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INDIE GAMES IN THE DIGITAL AGE
Edited by M. J. Clarke and Cynthia Wang
https://ereader.perlego.com/1/book/1387489/150 1/147
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First published in the United States of America 2020
Volume Editor’s Part of the Work © M. J. Clarke & Cynthia Wang
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Cover design: Eleanor Rose
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CONTENTS
Introduction M. J. Clarke and Cynthia Wang 1
Part I Indie Game Creators 15
1 Brews, Burgers, and Indie Bombast: °e Antiestablishment

Neoliberalism of Devolver Digital John Vanderhoef 17
2 Queer Indie Game-Making: An Interview with Mo

Cohen Bonnie Ruberg 35
3 Postmortems and Indie Cultural Work M. J. Clarke 48
4 Five Nights at Fan Games: Feminism, Fan Labor, and Five

Nights at Freddy’s Betsy Brey 73
Part II Indie Game Tools 97
5 From Tool to Community to Style: °e Influence of

Soﬅware Tools on Game Development Communities and
Aesthetics Emilie Reed 99
6 °is Is How a Garden Grows: Cultivating Emergent Networks

in the Development of Stardew Valley Kevin Rutherford 123
7 °e Making of Escape Room in a Box Cynthia Wang 142
Part III Indie Games Texts 159
8 °e Hunt for Queer Spaces: Mainstream Indie Games,

Representation, and Limited Worlds Cody Mejeur 161
Contents
9 Indie in the Underground Aaron Trammell 184
10 Paper Code and Digital Goods: °e Economic Values of

Type-In Market Games Patrick Davison 199
List of Contributors 221

Index 224
vi
INTRODUCTION
M. J. Clarke and Cynthia Wang
°e digital realm has reconfigured the ways in which production and

consumption of games happen. Consider some prominent examples:
— In November 2010, a group of high school friends from Chicago
presented a version of their game, Cards against Humanity, as a
Kickstarter campaign. Aﬅer surpassing its modest funding goal, the
game sold over 500K units in the next three years and enabled its
creators to generate a number of politically minded publicity stunts
in the wake of Trump presidency.
— In May 2011, self-taught game developer Andrew Spinks released his
own world-building game aﬅer only five months of production. °e
game, Terraria, now available on all major computing and gaming
platforms, has sold over 20.5 million units, but is still only available
through Spinks’s own publishing firm, Re-Logic.
— In June 2013, student video game developer Toby Fox pitched his
own project, Undertale, on the financing platform Kickstarter using
the free-to-use production tool, GameMaker. Aﬅer raising over
$50,000 for his game, Fox’s Undertale sold over 2 million units before
being named 2015 Game of the Year by several video game trade
journals, including IGN.
— In August 2012, the disillusioned pen-and-paper game developer
Monte Cook leﬅ his job at the publisher of industry leader, Dungeons
& Dragons, and pitched his own role-playing system, Numenera,
directly to fans in a Kickstarter campaign that earned over $500K.
Subsequently, the game has become a brand-franchise spawning a
series of spin-offs, novels, and video games.
— In February 2016, two stay-at-home moms and escape room
aficionados launched their Kickstarter campaign for a home-based,
single-use escape room board game called Escape Room in a Box.
Aﬅer they hit their goal of $19,500 within fourteen hours, and were
funded for over $135,000, they ultimately licensed the game with
board game giant Mattel.
Indie Games in the Digital Age
In all these cases, creators have leveraged the ease and availability of online
tools and platforms and, as a result, have forged paths to both creative
and financial success previously unavailable. Traditional mass media and
game publishing models have operated with high barriers to entry and
high production costs, reinforcing capitalist power structures, wherein the
richest, most privileged, most connected and the most culturally, socially,
and artistically normative have had the best chance to have their creative
works made and exposed to a wide audience. And because mainstream
board game companies like Mattel and Hasbro, as well as traditional video
game companies such as Nintendo, Microsoﬅ, and Sony have presided
over an oligarchical system, independent game-makers historically have
had more limited chances to get their work in front of an audience without
directly working with one of these gatekeepers.
°e concept of “indie” or independent creation outside of traditional
channels of cultural production has been a predominant theme in academic
and critical press as well as in creator investment around film, music, and
other mass media in the last several decades, a tendency that has only
expanded along with new digital affordances. Recently, media coverage
is replete with celebratory examples. For example, in music, Chance the
Rapper’s album, Coloring Book, was first self-released on the free digital
platform Soundcloud before winning the 2016 Grammy for Best Rap
Album of the Year. And in the previous year, Sean Baker produced the
award-winning film Tangerine—a movie about transgender sex workers
shot entirely on an iPhone. Digital tools have also encouraged the indie
impulse in other fields of expression, such as the use of social media and
blogging to establish and promote underground restaurants (Tran, 2017), as
well as in the growth of podcasting as a new vehicle for independent critics,
essayists, and historians (Markman and Sawyer, 2015). Among this new
wave of independent cultural producers is a growing and vocal group of
game-makers, critics, and users using the moniker of indie games.
°is collection of chapters explores useful inquiries into the motivations
and functions of current indie cultural work, and specifically indie gaming.
Indie gaming is not simply an experiment in artistic creation but also one
of social and economic experimentation in which its participants actively
interrogate their internal cultural and economic motivations, their relations
to the larger community of makers and users, the sociocultural function of
their texts, and their attitude toward the technological affordances available
to them. Each chapter explores, in various contexts, how indie game
producers have negotiated their processes of production and distribution of
Introduction
their creations in ways that challenge traditional models of game-making,

while also forcing us to rethink our understanding of late capitalist cultural
production and consumption processes. Investigating the products and
practices of indie game-makers presents scholars with an opportunity to
reconsider the debate over user-generated content and digital labor more
broadly. How much does the dissolution of mainstream gaming’s production
chokeholds on financing, marketing, distribution, and production empower
indie game-makers to rethink cultural, economic, and political models?
Conversely, how are indie game-makers potentially exploited by new
media platforms that siphon off their biopolitical labor, reinforcing and re-
interpellating them into traditional models of capitalism and power? Our
understanding of indie games lies at the intersection of these debates, which
allows us to posit the indie games not simply as a cause or consequence
of economic or social forces but also as an active negotiation and balance
between art, representation, theme, labor, and reputation. In other words,
this book is less about playing indie games and more about “playing indie”
in games work.
Like all cultural industries, the business of games and video games is
plagued by great risk and uncertainty, a problem only exacerbated by current
trends among mainstream publishers. Although the latter’s field is immense
and growing, tallying nearly $29 billion annual revenue, these spoils go to a
relative few number of incumbent firms; in fact, well over half of this figure
was commanded by just five firms (Sony, Microsoﬅ, Activision, Nintendo,
and Electronic Arts) in 2017 (Alvarez, 2017). °is ballooning overall
performance has inflated the importance and risk associated with individual
projects as typical production budgets now hover between $20 and $50
million, and average production staffs push past one hundred personnel on
AAA (major publisher, big budget) releases. In exemplary cases these costs
and worker hours surge even higher; Bungie’s Destiny (2014) reportedly cost
the developer $140 million to produce with a team of approximately 400
staff members and Rockstar’s Grand °eﬅ Auto V (2013) costs almost just
as much—$137 million according to contemporary press—and tasked as
many as 1,000 creative workers (Pham, 2012; French, 2013; Lanxon, 2013;
Sinclair, 2013). As these inputs increase, the overall success rate of games
produced diminishes as, according to several estimates, only between 4
percent and 20 percent of video games manage to return a profit to their
makers (Zakariasson and Wilson, 2012). In response, larger publishers have
adapted several mechanisms of risk aversion in their work practice as well
as in the choice and elaboration of their products. Both AAA publishers
and the developers that supply their games increasingly rely on the licensing
of presold intellectual properties from other media supply game concepts,
the reiteration and sequelization of their own game franchises, and the
narrowing of products in line with established game genres and gameplay
mechanics. Moreover, these same pressures have equally encouraged the
forces of so-called rationalization to appear in the industry through stricter
fragmentation of labor, the establishment of clearer work hierarchies, and
the use of timetables and deadlines, all hallmarks of classical bureaucracy
(Tschang, 2007).
In addition to the economic pressures of the gaming business,
mainstream console video games, too, are notorious for labor problems
and a high rate of creator burnout (Deuze, 2007). Specifically, video game
production is typically understood as a dues paying job in which short-term
job performance becomes the measure of a worker’s ability to be rehired to
staff subsequent short-lived development teams and so-called self-organized
projects (Grabher, 2002). It is also a profession that requires off-the-clock re-
skilling to keep abreast of technological changes in tools and programming
languages. And it is a job that oﬅen requires long periods of extended work
hours—colloquially known as “crunch time”—that may or may not be
appropriately remunerated. °ese factors then are typically papered over
with a corporate philosophy of “work as play” (Kline, Dyer-Witheford, and
De Peuter, 2003) that encourages workers to have “fun” on the job in an
effort to keep them at the office if not on their terminals.
While trend lines have slightly shiﬅed in the short term, these work
demands have tended to overdetermine the typical demographic profile
of video game workers. According to the most recent International Game
Developer Association survey, the average age of the video game creative is
thirty-five (compared to the economy-wide average of forty-two) and that
almost half of the game worker labor force have been in the industry for less
than six years, evidencing a high degree of aging out (Legault, O’Meara, and
Weststar, 2017). Moreover, the same study also demonstrated demographic
biases overall as still 79 percent of the workforce is male. And, according
to many reports, the gender imbalance has resulted in work environments
oﬅen hostile or at least unfriendly to women across new media in general,
echoing McRobbie’s (2016) claim that boundary-less creative careers have
enhanced negative effects on already disadvantaged or marginalized workers
who have less access to institutional support and oﬅen are compelled to
“play along” in order to ensure re-hireability. In one recent report about
work in Silicon Valley, 66 percent of female workers indicated that they had
Introduction
been excluded from work events on the basis of their gender (Kolhatkar,
2017). °e countervailing presence, relative success, and rising critical
legitimacy for indie games then acts as a counterweight attracting both
old gaming professionals disaffected by work demands and young aspiring
creative workers resistant to the work and life culture perpetuated by larger
publishers and developers, bringing along with them stories, ideas, and
representations outside the sometimes circumscribed experiences of the
typical young, male AAA industry.
Industrial concentration and the artistic conservatism associated with
risk aversion in AAA publishers concomitantly have leﬅ fruitful gaps,
niches, and agendas in the business of games and video games through what
organizational theorists call resource partitioning, what economists call
creative destruction, or what critical theorists call commoditization. In the
first case, resource partitioning theory explains the mutual co-existence of
consolidating, large generalist firms and small, emerging, specialist firms
in single industries. Simply put, as the former grow, larger firms oﬅen seek
out the largest market segments with the broadest serving products and
texts to take advantage of their scope through economies of scale (Markman
and Waldron, 2014). °is strategy leaves neglected market segments and
other value propositions open to be exploited by properly scaled firms;
however, business thinkers have noted that the vitality that these smaller
operations—whether they be microbreweries, luxury watches, or indie
games—necessitates a cultivation and maintenance of a distinct authenticity
or identity to avoid being reabsorbed into the generalist market (Carroll and
Swaminathan, 2000).1 Resource partitioning theory suggests that industrial
concentration can engender indie growth, while creative destruction
suggest that any technological dependent industry harbors the dilemma
of outside, upstart innovation. Economist Joseph Schumpeter elaborated
the concept of creative destruction to suggest how actors in industries
must repeatedly update their methods and products and that “such change,
both great and small can be triggered by entrepreneurial effort which
disrupts equilibrium, destroys established value, and creates new value”
(Cunningham, Flew, and Swiﬅ, 2015, p. 104). Like all new media firms,
major AAA publishers spend a large amount of time and effort on research
and development and on purchasing innovative firms and technologies
to stay abreast of the technological churn that has made more cautionary
tales than durable successes in the gaming business. For example, current
accounting documents for the publisher Electronic Arts mark the firm as
spending an amount approximately equal to one quarter of their revenue
on research and development (Electronic Arts, Inc., 2018). However, the

