Disney Studios released Star Wars: The Rise of Skywalker last month, already aware that the movie includes flashing images that could trigger seizures. In a letter sent to theaters two weeks before the film premiered, Disney stated it “contains several sequences with imagery and sustained flashing lights that may affect those who are susceptible to photosensitive epilepsy or have other photosensitivities.” The letter requested that theaters post this seizure notice at their box offices and online.
To alert the epilepsy community, Disney also approached the Epilepsy Foundation, which issued a news release with the seizure advisory and a few recommendations for seizure prevention. The studio’s preemptive effort shows progress on addressing seizure triggers in their movies. In 2018,
after complaints of seizures triggered by Incredibles 2, Disney–to its credit–re-edited the film to take out offending sequences and redistributed it. If Disney knew how fix problem flash (flash that creates a strobing effect) in Incredibles 2, one might wonder, why wasn’t it done preemptively for Skywalker, instead of issuing warnings?
Warnings are less effective. Already there are reports of audience members having seizures or just barely averting them (h/t to John Ledford).
What Disney should have done
It was a positive step for Disney to approach the Epilepsy Foundation to help spread the word. But if the company is serious about protecting the public. Disney can do even better by:
- Taking more responsibility for the safety of the visual effects. Before releasing the movie, they should remove/alter the seizure-inducing aspects of visual sequences that could trigger seizures.
- Hand out dark blue or dark green plastic glasses to all moviegoers and encourage them to wear them to protect against the flashing visuals. The cost of glasses should not be an issue; in its first two weeks the movie generated $840 million worldwide.
- Another inexpensive option: Distribute eye patches to wear during the movie. Print a Star Wars logo on it, even. Photosensitive seizures aren’t triggered when the viewer watches with only one eye.
The Epilepsy Foundation recommendations
To be more effective, the strategies for seizure prevention offered in the Epilepsy Foundation’s news release should be more practical and detailed. The three recommendations are:
- Ask a friend to watch the movie first.
Will your friend remember which scenes have a lot of flashing?
- Take your friend with you when you go see the film to alert you to which scenes contain the flashing lights so you block your eyes during those scenes.
Several issues here. A photosensitive seizure can be triggered in a matter of seconds. Your friend would need to anticipate these scenes in time for you to block your eyes. After the scene begins, it may be too late to prevent the seizure. Disney could easily have identified these scenes in its warnings, providing enough identifying information about the prior scene for you to know to block your eyes in time.
In addition, the advice to block your eyes is inadequate because people need to know that merely closing their eyes will not work. At least one eye must be blocked for protection.
- Teach your friend the three simple steps of seizure first aid — Stay, Safe, Side — so that they can assist if you have a seizure.
Staying with you and keeping you safe are good advice. But not every seizure is obvious to others. Your friend may not even know you’re having a seizure if you don’t lose consciousness or don’t have noticeable body jerks. You could have a seizure where you lose awareness but don’t lose consciousness, with minimal body movement, for example, which may not look like much but takes time to recover from.
My wish list for The Epilepsy Foundation
In this instance, the seizure prevention glass is half full, for which I am grateful. Some ideas to help fill that glass:
- Lobby Disney (and other major movie and video game studios) to release entertainment that is less likely to trigger seizures. I don’t know whether the Epilepsy Foundation is already doing this behind the scenes. Their advocacy work has focused on other very important issues such as discrimination and generic drug substitution (that risks making anti-seizure treatment less effective).
- When educating the public about averting photosensitive seizures, give greater prominence to the wearing of dark glasses or an eye patch, two simple remedies.
- When educating the public about photosensitive epilepsy, always point out that the people affected are not just those with known epilepsy. In place of the news release wording “for about 3% of people with epilepsy,” expand it with “…and an unknown percentage of others who are unaware they have the condition.”
Terrible idea. Take a genre of video games—first person shooter– that is especially likely to provoke seizures. Make an action movie filmed entirely in that style. Put it on the big screen for release in theaters. The larger an image is, the greater the area affected in the brain’s visual cortex, and therefore the risk of visually triggered seizures is increased in those who are vulnerable.
Hardcore Henry opened (and in most cases, also closed) in theaters this month. It’s described by the student newspaper of Washington College as 90 minutes of “non-stop chase scenes, splatterhouse shootouts, and barely comprehensible fistfights that often end in ridiculous dismemberment.” Glenn Kenny’s New York Times review explains the film’s R rating thusly: “for not letting a minute pass without subjecting one character or another to grievous bodily harm or worse.”
