Elizabeth C. on Games as Therapy

Beyond Good and Evil: Videogames as Mental Health Management Tools

Guest Article by Elizabeth C.


~CONTENT WARNING: This article includes frank discussion of depression and related mental illnesses.~


“Would it be alright if I read you something?”

I am sitting in my therapist’s office just before the holidays. He’s only asked me this question a few times before in the two-plus years that I’ve been seeing him, and I know what’s coming.

“Sure,” I respond cautiously. “Go for it.”

He reaches for a small end table and shuffles through the four or five books on it until he finds a portable copy of the Diagnostic Standards Manual 5th ed. (or DSM V). He opens it up and starts flipping through the pages. The last time he did this he was helping me understand what Post Traumatic Stress Disorder was. I tend to pretend everything’s fine, especially when it isn’t. I also have fairly rigid ideas about how things are supposed to be, which causes me to distort or ignore how things actually are when there’s no concrete way to judge them. Because of this, showing me the diagnostic criteria for a condition can be a powerful tool in my therapist’s belt. The criteria are essentially rules, and reading the descriptions forces me to acknowledge what I’m feeling. “Well I guess based on that description I have flashbacks.” Rules trump feelings.

My therapist finds what he’s looking for. “Okay. I’m going to start reading and you tell me what resonates with you.”

“What’s this one?” My shoulders and chest are tight and my heart is starting to race. I don’t like the idea that I’m anything other than perfectly healthy, though anyone who I let get to know me even a little knows I’m not.

“Obsessive-Compulsive Disorder.”


There are two things about OCD that a lot of people don’t understand, that I didn’t understand. The first is that the “O” and the “C” can be separate. The DSM has two sets of criteria, one for each, and it says that if a person meets the requirements for one or both, along with some additional features, then that person could be said to have the disorder. The second is that it doesn’t necessarily have somatic components. You don’t need to wash your hand 15 times to obsessively worry about germs.

Back in my therapist’s office I’m sitting on the couch with an uncomfortable smile frozen on my face. It’s my default facial expression for times of internal chaos. He finishes reading, and, well, a lot of what he said resonated with me. To say that I’m upset would be a bit of an understatement.

“Well? What do you think?”

I sit quiet for a minute. “I guess. Yeah. That sounds about right.”

My OCD is of a fairly moderate level, and it is almost entirely weighted towards the obsessive side of things, and the few somatic features I demonstrate are pretty subtle. I don’t experience strong symptoms all the time, but during those times that I do I can be quickly overwhelmed and pushed to some dark places. The best way I’ve heard it described is difficulty shifting gears. I become overwhelmed with intrusive thoughts about a thing, and am completely unable to move past it until it’s solved somehow. Part of the cycle is this feeling that the answer lies inside my mind, that if I can only think about a thing enough I will solve it. It’s easy to see how thoughts like these can spiral into an endless loop. Later on down this spiral, when I’ve been completely exhausted, I often end up battling suicidal or self-injurious thoughts. Anything to give me a break from my mind.

My therapist and I start to talk about things that can be done in the short term that could help alleviate my symptoms. Obviously it will be a longer process to start to appropriately manage things, but in the moment having non-harmful ways of coping could literally be life-saving. I rattle off a few different ideas. Naps. Holding an ice cube. Reading. Going for a walk. Meditation.

“What about video games?” he suggests.

I’ve historically avoided discussing video games with people, much less telling people how often I play or how much they mean to me, so the idea of them as something “beneficial” was completely novel. Growing up I was taught that video games aren’t… anything really. That they’re the junk food of media. That they add absolutely nothing to my life, that I should be ashamed for playing them. They were the lowest form of “entertainment.” My parents modified their approach as I demonstrated a complete failure to heed these lessons, allowing me to get quasi-educational games like Civilization 3 and SimCity 3000. But their conservatism in this regard couldn’t stop me, and eventually I turned to the fledgling internet to feed my hunger.

Playing Runescape with my brother was an incredible time in my development as a gamer, and MMOs have maintained a special place in my heart since then. It’s the possibility that drives me. The wide open world, the skills to learn, the challenges to master, the people to meet. But more than that, my therapist was seeing something in video games that I had always appreciated, but never really put into words: they had boundaries. My brain likes structure. It likes rules. It just thinks and thinks about the way things are until it finds the end, and God help me if there isn’t one. In real life there are too many rules, too many variables, and my brain gets stuck, my wheels spinning. Sometimes I will physically dither, jerking back and forth as my mind pulls me in two directions at once because each choice has equal value.

