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Dear Dr Mark.

I have suffered from Bipolar Disorder for a number of years. I am currently seeing a psychiatrist for therapy and medication.

My family is mostly supportive, but there is some conflict when it comes to gaming.

I’ve been playing games for years, and have a tendency to spend more time on them when my depression is worse, and less time when I’m feeling better. Certain members of my family have tried to say that gaming causes my depression instead of helping me deal with it. Others say that gaming is merely a way of withdrawing instead of getting the help I need.

I always thought that gaming was a way of empowering myself when I felt sad and powerless. When I play I feel like a hero who is making an imaginary world into a better place. I love immersing myself in role-playing games that give me that heroic feeling. But now I’m worried that I’m just hiding in a shell, keeping the world at bay.

I guess my question really comes down to this: Are those family members right or am I? And what is your opinion on gaming and depression? Any ideas or advice would be greatly appreciated.

Thanks for a fascinating question. Bipolar disorder is a serious condition which can involve severe, paralyzing, depressive episodes and intermittent manic phases with bursts of frenetic euphoria, sleeplessness, racing thoughts, grandiose thinking, impulsiveness, and poor judgement. There’s obviously much more to say about this disorder, but I want Escapist readers to understand that this is heavy stuff.

Typically, drugs called mood stabilizers are used to manage this condition. The grandaddy of these is Lithium, but there are many others now in common use.
Some of my colleagues worry that Bipolar Disorder is over-diagnosed these days, to justify the use of these particular medications, which have complex risks and side-effects. For the sake of this response, I’m assuming you were properly diagnosed.

I find much hope in the way you have accepted the situation and sought out appropriate assistance. Since manic episodes can feel like a terrific joyride, many people resist both the diagnosis and treatments that will moderate them. You also have an awareness of your mood cycles and an idea that gaming may be a valuable coping strategy some of the time, and less necessary at other times. You seem to have found a balance that you feel good about, but some important family members are leery of it. They may be uncomfortable with gaming or they may underestimate the gravity of your condition and the need to escape from crushing psychological pain.

That said, it’s worth evaluating their feedback dispassionately because your family cares and wants you to feel better. Does gaming cause you to become less social and more withdrawn? As Escapist readers know, gaming can be a rich way to conduct a kind of social life that many non-gamers don’t appreciate, so gaming may not simply equal social avoidance. Does your mood worsen dramatically after you game, either because you miss being in a fantasy world, or you experience some kind of withdrawal from the intense stimulation of gaming? Do you find that the time and psychological investment placed in gaming interferes with your capacity to engage in other activities? When we feel hurt or angry that others question our choices, it can be easy to reject their feedback entirely. It takes a certain kind of maturity to override this impulse, but if your family feels that you hear them, they may be more likely to hear you.

If you find some merit in their concerns, you might consider moderating gaming activity to allow for greater participation in real life activities. You could make more occasions to get out, and work harder to connect with those who are worried about you. These efforts may reassure your family that gaming isn’t taking you away from them and the rest of reality. It may be difficult for your family to join you in gaming, but if there was some way to show them how you game and why you find such relief in it, they may come to have more sympathy for it.

Your broader question about gaming and depression is also very interesting. I’ve known people whose gaming habits precipitated a mood disorder, and others for whom the activity was part of a serious decline. While I think gaming has robust neurobiological effects, I’m not confident that it can cause a mood disorder by itself. Usually there are other factors that pre-dispose an individual to these conditions.

I am very confident that many people with relentless psychological and physical pain find respite in an activity which has a wonderful capacity to take them away from themselves and their woes. Gaming can extend the mind’s ability to engage in imaginary journeys, and this kind of distraction offers tremendous relief. As you’ve noted, it provides a sense of empowerment and effectiveness that you have a hard time finding elsewhere

You already seem to have found a way to use gaming judiciously. Hopefully you can improve the communication with your family so they feel their concerns are taken seriously, and they can come to appreciate the role gaming is playing in helping you tolerate your condition.

Dr. Mark Kline wonders if life is actually a role-playing game. Have a question for Dr. Mark? Send it to askdrmark@escapistmag.com. Your identity will remain confidential.

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