Definition Of Insanity: Games & The Stigma Of Depression

The relationship between gaming and depression tend to only be addressed by sensational misinterpretation of studies by the mainstream press. RPS contributor David Owen set out to find out whether gaming can be linked to mental health, how games could better represent depression, and whether games themselves can be an effective means of helping those who suffer.

Far Cry 3 gives a definition for insanity. “Insanity is doing the exact same fucking thing over and over again, expecting shit to change.”

You’re probably familiar with how madness manifests itself in the world of games. It’s that ill-defined brand of hyperbolic insanity that compels antagonists to shoot people in the face, hatch needlessly convoluted plots to take over/destroy the world, and maintain a socially unacceptable hairstyle. And this is not just a cheap dig at Far Cry 3, which rode a wave of promotion centred on insanity. It just happens to be the most recent example, in that every major character on Rook Island is unhinged in some capacity – we know this because of their propensity for murder, rape, and to hallucinate giant voodoo demons. At no point in any of this is a specific mental illness named. Far Cry 3 does not know the definition of insanity.

It’s not only games that risk the accusation of paraphrasing mental health issues for ease of narrative. Whenever any commercial entertainment media portrays insanity it leaves itself open to scrutiny. The reason for singling out gaming is that it’s the medium with unrivalled access to, and relies on much of its revenue from, young people, where mental health figures are going through the roof. Most prevalent of these is depression. Mental health charity Young Minds claims that nearly 80,000 children and young people suffer from depression in the UK alone. This link has given rise to the question of whether gaming nurtures or causes depression in young people. Whether or not this is true is not the topic of this article, although out of necessity it will be touched upon along the way. This article will instead ask whether, blame-game aside, mainstream gaming has a responsibility to address spiralling youth depression figures.

There have been some attempts in mainstream games of recent years to depict depression authentically. Heavy Rain starred Ethan Mars, a bereaved father pushed to the brink of suicide. The Walking Dead game flirted with aspects of depression such as hopelessness, suicide, and the subsequent strain on relationships. But the very nature of depression means that these depictions could be considered flawed. Depression can be an illness that’s difficult to quantify or to rationalise with cause and effect. In fact, according to mental health experts, there might not be exterior stimuli for its onset. “Most depression starts in late adolescence,” says Laura Oates, a cognitive behavioural therapist at Harley Therapy in London. “There’s a genetic component to depression. If you’re going to get it then it’s unavoidable. The first time you get it, you’re unlikely to realise what’s happening. You’re not likely to know you’re getting depressed.”

Ethan Mars is depressed because his son is dead and he might be a schizophrenic serial killer. Characters in The Walking Dead are depressed because zombies ate their families. These are perfectly legitimate reasons to be depressed, but it’s perhaps arguable that young gamers are unlikely to identify. So could such depictions cause young people to dismiss their symptoms because there is no such extreme problem in their own life? “Any depiction of depression that is stigmatising could make people embarrassed,” says Dr. Theresa Fleming of the University of Auckland, creator of gaming project SPARX. “Representation of challenging issues that we see around us impacts on how we understand and deal with those issues.” So it could be argued that the misinterpretation of depression and mental illness by games as something causal or violent could be considered harmful to affected young people.

Yet this doesn’t explain why games have previously been singled out for causing depression. There is sadly very little in the way of scientific data in the form of psychological studies on this issue, particularly relating specifically to young people. The only substantial study was conducted at Iowa State University by Dr. Douglas Gentle and a small team of fellow researchers. Entitled Pathological Video Game Use Among Youths: A Two-Year Longitudinal Study, the project monitored the gaming habits of school children in Singapore over the course of two years. It aimed to determine whether “pathological gaming” had an impact on the mental wellbeing of the children. The study defines “pathological gaming’ based on criteria such as subjects neglecting homework to play games, stealing money to purchase games, or gaming to escape problems or bad feelings. (Other researchers have summed up such behaviour related to gaming as “problematic use”.) And Gentle’s results drew a direct line between heavy gaming and depression.

Despite these results, Dr. Gentle believes it would be an oversimplification to say that gaming directly causes depression. “Depression and pathological gaming seem to be truly co-morbid,” he tells me. “Where they make each other worse.” Subjects turned to gaming to escape their feelings of depression instead of seeking help. When it didn’t work they simply gamed more, so both issues deepened.

Laura Oates talks me through how cognitive behavioural therapy works, which, when combined with anti-depressant medication, is considered the best treatment for depression. It essentially encourages patients to tackle depression by altering their thoughts, feelings, behaviour, and physiology. “If you’re lying still and gaming, you’re not going to feel better. How could you change your behaviour? What could you be doing with your body to make you feel better?” As Dr. Gentile’s study shows, turning to games might prevent young people from making these vital changes. Oates continues, “Any compulsive behaviour like gaming is known as self-medication. It may not be terribly helpful.” As for how games approach the subject itself, Oates believes that “games could do more to remove the stigma” of depression.

So if young people are turning to games when they feel depressed, should developers be doing more to address the issue? Those I speak to are open-minded yet sceptical. “I think gaming, like any pastime, needs to be consumed responsibly,” says Karl Hilton, managing director of Crytek UK. “As an industry we need to always be aware of the content of our games and who we are making them for. After that it’s up to the people who buy games to decide what is right for them.”

He admits that his non-committal answer is due to being uninformed on the issue. The difficulty here stems from the question of how capable an individual is to make the right decisions regarding their gaming habits if a mental health issue has not yet been diagnosed.

Andrew Eades, CEO of Relentless Software in Brighton, also acknowledges that he is unaware of evidence that links gaming with depression. He’s keen to defend against such accusations. “I’m an advocate of playing games. I think the positives outweigh the negatives. My children get a great amount of joy out of playing games.” Yet he also concedes that, “If there’s evidence that shows games are affecting susceptible teenagers, then [developers] should be man enough to admit that and deal with it.”

It is immediately difficult to see how games could tackle the issue of depression. But it’s not uncharted territory. Unsurprisingly, it’s the indie sphere that’s set about exploring mental illnesses. Tourette’s Quest by Lars Doucet tries to capture the experience of living with Tourette’s syndrome. The player controls a yellow smiley face, and must manage its stress levels as they explore dungeons. Enemies are docile, but get more difficult to evade or confront as stress levels grow, and symptoms of Tourette’s are exhibited.

Daniel Benmurgui’s Today I Die is an independent browser game designed to represent how it feels to suffer from depression. On a single screen, it asks the player to rescue a girl from being dragged underwater by fighting off maleficent creatures, uncovering secrets, and piecing together poetry. It’s a simple and elegant concept, and a deliberately abstract experience. After all, depression could be considered an abstract illness.

SPARX is a much bigger project, and takes a different approach entirely. Designed by a team at the University of Auckland, the project aimed to develop a game that would help young people to deal with symptoms of depression in the real world. It takes the form of a fantasy-adventure game that packages elements of therapy inside puzzles and challenges. The player is responsible for defeating the darkness and gloom that has descended upon the world. Results showed that those who played SPARX found it to be at least as effective, if not more so, than traditional counselling. I asked Dr. Fleming, who worked on the project as a PhD student, why this was the case. “It’s a whole lot of things. You have the therapy content, but the user also has a whole lot more control in the programme than many young people experience in counselling. [We] have the ability to use games and visuals to communicate ideas rather than relying quite so much on talking.”

The stigma of embarrassment around mental illness could make it difficult for young people to seek help by traditional means, so they instead try to block it out by gaming. “A [traditional] game can easily bring your mood up for a little while,” says Fleming, “but they can’t change how you deal with issues in your life.” SPARX might be the first step towards changing this, but it was never conceived of as a mainstream title. While Fleming hopes that it can be made readily available on PC and Mac, it could only ever serve as a means of alternative therapy. Each mission begins with a mood-monitoring questionnaire, and there is an in-game guide who explains how lessons learned within the game can be applied to real life. “You wouldn’t play SPARX for fun,” concludes Dr. Fleming.

Does Dr. Fleming think a major mainstream game could offer legitimate therapy? “Maybe an MMO or RPG of some kind, featuring a character that depicts depression,” she says. “Just seeing an authentic depiction in a game could help a young person recognise their own problems. By seeking positive change in the game, it could encourage them to do the same in real life.”

Laura Oates agrees. “We encourage [patients] to exhibit behaviour of someone they’d like to be similar to. Mainstream games could offer a positive role model.”

Like Andrew Eades, Dr. Fleming is reluctant to place blame directly on gaming. “It’s no different to any other compelling activity. Doing one thing too much will stop you from doing other things. Not becoming depressed is about having a balance of everything in your life.”

MMOs are of course the genre most often vilified as a modern day Pied Piper. They have the potential for endless play, and can offer up ever greater rewards for every hour invested. I ask Simon Bradbury, founder of Firefly Studios, if MMOs risk upsetting the balance needed to keep young people healthy. The studio develops the Stronghold series, and has recently launched an online version.

“MMOs can be a retreat from the world, but escapism is not necessarily a bad thing,” says Bradbury. “If one of our players wants to spend a few hours every day in our online rendition of medieval England then I think that’s a healthy thing. It’s about balance… not hours of grinding.”

Toward the end of 2008 my own sister Christina, who has suffered depression from a young age, experienced a particularly low period. “I began playing Fallout 3 because I needed a distraction. I didn’t think it would help because I was having trouble focusing on anything for very long. I ended up playing it for 14 hours a day for about 3 weeks.” This might be considered unhealthy – some might want to categorise it as “pathological gaming” – but for Christina it was crucial for getting through the day. “It got me out of bed in the morning. Becoming so involved in the storyline and the tasks gave me a reason to keep on going, and it was so far removed from real life that it made me feel better.”

Rather than inadvertently deepening her depression, the mood lift Christina experienced as a result of these long gaming sessions made her feel better prepared to deal with the real world. “Towards the end of that three week period I felt better, so I played less and took the opportunity while I was feeling more productive to spend short periods of time tackling my issues and doing everyday tasks. I think I just needed some time out.”

Discussing her situation with Dr. Gentile, he stresses the importance of defining “pathological gaming”. “It’s not defined by how much time is spent doing it. It’s defined by whether the gaming is dysfunctional – that is, it’s damaging other areas of life. In this case gaming may have actually been helpful. But if over a longer time she couldn’t get back to her job, family, friends, school, etc., and just kept gaming, then that would be evidence that it has become a problem.”

Christina agrees, and insists upon a healthy balance. “There’s a fine line between escapism and avoidance, and I think you have to know where that line is and not cross it.”

It appears then that some mainstream games at least can offer indirect therapy for those suffering depression. Yet arguably this alone isn’t enough to absolve them of the responsibility to do more. All of the gamers I spoke to had had their condition diagnosed long before they found that gaming could be a comfort to them. With the difficulties inherent in recognising depression, it is likely the case that many young people are unaware that they have a serious medical condition, leaving them unprepared to draw that crucial line between escapism and avoidance. If mainstream games already hold the potential to be mildly therapeutic, surely more could be done to help young people recognise the condition, or encourage those that already do to seek help, therefore fulfilling that therapeutic potential to the utmost.

