Digital Fantastic: Video Games are not Your Therapy

But they can be!

*Content warning: Trauma, PTSD, Therapy *

My publication in Mapping the Impossible is a recent edit of the dissertation I completed for my Fantasy MLitt. The original title was Of Heroes and Heartbreak: The Therapeutic Function of Fantasy in Video Games. The premise included an argument which advocated for video games as a therapeutic experience. My new article makes no such claims, instead focusing on how one particular game (Ni No Kuni: Wrath of the White Witch) deploys literalised psychoanalytic metaphor in the form of Fantasy, in a way that makes emotional processing easier to understand (if you’d like more information, find the article here).

The best thing about writing my article was using Mr Drippy’s name in an academic context.

When I was a vice-editor for Press Start I always used to tell people who submitted to us (in nicer terms) that you can’t just recycle your coursework for publication, you have to actually DO SHIT to it. And, like the icon, the mentor, the PARAGON of the academic community wot I am (jk jk) I practised what I preach and DID SHIT to my own paper before submitting it to the journal. This post revisits the academic and personal processes that led to my original argument, before explaining why I have since changed it.

Editing the article, which included extensive studying of my prior draft, made me consider whether video games are therapeutic, which raised further questions as to what the term ‘therapeutic’ actually means and how I arrived at describing video games in this manner.

Are Video Games Therapeutic?

To answer this question, first we need a functional definition to work from. The term therapeutic means something different depending on who is using it. I’m going to keep it simple and include a couple of common functional definitions, then compare these with a working definition I used in my original dissertation.

The colloquial definition, as written in the Cambridge Dictionary is ‘causing someone to feel happier and more relaxed or to be more healthy’ with the example: ‘I find gardening very therapeutic’. By this definition then, anything, including video games, can be therapeutic. 

According to the most reliable and academic source on the internet, Google, therapeutic also means ‘relating to the healing of disease’ and a ‘treatment, therapy, or drug’.

There are arguments that games are therapeutic in relation to both understandings of this word. People find that games might chill them out and have escapist qualities that help them cope with challenging situations such as the COVID-19 pandemic, or they may provide parasocial interaction which can help cope with loneliness.

Furthermore, there have also been advancements regarding the use of both serious and entertainment video games for therapy with practitioners such as Kourosh Dini (amongst others) using them as a means to talk through emotional problems with patients, and even simple games such as Tetris have  been used to prevent post-traumatic stress symptoms.

In my dissertation, I took a psychoanalytic approach. I looked at Fantasy imagery using writers such as Ursula K. Le Guin, who describes Fantasy as ‘the ‘language of the inner self’.  I argued that video games give us direct access to these unconscious processes by literalising them (as magic, monsters etc) which presents them in a form that allows players to interact with them. I argued that playing video games could offer players catharsis without abreaction via the metaphorical processing of similar emotions as a part of gameplay. I wondered if literally mending broken hearts in a video game might help heal players’ own broken hearts figuratively.

What I proposed was that by allowing interaction with literalised metaphors of affect, video games could allow for the same release of emotion as therapy (catharsis), without the requirement of reliving the traumatic memory attached to it (abreaction). I think what I was suggesting was that video games could do psychological therapy on players, in a way that felt therapeutic in the colloquial sense.

The dissertation did pretty well, so maybe some of my ideas have legs, but they were so intricately woven from the fuckery I was experiencing at the time, that my argumentation was rather tainted by my personal perspective.

Editing your writing is editing your perception

The change in my argument signals a progression in both my academic and personal journey. I didn’t realise it until I started typing this very sentence, but my new argument – that analysing Fantasy imagery in video games can help us better understand emotional processing – was exactly what I was doing during my MLitt dissertation without knowing it.

You see, that was the year I realised I had dissociative amnesia and started to experience the symptoms that accompany the resurfacing of repressed memories. I had no idea what was going on. I had experienced flashbacks and nightmares before, without knowing what they were, but during my research they amped up. At the time, I hadn’t quite realised what had triggered this; I didn’t properly connect my personal experiences to my research until well after I had submitted my work – describing the experience in a blog I wrote a little while after. It’s obvious now that reading about psychoanalysis and trauma theory had triggered partial abreaction, meaning that I had to navigate reliving my trauma and writing a dissertation at the same time.