incumbency of these firms and their relative success, attached to the current
construction of the industry, leads to a countervailing conservative impulse
notably absent in upstart firms. °e unceasing nature of technological
change may then equally engender an innovative, indie fringe that lacks a
definitive investment in the industry and its market as it currently exists and
is, thus, more eager for difference in both their production and their texts.
Drawn from Marxist notions of the commodity, critical theory poses the
rationalization characteristic of profit-seeking creative firms as diminishing
and perverting the artistic impulse at their very core into mere ideological
reproduction through rote, repetitious, and standardized formulas (Adorno
and Horkheimer, 2002 [1944]). In most versions of the theory, a text’s mode
of production ultimately determines, albeit in the last instance and with
relative autonomy, or at least delimits its mode of representation (Althusser,
2005 [1969]).
Further, many applications of critical theory then suggest that perhaps
alternate modes of production, not subject to the same economic and
organizational pressures, may enjoy an enhanced leeway for both artistic
and political expression. Despite their radically different evidentiary bases
and their respective disciplinary divisions of all these theoretical strands,
each suggest a macrological advantage of the relative smallness of actors on
an indie field that structurally have either an opportunity, an edge, or even a
mandate to innovate in their cultural production.
°e gaming business is traditionally organized around a publishing model
typical of many cultural industries (Hesmondhalgh, 2013). In this model,
smaller, oﬅen disconnected firms or individuals—in games, usually termed
developers—provide most of the creative or symbol-producing labor, while
oﬅen larger, managerial firms—in games, typically termed publishers—
handle the promotion and circulation of resultant texts. Publishers, through
their control of either or all of the following—hardware, marketing, and
distribution—hold a tremendous negotiational advantage over creative
partners pulled from overpopulated pools of aspiring laborers as well as
a gatekeeping function, resulting in high barriers of entry for developers,
particularly in traditionally higher costs fields like console video games.
In the past, publishers were oﬅen the only firms able to convert a set of
computer directions and associated graphics or manuscripts of arcane rules
along with a set of polyhedral dice into a package that could sell millions of
units. °e obvious result of this power imbalance was the creation of large
pools of creative workers producing materials on speculation. In the case of
Introduction
video games, these aspiring developers oﬅen pursued so-called third-party

deals in which they acted as freelanced labor for publishers in deals that
inevitably were skewed in favor of the latter in terms of money, ownership,
and scheduling, again reflecting the structural imbalance of the industry and
developers’ reliance on publishers. Moreover, the high cost and expertise
associated with technology-dependent creative fields, like video games,
oﬅen only pushed the barriers of entry and the stakes of publisher deals
even higher. However, the ubiquity of newer, low-cost digital technologies
as well as Internet-enabled connectivity increasingly have disrupted the
staid structural imbalance that characterized most of twentieth-century
mass media. In turn, these innovations have enabled experimentation of
new production logics, including the recasting of games as ongoing services
and the bundling of games on online portals (Kerr, 2017). °e latter has
been particularly important for indie game-makers as portals offer cultural
laborers access to financing, marketing, and distribution as well as more
direct relationships with their end users.
Indeed, the availability of these new digital affordances in many cases
has complicated traditional barriers of entry and the division of labor in
many de-massifying cultural industries. In game work specifically, these
new tools and technologies have diminished the exclusivity of most of the
linchpins of publishers’ control. Gaming systems like Steam for video games
and Open Game License in pen-and-paper role-playing games have reduced
the bottleneck of hardware and, in console video games, control through
the dissemination of Soﬅware Development Kits (SDKs). In the same vein,
Yochai Benkler (2006) argues that the ubiquity of the Internet eases both
physical and economic constraints for individuals to produce and distribute
media content. °is celebration of the Internet as an equalizing platform for
media content belies the long-held hope that decentralized production may
increase diversity within society through the use of these new technologies.
Meanwhile, the reach and costs of social media marketing have chipped
away at the exclusive promotional power of publishers. °ese affordances,
according to Nancy Baym (2010), include the ability for an individual to
share messages (and, extendedly, media, creative works, projects, etc.) to a
wide audience instantaneously, regardless of location. °e ability to share
messages and information also comes at a diminished cost, lowering the
barriers to publication and distribution and allowing previously marginalized
and/or disempowered voices to be more accessible and heard. Crowdfunding
platforms like Kickstarter and Indiegogo have provided alternative avenues
to generating the economic means for cultural production. °e “long tail”
(Anderson, 2006) effects of online game and app markets, along with the
slow decline of brick-and-mortar retailing and its associated wholesaling,
have decayed the importance of traditional publishers’ logistical and
distributional acumen. And the spread of inexpensive and approachable
digital authoring tools further have complicated the association of quality
game work only with well-connected and funded developers. In short, a
suite of effects connected with recent digital affordances have provided a
new opportunity for creative work unavailable in stricter applications of the
publisher model.
Of course, the association of aesthetic value with perceived artistic
independence is a familiar myth as well as a theme of social scientific
research (Berger and Peterson, 1975). Romantic notions of struggling artists
with singular, uncompromising, and sometimes misunderstood vision posit
that the closer a text is to the hands of its creator, the more legitimate it is as
a form of expression. And certainly, gaming history is filled with similarly
wrought origin stories of monomaniacal, driven creators from Dungeons &
Dragons’ Gary Gygax (Witwer, 2015) to Adventure’s Warren Robinett (2006).
More recently, celebrations of more artisanal mode of production resonates
in Anna Anthropy’s deeply influential Rise of the Videogame Zinesters
(2012), a book-length manifesto call for more games to be produced from
an individual sensibility.
Despite the appeal of such narratives, most of our analyses of indie
game production pose this evolving art world as a social and emergent one
across texts, producers, and end users. In this manner, the development of
indie games echoes not so much a hagiographic timeline but a complex,
interactive system mirroring Pierre Bourdieu’s field of cultural production
(1993). In Bourdieu’s elaboration of the concept, the sociologist examined
the emergence of a distinct tradition of literary novels—a field shaped not
simply by a book printer’s bottom line but equally determined by the relative
reputation of authors, the attitudes of critics, and the formation of artistic
tendencies and canons—or, in a word, cultural capital. Self-aware assessment,
evaluation, and competition of a set of internal and unique values pushes
cultural fields toward Bourdieu’s concept of autonomy, away from the lone
concerns of economic and political power that had animated literary and
visual arts, and culminating asymptotically with an attitude of l’art pour l’art.
Arguably, games and the scenes growing around them are building a similar
field. Gaming texts are both discussed and in subtextual conversation with
one another in an effort to refine the budding field’s internal values.2 As a
field grows in autonomy, so too should it grow in legitimacy as a space for
Introduction
artistic experimentation and critical introspection. °is legitimacy, in turn,

is vital to the growth and innovation of the field which is then able to attract
producers, critics, and users dissatisfied or even alienated from traditional
game production or other adjacent fields of cultural production.
Regardless of whether it is informed more by structural changes in the
gaming industry, the formation and elaboration of a meso-level cultural
field, or the dissatisfaction and alienation of game workers, recent indie
games have indeed emerged as a site of textual experimentation that
provocatively have mutated and altered typical gaming formats in terms
of mechanics, gameplay, visual style, and theme. In Firewatch (2016), a
user spends a majority of the game moving through and observing nature,
artfully subtracting the destructive mechanics typically associated with
3-D gameworlds. Similarly, in Journey (2012) gameplay is dominated by
discovery and visual novelty. °e aforementioned Undertale (2015) blends
innovative storytelling with the nostalgic pixelated visual style, as does To
the Moon (2011). And, in games like °at Dragon, Cancer (2016), which
takes the player through the highs and lows of cancer treatment, indie games
have addressed thematic material largely absent from commercial game
production. Similarly, Depression Quest (2013) brings socially stigmatized
issues like mental health into the foreground.
Previous academics typically have examined indie cultural work and
its appellation with measured skepticism. Examining the phenomenon in
music and film respectively, Ryan Hibbert (2005) and Michael Z. Newman
(2009) cast these tendencies as built around the end users’ need to have
and accumulate cultural capital that allows connoisseurs to distinguish
themselves from consumers of less rarefied forms of popular culture.
Alisa Perren (2012) similarly investigated the emergence of indie film,
which savvy industry players used a marketing hook to control and corral
dispersing consumer choice in an overflooded media landscape. And when
video game scholars, Greig de Peuter and Nick Dyer-Witheford (2009)
examined independent game work, they characterized it mostly as a site
of extra surplus labor to be soaked up by industry-leading firms, creating,
in Marxist terminology, an “expropriation of the commons.” While we
are sympathetic to all these analyses—indeed so-called independence in
cultural work can be understood as a manipulation of users’ vanity, a sly
marketing tactic, or a just a ploy to get free labor—we do not believe that
these critiques exhaust the subject matter. In our collection, we instead take
a more cultural studies informed approach, examining this tendency from
the inside out to plumb the fundamental uncertainty around the concept
of indie. While indie games are certainly manipulatable by economic and

