ANIMAL’s feature Game Plan asks game developers to share a bit about their process and some working images from the creation of a recent game. This week, we spoke with Matt Gilgenbach of Infinitap Games about Neverending Nightmares, a game that conveys the horrors of one developer’s struggles with mental illness.

Depression is becoming a more and more common subject for video games to tackle, from the highly publicized Depression Quest to Prisoned (profiled here). But never before has it been approached in the way that Neverending Nightmares shows it.

This is a horror game through and through, but its shocks and terrors don’t feel gratuitous once you hear what its creator, Matt Gilgenbach, has to say about it. From the little girl chasing you around with a bloody knife to the spasmodic visions of your character yanking out his own veins right through the skin of his forearm, many of the most horrifying visions in Nightmares are things that Gilgenbach has dreamed of or thought about himself, and their inclusion serves the designer’s purpose.

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“I have these intrusive thoughts and my mind comes up with these horrible, gross, awful, self-injury things, and those images have haunted me for over ten years,” he told ANIMAL. “I really wanted to put those in the game and be able to show people and point to it and say ‘this is what mental illness can do.'”

Gilgenbach said he suffers from depression and obsessive-compulsive disorder. Although he’s in a good place now, a decade ago was a different story. “I wanted to die,” he said. In Neverending Nightmares, he tried to capture what his lowest points felt like. “I wanted to convey the uncertainty when you’re dealing with mental illness, like the fact that you don’t know where you end and the mental illness begins. You don’t know exactly what reality is.”

“I’m not saying I hallucinate,” he added, “but just the general feeling that you’re not seeing the world as it is. You’re seeing the world filtered through your illness.”

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Neverending Nightmares is comprised of a cyclical and ever-escalating series of dreams experienced by a character who continually wakes up back in bed, only to be faced with new horrors. This is, admittedly, not an original idea, but its execution in Nightmares is definitely unique. Throughout an eerie mansion, a grisly asylum, and a few other locations, the game’s ever-shifting black-and-white aesthetic is marred regularly by splotches, pools and sprays of bright red blood. Darkness and shadows are seen as solid patches of scribbled lines that can hide entire rooms from view.

A chilling soundtrack by electronic artist Skyler McGlothlin (a.k.a. Nautilis) charges every scene with anxious tension. The game is played in 2D, and it proves that you don’t need photorealism or difficult puzzles to experience terror from playing a video game.

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The game was inspired by a dream Gilgenbach had long before he ever began working on it. “I was a little kid, and I had a sister, and something terrible happened to my sister and she turned into a crazy murderer and I had to kill her,” he described. “But then in the dream there was this time limit aspect to it. Something happened and things would go terribly and then I would try again, and things would still go terribly.”

That aspect originated either from playing lots of video games, where you’re constantly dying and respawning at previous checkpoints, or from “a fondness for the movie Groundhog Day,” as Gilgenbach guessed. “It’s tough to say with dream analysis,” he explained. “I don’t know if I’m very good at that.”

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Nightmare‘s environments and characters do a great job of imparting the uncertainty that Gilgenbach and his team at Infinitap were shooting for. You’ll plummet off a cliff, be crushed to death by a giant, muscle-veined baby, or catch an axe through the head courtesy of a murderous doppelganger, only to wake up in your bed again. Only now the doors have all moved, or the hallways are filled with bloody, blinking dolls, or you’re suddenly a little kid, or you’re in a psych ward filled with cannibals, or your sister is in bed with you, or the portraits on the walls (featuring the faces of Kickstarter backers) are simply looking at you funny, or you’re feeding your hand into a meat grinder.

The developers also did their best to make the player feel “disempowered,” Gilgenbach said, and Nightmares perfectly captures the randomness and malleability of dreams. The only other character in the game, Gabby, is the protagonist’s sister in one scene, his wife in another, and his psychiatrist in the next. He’s as confused as the player, and the game never deigns to explain what the reality is, even when it’s over—there are three endings, and it’s up to interpretation which one (if any) is real. Not one is particularly pleasant.

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These branching paths, once common in games, have lately become something of a lost art (or a good-riddance relic, depending who you ask), but Gilgenbach said he enjoyed giving players some control over the story—not to mention leaving things ambiguous. “The endings can redefine the context of everything that led up to them,” he said.

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But there was another reason for leaving things bleak. “One of the things I wanted to convey is there’s not a quick and easy fix for mental illness,” Gilgenbach said. “I feel like it would be sort of unfair to wake up and everything’s in color and there’s flowers everywhere. That, to me, wouldn’t be authentic.”

But if you pay attention to the credits you’ll spot a link to the National Institute of Mental Health’s website with a note for any players who are currently suffering.

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Gilgenbach wanted to make sure people know that “things can get better.”

“At this point in my life, in the years and years of therapy, I’ve found techniques that work for me and have made my life worth living,” he said. “The fact that recovery is a long, slow process is not something easily conveyed, so we didn’t really try, other than to say it’s really a good idea to seek out help.”

Neverending Nightmares is available now on Steam and Ouya. Learn more about it on neverendingnightmares.com.