Since developing epilepsy after sustaining an injury in the military, Liana Ruppert has endured four grand mal seizures. One briefly stopped her heart. But it was her most recent that generated international headlines.
“It took me a long time to recover speech and autonomy,” Ruppert said. “I couldn’t walk for the rest of the night.”
Some games and other forms of visual entertainment involving flashing lights or screen flickering are preceded by warnings for those who are sensitive to such effects. But “Cyberpunk 2077” lacked such a warning and did not include a way to turn off potential seizure-triggering scenes, garnering international media attention after Ruppert authored an article about her experience playing just before the game’s launch.
“Cyberpunk 2077′s” developer, CD Projekt Red, responded to the article with a statement on Twitter thanking Ruppert for surfacing the issue and noting the company was “working on adding a separate warning in the game, aside from the one that exists in the EULA [end user licensing agreement]” and that it would implement a “more permanent solution” as soon as possible. The company would do so with Ruppert’s help after reading her article.
Thank you for bringing this up. We’re working on adding a separate warning in the game, aside from the one that exists in the EULA (https://t.co/eXpPn73VSK). Regarding a more permanent solution, Dev team is currently exploring that and will be implementing it as soon as possible. https://t.co/lXFypnSit2— Cyberpunk 2077 (@CyberpunkGame) December 8, 2020
“I honestly didn’t expect anybody to read it because I have written about epilepsy so many times, and I’m just kind of used to it being ignored,” Ruppert said.
In an email to The Washington Post, CD Projekt Red’s North American head of communications, Stephanie Bayer, said that the developers fielded suggestions from Ruppert and “adjusted the entire sequence” to no longer be a seizure trigger.
By release day, a seizure warning was added. A day later, the most problematic scenes, called “brain dance” sequences in the game, were adjusted via a software patch to be safe for epileptic and photosensitive players. These changes were implemented thanks to Ruppert’s article and subsequent consulting with developer CD Projekt Red, work she did on a pro bono basis and for which she was not compensated.
“For those that have been excitedly waiting for ‘Cyberpunk 2077,’ I didn’t want that anticipation to fizzle out because of [an] oversight,” Ruppert said of her motivation to volunteer her time.
“We absolutely did take this seriously and we thanked her for allowing us to correct this,” Bayer wrote in the email to The Post.
Epilepsy, a neurological disorder in which abnormal electrical activity in the brain can induce convulsions, impair the senses and result in a loss of consciousness, affects one in 26 Americans at some point in their lifetime, according to the Epilepsy Foundation. A smaller percentage (around three percent) of those are photosensitive, meaning lights at certain intensities or certain visual patterns can trigger a seizure. The condition can be present at birth, but people can develop epilepsy over the course of their lifetime, as Ruppert did. It affects individuals differently — Ruppert lists heat and stress as some of her other seizure triggers, for example — and seizures can vary in severity depending on the circumstance.
Movies, TV shows, video games or environments that feature sequences of flashing lighting have been known to trigger seizures for those with epilepsy, which can be lethal. Epilepsy Foundation Chief Medical and Innovation Officer Dr. Jackie French said one of the first occasions where epileptic seizures received mainstream media attention was in 1997 when hundreds of children suffered seizures in front of their television sets while watching an episode of “Pokémon” that aired in Japan.
“That made everybody realize, ‘Oh, this is an issue that we have to pay attention to,’” French said.
The video game industry endured scrutiny on this subject earlier. Since 1991, multiple lawsuits have been brought against video game makers alleging that a game had triggered a seizure. And yet (aside from rare, highly specific exceptions, like a video game used in a federal setting) there is no regulation that requires gameplay to be tested for seizure-triggering content. Nor is there a legal requirement to administer a warning of potentially seizure-inducing content. Whether individual platforms, publishers and developers implement policies to design, test or warn for photosensitivity triggers is entirely voluntary.
A blanket statement about seizure triggers at the start of a game has become a norm for many video games. Ubisoft, for example, adds a warning in most of its video games and standardized testing to remove seizure-triggering scenes as of 2008. The company applied such measures after a 10-year-old had a seizure while playing “Rayman Raving Rabbids.” Ubisoft stated at the time that their testing “showed that no images posed a high risk for photosensitivity epilepsy.”