I suppose it’s possible to produce such subject matter without seizure-inducing images, but given such descriptions of the content, I wanted to check. Without going the movie. So I tested** the movie’s promotional trailers for compliance with seizure reduction guidelines. The guidelines were designed to protect all but 3 percent of those who may have seizures triggered by visual stimuli. After watching the trailers (I do not have photosensitive epilepsy), I was not at all surprised that the movie does not comply.
This is hardly the first movie to include images that could trigger seizures. But based on the trailers and reviewers’ accounts of a relentless pace of action, most likely there are many potential seizure triggers during the film. Researchers of photosensitive epilepsy believe there is a cumulative effect on the brain; the risk of a seizure increases after prolonged exposure to potential triggers.
Strong stomach required
Many reviewers of Hardcore Henry cautioned readers about motion sickness. One reviewer interviewed the movie’s producer about apparently significant (yet not entirely successful) efforts to minimize it. The producer said those efforts were begun long before film production began, with many tests and test screenings.
Some representative remarks:
“…many people are going to feel ill when they try to watch Hardcore Henry on the big screen…make sure everyone in your party either has no issue with motion sickness, has taken their Dramamine, or rolls into the theater with an empty stomach…” — The Daily Dot
“…as I waited for my nausea to subside, I began to appreciate the dastardly marketing plan built into Hardcore Henry: It’s essentially a dare to see if audiences can finish the whole thing without throwing up.” — Vox.com
“Hardcore Henry will probably go down as the film of 2016 that is most likely to make you feel nauseous from watching it (due to motion sickness, that is, not the gory, over the top violence).” — Screenrant.com
Back-handed seizure warnings
A number of reviewers mentioned seizures, but not with the same concern with which they write about motion sickness. Sure, motion sickness is unpleasant, but a seizure is not only unpleasant, it can be dangerous and life-altering, and its effects on the brain can linger. You wouldn’t know it from these reviewer comments, though:
“It’s remarkably watchable, in fact, with none of the motion sickness you might expect, which is especially amazing given the film’s unswerving dedication to full-bore, seizure-inducing action.” – The Georgia Straight
“…Hardcore Henry is a 90-Minute Cinematic Seizure…a frenetic editing style that can make you feel like you’re having some kind of seizure…I don’t see how anyone could watch it and not experience motion sickness…I definitely felt like I’d suffered from some sort of brain trauma when I walked out of the theater. (Can you get a concussion just from watching a movie?)” — Esquire
Treating seizures (and those who have them) with respect:
Just 2 reviews of dozens I read seemed to be genuinely concerned about the movie’s potential to trigger photosensitive seizures in audience members:
“If 3D gives you a headache, Hardcore Henry is enough to bring on epilepsy.” — Moviehole.net
“I left the theater wondering if the jittering, disoriented feeling I had buzzing through my skull was some sort of sudden onset epilepsy.” — University News
If you live in the UK, there are real warnings about the risk of visually induced seizures. Listings for movies with images that don’t comply with seizure reduction guidelines warn of “a sequence of flashing lights which might affect customers who are susceptible to photosensitive epilepsy.” That’s because the UK regulates the appearance of TV, movies, and advertising to protect those individuals. Some of these people with photosensitive epilepsy don’t realize they have the condition. It may have developed only recently or it’s quite possible they were never aware of experiencing a seizure. Not all seizures look like what you typically see portrayed.
What lies ahead?
What’s most worrisome is that the consensus among reviewers — regardless of how well they liked Hardcore Henry — is that the influence of video games on movie-making is only going to grow.
“Virtual reality is on the way. Video games and movies will soon start to blend and borrow from one another in many ways. And this movie, imperfect and nasty and often astonishing, is a vanguard.” — Slashfilm.com
“…the visual language of games will soon come to have as much of an impact on up-and-coming film directors as cinema does… and it’s safe to say that we won’t be short of films based on video game properties…With an increased push towards the home viewing experience in movies and interactivity in media, it will be interesting to see how the cinema of tomorrow is influenced by gaming perspectives. “ — Den of Geek
We will certainly see more of the first-person perspective, too. Some hailed the project as a technical marvel and “a revolutionary approach to narrative filmmaking.”