LOVE THAT FOR ME 🙃.

I only figured out what was going on after reading @thalstral’s thread about dissociative amnesia  on academic twitter, which gave me insight into both what was happening to me and how my research was connected. Looking back, I’ve realised that playing video games, and analysing them, did the opposite of what I’d claimed: it caused me to experience partial abreaction without any catharsis attached to it. Video games were therapeutic for me, but not the good, thorough kind of therapy that helps you cope with things – what happened to me was like going to a crappy therapist who gets you to rip your heart out and show it to them, without taking the time to sew you up again.

So, are video games therapeutic???

Well, it depends.

I don’t want people to read this post and come to the conclusion that both games, and the study of them are ‘bad actually’. Like every game studies academic I have written numerous ‘apology paragraphs’ explaining that GAMES AREN’T BAD. So I must make it explicit that my PTSD symptoms are not the fault of video games.

Video games have the capability to provide a therapeutic experience in a colloquial sense – all us ‘gamers’ use them to change our moods or experience some kind of release. Entertainment video games have also been used by professionals to provide therapy in a psychological sense, and serious games such as Sparx and Apart of Me have been designed for this very purpose. Video games do have therapeutic potential.

Apart of me is a game designed to help people cope with loss.

The way my gameplay and analysis does benefit me, is by helping me to understand emotional processing in a way I hadn’t before, which facilitated a lot of growth. I’m doing SO much better than when I wrote that first unfortunate blog post, and I owe a small part of that to my research which has become a record of my journey.  

Perhaps then, my contribution can provide insight into how games can be therapeutic, rather than labelling them as inherently being so. What I’d like to argue is that understanding games, like understanding any form of art, can aid in the cultivation of emotional literacy which can be used to benefit mental health.

References

See links in text and go read my article ‘Of Heroes and Heartbreak: Digital Fantasy and Metaphors of Affect in Ni No Kuni: Wrath of the White Witch‘ in Mapping the Impossible.

Acknowledgements

Thank you to my dear friend Michael Deerwater for helping me edit this post!

Exercise is not a Cure: Long COVID and Physical Activity

I didn’t take the time to recover properly from COVID, so I might never recover from COVID.
August 2020, when I could still run in the rain.

I’m not writing this post because it’s one I particularly want to write. I know that waiting to feel inspired is a fool’s game, and that the best inspiration comes about by creating it yourself, but out of all my writing, blog posts are what I write in a frenzy. I write them when I feel possessed by an idea and need to get it out. It’s the best feeling. It feels like making art.

Not this though. This post doesn’t feel inspired, but it does feel necessary. I wanted to take some time to briefly tell you about my experience of getting long COVID and its interactions with my exercise regime. I’ll level with you – a lot of what I’m talking about is unconfirmed – for reasons I’ll explain below. I’m going to ask you to listen to your doctors, your personal trainers and the experts, rather than taking what I have to say at face value. I have made an effort to include reliable sources, but I’m not qualified to interpret medical literature. I can only speak my truth.

I want to tell you my story on the off chance it will help just one of my readers, because I care about you a lot. I have even included a TL;DR if you want to skip to the main points!

I’m not sure people have been taking me seriously, or listening to what I have to say. It feels like people try and minimise the impact of COVID in general, and say it’s not that bad. I know it might be difficult to admit, BUT IT CAN BE THAT BAD. Minimizing the reality of COVID is a shoddy defence mechanism, because it will not protect you from it.

Even if it feels like people don’t listen to me, I know that people do take my blog seriously. So rather than continuing to put it out in tweets, or text people, or PLEAD with them down the phone, I thought I’d get it down here.

The Initial Illness

In winter 2020-21, I got COVID-19. I’m not sure of the date because the symptoms I got were not listed on the government website, and they were advising to test sparingly at that point. Rather than the expected cough with a fever and flu-like symptoms, I experienced a lot of strange ailments that I struggled to put together.

