Goodbye, Cruel World

Many years ago I had a friend whose girlfriend was going through a tough time. She would often call him several times a night. They’d speak for a few minutes or a few hours, depending on how badly she was feeling, until they were talked out for the night. Late one evening he hung up the phone after a particularly long conversation and trudged back to the computer room, where I was plowing through our hot-seat campaign in Shogun: Total War and doing my best to ignore the sad fragments of conversation that drifted upstairs.

He collapsed in his chair and stared blankly at the screen until my first wave of shock troops hit the enemy line. Then he said, “I’ve finally figured out why girls are so fucked up.” Mind you, we were 16 and fond of worldly-sounding generalizations that concealed our lack of experience.

“How’s that?” I asked, ordering the heavy infantry forward. The battle was on autopilot for the next few minutes.

“They don’t play enough videogames.”

I laughed, but he was serious. “Think about it,” he insisted. “We’ve all got stuff to be depressed about, but the difference is that girls don’t play videogames, so they just end up thinking about it too much. You and me? We’ve always got this shit. We go inside Shogun or MechWarrior and nothing else even exists. No matter how bad we feel, a game makes us forget it. Most girls don’t have that.”

Blatant sexism aside, my friend had a point. Sometimes games are just entertainment, but they can also be an escape from a painful reality. It’s one of the hobby’s most powerful properties.

This escapist aspect of gaming is proving increasingly useful in medicine, where an evolving understanding of pain has led to new approaches to treatment. As it turns out, distraction and immersion are powerful weapons against pain, and employing them effectively can help solve many problems that crop up with more traditional treatments.

Pain can be as much about perception as it is about an injury or condition, something that only came into focus in the last half century. Prior to this realization, pain was generally misunderstood as “a fixed, direct-line communication system from the skin to the brain … which imputes a direct, invariant relationship between stimulus and sensation,” as Dr. Ronald Melzack and Dr. Patrick Wall characterize the old theory.

This model was unsatisfactory for a number of reasons, but it wasn’t until after World War II that it really fell apart. Particularly telling were some of Dr. Henry Beecher’s observations based on his experience as a wartime medical officer. In the years following the war, he noticed some discrepancies between the behaviors of his peacetime patients and those he treated during the war. Most notably, peacetime patients requested painkillers at a significantly higher rate than veterans, despite suffering similar injuries.

He theorized that the difference was one of mindset. A soldier treated in a field hospital may be seriously injured, but he is also out of the combat zone and might soon be evacuated home. On balance, he was lucky. A person who gets into a car accident on the way home from the office, on the other hand, cannot help but feel stricken by misfortune.

Beecher’s observations rendered the traditional model increasingly untenable and sparked a closer examination of the psychology of pain. In 1965, Melzack and Wall published “Pain Mechanisms: A New Theory” in Science, where they introduced the Gate Control Theory of pain (GCT). Their theory recognized the complex physiological and psychological factors that influence the experience of pain.

Two important and related factors are attention and distraction. This is where gaming enters the discussion. Crudely put, we have a limited amount of mental “bandwidth” available, and higher brain functions can sometimes take precedence over information coming in from the nervous system. In tests of distraction’s effects on pain, people who concentrate on some moderately challenging intellectual task report reduced pain. Furthermore, functional MRI scans indicate that parts of the brain’s “pain matrix” show decreased activity when subjects focus their attention elsewhere. A study by Michael Valet and collaborators at Technische Universität München found that someone subjected to painful stimuli with no distracting task showed activation in 69.2 cubic centimeters of the brain. When participants were subjected to the same stimuli and given a distracting task, only 5.6 cubic centimeters showed full activation. Subjects also rated their pain as 16 percent less unpleasant when distracted.

