That Dragon, Cancer was one of the most critically acclaimed indie games released in 2016. The point and click adventure’s frank depiction of a family’s battle with illness seemed to push video games into new territory. Tof Eklund spoke with one of the game’s creators about how the game was made and how some critics missed the point.  

Read our review of That Dragon, Cancer from last year.

Last weekend, American indie game creator Ryan Green was in Auckland for the Documentary Edge festival introducing Thank You for Playing, a film about how he and his wife Amy created That Dragon Cancer, a documentary video game about their son Joel’s struggle with and ultimate death from cancer.

I caught up with him at the festival and we spoke about using choice to create a sense of powerlessness, the Greens’ dashed hopes for a miracle, and the universality of pain. You know, the usual video game stuff.

Can you tell me a little bit about your background before you made That Dragon, Cancer?

I was a theatre kid and caught the bug when I was in sixth grade. I did school and community theatre, met my wife in an audition at high school, and my background has always been in the performing arts and wanting to be in that space, wanting to be a filmmaker and doing that kind of stuff growing up.

Then the dotcom boom happened and I found that right out of high school I could be a programmer and make a good living that way. I fell into websites and then eventually into software development and I spent a decade doing healthcare applications – record systems and scheduling systems and stuff like that. But during that time I also would do video production and things like that. In general my wife and I are communicators and we spend time either making art or writing or making videos or that sort of thing. I learned to program to make video games with my best friend and that quickly became a career I could have.

Around the time Joel was sick and his cancer had returned there was just those moments of profound self-reflection, thinking about how am I spending my time and what should I be doing and all of that. It just felt like it was time to move back into the video game space and so that’s when I moved into independent games, doing app and game development as a freelancer. I spent a couple years at a small studio in Oregon called Soma Games and did some games with them. They were mostly mobile casual games and things of that nature and then it was a few years after that I went more independent.

I was really keen to explore the meaningful game space. I met my business partner during a game jam: a game jam is similar to a 48 hour film festival where you make a game in two days. Josh, who eventually became my development partner, held a ‘meaningful gameplay’ game jam and I participated remotely. I remember he made something that dealt with predestination versus free will, and it was like ‘How do you predict the future to a probability of one, mixing freewill and fate, and what does that look like?’

A lot of ink has been shed by theologians on that topic.

Exactly, and so right off the bat I knew I liked Josh. His interactive inclination was to move in the meaningful space and he’d even made something for meaningful worship using interactivity. I felt we had kindred spirits in that way. What I made, at my wife’s suggestion, was a Tamagotchi-style virtual wife. I said ‘Are you sure? A virtual wife?’ so I made that and what was interesting was that it started tongue and cheek – it was this simulator where you feed your wife compliments or gifts or quality time or insults and neglect and all these different things that go into a relationship – but I was very sobered by it. It was this weird mix of something that was tongue and cheek but was also meaningful to me in examining our relationship, and examining how I act, and so that was the first taste of really doing something in a meaningful space. Josh and I have a shared affection for Terence Malick and the way that he approaches cinema and that space of feeling rather than doing, of being present. I really wanted to do something meaningful with Joel’s story.

At what point in Joel’s life did you begin work on That Dragon, Cancer?

He turned one when he was diagnosed and he turned two just a few months after they told us that his cancer was not curable. They gave us a short timeline, they gave us weeks to months, and yet the cancer didn’t respond like they expected, it didn’t spread like it was supposed to, and so we could keep knocking down the tumors. Six months passed and all of a sudden we were in a ‘no evidence of disease’ state and it was crazy to us, all the expectations he was subverting. And so that turned into 18 months and we were almost two years in, thinking to ourselves ‘We’re faith-filled people, maybe this will be a miracle, maybe Joel will be the miracle, and wouldn’t we want to talk about that? Wouldn’t we want everyone to see what a miracle he is?’

[By then] he was about three years old and our initial intent was to share something spiritual, to share something good and encouraging with people. We were going to document this miracle and we were going to talk about what it means to walk through this as a family facing uncertainty and facing the knowledge and the fact that his cancer is incurable and yet also holding onto that hope that maybe this will be different. We wanted to do it from that space because so often when you hear about spiritual stuff, they do it after the fact. A coulda, shoulda, woulda approach. But you don’t have the benefit of retrospect when you’re in the midst of it and that was important to us because we wanted to be truthful about where we were at, and we didn’t want to sugarcoat it.