Whether games do cause depression in young people will remain a controversial topic until a great deal more research is done. In the mean time, it remains incredibly unlikely that mainstream developers and publishers will take steps to tackle the issue – flamboyantly crazed bad guys needn’t be looking to expand their range just yet. “We all have a responsibility,” insists Relentless’s Andrew Eades. “As members of society we should be looking out for [depression] and not dismissing it because it’s inconvenient.”

Gamers allow games into our lives like no other form of entertainment. We let them in even when we’re at our lowest ebb. They are therefore in a unique position to affect our lives, and, in an issue that spans all media, it could be games that take the first step to lead the way forwards.

If you have concerns or questions about depression, or think you would benefit from talking to someone about it, you can call Mind in the UK on 0300 123 3393.


  1. Brun says:

    I feel like gaming is a good stress reliever, although I imagine that could be said of just about any hobby that one finds enjoyable.

    • smeaa mario says:

      true. I mean I might have become a vicious psycho if gaming hadn’t given me joyous time of virtual head smashing and teeth shattering. who knows? I might have wanted to do it on actual people for real. games are a superb way of discharging that totally normal rage everyone has inside against some random people or facts of real life.
      politically-correct psychos who cannot channel their excess rage out will continue to blame gaming for causing violence but woofers gonna woof. can’t really do anything about that.

    • tourgis says:

      You have not done depression any service here. Of what kind of ‘depression’ do you speak? The blues? The black dog? Melancholia? ‘Clinical’ depression? Once again this myth of cognitive behavioural therapy being ‘considered the best treatment for depression’ is trotted out without thought or reference. If you had bothered to dig deeper you would have discovered that the research for the efficacy of CBT is in serious doubt. CBT is the preferred therapy in the NHS only because the government likes to think it gets people back to work and off benefits – and because of this it has become an industry along with most of the rest of therapy, with ‘experts’ and ‘authorities’. Other research indicates that any talking therapy can be beneficial* and that it is the quality of the relationship between therapist and patient that is curative, not a pseudo-medicalmodality. I speak of this (passionately) from a position of experience as a therapist myself.

      If you want to write an article about the imaginal in games, about how games can serve to ignite the sparks of imagination that can lead people out of the ‘swamplands of the soul’, then I would be delighted to read it. In fact I’m inclined to write it myself after reading this piece.


      • honuk says:

        “CBT is the preferred therapy in the NHS only because the government likes to think it gets people back to work and off benefits”

        Bingo. The mental health industry is socionormative, it is literally an economic failsafe instituted by western governments to 1) promote the bottom line, 2) make a lot of people (drug companies) rich, 3) provide the backbone for pop media articles to justify the status quo by labeling everything else as pathological (i.e., caused by chemistry rather than the circumstances of living in a broken world). Follow the money. CBT is all symptom, it is all show-me, the mental equivalent of treating a bleeding cut by painting everything around it red.

        • scatterbrainless says:

          To be fair, “health” itself, whether mental or physical, is a socionormative term; so to claim that therapies are “healthy” isn’t incorrect, it’s just whether or not we understand that to mean “fitting into a prescriptive social context.” A wholly individual, a-social mental state would be… insanity. There, that’s a definition.

        • Josh W says:

          In the UK at least, I would not say that mental health provision is designed to make anyone rich. It’s designed to save costs and mitigate other social problems.

          And to be honest that functional attitude is implicit in the commonly used definition of mental pathology itself; it says nothing of your personal feelings, but relates to your ability to perform your expected role in society. I don’t believe this is intentional a lot of the time, it is simply easier to see if someone’s mental state is getting in the way of other normal expected parts of their life, rather than considering it in terms of generic capacities that do not assume certain modes of life.

          Someone who is depressed in one context may be much better suited by developing other capacities that allow them to live in another one (retraining and changing from an abusive or boring job for example, or learning a language and moving to a sunnier country or one with a different pace of life) than they would by learning to cope with their specific circumstances. On the other hand, developing more effective coping strategies is useful given that the world changes, and you cannot always preserve favourable circumstances.

          That psychology tends to focus on coping with the present is as much a consequence of it’s focus (it really isn’t politics or lifestyle design, it focuses on the individual and how they see their world) as it’s functional role (brought in to fix a persons symptoms by direct interaction with them).

          Of course, games can be broader, although single player games can have many functional similarities to talking therapies (people can turn to one or the other when stressed), they can also focus on multiplayer experiences that build alternative social arrangements (potentially closer to family therapies) and they also can deal with the whole region beyond people who recognise themselves as depressed or otherwise in a hole (because no one goes to a psychologist because they are already happy and well adjusted and want to be happier!).

    • Mctittles says:

      I think a lot of times, the thought of depression while gaming is just because of the stigma of feeling guilty playing games.

      Just recently I was in the middle of working on a project when someone gifted me TorchLight 2. That evening I started playing and was enjoying myself so much I couldn’t stop. I got little done on my project the next day and felt guilty for playing but just had to keep going.

      Eventually I just told myself, fuck it, I’m finishing this game and the project can wait. After allowing myself this freedom I felt much more relaxed playing and instead of feeling guilty or depressed my mind started to wander and I came up with a bunch of great ideas for my project. I ended up quitting Torchlight 2 before the end once I had my fill and was excited to get back to work.

      So for me anyway, I found out sometimes games can make me depressed or stressed when I feel guilty playing them, however if I remove the guilt then they can help me think and I actually don’t feel the constant “need” to play.

      • Josh W says:

        I’ve noticed this feeling as well, where you do something to avoid the negative emotions of knowing your neglecting something. But of course increasing those negative emotions at the same time.

        I think this is the core of a lot of procrastination, and I’ve personally solved it by saying to myself that I cannot do the same thing all of the time, however important it might be, so I might as well just enjoy the rest of my life.

        From revision to tidying up to personal projects, sometimes things just need to be rested for a while.

  2. Drayk says:

    “Far Cry 3 gives a definition for insanity. “Insanity is doing the exact same fucking thing over and over again, expecting shit to change.” ”

    It’s a rip-off from a Einstein quote. Insanity: doing the same thing over and over again and expecting different results.

    I am not really sure it’s from him but I like this quote.

    • Brun says:

      Agree that its use was appropriate given the context of the game and its Carrollian overtones (all the Alice in Wonderland quotes). The game makes many pop-culture references to insanity or madness throughout.

      • phlebas says:

        Only mad people play this game?

      • Drayk says:

        I don’t know yet. I haven’t played the game. But I read the writer’s interview, and will probably play the game hunting for such clues.

        I must also read Lewis Caroll masterpiece. I am afraid that the subtilties will elude me if I read it in English and that a translation would not convey the book greatness.

        • Brun says:

          I would also read Conrad’s Heart of Darkness, since Far Cry 3 (as a game set in a jungle full of crazy people) draws heavily from it, even if it is largely unintentional.

        • f1x says:

          Hum, I have to get grumpy and say that Far Cry 3 never gets not even close to what Heart of Darkness achieves in terms of atmosphere, sensations, etc, but I understand why they can be linked

          Still a great recomendation to read
          same for Alice in Wonderland

        • Chuckaluphagus says:

          “Alice in Wonderland” and “Through the Looking Glass” are excellent works of English literature, but they were also written for children as the intended audience. That makes them much more accessible to non-native speakers of English. They’re also old enough that they’ve entered the public domain and can be had freely, if you want to read an electronic copy.

        • Zern says:

          I would recommend “The Annotated Alice – The Definitve Edition”. That version goes into great depth explaining all those subtleties.

    • DonDrapersAcidTrip says:

      I can’t believe Einstein really ever said something so stupid. Sounds more like a hollywood pop psychology quote. It doesn’t even make sense. Dude, scientific method is sooooo INSANE.

      • Mr. Mister says:

        He probably said that when he first was opposed to some aspects of quantum theory, but I’m not sure. It also makes sense as a critique to conservative scientists who would discredit the result of new experiments that would prove old, comfortable theories wrong.

      • Razgovory says:

        I think it may have had to do with his early dislike of quantum mechanics.

      • iucounu says:

        The attribution is disputed: link to

      • ScreenCheetah says:

        I beg to differ. The scientific method is all about repeating the exact same situation in order to get the exact same results. Experimental results are listed with specific details of how the experiment was performed, so that other scientists may repeat the test and hopefully achieve the exact same results. If different results are obtained, something unaccounted for by the scientists must have changed. Or changes are deliberately made to the experiment and different results can be obtained, allowing us to test and discard hypotheses.

        The quote may or may not be attributed correctly, but I don’t think it’s “hollywood pop psychology”. If nothing is changed, why should the outcome be any different? What leaps of logic would lead anyone to conclude that after years of living in the same house and using the same lightswitch every day, *this* time they flick the lightswitch and their garage door will open instead?

        Or in the context of the article, if someone plays videogames to get themselves out of depression, but playing games doesn’t make them feel any better, then playing games tomorrow, or the next day, or the next day, is just as unlikely to make them feel any better.

        • scatterbrainless says:

          It’s a classical argument against a naive inductivism, which quantifies confirmation as increasing epistemic authority, which would claim that repeating the same experiment repeatedly somehow garners increased authority for its hypothesis. “Reproducibility” is important as an in-principle mechanic for the scientific method. Endlessly reproducing an experiment is not.

          • ScreenCheetah says:

            Yes, reproducibility. I didn’t mean to suggest that science involves endlessly repeating the exact same experiment for shits and giggles. I agree that a sheer quantity of data should not give any hypothesis greater strength against new contrary evidence, too.

    • Phantoon says:

      Isn’t doing the same thing over and over and hoping for things to be better what everyone does?

    • maninahat says:

      In real life, repetition is an actual sign of depression. Animals in zoos sometimes exhibit a behavior known as “stereotyping”, wherein they perform repetitive actions out of sheer boredom and desperation. I doubt that this was what Einstein (or whoever) was referring to though.

      More simply, Vaas was making a sarcastic remark about how stupid (or crazy) you must be for continually getting caught by him, whilst his remark ironically betrays his own insanity through his habit of saying it over and over again.

      Entertainment on the whole has long been paraphrasing and misrepresenting mental illness for kicks. Sadly, it isn’t something that has changed much from our days of observing the freaks of bedlam.

  3. pandiculator says:

    This. Articles like this are the reason I come back to RPS, day after day. Bravo.

    • Sleepymatt says:


      • Matt says:

        Thirded. Really good article guys, I hope more is done to look into this particular topic…

    • Gorf says:

      Nothing new here, stuff has been written about this for years now.

      didnt mean this to sound dismissive sorry, its still relevant.

    • Vaedresa says:

      Funny, articles like this are why I’m beginning to hate RPS. It’s kotaku shit, soapboxing with the vague injection of games as if that makes it games related. It doesn’t. Games used to be a fun hobby, but people everywhere seem determined to politicise them needlessly these days.

      • Pony Canyon says:

        So why click on these articles? If you come for the gaming news and reviews, there’s still plenty of that elsewhere on the site.