social power, it is also an aware, self-monitoring social unit, informed by
unique structural and technological conditions and creating self-conscious
and identifiable creative projects.
°e political economic question of this new site of cultural work is a
complex and unsettled one. Are developers taking advantage of these new
opportunities the vanguard of an Internet-savvy neo-artisanal class prepping
the world for a de-massified cultural space, or are they simply neoliberal
dupes providing biopolitical labor to an increasingly precarious, platform-
based gig economy? °is debate can be traced back to intermittently
optimistic and pessimistic prognoses of digital technology, the Internet and
new media more broadly. Famously, Tzivana Terranova (2000) recategorized
early Internet use as “free labor” in which user’s enthusiastic activity in
producing websites, contributing to forums, and so on was just surplus
value to be soaked up by others without remuneration. It is a diagnosis
that has only become more convincing with the growth of surveillance
economics online coordinated to store, sort, and package more and more of
users’ actions and affects as usable and saleable “data.” In a recent example,
Cynthia Wang (2012) notes how Apple originally blocked third-party
developers from making apps for the iPhone, until hackers did it anyway,
and Apple implemented the App Store and their SDK, allowing third-
party developers to create and distribute their apps—but on Apple’s terms.
Andrew Ross (2004), in his complimentary examination of professional
digital cultural work, found new opportunities not for expression but for
alienation as workers accommodating themselves to unstable work and the
dismantlement of traditional work-life boundaries through the institution
of playbor—work that’s fun! However, with the growth of so-called Web
2.0, digital labor was increasingly rebranded as user-generated content,
citizen journalism, or convergence culture. And, more recently, McRobbie
(2016) has interrogated the attempt by government and higher education
to encourage its citizens and students to “be creative.” In this effort, the
author found that creativity was accompanied less by the liberatory and
expressive functions of art and culture but was transformed into a technique
of labor reform, disciplining subjects in the realities of a neoliberal work
regime that combines a distaste for routine and institutionalization with an
individualized sense of precariousness, competition, risk, and consequent
stress. Indie games and the workers associated with them, leveraging the
availability of digital tools and Internet-enabled connectivity, are largely
the beneficiaries of digital laborers and content creators of the past, yet our
10
Introduction
understanding of their work and its processes are equally haunted by the
theoretical baggage of this previously unsettled debate. Ultimately, whether
indie game work as an emerging site of digital labor looks more like the
“full development of productive forces” fantasized by Marx (1971) wherein
each would create to their means and desires, or whether the practice simply
reproduces preexisting power and hierarchy through what Jodi Dean (2003)
calls communicative capital, or whether, more drastically, these activities
add up to a form of digital slavery that, Christian Fuchs (2018) argues, late
capitalist ideology compels us to forget or ignore has largely do with the
analyst’s critical and disciplinary perspective. In other words, the notion of
indie games, the work that produces them and the structure that engenders
them retains an analytic and theoretical uncertainty. Our current volume
plumbs this uncertainty, investigating the production, production cultures,
and texts of several indie game creators.
°is collection is divided into three sections. °e first section will
address indie game creators themselves and how they have sought alternate
paths of production and distribution. First, John Vanderhoef contributes
a critical deep dive into Devolver Digital—an indie game publisher—and
how the ethos of the firm seeks to create an image of rupture of hegemonic
masculinity, yet may also reinforce it at the same time. Bonnie Ruberg’s piece
looks at how queer indie game-makers contribute to the changing cultural
landscape of game-making through the trials and tribulations of queer game-
maker, Mo Cohen, and their game Queer Quest, highlighting the importance
of video games in representing queer identities, communities, histories,
and experiences. M. J. Clarke examines the self-reflexivity of indie game
postmortems and uses these documents as practioner self-theorizations and
representations in which game-makers consider what being “indie” means
from the perspective of motivation, technology, and business practice. And
Betsy Brey explores the shiﬅing relationships between indie game producers
and gaming fans through the horror-game franchise, Five Nights at Freddie’s,
tracking the proliferation of fan-made games based on the original title as a
site of negotiation around issues of authority, ownership, and meaning.
°e second section explores the various tools and communities that are at
indie game-makers’ disposal, thanks to the affordances of digital platforms.
Each of the articles in this section investigates the various ways that indie
game-makers have deployed new and emerging methods of funding, of
creating, of community-building to do their game work. Emilie Reed begins
this section by elucidating, through three case studies, how accessible game-
making tools influence the aesthetic styles of the games that are created
11
as well as rise of communities around these toolkits. Kevin Rutherford’s

chapter explores how the singular creator of Stardew Valley participated
in gaming forums and communities, forging a community of fans who
informed his narrative, style, and design. And Cynthia Wang follows the
journey of the creators of the aforementioned Escape Room in a Box game as
they leveraged digitally afforded resources, such as crowdsourced funding
sites and indie game blogs, in the production, distribution, and publicity of
their game.
°e last section examines the impact that indie production and creation
has had on the texts of games themselves. Cody Mejeur takes up three
mainstream queer indie games as sites to consider both the potential
and the limitations of queer representation within the framework of
normative gaming practices, and the implications of these representations
as they are consumed by (mostly) heteronormative audiences. Aaron
Trammell compels us to reconsider the term “indie” by thinking about
the implication of subcultural fan communities in role-playing games and
their interdependence with and influence on mainstream corporate gaming
companies. Finally, Patrick Davison takes a historical look economic
simulation games distributed in the newsletter, °e People’s Computer
Company, and the contradiction between the countercultural ethos of the
newsletter and the themes of economic domination reinforced by the games.
Notes
1 Colloquially, this would be known as “selling out.”

2 In fact, this book is a reflexive part of this effort.
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14
PART I
INDIE GAME CREATORS
16
CHAPTER 1
BREWS, BURGERS, AND INDIE
BOMBAST: THE ANTIESTABLISHMENT
NEOLIBERALISM OF
DEVOLVER DIGITAL
John Vanderhoef
Introduction
Indie game developers have contributed to profound transformations in

the overall video game industry, repositioning indie game development
from a niche, exploitable, and subservient part of the business to a central,
constitutive pillar in the global industry that actively shapes the structures and
strategies of the industry’s largest companies. °e emergence of ubiquitous
indie game development and the ascendency of digital distribution for video
games occurred in tandem in the twenty-first century. With the means to
digitally distribute their cultural work across the globe, indie developers no
longer depend entirely on platform holders and corporate publishers, while
the sheer volume of diverse content they produce makes them attractive to
these same large companies.
In the wake of the critical and commercial success of indie games in
recent years, publishers interested in partnering with indie developers have
emerged in several forms. Console platform holders like Sony, Microsoﬅ,
and Nintendo have all implemented dedicated indie development outreach
teams in order to attract indies to their respective consoles. Meanwhile, a
group of small, indie-focused game publishers have emerged to reinvent
the relationship between indie developer and digital game publisher.
°ese companies include Devolver Digital, Good Shepherd, Curve Digital,
Raw Fury, Serenity Forge, and Playism, among many others. Traditional
corporate game publishers sometimes influence design decisions through
benchmark choke points where developers have to reach certain milestones
in order to maintain publisher support for the project, sacrificing creative
freedom in favor of timely delivery of content (Strebeck, 2017). Corporate
game publishers oﬅen also retain ownership of intellectual property and

claim the majority of sales profits. For examples, THQ retained ownership
of the Homefront intellectual property aﬅer Kaos Studios developed the
original. When THQ went bankrupt, Deep Silver acquired the rights to
the IP and hired developer Dambuster Studios to develop the sequel. In
contrast, smaller boutique publishers purportedly share the same values as
indie developers, offering financial and marketing support while allowing
indies to remain creatively autonomous. °ese specialist publishers have
yet to receive much critical attention from media industry and video game
scholars. °is is particularly troubling given that, despite many adopting the
antiestablishment aesthetics and devil-may-care attitude of the punk rock
counterculture, or indeed perhaps because of this adoption, these publishers
tend to perpetuate the cultural myths of neoliberal romanticism—the idea
of the independent artist or genius succeeding within the meritocracy of the
free market and in opposition to stifling societal etiquette (Harvey, 2005;
Streeter, 2010). °e overlapping tenants of neoliberalism and romantic
individualism have animated the tech industry since at least the 1970s with
the promise of individual self-sufficiency, a rebuke of centralized power in
the form of corporations or governments, and the allure of a meritocracy
that rewards innovative and risky ideas which challenge the status quo. In
the tech and video game industries, these underlying ideas have influenced
a culture of risk and celebratory entrepreneurialism that oﬅen conflate the
concepts of self-sacrifice, financial precarity, a sense of self-determination,
and the idea of the “cool” (Neff, 2012; O’Donnell, 2014; Liu, 2004). In the
indie context, entrepreneurial language is oﬅen obscured and replaced with
the language of rebellion, authenticity, and alternative cultural production.
Devolver famously enacts its rebellion in many ways, not least of which
is the creation of a fictional chief financial officer character named Fork
Parker, a purposefully crass salesman that presents a transparent critique of
unscrupulous corporate executives.
Like the commercial ascendency of alternative music labels, indie
cinema, and indie comic books before them, indie video game publishers
obscure their market goals with a performance as countercultural outsiders.
°is chapter explores the transformation of the indie moniker into
an incorporated marketing brand, used not only by corporate platform
partners and commercial indie developers themselves but also by an
emergent group of boutique game publishers focused on small titles. By
commercial indie games and developers, I mean those games and studios
that exist to explicitly sell games in the marketplace with the goal of making
18
Brews, Burgers, and Indie Bombast
a profit. °ese contrast, for example, with more informal game development
practices, such as noncommercial, DIY, and craﬅ game-making (Keogh,
2019). °ese boutique indie publishers seek to engage with the dominant
industry while sustaining themselves in a liminal space. °rough an analysis
of the changing relationship between publishers and indie developers,
this chapter suggests commercial indie games have been successfully
incorporated into the machinations of the dominant video game industry,
but in the process their alternative status or potential for resistance has
been largely reduced to a brand or marketing scheme more interested in
the performance of outsider status than in challenging dominant industry
structures or ideological constructs.
In particular, this chapter offers a critical perspective on one of the
most prominent and prolific indie-focused publishers, Devolver Digital, a
company formed in 2009 which positions itself as a “punk rock” indie game
label that favors small, o±eat, retro, and hyper-violent game experiences
such as Hotline Miami (Dennaton Games, 2011) and Broforce (Vlambeer,
2015). Using the discourse surrounding the publisher within the gaming
culture and industry, and complimented by first-hand observations gained
from attending Devolver’s media events at E3 2015 and 2017 in Los Angeles,
this chapter argues that despite providing indie-friendly publishing services
and an implied critique of the commercial practices of corporate video
game publishers, Devolver Digital nonetheless conflates countercultural and
antiestablishment punk aesthetics with the same neoliberal romanticism
that has motivated the tech industry since the earliest days of Silicon Valley.
Devolver Digital’s performance of romantic individualism conceals its
collusion with neoliberal capitalism, particularly as a publisher that operates
a global commercial enterprise disguised as a grassroots basement operation.
Moreover, like the musical indie rock scene (Bannister, 2006), Devolver
ultimately privileges an overwhelmingly white masculine identity heavily
invested in ironic postfeminist ideology, a self-conscious but retrograde
ideology which reflects the problematic identity politics of the commercial
indie game sector more broadly.
The Emergence of the Boutique Indie Publisher
A group of boutique, indie-focused publishers emerged since 2010 to take

advantage of the exponential growth of the indie sector. °ese boutique
publishers, including successful firms like Devolver Digital and Curve
19
Digital, and less successful enterprises like the now-defunct Majesco’s

