Up, up, down, down, left, right, left, right, B, A, start.
To most gamers, it’s the Konami Code.
To some, it’s an obsession.
To those who suffer from OCD, every day comes with the ever-pressing stipulations of your mental illness. It’s malignant. A persistent growth that turns every action into a mental chore; one over-encumbered with cognitive calculations that draw a thinning line between safety and catastrophic harm. But, between the incessant flicking of a light switch and becoming paralyzed by the uncertainty of the world around you, there are video games. And they can be good.
Not just in the sense of enjoyment, but as a source of liberation – of freedom rarely felt from the prison of a mental condition. Whether it’s exploring haunted hallways in Castlevania or traversing time and space in Super Mario Galaxy, every minute spent in another world can become a relief from your own.
To those who have experience with the illness, this may seem counter-intuitive. Blogger and PlayStation social media specialist, Ryan Clement, writes about it at length for IGN, noting how a highly-regarded game like Skyrim became debilitating: an open-world sandbox littered with collectibles “needing” to be collected and 100-hour achievements “begging” to be achieved. Every number becomes a necessity, one that drives an ever-pressing spike through the heart of a game. Often, it’s overwhelming – searching through the tall grass of Uncharted’s jungle terrain for forgotten treasures – and, more severely, catalytic – remnants from the anxiety leaking into your everyday experiences. However, for every anxious tinge felt for missing a single talisman, a cathartic rush of adrenaline replaces it, driven by the game’s uncontrollable elements.
Control: That’s what it all comes down to. In a world where your every action comes premeditated, the feeling of uncertainty becomes unbearable. Thus is the nature of the condition: You obsess, stress, give into a compulsion. You alleviate the anxiety. You gain control; lose control. You repeat. Causally, a cyclical pattern develops, one driven by dependency on the very problem you’re trying to alleviate.
But in video games, that’s not an option. Play is predominately reactionary. Non-playable characters (NPCs) puppeteered by artificial intelligence swarm you. In-game events trigger without your knowledge. Online combatants attack with little, if any, notice.
In lieu of control, instinct takes over. There’s no time to count the amount of pixels on the screen or bullets in your clip. There’s you and the element of intrusion, one that rapidly refuses to wait for an errant lapse of calculated logic. But, with practice, we become acclimated to these pressures, honing the ability to adapt within a large spectrum of instances.
These are the foundational elements of cognitive-behavioral therapy (CBT). Used as the predominate source of treatment for OCD and Generalized Anxiety Disorder (GAD), exposure and response prevention (ERP) – one of the two defining sub-segments of CBT – becomes the practicing mandate to control obsessional fears.
Through ERP, you’re asked to expose yourself to the obsessional fear, then prevent yourself from succumbing to the compulsion, consequently leaving yourself vulnerable to the anxiety and discomfort that follows. This is measured through Subjective Units of Distress (or, SUDs) on a scale from 0 to 100.
Take, for example, a germaphobic obsessional fear. With ERP, you would be asked to construct a hierarchy of SUD-inducing acts – touching a garbage can, shaking hands with a stranger, using a public restroom. Then, systematically you consciously expose yourself to each tiered item in escalating order, without relapsing into a period of compulsion. Through repeated and prolonged exposure, what you initially diagnosed as a 50 becomes a 30, then a 10, until it’s only a passing thought that doesn’t elicit a catastrophic response worth compulsion.
We work to deal with it; but so too does the body. Intrinsically, we have an anxiety-relieving mechanism, one that quells any prolonged feelings of discomfort. As such, the goal of treatment becomes reaching this precipice of uncertainty without caving to our comfort-inducing compulsions, letting our anxiety naturally de-escalate.
And, after the comedown, we’re struck with the frivolity that’s come to define our misunderstanding. Shaking hands doesn’t cause cancer. Stepping on a crack doesn’t harm a family member. A siren is not a signal your house is on fire.
Comparatively, games become an unrelenting locomotive hurdling through the tunnel vision of OCD-centric thinking. In games, an obsession triggers, but instead of fidgeting on the analog four, eight, twelve times, you’re instead forced to deal with external forces attacking from all fronts. Compulsion’s not engaged. And there’s no time to go back either; the element becomes a digital linebacker, one that keeps pushing you away from the same toxic, well-worn route.
Little by little, you learn. And when the game is over, and the system fan begins to cool, cognitive cause and effect slowly becomes unhinged with the realization that these actions don’t come with life-shattering consequences.
Reimagining the Mind’s Eye
And yet, we’ve only scratched the surface of gaming’s potential to alleviate mental illness. Because while the pre-mentioned method becomes a potent formula to alleviate the strain of physically evidenced OCD, it lacks an integral component for those suffering from metaphysical manifestations – proof.
As suggested before, a germaphobe can physically “see” that shaking hands with a stranger doesn’t give them a life-threatening illness. The same can’t be said for an individual suffering from the fear of God. Scared of even the slightest of blasphemous slips, they stand in paralyzing judgment of whether thier actions in mortal life will grant them acceptance to “heaven.” But where is their proof? How can they be shown the consequence, or lack thereof, of their actions?
In CBT, the answer lies in Imaginal Therapy. ERP becomes constructed scenarios, ones you write out in graphic detail and visualize, reading over every catastrophic detail in real-time as if you were painfully present. And it works – but only for a moment.
The mind can only imagine so much – acclimate you to so much – before the exercise exhausts its utility. But what if we could create these scenarios? What if these metaphysical worlds could be visually manifested before our eyes? It would dramatically change the way we dissect, tackle, and effectively treat mental health. It would be VR, and stigma-inflicted worlds that we could live through. Why not create the worst possible scenario? Why not create “hell”? Through immersive means, catastrophic events could be actualized; proof could be realized.
Intrinsically, it becomes about increasing tolerance, not certainty. It’s about facing your worst fears imaginable, and understanding it’s only one of a myriad of possible low-probability scenarios that could occur. And, if it did indeed take place, however insignificant the percentage of possibility, we’ve acclimated ourselves to the thought – through the virtual experience – that it could happen.
Fundamentally, video games begin to transcend their perception as an entertainment platform and enter into the realm of psychotherapy. Whether it’s OCD, GAD, or PTSD, video games firmly cast their gaze onto the mainstream eye of mental health, catalyzing an everstigmatized group of people who have long been left to their own catastrophic devices. ////
John Wither is a creative strategist and writer at Idea Couture. He is based in Toronto, Canada