So to ask the most obvious question, something that you’ve heard too many times, why a game?

I can be cynical and say why anything? Why any medium? Why should I think that anybody should care about my pain because pain is the most common thing in existence? But I think sometimes that’s the way you’re encoded. It’s like, what else would I do? When all choice is taken away, what am I left with? If I’m an administrator then maybe I start a foundation, if I’m a motivator maybe I go out there and I just encourage people or run a 5k or whatever it is. I think that our response is the most common thing parents do: you look for meaning and you look for purpose in your pain. And so for us, it was a natural extension.

The game wasn’t the first thing that we did, it was like the third or fourth thing that we did – we did a book and a film and we talked on blogs and we wrote poetry and we shared with our community and we did all of that stuff, that’s just the natural activity and I think for me it felt like, as a person that believes in this idea of creation, a game seemed like the best reflection. It’s like ‘Oh, I can talk about things like free will, I can talk about feeling powerless, I can communicate that with somebody else’.

The first thing that we made was this poetic recreation of a night I spent in the hospital with Joel when he was very dehydrated and sick.

It was a time where I felt completely helpless, completely powerless. All the tricks you learn as a parent fail, and yet here was this moment of actual grace, actual divine intervention that I felt and I wanted to share that. The video game felt perfect because I could be like ‘What happens when the mechanics fail? What happens when all the things that we learn, all the tricks that we learn, all the things that we idolise in our life fail? We idolise free will in this culture, we fetishise it, like if you do good then good will happen and if you do bad then bad will happen, so if bad’s happening to you, it must be your fault in some way. And I just wanted to challenge that. Not saying that I’m perfect, but it was just like ‘here’s me at the end of myself and something good happened’, even though I couldn’t be the agent.

It’s very much not the ‘will it and it will happen’ kind of thinking.

Yea, not the positive mindset stuff, because that’s an insidious blame that we place on people and I didn’t want to subject anybody to that.

As a religious man would you describe that as a moment of grace?

Absolutely. Grace is this idea of divine help that we don’t deserve, and so it wasn’t a matter of deserving, it’s a matter of a gift. That’s a moment where I felt a gift. I’m a software developer, I wouldn’t call myself an engineer, and I have a mindset where I’m notorious amongst my friends for being more critical, more cynical in my thinking, and rationality and reason are very important to me right? It has to make sense. This was a moment that transcended that sense, where I could actually point to it and say ‘This is evidence’.

With other things it’s very hard for me. It was part of the tension between Amy and I. She’s much more naturally gifted with belief and faith and the rest, whereas I’m much more into the thrashing and the ‘let me see what I can do, let me work it out, let’s figure it out’ before I believe it. That tension was very present and we wanted to be able to express that, like yes we’re both these ways, and the thing that we learned through this process of loving Joel is that it’s OK that we’re different in these ways. The important thing is how do we come together in those moments.

In the game itself there are three figures: Joel’s at the centre but it’s also you and Amy, and since Amy isn’t here right now, what was it that she brought to the process of creating the game?

She brought a lot. I tend to be rather melancholy, and when I first told her I was going to make the game I told her the first thing I was going to make was Joel crying the entire time and me not being able to help him. She was like ‘Are you kidding me? Who’s going to want anything to do with that?’ She brings a certain amount of levity and a candor and a sense of humor. I tend towards poetic navel-gazing and she tends towards ‘How can we encourage people?’ There’s a moment in the film (Thank You For Playing) where she’s chastising me for everything being slow and poetic and she really wants to do something fun and to have this moment of fun. For both of us, it was very important that people see that life with cancer isn’t just one note.

I think you see that in the film and in the game where we have a range of emotions and experiences, so when you asked why a game, it’s because a game is a reflection of our choices and it’s about grace and it’s about fitting into this design framework and going down this river of life and understanding where the banks are but it’s also play and it’s also connection and it’s also love and sweetness and all of those different things. I think she balances me in that way and certainly she brings an element of faith that I am very jealous of. That was true throughout our whole experience, I would think ‘I wish I could believe like you.’ Amy is extraordinarily rational and logical and you can see in her writing that she takes things apart in a way that’s constructive rather than deconstructive. I feel like we complement each other in those ways, and so it was important to me that both of us had our voice in that, and that people could hear both of us because most people tend towards those extremes. I was hoping that by Amy and I writing our own voices in the game, and by her also writing a number of the scenes in the game, I’d say she wrote most of it, that there’d be these moments where ‘how does it feel in this space?’, was my input, and what was being said was her input.

