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Monday, May 13, 2024

How Video Games Are Saving Those Who Served

It’s hard to understate how important video games are to veterans. An idle hobby to some is lifesaving, grounding, and even therapeutic for others, especially those who have served overseas in combat zones. I know it is for me, a Navy veteran who finds the worlds of Mass Effect and Resident Evil 4 more approachable than this one sometimes, and I’m not alone. My fellow vets and medical researchers are using video games to treat PTSD, depression, and more, and best of all, it’s working.

Of course, the Covid-19 pandemic doesn’t help matters, since it adds to the isolation we all feel. On one not-so-great day, while I was struggling with Covid-19 and depression, my mother called me. “I wish I could be there and make you soup,” Mom says over the phone. Her mothering is breaking my heart. I say, “Then you’d catch the virus,” and cough out a laugh. I am thinking in contradictions; I haven’t died, but I hope I do die whenever the few hours of sleep I get are broken by heart palpitations, a chilling fever, and memories of trauma. My friend, Dean, just died from the virus. I miss him, and I keep looking forward to seeing his lack of pain. It never comes. “I’m fine,” I lie to her. I’m in my third week of coronavirus. I’ve already thought about jumping out the window three times today. And it’s only 11 am.

Fortunately for me, I’m feeling well enough today to play Mass Effect 2. All I need is a controller and a pillow. I can’t lift my head, but at least I can play. This is how I’ve prevented my own suicide. Otherwise, PTSD and the nearly unbearable effects of the virus would have ended me. For many vets, gaming is much more than just a waste of time—it’s a godsend.

If you are in crisis or you think you may have an emergency, call your doctor or 911 immediately. If you're having suicidal thoughts,
call the National Suicide Prevention
, at 1-800-273-TALK
(8255) to talk to a skilled, trained counselor at a crisis center in
your area at any time. If you are located outside the United States,
call your local emergency line immediately.

The Unspoken Price Veterans Pay

The pandemic has made things tougher for many vets, an additional unspoken cost to add to the bevy of military traumas. Alone, isolated, sick, and plagued by inner demons, I was rarely at peace. I didn’t want to put in the effort to eat, which left me too fatigued to get up to eat when I wanted to do so. I lost about 30 pounds in two weeks.

According to the RAND Organization, 18.5 percent of service members returning from conflicts in Iraq and Afghanistan meet the criteria for either depression or post-traumatic stress disorder (PTSD). Veterans were 1.5 times more likely to commit suicide than the general population before the coronavirus pandemic even started. Similarly, many vets have been unable to get life-saving medications through the mail—including treatments for mental health. To make matters worse, an overwhelming 80 percent of vets get their medications this way.

From watching the humanitarian tragedy of the 2004 Haitian coup d’état of President Aristade and the sick and dying masses trying to escape a regime intent on control by any means, to waiting on the call to help during Hurricane Katrina, I learned one thing during my first year in the Navy: We were able, yet unwilling. As I informed another of my shipmates that someone in his family had died during the storm, I apologized. I passed him the Red Cross message, a courtesy response from the Red Cross to let service members know when someone passed in the family. “It was your sister,” I told him. I would deliver many more of these messages as our ship sat off the coast of Georgia, watching New Orleans drowning on TV. His was a reaction I’d come to know well: He looked as if he wanted simultaneously to strangle me and hold onto me for comfort—wide, angry eyes, wet, red, and in pain and disbelief. He screamed and burst into riot of tears. Most people usually did.

The nightmares and the guilt would catch up to me after I left the military. I try not to reflect on how many people died because we did nothing. There are still things about my military career I won’t talk about. Now 34, I wish I’d gotten back into gaming in my twenties.


Like most people who grew up during Nintendo’s dominance of the console market, another vet knows well the special kind of magic that comes from gaming. 42-year-old Noel Nero Gregorio was no exception. He knew all about Mario, Metroid, and Castlevania, and he played religiously.

Originally from the Philippines, he moved to California in 1991, the year the Super Nintendo came out. “My favorite game is Chrono Trigger,” he tells me. “When that game came out it was on retail for 80 bucks, and I had to work my butt off just to own it!”

He describes his unique military career: “I joined the Army in 2003, did a couple tours in Iraq. After working with the Marines in 2006, instead of reenlisting in the Army, I signed up for the Marine Corps, 'cuz I liked it more,” he laughs.

Almost immediately after signing up in 2003, he “shipped off to Iraq, and started getting shot at all the time. I had no idea what I was going to get into. Seeing people getting blown up. Mortar fire. Lost a couple friends. You try to shake it off, try not to think about it too much. But when you’re alone, you think about it then.”