In that light, the idea of playing video games to soothe anxiety and obsessive thoughts is wonderful. There is no way for me to get really stuck in a game. Even if I physically can’t do something, say due to reflex speed, at least I know exactly why I can’t do it. There is only one reason. No hidden variables or contexts. Just that. It’s soothing. When I can’t get a break from my brain, when all it’s doing is spinning, grinding me away to nothing, nothing is so wonderful as giving it something to chew on. Anyone who has ever had a car stuck in snow or mud knows the infuriating whir of machinery spinning to a fever pitch without effect, followed by the satisfaction of feeling things catch and begin to move again.

Final Fantasy XIV is my favorite game for symptom relief. It offers everything I need to really dig in. Like all good MMOs it’s linear without being overly constraining. It’s easy to learn, but mastery takes a reasonable combination of physical skill and understanding the systems at play. It’s comfortable. I imagine that there are plenty of people out there who would disagree with every aspect of my assessment of the game, but all I’m doing here is speaking to what it provides me, and trust me I have searched high and low for these results.

Unlike movies and books, games require my full attention, frequently requiring both physical and mental engagement to play at a high level. While there have been countless times in my life that I’ve had to reread the last 20 pages of a book because I’d zoned out somewhere along the way, games do not often tolerate looking away. Outside of play I enjoy thinking about the way that games are constructed and designed, as well as planning my next play session. Gaming is a constant source of fodder for when my mind is too overactive.

All this is not to say that games do not have their limits as well. They most certainly do. First and foremost, they are not a replacement for professional help or prescribed medications. Games can also be isolating, and shades of addiction can set in, enhancing my already-avoidant personality and psyche. For me, my social anxieties around games lead me to resist sharing my experiences with others for fear of being looked down on or ostracized. Games are an isolating hobby for me overall, and that is most certainly unhealthy, which is why understanding my needs and moderating my time playing them when I don’t need to is of paramount importance.

Why treat the symptoms though? Why not do something to help the severity of the condition? “How much exercise do you get?” friends and doctors ask. Physical exercise is a frequently suggested panacea, but it presents even more limits for me than gaming, and is generally less effective. For one thing, I highly prefer to be active outdoors, where there is a constant change of scenery to keep me occupied. Indoor activity simply doesn’t provide enough distraction, and often results in me getting lost inside my own head, contrary to my goals. Going outdoors then is best, but it carries its own challenges and drawbacks such as photosensitivity, social anxiety, and exacerbating my gender dysphoria. Ultimately though, physical exercise can be good while it lasts, but it doesn’t provide the necessary long-term emotional stabilization I need to stay safe and healthy.

But when I am in true need, games can be truly life-saving. They can alleviate some of my more distressing symptoms, which originate mostly from bouts of depression, anxiety, or peaks of obsessive thoughts. During these times my mind can become fixated on thoughts of self-harm or suicide, and having an active, engaging distraction can do wonders. At times like those, slowing my thoughts and curbing my urges is incredibly important. Moreover, the semi-social space of online games is a great way for me to feel connected to people, while also being able to maintain control over my level and style of engagement. Thus I can avoid both feelings of isolation and adding social anxiety to the mix.

The question of whether games are good or bad is simplistic. Some people argue that they improve reflexes and cognition while others say that they promote violence and antisocial behaviors. Perhaps both are true. Perhaps neither. For me games can be isolating, but they can also provide a more engaging experience than films or books. I didn’t even write about the times I’ve used video games to explore aspects of my life I wanted to change. I think it’s time that we started to think more complexly about games. Instead of simply looking at what they provide for us passively, it’s ever more important that we, as a nation and as a community of fans, start to look at what they can provide us when we’re being proactive about their use. Now is as good a time as any to start thinking about how they can be tools.

My experiences of self-discovery and symptom relief only represent a small fraction of what I believe games are capable of. Games are incredibly powerful experiences, and they can be harnessed to help, heal, and educate. But to do so we must, as a society, also begin to move away from old notions about the value, or lack thereof, of games. They cannot be both pointless wastes of time and tools of change and growth. Shame would only poison games’ incredible potential. Instead of waiting for “video games’ Citizen Kane” we should look to the power that is already present and palpable in the medium.

–Liz lives in VT with her two rats and talks incessantly about video games and psychology. Sometimes she writes things.