      • TCM says:

        “Stop letting your reality get in the way of my escapist fantasy.”

      • Toberoth says:

        This isn’t soapboxing or politicising, it’s an effort to better understand what games are capable of making players experience. I don’t understand how anyone that likes games could object to this. And there are still plenty of articles about fun and silly games on RPS, no?

    • Zogtee says:

      I suffer from chronic depression. When I’m down and feeling bad, I actually don’t play a lot of games, because it’s hard for me to focus on them. I play the most games when I’m feeling good.

      Fuck knows what it means, but that’s how it is.

      • Razgovory says:

        This makes perfect sense. Part of being depressed is a lack of energy and desire to do anything. A lot of people who are depressed just sit around listlessly and stay in bed.

      • darkmouse20001 says:

        Funnily enough I’m the same. When I’m really busy, which is generally when I’m enjoying myself, I seem to play much more than when I’m not. When I have very little to do, and get a bit depressed, I can waste entire days doing absolutely nothing. When I only get to snatch the odd hour of gaming because I have so much on, I dream of having a whole day to play, and then absolutely waste the chance when I get it.

  4. Dilapinated says:

    link to

    Relevant + well worth watching.

  5. evenflowjimbo says:

    The only time I was depressed was because of a woman. I’m sure video games help, because it stopped my brain from thinking about her all the time. Which is why WoW was a life saver for me.

    • f1x says:

      Weird shit, because I experienced pretty much the same, failed love with the agravant that I also found myself in a moment where I didn’t know how to direct my life, as I also abandoned the university degree I was doing

      I found that WoW “hardcore” raiding (it was Naxx/AQ times in vanilla + burning crusade right after) filled a hole and allowed my mind to rest from going back to my mistakes, my failures, why I did that or what i said this or didnt say that,

      It really helped, the downpart is I became quite addicted to WoW, but only for some months, on the other hand I feel it saved my sanity

      • QualityJeverage says:

        This is interesting, I haven’t seen this sentiment before and I feel the same way. I’ve struggled with both anxiety and depression (often feeding each other) my entire life. I’m in a pretty good place right now, but these things never go away, you just learn to manage them better.

        A few years ago though, around when Wrath of the Lich King came out, I was in a pretty shite state. School was going badly, work not much better, lady troubles, and I was 18 years old so, y’know, hormones. Lots of fuel for a mind that really doesn’t need much.

        But Wrath of the Lich King came out and I bought it, and got a character to level cap for my first time. Joined a guild, started raiding, got more into it and, as you say, definitely reached an “addicted” level for a period of a few months. But I don’t look back on it with shame or regret. In a really difficult time in my life where I probably got the closest to “suicidal thoughts” that I ever have, it was somewhere to go, somewhere where I felt successful and could escape.

        I’m wary of saying things like “WoW can help everyone!” because there definitely is that addictive aspect, not everyone can escape it so easy, and everyone deals with these mental issues in different ways. But I’ll always be grateful for it myself. It got me through a rough time, and if I’m feeling like being dramatic, it might have saved my life.

      • scatterbrainless says:

        Weirdly enough when I got down it was all STALKER for me, which seems like a totally isolating and depressing game. But its focus on self-sufficiency and survival against a hostile environment, where the player is self-determining rather than being shuttled around, really helped. Also how it manages to be simultaneously ugly and kind of beautiful at the same time.

    • Gorf says:

      Same thing here. I broke up with my first long term partner about a week before WoW came out, and it totally helped me through that period of soul crushing sadness.

  6. Zanchito says:

    We can have this discussion with any other form of entertainment. Football, maybe?
    “Games cause depression” is as sensible as saying “police cause crime. You usually see police wher there’s crime!”. Games (as any other enterntaiment) provide escapism, something sought after by many mentally strained people (depression, stress, anxiety. Not just at medical level, anyone). And yes, of course there’s a part of the public that will take gaming to unhealthy limits. Just like every other form of entertainment. And they can actually be used to improve mental health (by teaching, relieving stress, trying to convey emotions or letting the user express themselves). Just like every other form of entertainment.

    Games are like every other form of entertainment. No more, no less.

    • John Walker says:

      Can I recommend reading the article?

      • Zanchito says:

        I did, please excuse me for not getting the point you were trying to make. I’m being serious, the internet is pretty bad to convey intention. What I got out of the writing are some experiences regarding games, depression and youth, some different ideas about how they may interact or not with each other, an idea about how games should do more than other media because that’s what we like (similar proposals can be found everywhere. Using Sports/music for mental health is very common) and a very sensible comment about how so many depressed people don’t evern realise what’s happening to them. I just don’t think gaming is any more special than any other form of entertainment (both for good and for worse).

        I don’t mean disrespect or anything, as I said, I must have missed the point. I apologize if I come across as rude.

        • Dave Owen says:

          I think it can be argued that gaming has more of a responsibility than other entertainment media because of the access it has to young people and the money it takes from them. As I say in the conclusion, I agree with you that it’s not /just/ gaming that could do more, but games are in a position where they could lead entertainment media as a whole forwards.

          • JFS says:

            I don’t think videogaming has an especially large influence on young people. It heavily affects the subgroup of gamers, but I believe this subgroup isn’t *that* big. I’d rather Facebook and big TV stations concerned themselves with these issues, as that is where then general young populace spends their time nowadays.

            If gaming has to intervene on a therapeutic level (that is, in contrast to artistically approaching the subject like the above-mentioned “Today I Die”), the responsibility lies mainly with the “big” players: Rovio, EA (The Sims), Zynga, maybe Blizzard with WoW. They are able to reach far more people than Crytek, or even smaller operations such as Paradox or Double Fine or what have you.

            I don’t believe the part of gaming that is discussed and treated on RPS is the most relevant and/or biggest. If mental health is to play a role in videogames, you’d have to intervene in a different section.

          • aepervius says:

            “I think it can be argued that gaming has more of a responsibility than other entertainment media because of the access it has to young people and the money it takes from them”

            As opposed to comic book, cinema film, and tv cartoon/movie which young people would never ever buy.


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            FhnuZoag says:

            Gaming is a billion times larger and more popular than comic books, and takes up far more time in a person’s life than a movie. It is also more usually enjoyed alone. TV is more comparable – and much of what is said applies strongly to japanese anime shows that to some extent exploit the social alienation and collective depression of their audience. But RPS is a gaming website, soo…

            I think the subgroup of gamers is ginormous. Recent surveys show between 91 and 97% of children play games, and 8.5% show ‘addiction’.

        • Ergates_Antius says:

          The important point you apparently missed is that at no point does the author state or suggest that “games cause depression”.

      • Donjo says:

        Edit: My sarcasm adds nothing.

    • Bradamantium says:

      Just like every other form of entertainment, certainly, excess is never a good thing. But this is a gaming website after all, so it might make sense that it’s discussing this in relation to games? Maybe? If you pretend hard enough?

  7. mandaya says:

    Two more relevant examples: “Elude” “aims to raise awareness for depression and to inform about this dangerous illness. It is specifically intended to be used in a clinical context as part of a psycho-education package to enhance friends’ and relatives’ understanding of people suffering from depression about what their loved ones are going through.” link to
    And Dan Pinchbeck’s “Korsakovia”, which tries to simulate a mental illness, Korsakov’s Syndrome. link to

    • karmafarm says:

      Just played through Elude (have a go, it’s only 5 mins or so.) Absolutely beautiful exposition of depression and captures very well some of the feelings that accompany an episode. I’m forwarding that one to friends…

  8. Mordsung says:

    I think you nailed something important: most games display depressed characters who have a reason to be depressed.

    It means a lot of people are never going to understand that depression isn’t rational. It’s not caused by a rational reason. You’re not sad because things are bad, you’re just sad.

    I liked Stephen Fry’s take on it (he is a life long sufferer or pretty severe bi polar). It’s like a rain storm. No amount of comfort will make the rain stop, but it will stop eventually. The rain always stops, so you just have to learn to survive the wet parts. And a person trying to help is about as useful as a putting a hand above your head in a monsoon.

    • Gap Gen says:

      Yes, there’s a difference between medical depression and depression sparked by personal events. I do suffer from depression a lot, but I suspect it’s more my personal past than medical reasons.

      • Eddy9000 says:

        The only difference between ‘depression’ and ‘clinical depression’ is the use of the terms, they don’t represent two clinically recognised syndromes. Depression is more commonly used as a layman’s descriptive, clinical depression is used when a clinician has determined that a person’s experiences are so severe that they warrant clinical intervention and being recognised for things like sick leave and disability living allowance.

        There is very little evidence for a biological aetiology for depression or indeed that it represents a discreet disease or syndrome. Originally the term depression was used descriptively of an emotional, physical and cognitive experience of lethargy, hoplessness and ennui. The drugs given for this were referred to as ‘stimulants’ as they literally, physically stimulated the body. Somewhere in the 50’s the term depression went from being used as a describer of someone’s experience to being thought of as the reason they were having the experience. This corresponded with a drug-company branding change of stimulants to ‘anti-depressants’ inferring that the drugs were fixing a condition rather than alleviating it, and that there was a condition known as ‘depression’ which had a chemical basis. This was a semantic shift encouraged by people that had a financial stake in the medicalisation of experience and was not based on any research evidence.

        The primary evidence used by people with a stake in the chemical/biological basis of depression has been that ‘anti-depressant’ drugs counteract it, there is little direct evidence of any biological cause. Recently a meta-study by Irvine Kirsch has challenged the action of ‘anti-depressants’ suggesting that anti-depressants have no significant benefit over placebo. The important thing about Kirsch’s study is that he used the official secrets act to obtain unreleased drug trials from pharmaceutical companies, finding that the majority of trials found no significance, but the few trials that did were those that were published.

        While there is currently a dominant discourse of ‘depression’ as being a discreet biological illness seperate from the environmental contingencies that might imbue it with the notion of ‘rationality’ this is not supported by research evidence. Most research into ‘depression’ tends to assume that depression already exists as a valid construct and builds on it (i.e. ‘do videogames cause depression?’) without critically evaluating whether the idea of ‘depression’ they refer to is valid or not.

        • Gap Gen says:

          Interesting! Will take a closer look at that when it’s not gone 2am.

        • Josh W says:

          While this may be true, sentiments like the above really helped a friend of mine to understand the extent to which his negative feelings could go away without any discernible reason at all.

          He told me that he actually found depression really funny when he was out of it, because of it’s total lack of proportion and lack of sense; “those railings make me really sad” ->”what on earth was I on about!?”

    • Zanchito says:

      Very well put. If you are not depressive or live or work with them, it’s just really difficult to understand it, because it’s not rational at all. It damn looks like it is, but in the bottom of it, it’s really not.

    • JFS says:

      Depression may be influenced by external events, though. It’s not always non-rational. You just can’t be that categorical.

      • sonson says:

        There can be a conflation of the two. Situational depression can become clinical, for example.

