Descriptions and depictions of Post Traumatic Stress Disorder, also known as PTSD or PTS in military parlance, can sound like the dramatic pitch for a video game – flashbacks, tortured souls, and stories of war, abuse, and survival. but for 5.2 million Americans and millions more around the world, Post Traumatic Stress is our reality.
It’s normal to feel bad about bad memories and to want to avoid unpleasant things. People with PTSD, however, end up avoiding, reliving, or blaming ourselves for the bad things to the point that it interferes with our lives for months or even years. In essence, PTSD is the brain getting “stuck” due to a severely traumatic experience or series of experiences. For a detailed list of potential causes and symptoms, check out the Mayo Clinic’s website It is, in my opinion, one of the better outlines and overviews of the risk factors and symptoms of PTSD.
PTSD treatment does work, but it’s gruelling. In the words of USC psychologist Skip Rizzo, it’s “hard medicine for a hard problem.” I spent a year in trauma therapy after a cumulative combination of childhood abuse and stuff the police and therapists have cautioned me not to talk about knocked me flat a few years back. It definitely got worse before it got better, but it did work. I’m writing this piece for The Escapist because I don’t think I could have gotten through that process without video games.
I didn’t have much social support. I didn’t tell some people because I didn’t think they could handle it. Most of the people that I did tell couldn’t handle it either, and I lost a large number of people I thought were my friends. Meanwhile, there was something about the inherent control of playing a video game that was more comforting than watching a movie or TV show. I wasn’t avoiding the problem. I just needed wins in fictional realities that I wasn’t getting in the real world. Video games got me through when people abandoned me, and I think a lot of those people ditched because they had no idea what PTSD and the treatments for the condition actually entail.
Honorably discharged decorated US Army Forward Observer, and gamer, Michael Stevens describes treatment and recovery from PTSD in this way:
“You can’t get rid of your PTSD, but PTSD is something you can “beat” — YOU, not anyone else. People can help you, and support is more critical for some than others, but at the end of the day, the person with PTSD is the one who has to get in the ring and fight. PTSD might knock you on your ass from time to time, but as long as you keep getting up, keep fighting and stay ahead on the scorecard, that’s all that matters.”
It’s true: you don’t get “cured”; you beat the crap out of the thing. This involves a lot of anger and frustration and some people can’t handle that. But over time, the fighting gets easier and your reactions are no longer overwhelming. There are a lot of gamers out there who are still struggling with PTSD, and I noticed that there weren’t a lot of gamer-specific stories told by people who have successfully conquered their demons. So I decided to write this series to educate, inform, and provide hope, as well as offer some potential improvements regarding the way the video game industry and community deal with and discuss PTSD and the people who have it.
Because gaming is inherently about big experiences and player control, I think that video games and gamers can lead the way in understanding and supporting people with PTSD. Many video games already tackle the subject of trauma, albeit in artistic, not clinical format, because military stories are huge in AAA gaming. Video game technology is also being used to treat veterans with PTSD. Dr Rizzo’s Medical Virtual Reality Program at USC Institute for Creative Technologies uses VR game technology in a type of PTSD therapy that has seen great success.
In the video game community, however, things are rocky, notably concerning the ongoing community battle regarding “trigger warnings” that shows no sign of abating. Personal breaking points have essentially become something to mock as opposed to something to respect. We need to turn that around because PTSD affects entire families, entire communities, and every person has a role to play in making survivors of trauma feel more accepted in society. There’s no point in playing games featuring military heroes if we don’t know how to properly show respect for real world ones. Admittedly, that’s a big challenge in realms where trolling is rampant.
Stigma is a huge barrier to this sort of understanding. It’s pretty common to see trauma knock a person down in media. It’s much rarer to see a story where they get back up. So there’s a false perception in too many minds that people with PTSD are dangerous or permanently damaged. We’re not… at least not any more so than anyone else. Gamers understand stigma because gaming and gamers suffer stigma. That’s another reason I think that gaming can lead the way on this issue. All the fundamentals to understanding are there, especially since there is an indie game part of the industry that has the potential to look at PTSD from a quieter perspective.
