“Plenty of Hominids” is a collection of words and thoughts by MJC.

The Lazy Design Aesthetic of Misrepresenting Genetic Conditions

The Lazy Design Aesthetic of Misrepresenting Genetic Conditions

This morning, around 6:15AM, I did what one is never supposed to do: I looked at my phone while still in bed. I had woken up around 6:05, laid there thinking to myself for ten minutes, then checked my phone for the time again. As is my custom, I checked for new content on videogames.com, a web site about video games, and noted a new “Quick Look” (a “quick” horizontal slice of a new video game) of the new game Rage 2. What I saw was pretty standard post-apocalyptic fare, albeit with the addition of a neon overlay and a car with guns on it. A pink-splashed, first-person rendition of 2015’s Mad Max, which happened to have been developed by the same company, Avalanche. And, not unlike Mad Max, the wasteland of Rage 2 was filled with what appeared to be disfigured people. But they aren’t called “disfigured”; They’re called “mutants”.

As a geneticist, “mutant” certainly has a different, more specific meaning to me than it does to the average person. For most, the word “mutant” probably conjures images of humanoid ninja turtles, or the comic book superheroes of the X-Men, or maybe the giant orc-adjacent monstrosities of the Fallout series. But for me, “mutant” is a technical term—something we use in my profession to describe a variant form of a gene. I cannot think of a time where, in the professional setting, I’ve heard a human patient referred to as a “mutant”. Rather, they may carry a “mutant gene” or, even more likely, a “mutation”. I do not believe this is due to some pejorative meaning to the term “mutant” per se, but rather because every single one of us is carrying around “mutations” in our genome. Most of those mutations are benign, causing no obvious phenotypic effect. Therefore, calling one specific person a “mutant” in a general sense is rather meaningless.

We’re all “mutants”.

As an aside, I carry a mutation in a gene called FLG, which codes for a protein called filaggrin. That “mutation” causes me to have a condition called atopy, and thus I suffer from eczema, asthma, and respiratory allergies (among other things). A lot of people have eczema, asthma, and allergies and don’t realize that together, these symptoms point towards the FLG-mediated “atopic triad” and, therefore, that they too likely have FLG mutations. But I wouldn’t call myself or any of them a “mutant” because that’s just not how we use the term.

In fact, the term “mutation” and “mutant” has largely fallen out of favor in the genetics field. It’s not that we never use it, but we tend to prefer the term “variation” because it is more accurate. “Mutant” implies that a change has occurred to a particular gene, but over the last 20 years, our understanding of human genomics has advanced to the point that we realize most of these “mutations”  are naturally occurring variation in the population. In other words, these “variants” are just part of the overall structure of the "human genome” when viewed from a population-wide perspective. Genomic science generally considers the human genome to be a massive collection of variation, not a single immutable monolith. Hence, “variants” rather than “mutations.”

As a discreet example, 20-30% of people with atopic dermatitis have variants in the FLG gene. In Europeans, at least two specific variants (R501X and 2282del4) are common causes[1.] These are typically inherited variations, not mutations arising independently in each individual with atopic triad. That said, it is possible that a de novo variation, or a variant that arose newly in an individual and that is not due to inheritance, causes a genetic condition. It’s just that there are very few random mutations in every individual and with over six billion bases to potentially mutate in the human genome, it’s just very unlikely to happen to occur such that it adversely affects a gene.

With all that in mind, it is clear that the word “mutant” as it is used in genetics differs substantially from the way the word “mutant” is used in mass market entertainment media. In books, films and video games, “mutant” is often used interchangeably with various terms that essentially mean “other”: “freak,” “monster,” “beast,” et cetera. However, it isn’t completely interchangeable because everyone understands that “mutant” has something to do with genetics and biological development. Therefore, the choice to use the term “mutant” implies that there is some biological, likely genetic, basis for why these “monsters” are the way they are.