  • A severe, persistent headache that didn’t subside with pain relief
  • Intermittent difficulty breathing
  • Chest pains
  • Extreme muscle aches
  • Fatigue
  • Brain fog
  • An unexplained decline in mental health (leading to a relapse)
  • Loss of taste (food, not aesthetic)

I didn’t know I had COVID because of a variety of factors. One of the reasons was that the symptoms hadn’t yet been recognized by the official bodies, and reports of the headache/fatigue variant were largely anecdotal. The more personally distressing reason is that due to my neurodivergence, I find it difficult to identify and understand my feelings, and therefore it’s tricky to tell whether I am physically or mentally ill. As someone with chronic mental health conditions, I am used to fatigue, brain fog and some degree of pain as being caused by mental illness. Physical symptoms of mental illness are real and valid, but require different treatment. Telling the difference between illness caused by pathology, and symptoms of mental illness is always confusing – but in this case it was dangerous. I had been experiencing a period of relative stability before I began to get these symptoms, which led to a relapse in my temporary sobriety (that I had maintained for 6 months prior). I didn’t know what was making my mental health to deteriorate so rapidly; I think being physically ill for an extended period of time depleted the resources I used to stay sane, especially because I was not resting. I had no idea what was going on. I used to disassociate a lot when I was in pain or distress, so that didn’t help either. There’s a lot around that time that I just can’t remember. I don’t know when I was viral.  As mentioned above, I was never tested. I checked in with my doctor once a week, over the course of a month, confused about my symptoms, and they told me it was probably just a different virus. Eventually, the guidance regarding COVID symptoms was updated, and I was advised it probably had been COVID all along, and I was suffering with post-viral fatigue. I’ve been post-viral for over a year, and it’s still happening.

Due to this, I can’t tell you what it was like to have COVID in the ten days I was viral. I can’t remember feeling very unwell, but perhaps that’s the disassociation. I remember thinking I was going crazy. I remember having very vivid dreams and hallucinating birds after I woke up most mornings.  I probably spiralled a lot. Other than that, I just got on with it; as someone who has a history of chronic illness, I’m used to ignoring the signals my body sends me in order to function. It kills me that I didn’t know I had it. Luckily, I was following the rules. Luckily, no one in my support bubble got seriously ill. It kills me that even though I was reading the news and checking the rules, I put people in danger. Thank fuck it wasn’t worse.

My Long COVID Symptoms

I will never be able to tell you what having COVID is like, but I can tell you what having long COVID is like. The most intense period of my symptoms lasted for around 2 – 3 months, and I’m still suffering with it, though, thankfully, my symptoms are relatively minor. Below are the symptoms I have. The ones highlighted in yellow are symptoms I am certain are caused by long COVID, the ones underlined in blue are issues I have struggled with in the past, but are definitely triggered by a long COVID episode.  As well as the below symptoms, during episodes, I have extremely vivid dreams, insomnia, night sweats and dry eyes. I also suffer with bladder issues, which in some literature, has been linked with long COVID – but that could very well be a separate and unconnected chronic illness and may be related to my PTSD.

It’s very hard to tell things apart, which is why it’s so important to be extremely careful.

I’m lucky that my symptoms don’t occur all the time. I’m lucky that they’re largely manageable, but when they occur, they tend to attack ALL AT ONCE, and it can take days to recover. I can’t know for certain, but what I’ve deduced is that they’re connected with physical activity.

My Long Covid and Exercise

A couple of years ago, I started mirtazapine to treat my mental illness. Its side effects include extreme appetite and fatigue. To combat these side effects, I started a nutrition and exercise regime and had been enjoying my new lifestyle for at least half a year before I got COVID. I ran most days of the week (sometimes up to 8K in one session) and when social distancing began, I started lifting weights in my apartment.