His PTSD finally cemented itself in April 2008, after surviving a suicide bomber attack in Iraq. “This one Marine, just 19 years old, took out a huge truck that almost ran into the base’s entrance gate. He died but he saved a lot of people.” But that’s when the nightmares came. And his anger began to build. A lot of that anguish crossed over when he got out of the military.

“In the beginning, I didn’t feel like the VA was working for me. It took four years for my disability claim to get filled. Lots of people slip through the cracks, and those are the ones I feel saddest about. I eventually got help, but the VA can definitely streamline a lot of their processes for others.” Now, however, he plays Animal Crossing when he needs to relax.

David Crouse, 35, remembers his first experience with the original Nintendo. “It was '89 or '90, when Dad brought home the NES (Nintendo Entertainment System), introducing me to Mario and Duck Hunt. I became a lifelong gamer that very day.” Crouse is a disabled vet and director of veterans services at Stackup, a nonprofit that seeks to promote positive mental health through gaming. Its goal is to prevent veteran and active-duty suicides. Retired from active duty in 2014 as a Marine sergeant, Crouse recalls what led to his bouts with PTSD.

“As an explosive-ordnance-disposal tech, I knew the dangers of my job. Our mission was to cross-train with Cambodian deminers. We would disassemble old ordnance, then reuse parts for new ordnance and blow up stuff we couldn’t move without hurting ourselves.” Crouse had done the job many times before. Then, in 2013, a high-incendiary round he’d been handling sparked. “I yelled out to my people to stay back, because I knew what was about to happen, then held the explosive out, away from my chest. It popped and I lost my left hand. Lost my left eye. About a quarter of my teeth. Heavy damage to my skull and tissue. But the blast didn’t knock me out.” He was certain he’d die then and there, but he went on to spend two years at the Walter Reed Medical Facility in Maryland, rehabilitating, blaming himself for what happened that day.

He says, “I’d spent my life trying to help others. I didn’t feel I deserved all the attention I was getting.” His PTSD didn’t make things better. An ordinarily outgoing sort, his trauma got so bad that he started suffering crowd anxiety. First, it was nightmares, then he couldn’t sleep at night. “I’d wake up in the morning and just start staring at the wall for hours. Then the sun’s up.” It wasn’t until he got back behind a controller that he began to fully feel a sense of normalcy.

Gaming as a Treatment, Not Just a Respite

Michelle Colder Carras sees games as a treatment, not just a respite. A researcher at Johns Hopkins Bloomberg School of Public Health who specializes in treating veterans, she is also a gamer. Her first experience with veterans' unique mental health challenges came while playing the MMORPG (massively multiplayer online role-playing game) World of Warcraft. Her guild (team) leader went off on a 13-year-old, saying that he didn’t care if he was a kid, he was a terrible player and didn’t belong in the guild. She spoke to the guild leader in private, soon learning he’d recently left the military and had anger issues. He used gaming and the military-like structure of the guild he’d created to keep his life in check. She knew then that games might be able to provide the kind of structure transitioning veterans needed, and she directed her research toward finding that out.

Her 2018 study on how gaming can help veterans with mental health issues found that vets use games in a variety of ways to better their mental health, whether it’s through connecting with others, coping with symptoms of PTSD, suicidality, or substance cravings, or creating meaningful leadership roles or even jobs through games. Other researchers suggest that therapy through PE (prolonged exposure) and CPT (cognitive processing therapy) have proven immensely helpful to vets. PE, which, as Carras puts it, “involves people practicing thinking about the traumatic events they’ve been through—at a time everything is fine—to help them realize that those memories are not harmful.” CPT teaches a patient to evaluate the upsetting thoughts they’ve had since the trauma, with a focus on changing negative perceptions of self and the world. Virtual treatments such as StrongMind are designed to help with both PE and CPT therapy.

Another nonprofit, Warfighter Engaged provides special gaming controllers, makes prosthetic enhancements, and offers a variety of options for greater mobility to severely wounded and handicapped vets, from Walter Reed.

Its founder, Ken Jones, an engineer by trade, speaks on how the organization came to be. “I worked in defense for 20 years, before I went to work at Walter Reed. I started making household utensil holders, prosthetics, and hygiene equipment for vets who lost some or all use of their limbs.” One of the first vets he worked with had lost both legs. Jones started visiting him for the next two months. In therapy, he says, “many severely disabled vets assume they’ll never be able to play video games again,” a depressing thought for former service members who feel they have nothing left to lose.

Jones had been going to hackathons for years before being approached by someone who worked at Microsoft. “He was a programmer. He asked me if I had any ideas for improving the design of Xbox controllers for the severely disabled. It was mostly just simple things, at first, just add a button or two.” After being initially impressed, Microsoft asked for more suggestions to improve their gaming peripherals. Jones’ project for the 2015 hackathon in Austen, Texas, became the Xbox adaptive controller. “Once those disabled veterans were able to get back into gaming, they’d come back with positive attitudes toward therapy. Playing video games was a major plus for them. So many people are alive today because of these technologies. Many would have committed suicide, otherwise.”

