Joshua woke up one morning two years ago with excruciating nausea. “It was waking me up at 4 or 5 in the morning,” the 16-year-old tells MEL. “The first time, it [went on for] like 34 days straight.” He was ill on and off for a year and a half. “I’d be sick for weeks at a time, and I couldn’t go to school for the first half of the day because I’d be sick.”
Doctors weren’t sure what was causing it. Finally, a pediatrician offered an explanation: anxiety. Feeling isolated, Joshua (a pseudonym) soon snowballed into depression. “At night, I would get to this super-low point,” he says. “I didn’t want to wake up the next morning and go through that whole sickness again.”
The only thing that made Joshua happy during this time was the video game Fortnite, the smash-hit online survival game. “I would take [an anti-nausea medication] in the morning, and then I’d play all day until probably 11, 12 at night,” he says. Fortnite sated Joshua’s need for a distraction from his constant sickness. He calls it his only outlet. “When you play video games, you’re forced to think about other stuff.”
Joshua is part of a growing trend of young people who turn to games like Fortnite during times of crisis. Reddit is littered with stories of gamers who say Fortnite saved them when they were at their lowest. “All I can say at this point is that when I feel lonely and depressed, I turn on my PS4 and play online, [and] the pain stops,” one Fortnite player tells MEL. “This game mentally saved me,” writes another. The players I spoke to for this piece say that the long hours they spend perfecting their strategies allowed them to redirect negative energy, and that they’ve found solace in the communities associated with these games.
But Fortnite isn’t therapy. In a country where one out of five adults with a mental illness reported being unable to receive the treatment they needed — and where the costs and stigma of therapy prevent many young men from seeking it — it’s a mixed blessing that people are turning to video games for mental health support. No game developer currently offers support — in-game or otherwise — for users struggling with mental health issues. (Epic Games, the developer of Fortnite, did not respond to requests for comment.) And, as I found talking about mental health with these players, over-relying on games to escape from “real life” is clearly a risk as well.
‘I Like to Win’
Virag Mody, 22, is one of 100 players flying over a massive map, looking for the most ideal place to drop into Fortnite Battle Royale, the most popular version of the game. He sees forest, desert and (in the most recent iteration of the game) tundra areas. He’s looking for a spot populated with enough “gear” — weapons, ammo and power-ups — but not swarming with other players. He glides down from the sky, makes landfall and quickly reconnoiters the area, scanning the horizon and listening intently.
Mody turned to Fortnite after a calamitous job change. He ended up giving up a stable, comfortable job — the kind he and his parents had had their eyes on since he was a teenager — in favor of starting his own company. Mody had struggled with depression before, but the stress and anxiety of making this decision hit him hard. “This is when I sort of started to relapse into depression,” he tells MEL in a video chat.
As his depression started to spiral, Mody found solace in Fortnite. “What draws me into video games is specifically the competitive multiplayer aspect of it,” Mody said. “I like to win. I like to outplay other individuals. I like to have strategies and tactics that prove to be a high-level skill. And you get that a lot with Fortnite because it is a fairly complex game.”
Dr. Isabela Granic, chair of the Developmental Psychopathology department at Radboud University in the Netherlands and director of the Games for Emotional and Mental Health Lab, underlines some of the cognitive benefits of playing games like Fortnite. “All sorts of cognitive flexibility measures are definitely improved in hardcore gamers,” Granic, mother to two Fortnite-loving 12-year-old boys, tells MEL in a video chat. “Things like being able to track a bunch of things and keep your attention focused while still being able to track spatially other things, [or] being able to reason and plan ahead of time while doing other things in real time.”
One X-factor in Fortnite is the building component. When you play, you feel kind of like the Master Builders from The Lego Movie, mining the surrounding environment for materials you can use to build structures. These let you reach otherwise inaccessible areas and, most importantly, defend yourself when you’re under attack. Players need to be able to throw up a quick barrier in just a couple of seconds — a “reflex as soon as you hear gunfire,” Polygon explains.
The other thing you should know about Fortnite is that it’s often blissfully quiet — not what you’d expect from a battle game. There are no throbbing action-movie strings, no chippy pop music. A good Fortnite player like Mody learns to find the breaks in the silence, the hacking of an ax on a tree that might signal they’re not alone. The difference between life or death in the game is what a player does in the second after he hears the sound of a nearby enemy. There’s no goal in Fortnite other than to stay alive.
Mody says he can feel the dopamine and serotonin release as he plays. “If you have a really good game where you feel engaged and everything is working out for you … that’s not a feeling that you really get anywhere else where you’re depressed.”
In some ways, the young men I spoke to were lucky. Three of them had worked with mental health professionals in some capacity, and they found the work they did in therapy to be helpful. They still needed an outlet.