        The valuable point raised however I think is that clinical depression is not something which can be logically reasoned away. It is an illness, a disease, which puts you into a medical state of despair beyond the usual emotional paradigm of cause and effect. Telling someone with medical depression to cheer up is equivalent to telling someone with cancer to not have cancer anymore. At that point they are depressed, and will be until the depressive episode goes away. There are certain things which can help this on occasion, like most illnesses, such as exercise or keeping oneself occupied, but they don’t always.

  9. gerafin says:

    I’ve had my bout with depression and gaming. It was serious enough that I ended up in the hospital on suicide watch. I was playing L4D at the time, to the point where any free time I had was spent playing. I can definitely relate to playing the game to escape and not deal with the issues in front of me, and things definitely got worse because of it.

    But I think another aspect is the stigma surrounding gaming (gaming guilt). If I had spent all that time sewing, or reading, or writing, or some other hobby that makes people happy, then I probably would have been happier because ‘society’ (oh god I’m sorry I had to use that term this way) has convinced me that I should be happier. Doing something that you love for 8 hours a day is great! … unless it’s gaming. So I got little or no satisfaction out of my long gaming sessions. Indeed, they made me more miserable because I felt like there was something inherently wrong in doing so.

    I pulled through, in the end, and now I can barely recall what it felt like, during those darkest days. Unfortunately, there’s no easy route out of depression. But if you’re going through what I was, try anything and everything. Exercise. Take antidepressants. Go to counseling. Create something you’re proud of. Spend more time with friends. These are all things that you’re not going to want to do when you’re depressed, but you have to force yourself. And if gaming makes you happy enough to overcome your feelings of suicide, then game dawn till dusk.

    • Joshua Northey says:

      I totally agree that as someone who read a lot (both fiction and non fiction) and who gamed a lot, I was always shocked that people seemed to think the virtuousness and the value of the activity went something like:

      Fiction reading
      Non–fiction reading
      When it should be:
      Non-fiction reading
      Fiction reading

      When as far as actually learning things, or (in the case of games) having actual decision events which hone your analysis and math skills, games were far superior to fiction reading. You spend 8 hours straight reading Catch 22 (an important and interesting, but somewhat frivolous book) and people think you are a cultured interesting guy. Spend 8 hours straight playing EU2 and people think you are “addicted to games”.

      That might be different now, but it was how I felt 15 years ago. It still feel my wife doesn’t think my time playing games is as well spent as her time on the couch reading novels of extremely mixed quality. Having read some of those books I think that is kind of funny and absurd.

      • Berzee says:

        Probably the main reason for this is that computer games haven’t had their Reading Rainbow yet.

      • ucfalumknight says:

        I agree with you 100%. I have been diagnosed with clinical depression for the better part of my adult life. I am engaged in other therapies (counseling and pharmaceuticals), but gaming has been the one thing where, when I am feeling lowest (and thankfully I understand my illness) I will delve into one of the many strategy games or RPG’s resting on my hard drive. The fact that I have engaged my higher order thinking helps me to get over the “Blue Period”. But when you tell people “I was up all night playing Civilization X, they look at you like you are some kind of miscreant. I think this occurs because of the stereotypes of gamers that are perpetuated by Hollywood and other media sources.

      • solidsquid says:

        Not sure there should really even be a scale for this, you get different things out of each one. Like you said, decision making and problem solving are a large part of games, but non-fiction means learning about history and fiction can improve your vocabulary and understanding of narrative. All of these are useful skills to develop, and none really take precedent over the others

        • Joshua Northey says:

          In your day to day life decision making and mathematics will serve you much better than vocabulary and understanding of narrative. In fact I think an “understanding of narrative” is in many cases actively harmful to people’s lives because life frequently does not follow traditional narratives so it builds up false expectations.

          As just one example my sister went through a messy divorce with a guy who treated her like garbage. Why did she not see the signs before they got married, why didn’t people warn her off all the red flags. Because he was legitimately trying his hardest and loved her. His hardest just wasn’t good enough. That is not a lesson you will find in many if any stories because it is a depressing one. But it happens all the time in real life. Some people just are not ready/mature enough for the projects they undertake (in his case being a responsible husband/father). Fiction teaches you that if someone really cares it will all work out in the end. That is pure BS.

          In general of course I agree with you. Certainly people should try to be well rounded and develop lots of skills. But for most vocations decision making and mathematics are going to trump things you get out of a fiction story regardless of how good. that story is Granted not all games do a good job of teaching you math or decision making, but a large number do.

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            FhnuZoag says:

            Such a cold rationalist philosophy! I think I disagree fundamentally on a whole bunch of levels, but the most important level is that we should not read these fictional stories as ‘this is true’, but rather we should read them to fuel our moral, intellectual, and emotional imagination. It might not be factual that in real life things always turn out fine in the end, but reading works where it does connects you to the vast world of humanity that feels that it *ought to*. And that can be very precious, because without that sort of crazy hope, why do anything at all? Sometimes, of course, we fall prey to romanticism, but that’s the price we sometimes have to pay.

            And I’m speaking as a scientist with a PhD and stuff.

          • Brun says:

            Such a cold rationalist philosophy!

            The world is a cold and cruel place.

          • Askeladd says:

            I can only recommend reading up on fiction and history. They can give you the ability to see things from a different angle. It’s not a beautiful angle and you may regret it at some point, because math and ‘decision making’ is much more soothing to the soul. It’s a life style which is strongly defined in itself and thus gives security.

            Balance is the key.

            Really, read to much and you feel sometimes like a damned conspiracy theorist! I’m not talking about aliens and that stuff.

    • Gap Gen says:

      For me, some games feel self-destructive. The sort of thing characterised by grind rather than new experiences, say, or the feeling that you’re repetitively doing the same thing again and again in the hope of another pleasure hit, as the quote in the article suggests. I get the same thing with clicking Facebook every 5 mins. Co-op games like L4D tend to have a positive effect on me.

  10. Skeletor68 says:

    I’d say I’m guilty of ‘self-medication’ with games alright. It wasn’t for long periods of playing time but it did feel like I ‘needed’ it regularly more than I should even if only for an hour.

    When my own life was really stressful – in particular about two years ago – it was the only full escape I had. I didn’t find books or even movies engaging enough to take the edge off. My mind couldn’t process all of the external real life stuff so problem solving with small immediate rewards in gaming terms was a nice way to trick my brain into feeling a little more in control.

    • Joshua Northey says:

      Well said.

    • Gap Gen says:

      Yeah, it’s a fairly effective way of shutting out bad stuff around you if you can’t avoid that bad stuff. But I don’t know whether it’s a cure per see, or simply something that buries emotion. At least, that’s the way it was for me.

  11. Lambchops says:

    I found the “representation of mental illness in gaming” angle to this article a far more interesting topic than the “are games linked to depression” side of things, as it’s certainly true that it’s an issue that is rarely explored (and mostly by an indie game here and there),

    • Zanchito says:

      Just like movies, internal themes are really difficult to deal with, because the transmission is external. You can see, you can read, you can hear, but it’s complicated to meake someone FEEL. Also, not sexy for AAA blockbuster stuff (escapist), so it’s indeed naturally relegated to indies. Just like movies.

  12. Ayam says:

    I’ve always thought jrpgs would be most likely in the gaming sphere to be positive for those in depression because the protagonist is usually quite a detached soul that eventually overcomes some powerful dark force. I’m probably stereotyping the genre and have a huge lack of understanding of depression, but it constantly crosses my mind when playing such titles. Interesting read, thanks rps.

  13. Porpentine says:

    i don’t think any discussion about depression and games is complete without talking about how people use Twine as “self help” (to quote cartoonist Mia Schwartz from the other day on Twitter)

    link to

    link to

    link to

    to name just a few great games made as self help, in response to death, depression, pain

  14. Porpentine says:

    or for that matter Courtney Stanton’s project where she made a Twine game every day of December…many of those feel like self-help to me link to

    • JFS says:

      As is the case with a lot of art. I wouldn’t want to have to count the number of paintings or songs that are related to their creators’ mental health issues.

  15. dE says:

    -scratched the first part. Not really that relevant to the point of the article.

    About mental health in general, people are scared. They’re scared that they too might have mental issues. They don’t want to talk about it. When I tell people I have a medium bipolar disorder they act like
    1) It’s highly contagious and requires atleast a distance of New Distance = Current Distance + 10m
    2) Any second I might start rampaging, killing and pillaging in a random fit of a berserkergang
    3) I should be put away. Preferably somewhere out of sight. Yeah, definitely out of sight.

    The second folks know about it, they’re scared. No matter how many informations I hand out about it. So yeah, media loves the more aggressive types of mental issues. Because it’s easy to see them and judge them. The average lunactic like me though, what are they gonna do? I have absolutely zero violent tendencies, at worst someone might see a sudden change in mood. Folks would never guess or notice. Yet the second they know it’s a case of “dear lord, what if I have it too?”.

    • solidsquid says:

      Possibly they’re worried you’re going to start hitting on them if they’re the same gender?

      More seriously, if people do react badly to it then something worth pointing out a well known person who suffers from bipolar disorder, Stephen Fry. Worst he did was disappear for several days when he was supposed to be in a stage production (he was one key turn away from committing suicide), realised he just needed to get away from everything and went to Belgium without telling anyone.

      • Snargelfargen says:

        I think pointing out average people or acquaintances would be more helpfu than creating false celebrity expectations. Glamourizing mental illness is almost as bad as demonizing it. Most folks don’t hold up well compared to Stephen Fry or Russell Crowe from A Beautiful Mind or Howie Mandel or Kurt Cobain, etc, etc…

        Just normal people with off-spec brains.

    • Snargelfargen says:

      Yeah, the stigma for mental illness and bipolar in particular is way out of hand. I don’t really understand where people get it from, but popular media has to be at least partly to blame.

      The truth is a lot more banal. I know many people with mental illnesses who appear completely normal in public life. My own experience with bipolar is boring as hell and went unnoticed for a very, very long time.

  16. Kaira- says:

    Interestingly enough, I’ve always felt that Silent Hill-games have much to say about depression, what with each games major themes running around feelings of loss, isolation and detachment. “Feeling of not belonging”, I guess it’s called. Especially Shattered Memories resonated with me with these themes while I was going through some darker times.

    Great article, nontheless.

    • Chandos says:

      To me it was Planescape: Torment. Finding yourself in a strange predicament that you can’t seem to get out of (like the Nameless One being unable to die), trying to figure out who you are, what your purpose in life is, how to break the cycle etc… very much like my real life in my early twenties.

    • strangeloup says:

      Absolutely, I was going to bring up Silent Hill myself. I think for the best term to describe what you’re looking for, we have to resort to German; “Unheimlich”, literally un-homely, which is the basis for the English term “uncanny”. The Wikipedia article summarises some very interesting thoughts on the topic by Jentsch and Freud.

  17. Joshua Northey says:

    “The Stigma Of Depression”: I have to say growing up in the US (In a pretty poor but progressive area) in the late 80s and 90s I found zero stigma with depression.

    I was extremely depressed for a variety of good and not so good reasons from about 12-19, and struggled with mini bouts of depression after that. I do not remember the least bit of stigma associated with it, or remember noticing one bit of stigma being projected onto the dozens and dozens of other depressed students by myself, students, teachers, or parents. There was certainly frustration at times, but frustration is very different from stigma.

