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 (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."

Watch: Shooting the Truth (Whoomph)

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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Comments

[SkipRizzo]

07:07 PM on 07/30/2010

Part 2 to my comment:

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

[SkipRizzo]

07:03 PM on 07/30/2010

Hi Tom, I just saw this piece and the comments in response to your informativ­e article and just want to add a little something here. I developed the Virtual Iraq/Afgha­nistan exposure therapy system and have often times tried to explain the approach as a therapy tool for better delivering exposure therapy rather than as a "Game". I recently wrote an extensive "manifesto­" on the history, developmen­t and data from this project for Veteran's Today, in part due to some of the misconcept­ions that have arisen on this work. In that piece:

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.

[INDYSHOGUN]

08:56 AM on 06/30/2010

American Enterprise Institute - the far right-wing think tank that advised on policy during the Administra­tion of G.W. Bush from who President Obama inherited HIS WARS - spear headed efforts to downplay the impact of PTSD or combat stress. Their spokespers­on was Dr. Sally Satel, and Sally is the Mental Health profession­al the Bush administra­tion turned to for guidance on how to convince troops to return on multiple deployment­s if they were stressed out or not. Both Dr. Satel and the AEI promoted experiment­ation into virtual reality as a means to make troops immune (numb) to combat stress. Progressiv­e critics of this approach, both anti-war and true Mental Health profession­als viewed, and still do view, this approach as inhumane, punishing, and unethical as brain washing.

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.

[INDYSHOGUN]

08:45 AM on 06/30/2010

I did an article on Veterans Today News Network called Virtual Reality Combat Simulation­s as a Treatment for PTSD (http://www­.veteranst­oday.com/2­010/05/18/­dr-sally-s­atel-promo­tes-virtua­l-reality-­war-games-­as-a-treat­ment-for-p­tsd/)

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.

[INDYSHOGUN]

08:33 AM on 06/30/2010

The POINT I'm getting at Tom is that you do not paint a balanced picture but a biased account based on the views of only one authority you've interviewe­d.

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.

[Tom Matlack]

04:41 PM on 06/30/2010

"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."

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.

[INDYSHOGUN]

08:19 AM on 06/30/2010

"I actually don't have a point of view as to whether the use of remote technology during warfare is a good or bad thing."

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.

[Tom Matlack]

11:46 AM on 06/28/2010

Fein, I actually don't have a point of view as to whether the use of remote technology during warfare is a good or bad thing. My interview with Dr. Pollack was really about healing soldiers and PTSD. He mentioned the cases in which virtual intelligen­ce worked and I read the pieces on NYT. If they are wrong my apologies, but truly my focus in this short piece and the longer one I posted here http://scr­.bi/PTSDMP (which I suggest you read before criticizin­g me) is our fallen heroes and how to both get them to admit they have a problem and help them get better. I am not trying to address the validity of the war or how it is being carried out.

[Fein]

10:20 AM on 06/28/2010

Tom, details DO matter. First off, the civilians killed by the helicopter in Iraq weren't filmed by a 'drone'.
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.