“Cyberpunk 2077,” during the prerelease review period for journalists, had no warning outside of a brief mention in the end-user license agreement (a primarily legal document that most players won’t read).
This isn’t the first time Ruppert, 33, experienced a seizure while playing a video game. In fact, she said she experienced a second seizure while playing “Cyberpunk 2077,” though not as severe as the first.
“It’s certainly not every flashing light,” French said regarding potential seizure triggers. “It has to be a certain frequency, a certain luminosity. It is much more likely to trigger a seizure if it covers your entire field of view.”
To remove the biggest seizure triggers in “Cyberpunk 2077,” CD Projekt Red, based in Warsaw, spent several days ahead of launch speaking with Ruppert, particularly through text message and email. Taking care to ensure her safety, the developers sent her new animations to fix the “brain dance” sequences, and put her in touch with designers to discuss what other areas of the game need attention. Ruppert took her own safety precautions while playing, including having her husband nearby at all times, and taking medication to reduce risk.
“[CD Projekt Red] was very quick to be like, ‘Let’s set up something this week. Let’s send you some stuff, let’s do some roundtables and let’s talk with the [Epilepsy Foundation,’]" said Ruppert. “They were very proactive about that.”
Shortly after publishing her article about seizure triggers in “Cyberpunk 2077,” Ruppert was harassed online, particularly from disgruntled gamers who expressed fear the attention the article received would lead CD Projekt Red to alter its “artistic vision” of the video game. The harassment was so serious that Ruppert received GIFs with flashing lights, sent specifically to induce a seizure. In one instance, a sender disguised such a GIF as a message of support.
“I don’t think people realize [these safety changes are] as simple as muting a color by just a few shades,” Ruppert said. “Or with the ‘brain dance’ sequence, we changed it from flickering to a transient animation instead, which conveyed the same result, but slightly different.”
Though that sequence has been changed, with lights that flash at a slower frequency safe for epileptic and photosensitive players, several other potentially harmful sequences remain, according to Ruppert, including a glitch effect in the main menu and other cinematic scenes within the game.
Ruppert emphasized that a seizure warning at the start of the game isn’t enough, as many players can overlook it or ignore it. “What I’m hoping for is a toggle option,” she said. “[Independent game developers] really tend to spearhead this, where there are options specifically meant to toggle off certain animation sequences.”
According to French, the Epilepsy Foundation’s biggest concern is primarily toward individuals playing games who don’t yet know they have epilepsy. Being able to toggle off features, especially if someone begins to feel dizzy or confused, can prevent a seizure. French also noted that players can close one eye to keep a seizure at bay.
While the Epilepsy Foundation doesn’t have the knowledge to consult on a technical level, its leadership hopes to help CD Projekt Red, and other game developers, with a broader approach.
“Our goal is to educate and to persuade designers and the sellers of these products of the value, first of all, of the danger to people with photosensitive epilepsy, and then the value of informing the public about them before a seizure incident takes place,” Epilepsy Foundation director Allison Nichol said.
Video game publishers have a certification process that developers must pass to put their games on the market, but accessibility isn’t always a standardized step.
“I can’t speak for CD Projekt Red specifically, but it has been my general experience that issues like that arise from lack of awareness,” Ian Hamilton, an accessibility consultant who has worked on games like “The Last of Us Part II” and “Destiny 2,” said. “While putting requirements on games is a tricky business, I think there are a few things that could be reasonably expected across most games, with consideration of photosensitivity being one of them.”
Tools exist to help developers, filmmakers and creators identify and remove seizure-triggering content from their work as well, including the Harding Flash and Pattern Analyser (FPA). This software program automatically identifies harmful photosensitive content and flags it for removal.
“For wide adoption — especially with small independent developers — the economics and awareness around trigger testing both need to shift,” Hamilton said. “Developers of game engines [the coding scaffolding that most games are built around] are in a really tremendous position to help with this.”
A representative for CD Projekt Red said the company will be teaming up with organizations in the new year to make “Cyberpunk 2077” safer. These partnerships haven’t been publicly announced, but the Epilepsy Foundation confirmed that conversations will continue with the developer to bring more permanent solutions to the game.