Yes, OBVIOUSLY these are my usual workout clothes! :3

I can’t remember when it started, but during winter last year I started to get awful headaches that refused to go away, even with strong painkillers. It was a constant pressure around my temples, and even a light touch made them hurt even more. My workouts started to feel absolutely awful – my muscles never stopped hurting, and exercise made my headaches worse.  I couldn’t recover. I got pains in my chest, and it felt heavy all the time. I thought perhaps that I was pushing myself a bit too much – exercise can be hard, right? I just carried on until eventually I couldn’t do anything any more.

It got to the point where I could no longer run, and I struggled even to complete short walks. I had to stop to catch my breath. Sometimes, I’d be sitting on the sofa, watching Netflix, and suddenly find it difficult to breathe. For months, not a day went by that I didn’t have a headache.

There was lots of advice about recovering from COVID, much of it advising a gradual return to physical activity. Exercise is prescribed to treat a lot of conditions, and that’s fucking dangerous. What benefitted me most was listening to my friend who has chronic fatigue syndrome. She told me to ‘rest more than you think’, to only increase my physical activity a little each day, and to rest if the increase made me feel worse. She told me that physical activity means ANY AND ALL physical activity – not just exercise. I had to be careful with everything I did – even things like cooking, cleaning, and sitting at my desk.

It was only by stopping my fitness regime and staying in bed that I was able to eventually recover. I rested most was when I was post-viral: because I hadn’t rested during my viral phase, I had to repay the debt ten-fold.

Thankfully, the vaccines have been a big help: I’d had a headache every day for months and after my first dose, it went away, and it only returns when I trigger an episode. I still can’t do certain types of exercise: if my heart rate elevates to a certain point, I feel the headache coming on, and if I work through that and my heart rate raises too much, then I can trigger an episode of symptoms that flair up intensely for days and linger for weeks.

18/03/2022 Edit: The benefits of the vaccines have since vanished. I now find it difficult to take long walks. I do not exercise at all.

I think what gave me long COVID, was the fact I didn’t know I had COVID and continued exercising, which prevented me from healing.

Badly Worded Advice

The NHS guidance regarding returning to physical activity after COVID, is not the worst. It suggests monitoring your fitness levels during short walks and increasing your activity over time  – which is sensible. What I disagree with, though, is the focus and tone of the advice. It feels as if fitness is emphasized rather than rest, when rest should be at the centre of the guidance. I often wonder if I had properly rested during my illness, and in its aftermath, if I would be in a better state than I am in now.

Let’s take a look at the NHS COVID recovery website:


Recently, I can walk a long way without a struggle most of the time. I have even managed a light jog, but it doesn’t feel healthy, or possible for me to attempt to obtain the level of cardio fitness I reached before when one tough training session can floor me for a week. Walking is still a little more difficult than usual during an episode and often, I don’t risk it. I rest.

I was going to highlight the above section, but there is so much I disagree with that I’ll address this section point by point:

  1. As someone who has done cardio exercise very frequently, I can tell you without a doubt that COVID breathlessness is not the same as breathlessness due to exercise. It feels different. It feels damaging.
  2. You CANNOT do things that are important to you when you have triggered a long COVID episode, because you might not be able to focus, or even get out of bed.
  3. Maybe physical activity will help your joints, or maybe it will make your muscles SCREAM for DAYS.
  4. No amount of sleep will be enough if your physical activity triggers fatigue.
  5. You know what else can help manage chronic conditions – rest!
  6. This is a terrible, terrible sentence. Physical activity does not cure everything and can sometimes make things worse!

Good Advice

What I’ve found useful is looking at the BMJ which contains discourse pertaining to the ongoing debate surrounding exercise and recovery. This is linked with the controversy surrounding advised treatment for chronic fatigue. I’ll link all the articles below, but here are the parts that I found particularly useful:

Long covid: doctors must assess and investigate patients properly:

Returning to physical activity after covid-19

18/03/2022 Edit: Many of the above services are not yet available.

The TL;DR

We are getting fucked over by the fact that fitness is touted as a moral imperative. This is nothing new. Chronically ill and disabled people aren’t always believed, and fat people are often refused treatment until they lose weight (which happened to me a few years ago, even though my pain was contributing to my low activity levels). The prescription of exercise is par for the course in the UK healthcare system, suggested not always for the benefit of the patient, but to ease the burden of a system which should be supported by more adequate funding, rather than propped up by longing people off.

