Chris Button looks at the popular pastime helping people with mental illness and its growing possibilities.
To parody the Australian Prime Minister, there has never been a more exciting time to play video games. Virtual Reality (VR) is making inroads to being a household technology, and game developers are constantly pushing the boundaries of modern hardware to create memorable experiences. As one of the fastest-growing entertainment mediums in the world, video games offer escapism rarely found anywhere else.
This escapism from everyday stress can also provide significant relief to those struggling with mental illness.
Mental health is serious business. A recent media release from Beyond Blue revealed that 3,027 Australians took their own lives in 2015; approximately eight people every day. An average of one in six people will experience depression in their lifetime, and one in four will experience anxiety. This means, potentially, in a full match of Battlefield 4 of 64 players, upwards of 10 people will live with depression, and 16 people will suffer from an anxiety disorder. Up to five players in a single round of Overwatch could experience the difficulty of living with one of these mental illnesses.
Video games bring joy to so many, but a casual observer of the medium would draw the opposite conclusion. Mainstream media often report horror stories ranging from how Pokémon Go can harm your health, to video game-related deaths, and police commissioners expressing concern over violence in video games. These stories often falsely depict a correlation between video games and negative behaviours, and dismiss the benefits associated with gaming.
It is true that people can lose their lives to games in more ways than one, though. In Simon Parkin’s 2015 book Death by Video Game: Tales of obsession from the virtual frontline, he examines some of the notable deaths that have occurred in gaming cafés around the world, usually the result of excessively-long marathon play sessions without breaks. Refreshingly, instead of simply denouncing the validity of this pastime based on the minority, Parkin forensically looks at why the medium is so attractive to so many people worldwide. His findings range from the obvious test of skill video games provide in addition to the human benefits of belonging, socialising with others in a safe space, and educating ourselves about the world we live in.
In polar opposition to many other news reports at the time, Triple J’s Hack ran a story highlighting the positive effects Pokémon Go was having on people with mental illnesses. Many video games, like Pokémon Go, are not created with the sole purpose of treating mental illness, but can be a highly effective coping tool to use in conjunction with psychological therapy. Parkin writes that video games are uniquely placed in comparison to other forms of entertainment to act as a space of solace for those struggling in life:
Literature is able to remove us from our own lives and focus on the hopes, dreams and conflicts of another. But only a video game gives us the sense of being in control, of being the author of our destiny.
James, a 41-year-old gamer from Hobart, Tasmania, can identify, having grown up playing RPGs such as The Bard’s Tale on the Commodore 64 to help stave off depression and anxiety when he was younger. The symptoms of depression vary, but it often manifests as an overwhelming feeling of dread and lack of motivation, whereas anxiety can come in the form of non-stop worrying and a constant state of panic. One of the main drawcards for James was the feeling of progression he achieved through games, which was at complete odds with how he felt in his struggles to manage his mental illness.
“Games have an end, and investing time and effort into them to be rewarded with progress and victory can be such a salve against overbearing feelings of hopelessness against problems that never seem to end,” James said.
He adds that the therapy he received in early adulthood was a crucial part of his healing process, and that slow-burn games such as Elite: Dangerous are a great way to clear the mind. Other interviewees echoed James’ point regarding slower paced games, naming Minecraft, No Man’s Sky and any MMO or large-scale RPG like Skyrim or The Witcher where inventory management, exploration and performing set tasks were the focus of the game. Especially for those struggling with anxiety, games offering deep customisation of their characters and equipment allow the player to feel in control.
Socialising is one of the greatest challenges for anyone with anxiety; talking with others in an unfamiliar environment can be incredibly stressful. Although not a new innovation, the ability to play online allows for easier social interactions for people who would normally shy away from face-to-face interactions. Aimee, a 42-year-old from Western Australia, finds online gaming a great way to socialise. She sees a psychologist to help manage her post-traumatic stress disorder (PTSD), chronic pain, anxiety and depression, and it was recommended she find a way to socialise and talk to other people.
“I found that it was easier to chat with people while playing, than talk face-to-face with anyone,” Aimee said. “I came to realise that there are a lot of players who just want to be able to connect with other people - I wasn't alone in my quest.”
Socialising is one of the greatest challenges for anyone with anxiety; talking with others in an unfamiliar environment can be incredibly stressful.
Aimee’s partner of 11 years noticed a significant improvement in her social skills since taking up online gaming, and her psychologist agreed it was a good outlet when life became overwhelming. Aimee says she is usually able to deal with the occasional nasty teammate, choosing to hit the mute button or playing offline when she needs a break.
Michael, a 19-year-old from Gippsland, Victoria also spruiks the benefits of playing online. He has struggled with chronic depression and anxiety for much of his life, but playing online cooperative and MMO games provides him with a safe social space, where he has been able to make friends based on his personality and shared interests with others, as opposed to being defined by his mental illness.
“Gaming provides an environment in which people are spending time with each other purely because they’re enjoying themselves, not out of proximity or obligation,” Michael said.
Through his passion for gaming and art, Michael has been inspired to create a game based on his experiences, as an outlet for self-expression and so that others know they are not alone in their battles with mental illness.
“It was when I was at my worst with depression and on the brink of suicide that my psychologist insisted I find an outlet or a distraction from my feelings,” Michael said.
