Video games and combat simulation programs are a promising therapy tool for veterans of all eras.
Dawn breaks over the village, which, like so many others you’ve seen this tour, is a collection of mud-brick buildings, dusty streets and small, white pickup trucks haphazardly parked on the road. You think to yourself, “Everyone in this region must be issued a white pickup truck.”
The quiet is broken by the occasional snapping sound of tattered clothes hanging from outdoor lines, fluttering in the low breeze. A dog barks. A goat bleats. You lead your fire team through the village; they each put their life in the hands of their buddy a few meters away. The team moves forward in a staggered wedge formation with each person on the alert for enemy threats in their assigned sector of fire.
SMACK! The entire team instinctively flinches at the sound. Some duck, others look for cover, and one starts to raise his weapon. Then the momentary adrenaline rush is over as quickly as it came. Your grenadier has just smacked an annoying desert fly against the back of his neck. He sheepishly mumbles an apology as the fire team moves out. You shake your head and take a deep breath, trying to force your heart rate down.
The chatter of gunfire erupts from what seems like all directions. The team begins to return fire at the muzzle flashes blinking in and out of the darkened buildings in front of you. You can actually hear the rounds getting closer. Then the screen flashes red.
Your character in this first-person shooter video game respawns as your friends, some miles away, are cackling at you in your headset. You swear revenge and attack the digital village again.
This make-believe scenario plays out in various forms every day. Millions of people around the world, including veterans and military personnel, relax by fighting a digital battle with high-definition graphics and realistic sound. But when players are “killed,” they reset and live to fight another day.
Video game technology has advanced exponentially over time. The simple joystick, one-button controllers of the 1980s have been replaced by multi-button consoles. Three-dimensional graphics and enhanced simulations provide players with heightened game experiences.
But this same technology that some service members and veterans call a “hobby,” others call “therapy.”
Military Members and Video Games
Hank Keirsey, a retired Army lieutenant colonel, master parachutist, Army Ranger and former West Point history and ethics professor, has lent his expertise to the “Call of Duty” (CoD) video game franchise as a military advisor and consultant. He was surprised at the number of active-duty personnel playing CoD while they were deployed in actual combat theaters.
“I’d go wandering off as an advisor to a general, and the soldiers didn’t care,” said Keirsey. “But when they found out I was involved with ‘Call of Duty,’ they’d stop me and tell me they had ideas for the next one. Those guys were playing these games while at a [forward operating base].”
But why would someone deployed in a combat zone take pleasure in a simulation of something that could happen for real? Keirsey has a few ideas. “I think the average Joe on patrol is ready for action but doesn’t normally see a lot of action,” Keirsey said. “There are countless days slogging through the streets, slogging through the sewage, sweating through your uniform while your brain is armed for a big fight but rarely do you get one.”
Keirsey believes the appeal of battlefield simulation stems from the fact that a service member can sit down in a lounge, under an air conditioner and, in a controlled environment, get hit, see a red flash across the screen and then get right back in the game. They can play out a variety of scenarios and not suffer actual bodily harm.
Retired Marine captain and California DAV Chapter 73 member Dale Dye agrees. “First-person shooter video games seem to be all the rage with the active-duty people I talk to about the subject,” he said. “There’s an element of challenge and personal accomplishment inherent in the form, and I think that appeals to military people for the same reasons that drove them to enlist. They want to test themselves, and I think that’s always healthy.”
Dye has been a military advisor for the “Medal of Honor” video game franchise, as well as an actor and advisor for more than 40 movies and TV shows, including “Platoon,” “Saving Private Ryan,” “The Great Raid” and “Band of Brothers.”
“Military-theme video games naturally emphasize constant combat, run-and-gun, shoot-and-scoot scenarios,” said Dye. “But anyone who has served realizes that kind of thing is only a small part of what you encounter in military service, if you encounter it at all.”
So do first-person shooter video games trivialize or make light of a veteran’s service? Keirsey said comments like that are, in his experience, usually from people who have never played the game or don’t like video games in the first place. He views games like CoD as an opportunity to tell the story of veterans through a different medium.
“I was reluctant to join [Activision] because I didn’t see the connection in video games making the next generation of centurions,” he said. “But, the modeling of the weapons, the uniforms…I saw this as an opportunity to teach history from the indirect approach. I’ve had 13-and 14-year-olds tell me they had no interest in World War II until playing this game.”
Keirsey has often been told how the previous CoD games in World War II settings have prompted young people to ask their relatives about their war experiences. “It’s opened the eyes of people who didn’t know what Normandy was, where Pointe du Hoc is or what the Big Red 1 was,” he said.