**How I tested the movie trailer
I run downloaded video clips through an application called the Harding Flash and Pattern Analyzer. (Graham Harding is one of the world’s leading experts on photosensitive epilepsy.) The FPA is widely used by producers and networks in the UK—including by the BBC—to reduce the risk of seizures from material on broadcast TV.
The analyzer examines video sequences frame by frame for very specific and measurable image qualities that researchers have found can trigger seizures. When such images are found, it displays and indicates the specific frames that violate seizure reduction guidelines. Violations occur with:
- rapidly alternating light and dark images (flash/flicker)
- certain stripes and geometric patterns with high contrast
- large areas of very bright (“saturated”) red
- problem images that take up more than one quarter of the total screen area
A huge amount of work is needed to protect consumers from the seizures triggered by flicker and flash from screens of everyday electronic media. But in 2011 there were some notable milestones in public awareness and prevention of photosensitive seizures. In no particular order, these are the year’s top five developments:
- A scene in the film Twilight Saga: Breaking Dawn triggered seizures in some audience members, most of whom had never experienced seizures before. Publicity about the seizures led to warnings by the UK’s Epilepsy Action and the Epilepsy Foundation of America. The film’s distributors provided a warning that cinemas could opt to provide to audiences. Although seizures triggered by movies shown in theaters aren’t common, this story brought wider attention to the risk of seizures from visual entertainment stimuli.
- Multinational game developer and distributor Ubisoft released a developers guide for creating video games that will not provoke visually induced seizures. Presumably it translates international guidelines for visual seizure safety into specific protocols for programmers. However, the guide is available only to member companies of TIGA, theUK’s trade association for video game developers and publishers.
- After the UK’s Epilepsy Action notified YouTube that an extended flashing segment in Kanye West’s music video “All of the Lights” could trigger seizures, a seizure warning was placed at the beginning of the video. It would be far better to fix than to keep the problem segments as is, even with a warning. Nobody pays attention to warnings, especially those who so far haven’t had a photosensitive seizure.
- Results of the first study to examine the rate of photosensitivity in young people on the autism spectrum were announced. They showed this population is at significantly increased risk of visually induced seizures. In young people 15 and older on the autism spectrum the photosensitivity rate is 25 percent. More studies are urgently needed, but with results as significant as these, more research will certainly be funded. While the study authors were focused more on commonalities in the roots of epilepsy and autism than on environmentally induced seizures in everyday life, the findings provide data that can be put to use immediately. The authors caution that it was too small a study (approximately 200 subjects) to merit placing limits on screen time. Nonetheless, parents of young people with autism spectrum disorders might want to be especially watchful of their children’s exposure to flashing electronic screens and any behaviors associated with screen time.
- Lenses that protect against visually induced seizures became readily commercially available. Zeiss F133 (previously known as Z1) cross-polarized, blue lenses can now be obtained from optician Antonio Bernabei, who ships worldwide from Rome. The lenses were developed by Zeiss with Italian photosensitivity researchers who demonstrated their effectiveness in clinical studies. In a study of people vulnerable to visually-induced seizures, while wearing the lenses 76 percent showed no abnormalities on EEG when tested with photic stimulation, and another 18 percent showed reduced EEG activation. Only 6 percent did not benefit at all. Until Bernabei began offering the lenses this past year, consumers and clinicians were unable to locate them without encountering a lot of dead ends.
These developments are more significant for the general public than most people realize because photosensitive seizures are not at all limited to individuals with epilepsy. Nobody knows for sure how many consumers experience visually induced seizures—including the small, unseen seizures that are never identified or reported. Three quarters of the affected people have no known history of seizures, no suspicion that they have this genetic vulnerability to flickering light, and therefore no prevention strategies. Onward to more progress in 2012!
Epilepsy organizations in the US and UK have issued warnings about seizures during the birthing scene in the film Twilight: Breaking Dawn. Because of the warnings, the seizures have received additional press attention.
Unfortunately, the warning in the US did not address consumers outside the epilepsy community. It released a warning last week on its website, addressed only to people who know they have photosensitive epilepsy:
“If you have photosensitive seizures, please take this information into consideration when deciding whether to see this movie. Around 3 percent of the nearly 3 million Americans with epilepsy have photosensitive epilepsy.”
The Epilepsy Foundation missed a major opportunity to explain that those most at risk for visually triggered seizures are those who have a genetic vulnerability but haven’t yet experienced a seizure. So while the Epilepsy Foundation is to be commended for responding to early reports of seizures provoked by flashing light in the scene, it downplayed the extent of the seizure risk.