Midnight City, focus on publishing indie titles across an array of digital
distribution platforms. Unlike traditional publishers who exercise control of
content through development benchmarks and who oﬅen retain ownership
of intellectual property, smaller publishers purport to understand the proper
support and distance to offer indies, who value their autonomy while still
requiring financial and marketing assistance. For instance, when discussing
what it took to convince Majesco to establish its ill-fated indie label, former
vice president of business development at Midnight City Doug Kennedy
explains, “We got into a conversation about what it would take to offer up
the right type of support, the right type of funding, and the right type of
vehicle so independent developers didn’t feel managed by the traditional
publisher but felt supported by the traditional publisher” (Sinclair, 2014).
Here “managed” and “supported” are juxtaposed verbs. While management,
in this case, implies a degree of unwanted control and influence, support
stands in as a welcome set of affordances in line with an indie developer
ethos that they feel comfortable accepting. While Majesco formerly had
experience funding independent games like Double Fine’s Psychonauts
(2005), the company still needed to develop a particular identity for its
indie-focused offshoot and a specific strategy to deal with the emerging
expectations of indie developers in a marketplace that does not entirely
necessitate a publishing partner.
A set of best practices emerged for boutique publishers over the last
ten years based on the mistakes corporate publishers like Electronic
Arts (EA) had perpetuated in the past through creative interference or
poor marketing. For instance, aﬅer EA acquired developers Bullfrog and
Westwood, employees at these studios felt “buried and stifled” creatively—an
accusation which former EA CEO John Riccitiello has admitted to publicly
(Robinson, 2008). Moreover, Oddworld Inhabitants founder Lorne Lanning
has pointed to EA’s poor marketing of his game, Oddworld: Stranger’s Wrath,
as one reason the game failed to perform on the market when released in
2005, leading to the franchise going dormant for many years (Yin-Poole,
2011). In sharp contrast to these practices, most indie-focused publishers
allow developers to maintain ownership of their intellectual property,
something that rarely occurred in the past. Additionally, like similar digital-
only publishers, Midnight City never forced developers into first-look
contracts for future games. As Kennedy indicates: “If we’re doing a good
job, [developers] will want to stay. If we’re doing a bad job, why have them
handcuffed to us . . . because we have the rights to their next round of titles?
20
So, it really puts the onus on us to perform based on our relationship with
the developers” (Yin-Poole, 2011). Rather than an operating ethos based
on control that treats indie developers like widgets in need of managing,
boutique publishers build relationships with developers based on mutual
respect for the particular talents each possesses: game design and creative
development on the one hand, and public relations, marketing, and business
on the other. To be a good partner to indies, in other words, many publishers
had to start thinking like indie developers.
Many prominent indie developers that had already launched commercially
successful games recognized the potentially robust business model of
these boutique publishers and realized they were increasingly equipped,
culturally and financially, to expand into publishing operations using the
same strategies. Alongside boutique publishers like Devolver Digital, a
collection of successful indie developers has expanded into publishing
operations, partnering with unproven but promising indie developers. Indie
developers-turned-publishers promote themselves as publishing units that
understand the concerns, experiences, and mentality of indie game studios.
For instance, in a blog post announcing their new QA and funding services
in 2014, indie studio °e Behemoth stressed that “since we’re developers, we
understand that quality of service and communication are paramount” (Lam,
2014). Aﬅer releasing one or two significant financial hits, many indies see a
business opportunity in helping other upstart developers enter the market.
For example, aﬅer releasing the award-winning and financially successful
Fez (2012), Polytron moved into the publishing space. Similarly, successful
games like the Democracy series (2005–2016) and Castle Crashers (2008) led
to Positech and °e Behemoth expanding to publishing, respectively.
°e impetus to expand into publishing allows successful indies to diversify
their investments and improve their potential for sustainability, provided
they choose the right external titles to support. As a business predicated on
the risk of hit-or-miss game titles complicated by unpredictable production
cycles, having multiple games in production across studios that handle
their own overhead allows developers-turned-publishers to mitigate their
risks while also building and retaining marketing expertise. °is trend
reflects a grassroots ethos where scrappy upstarts use their success as a
foundation to help other small, struggling indies while also highlighting the
communal nature discursively linked to indie development communities.
However, these developers-turned-publishers also tend to follow traditional
investment and incubator models used in the tech industry in order to
transform intuition for potentially successful games into a profitable return
21
on their investments. °e Indie Fund essentially uses this incubation

model. Composed of a number of high-profile indie developers, the Indie
Fund’s board carefully invests in game projects they believe will do well
in the marketplace and result in profits for the fund’s investors. Rather
than traditional publishers, indie publishers act more like highly selective
incubators, choosing projects carefully and providing development support,
operating funds, marketing advice, and media outreach. In this way, indie
publishers reflect the same growth trajectory of technology start-ups in
places like Silicon Valley. Successful small firms graduate from being part of
another company’s incubator to opening and operating their own.
The Antiestablishment Performance of Devolver Digital
Devolver Digital epitomizes the latest generation of born-digital, indie-

focused game publishers. While established in 2009, Devolver’s founders
have a long history of advocating for indie games as previous self-styled
rebellious, outsider publishers. Before Devolver, company founders,
including Mike Wilson, started two previous indie-focused publishers,
Gathering of Developers in 1998 and Gamecock in 2007 (Webster, 2014).
Infamously in 2007, in an act meant to disrupt the status quo of the highly
commercialized Spike Video Game Awards, Gamecock representatives
stormed the stage at the event, wearing red capes and dressed in rooster
hats, just as BioShock won the Game of the Year prize. °is stunt was
widely reported on and criticized by gaming blogs, not unlike the response
to Kanye West interrupting Tailor Swiﬅ during the 2009 Video Music
Awards. Unfortunately, Gathering of Developers and Gamecock went out
of business aﬅer they could not exploit the business models that allowed
current boutique publishers to find success in the marketplace. °is is likely
because Gamecock lacked the mature digital distribution platforms and
audience awareness of indie titles we see today. Nonetheless, the indie ethos
and radical antics of these earlier companies continues through Devolver
Digital, which operates with a limited number of employees who work out
of their respective houses in Austin and London.
Owing to its anti-corporate origins, Devolver enacts many of the same
cultural myths of the outsider artist or visionary, influenced by neoliberal
romanticism, that have fueled small game companies since the earliest
days of the formalized industry. While Devolver imagine themselves in
opposition to the streamlined corporate structures and showmanship of the
22
dominant games industry, such as Sony, Nintendo, or Ubisoﬅ, the publisher