    Honestly, I think a huge amount of teenage depression stems from society keeping teenagers rooted in place (and rightly so). When teenagers have conflicts with parents or a badly situated social position, the natural and extremely strong instinct is to move away to another tribe. In modern societies that is generally not open as an option for teenagers (for very good reason).

    As for games as a balm for a depressed youth, I certainly found that to be the case. The most important life raft for a severely depressed/suicidal person to have, is some reason to look forward to the future, or in dire situations, just a reason to get up tomorrow. Games can certainly be a large element in that as they are very entertaining (especially when you have the low standards and unsophisticated tastes of a teenager), provide an escape to an alternate social environment, and generally just allow one to retreat from those things which are burning you down.

    Some people seem to feel that depressed teenagers should need to face their problems, to work through their depression. But I think in most cases that happens naturally with maturation and the transitions people rapidly go through at that time anyway.

    Anyway those are my thoughts on games and depression.

  18. Mollusc Infestation says:

    I was playing Spore when i had my last major bout of depression, at the space stage. I was being constantly hounded by a race of sentient tauntaun (from Star Wars) who were extorting me for vast quantities of cash due to their religious convictions. When i couldn’t pay, they’d attack my settlements and my spaceship. I came to see this as a metaphor for my life, in that i felt that i was inadequately “tooled” to deal with the situation. It was certainly an unhealthy interpretation and i actually had to stop myself from playing, as it was making me significantly more miserable.
    About a week or two later, i went back to the game and blew up all their planets. It was strangely cathartic.

  19. Vorzac says:

    I found this article to be such a good read, that I finally decided to register an account! The subjects of gaming and mental health are two areas that are close to my heart. I’m a disabled man with severe schizophrenia, currently living in supported accommodation/a halfway house. I spend a lot of my time playing games, and can relate to Christina’s situation on many levels. I do feel however, that games are actually less damning of mental illness than many other forms of media. A game in and of itself has never caused me any psychological distress. However, the vitriol I have received from other players in competitive games has directly caused me to have major psychotic episodes and panic attacks in the past. So rather than any prejudice built in to the framework of a game, sometimes the interactions over the game as a platform can be harmful. That’s a different kettle of fish, though. If video games are going to help people notice the elephant in the room, developers need to study the symptoms and (more importantly) the experiences of people living with mental illness. Silent Hill is probably the most profound gaming allegory of mental illness I have personally seen, not to mention the fact that it pretty much sums up my day-to-day experiences! More games that explore the concept of mental illness from a sympathetic standpoint are definitely a requirement, though aside from games like Amnesia: The Dark Descent (which I found neatly encapsulated the anxiety of being mentally ill, whether intentional or not) I’m not going to hold my breath. Hopefully, with more insightful articles like this one, and a growing awareness of mental health, things will change for the better, no matter how much time it will take.

    • Skeletor68 says:

      Thanks for the input and welcome to RPS. :)

      If you want a friendly multiplayer environment I’d suggest one of the many RPS gaming groups. Some really nice people in these here parts.

  20. Bostec says:

    Depression runs in the family and alas I believe I have bouts of it now and again. I only do lots of gaming because I have loads of free time and I’m mostly bored. I don’t think theres any real connection to it, its there just to distract the mind(probably a good thing). Saying that the only game I felt that I did have a connection was the Max Payne games. Although it was a different depression (A sudden loss instead of bad days and worst days for no reason) It was done brilliantly and it almost felt like what I was going through.

  21. Tuor says:

    Reading things like: ‘It appears then that some mainstream games at least can offer indirect therapy for those suffering depression. Yet arguably this alone isn’t enough to absolve them of the responsibility to do more.’ Stuff like this just infuriates me.

    Really? Do you think I play video games so that I can be subtly “treated”… maybe get some sort of indirect counselling? No. I freaking DO NOT. I don’t want that at all.

    Game makers are NOT responsible for my mental health. Where in the Hell do you get the idea that they should arrogate onto themselves something like that? They MAKE GAMES. And what I expect when I buy their product is a game, not a freaking counselling session with a shrink.

    I suppose you think you’re being “sensitive” by bringing this whole issue up, but IMO you’re just sticking your nose where it doesn’t belong. Worse, you seem to be saying that game developers have some sort of obligation to do the same thing. THEY DO NOT. That’s like saying a bartender has some sort of responsibility for solving your drinking problem.

    Chronic depression is not fun. I’ve had to deal with it for a long, long time. But it is MY problem, and *I* will choose how to deal with it. It’s bad enough having some armchair idiot try to tell me how to live my life, but now you’re going to advocate having one of my few enjoyable escapes be turned into a form of treatment? HELL NO.

    The path to Hell is paved with good intentions, and this idea definitely qualifies. Thanks, but stay the hell out of my mental/psychological life. And I promise you this: if I suspect that a game is trying to do what you’re advocating, I will not play it, let alone buy it, and my opinion of whomever made it will become very low indeed.

    Honestly, I can’t believe you guys even wrote an article like this. I’m hugely disappointed in RPS right now.

    • JFS says:

      Games covering mental health in a reasonable way might have a purpose for other people, especially those discussed in the article who don’t have a diagnosis and don’t necessarily know about their state.

      It seems you’ve given up on treatment, but that doesn’t mean everybody has. I think this article, while certainly debatable, does have a right to be on RPS.

      • Brun says:

        While RPS has had an annoying habit recently of trying to be “socially conscious” by looking at various issues – ostensibly through the lens of gaming, but in some cases that lens has only been cursory – I feel like this topic is a bit less toxic than the others. The tone of it is certainly less hostile and condescending (perhaps because it wasn’t written by Walker), and (un)surprisingly enough the comments so fare are all pretty tame.

    • JohnS says:

      Could you clarify why that would be so reprehensible? I keep re-reading your comment, but all I’m getting is “I don’t want it! I don’t want it I say!”

      • Snargelfargen says:

        Sometimes people with mental illness get sick of being treated differently, basically. Attempts to “relate” or help can come across as condescending and ignorant. Tuor’s reaction is maybe a little over the top, but it’s understandable.

      • Tuor says:

        I play games because I enjoy the stories, or the gameplay, or for similar reasons. Maybe there are times when I do play games solely to escape from my problems, too. But whatever the reason, I play them because I want to, and the decision to do so is my own — my responsibility. However, when I read articles like this, I can’t help but feel that there’s this inference that it is *not* my responsibility.

        When someone starts talking about how game devs aren’t absolved from responsibility, that means that they are to some degree responsible. They are, not me, is what I hear. But the moment that game devs take the bait — the moment they accept that suggestion — the result is that they can be held accountable: accountable for my (and your) mental health. And once that is accepted, then what naturally follows is that Something Must Be Done to help people maintain good mental health and hygiene. At the very least, it will be a sort of self-imposed “mental correctness”, to go alongside self-imposed political correctness. It will change the whole relationship between game makers and those who play games, and that change will NOT be for the better.

        Furthermore, it’s insulting, or perhaps condescending is a better word. I’m not responsible for my own actions? For my own self? I need treatment through gaming? Are you going to come into my apartment and paint my walls a “mentally healthful” color? It’s intrusive. It’s unwanted. It’s unnecessary. And it won’t help. It’s just another way for one group of people to dictate to another group “this is right, and it’s for your own good.” Can you blame me for getting upset over that?

        Now, I understand that the author(s) of this article are trying to be helpful. And also, the whole Sandy Hook thing, with vidoe games coming under fire, is probably a factor, too. But all I hear is, “You can’t handle your shit, so we’re going to come in and fix you up whether you want it or not, and we’re going to do it through one of the few things in life that you really enjoy. It’s for your own good.”

        Just let game devs make their games, and let me decide for myself if I want to buy them. If I want to spend a lot of time playing video games, that’s MY decision. If I have chronic depression, that’s something for me to deal with as I see fit. If I want to get some sort of treatment, then that’s my decision, and if I don’t, that’s also my decision. I don’t need game devs trying to act like shrinks and “help” me with my problems.

        Also, I don’t have a problem with games that are made with the intent to help people, so long as this is clearly stated. That isn’t what I’m talking about here. I’m talking about video games in general being created with some underlying, unstated “help” included… a sort of pervasive thing like political correctness in movies and TV shows. Where all games are evaluated on how much they benefit mental health as much as whether they are fun to play or have a good plot. When you start to talk about responsibility, then legal and self-imposed pressure eventually comes to bear, and the results are never good.

        • JohnS says:

          Thank you Tuor, I get your point much more clearly now.

        • Josh W says:

          It’s funny, my first reaction to this is to see it as a certain kind of individualist conservatism that doesn’t recognise overlapping responsibility, but you do actually have a point!

          Trying to address things and have an effect on other people can lead to some very tiresome results. I’ve been in jobs before now that focused on trying to improve other people’s choices, and it can have a weird kind of overcoming-resistance to it. You’re trying to help people yes, but you know that sometimes they won’t thank you for it, because you’re always going to be a bit ignorant of the situations you’re trying to get involved with, and so not produce as positive an effect as you think. So you always have to be careful about pushing through for “ah they’ll thank me later” because sometimes they really won’t.

          Course, where I’m from bartenders actually do say “I think you’ve had enough for one night mate”. It doesn’t really feel like any reduction of freedom, or an insult on the drinkers intelligence.

    • sonson says:

      One thing I have found in my experience of working in mental illness, experiencing it personally and looking after family members who suffer from it-all that matters is what works, and different things work for different people.

      There is no silver bullet for any condition. I am sorry to hear that the above has not helped you and that you find certain games offensive in their aims; but there will be, and are, other people with experience of mental illness who find this article and the games you dislike very helpful in regards to their experience, and so I encourage more of the like for the sake of those it does benefit.

      One is always free to ignore them (as you do) so I see no need to argue against their existence.

    • sinister agent says:

      Really? Do you think I play video games so that I can be subtly “treated”… maybe get some sort of indirect counselling? No. I freaking DO NOT. I don’t want that at all.

      Operative word: Can. CAN. Games CAN offer escapism or a therapeutic outlet or other positive stimulation to people. Nobody’s saying “people with mental health problems just play games because they need help, the poor dears”. I think you’re reading a lot more into this than was actually said.

      • Tuor says:

        Reading too much into it? Think about how the food industry is being asked to show some “responsibility” for obesity (which is being made into a big deal here in the US). All sorts of foods are having their ingredients changed in order to make them more “healthy”. It doesn’t matter that people are able to choose for themselves what they eat, no, they need to be “helped” for their own good. The whole mentality is what I’m talking about, and I don’t want to see that taking root in my games as well as what I eat.

        • sinister agent says:

          Okay, I think I can see your point, however I don’t think that discussing the efforts, or lack thereof, of games developers to consider mental health issues, either in terms of depiction or consumption, is necessarily a call for them to start taking choices away from players “for their own good”. It seems like an overreaction to treat it as such, especially given how little discussion there is about this within gaming circles.