Michael’s project follows in the footsteps of a number of games currently on the market such as Actual Sunlight and Neverending Nightmares, which are based on their creators’ personal experiences with mental illness. Sharing these experiences through the medium of video games can be an engaging way to help people better understand mental illnesses. It also yields a greater representation of characters that mental illness sufferers can identify with and relate to; sometimes just knowing there are other people going through the same thing is enough to keep pushing on.
In some instances, video games are directly prescribed into therapy treatment plans, as is the case with Keira, a 30-year-old Queenslander who is currently receiving therapy for PTSD and bipolar disorder.
“My therapist is also a gamer so we connected through a mutual love of video games. I completed a program called DBT (dialectical behaviour therapy) which teaches you a number of techniques to ‘ride through’ an active suicidal urge,” Keira said.
When she is struggling, she will contact her therapy team and play a puzzle game or a Zelda title for an agreed period of time. Once this time has passed, either Keira or the therapy team will call back to check in and follow-up where necessary. Keeping her thoughts in the present is one of the benefits video games give Keira. Watching Twitch and YouTube Let’s Plays, and Good Game Pocket help too, as she also manages arthritis which sometimes limits her ability to play.
Save early, save often
Many of these benefits correlate with the findings of Australian not-for-profit organisation CheckPoint. Founded by Dr Jennifer Hazel and Jane Cocks, CheckPoint aims to connect mental health care with video games and technology. A gamer since she was five, Dr Hazel recognised during her psychiatry studies that the benefits of gaming were being overlooked in favour of the potential negatives, and sought to educate others about the therapeutic power of video games. She states that the technology is proven to work, allowing for cognitive behavioural therapy (CBT) to be administered via games.
“There is strong clinical evidence to suggest that eCBT and game-based treatments can be useful adjuncts or even perhaps standalone treatment for mild to moderate depression and anxiety,” Dr Hazel said.
eCBT uses the process of traditional CBT combined with game elements, such as an achievements system and an attractive gaming interface, to deliver a cheap, accessible and effective method of treatment. Smartphone apps such as SuperBetter have successfully used this model to reward and motivate players to change lifestyle habits, and help to strengthen resilience against harmful thought processes. Even video games not designed with therapy in mind are of great benefit in treating mental illness. As with many things, moderation is important.
“The catch of an activity being pleasurable and rewarding is that there is a risk of this feeling becoming all-consuming and taking priority in a person’s life,” Dr Hazel said.
To find the right balance between gaming and the outside world, Dr Hazel refers to Digital Nutrition, a website that promotes a healthy relationship between technology and its users. In addition to this, CheckPoint offers support to game developers and companies, and provides safe spaces at conventions such as AVCon and Oz Comic-Con, alongside youth mental health organisation ReachOut. The common theme behind much of what CheckPoint does is a common love of video games and their healing power.
It comes as no surprise to me that video games help alleviate mental illness symptoms, as I have struggled with anxiety myself. I previously worked full-time where I placed immense pressure on myself to be perfect 100% of the time. If one thing deviated slightly from my idealistic vision, my mind would viciously berate me for daring to fall short of what I considered an acceptable effort. It eventually came to the point where I could not get out of bed in the morning and I would become nauseated at the thought of facing the day. Video games were a reliable source of solace from my mind’s constant vitriol, especially Rogue Legacy: a roguelike 2D platformer where you play as a character fighting through a castle to reclaim what’s rightfully theirs. However, the game is brutally difficult early on. You will die many times. The quirk is that upon death, you then play through again as the character’s successor and use the treasure accumulated on the previous run to upgrade the successor’s powers. Each character has different skills – sometimes detrimental to progress – and the layout of the castle changes every run, so the game never allows you settle into a comfortable rhythm. It forced me to focus my concentration on defeating tough enemies and navigating treacherous dungeons, which restricted my mind’s ability to focus on my anxiety.
Playing Rogue Legacy and other games was a fantastic way to unwind from a day filled with worries and stresses. Eventually I had to step away from full-time work due to anxiety. During my low points I would sit on the floor at home, paralysed by my own thoughts, and dwell on how much of a monumental failure and disappointment I must be to my family, friends and colleagues. These moments still happen every now and then. It was during one of these times that my beautiful girlfriend used Rogue Legacy and the roguelike genre as an analogy for what I was going through, having experienced mental illness herself. She pointed out that it is a difficult and scary journey, one that is filled with many unknowns. Sometimes you will make significant progress and feel good about yourself, only to stumble and feel like you’re back at the start of the dungeon. But there will always be progress. It may be defeating one enemy, or clearing five rooms of treasure – which in the real world translates to getting out of bed, or seeing a psychologist – but it is important to acknowledge each success, regardless of its size. Pressing start on the menu, or getting up in the morning, is all it takes to start the healing process.
While video games and interactive media are no replacement for therapy from a medical professional, they can be a very powerful tool in building skills and confidence to use in the real world. The wider use of apps and other technologies has the potential to help many people strengthen their mental health in between therapy sessions. As Parkin writes, video games have the power to instil a sense of belonging and community, and that “the right game appearing at the right moment can have a transformative effect”. Dr Hazel agrees just how transformative games can be, and wants to continue seeing “brave people making games that will change the world”.
She, among many other gamers around the world, is fully aware they already are.
If you or someone you know need mental health support, please call Lifeline’s 24-hour service on 13 11 14.