nonetheless embraces the same neoliberal logics that disguise labor in the
creative economy as a perpetual playground for antiestablishment creative
and technology workers.
While predominantly a publishing label for o±eat indie games, Devolver
Digital owes much of its cultural ethos and aesthetic to alternative and punk
rock record labels. Kevin Dunn (2012) suggests that, in their circulation of
alternative and critical cultural work across the globe, punk record labels
exist at the nexus between politics, cultural production, and the global
political economy. Yet while Dunn argues that DIY record labels function
as sites of social engagement and embrace anticapitalist business models,
Devolver Digital occupies a decidedly commercial enterprise, despite its
alternative bravado. Devolver leans into its role as purveyor of quirky, if not
challenging, indie game experiences and performs a highly polished outsider
status in the video game industry. In its aesthetics and attitude, Devolver
resembles a music label like Epitaph, which started with a DIY ethos in
the 1970s but became a much larger, recognizable, and powerful label by
the late 1990s. Devolver has yet to be accused of being profit-driven by the
indie games community, but it shares Epitaph’s contradictions of promoting
alternative cultural production, on the one hand, and on the other operating
in a globalized consumer economy that requires a return on investment to
maintain sustainability (O’Connor, 2008). °is duality defines much of the
commercial indie game sector and has become a central problem of creating
work in the space for some invested in the political potential of indie games
to challenge dominant tropes and even economic systems.
In their comportment, Devolver Digital present themselves as being
in opposition to corporate publishers through sarcastic language, casual
cursing, drinking during press events, and the performance of an outsider
authenticity. Here, following scholars like Richard A. Peterson (2005),
authenticity is treated as a social and performative construct deployed to give
people and companies credibility in their respective fields. Of significance
here is the development of a specific outsider authenticity performance as
market brand. Following Adam Arvidsson (2007) and others, brands act
as constitutive pillars within our current era of information capitalism that
provide additional value to companies and consumers beyond the actual
products being sold—in this case, the suite of games that Devolver chooses
to publish. Cultivating and exploiting its brand as industry rebels has been
central to Devolver’s cultural and business strategies. For instance, Devolver
is careful never to take themselves too seriously. In a 2014 interview, when
23
talking about what he sees as the company’s purpose with the ironic phrasing
that children of the 1990s might recognize, co-founder Mike Wilson
remarks, “We’re a publisher for people who don’t need one” (Wilson, 2014).
With language like this, Devolver acknowledges and distances itself from
the problematic and predatory history between developers and publishers,
while also complimenting the latest generation of indie developers for
being self-sufficient.
Devolver’s owners and operators maintain a laidback, cheerful, and
reckless demeanor, going out of their way to make the publisher-developer
relationship tantamount to hanging out with friends. In self-conscious
fashion, Devolver’s website invites potential players, like a bartender
might, to pick their poison when it comes to what they call “magnificently
handcraﬅed games” and “farm fresh indie films,” the latter of which the
company started publishing in 2013 (Devolver Digital Homepage). On its
“About” website the publisher suggests, “Let’s get a beer sometime!,” inviting
potential indie partners to contact the company while ensuring them that
their interaction will be informal and low-key. From its website to its press
events, the publisher attempts to position itself as down-to-earth and self-
aware, cultivating an easygoing atmosphere where beer flows and small
quirky games from small, quirky developers are supported and valued.
Although Devolver attends most large industry trade shows and
conventions, they strategically position themselves geographically and
figuratively on the margins of these events. For example, one year at the
Game Developers Conference (GDC), the largest annual gathering of the
industry’s developers, Devolver rented out a bus and drove past the Moscone
Convention Center in San Francisco to invite listless indie developers to take
a ride, drink a beer, and discuss their latest projects. Devolver called this
stunt the “indie bang bus,” riffing on a pornographic video series filmed with
amateur aesthetics inside a bus. In fact, in several interviews, the publisher
references porn, using it as a point of humor—juxtaposing the discussion
of sex with the standards expected in a professional setting—to associate
itself with the taboo nature of pornography in culture and society. Of course,
realizing that they were breaking the law by offering open alcoholic beverages
in their “indie bang bus,” Devolver moved its operations to a “basement
bunker” at GDC 2014, being sure to remind journalists during interviews,
in between tequila shots, that they were not officially part of GDC. Devolver
has since moved their GDC presence yet again to the Galvanize speakeasy
room in San Francisco and rebranded this space Devolver Underground.
°is move perpetuates Devolver’s connection to alcohol and illicit locations
24
linked to illegal bars during prohibition while also providing those who visit
Devolver during these events with a certain subcultural capital gleaned from
“being in the know.”
John T. Caldwell (2008) has identified two common practices within the
milieu of entertainment industry tradeshow events that facilitate networking
between people and companies. Caldwell calls these rituals “solicitation”
and “cultivation,” and each acts to forge and maintain industry identities
and connections. Solicitation occurs when companies strategically identify
partners that can be useful in advancing the individual or company’s goals,
while cultivation activities include manufacturing a sometimes paradoxical
or antithetical view of the industry itself, such as the use of parties and
informal get-togethers overs drinks that mask the precarity, risk, and
suffering that occurs across the entertainment industry more generally.
Devolver’s language across media interviews reflects a deliberate effort to
remind people that they are not the traditionally stilted, obsequious PR
representative simply repeating the talking points they have memorized.
Instead, Devolver cultivates their brand of rebellious authenticity by not
being well-spoken or well-practiced, by cursing and drinking, and by
maintaining a constant irreverence about everything while simultaneously
communicating a passion for their development partners.
Nowhere is this more apparent than at the Electronic Entertainment
Expo (E3), a yearly industry marketing event where developers showcase
their upcoming games to the press, retailers, and other industry parties.
For many years, Devolver has rented out a parking lot across from the LA
Convention Center where the rest of E3 is held. In this parking lot, Devolver
sets up a barbecue with tents, picnic tables, and mobile homes to shelter
their indie partners and their games from the grueling LA sun. °ey are
also quick to remind people that a Hooter’s—the restaurant chain famous
for barbeque wings and scantily clad waitresses—is right next door, a detail
that contributes to the masculinized, ironic, trash aesthetic the publisher
cultivates at such events.
While attending E3 in 2015, Devolver representatives offered me
something hot off the grill and a cold drink as I checked in for my meetings
with several indie developers in Devolver’s makeshiﬅ trailer park. In between
appointments, journalists, publisher reps, industry folk, and developers
chatted in the shade of trailer overhangs or in the designated picnic area
under tents. Indie developers invited me into their (sometimes) air-
conditioned trailers to discuss and exhibit their games to me personally, not
through the traditional public relations intermediaries. Inside the trailers, I
25
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extremities.
When the patient is in bed, as in the regular rest treatment, this

method has to be modified, and then the best treatment is by direct
muscular faradization. Two sponge electrodes are employed. The
sponges are moistened, so that the current may pass through the
skin and reach the muscles. Both electrodes are taken in one hand,
the handle of one, pointing backward, being between the first and
second fingers, while the handle of the other is between the third and
fourth fingers. In this way the distance between the points of
application can be readily altered. The current is then applied to the
muscles everywhere, beginning with those of the feet. Muscles
should be relaxed before passing the current through them. The
whole body can be gone over in this way in the course of half an
hour.
The hydropathic treatment of hysteria is one that has much in it to be

commended. Jolly approves the systematic external application of
cold water; Chambers advocates the daily morning use of shower-
baths, holding that the bracing up of the mind to the shock of a cold
shower-bath is a capital exercise for the weak will-power of the
hysterical individual, and some admirable results have been reported
by Charcot in inveterate neurasthenics and hysterics.
Hydrotherapeutic treatment, continued perseveringly for a long time,
says Rosenthal, “diminishes the extreme impressionability of
hysterical patients, strengthens them, and increases their power of
resistance to irritating influences, stimulates the organic functions,
combats the anæmia, calms the abnormal irritability of the peripheral
nervous system, and by diminishing the morbid increase of reflex
power relieves the violence of the spasmodic symptoms. Even
chronic forms which are combined with severe paroxysms of
convulsions are susceptible of recovery under this plan of treatment.”
The hydrotherapeutic treatment may be contrasted with the

treatment by seclusion, rest, massage, and electricity. Undoubtedly,
one class of hysterical patients is greatly benefited by the latter
method systematically carried out; these have already been
described. In other cases, however, this method of treatment is
useless; in some of them it has a tendency to prolong or aggravate
the hysterical disorder, while in the same cases a well-managed
hydrotherapeutic treatment will answer admirably. This is applicable
in hysterical patients who eat and drink well, who, as a rule, preserve
a good appearance, but whose mind and muscles are equally flabby
and out of tone, and need to be stirred up both physically and
mentally.
Dujardin-Beaumetz recommends prolonged warm baths of from one

to two hours' duration, and believes that the therapeutic virtues of
these baths are augmented by infusions of valerian.
In order to obtain satisfactory results from hydrotherapy, as well as

from massage, electricity, etc., it is best to remove patients from their
family surroundings. Good sanitariums near our large American
cities where hydrotherapy and other special methods of treatment
can be carried out are sadly needed. Hydrotherapeutic treatment is
much more efficacious when conducted at a well-regulated
institution, for several reasons. Measures troublesome in themselves
are here carried out as a matter of daily routine. Numerous patients
permit of the employment of competent attendants. The change is
often of great benefit. The close personal supervision which
hysterical patients are likely to have in a hydrotherapeutic
establishment is also to be taken into consideration. Better modes of
living, proper forms of exercise, regulated diet, etc. also enter; but
still, a fair share of the good which results can be attributed to the
water treatment.
While, however, it is better to remove hysterical patients, for

hydrotherapeutic as well as for other treatment, from their family
surroundings, and to place them in some well-regulated
establishment, it is not by any means impossible to carry out such
treatment in private practice, particularly in a house supplied with a
bath-room. Many of our hydrotherapeutic institutions are in the
hands of charlatans or of individuals who are not practically well
fitted for their work. Not infrequently, however, good results are
obtained even under these circumstances. Much more can be done
in this direction with modest buildings and appliances than is
generally supposed. It is not necessary to have numerous
apartments: three or four rooms in a well-appointed house, if the
arrangements for carrying out the hydrotherapeutic treatment are of
a proper kind, will suffice for a large amount of good work. In almost
any house provided with bath-rooms with hot and cold water some
useful hydrotherapy may be attempted. The spinal douche or pour
can be used by placing the patient in a sitz- or ordinary hip-bath and
pouring the water from a spout or hose held at a certain height, the
distance being regulated according to the patient's condition. Again,
the patient sitting in a tub, water can be poured upon her, beginning
at first with a high temperature and gradually lowering it. The
shower-bath may also be used. An extemporaneous shower-bath
can be provided by an ordinary watering-pot. Whole, three-quarters,
or half baths at different temperatures can be given. One method of
carrying out the wet pack is very simple. A comforter is spread upon
the bed; next to this is placed a woollen blanket, and over the
blanket a wet linen sheet, upon which the patient rests, with the head
on a low pillow. The wet sheet, blanket, and comforter are then
wrapped closely about the patient, bottles of hot water being placed
at the feet. The cold drip-sheet method is another easily used. It
consists in placing about the patient, while sitting up or standing, a
sheet wet with cold water, and then vigorously rubbing her through
the sheet.
Baths to the head may be used in some cases; cool head-baths are
most frequently applied. One method of using these baths is to have
the patient lie in such a position that the head projects a little beyond
the edge of the bed and over a basin or receptacle of some kind.
Water of a suitable temperature is then poured gently or squeezed
out of a sponge over the head. For some forms of insomnia or some
of the disorders of sleep in hysteria this treatment is a valuable
auxiliary to other measures.
For the hysterical spine cold compresses may be used along the
spine. On the other hand, hot fomentations may be found of benefit
in some cases. Where hydrotherapeutic measures are employed
attention should be paid to the condition of the circulation,
particularly in the extremities. If the feet or hands are cold, hot
applications or frictions should be used.
For certain of the vaso-motor disorders of hysteria, such as cold or

hot feet, flushings, etc., local hydrotherapeusis will be of service. In
hysterical contractures local stimulation by the douche method or by
the steam bath may be tried. For the excitable rectum cold enemata
in small quantities, so as not to be expelled, will be found to be very
efficacious. For spasmodic attacks, whether purposive or involuntary,
the use of the wet pack or the plunge-bath will sometimes be found
of good service. In neuralgias and other painful local disorders of
hysteria, frictions, fomentations, Turkish or Russian baths, and the
wet pack are often very beneficial.
When hysteria is complicated, as it very often is, with disorders of

the liver and stomach, hydrotherapeutic measures will be of added
efficacy. When it is associated with genito-urinary disorders, even
though the latter are not regarded as the cause of the former, special
beneficial effects, both local and general, can be obtained from
hydrotherapeutic measures. Locally, sitz-baths, hip-baths, douche-
baths, hot and cold injections, and foot-baths may act as revulsives,
astringents, or local tonics, while at the same time they are
measures which tend to strengthen the system as a whole.
Sea-bathing is often of the greatest value, although it is sometimes