Is there a moment that is especially Amy in the game?

The platformer was her idea. Also the scene where they tell us things aren’t good, and they’re giving us the news that Joel won’t survive, she wrote all of the nurses and the doctors in her voice, and the original concept for that was her idea. There are a number of other places. All of the voicemails were things that she wrote and performed and even some of the stuff we recreated in a park, so her voice is everywhere, even when people don’t realise it.

The visual style of That Dragon, Cancer is incredibly striking. Some might call it minimalist but I don’t think that’s a sufficient description just because it’s low poly count. You mentioned the look of the game was incredibly important, the visual design of the game, what would you say that you were going for and what were you inspired by?

We were inspired by styles we were emulating early on, and then trying to find our own take on it. Something beautiful and impressionistic, especially as we were building the world. There was this sense of memory being impressionistic: you only see it through a dirty lens, it’s these moments that you think you remember and you’re not sure how you remember them, and so it was important to create a world that was expressionistic, we wanted the environment to convey emotion and so in the lighting and in the set design and all of that, we wanted that feeling to be there.

There’s a book called The Great Divorce by CS Lewis, and in it he describes this grey world that’s either at the edge of a sunrise or a sunset and in that space there are these people stuck in purgatory. They’re not sure if they’re going out into isolation or if they’re getting the bus up to the new place. That’s kind of how we felt. We’re at this edge: it’s either going to be a sunrise or a sunset, and it’s beautiful in this space. I really loved the colour palette of that and I wanted everything to represent that so that in the park area it’s much more of this sense of eternity, it’s the edge of the oldest parts of us as humanity. That’s why it was a composite. We went to California to see the redwoods and we stood in this cathedral of trees and I wanted that because it’s among the oldest life on this planet. It’s the closest we can get to the old. I wanted it to feel full of vibrant and living light, within the constraints of the video game.

Anything you do in videogames has to run on the hardware, so there’s limits to how you do that. You can’t make volumetric light on a mobile device. I can’t fill the space with fog and have beams that you walk in and out of, I have to fake that. And so that’s why rather than going for realism we were going for impressionism. We wanted to communicate those things without the details. In the clinical space we wanted it to be warm, because there were moments of warmth, but it was also sterile, and so that’s the lighting palette in there, it’s a mix of that warmth and that sterility.

Then when we were in the sea, it was kind of that space after a storm. The pink clouds and the peace that comes after this storm. That’s what we rode on most of the time. Spiritually we rode on that peace. It wasn’t our own, the wreckage was there, but we were being carried through it. And then a return back to the cathedral as this space as an expression of the inside of us. The hospital is everything humanity does to achieve an escape from death. We use the latest technology to burn holes in our tissue, and then, on the faith side, we adorn ourselves with all these different things to try and get God to do stuff. And so the cathedral is a representation of us and the life that’s found within us, whether it’s marred by us or not. And then returning to the edge of the world.

The lighting was very theatrical in that sense, and very intentional in terms of the palettes we wanted to use.

I saw a critic say that the racing minigame in the hospital was one of the game’s less effective moments, but for me it was absolutely heartbreaking. My little brother was born with cancer, and had it again later, and I’m very fortunate to still have him in my life. Nothing reminded me more of my feeling going to see him in the hospital when I was a kindergartener than that wagon racing game. Any thoughts about that? What specifically inspired that part?

First what inspired it. Part of it was the space that you’re in. That whole hospital section, time seems to collapse in those spaces where you just don’t know the day or the time and time goes slow then it goes fast and it’s a mix, but also the children’s hospitals are full of art and toys and games and kids riding around on their IV poles. Those red wagons are in the children’s hospital in Denver and you see families loading their stuff in and out in the wagons or they’re pulling their kids around on the wagons when they’re allowed off the floor. So there’s play even in the midst of all that illness, and that’s one thing that we wanted to communicate.

The other thing is that you’re brought into that hospital and all of a sudden you get there one day, his brain is open the next day, he’s in the NICU the day after that, you’re doing MRI’s, you’re doing treatment, he’s got meningitis, it’s just this whirlwind and all of a sudden you don’t have a choice. You think you do, you think you’re going to get in there and ask all the right questions and the grandparents are gonna do their research and we’ll come up with a plan.