And different perspectives are much needed. “The entertainment industry really sucks at [depicting PTSD].” Says honorably discharged Canadian Forces Signal Operator “Mike”, aka “Corbin” online. “Everything has to be big and flashy, and it’s not.” Mike told the story of growing up on base. His dad cut the grass every Saturday, then went three doors down the street and mowed the neighbor’s lawn because the neighbor “would not set foot off the hardpack. Absolutely refused. But nobody talked about it. Nobody did anything about it. Somebody else would just cut his grass. He had PTSD pretty bad but it was specific. It wasn’t explosions and car crashes.”
Rick Collins, Founder and Executive Director of Carry the Challenge, a veterans organization that seeks to destigmatize PTS, says that “in the military voicing ‘concerns’ about PTS is viewed as a sign of weakness” This comment was echoed by multiple veterans interviewed for this series. “They carry that when they go into civilian life and no one firmly and with open arms tells them it is okay to stand up and say ‘I am struggling with this’.”
This is true of non-military forms of PTSD as well. Struggle is seen as weakness. Weakness is seen as a defect. A defect is seen as a reason to ostracize a person. Sensational headlines about feminist jazz hands and anxiety triggers drag the discussion into the realm of juvenile mockery which helps no one.
Granted, juvenile mockery has become a cornerstone of online communication.
Understanding PTSD is tricky because every story of a person with PTSD is different. Think of Joel’s gruffness and unwillingness to form connections with people in The Last of Us. Or Dom’s ongoing emotional struggle after finding what was left of his wife Maria in Gears of War. Or Augustus Cole from the same series: that dude had a lot more going on inside him for three games than anyone knew. These three characters are all very different men with very different traumas. And I didn’t forget Marcus Fenix. We just saw a lot more of what was going on in his head, with the combination of unresolved issues with his father and the horrors of war.
From the outside, PTSD can look like tuning out, an avoidance of certain topics, or sudden bursts of anger. Learn from my mistakes: don’t try to keep live tweeting a press conference after being triggered. You’ll never live it down.
The online mockery is missing signs of what could be the hypervigilance, irritability, and increased startle response that can come with PTSD. While I understand that the joking, for the most part, has no ill intent, I think it’s important to talk about the realities of triggers and stigma. I want to believe that people really just aren’t aware of stigma, as opposed to them not caring, because gamers understand that video games have the power to help people get through our darkest periods.
Games can help us through sleepless nights, break patterns of intrusive memories, and even help us find new ways to discuss our situations and tell our stories. Norwegian hip hop Youtuber Morbid Complex insists that without video games, “without a shadow of a doubt, I would not be alive today.” Check out his powerful song about PTSD, which he’s suffered since being badly bullied in school, that he wrote specifically for this series here:
For writer Stacy Washington, video games have helped her manage her complex PTSD due to childhood abuse in a number of ways. “For a really long time I was so agoraphobic that I couldn’t leave the house to even get my mail.” She explains. “Things like Skyrim, having that open world to explore and just wander around in, at least gave me something to do during the day when I wanted to go outside and I just couldn’t.”
Washington even credits games with helping her break the cycle of self-harm that she started at the age of six and was covering up by the time she reached her thirteenth birthday. “I needed something to distract me when that want came about, and games were a great outlet for that. Be it just sitting around planting crops, or going into Gears of War 2 and killing weird alien things…. I needed something to keep me from falling back into bad habits.”
Gamer Mister Seven credits video games for allowing him to develop a social circle while being treated for PTSD stemming from schoolmates bullying him for being on the Autism Spectrum. “They helped me forget my reality at first. I actually barely played online in those years. But… I became more social, including in games, and I’ve found the most amazing friends.”