Rant aside, here are the things I’ve learned that I have been begging people to listen to:

  • You can be young fit, healthy and eat a ‘good’ diet and still get seriously ill from COVID.
  • Take note of your activity levels, remember that ALL activity counts as physical activity, not just what is generally classified as exercise.
  • DO NOT work through the pain, please listen to it.
  • Look for research a little beyond what the NHS or your doctor give you. They’re not always up to date with the latest developments, and sometimes the services they’d like to offer are just not available.
  • Let your fitness and physical activity serve what is in your best interest. It is not a cure for everything and can make things worse. When you have depleted resources, you need to prioritise.
  • Please rest more than you think! When you feel better – rest again!

I’ve written this not because I wanted to write it, but because I don’t want what happened to me to happen to you. I used to love running, and it changed my life. I don’t run any more.

Thank you to the friends who have supported me and gave my advice during my continuing illness. This post is dedicated to Ting Ting, in particular <3!

Thanks to my support bubble (Doug and Ollie) who were very understanding about my situation.

Thank you also to my lovely readers – I know this isn’t the kind of content you usually get from me.

To anyone struggling with long COVID – if you feel comfortable, then I’m super curious to know about your experiences and whether we share any similarities. Please do tweet me, or post a comment down below.

If you’d like to support my work, you can find links here.

03/2022 Edit: I tried going back to weight lifting after writing this post, did too much and made myself worse! I read an article that says sometimes increasing activity levels may make patients feel better, but it’s temporary. If I find the article, I’ll link it.

So please be careful.

Useful Resources:

How to manage post-viral fatigue after COVID-1918/03 update. This is a much better guide sent to me by my fabulous Doctor! Go here if you need clear advice for recovery.

Long covid has resurfaced tensions over treatment of chronic fatigue syndrome

Long covid: doctors must assess and investigate patients properly

Returning to physical activity after covid-19

Why Vaccines May Be Helping Some With Long COVID

Long COVID and COVID-19-associated cystitis (CAC)

I was offered therapy, and I chose my PhD instead

Content warning: this blog discusses mental illness, trauma and mentions maladaptive coping mechanisms. It may be difficult to read for people who have experienced abuse.

When I finally got the consultation for the therapy I’d been waiting over a year for, the therapist was the first I’ve spoken to who actually seemed to understand me. She noticed things about me that no therapist has before.

See that tattoo on your arm Gabe? If you’re going to do this kind of therapy, you’re going to need to take off your mask. Just like that. You have to be vulnerable and stop over intellectualising your feelings.”

I was shocked. People usually mistake my mask for my face. That’s OK. So do I.

Even though I knew this therapist could help me, I refused the treatment.

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When I say I refused treatment, what I mean to say is that after extending a one session consultation to four sessions, both the practitioner and I came to a consensus that psychodynamic therapy is not right for me at this time. You’d think that after such a battle to get treatment I’d be angry or upset; I was referred to the community mental health service, who sent me to the trauma team, who referred me back to the community team again – with months of waiting in between. Worse still, this is only my most recent therapy journey: it is the latest in a chain of therapeutic misadventures that started when I was around seventeen. I was, understandably I think, growing increasingly desperate and frustrated with the system.

I’m not being dramatic when I say that the wait could have killed me; it nearly did. I was referred to these teams because I was in crisis, but now I am not. As I write this, I’m approaching six months of being sober from alcohol, and free from self-harm. I discussed my progress with the consulting therapist, and we came to an agreement:

Could I benefit from therapy?

Yes.

Is this the right time?

Probably not…

There’s so much discourse URGING people with destructive behaviours to ‘GO TO THERAPY’. In fact, it’s a bit of a meme. What we’re really saying when we ask people to ‘go to therapy’ is: please develop a modicum of self-awareness, and do some work on yourself rather than causing people grief with your fuckboyish ways, or rather, please take some responsibility for your actions by learning how to express your emotions in a more constructive manner. It’s not quite as funny when we put it like that, right?

