Healthy Gaming with Daniel Greenberg

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Daniel Greenberg is an extremely talented game designer, having worked on some of the biggest game franchises of all time, including The Lord of the Rings, Star Wars, Star Trek, X-Men, Ghost Recon, Crysis, the Elder Scrolls and more. Games blessed with his magic touch have sold millions of copies worldwide for companies like Electronic Arts, Activision/Blizzard, Ubisoft, Bethesda/Zenimax, Time Warner, Disney and many more.

So why would he decide to switch over to serious games? About five years ago, Greenberg founded Media Rez, a Washington DC-based studio that produces virtual reality environments for healthcare and related industries. Greenberg even lectures on harnessing the engaging power of games for training at many conferences and events, including ones held at the Centers for Disease Control, SFN Neuroscience, the Game Developers Conference, mHealth, the International Red Cross, the American Society of Addiction Medicine, NATO, and the White House. This summer, he’ll be speaking at the Serious Play Conference at George Mason University, July 10-12.

We talked with Daniel about why someone would choose serious gaming as a career over the more widely pursued, pure entertainment path, and how serous game developers can be successful in today’s burgeoning market.

GiN: Did you always have an interest in gaming? What were some of the first games you played that peaked your interest in game design?

Media Rez's Daniel Greenberg
Media Rez’s Daniel Greenberg

I liked board games like Monopoly and Chess and Go, but my driving childhood interest was imaginary play and world building. I wrote and drew some very amateurish superhero comic books, wrote embarrassing fantasy stories in the style of Tolkien, and made some passable animated stop-motion Super-8 movies about mythology and wars between the gods. I put all my savings into buying one of the early color personal computers (Texas Instruments) and taught myself programming to try to make games. But what consumed my thoughts the most was theater. In elementary school I begged my parents to let me be a child actor. I would memorize scripts instead of doing my homework or playing ball. I performed on off-Broadway and got some decent reviews. The common thread in all that was creating believably unbelievable worlds to inhabit and share.

GiN: Did you formerly study game design at school, or did you come to it later on?

I majored in Theatre with a self-directed minor in world-building—which baffled my adviser. There were no game design courses when I went to college in the ‘80s, so I had to make my own course of study by combining acting, directing, computer programming, and world-building courses like anthropology and mythology. I had discovered Dungeons and Dragons in junior high school, and by college it consumed my thoughts and supplanted my passion for theatre. I doodled monsters all over my theatre scripts. I launched D&D clubs in college and after graduation, which gave me a huge supply of play-testers for the RPG worlds I was dreaming up and good friends for late night discussions about the untapped power of story-telling games to change the world. D&D was originally a wargame, but it was spontaneously re-created by hordes of fans around the world as a form of experimental improvisatory theatre to build shared stories.

Entire game sessions could pass without a single round of combat, as players delivered amazing group-storytelling as they maneuvered their characters through worlds full of mystery, magic, and intrigue. I witnessed more outstandingly authentic acting from total amateur players in my RPG worlds than from the trained actors in my theatre classes, and even from some professional actors onstage or in movies. I’m proud to have been part of that worldwide, underground fan phenomenon to put the “role-playing” into RPGs. I could sense that we were on to something real, and that theatre could no longer compare to this new form of gaming that my friends were helping to pioneer.

GiN: When did you officially get your start making games, and how was that experience?

When I was in college, a career in game design seemed even more unlikely than a career in theatre (which is also shockingly unrealistic, but hey, I was young). I surprised myself to find that I could quit washing dishes and pay tuition by publishing my game modules for use with D&D. My RPG supplements soon won game industry awards, and that opened a lot of doors. I also worked on games like Vampire: The Masquerade, which helped pioneer a commercial path for the kind of group storytelling I had stumbled onto as a kid. In addition to my original worlds, I designed licensed RPGs for many of the worlds I loved, like Star Wars, Ghostbusters, DC Heroes. The licensed stuff usually sold very well.

On a whim, I cold-called video game companies to tell them I could help them make their worlds more exciting. Within a week I had a freelance job designing early computer RPGs for Activision. I made a lot of great friends, formed alliances with brilliant creative professionals, and did scripting, narrative design, level building, voice direction, programming, and creative direction for the biggest game publishers and small game studios. I remained a happy freelance video game developer for years until I founded Media Rez.

GiN: The resume of games you have worked on reads like a who’s who, or a what’s what in popular titles. You worked on Ghost Recon, Star Trek, Star Wars and Elder Scrolls games, plus a bunch of titles for the Cartoon Network, among others. What was it like working on products like that?