As of today, 15 individuals have provided information about their Twilight seizures to a website tracking them, and only three had experienced prior seizures. What about the remaining 12 people? Would they have avoided the movie on the basis of a warning aimed at people who know they photosensitive epilepsy?
Not surprisingly, media coverage relied on information provided in the Epilepsy Foundation’s statement. For example, the Baltimore Sun’s story, which was picked up by a number of other newspapers, stated,
“While epilepsy is relatively uncommon in the population — about 3 million Americans have it — photosensitivity is even rarer, occurring in just 3 percent of those with epilepsy.”
To its credit, the Epilepsy Foundation warning provided links to excellent information on its site about visually induced seizures. Next time the organization should point out that anyone might have these seizures, not only people with epilepsy. When balancing the desire to protect those with epilepsy from unnecessary restrictions on daily activities against the greater public’s need to know about visually induced seizures, the Foundation favors the sensitivity of its own membership.
For its part, Epilepsy Action made clear in its own news release about the film that photosensitive seizures can also affect people with no prior connection to epilepsy.
“Many people with photosensitive epilepsy, especially young people, do not know they have it until something triggers their first seizure. In 1997, an episode of Pokemon shown on Japanese television caused almost 600 people to have seizures. Of these, 76 per cent had no previous history of epilepsy.”
According to Epilepsy Action’s news release, the group contacted Breaking Dawn’s UK distributor and requested confirmation that the birthing scene had been checked for photosensitivity. The distributor (which did not confirm the photosensitivity check) then issued a seizure warning that will be displayed for movie audiences.
One of the biggest challenges of spreading awareness about video games causing seizures is that many video game seizures take place when people are alone. With nobody else around to witness and document these events, people assume these are very rare. Along comes a blockbuster movie with a graphic scene that triggers seizures, and photosensitive seizures are suddenly in the spotlight, as it were.
I’ve held off writing about the seizures triggered by a scene in the movie Twilight: Breaking Dawn, because I keep waiting to hear whether it’s in fact causing “epileptic seizures in filmgoers across America,” as described in the Guardian. Although the story has been picked up by many news outlets, it is based on just a handful of reported events. There are still not many people who have publicly reported seizures. (If you want to report one, you can share your experience at https://www.facebook.com/breakingdawnseizures and
The Twilight seizures are getting widely publicized because, in addition to the high profile of the movie, the seizures that have been reported were convulsive events occurring in a crowded movie theater. A theater inDedham,Massachusettsstopped the film while the stricken viewer was given emergency assistance. In a way these people are fortunate that their sensitivity to flashing light became so evident that they can take precautions in the future. It’s possible other audience members had seizures that didn’t involve convulsions and weren’t recognized as seizures.
The birthing scene is described as graphic. In addition to the visual stress of the flashing, viewers are probably stressed by what they’re seeing. Some of the news stories remind readers of graphic scenes in other movies, such as 127 Hours provoking visceral, physical reactions in certain viewers. Stress lowers the seizure threshold, meaning that the same degree of flashing in a context that’s not so tense might not result in a seizure.
The excitement of playing video games probably has this same effect of lowering the seizure threshold. Also, while playing alone it may be easier to enter an altered state of awareness of one’s surroundings that lowers the seizure threshold. My daughter preferred to play with nobody else in the room so that she could get into a “zone” she found very pleasant. Unfortunately, once in the zone, seizures were more likely and she was less likely to have the awareness to sense them coming and prevent them by stopping or covering one eye.
I contacted the British Board of Film Classification, which screens movies prior to their release, to check for objectionable content and rate the maturity level of the content. In the UK film makers and distributors are responsible for identifying material that could provoke seizures and other adverse reactions in audiences, and provideing the appropriate warnings to audiences. If BBFC examiners notice sequences they think could affect a large number of viewers, they may require that audience warnings be added. For example, the review board noted last year that Enter the Void “includes a number of sequences of flashing and flickering lights that are likely to trigger a physical reaction in vulnerable viewers. It also contains extended sequences featuring rotating and handheld camerawork that may induce motion sickness in some viewers.”
In the UK, according to a BBFC spokesperson, no reports of Twilight: Breaking Dawn seizures have been received, nor did the BBFC identify any material likely to provoke seizures in those with light sensitivity.