          Games are growing up as a form of expression and entertainment, and this is just one of many areas that they’ve not really considered very much. I doubt anyone’s going to start turning their AAA titles into a counselling session any time soon just because a few people have expressed a curiosity about what, if any relationship, there may be between playing games and having a mental health problem or condition.

        • DXN says:

          I get where you’re coming from, but the way I see it, as much as it’s tempting to put everything down to “personal responsibility” and choice, it’s just not really realistic. Like it or not, we are influenced by the things around us, the choices we’re presented with, and the assumptions and expectations encoded in the our social interactions (passive or active). If unhealthy food is made available more easily, cheaply and attractively, and if there’s nothing out there offering or promoting healthy food, then we eat more badly. We can improve health by improving how food is made and presented. The same goes for gambling, cigarettes, booze, and (I think it’s fair to conject and think about) addictive games like WoW. It’s all very well to say these are all the prerogative of the user, but that really does only go so far, and at some point, you have to strike a balance between freedom to sell or consume them and public health, because by doing so you can lessen the number of people who get caught in feedback loops and spiral into a worse and worse condition.

          No-one (I think) is arguing that junk food, casinos and MMOs (etc) shouldn’t exist. The problem is that they don’t just “exist”. They are pushed, packaged and presented in certain ways that can induce people to make bad decisions about them, and sometimes for those bad decisions to start feeding back on and piling on top of each other in ways destructive both to the user and to the people around them (and, in aggregate, to society). They can be tailored to facilitate that kind of process — unintentionally, or sometimes e.g. with certain casinos, or let’s say, Farmville, with at least some degree of deliberateness.

          I think it’s worth at least looking, talking and thinking about that more than we have so far (which is almost none).

  22. mattevansc3 says:

    Good article but it makes the same error its trying to enlighten us on. Depression isn’t genetic, Clinical Depression is genetic. A huge amount of depression is non-clinical and results from pro-longed periods of stress.

    • JFS says:

      Well, no. To this day, there is no unequivocal opinion on the etiology of depression. And even if there were, I bet it wouldn’t be “Genetics!”, but something far more complicated and interactive.

    • Snargelfargen says:

      Yeah I’m not sure if “depression” was used a s catch-all term for mental illness in the article or not.

      There are a lot of illnesses that could be pertinent to this articl… OCD, bipolar and anxiety disorders, just off the top of my head.

  23. WibbsterVan says:

    As with a number of other people, I have just registered on the site specifically to respond to this. I feel it is extremely well written and thought provoking, and these types of article are one of the main reasons I read RPS every day. I might not agree with them all, but they make people think and draw attention to issues that are seldom covered elsewhere.

    I have suffered from depression of varying severity on and off since my late teens, and just recently I have also developed a serious anxiety disorder. Throughout this time I have found gaming to be one of the few activities that I can consistently enjoy, as the way it focuses my mind on something that is essentially meaningless in real life helps to give the mental and emotional part of me a break.

    In particular, I find MMOs and other multi-player games (yay for Planetside 2!!!) one of the few ways I am currently able to interact with people on a meaningful level at the moment, as removing the face to face aspect of talking to people is enough to allow me to be able to deal with it. Without this, I would be reduced to almost no social interactions at all.

  24. SRSavior says:

    Whenever I hear someone say that, “Definition of insanity” quote as if it really is the definition of insanity, I want to stab them in the face and wear their skin.

    • Mollusc Infestation says:

      The definition of insanity is wanting to stab people in the face and wear their skin.

  25. sonson says:

    Excellent article.

    One in four people in the UK (I’m not sure about the populations of other countries, apologies) will have a mental illness in their life so most of us will know someone who either has had or has lived experience of mental ill-health one currently. It is a hugely common issue which is sadly still driven under ground due to stigma and hysteria, and this is also a trend which I note seems to have been mirrored in the majority of gaming culture, as examined above.

    To see an article as candid as this in regards to both talking about mental health and it’s portrayal in gaming is heartening and necessary. Thank you.

    • Archonsod says:

      “One in four people in the UK (I’m not sure about the populations of other countries, apologies) will have a mental illness in their life”

      Also known as “voting Conservative” :P

      The main problem with mental health statistics is that we’ve yet to accurately describe what a ‘healthy’ mental state is, so for a large majority of those cases it’s often not quite as clear cut (i.e. the subject is not acting as ‘normal’ to whoever the observer is, but is not clearly showing mental incapacity as they would if for example they were at the upper end of the autistic spectrum).

  26. pupsikaso says:

    Is there a number that can be called in Canada?

  27. Milky1985 says:

    Gaming is a great way i think to handle times when you are feeling down, but as the article says you have been careful of escapism and avoidance. After blue Monday this week and all of the articles about depression that were flying around I needed games to distract and have a bit of a laugh and relax, but this was after I spent a couple of hours chatting to mates and socializing, i don’t think games should ever come before socializing, that is where the downhill spiral starts.

    Didn’t help that according to the articles i had 9/10 of the signs of depression, but that most likely because of the simple fact that it was a Monday and the articles were on places like MSN which is about as trustworthy as fox news :P

    • Gap Gen says:

      Yes, I’ve used games in the past to escape issues in my family, but it was never a way to heal mental scars, only to cover them over so that I could continue functioning as a human being. I accept that games, while an important part of my life, are not a cure for depression.

      Also, yes, internet diagnosis can be quite fishy.

    • ocelotwildly says:

      Yeah, as you were kind of insinuating in your comment, Blue Monday is all kinds of baloney. It was a piece of research originally commissioned by Sky Travel, undertaken by academic laughing stock Cliff Arnall of Cardiff University. Any time some research comes out with a handy little equation full of unquantifiable variables, you can be sure it’s one of his.

      Obviously, this time of year probably does see an increase in the incidence of depression for a variety of reasons, but I think that particularly piece of ‘research’ is cynically trotted out by the news every year without fail. It’s pretty depressing really…

  28. x1501 says:

    Far Cry 3 gives a definition for insanity. “Insanity is doing the exact same fucking thing over and over again, expecting shit to change.”

    Also, adding meaningless profanity to a perfectly good quote and expecting it to sound in any way pithier than it already was.

    • Brun says:

      Vaas wasn’t exactly an intellectual, I think the addition of profanity was just to make it fit more with his character.

    • sinister agent says:

      An eye for an eye, and the world will soon be motherfucking blind, yo.

  29. SuperNashwanPower says:

    I’ve suffered depression all my life, and I have had almost 10 years of therapy and medications. Things are changing very slowly through a myriad of helping sources. No one thing is a ‘cure’. Gaming is an escape for me, a distraction if not a cure – but certainly I would welcome widely available virtual reality ‘exposure’ simulations and anything providing psychotherapeutically designed emotional experiential content.
    Whether this would be a “game” or not I don’t know.

  30. InsanityBringer says:

    I’ve been having way too much issues trying to fight down moods lately using video games (or other forms of entertainment really) if only because I’m selfish and worry way too much if what I play and consume is actually “acceptable” in a world becoming more aware of social issues I was previously blind to. It makes me feel incredibly stupid, and it’s these feelings of stupidity that make me not want to talk about them to people.

    I might feel better with one of these games that have been mentioned, but I might just have to talk to a professional, which I guess isn’t a bad thing. It makes me feel out of place since almost none of my peers seem to have issues worrying so much (as my family says all the time, I worry way too much but I haven’t been able to follow their advice to stop)… Or maybe everyone I know does worry too much and feel the same way and just don’t want to say anything.

    • Brise Bonbons says:

      Anxiety is a tough one, since some amount of it is normal. My own anxiety comes and goes, but is usually pretty high unless I really pay attention to calming my thoughts down.

      I recommend looking into cognitive therapy, as mentioned in the article. I wasn’t familiar with it until recently, but it’s a fascinating area of study and offers some really good active exercises which can improve unexamined and destructive thought patterns/habits (so much of what we do is habitual).

      And it can’t hurt to talk to a therapist; if you don’t like them just keep looking for one you like, or try something else for a while. Either way, therapist or no, cognitive therapy is a really interesting field that could offer some tools to you for understanding and managing your anxiety.

  31. Universal Quitter says:

    ‘”defines “pathological gaming’ based on criteria such as subjects neglecting homework to play games”‘

    Well, I’ll be damned. Mom was right.

    Seriously though, I suffer from depression and I’ve never been able to relate to any portrayal of mental illness in any game, and rarely in any other form of entertainment. I don’t expect to, but if they’re going for realism or education, they’re not only falling short, but probably doing a slight amount of harm to those causes.

    When you actually have these problems, arguments about games causing it aren’t even on the radar. It’s just an inherently ridiculous proposition. The only thing that makes it not funny is that fact that we face societal judgment, and are used as pawns by politicians in sound-bites.

    Where it gets messy is when you ask yourself the difficult (and realistic) questions. “Is my life a mess because I’m depressed, or am I depressed because I have lingering feelings of being a fuck up? Or some unholy, self-sustaining combination of the two?”

    LAST THOUGHT: Why does every aspect of gaming start with the preconceive notion that it’s all about the kids? Aren’t young adults the largest demo in gaming these days?

    Kids need help, too, but to only approach this question from the “won’t somebody think of the children!?” mindset seems kind of limiting, or worse, counter-productive.

    Then again, maybe I’m just being pissy. Also, I forgot to mention that this piece was very well-written. Excellent work. Mainstream journalism wouldn’t have even come close to this.

  32. Surlywombat says:

    Great article. Glad the blame aspect was left out. Though I do feel that of ways to self-medicate, gaming is probably one of the least damaging.

    • Archonsod says:

      Yup, I’m pretty certain drug abuse remains the most popular method of medicating for depression.

      • Wisq says:

        I’ve long been grateful that of all the “addictions” I could have chosen, I ended up with one of the least (physically) harmful.

        (And no, let’s not get into the whole “is there such a thing as gaming addiction” debate again. Just accept that there are some people for whom the condition feels very real, and leave it at that.)

  33. Megakoresh says:

    Interesting. To be honest I never experienced depression. I despise the very notion of it, always did from a very young age, so even if there were some seeds of this disease I rooted them out. As with any mental illness, if done early enough, it can easily be completely defeated through, for the sake of being a Witcher 2 fan, self-hypnosis. :P

    I do agree completely that gaming goes hand to hand with depression. As does TV, music, cigarettes or alcohol. Anything that has effect on mentality severe enough to cause addiction. In my opinion there is no point in doing long research or writing heaps of text on this matter as it always comes down to one thing:
    Finding the balance.
    And that, fellow gamers, is a completely individual thing.

    • karmafarm says:

      Don’t assume that your experience is a yardstick for others, but congratulations on tackling any depressive tendencies you may have had head-on.

      • SuperNashwanPower says:

        Do not feed the troll.

        • Megakoresh says:

          Now here is someone who has clearly failed at keeping his or her mental health in check. I don’t know if anti-social behaviour could be considered a mental disease, I guess it depends, but presuming offensive content when there clearly wasn’t any and insulting a random person just for the sake of trying to piss them off is directly on topic for discussing mental issues, as well as methods for getting rid of them.