Dye has made similar observations. “In the original concept for the ‘Medal of Honor’ series, we intended to reward good play with lessons about World War II history. I’m a big fan of that kind of thing. We need to teach young people about America’s military history, and our schools are failing miserably in that regard.”
Video Game Technology and Treating Veterans
Moving a joystick and pressing a trigger on a digital battlefield can be more than just entertainment for some veterans. It can actually be a form of treatment. Dr. Kathleen M. Chard, a clinical psychologist with the PTSD and Anxiety Disorders Division at the Cincinnati VA medical center, has treated mental health disorders for more than 20 years. “It’s our hope that the current generation of veterans are comfortable and familiar with this type of technology,” Chard said. “We want to remove the stigma associated with seeking help. The goal of Virtual Reality Exposure (VRE) therapy is to help veterans process the traumatic memory so it no longer controls their life.”
The treatment procedure would be familiar to a veteran who has played a video game such as those in the CoD franchise. The patient is given a control stick similar to a joystick on a video game console. It’s connected to a weapon, a pair of virtual-reality glasses and headphones. There’s even a machine in the room that replicates smells familiar to this generation of veterans: the marketplace, burning fuel, explosives and gunfire. The goal is to recreate the scene of the traumatic event in painstakingly accurate detail to change the veteran’s perception of what happened.
“The VRE treatment allows us to trigger memories about the event to obtain the full story,” said Chard. “Once these memories are triggered, we can challenge those misperceptions in the veteran’s mind, including areas where they may be blaming themselves for things they could not have controlled or predicted.”
One symptom of PTSD is avoidance of the emotional state of the traumatic experience and emotional shutdown, out of fear of reliving the event. But Chard said experiencing emotions and moving forward are natural parts of life. “The virtual-reality technology allows us to put details in front of them and challenges the misperception the veteran may have about the event,” said Chard. “It allows them to process the emotion.”
The Veteran Connection
Keirsey believes first-person shooter games such as CoD can resonate with veterans. He said veterans and military personnel will be able to identify with many aspects of this year’s much anticipated title, “Call of Duty: Ghosts,” in which the United States is no longer a superpower but a mere shadow of its former self. A group of special operations forces from each branch of service form an elite unit to defend the homeland. “It’s a dystopian world,” Keirsey said of the new title. “We’re now the underdog, and bad things have happened.”
“Ghosts” involves brand-new types of scenarios and tactics to advance through the story. An interesting twist, which Keirsey believes will appeal to anyone who has served in uniform, is the emphasis on subunit integrity. “This is what you identify with,” he said. “You’ve got this guy on your left and right and your squad leader. You really learn about your squad and feel like you’re a member of a team.”
Dye said there seem to be two schools of thought among military people and veterans who play firstperson shooter games. One group tends to be service members whose jobs involve direct combat action and who find the game an entertaining distraction, as no one actually gets hurt, or worse, if they make a mistake. The other group has typically not engaged in direct combat, but they enjoy first-person shooter games because those are as close as they’ll get to combat. “I understand the motivations in both camps, and I don’t think there’s any harm in it,” he said.
Both Keirsey and Dye say that while the games should be considered authentic, they should never be called “real.” “We’re making a game,” said Keirsey. “This is entertainment; this is a gaming product.” He said games such as these can allow people who have never served to gain a small perception of what veterans have
“Less than one half of 1 percent of this generation have been in uniform,” he said. “You’ll find whole towns without a military family. I think one side effect of these games is that they can foster respect for people who’ve served. The product honored the folks who were out there. It made a gamer get a better idea of what a bad day in Fallujah would look like.”
However, Keirsey added that there is no way games such as those in the CoD franchise could depict what a veteran goes through in reality. “It’s not realistic,” he said. “There’s no sweat, no dirt, no waiting three to four weeks to cross the border. And no bad food.”
Dye agrees. He said gamers in uniform know the difference between a video game and the “real deal,” and the “morality” question of video games depicting military combat is certainly not a question to be asked of a video game producer.
“I don’t know if video games are the right place to teach young people about things like selfless service, sacrifice, dedication, patriotism and teamwork,” he said. “[It] seems to me those valuable things should be taught by parents in the family setting and then possibly reinforced by service in uniform.”
What is real, however, and arguably quite moral is that the technology found in video games is available to treat mental health disorders affecting so many veterans. Chard said that 70 percent of her patients using VRE therapy—most of them Vietnam veterans—no longer have PTSD symptoms after seven to 15 sessions. The remaining 30 percent show improvement.
“Whether you like video games or not, they have changed the way we communicate and can change how people perceive military service,” said National Adjutant Marc Burgess. “Dr. Chard and her team at the VA are seeing positive results stemming from a platform very familiar to many veterans. I encourage any veteran experiencing mental health issues to talk to their health care provider and explore all treatment options, including VRE.”