden cat as an homage to their cat Freya. Do look and see if you can find it!)
What do you think is an important experience a person suffering from Alzheimer’s goes through? How have you tried to replicate that feeling in Inner Ashes?
Jose: Something that they might experience and that we want the player to go through? I’d say everyday tasks. For example, we have a puzzle in Inner Ashes. Well, it’s not really a puzzle because it’s really guided. But at some point, the player is asked to make coffee. It’s just a simple cup of coffee. But Henry is going to struggle a little bit, trying to complete the task.
Rebeca: Even though the House is just a place that we visit to go to other islands, there are many small details hidden there to show these hurdles. One is the cup of coffee. Another one is cleaning the house. (These normal everyday tasks are now challenging because of Alzheimer’s).
How did you go about creating the mini-games? What was the important aspect of designing them so that they fit into the theme and into the narrative?
Jose: We have two main mechanics implemented in the game. There are not too many of them, to begin with, but these 2 are important to the theme. The first one is using Post-it or sticky notes. It is something we observed in daycare centers and old age homes.
People who are suffering from Alzheimer’s are guided to start to write down everything. Why they’re using some things or even a details like: ‘In the morning you’re going to see a woman. Do not be scared she’s your daughter.’ They use Post-its to understand the world. At some point during the disease, from our understanding, the Post-its mean ‘existence’ for these patients.
When Henry is able to interact with something and pick up something, it becomes a Post-it note. If it can be a Post-it note, it exists, thus I can use that object. That’s the rationale behind it.
And then we have the second mechanic that are puzzles, like one where we have to fill these holes with Tetris-like pieces. This is also inspired by Alzheimer’s treatments. These puzzles and others like it are used to, I wouldn’t say improve, but to slow down the progress of the illness. It serves to keep their mind at least active. Yep, basically regarding mechanics we have those two foundational pieces. We have tried to experiment with them and build them up to show mood changes, short-term memory loss, sudden rage or disorientation, etc.
From everything you have told me about Inner Ashes so far, it seems like there is a lot of detail for the player to absorb. But if you could distill it down to one message, what would it be?
Jose: I think that the message would be: Alzheimer’s is a tough topic. Someone near you might be struggling with it, either dealing with the disease or struggling because their family member has it. So just try to be more patient. Try to understand how they’re feeling that might lead to their behavior. Be empathetic to their struggles.
Inner Ashes is available to experience now on Steam, GOG, Xbox (Microsoft stores), the PlayStation Store (PS5 and PS4), and Nintendo Switch. You can also follow the team on Instagram.