          It’s not just my experience, it’s a known fact. If a newly born child shows tendencies for mental issues further down the line, medics always recommend a set of therapies this child undergoes, as early as possible. When the mind and personality have not formed, it is a lot easier to root out issues that could appear in the future. Same as it’s a lot easier to troubleshoot an installation of Windows when it’s fresh. Brains function similar to computers in this case.

          • SuperNashwanPower says:

            Well that is interesting.

            I’m off to talk to slightly more important people now. See you.

        • sinister agent says:

          Heh. Called it, and clearly hit a nerve, judging by the desperate, grasping response you got. Good work.

    • Arren says:

      Do your mental masturbation in private, please.

    • TCM says:

      I’ve despised depression since a young age too, have lived a very upbeat and positive life, in a loving home, in, for lack of a better term, privilege.

      That doesn’t stop me from taking two kinds of medication for the clinical depression and anxiety I inherited from my mother’s side of the family. But hey, your solution of ‘just get over it’ probably works better, thanks for the advice.

  34. lordcooper says:

    I think Journey may very well be helpful in some instances. It’s a beautiful game that makes interaction with other players an absolute joy.

    • DXN says:

      Yes. Journey literally restores my faith in humanity, sometimes.

  35. karmafarm says:

    Excellent article, thank you! I’ve suffered from mild clinical depression off and on since my mid teens. I’ve certainly had periods of ‘problematic gaming’, where during a depressed period gaming becomes my only or main activity- but equally I’ve had periods where gaming has proved a marvellous release and a real help. If my experience is anything to go by, the relationship between gaming and depression is complex, personal and subject to change.

    I would advocate for moderation and mindfulness as being sensible tools to keep one’s relationship with games healthy. Gaming provides temporary release from negative thought patterns, but if you don’t address those patterns the constant avoidance gives them room to grow and to seem more concrete. It’s been important for me to spend time paying attention to my thoughts, considering their content and my responsibility for their authorship. Gaming diminishes the time available to do this, and if I’m ‘stealing’ my gaming time from work or family it’s not so healthy either. That said it’s also been extremely important to allow myself treats when in depression and gaming makes an excellent treat!

    TL:DR- don’t believe everything you think, take care of business, and make time for things you really enjoy. Be well. =)

  36. sinister agent says:

    To anyone who’s suspected/feared they might have depression but not sought treatment: talk to your doctor. They can’t force you to do anything, and at worst you will be unlucky and get one who is crap or simply gets it wrong. Even just resolving to talk to them and doing so can be a big step in feeling better.

    Also, note down any other health things you’ve noticed. Do a bit of reading (but take anything you read on the internet with a pinch of salt, of course, and if you’re prone to paranoia or hypochondria (which aren’t things to be ashamed of), best skip that part) and don’t be afraid to ask questions. I mention all this because I spent about fifteen years being exhausted and depressed, thinking that’s just how life was, before I happened to look up a minor symptom, which indicated I was suffering from an autoimmune condition that that linked together just about every health complaint I’d had ever, from my poor concentration and tiredness right down to having my upper lip swell up for no reason every other month. It just so happens that I’m off prescription right now thanks to my GP bunking off because of 2mm of snow last week, and jesus fuck, I don’t know how I managed to put up with feeling like this since I was 13.

    Also if you are treated for depression, be it with antidepressants or counselling, don’t be disheartened if that particular counsellor or medication doesn’t help you. Antidepressants are complex and their efficacy varies from person to person, and counsellors are just people, and can be poor at their job, have a bad day, or just get off on the wrong foot with you. Keep trying. Having someone to talk to who won’t get involved can make a huge difference.

    You can also speak to the Samaritans if counselling isn’t working or an option. They’re there for anything, and are not there to talk people out of suicide, or even talk about suicide if you don’t want to (though they’ll probably ask if you feel suicide, just because it’s an effective way to bring it up if people want to). Just having the opportunity to say out loud what it is that’s bothering you and how you feel is sometimes even enough to clear all the shit out of your head so you can see what it is you want to do next.

    If you’re worried about a friend who might be depressed… just listen. If they need to talk, listen. Don’t pry, but let them know they can talk to you if they want to. They may not want to or be able to. Don’t take that as a lack of trust or appreciation. Don’t try to save them or solve their problems. Don’t offer advice unless they ask for it (you can ask them if they want advice, though). Don’t get out of your depth or lose yourself in their problems – that will help neither of you. Just listen. You don’t have to do any more than that.

    • sonson says:

      Excellent advice and very well communicated, thank you

    • gwathdring says:

      I am not a medical professional, so consider that when reading what follows. Personally, I would advise staying away from (physical) doctors unless your insurance requires you to see a general medical practitioner in order to be refereed to a mental health professional. Physicians rarely have the same training in dealing with and identifying depression and those trained specifically to deal with mental health and certainly do not have knowledge of the medications and their effects on par with a fully-certified Psychiatrist. There is a reason we offer different degree programs and training regimens for mental and physical health professionals and in many cases even a low-level mental health professional can be more helpful than a highly trained physician if the ailment is mental.

      Furthermore, especially due to the resistance of insurance companies, the importance of in-person therapy in addition to ANY medication for depression is sorely overlooked. Using non-medicinal treatments as alternatives to medication is also overlooked, but I don’t think that’s as much of a shame since many psychiatric medications we’ve developed have high success rates and more immediate impact–which is sometimes crucial to establishing a therapeutic basis for fighting a given mental illness even if long term medication turns out to be unnecessary or problematic. As with all medications (and in the case of anti-psychotics, more so) one should always be weary of medication and look at alternatives very carefully. Second opinions for medications are extremely important if money/insurance allows. Many of these medications can worsen symptoms in as many people as they alleviate symptoms–it’s all very complicated and unpredictable.

      • sinister agent says:

        Yeah, a GP isn’t a psychiatrist, and can’t know everything. But they should know when they’re out of their depth – it’s the whole point of their job, really. That’s what referrals are for. It’s how I was diagnosed – my GP realised he didn’t know enough about this, but he knew someone who did.

        As for the insurance stuff… the mere thought that there’s a whole country of hundreds of millions of people who have to even think about that kind of crap before they even talk to a doctor about their health makes me want to cry.

      • Archonsod says:

        The thing is depression and it’s associated symptoms are also key indicators of physical conditions such as cancer and diabetes, so it’s important to ensure you’re physically healthy before heading to a psychiatrist, particularly if you have no family history of depression or similar psychological problems. A week or two prior to commencing treatment for depression generally isn’t a life or death situation; a week or two prior to commencing treatment for something like cancer on the other hand is.

  37. The Random One says:

    Ugh. This article is really depressing (ha). It just shows how little medical professional and game developers know about each other, even when directly basing their work on the other’s field. Just another indicator of how alienated present-day gaming industry is.

    Also, judging from the amount of people on this thread alone claiming they would become literal murderers if not for video games, I’m amazed mankind survived long enough to invent them.

    • TCM says:

      Well, murders used to be a bit more acceptable, if done properly.

  38. Mario Figueiredo says:

    Games are under no obligation to help against depression. In fact I think it is extremely dangerous they do so. I don’t trust game developers to know the exact causes of depression, or how to deal with it. And would never trust C++ to be able to come up with a anti-depression codebase. There’s no such thing when we can’t even understand the disease itself.

    Games may deal depression in any way they choose, of course. But personally I think they should steer away from realistic depictions. A realistic depiction of untreated depression usually ends in either suicide or a miserable life that should never be that of the game protagonist or one of its main NPCs; the characters players tend to identify more with. That said, if the game chooses to go this venue, it better also be able to handle with the effects of suicide and work its story in such a way as to never advocate suicide as a “way out”.

    If a doctor prescribes games as a way to treat or help alleviate depression, more power to him if he can identify exactly what games and under which circumstances they should be played. Otherwise that doctor should not be trusted. But above all, depression isn’t a disease that should be treated without medical attention or in a one-size-fits-all approach like that of one game that thought it could help against it.

    As for games influence on depression, I’m skeptical. Depression is poorly handled by games. Usually they put an extremist tone to it exactly because its writers cannot properly depict the nuances of tru depression and how easily it can escape your best friends scrutiny. So depressive characters in games end up being douches, mass murderers, weirdos or slightly deranged.

    I think a much more focal point to depression in games is the communities around them and how people talk and behave on the internet these days.

    • Snargelfargen says:

      “A realistic depiction of untreated depression usually ends in either suicide or a miserable life that should never be that of the game protagonist or one of its main NPCs; the characters players tend to identify more with. That said, if the game chooses to go this venue, it better also be able to handle with the effects of suicide and work its story in such a way as to never advocate suicide as a “way out”.”

      -Mentally ill people are often depicted as being suicidal, homicidal or otherwise completely unhinged. Is that a realistic representation?

      -There are many people that cope with depression through various means and lead long and fulfilling lives. Would that not also be realistic?

      -If suicidal thoughts were consistently depicted as being the wrong choice in a game, what effect would that have on someone suffering from suicidal depression?

      • Archonsod says:

        Yeah, but then doctors and psychiatrists are trained and equipped to deal with depression. Game developers aren’t. I wouldn’t say developers have a responsibility towards mental illness any more than they have a responsibility to perform liver transplants.

  39. SuperNashwanPower says:

    The thing that is always missed when discussing depression in this way is that we are looking for a technological or pharmacological solution.

    Depression represents a rupture in a person’s view of themself, of others, and their relationship to both of those things. Relationships are the things that break the most when a person is depressed, but they are also a source of it, in a reciprocal way. Its been identified that in psychotherapy, there are ‘common factors’ that help OVER AND ABOVE any discipline-specific aspects e.g. CBT, DBT, ACT, psychoanalytic and so on. One of those common factors is an empathic listener. Another is a person who is able to withstand the intensity of emotion the patient / client exhibits – a ‘container’ for them. A central item is trust, and whether the therapist is able to build it. Through these elements, the ruptures with self and the world gradually change. The person’s ability to have or strengthen relationships, and to seek the emotional support and guidance that itself leads to a lifting of depression, all act together as an underpinning to any direct behavioural, emotional, cognitive or experiential component that might be specific to that therapy type.

    These common factors are things that can never be found in a computer game, a drug or a technology, and if the rupture in relating is not changed at a deep (beyond cognitive) level, then these treatments are at best a temporary reprieve. Whilst I applaud the efforts of the author to examine gaming’s role in depression, I believe it is starting from a faulty assumption about depression, and being informed by over-simplistic models of depression and its treatment.

