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 (http://www.homebaseprogram.org), 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."
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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)
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Any gamer that has tried Virtual Iraq/Afghanistan is disappointed by the level of graphic realism compared to a 20million dollar budget video game and the fact that there is NO game interaction in the simulation. This can be actually seen in the comments by mostly gamers in response to a You Tube video called “Not a Game: Inside Virtual Iraq” which was posted by the author of an article that was published in The New Yorker magazine and that article presents a bit of history on the project, and you may perhaps want to check that out here: http://www.newyorker.com/reporting/2008/05/19/080519fa_fact_halpern.
So while the start of the work came from a game and uses game type software technology, it is a therapeutic simulation tool and is NOT A GAME. Those familiar with and who regularly play off-the-shelf war games should definitely see that. Also, while many Service Members play a lot of first person shooter war games like Call of Duty or Medal of Honor. The key here was to construct simulations, which while created digitally, do not have the features of a game, such as multiple lives, unlimited firepower, etc. Instead the aim is to put a user in a context that helps them to emotionally process very challenging traumatic memories.
Thanks for your effort in the above article, Dr. Pollack is an intelligent and very credible source to discuss these issues!
SkipRizzo
http://www.veteranstoday.com/2010/07/29/virtual-iraqafghanistan-and-how-it-is-helping-some-troops-and-vets-with-ptsd/
I make this distinction in the following manner: "The early development of the prototype of this therapy tool, Virtual Iraq/Afghanistan, did originally come from taking the graphic art from a section of the Xbox game, Full Spectrum Warrior. This was done since we had NO funding to start this project and needed a cheap way to start building the application in order to convince possible funders that this may be a useful method for treatment. Even then, the initial prototype was NOT a GAME. We used game-type software and some of the art from the game, but we created a treatment tool using those assets as a start point and have since replaced most everything in the VR simulation based on our experience with OEF/OIF experienced persons." See next comment for conclusion.
Not being a Mental Health professional myself, I'm not totally down on experimentation into virtual reality as one among many innovative approaches to treating PTSD or TBI, but rest assured it will NEVER be a cure, and I caution against it's manipulation and use by both DoD and the Department of Veterans Affairs to deny compensation for claims by troops and Veterans who do have the courage it takes to admit they have a problem to step forward.
I caution that DoD will use such treatment as a means to convince and encourage human beings with cognitive disorders to return to combat over and over and over again to continue avoiding asking for THE DRAFT.
We had been getting a lot of feedback both positive and negative on the Pentagon’s experimentation with Virtual Reality War Simulations as a treatment for PTSD.
Note Tom that experimentation like Virtual Iraq began within the Pentagon before being exported out into the Veterans' community. Did you know that the war game that is not a war game - Virtual Iraq, is based on the shoot um up wannabe killer war game Full Metal Warrior?
Despite my own personal bias against depending on this experiment due to the emphasis placed on Military Force Readiness, I personally want to approach this with an open mind, heck I’m a strong, passionate supporter of Assistance, Service, and Companion Dogs for Vets and Troops as a treatment for PTSD but not as an exclusive approach.
That said, not even the Pentagon is advocating the use of virtual reality combat simulations as the answer for PTSD, combat stress, or combat trauma but as a weapon in their arsenal for dealing with and helping troops cope with PTSD. After all the MISSION of military medicine is Force Readiness.
Ok, I know your article focuses on the outside use of treating Veterans and pray fully the goal is not to convince them to return to combat.
That said, I believe that articles such as yours and efforts such as Dr. Pollack (and yes I did read your other longer article) beat no discussion at all but said communication should be in the form of debate. Why?
For every doctor, Psychiatrist, or Psychologist you come up with endorsing this very limited, and experimental approach to treating PTSD and TBI, Tom you will find them outnumbered by critics in the medical and Mental Health community who have problems with this approach that have nothing to do with addressing the validity of the war or how it is being carried out.
Fein bring up some very intelligent counter-points, but I'd caution you taking them as constructive criticism not shooting from the hip criticism because Fein just may or may not be addressing the validity of the war(s) or how they are being carried out.
Instead of apologizing in the event your sources got it wrong, or as you said, "If they are wrong my apologies," the best approach would have been for you to do a more balanced piece reflecting the pros and cons of virtual reality and war games being used to treat Veterans with Mental Illness.
You could have found a professional with Dr. Pollacks credentials to provide a counter balance.
I am glad we agree on that much. I am not trying to present myself as an expert on this topic or present an exhaustive feature piece on it. I wrote a blog based on what I thought was an interesting conversation. As you note there is way more to it than that if one wanted to dig deeper and get a variety of points of view. My goal was not to be exhaustive but do an interview with one professional doing interesting work.
Tom, unless I'm missing something in your narrative, you come across leaning more toward the used of remote technology during warfare (something of which you must know a lot about, since you are a combat Veteran - or Veteran at all right?) the wording used in your narrative tends to lean a bit more toward it and war being a good thing. Since you've been there and done war, you should know.
Seriously Tom, and I quote:
- 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.
- the successful invasion of Marja with minimal casualties in southern Afghanistan
- 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.
- 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.
That was footage from the helicopter's gun cameras. Secondly, anyone paying attention knows that the 'invasion of Marjah' was a semi-successful PR stunt, not a military success. The rest of your article rambles through a comparison between reality vs. virtual reality, but does not make any coherent points. If you're saying that the use of virtual reality by the military is good, I'd have to counter that by pointing out that the 'videogame' images are used by the military killing machine to
intentionally detach the killers from the carnage and therefore, make it easier for the troops to kill and to ignore the 'collateral damage'. Of course, many will think that this is a good thing.