But you don’t have a plan, you have a treatment, and you kind of fake-choose between two options that are both bad, and that’s what we wanted to communicate that there was this idea that you’re rushed into this slipstream of treatment and you’ll notice in the game, at the top right, the dates are just spinning by. It’s fun because you’re on this adventure and you think you’re going to get it and you have this audacity and this joy in the midst of it, and yet you invariably crash into the fallout from all of that. All of those things you’re collecting, like the beads of courage we have in the States. The kids get them for every injection or treatment or anything like that, then you string them around your neck. Those are the things you collect in the race. ‘We’re collecting all the beads this is great look how brave I am!’ Then you crash into the fallout and you hear it in the helicopter: he was blinded, he was deafened, the tumors caused him to delay learning to walk, he couldn’t talk, secondary cancers like your brother experienced, there’s all of that stuff, and that’s what I wanted to communicate.

Instead what I got from critics was like ‘It didn’t play very well’, but that’s not the point! And that’s why I think that we teach people to parse video games incorrectly. I know as a designer, and any designer I talk to, they get it. Whether they come from a formal or non-formal context, they want to communicate metaphor in their mechanics. If people are just like ‘I didn’t like the steering’, it’s like ‘I could have improved that, sure, but if you miss the forest for the trees on this, I’m bummed’.

Gameplay is one of the most powerful ways to convey meaning in a game. The way that people interpret gameplay can be so incredibly narrow, as if nothing’s changed since since the heyday day of the arcade when understanding a game was literally about how long you could keep playing.

That’s why I hope that video games in education are taken into the humanities instead of just STEM. It bothers me because it’s important for students to create stuff through mechanics and stories, and to break it down like you would poetry, peel the onion back, look for the metaphor, look for all of those things, those are the things that humanities and our english teachers and our lit teachers can teach us, so my hope is that we can introduce that kind of language and reasoning to games because we’re not the only game using metaphor in the mechanics.

I’d say that every game ends up having its mechanics acquire metaphorical meaning even if it’s unintentional. Do you have any particular thoughts for the player who comes to the game from a secular perspective and leaves the game feeling that there’s no pattern to or greater power in the universe?

I read a comment online that the message of That Dragon, Cancer, is that there’s no purpose and no meaning and I was like ‘ugh, that’s the opposite of what I want you to walk away with’ but I think in the collision between faith and secularism in our culture, the artifact of that is usually this fierce defence of God, that I’m here to defend God from all comers. We just determined that wasn’t our job. You’re not going to find in me a defence of God, because God can handle himself. That was a really hard thing because in our culture that’s what we’re taught to do. Christians are taught to defend their faith from a very early faith. There’s an entire school of thought in theology called apologetics, of how you come to the defence of your faith. All I can come with is my story. I hoped to tell a story of the miraculous, to tell a story of us escaping pain, and I think going through that, that was a very American thing to do because in our faith, and particularly in the brand of evangelicalism that I came up with, we spend a lot of time avoiding pain. But pain is the most common thing. Death is the most common thing. It’s the thing we all share. Religions of all stripes has survived millennia with far more death than we have in this culture. I would be lying if I said I didn’t take a hit to my faith. I’d be lying. But even if I can’t defend it, it’s still there. It still sticks.

I believe that faith is a gift and I also know atheists who would love to believe, but they just can’t. So I don’t come at it from an antagonistic perspective, this is just where I’m at, this is my story, and this is where I find the face of the eternal. This is where I find love and this is where I find God. I would love to tell you a different story but I didn’t get to, and that’s the thing that we struggled with the most: ‘Should we even do this? Is this good? Is it good to release something when we weren’t the winners here?’ That was hard. It’s not what we tend to associate with faith, but within my circle it’s the most common thing and all of our testimonies as believers or non-believers come with our own personal experiences.

So my hope was more than proving something, I wanted to come alongside people and be able to say ‘I get it, I get where you come from, I’ve had those same questions, I have those doubts daily too, so let’s not make this a game of defence but let’s make it a game of trying to find common ground and a place where we can love each other in the midst of pain’.

So that’s my hope. My hope is that you’ll feel love from our family for what you’ve gone through. Obviously we still have our beliefs, obviously I hope that everyone becomes a Christian, I wouldn’t be in the business of following these beliefs if I didn’t actually believe it. I hope people feel love and hope, even if they feel like the hand of God wasn’t there.

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