difficult to induce hysterical patients, who are willing enough to go to
the seashore, to resort to surf-bathing. Few measures are better
calculated to bring up the tone of the nervous system of an hysterical
or neurasthenic patient than well-directed sea-bathing. Where sea-
bathing cannot be employed sea-water may be used indoors. Sea-
water establishments, where baths at various temperatures may be
had, are now to be found at all the best seaside resorts. In a few
cases the internal use of large quantities of either hot or cold water,
or of the ferruginous mineral waters, may be associated with the
external treatment.
The climatic treatment of hysteria has received little or no attention;

undoubtedly, much could be said in this connection. In a great
country like ours a climate suited to the requirements of almost every
form of disease can be had. The climate of those regions, either of
the seaboard or inland, particularly well suited to cases of lung
trouble, will often be useless, and sometimes harmful, to neurotic
patients. For a certain class of hysterical patients a sojourn at the
seashore, if not too protracted, will prove of great value. On the
whole, for most hysterical patients of the neurasthenic type the best
plan is to go first to the seashore for a few weeks, and then resort to
an inland hilly or mountainous country, but not at too great an
elevation. I have known the climate of some of the high altitudes of
Colorado to be of positive injury by depressing the nervous system.
Resorts like Capon Springs in West Virginia, out of the reach of
steam and worry, with prevailing south-west winds, are desirable
places.
The treatment of hysteria by the method of metallotherapy is worthy

of some consideration. It is a method by no means new. It was
known and practised by the ancients with rings and amulets.
Popularized at the beginning of the present century by certain
travelling charlatans, it was later, for a time, wholly ignored. In recent
years it has been received with considerable attention. One Burq for
many years practised metallotherapy in Paris disregarded or scouted
by the profession, but claiming many remarkable cures. Finally,
Charcot was induced to give him an opportunity of demonstrating the
truth or falsity of his claims at Salpêtrière.124 Cases of grave hysteria
were submitted to the treatment, and in certain instances with
striking results.
124 Lancet, Jan. 19, 1878.
After having determined by a series of experiments the particular

metal to which the patient is sensitive, bits of metal may be applied
to the surface of the body in various places; this constitutes external
metallotherapy. Or the metal, in the form of powder (as reduced iron)
or an oxide or some other salt, may be administered; this is internal
metallotherapy. That certain definite effects may be produced by the
application of metals to the surface of the body is unquestionable.
Some of the results which have followed their employment are the
removal of anæsthesia and analgesia, relief of hysterical paralysis,
improvement in the circulation, removal of achromatopsia, relief of
contracture.
Many investigations in Germany, England, France, and this country

have demonstrated that the same or similar effects can be produced
by the application of other non-metallic substances, such as discs of
wood, minerals, mustard plasters, etc. Hammond, among others,
has shown this. How the results are obtained is still a matter of
dispute. On the one hand, it is claimed, principally by the French
observers, that the cures are due to the metals themselves, either by
virtue of some intrinsic power or through some electrical currents
generated by their application. On the other hand, it is asserted,
particularly by the English observers, that the phenomena are best
explained on the doctrine of the influence of the mind on the body; in
other words, by the principle of expectant attention. Some at least of
the effects are to be explained on the latter hypothesis, but it is likely
that the monotonous impressions made upon the peripheral sense-
organs by different substances applied locally may act reflexly on the
brain.
Seguin125 reports a case of convulsion and hemianæsthesia in an

adult male cured by metallotherapy; the metal used was gold. Two
ordinary twenty-dollar gold pieces were placed in the patient's
hands, and afterward on his forearm, cheek, and tongue. Nothing
else was suggested or done to him; sensibility returned, and the
staggering and other symptoms disappeared. The patient left the
hospital claiming to be perfectly well. The same author reports
several other successful cases of metallotherapy, all of them
reactions to gold. One was a girl sixteen years old with analgesia.
125 Arch. of Medicine, New York, 1882.
Not a few cases are now on record of the cure of hysterical
contracture and other forms of local hysterical disorders by the
application of a magnet. Charcot and Vigouroux cured one case of
hysterical contracture of the left arm by repeated applications of the
magnet to the right or healthy arm. Debove by prolonged application
of magnets relieved hemianæsthesia and hemiplegias—not only the
hysterical varieties, but also, it is said, when dependent upon such
conditions as alcoholism, plumbism, and even cerebral lesions.
Maggiorani of Rome studied the physiological action of the magnet
and laid down the first rules for its therapeutic use. In the case of
powerful magnets we have more room for believing that an actual,
tangible force is at work in producing the results than in the case of
simple metals.
The question has been sometimes asked whether hypnotism can be

used with success in the treatment of hysteria. Richer reports a few
cures of hysteria through this agency. Braid has put on record
between sixty and seventy cases which he claims to have cured by
the same means. This list undoubtedly includes some hysterical
cases—of paralysis, anæsthesia, aphonia, blindness and deafness,
spinal irritation, etc. Both on theoretical grounds and from
experience, however, I believe that the practice of hypnotization may
be productive of harm in some cases of hysteria, and should be
resorted to only in rare cases of mental or motor excitement.
By some, special measures during the hysterical fit are regarded as

unnecessary. Jolly, for instance, says that we must merely take care
that the patients do not sustain injury in consequence of their
convulsive movements, and that respiration is not impeded by their
clothing. Rothrock126 reports several cases of hysterical paroxysms
relieved by the application of either snow or ice to the neck. The
applications were made by stroking up and down either side of the
neck along the line of the sterno-cleido-mastoid muscles. He
believed that the most probable explanation of the results obtained
was the shock received from the cold substance, but that
supplemental to this there may have been supplied through the
pneumogastric nerve a besoin de respirer. This measure and the use
of the cold spinal douche are both to be recommended.
126 Philada. Med. Times, 1872-73, iii. 67.
Emetics are sometimes valuable. Miles127 reports several cases of

severe hysterical seizure in which tobacco was promptly efficient in
controlling the affection. He used the vinum tabaci in doses of one
drachm every half hour or hour until the system was relaxed and
nausea induced, the effects usually being produced after taking
three or four doses. Fifteen grains of sulphate of zinc may be used in
adult cases. James Allen for a case of hysterical coma successfully
used a hypodermic injection of one-tenth of a grain of apomorphia.
Recently, at the Philadelphia Hospital this remedy has been
successfully employed in two cases, one of hysterical coma and the
other of hysterical mania. Inhalations of nitrite of amyl are often of
surprising efficiency. This and other measures referred to under
HYSTERO-EPILEPSY are also applicable in the treatment of any form of
hysterical spasm.
127 Clinical Med. Reporter, 1871, iv. 25-27.
For hysterical convulsions occurring during pregnancy an enema of

asafœtida, camphor, the yolk of an egg, and water, such as has
been recommended by Braun of Vienna, will often be found promptly
efficacious.
Fagge128 mentions a procedure which he had often seen adopted by

Stocker—namely, pressure upon the arteries and other structures on
each side of the neck.
128 British Medical Journal, March 27, 1880.
For hysterical paralysis faradism and galvanism hold the chief place.
Metallic-brush electricity should be used in the treatment of
anæsthesia.
Whenever, in local hysteria, particularly of the paralytic, ataxic, or
spasmodic form, it is possible to coax or compel an organ or part to
perform its usual function long unperformed or improperly performed,
treatment should be largely directed to this end. Thus, as Mitchell
has shown, in some cases of aphonia, especially in those in which
loss of voice is due to the disassociation of the various organs
needed in phonation, by teaching the patient to speak with a very full
chest an involuntary success in driving air through the larynx may
sometimes be secured. Once compel a patient by firm but gentle
means to swallow, and œsophageal paralysis begins to vanish.
Mitchell makes some interesting remarks upon the treatment of the

peculiar disorders of sleep, which he describes and to which I have
referred. When the symptoms are directly traceable to tobacco, he
believes that strychnia and alcohol are the most available remedies,
but gives a warning against the too liberal use of the latter. A
treatment which was suggested to him by a clever woman who
suffered from these peculiar attacks consists in keeping in mind the
need of breaking the attack by motion and by an effort of the will. As
soon as the attack threatens the patient should resolutely turn over,
sit up, or jump out of bed, and move about, or in some such way
overcome the impending disorder. Drugs are of little direct use.
Small doses of chloral or morphia used until the habit is broken may
answer, but general improvement in health, proper exercise, good
food, and natural sleep are much more efficient.
Fagge says that he has seen more benefit in hysterical contracture

from straightening the affected joints under chloroform, and placing
the limb upon a splint, than from any other plan of treatment.
Hammond129 (at a meeting of the New York Neurological Society,
Nov. 6, 1876) reports a case of supposed hysterical contracture in
the form of wry neck, in which he divided one sterno-cleido-mastoid
muscle; immediately the corresponding muscle of the other side
became affected; he cut this; then contraction of other muscles took
place, which he kept on cutting. The case was given up, and got well
spontaneously about two years later. Huchard130 entirely relieved an
hysterical contracture of the forearm by the application of an elastic
bandage.
129 Philadelphia Medical Times, vol. vii., Nov. 25, 1876.
130 Revue de Thérapeutique, quoted in Med. Times, vol. xiii., June 16, 1883.
A lady with violent hysterical cough was chloroformed by Risel of