Medically discharged military medic James Gavin agrees. “I found it much easier to socialize while online, and being a part of a guild was another fantastic source of support.” He calls gaming “an escape from what at times felt like an entirely unbearable reality.” Despite avoiding most games that deal with combat trauma, Gavin praised the God of War series and enjoyed the way Eternal Darkness handled the sanity meter. “Although it broke the fourth wall, it made sense in the context of the game.”
Lenna Suzaka has found role models in video game characters to inspire her in her fight against complex PTSD related to childhood abuse and abandonment. “I wanted to be like Celes from Final Fantasy VI when I “grew up,” because of her ability to conquer her doubts and overcome the pain of loss and trauma.” She says. “Same goes for Tifa in Final Fantasy VII. She lost her family and friends when her town was torched, and despite the traumatic experience and the heart-wrenching pain, she continued to wear a smile. Even Kid from Chrono Cross suffered immensely, being an orphan and losing her home… she still walked forward with a smile on her face and with enviable strength. These girls all suffered some sort of trauma, but they were able to overcome the past.”
Widower and single dad Devin connects with single father figures in games like Lee in The Walking Dead and Joel in The Last of Us. Devin broke ties with an organization he refers to as a “Christian cult”, and developed PTSD after the dual loss of his mother from colon cancer and his wife from a drug overdose – PTSD can take hold after witnessing deaths as well as being threatened with, or subjected to, violence. He also notes that games give him “something I look forward to”, a subtle, yet important thing in fighting off the hopelessness tied to PTSD.
Piper hasn’t been able to play survival horror games since she developed PTSD, now preferring games that give her “full control” like FPS games and Nintendo titles. The issue of control is central to recovering from trauma, and many of the gamers interviewed for this piece spoke about games giving them back a much needed sense of control.
Video games also allowed Alice Caruso to have more of a connection with her girlfriend who was diagnosed with abuse-related PTSD over two years ago. “She might bring things up out of the blue due to her watching [me play] a game and being relaxed.” She says. Indie games and games with good soundtracks like Dragon Age: Origins, Borderlands 2 and Portal are preferred. “She gets distracted by them, tries to help, she interacts more, and seems more open to talking”.
While this article was being written, Alice’s girlfriend attempted suicide. Alice was told to go home from the hospital before she knew if her girlfriend would survive. After that extremely rough night – and the good news that she’d pull through – Alice treated herself to punching “evil motherfucking buttface Superman the third’s evil motherfucking face” in Injustice: Gods Among Us. Caregiving is a roller coaster, and having healthy outlets for frustration is an important part of self care.
Stevens agrees that video games can be used as stress relief “to take your mind off things,” but cautions that “PTSD manifests itself in a lot of different ways and video games aren’t always going to be there when you’re in a ‘heightened emotional state’, so relying on video games or anything but your own willpower to ‘heal’ or ‘help’ you can result in an unhealthy and unnecessary dependence.” [Quotations his]
There is an undeniable potential for video games to feed into the avoidance element of PTSD. Collins points out “Too many vets struggling with PTS will not get up to go to a sporting event, healing action, interviews etc. but they will sit for hours on hours and play Call of Duty.” It’s important for people with PTSD to get face time in with other real people, since difficulty maintaining relationships is a symptom of the condition.
With these cautions in mind, video games can definitely help gamers cope with PTSD alongside proper treatment and a commitment to getting better. With some education and simple additions to games, I believe video games and the video game community can be an active part of the healing process.
Other elements are not as simple. Ensuring the video game community, both online and in person, is inclusive of people with PTSD is riddled with complexity. So the next three parts of this series will explore those complexities, get into more detail about how trauma is depicted in video games and how video game technology is being used to help treat PTSD, and offer some suggestions regarding making an already awesome video game community even better. Thanks for reading, and thanks for caring. Sometimes, just asking someone “Are you okay?” can make all the difference in the world.
Part two of this four-part series, which will go live next week on Wednesday at 3 p.m., will Triggers and warnings of PTSD.