There is an entire literature all about the problems of “othering” in general that I won’t get into here, but sufficed to say that “othering” is a method used in fiction to differentiate between characters but that is also applied in real life by people trying to discriminate against other people. There is another major problem with disabled people being represented as “monsters” that needs to stop which, again, I won’t get into here. Frankly, I feel out of my depth discussing those issues generally as, despite having a couple of genetic conditions myself, I do not consider myself disabled and do not face the same challenges as those who do. When it comes to video games, advocates like Steven Spohn of AbleGamers speak with great authority on these specific subjects, far beyond what I can speak to.

But with the issue of “othering” in mind, the use of “mutant” specifically is thorny because there are actual human beings walking around with genetic conditions that inherently “other” them in the eyes of many people. In my time as a geneticist, I have seen patients with genetic conditions that dramatically affect their physical appearance. In fact, part of our training as geneticists includes classes where we see photographs of individuals with various genetic conditions and note classic physical markers of the conditions—hypertelorism (widely spaced eyes), for example. Knowing these markers enables us to start diagnosing people who have these conditions and recommend them for the correct genetic testing. (And, importantly, even in the genetics field, there is debate about showing patient photographs, whether they were consented correctly, whether it is ethical to be treating humans that way, and so forth.)

Lazy Design is Reasonless

With all that background in place, I want to discuss Rage 2, its “mutant” characters, and the unifying dysmorphic features that seem to appear in all of the designs used in the game. I noted while watching footage of it that the “mutants” all seem to share specific features: broad and bulbous foreheads, hypertelorism, and cleft lips. Each of these features, independently, is a type of feature we might see in our genetics training. I’m not a walking encyclopedia of genetic disorders, but I know where to look and I couldn’t really find any specific genetic disorder that’s inclusive of all three of these features.

Given these specific features are so widely represented among the “mutants” in Rage 2, I looked into the (relatively sparse) story attached to the game. Initially, I erroneously figured the “mutants” were the result of some kind of nuclear radiation or chemical contaminant, but apparently the apocalypse in Rage was caused by an asteroid impact. According to the Rage wiki (literally everything has its own wiki now), the “mutants” are the results of “failed” human experimentation using fictional “symbiotic microcomputers” called “Nanotrites”. It’s not clear to me, based on this information, how the “mutants” actually end up with genetic alterations that “mutate” them, let alone how they’d all end up with the same set of dysmorphic features.

Why cleft lip? Why hypertelorism? The fiction seems to suggest that “the Authority”, some kind of technologically advanced organization, was “mutating” people with the “Nanotrites” to create super soldiers and that the ones wandering the wastes of Rage 2 are the “failed experiments.” According to that same wiki page, there are “Authority mutants” that are completely obedient to the “Authority” and presumably these ones are not “failed experiments.” Those “Authority mutants” still have cleft lips and hypertelorism. So it’s not that these physical features are part of the “failure” and rather it seems they were intentionally designed into the “mutants.” But why?

Maybe I’m getting ahead of myself here. Let’s briefly look at cleft lip in particular. According to one 2014 summary of the genetics of cleft lip and palate (CL/P), there are “at least 275 syndromes” where “clefting is a primary feature”[2]. Table 1 in that paper includes a big list of genetic syndromes and genes associated with clefting. There are a huge number of genes that can lead to clefting. But there’s a very important comment in the epidemiology section of this paper: “The majority of orofacial cleft cases lack additional features and are categorized as ‘non-syndromic’, i.e., 70% of all CL/P cases and 50% of all CPO cases.” So while clefting is relatively common, it can be caused by a large number of different genes, and typically those variants do not also cause other phenotypes (they don’t appear to have any other effect on the individual’s development).

The “mutants” in Rage 2, however, clearly have clefting along with a lot of other phenotypes. But why? What “advantageous” variant, one that isn’t related to the “obedience” trait described above (since plenty of “mutants” that aren’t obedient obviously have clefting), is linked to the clefting phenotype? Neither biology nor the game itself gives us any clue as to why the “mutants” all share these features.