    CBT is a prime example – it has a wonderful laboratory and study record. However its in-clinic, real world effectiveness does not match up to the trials because trials necessarily use restricted criteria by which to judge ‘improvement’, typically symptom focused (my source for this is 3 Clinical Psychologists I have been treated by, numerous other sufferers I have spoken to over the years, as well as personal experience). Unfortunately there is a huge difference between feeling better, and BEING better. A statistically oriented psychologist may pronounce a person free of symptoms, but this does not mean that person feels themselves to be leading a fulfilling life or has the relationships with others they feel are lacking. Its much much greyer, but studies cannot abide by greyness. That is why they rely on rigid definitions of ‘cure’, typically assessed with sliding scales against the limited, often contested DSM criteria. The criteria by which something is assessed is of core importance to the quality of the conclusions, and if the criteria are faulty, so are the conclusions. Other, lesser known therapies acknowledge that the judge of an effective therapy is much deeper than this but difficult to measure – life satisfaction, the sense of being able to let go, the sense of a fundamental shift not only in mood but in who they feel themselves to be – but lack of published evidence is so often taken for lack of effectiveness.

    Even CBT itself had to concede its ineffectiveness in certain areas, in that Schema Therapy developed from it. A sizeable population was simply not helped, and so CBT was combined with Gestalt, Psychoanalytic and ‘Inner Child’ therapies. It started to resemble the older, ‘long’ therapies that CBT had claimed to supplant. But when its cited in articles like this, it tends to be accepted at face value that it is “empirically validated”. It may be true that a great many people are helped, but I feel a great deal of frustration when other therapy types and options are ignored due to what is effectively the market dominance of CBT. So often people get a three week course of CBT (something which the government wishes to implement as a ‘first line’ treatment) feel they aren’t being helped, and say “I tried therapy, it didnt work”. There are a great many options out there for people to try, but which they are so infrequently exposed to.

  40. uNapalm says:

    Games help me to ‘switch off’ my brain which is otherwise constantly whirring and working. I often suffer from depression, sometimes quite badly so and games have always helped me to carry on as they give me something back, help me to feel I am making progress and, along with films and music, enable me to feel emotions that I often can’t experience in day to day life. I’m also quite good at games, meaning that I can spend at least some time every day in a place that I feel confident and comfortable in and where I can be in control.

  41. strangeloup says:

    Really interesting article, thanks :) Having suffered from very serious depression and anxiety at least since my teens, and also having been interested in gaming since… well, ever, really, it’s very relevant. I’ve found a number of games to be emotionally moving, but at the same time, for me at least, they occupy a much more ‘safe’ space than, say, a film — I suspect largely because in a game you have some degree of agency.

    Equally I find that gaming can lift my mood, as in a great many cases the player’s role is of someone powerful and/or influential. Games with a more open/flexible setting — such as my favourite game of the last decade or so, Morrowind — provide again a safe space for experimenting with different responses to events and, although games have got a long way to go in terms of presenting complex moral/ethical decisions (despite The Walking Dead making a remarkably good go of it) there’s some degree of flexibility there too; being able to explore the possibility of being a paragon of virtue (or, by contrast, living vicariously as an absolute bastard) provides plenty of material to think on without risking the feelings of people in the real world.

    I find creative expression — I have some modest talent with art and music — is even better for making me feel better than gaming, but there’s plenty of occasions when I don’t feel good enough to work on that kind of thing. There are rarely times when I feel too bad to pick up a game for half an hour.

    However, as someone said elsewhere, online multiplayer can be a conduit to some genuinely unpleasant people, which (because of my state of mind) has often upset me out of all proportion to the comments themselves. As a result I’ve stopped playing MOBAs for good, and I’m taking an indefinite hiatus from other competitive multiplayer games. (Co-op, though — that’s good, it helps.)

    • gwathdring says:

      Mmm. For myself I find that gaming makes me feel better, but careful analysis has discovered that it typically does so in the same way that catharsis does–an immediate relief coupled with an insidious simmering that is not really dealt with by the activity. There are enough ways gaming can frustrate, too, that I can easily find myself in a bad mood while playing but unwilling or unable to stop–especially if I started playing because I’m bored and depressed.

      I do not find this to be true with many other sorts of distractions such as athletics and reading–though I am often unable to read when I’m depressed because it requires and intensity of focus that I seldom muster while in a disinterested funk. I do find television to be worse, because at the balance I can more easily find a game that brings me moment-to-moment joy instead of pure distraction followed by retroactive pleasure despite there also being games that hinder recovery or worsen my mood.

  42. solymer89 says:

    A deep seeded psychological issue like depression is caused and maintained by much more than our favorite form of stimulation.

    With that said, gaming, at least for me, is most definitely a release from the everyday BS they call real life. I think a majority of us here and most every intelligent person out there can attest to the fact that life really does blow balls until they’re blue then stops to let you feel the pain. Ignorance is bliss right? So no morons are depressed, or if they are they don’t know it and therefore it doesn’t affect them to the same degree.

    There have been a few scenes from various games I’ve played over the years that didn’t sit well with me. Whether it was the visual aspect or the psychological aspect, it just struck me as uncomfortable… or maybe morbid is the better word. Still, those scenes were far from causing me any real, tangible issues. If anything they made me stronger in a weird sort of sense. I like the quote “put yourself through the scariest of scenarios.” It means try to think of some really F’ed up situations you could be in, or someone you love could be in. How do you feel? How do you think you would react? Then process that and integrate it into your person. Some would call the desensitization, but guess what, we are all already so desensitized that it goes a step beyond that.

    This all leads to the fact that we as humans, when something happens, people don’t always see it, or understand it… or accept it. This creates dissonance in the mind and it is then a psychological unbalancing.

  43. floogles says:

    Great article, and teased out a lot of subtle relationships – thankyou for stepping away from “OMG Gaming Causes Depression – MOG No It Doesn’t”.

    Eg. the idea of Christina using Fallout as a temporary suspension of reality in order to navigate a difficult time is profound. Like a friend who visits for the weekend of your darkest time, or the anti-depressant that allows you to continue therapy for another 6 months, there is enormous value in ephemeral tools to get a person with depression from here to there.

    I notice that SPARX is unplayable but may be in the future with funding.

    In the end, there will always be escape, and addiction. Ban gaming and you are just left with more ways to escape reality.

    The varieties of compulsive/escapist gaming is there to teach us about the causes of this behaviour.

  44. psepho says:

    Interesting article.

    For what it’s worth, I have certainly used games as a form of “time off from myself” when dealing with difficult periods of life and think this is quite healthy. However, I would be concerned at the prospect that I might abdicate from myself on a longer-term basis through gaming.

    Also, I’ve had periods of mild-to-moderate depression on a number of occasions. A number of things I found helpful personally were:

    St John’s Wort tablets (I was sceptical but GP suggested — they contain a similar active ingredient to SSRIs but in a much milder dose and seemed to be effective in taking the edge off it over time)
    Good regular exercise makes a huge difference
    Being outside in green spaces (parks when I lived in London, fields now that I am in the country)
    Sunshine if available (at work if I see the sun come out, I try to make sure to go for a fifteen minute walk at some point for just this reason)

    In addition to the Mind number mentioned above, it’s also well-worth discussing with your GP if you at all think you might be getting depressed, even if it doesn’t seem so bad. Mine has been very helpful and its easier to ‘break the ice’ on this topic at an early stage, not least because your GP can reassure you and let you know what to watch out for if it gets worse. Even if it’s a false alarm, no good GP should mind having the conversation.

  45. Jakkar says:

    Thank you, RPS. Mirrors my experiences with some years of worsening depression quite accurately; a balance between heavy gaming periods both easing and exacerbating my depression depending upon my mental state, life state and the games themselves.

    For example team-based multiplayer games, particularly those heavily benefiting from text or voice communication are likely to worsen depression – as you rely upon others, often not the most pleasant of people, to achieve any sense of progress or to ultimately succeed. In short; they induce frustration, even anger – or the infamous r4g3. Spare a thought for the next angry gamer you meet, there might be a reason for those childish, seemingly disproportionate outbursts. Yes, it’s ‘just a game’, but that game could for him or for her be a concerted attempt to escape from a deeply unpleasant mental state or life situation into fiction – and to have trolls, griefers, cheaters and so forth, or just a string of bad luck spoil that game could be bringing a great deal of suppressed negative emotion back to the surface.

    Meanwhile a creative opportunity with some rich simulated systems that ‘play back’, such as the emergent delights of Dwarf Fortress can do a great deal to draw the mind away from the real world, occupying it on several levels at once and achieving a highly effective distraction, while the challenge and creativity offer a small but significant sense of achievement, and might mark the first steps to repairing a damaged ego, prior to performing the main work of rebuilding in ‘real life’.

    Choose your medicine carefully. As a loose advisory rule, fellow unfortunates; avoid compulsive gaming in multiplayer, with strangers, it can be a very harsh place for a fragile mood or a sensitive mind. MMOs do grant you a certain freedom in who you play with not offered by mainstream competitive shooters or co-op titles, but meanwhile offer little in terms of achievement or ‘repair’ for your hours of investment. Give yourself to a city-builder, or a game of exploration in randomly generated worlds – run a Dungeon, or a Space Station, build a castle and defend it. Lose yourself in singleplayer campaigns with rich stories.

    Take a break from reality, as the writer’s sister described, then go back the moment you feel some improvement and take advantage of it to kickstart a productive lifestyle again.

    • Aatch says:

      With regards to outbursts, that is a good sign if you’re talking about depression. Most sufferers wouldn’t be able to get angry or elated to that degree. So if they are doing that, then it’s a sign that they feel something, which is better than nothing. Even if they are calling you a faggot…

  46. Shifty Pete says:

    I’ve found that gaming helps ease a shitty quality of life, only just stopping me from slipping into full-on depression at times and giving up. So yes, it can be escapism, especially for games like fallout where there’s a big world to get lost in. The enjoyment of the game motivates you to get shit done so you can get home and play. When I actually am full-on depressed however (usually because of failed relationships), I have no motivation or excitement for games and just mope all day.

  47. Froztwolf says:

    I’m not sure I understand what the author is saying us game makers have a responsibility to do: Figure out whether games can cause depression? Admit it if evidence surfaces to show that they do? (None seems to exist, according to the article) Try to make all games in ways that help people identify and cure their own depression?

    The only one of these that is feasible is for game makers to admit it if research surfaces that shows that games cause depression. And if none such research does, what is there for us to do?

    Pathological behavior is always destructive, whether its pathological gaming, gambling, matchbook collecting, etc. and has little to do with the medium of the pathology.

  48. Aatch says:

    The “reason to be depressed” is actually a key part to understanding this.

    I make a distinction, there is being depressed, and then there is having depression.

    I have been depressed, most people get depressed one or more times in their lives. It’s normal, it’s natural. As long as you get over it.

    I have never had depression. Depression isn’t feeling sad, it’s feeling nothing. It’s a black hole of apathy and nihilism that sucks away at your soul. It is far more foul than being depressed precisely because you don’t have reason to feel that way. Depression makes you hate yourself for being depressed, then takes away the energy required to sustain that hate, so you are left just feeling sorry for yourself.

    That distinction is important. Having a reason is a lifeboat, it gives you something to hold onto and build on. Girl dumped you? It hurts, you get depressed, but you can focus on the reason and decide what to do about it. It’s not like that with depression. You wake up feeling terrible and have no idea why. You have no focus, you have nothing to steer you back towards normality. You don’t know how you got there, so you have no idea how to get back.