It’s a lot of hard work, but also a lot of fun. I love collaborating with talented people to find ways to open up and flesh out imaginary worlds, translating familiar but often distant universes into shared spaces that fans can inhabit, interact with, and them use as a springboard to tell their own stories together. I draw guidance from J.R.R. Tolkien, who said he wanted to share Middle-earth with other creators, leaving room “for other minds and hands, wielding paint and music and drama.” I’m excited by details that build authenticity into the experience, because it can resonate with fans of the source material.

For example, in my Star Wars game, Tatooine Manhunt, I was able to acquire the original blueprints of the Mos Eisley film sets from Lucasfilm and used them to help synthesize game maps, including the first published map of the Tatooine cantina. I must have done something right, because my original Star Wars characters were absorbed by Lucasfilm and used in books and toys and other games. Fans have pointed out that the plot of my game, Tatooine Manhunt, was used for the plot of The Force Awakens movie (heroes must race to uncover the hiding place of a reluctant Rebel hero, find him before the forces of the Dark Side, and convince him to return to action).

For my officially licensed Watchmen RPG, I worked directly with the brilliant creator Alan Moore while he was writing the first issues of Watchmen. I wanted to publish my Watchmen game simultaneously with the release of the landmark comic book—which meant having to design it long before the comic book world was fully created. As far as I know, that kind of simultaneous creation of source material and game adaptation had never been attempted before. I had to convince DC comics, Mayfair Games, and writer Alan Moore to support my creation of a game for a comic book that did not exist. This meant I had to create and reject many plotlines and characters to ensure that my RPG adaptation would contradict nothing while immersing the players in the wholly original and landmark themes of Watchmen (like the temptation to commit a terrible act for the greater good). It paid off, because Who Watches the Watchmen not only won top awards, but it is the rare licensed Watchmen work that was approved and praised by Alan Moore and not rejected with venom (like the movie and comic book sequels).

My licensed Dungeons and Dragons video game The Genie’s Curse was an early attempt at a real-time action-RPG and had multiple good endings in which the player must take difficult risks and sacrifice for honor to get the best ending. For video games like Star Trek: Elite Force II and I used my theatre background to voice direct Star Trek actors like Patrick Stewart, which greatly enhances the player’s sense of being an officer in the Federation.

I love working on Elder Scrolls games because Bethesda/Zenimax really gets it about fantasy RPGs and likes to take chances to expand what players can do. For the Lord of the Rings license, I integrated material scattered through the books and appendices into huge Style Guides that allowed creative teams to “wield their paint and music and drama” in a way that helped the team follow not only the letter, but the spirit of Middle-earth. The Lord of the Rings Online proved to be a hit with fans and critics for its authentic portrayal of Tolkien’s world and works.

GiN: Given your success in entertainment games, why did you decide to leave that and start making games that could be used for health behavior change and for training healthcare professionals, medical students and patients?

I switched to making behavior-change health games because those were the games that now consume my thoughts, far more than entertainment games. I read neuroscience journals with the passion I used to read blogs about upcoming games. I saw that game developers were ignoring an exciting and massively fertile area. Well-crafted entertainment games clearly help players grow in many areas—cognitive skills, perception, resilience, social skills, etc. By consciously focusing a game design on those areas of personal improvement, games can become powerful tools for cognitive behavioral therapy. Not just patient education, but positive behavior change. After all, what good does it do to improve your knowledge if you don’t act on it, or use it to change your life?

Early attempts at games for health suffered from being chronically underfunded and lacking skilled, professional game developers (in part due to being underfunded). So I began designing the kind of health and training games that ought to be made and talked about them to anyone who would listen. Entertainment game companies were intrigued, but said such games were far too risky for them to invest in. The few people talking about change from games were usually out to malign games– people who were good at getting media attention but not very good at getting the facts.

Despite constant setbacks, I found myself thinking far more often about the possibilities of positive behavior-change games than about the entertainment games that I was privileged to get paid to work on. It seemed ungrateful and unfair to my clients for my attention to be so divided, so I began to seriously consider another unlikely career change—just like when I was in college and found myself constantly thinking about game design instead of forging a career in theatre. I did what everyone told me not to do, and bet my retirement on self-funding a game studio. I cold-called health researchers and hospitals and studyed the arcane lore of grant-writing and funding. I learned to translate my ideas into funding proposals and formed alliances with some outstanding health experts to make sure my games would be rigorously tested for feasibility and efficacy. I was pleasantly surprised to secure funding, so I completed the last of my entertainment game contracts and told my clients I would not be available for a while. While I love making games for the entertainment market, that fun no longer compares to seeing real world improvements based on our health game interventions. I liken it to recently deciding to become a dad. When I was younger, I thought nothing could be as fun as being a single, freelance entertainment game developer. Now I find, inexplicably, getting serious can bring unexpected joys.

GiN: What skills did you take from making entertainment games when you moved over to serious games?