Instead Of Going To Therapy | Know Your Meme
See also, do a PhD.

These are all good and valid reasons to go to therapy, but the realities of therapy are vastly more complicated. There are different types for different things: some therapy is about coping with the day-to-day, and some therapy (especially trauma-based therapy) has the potential to make your day-to-day life infinitely worse during the process. The kind of therapy offered to me, the kind of therapy I may eventually need, is more likely to make my immediate life a living nightmare than help me cope with it.

Let me explain this using the story that my therapist and I told together.

In my head there is a box, and in that box there is a creature. We don’t know what the creature looks like, though we can hazard a guess from the shadows it casts. We do, however, know that it is there and if I speak its name, it will change me forever. When I first got my referral, I was in crisis because I had discovered the box by chance, and (because I, like Pandora, am a curious bitch) opened it. I slammed the lid shut as quickly as I could, but it was too late. The creature had awoken and wouldn’t let me close the box properly. Just catching a glimpse of it changed everything I thought I knew about myself. It made me feel and remember things I hadn’t dared admit, and still don’t entirely understand.

Pandora, by John William Waterhouse, 1896

I tried to weigh the lid down. I stacked books on the box to keep it closed, but they weren’t heavy enough. I couldn’t banish the monster from my mind – I was both fascinated and disgusted by it.

Oui, c’est l’abjection mon ami!

I didn’t know what to do: to close the box properly, I would have to open it again, and I was already so fucking weak. The creature’s presence dominated my waking life, and invaded my dreams. It became all I could think about. I tried various ways of appeasing it: I hurt the creature, I tried to get it drunk, I tried to starve it, and if you know me, you’ve probably guessed by now that I tried to fuck it too. None of it worked. The more I tried to silence the creature, the louder it screamed, and it became more and more difficult to block out the noise. It was hard. I was afraid to be alone.

Eventually I realised that living this way was killing me. Instead of giving up, I changed my strategy. I gave the monster a stern telling off, and scared it into stillness and silence long enough to give me time. I practised kindness as praxis and worked on becoming strong. Sometimes the monster tried to creep further out of the box, but this time, I’d recovered enough to drive it back. Eventually, after a lot of trying and failing, I managed to close the lid properly, this time, trapping the creature inside. It’s a victory, if a tentative and temporary one.

The box will always be there. Sometimes it oozes, and sometimes the creature whispers it will escape, take my sleep, and rob me of my sanity. I know that, one day, I will need to open the box and face the creature inside, but now is not the time. Right now the monster is manageable: when it makes a mess, I clean it, when it growls, I feed it snacks, and when it whispers to me, I tell it a story until it falls asleep. I’m still afraid of naming the monster, and afraid of what kind of person this monster has made me. However, most importantly, I’m not afraid to sit with it now – and sit with it, I must. It’s a lonely thing. The monster is open to polyamory, but it has to be my primary, or it gets jealous. It keeps its own schedule: google calendar is no good here. When it calls, I have to listen. I have to commit to it; I have to commit to myself.

My therapist said that I seem to have trouble distinguishing fantasy from reality sometimes, and that I use fantasy to make myself feel better about the bad things that have happened to me. She said it’s important to use fantasies to cope, but we can’t let fantasies undermine or invalidate the difficult realities of our lived experiences. The reality of therapy is that it’s like any treatment: you have to weigh the benefits against the costs. My reality is that I’m away from my support network to do a PhD. I’ve just managed to claw my way out of perpetual crisis, and doing this therapy would pull me right back in. Right now, if I want to finish this project, all I can do is damage control.

I’d like to open the box and face my monster. I’d like to sort through my issues, and get to the hope at the bottom of the box. The truth is, it’s not safe, and I’m not ready.

Pandora, by Walter Crane, 1885

My therapist told me that one day, that to do therapy, I will have to take off my mask and learn to be vulnerable. The thing is, that mask is doing something – it’s protecting my face.