06/28/2010 09:21 am ET | Updated Nov 17, 2011

War Games: Video at the Heart of Modern Warfare and the Attempt to Heal Our Modern Soldiers

Gamers in their twenties have taken center stage in the war on terror. In darkened rooms from California to Florida they control drone airplanes, monitor enemy conversations on the web, and communicate directly with troops on the front lines in Iraq and Afghanistan. Sometimes this works amazingly well -- like the successful invasion of Marja with minimal casualties in southern Afghanistan -- and sometimes it doesn't -- like the twenty-three civilians seen on a drone video camera who were killed in a helicopter attack in Afghanistan last February. But the lives at stake on these video screens are no game. They are flesh and blood.


The soldiers manning these screens have to endure war in living color; many are damaged by the experience. "There are about two million people who've served," according to Mark Pollack, MD, director of the Center for Anxiety and Traumatic Stress Disorders at Massachusetts General Hospital and the director of Home Base (, the partnership between MGH and the Red Sox Foundation dedicated to helping returning veterans with these injuries. "If 30 percent of people are affected by PTSD" -- post-traumatic stress disorder -- "or TBI, traumatic brain injury, that's about 600,000."

Gamer skills, it turns out, have a key role to play not only in fighting the wars in Iraq and Afghanistan but healing the wounded. At USC, at Emory, and now right here in Boston at MGH, doctors are perfecting the use of virtual reality to re-create the trauma that many soldiers can't access on their own but still plagues their civilian lives.

TBI is caused by repeated exposure to nearby explosives. "The symptoms include things like memory disturbance, dizziness, lightheadedness, a variety of physical symptoms -- stomach upset, lightheadedness, word-finding difficulties, depression, anxiety, irritability, those kinds of things," explains Pollack. "Often people who have traumatic explosions and stuff like that might both develop TBI because of the physical force of the blast, but also develop PTSD as a result of having been exposed to a near-death experience."

PTSD is created when a horrific experience -- having your Humvee blown apart by an IED, watching a comrade die, having to choose which child to save, to name a few real-life examples -- is lodged in the soldier's brain. It's a memory dysfunction that causes the soldier to repeatedly suffer from the recurring horror of being in that situation even though he is safely home. It can be triggered by a backfiring car or a familiar face or a boy with a backpack. This cycle can cause withdrawal from life as well as a kind of hyperarousal, since at some level the soldier has not left the battlefield.

The key to treating patients with PTSD is to get patients to re-experience the triggering situation in a way that allows them to realize that it happened in the past and they are now safe. "For some people, remembering what happened to them, or bringing it back up in their mind and talking about it, can be inordinately painful," says Dr. Pollack.

That's where highly advanced virtual reality programs like "Virtual Iraq" comes in.
Click to watch the video.

Says Dr. Pollack: "For those people, using a virtual reality, where they're surrounded, prevents them from avoiding thinking about it. The idea is to expose the person to what they're afraid of, and give them some tools for managing the arousal and anxiety. With repeated exposure, their fear tends to extinguish."


Not surprisingly, one of the biggest challenges with PTSD is the difficulty in getting men trained for their courage in battle to admit that they have a recurring problem. "The evidence is that probably less than half of people who are suffering with this are seeking any kind of treatment," reports Pollack. "That may be due to stigma around psychiatric issues. It may be a desire, in some cases, for people not want to get pulled away. Just last week we were in Walter Reed and saw some men who had been badly wounded, and they're anxious to go back. They certainly have enough injuries that they wouldn't have to, but they want to because their guys are still there."

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(Photos and SHOOTING THE TRUTH courtesy of Michael Kamber, The New York Times)