To be honest, I feel like I probably spent more time thinking about it than the people who designed these characters and chose to name them “mutants.” The “Nanotrites” seem to be a form of Deus ex machina used to explain away everything from the power-ups the main character acquires throughout the games to the existence of “mutants”. And that would be fine, except that the word “mutant” has a meaning and they gave every last “mutant” cleft lip specifically.

So there is no reason for them to have the design they do beyond laziness in designing monsters. It appears to me that the designers were just cribbing dysmorphic features that occur in real life and applying them to the game’s monsters, then naming them “mutants” and going on their way. Why do they look the way they are? Because they’re “mutants.” No additional thought went into that.

On that subject, this article by Chris Plante at Polygon addresses the issue of cleft lip’s representation in Rage 2 from a personal perspective. Plante noticed the abundance of cleft lips on the mutants in the first Rage game and even asked its director, Tim Willits, about it and whether they might reconsider the designs for the sequel. Given the designs in Rage 2, sadly Plante found nothing had changed in the sequel. Plante explains in his article that he was born with cleft lip, and that it being present on all the “mutants” in the game conveys a feeling that cleft lip is equated with being “subhuman.” I think one thing that makes this worse is that there is no reasoning given in the game for why cleft lip as a phenotype is attached to every last “mutant” enemy, leaving us with the conclusion that the only reason it’s there is to “other” them.

Whenever an article like Plante’s is published, there’s a contingent of people who clap back saying, “Stop ruining the artist’s vision.” But this artist’s vision sucks. It’s lazy. It’s not founded in a strong narrative that explains or even attempts to hint at why these “mutants” all have cleft lip or hypertelorism. It’s not founded in any kind of actual science despite parading as science fiction. They could have just as easily called them “freaks” and rather than cleft lip, they could have just given them no lips at all. It’s pure laziness that they didn’t come up with their own design aesthetic around the enemy characters and instead used real life genetic conditions in an inaccurate, insensitive way.

Compare Rage 2’s “mutants” to the Fallout series and its “super mutants” (I swear, literally everything has a wiki). The “super mutants” have a strong science fiction background as products of a fictional virus called the “Forced Evolutionary Virus (FEV)” which was designed to specifically create biological super soldiers. The visual design of the “super mutants” is similar to that of the Incredible Hulk—they’re huge and hypermasculinized. They are, indisputably, “monsters.” Yet they don’t have any specific physical feature that would equate them with any actual living human beings, really. Maybe one could see a similarity with gigantism, a real condition caused by an overproduction of growth hormone. But at the very least the basis for that is established in the fiction: The whole point of the “FEV” is to create physically large super soldiers. There’s nothing, as far as I can tell, that helps explain Rage 2 mutants’ cleft lips and hypertelorism.

People need to be less accepting of lazy design choices, especially when those choices are harmful to other people (as is the case with Rage 2’s representation of dysmorphia). It is not “just an artistic choice” in this case, and criticizing it as being an insensitive depiction of real genetic conditions and disability is completely fair. I go back to Plante’s interview with Tim Willits and see that the director of the first game didn’t really have any clue why so many of the characters in his game had cleft lip. Cleft lip and hypertelorism are low hanging fruit when it comes to picking dysmorphic features a lot of people have seen, but that’s a bad reason to use them to create “others” in your video game.

That’s what I mean by “lazy.” When I ask, “Why?” there should be an answer.

I want people to question the way the term “mutant” is used in their science fiction. I want them to question why particular portrayals of genetic variation exist in their science fiction. We’re smart enough to recognize the lazy design aesthetic of misrepresenting genetic conditions, and we should be critical of it whenever it appears.


  1. Greisenegger et al., Analysis of four prevalent filaggrin mutation (R501X, 2282del4, R2447X and S3247X) in Austrian and German patients with atopic dermatitis. J Eur Acad Dermatol Venereol. 2010 May;24(5):607-10. doi: 10.1111/j.1468-3083.2009.03469.x.

  2. Leslie and Marazita, Genetics of Cleft Lip and Cleft Palate. Am J Med Genet C Semin Med Genet. 2013 Nov; 163(4): 246–258. doi: 10.1002/ajmg.c.31381

The Problem with "Gaming Disorder"

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