John Peck served from 2005 to 2012 as a sergeant in the Marines. He tells me, “I never suffered from PTSD. And people get surprised when I say that.” He pauses. “However, I was suicidal. They put me on suicide watch while I was in the hospital, and I suffered from general depression afterward.” His harrowing story began on a mounted patrol in Helmut Province, Afghanistan. He and several others “entered a compound, and I had my mine detector. Everything seemed clear. I told my sergeant something, took one step forward, and an IUD blew off my right arm above the elbow, both legs below the knee, then a fungus ate my left leg up to the pelvic muscle. I suffered a traumatic brain injury. Due to complications, they later amputated my left arm. I even flat-lined at one point.” A few days later, he was at Walter Reed. “I’ve had around 35 actual surgeries. Two arm transplants. Using a prosthetic arm, I was playing with remote-controlled cars. But it was useless, because I kept crashing the $300 dollar RCs I bought.” While in the hospital, he met Ken Jones and asked if Jones could help him out. “He made me a joystick. But getting used to my limitations was a full-body workout. At first, I could only sit up for two hours at a time. Getting back into video games kept my life on track and helped my sanity.” Now, Peck, who loves the Assassin’s Creed series, can access the same gameplay as others.

In the ever evolving world of virtual-reality tech, gaming and simulations are providing even more resources for vets. Bravemind, a project using virtual reality as therapy, has been used at over 60 sites, including various VA hospitals. Bravemind project leader, Albert “Skip” Rizzo, director of medical virtual reality at the University of Southern California, has seen positive results from VR since the mid-'90s. His research shows that “a large and maturing scientific literature has evolved regarding the outcomes and effects of what we now refer to as clinical VR applications that target cognitive, psychological, motor, and functional impairments across a wide range of clinical health conditions.” Rizzo perfectly sums up how many vets feel after trauma: “They walk around angry all the time. They don’t want to talk to anyone about it, they don’t even want to admit they have a problem.” Although to a lesser extent now, I can attest to being one of those veterans who still feels uncomfortable when the subject of military trauma comes up.

Frans Steenbrink works at the world’s most advanced biomechanical laboratory. From the outside, the Netherlands-based Computer Assisted Rehabilitation Environment) looks like the dome of an observatory, but inside it brings together various elements that influence a patient’s behavior in one therapeutic environment. Comprised of a moving platform, a huge screen, wires, straps, and harnesses, the laboratory provides a total-body, fully immersive form of therapy. Working closely with the military, the lab is used for patients with PTSD. Says Steenbrink: “The real-time feedback options and dynamic and interactive environments with exercise games at the optimal level for the patient ensure the best treatment and analysis.”

Games Help, but the Challenges Persist

In too many ways, I long felt it would have been better to come back home in a casket than come back home any other way. The way civilians looked at me, treated me, when I showed my VA card as a form of ID, it was like I should have died a hero. However, I was now the villain. I was immediately treated like the bad guy. A baby-killer, a product of George Bush playing toy soldiers for oil. That’s how it felt. People would say things like, “Why does he get special treatment?” Then, as now, many people had a problem with giving me veterans’ discounts, even when the place of business promised a discount. Folks would often dismiss me as a fraud, saying I hadn’t been through enough, or just calling me a liar after giving a fraction of my stories about military service and trauma. I learned to shut up and keep it to myself. People say they will be there for you, and that they want to hear what veterans have to say, but I’ve found that when I begin to say it, they no longer want to hear it. Maybe it’s a disconnect. Maybe they really don’t care but have to pretend to because of the notion that America doesn’t do enough to help vets.

At the height of the 2008 recession, I was homeless, bouncing from shelter to shelter. Sleep only came when I kept the lights on; that way, I could at least wake from my nightmares and know that the demons of my subconscious hadn’t followed me. It being the recession, I also couldn’t find a job. Years later, I learned of the Call of Duty Endowment, which has placed over 72,000 veterans in jobs. The nonprofit takes a percentage of money from the wildly popular Call of Duty franchise to invest in vets, without whose influence and sacrifices there would be no franchise.

Now, 12 years after my life in the military ended, I can attest to the fact the VA has gotten better, at least in my specific case. But it doesn’t look great when they misappropriate funds, switch out bedrooms for boardrooms, fail to hire vets, or when vets in crisis have their calls dropped when trying to reach the Suicide Prevention Hotline. In the meantime though, while institutions shift to deal with the political climate and rising caseloads from retiring or injured veterans, consider supporting them by supporting nonprofits working to bring gaming to their bedsides and into their rehabilitations. For me and those like me, gaming has made all the difference.

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