MMORPG’s in my personal experience are heavily derided as evil, highly addictive and without any redeeming features as far as the public and even veteran gamer perception.

I beg to differ, they do have their uses. I acknowledge they aren’t exactly a shining beacon of ideals, setting people on the path to recovery. They do however serve as a very resilient claw stabbed resolutely into the cliff face by the individual holding on for dear life as the storm buffers and beats trying to dislodge their hold.

I have found that they are a door left open where all others are locked. I have cared for individuals with acute mental illness who are gamers and those who are not. I can tell you that gamers have far more pins secured to the cliff face of life on which to grab hold and stop them falling than those who are not gamers. Even if one of them is MMORPG’s.

When an individual who is not a gamer experiences psychosis you really are locked out, there are very few if any ways to communicate with them around the symptoms until meds have done their work.

Not just a few periods of depression, waiting for crisis services to accept or reject triage assessments, waiting for the next visit to the psychiatrist or CAT team, have been ridden out in game environments, robotically completing daily quests by him. Crisis mental health periods for the acute mentally ill don’t last hours’, days, or even weeks. Average wait times are 6 weeks for crisis outpatient care, admissions are incredibly rare primarily due to a shortage of psychiatric beds. Referrals to specialists take multiple months. The most dominant event of the “episode” may be short lived and occasionally result in a 48-hour admission, but depressive episodes last months. Mania can last weeks to months. Recovery can take years, and can be a slow process where the goal for this week is to get out of bed and have a shower each day. He doesn’t join parties, he doesn’t join raids, and if he does he rage quits at the slightest provocation to return to his robotic grind. Yet he is happy to sit at the desk beside me for days on end, accepting meals, drinks, even medications when they are due. With little more interaction than a glance or a grunt.

He could be experiencing suicidal ideation, mania, depression, disassociation, mixed states, panic attacks, psychosis. Outwardly he is sitting in his chair tapping at his keyboard, his macro’s long in place to make grinding a simple 2 key affair… 1 1 tab 1 1 tab 1 1 tab 1 1 tab 1 1 1 1 1 1 … and 4 herds of mobs have been pulled, killed and are ready to loot.

The skinner box built into these games motivates him to get out of bed, one of the most difficult things for anyone to do when that unwell. He is upright. He is awake.

He may not be particularly effusive or communicative, but he is tolerating the presence of other people in the room, which is also an incredibly difficult thing for an individual this unwell to do.

He is in crisis, but he is not “at risk”, he is safe, he is eating even if he doesn’t take time to see what is on the fork, his basic needs are met, he is waiting.

He can see in the guild list that his friends are there, they are bantering in chat, he can engage in discussion or not as he sees fit. He does not feel alone; his friends are with him.

And even able to communicate, at times like these over the years we have found particularly if he is experiencing auditory hallucinations, I can’t sit down and speak to him face to face, the message is garbled by the voices he hears, which includes my own voice among the chorus. Instead we use which ever in game messaging system is available, text only, particularly if it can scroll back through the history.
The good thing is unlike actual messaging programs the discussion doesn’t hang around for years in archives to haunt him if he becomes fixated and reads through years of message archives from when he was sick.

When he logs out it is gone, while he is in game we can have a discussion. If he gets confused, he can scroll back to review what was said that the psychosis and hallucinations has less hold to derail communication. Being written both sides also have a chance to take a deep breath reread what they have written and try to make sure it can’t be misconstrued before hitting send.

If a person is trapped in addictive behaviours, something is wrong and it’s time to contact them. These behaviours can be harmful for an individual who is alone, is unsupported. In a time of crisis, they can be a safer place than a psychiatric ward, while help is obtained. Don’t pull the plug, leave the network cable where it is. Pulling that cord may sever the only potential connection you have. Sit down, join them in game. Extend a hand, ask them if they are ok. Many years ago, we had a guild called Terra Australis on Blackrock server, it was built of families, friends, social rather than hardcore gamers. Our motto was, The Family Who Games Together Stays together. It’s good to be a gamer.