Messeberg131 for fourteen days at every access of the cough, and
another for eight days. In both the symptoms were conquered. Nitrite
of amyl is useful in similar cases.
131 Allg. Med. Centralzeitung, Oct. 9, 1878.
Graily Hewitt132 reports a case of hysterical vomiting of ten months'

duration, caused by displacement of the uterus, and cured by
reposition of that organ. The same authority, in a paper read to the
London Congress, advanced the opinion that the exciting cause of
attacks of hysteria and hystero-epilepsy was a distortion of the
uterus produced by a flexion of the organ upon itself, either forward
or backward. He believed the attacks were the result of reflex
irritation. He recited eighteen cases, all of which were relieved.
Flechsig133 favors the gynæcological treatment of hysteria, including
castration or oöphorectomy. He reports three cases with good
results. His article favors the idea that any morbid condition of the
genital organs present ought to be remedied before treating the
hysterical symptoms. Zeuner,134 on the other hand, refers to a
number of cases in which gynæcological treatment gave either
entirely negative results or was productive of positive injury to
hysterical patients. He quotes Perreti,135 physician to an asylum for
the insane, who gives the details of a number of cases in which
gynæcological examinations or treatment were directly productive of
injury. He mentions a case of a female patient who had delusions
and hallucinations of a sexual type in which the physician was the
central figure. He reports cases in which proper constitutional
treatment, without gynæcological interferences, led to a full recovery.
Playfair, also quoted by Zeuner, states that he has often known the
condition of hysterical patients to be aggravated by injudicious
gynæcological interference. Oöphorectomy will be more fully
discussed under HYSTERO-EPILEPSY.
132 Med. Press and Circ., June 2, 1880.
133 Neurol., 7 Abt., 1885, Nos. 19, 20.
134 Journ. American Med. Ass., Chicago, 1883, i. 523-525.
135 Berliner klinische Wochenschrift, No. 10.
HYSTERO-EPILEPSY.
BY CHARLES K. MILLS, M.D.
DEFINITION.—Hystero-epilepsy is a form of grave hysteria

characterized by involuntary seizures in which the phenomena of
hysteria and epilepsy are commingled, and by the presence in
unusual number and severity, between the paroxysms, of symptoms
of profound and extensive nervous disturbance, such as paralysis,
contracture, hemianæsthesia, hyperæsthesia, and peculiar psychical
disorders.
SYNONYMS.—Hystero-epilepsy has long been known under various
names, as Epileptiform hysteria, by Loyer-Villermay and Tissot; as
Hysteria with mixed attacks, by Briquet; as Hysteria major or Grave
hysteria, by Charcot. The term hystero-epilepsy has been used with
various significations, and often without due consideration, and for
these reasons some authorities advise that it should not be used at
all. Gowers,1 for instance, refers to epileptic hysteria, hysterical
epilepsy, and hystero-epilepsy as hybrid terms which tend rather to
hinder than to advance the study of the nature of these convulsive
attacks and their relations to other forms of hysteria. He holds that it
is a clear advantage to discard them as far as possible, and
suggests the use of the term hysteroid, as proposed by W. W.
Roberts, or that of co-ordinate convulsions, as describing accurately
the character of the attack. These suggested terms do not strike me
as improvements upon those which he wishes the profession to
avoid. The word hysteroid, while good enough in its way, is certainly
objectionable on the ground of indefiniteness. Co-ordinate is
proposed, because the convulsive movements are of a quasi-
purposive appearance; that is, they are so grouped as to resemble
phenomena which may be controlled by the will. This meaning of co-
ordinate, however, as applied to the disorder in question, would not
be easily grasped by the average physician. When it is impossible to
name a disease from the standpoint of its pathological anatomy, the
next best plan is to use a clinical term which in a plain common-
sense manner gives a fair idea of the main phenomena of the
affection. Hystero-epilepsy, if it means anything, means simply a
disorder in which the phenomena of both hysteria and epilepsy are
to some degree exhibited. Certainly, this is what is seen in the cases
known as hystero-epileptic. In forming the compound the hysterical
element is, very properly, expressed first, the disease being a
hysteria with epileptic or epileptoid manifestations, rather than an
epilepsy with hysterical or hysteroid manifestations. A study of the
definition of hystero-epilepsy which has been given will show that it
is intended to restrict the application of the term in the present article
to cases with involuntary or non-purposive attacks, the voluntary or
purposive having been considered in the last article.
1 Epilepsy and other Chronic Convulsive Diseases: their Causes, Symptoms, and
Treatment, by W. R. Gowers, M.D., F. R. C. P., etc., London, 1881.
HISTORY.—The greatest impulse to the study of hystero-epilepsy in

recent years has been given by the brilliant labors of Charcot and his
pupils and assistants in his famous service at La Salpêtrière. In his
lectures on diseases of the nervous system2 (edited by Bourneville),
and in various publications in Le Progrès médical and other journals,
Charcot has reinvestigated hysteria major with great thoroughness,
and has thrown new light upon many points before in obscurity. He
deserves immense credit also for the work which he has stimulated
others to do. Bourneville, well known as the editor of some of
Charcot's most valuable works, has published, alone or with others,
several valuable monographs upon hysteria and epilepsy.3 The most
valuable work on hystero-epilepsy, however, because the most
elaborate and comprehensive, is the treatise of Richer.4 Richer was
for a time interne in the Salpêtrière Hospital, and with Regnard
pursued his investigations under the superintendence and direction
of Charcot. His book is a volume of more than seven hundred pages,
containing a vast amount of information and profusely illustrated, in
large part by original sketches by the author. Charcot himself has
written for it a commendatory preface.
2 Leçons sur les Maladies du Système nerveux. A portion of these lectures have been
translated by G. Sigerson, M.D., and published by the New Sydenham Society of
London, and reprinted in 1878 and 1879 in Medical News.
3 Bourneville, Recherches clinique et therapeutique sur l'Épilepsie et l'Hystérie, 1876;

Bourneville et Voulet, De la Contracture hystérique-permanente, 1872; Bourneville et
Regnard, Iconographie photographique de la Salpêtrière. I have made special use of
the second volume of the last of these works.
4 Études cliniques sur l'Hystero-épilepsie, ou Grande Hystérie, par le Dr. Paul Richer,
Paris, 1881.
No article on hystero-epilepsy can be written without frequent use of

this work of Richer, and also of the numerous contributions of
Charcot. To them we are indebted for new ways of looking at this
disease, as well as for an almost inexhaustible array of facts and
illustrations of the diverse phases of this disorder.
While the curious, grotesque, or outrageous manifestations now

known as hystero-epileptic have been discussed with more or less
minuteness by authors from the time of Sydenham to the present,
usually, and more especially in all countries but France, these
manifestations have been studied as isolated phenomena. Charcot
and Richer, however, present a comprehensive view of hysteria as a
disease of a certain typical form, but often manifesting itself in an
imperfect or irregular manner. This regular type is characterized
particularly by a frequently- or infrequently-recurring grave attack,
which is divided into distinct periods, and these periods into phases.
This regular type of grave hysteria once understood, a place of

advantage is gained from which to study the disease in its imperfect,
irregular, and abortive forms. Whatever its pathology may be, such
striking symptoms as loss of consciousness with spasm,
hallucinations, and illusions show at least temporary disturbance of
the integrity of the cerebrum.
Hystero-epilepsy of imperfectly developed or irregular type is a not

uncommon affection in this country, but the disease in its regular
type is comparatively rare.
VARIETIES.—Hysteria and epilepsy, so far as seizures are concerned,

may show themselves in two ways in the same patient; but I believe
that it is best that the term hystero-epilepsy should be restricted in its
application, as Charcot, Bourneville, and Richer have advised, to the
disorder in which hysterical and epileptic symptoms are commingled
in the same attack—what is spoken of by the French as hystero-
epilepsy with combined crises. The other method of combination is in
the affection known as hystero-epilepsy with separate crises, in
which the same patient is the victim of two distinct diseases, hysteria
and epilepsy, the symptoms of which appear independently of each
other.
The fact that hysteria is at times associated with true epilepsy is
often overlooked. A patient who is known to have had pure hysterical
seizures of the grave type has also a genuine paroxysm of epilepsy,
and thus the medical attendant is deceived. I will dismiss the
consideration of hystero-epilepsy with separate crises with a few
paragraphs at this place, devoting the rest of the article to the
disorder with combined crises.
The coexistence of hysteria and epilepsy, with distinct manifestations

of the two neuroses, has been most thoroughly considered by
D'Olier.5 Beau in 1836, and Esquirol in 1838, first showed this
coexistence. Landouzy in 1846 first made use of the name hystero-
epilepsy with separate crises.
5 Memoir which obtained the Esquirol prize in 1881, by M. D'Olier, interne of the
hospitals of Paris, on “Hystero-Epilepsy with Distinct Crises, considered in the Two
Sexes, and particularly in Man,” translated and abstracted by E. M. Nelson, M.D., in
the Alienist and Neurologist, April, 1882.
In France the distinct existence of hysteria and epilepsy in the same

individual is not, according to D'Olier, a very exceptional fact. Beau
has reported it 20 times in 276 cases. The different modes of
coexistence have been summed up by Charcot as follows: “1,
Hysteria supervening in a subject already epileptic; 2, epilepsy
supervening in a subject previously hysterical; 3, convulsive hysteria
coexisting with epileptic vertigo; 4, epilepsy developing upon non-
convulsive hysteria (contracture, anæsthesia).”
The following case, now in the Philadelphia Hospital, illustrates the

first of these modes of combination: S——, aged thirty-nine, female,
a Swede, came to this country in 1869. She said that her mother had
fits of some kind. The patient had her first fit when she was four
years old. Her menses did not come on until she was nineteen. With
the appearance of her periods she had fainting-spells off and on for
two years, and in these spells she would fall to the ground. After two
years she improved somewhat, but still would have an occasional
seizure like petit mal. Four years ago she had a severe fit, in which
she bit her tongue. This was a paroxysm of true epilepsy. It was
witnessed by the chief nurse in the hospital, a competent observer.
Since then she has had attacks of some kind every month or oftener.
She rarely had a true epileptic seizure. Often, however, she had
hysterical and hystero-epileptic attacks. These paroxysms have
been witnessed by myself and by the resident physician and nurse.
Rarely they were epileptic, frequently they were hysterical. Mental
excitement will often induce an hysterical spasm.
PATHOLOGY.—Holding that hystero-epilepsy is a form of grave

hysteria, the remarks which have been made in the last article on the
probable nature of severe convulsive attacks will be applicable here.
In hystero-epilepsy with the typical grave attack we have the highest
expression of that disturbance of cerebro-spinal equilibrium which
constitutes the pathology of hysteria.
ETIOLOGY.—It will also be unnecessary to go at length into the

discussion of the predisposing and exciting causes of hystero-
epilepsy. In general, its predisposing causes are those of hysteria of
any form. Certain causes or conditions, however, predispose to
certain types or forms of hysteria. The Latin races are more inclined
to the hystero-epileptic form of hysteria than are the natives of more
temperate or colder climates. Bearing upon this point, I have already
quoted the letter of Guiteras with reference to hysteria and hystero-
epilepsy in Cuba and semi-tropical America. Forms of religion which
cultivate to an extreme degree the emotional or the sentimental side
of human nature tend to produce hystero-epilepsy.
With reference to sex it may be said that hystero-epilepsy prevails to

