This guest feature was written by Dr Neil R. Jeyasingam, Bsc(Med), MBBS, MBus, MPsych, Cert(Old Age), FRANZCP. He is a Psychiatrist, Psychotherapist, Philosopher and Player of Games. Buy his book (it’s pretty good!)
It was Super Mario Bros 2, World 4-1, when I had my first beneficial psychotic episode.
A lot of people get psychosis wrong. Whilst not many believe that schizophrenia is the same as multiple personality disorder, the term ‘psychosis’ is conflated with several other ideas. There is the sociopath in ‘Psycho’, so called because he is thought of as being a psychopath. For a very long time psychiatrists dealt with the amusing tendency of the general population to come up with their own mental health terms by simply dismissing them as not being real definitions – and then the Hare Psychopathy Checklist came along, and then discovered that it was actually pretty useful as a measure of dangerous social interpersonal deficits. News stories of incredibly aggressive individuals perpetuates the stigma that people with psychosis of any form are dangerous people who need to be locked up. This is, on one level at least true, as people who are acutely disturbed need to be protected and given a chance to safely recover, before they do something they regret. But it still brings us back to the idea that psychosis is a terrible, awful, bizarre and dangerous thing – at all times, and for all reasons.
What is psychosis?
If you try to look at mental health literature and understand what schizophrenia is, different sorts of terms start turning up – positive symptoms, negative symptoms, and then names of old dead (and therefore clever) psychiatrists like Schneider and Bleuler turn up. They can seem a mixed bag of descriptors for what is a single word. In fact current literature is a simplification of the older days – Bleuler needed 194 descriptors to define schizophrenia. But we can’t say that psychosis is the same as schizophrenia – because people with bipolar disorder can certainly develop psychotic symptoms – as can the depressed, and even severely anxious. So what is psychosis?
Psychosis refers to any experience or phenomenon that is not in synchrony with reality.
If you think that definition seems a little loose, it used to be worse. In 1841 when it was introduced by Canstatt, it was shorthand for any mental illness of any form. After we started to categorise mental illnesses, the popular dichotomy of mood versus psychosis started to turn up. There are still problems with diagnosis, and it can be hard to be clear one way or another what’s happening with someone, but although it can be messy at least it’s a little bit more organised than it used to. But having the concept of psychosis referring to anything that is out of touch with reality has an amazing number of repercussions. For example, it is perfectly possible to have a psychotic episode without having a mental illness – and pretty much everyone has.
Ever woken up or gone to sleep and, immediately at the boundary of consciousness heard a loud sound? Probably a hypnogogic or hypnopompic hallucination. Heard your name being called when out on the street? Still an auditory hallucination. Pulled a late night nonstop gaming session with energy drinks, and then suddenly had a vast deeper understanding of the game universe as a whole, realising how everything linked together in ways that your morning self found utterly bizarre (but still worth a Youtube rant or two)? Thought disorder, probably what would be called a ‘flight of ideas’ experience.
I hope, by the way, that I don’t need to point out that this does not suggest all psychotic episodes are normal.
But it does go part of the way to explaining why some people with serious mental illness try to avoid taking their medication. Unfortunately the sensations associated with psychosis can be very seductive, and medication aimed at bringing back reality can’t do the whole job, which is about creating a meaning in life. What I try to do with my patients is to find a balance in approach, so that they are able to maintain reasonable control of their thoughts, without being sedated and unable to enjoy life. It’s a difficult balance, but worth trying for.
So you might be thinking that I’m leading up a description of all videogaming as being psychotic episodes. And they’re not. You only get psychotic episodes from the good games.
Super Mario 2 starts already with a fairly bizarre gameworld, in which vegetables hidden underground can be newly plucked to be thrown at enemies wearing gas masks. Given the skill curve of most games of the time, however, you rapidly get used to this setting, with learning how to jump on enemies, and make your way to the right. Game starts at the left, obstacles are navigated, enemies defeated, and progression continues. Then World 4-1 occurs, where there’s an even bigger spike in difficulty with navigating fast-moving enemies on ice blocks. You eventually survive and get right at the end, where there is – nothing. A closed wall, the end of the road, and a few vegetable patches. It seems like there’s no way to progress, with no enemies to defeat, no ladders to climb. Then you try pulling up some of the grass patches on the floor, to discover a damn rocket ship blasting you to the next part of the level.
It happens without ceremony, without warning, without reason, and without explanation.
This, by the way, is a common thing that happens in gaming that is responsible for most of the truly great moments of gaming. The sweet spot where immersion in the experience of the game allows you to accept that these are the rules of the reality that is now inhabited, until the point when those rules are broken. The pervasive personal discomfort after the (temporary) loss of your silent protagonist avatar from Chrono Trigger. The unavoidable Call of Duty atomic blast, that exquisitely comments on the reality of the games’ reference material. The surprising glimpses of personality of your otherwise mindless killing machine avatar in Doom. Super Mario 3’s hidden exit, located behind the background scenery of the very first level.
One of Shigeru Miyamoto’s most endearing contribution to gaming was his intention to encourage people to see the world in different ways. His quote from Nintendo Power summarises one of the key differences between gaming and most other forms of entertainment:
“What if everything that you see, is more than what you see? The person next to you is a warrior and the space that appears empty is a door to another world? What if something appears that shouldn’t? You either dismiss it or accept that there is more to the world than you think. Perhaps it is really a doorway, and if you choose to go inside, you’ll find many unexpected things.”
And that is one of the great defining contributions of videogames to mental health – encouraging us to see the world, as perhaps not being the world that we think it is. To accept that the rules of reality are not quite as concrete as we think. The person who is our enemy today, could be our friend tomorrow. The job we think we have to have, perhaps may be just the stepping stone to something else. That there potentially is really such a thing as infinity. Edward De Bono popularised the concept as ‘lateral thinking’, but it really refers to ‘thinking with imagination’ – not accepting reality the way it is, and thinking that there may be more to it than we were previously aware. To lose touch with reality, in order to manage it even better. We all benefit by learning, occasionally, to think at right angles.
All things have to be in moderation.
As Sir Terry Pratchett once said, “Fantasy is like alcohol – too much of it is bad for you, a little makes the world a better place”. Untreated or undertreated schizophrenia can be fatal – or, even worse, not fatal, consigning the individual to a lifetime of pain. Living entirely in a world of videogames is to be deprived of the myriad other pleasures of life. But, in the middle is an amazing world. One where you can never be complacent, because every step brings newness to life.
So, for the sake of your mental health, please play your games. Make sure they’re good ones. And then walk outside, and have a check at what may be hidden under the grass.