We still don’t completely understand why this happens, but there are a few things that are certain. One part of our brain, the anterior cingulate cortex (ACC), is involved in both cognition and pain perception. When we’re focused on a mental task, it stimulates the periaqueductal gray matter (PAG), a part of the midbrain that plays an important role in controlling pain. When the PAG is stimulated, it “initiates a cascade of signaling events to stimulate the descending pain-modulation system and produce analgesia,” write Dr. Jeffrey Gold and collaborators. Opioid receptors, as the name suggests, respond to chemicals like heroin and morphine, but our bodies also produce their own opioids. The result is that concentration raises the brain’s defenses against pain, reducing the degree to which we experience it.

However it’s not enough to simply command someone to “think about something else.” Most people would love to think about something besides their discomfort, but a number of factors make us vulnerable. For instance, fear and anxiety can heighten the sensation. Anticipation is also detrimental, since it focuses your attention on the source of the pain. In other words, the feelings that many people inexorably associate with hospitals, doctors and medical procedures reliably make people feel worse. The trick, then, is to draw people’s minds away from their circumstances. That’s a trick at which games excel.

From personal experience, there have been many times when gaming has been less a leisure activity and more a retreat from pain. While spending a couple weeks recovering from knee surgery and undergoing some occasionally excruciating physical therapy, I found neither books nor movies were effective at helping me ignore the pain. A friend, however, was gracious enough to lend me his PlayStation and Final Fantasy IX, and through them I was able to shut out the pain in my leg, the machine that was strapped to it and my own frustration at being bed-ridden.

Likewise, when the time came for me to give up my pack-a-day smoking habit, I didn’t use nicotine gum to control cravings or self-help guides to find the resolve to stop. Previous efforts failed due to savage headaches, lethargy and my own absolutely abominable, withdrawal-related behavior towards others. This time, with a week off work and nothing very important to do, I decided to try something different. I immersed myself in computer games for several days, playing almost compulsively until I stopped feeling the tugs, gentle and sharp, of a five-year habit.

Contemporary research suggests my experience is not unique. Tests with patients using virtual reality equipment repeatedly demonstrate that the more someone retreats to a virtual world, the less he or she registers sensations from the real one. One of the leading research teams in this area, that of Dr. Hunter Hoffman at the University of Washington, has shown that VR games can more effectively attenuate certain kinds of pain than pharmacological painkillers. His team has used VR to help burn victims undergo dressing changes (an apparently agonizing procedure) and help chemotherapy patients endure the effects of the treatment.

Using games in pain therapy becomes more attractive when you consider the potential negative effects of traditional treatment. While there are doubtless those who feel that “videogame addiction” is a grave and growing threat, it pales in comparison to drug addiction. Introducing an addictive substance to someone exposes him to serious risks that grow with prolonged use. Someone who takes codeine for a few days after a surgery runs very little risk of addiction, but those who suffer from chronic pain face a significantly greater challenge. Physicians must constantly vary the treatment regimen as a patient’s body adjusts, but they must also weigh the risks of increased drug use against the very real need to treat the patient’s pain. Furthermore, patients who need treatment for pain often require other prescriptions, which physicians must take into account before administering a painkiller. Introducing a painkiller to a patient already being treated with other drugs creates a host of complications. Compared with this level of complexity, employing virtual reality or videogames is comparatively simple and requires far less time and attention from physicians.

None of this is meant to suggest that games are a panacea for those who are suffering, of course. Distraction is effective only up to a point. Pain can be so intense that it will overwhelm any efforts to direct one’s attention elsewhere. There is also the problem of outpatients who suffer from chronic pain who must also hold down jobs and go about their normal, daily life. It’s easy to take a prescription drug as needed, but how does one go about “popping a videogame” while at work or on the way to class?

Nevertheless, gaming shows considerable promise as an approach to pain therapy. With none of the difficulties and risks associated with pharmacological treatments and experimental results that sometimes surpass them, games can help those in pain avoid some of the most sapping psychological effects.

Rob Zacny is a freelance writer. When not focused on gaming, he pursues his interests in Classics, the World Wars, cooking and film. He can be reached at zacnyr[at]gmail[dot]com.