a greater extent among females than males, even proportionately to
a larger degree than some of the other marked phases of hysteria. It
does, however, occur in men and boys, although rarely. Richer
records, from the practice of Charcot, a case in a lad of twelve years.
Several cases have fallen under my own care.
Ten years since I saw a case of hystero-epilepsy, which in some

respects closely simulated tetanus, in a youth nineteen years old. He
was well until seventeen years of age, when he slightly wrenched his
back. Shortly afterward he felt some pain between the shoulders.
From that time, at irregular intervals, generally of a few days only, he
was subject to attacks of dull pain, which seemed to run up the spine
to the head. About two months after this injury he first had a
spasmodic attack. A spasm would come on while he was quietly
sitting or working. The body assumed the backward-arched position.
As his father described the case, there was always space enough
under his back for a baby to crawl through. Generally, he would have
more than one seizure on a given occasion. He would sometimes
have as many as six or seven in one hour. On coming to, he would
stare and mutter and work his mouth and lips, at the same time
pointing around with his hands and fingers in a wild way. Sometimes
he would sleep for several hours afterward if not disturbed, but his
sleep was not of a stertorous character. He said that he could feel
the attacks coming on; his body felt as if it was stretching, his head
going back. He thought he was not conscious during the whole of the
attacks, but between the spasms he could take medicine when
directed. When first examined he had decided tenderness on
pressure over the second, third, and fourth dorsal vertebræ.
Pressure in this region would sometimes bring on a convulsive
paroxysm. When first seen he had been for three months having
seizures every two or three weeks. He was under observation for
several months, during which time he was treated with faradization
to the spine, the hot spinal douche, tonics, and bromides, and made
a complete recovery.
W. Page McIntosh6 has reported several cases of hystero-epilepsy in

the male, one of which is doubly interesting because it was in a
negro. This patient was twenty-one years old, stout, and previously
in good health. He complained of intense pain in the stomach, and
soon passed into a violent convulsion. To show the importance of
diagnosis in these cases, it is interesting to note that the doctor first
thought of strychnia-poisoning, then of acute indigestion, next of
tetanus. Soon, however, he decided that he had a case of hysteria.
The patient had other convulsions on the day following the first
attack. The seizures were evidently hystero-epileptic or hysterical.
He was not unconscious, and believed that on a recent previous
evening he had been conjured by an old negress. The spell was to
work in three days, which it did. The doctor counter-spelled him with
a hypodermatic syringe, after which he promptly recovered.
McIntosh reports another case in a man forty years old and the
father of six children, who was laboring under strong mental
excitement because of the sufferings of a dangerously ill child. His
whole form was convulsed, and his body underwent a variety of
peculiar contortions. He had had similar attacks before, and had
subsequent recurrences.
6 Med. News, vol. xlviii., No. 1, Jan. 2, 1886, pp. 5-8.
The following case was observed in the Philadelphia Hospital: W. F.

——, aged twenty-eight years, married, has one child. His seizures
began seven years ago, when he had an attack while playing a
game of pool. At this time he had, according to his account, a
sudden feeling of giddiness or vertigo in which he fell over and had a
spasm, during which he thinks he was unconscious. After the seizure
he suffered from headache, but had no disposition to sleep.
From that time until the present he has been subject to these spells,
though the paroxysms are very irregular in frequency. Sometimes he
will have several attacks in a day; again, he will be free from them for
days, and perhaps for two or three weeks, but never for more than a
month at a time. They have come on him while walking in the street,
and on several occasions he has been taken to different hospitals.
He was admitted to the Philadelphia Hospital four times. On his first
admission he only remained over night; on his second and third he
remained for two or three weeks. On the last admission he remained
four weeks, and had spasms every day and night after admission.
He had, by actual count, from five to six hundred after he went in;
and in one evening, from seven P.M. to midnight, he had no less than
thirty-eight. These seizures, which were witnessed by myself and
two resident physicians, differed but little from each other, although
at times some were more violent than others. They began with a
forced inspiration; then the patient straightened himself out and
breathed in a stertorous or pseudo-stertorous manner. The pulse in
that stage became slow, and at times was as low as 48 per minute.
The temperature was normal or subnormal. The arched position was
sometimes taken, but the opisthotonos was not marked. The
paroxysm ceased by an apparent forced expiration, and the
breathing then became normal; the patient remained in a somewhat
dazed condition, which was only momentary. During the attack the
patient said that he was unconscious of his surroundings. In the
interval between the attacks he suffered from headache and from
pain over the region of the stomach. He also had tenderness on
pressure over the lumbar vertebræ. He never bit his tongue.
Age has some influence in the development of hystero-epilepsy. It is

of most common occurrence at the period of pubescence; it is rare in
old age, but occurs with comparative frequency in middle life; or,
rather, it should be said that middle-aged hystero-epileptics are not
uncommonly met with, individuals who have for many years been
subject to the attacks. In young children, girls or boys, it is certainly
rare.
With reference to the exciting causes of hystero-epilepsy, it will only

be necessary to say that of those which have already been
enumerated in the general discussion of the etiology of hysteria, a
few, such as domestic troubles, abnormal sexual excitement, and
painful menstruation, are likely to induce the paroxysm, but fright,
excitement, anxiety, sudden joy, and other psychical disturbances
are the most frequent of the exciting causes of the seizures. A threat
or a blow has been known to precipitate an attack. The use or abuse
of alcohol is sometimes an exciting cause. Reflex irritation, such as
that from intestinal worms, and digestive disorders sometimes
produces hystero-epileptic attacks in children.
SYMPTOMATOLOGY.—In considering the symptoms of hystero-epilepsy

the subject must be approached from several points of view. In the
first place, the disorder can be divided (1) into the regular or typical
grave attack; and (2) into the irregular attacks. These irregular
seizures can be greatly subdivided, but their discussion will be
confined to those types which have been most observed in this
country, although I do not think that any variety of hystero-epilepsy is
distinctively American; and this is what might be supposed from the
largeness of our country and the different nationalities of which it is
composed.
I have seen but few cases of hystero-epilepsy of the regular type.

One of these was first described at some length in the American
Journal of Medical Sciences for October, 1881. I will here give the
case, with illustrations, somewhat condensed from the accounts as
first published.7
7 For the opportunity of studying and treating this case I was under obligations to
Charles S. Turnbull and J. Solis Cohen, the patient having been for several months
under their care at the German Hospital of Philadelphia. Carefully prepared notes of
the case were furnished to me by H. S. Bissey and H. W. Norton, resident physicians
at the hospital. I was also under great obligations to my friend J. M. Taylor for a series
of sketches of the positions assumed by the patient at different stages of the attack.
R——, æt. 21, single, was first admitted to the German Hospital Nov.
13, 1879. Between her ninth and twelfth years she had had several
attacks of chorea. During childhood she was often troubled with
nightmare and unpleasant dreams; she often felt while asleep as if
she were held down by hands. She was frequently beaten about the
head and body. Her menses did not appear until she was nearly
eighteen. Before and at her first menstrual epoch she suffered
severe pain and cramp. During the first year of her menstruation,
while at Atlantic City, the flow appeared in the morning, and she went
in bathing the same afternoon. She stayed in the water two hours,
was thoroughly chilled, and the discharge stopped. Ever since that
time she had only menstruated one day at each period, and the flow
had been scanty and attended with pain. When about eighteen she
kept company with a man for five months, and after having put much
confidence in him learned that he had a wife and two children. This
episode caused her much worriment. She positively denied
seduction. She became much depressed. September 2, 1879, she
was seized in a street-car with a fainting fit. On coming to, she found
her left arm was affected with an unremitting tremor. Seven weeks
later she was admitted to the German Hospital. She had severe

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Indie Games in the Digital Age M. J.

Organizational Innovation in the Digital Age 1st

Brand Storytelling in the Digital Age: Theories,

Cinema in the Digital Age Nicholas Rombes

Celebrity and Mediated Social Connections: Fans,

Information Technology and Organizational Learning:

The Grinder s Manual A Complete Course in Online No

Competencies in Teaching Learning and Educational

Cultural Evolution In The Digital Age 1st Edition

INDIE GAMES IN THE DIGITAL AGE

Edited by M. J. Clarke and Cynthia Wang

Bloomsbury Publishing Inc

1385 Broadway, New York, NY 10018, USA

50 Bedford Square, London, WC1B 3DP, UK

BLOOMSBURY, BLOOMSBURY ACADEMIC and the Diana logo are trademarks

of Bloomsbury Publishing Plc

First published in the United States of America 2020

Volume Editor’s Part of the Work © M. J. Clarke & Cynthia Wang

Each chapter © of Contributors

Cover design: Eleanor Rose

Cover image © Chris Gorgio / iStock / Getty Images

All rights reserved. No part of this publication may be reproduced or

transmitted in any form or by any means, electronic or mechanical, including

photocopying, recording, or any information storage or retrieval system,

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Library of Congress Cataloging-in-Publication Data

ISBN: HB: 978-1-5013-5645-2

Typeset by Deanta Global Publishing Services, Chennai, India

and sign up for our newsletters.

Introduction M. J. Clarke and Cynthia Wang 1

Part I Indie Game Creators 15

1 Brews, Burgers, and Indie Bombast: °e Antiestablishment

2 Queer Indie Game-Making: An Interview with Mo

3 Postmortems and Indie Cultural Work M. J. Clarke 48

4 Five Nights at Fan Games: Feminism, Fan Labor, and Five

Part II Indie Game Tools 97

5 From Tool to Community to Style: °e Inﬂuence of

6 °is Is How a Garden Grows: Cultivating Emergent Networks

7 °e Making of Escape Room in a Box Cynthia Wang 142

Part III Indie Games Texts 159

8 °e Hunt for Queer Spaces: Mainstream Indie Games,

9 Indie in the Underground Aaron Trammell 184

10 Paper Code and Digital Goods: °e Economic Values of

List of Contributors 221

°e digital realm has reconﬁgured the ways in which production and

Indie Games in the Digital Age

their creations in ways that challenge traditional models of game-making,

Indie Games in the Digital Age

Indie Games in the Digital Age

on research and development (Electronic Arts, Inc., 2018). However, the

video games, these aspiring developers oﬅen pursued so-called third-party

Indie Games in the Digital Age

artistic experimentation and critical introspection. °is legitimacy, in turn,

Indie Games in the Digital Age

of indie. While indie games are certainly manipulatable by economic and

Indie Games in the Digital Age

as well as rise of communities around these toolkits. Kevin Rutherford’s