I use just about all of my entertainment game skills in our currently line-up of projects, but I’ve had to re-invent them. Game design uses the same processes, it just needs to take into account far more diverse elements than before. Game analytics is surprisingly similar, we just need to incorporate a lot more metrics, including incorporating a lot of real-world measures via connected devices, patient records, and patient self-report. Graphics are similar, but with some very unique forms of content that artists most are not familiar with. (“What? You never made a procedurally generated universe of interconnected neurons firing impulses across their synapses?”) We look for a special kind of person in key roles like programmer and level builder, because we want employees who are intellectually voracious when it comes to human behavior and translating that to games. Project management is similar, but with a wide new range of specialists to integrate. So, overall the skills are similar. I just had to modify them and gain some new ones.

GiN: what are some of the technologies that are proving useful in healthcare? VR? Sims?

Our current slate of products includes simulation technology, virtual reality, augmented reality, full body motion, voice control, artificial intelligence chat, machine learning, and, of course, RPGs.

GiN: Are other areas of healthcare looking to get into game-based learning and behavior change? Pharmacy? Nursing? Dentistry?

We are intrigued by a wide range of fields, including adherence, addiction, pain, resilience, insomnia, depression, anxiety, and many other areas that can respond to behavioral interventions. We are interested in developing alternatives to pharmaceuticals, but we also want to develop interventions that work in conjunction with them—allowing patients to step down to less drastic treatments and more benign medications.

GiN: Media Rez seems to focus on healthcare. Is that industry receptive to the use of game-based training?

The healthcare industry embraces games in fits and starts, with reactions running from intrigued to skeptical to disdainful. I don’t blame the skeptics, as there is still much that people in the game space need to prove. That’s why our focus at Media Rez is on rigorous testing first and foremost.

GiN: Has the attitude of medical schools and healthcare institutions changed, as new products have been introduced?

Yes, the attitudes are changing, but the serious games industry has a lot of work to do to overcome institutional concerns. Institutions are rightly concerned about any new treatments, not just games.

GiN: Can you tell us about some of the successes Media Rez has achieved using game mechanics indifferent applications?

Our drug treatment game suite, RecoveryWarrior, was shown to improve treatment-related outcomes. For example, we saw abstinence jump from 37 percent in one control group to 72 percent abstinent in the corresponding RecoveryWarrior group—four weeks after receiving doses of gameplay. We found a significant trend that more documented minutes of game play and more game play sessions corresponded to better abstinence outcomes. We also found some evidence that gameplay improves treatment adherence, with those randomized to game play more likely to report more counseling sessions over the past month and to be in treatment at 12 weeks. The game helps prevent relapse by using gameplay to deliver doses of behavioral rehearsal training, including spoken refusal phrases. Best of all, the young patients wanted to play it. Much of rehab is unpleasant and difficult, but this game gave them a way to get therapy (and exercise) while having a blast with their friends. Much of our other work is still proprietary, but early results from our latest efficacy trial indicates even stronger effects ahead for our next VR project.

GiN: You get invited to speak at a lot of conferences, in places as prestigious as the White House, and as important as NATO. What are you lecturing about at the Serious Play Conference in DC this year, and can you give us a tiny preview of some of the important points you will be sharing?

In past years, my lectures have been about how I think games really function beneath the hood and how a deeper understanding those game systems can help serious game makers apply game technology to other fields. People in the field are getting better at understanding this wildly undefined industry, but need help replicating our success in securing non-dilutive early stage funding. So, this year, instead of talking about game design, I have been asked to talk more about the nuts and bolts of building a serious game startup and funding a company to do this kind of very specialized work. (Step one: make a lot of fun games first, or hire people who have made them…)

GiN: This is often a corny question, but given your major career arc and shift, we think it’s a good one. If you could do it all over again, would you do anything differently, and do you think you would again end up working with serous games? Why?

That’s a great question. Yes, absolutely, I would get started running a serious games studio years ago, when I first wanted to. I would have resisted the temptation to take so many entertainment game contracts much earlier. (That’s heresy to many of my friends.) But I’m not totally finishes with pure entertainment games. While I am fortunate to have accomplished many of the goals I set out to achieve in the entertainment game space, there is one thing I would do differently.

If I had it to do over again, I would push a lot harder to convince video game publishers that procedurally-generated storytelling is not only possible but could be massively popular. Only a small portion of the open-ended delight in dice and paper role-playing games has ever been captured in electronic video games. Many fans of video game RPGs don’t even know what they are missing if they have not played a truly well-run RPG with a skilled Gamesmaster and fun group of friends. I know that we can bring much more of that unfettered freedom and interactive joy to video games, using AI, interlinked world systems, and characters as databases. That’s my unfinished business in the entertainment games space, and one of the few things that could lure me back. Who knows, maybe one day Media Rez will fund that risk…

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