Tyler Barstow, 31, co-founder of the music subscription service Vinyl Me, Please, dove into online games in the wake of his divorce. The split had unearthed previously untreated ADHD and depression, and Barstow was receiving eye-movement desensitization and reprocessing (EMDR) therapy in order to treat those conditions — as well as the trauma from the divorce. EMDR is a relatively new form of therapy in which the patient recalls disturbing images from their past while a therapist directs their eye movements. Barstow was doing EMDR twice a week. But it wasn’t enough.
“What people don’t tell you about divorce is the silence,” Barstow describes to MEL. “Your life stops. It was not possible to consciously walk around day-to-day and still function. It was a level of darkness that is hard for me to describe.”
In college, Barstow had dabbled in League of Legends — the multiplayer online battle arena game (MOBA) that boasts an estimated 100 million monthly players. Now, as things deteriorated at home, he searched for something to absorb his attention — and so he picked up the game again. Barstow describes the time he played League of Legends as “the only sane time of my day toward the end of my marriage.” He’d wake up at 5 a.m. and play League every morning before starting his day.
Barstow articulates his attempt to stay competitive in League like this: “Your brain is trying to solve a very complex problem. Each time, you’re chipping away at something.” For him, the game “was a really helpful way to redirect a lot of that energy.”
‘That Lovely Feeling of Being Connected to Someone’
One thing many people don’t understand about online games is how they strengthen real-life friendships. Tyler Barstow’s ideal evening, he says, is staying home with his roommate, drinking whiskey and watching his favorite League squad Team Liquid on Twitch. Joshua, the 16-year-old, tells MEL how Fortnite helped him reconnect with a friend from whom he’d drifted apart. “We’re literally best friends again,” he raves. “Literally, solely because of Fortnite.”
Ike (also a pseudonym), a 15-year-old, tells MEL that the ability to interact with people virtually on Fortnite has been a relief on his social anxiety. “I have troubles speaking with people more than most,” he says. “Like, I prefer not to order for myself at places.” He says he’s more comfortable in a world like Fortnite than he is with “real-life” interactions.
There’s psychological backup for the social benefits of these games. Dr. Granic said that online games like Fortnite provide “that lovely feeling of oxytocin and the feeling of being connected to somebody.”
In Fortnite, Virag Mody found a chance to get out of his bubble and interact with happy people. “Every so often you run into the individual who is really high energy, who’s funny, who makes you feel less anxious,” he says.
That’s part of the appeal for Fortnite players on Twitch, the Amazon-owned social streaming platform. “Each streamer has their own community,” Mody describes. You can passively watch the streamer play, you can engage in their Twitch chat and you can join their channel on Discord, a popular chat client favored by streamers. It’s a lot like pro-sports fandom: Watching a League stream on Twitch and second-screening on Discord feels like catching a baseball game at a bar and checking in with other baseball nerds on Twitter.
Fortnite streaming tends to be a positive place to hang out. Mody credits the Fortnite community with being far less toxic than other gaming communities, like League of Legends. There’s very little patience for cursing in Fortnite chats, Mody says, and he’s seen moderators and streamers temporarily or permanently ban users who swear. “People [who] got famous because of Fortnite have curated their language as well, so they stopped cursing.”
The players I spoke with say they weren’t really looking for help processing their issues. In their reckoning, playing a game of Fortnite while sad was like having a group of friends take you out to the bar after a breakup. Maybe you’ll talk about what happened, maybe you won’t. But having fun with people you like provides uplift on its own.
‘What Started as an Outlet Became a Crutch’
For these players, getting out of their everyday reality is part of the games’ appeal. “It is escapism, and there’s probably nothing wrong with that — up to a certain degree,” Granic says.
Most players are keenly aware of where that “certain degree” is, however. Joshua admits that playing Fortnite probably does isolate him and prevent him from keeping up with his schoolwork. Because of his illness, his school put Joshua on a flexible schedule where he can essentially choose to go to school when he wants. “[I’m] able to play video games all day rather than [do] work. Why wouldn’t you play video games?”
While Fortnite initially provided Virag Mody with a sense of calm and relief, eventually “it turned into a dangerous obsession,” he says. “There are days [when] I knew I wouldn’t need to interact with people. I wouldn’t shower, I would order food or not even eat if I could avoid it.”
“What started as an outlet for me became a crutch,” Mody adds.
While video games can be a refuge for those suffering from mental health issues, they’re not really a resource — and over-relying on games to escape from “real life” is clearly a risk. An organization like Dr. Granic’s GEMH Lab poses a unique question for the future of games like Fortnite and League of Legends: If players are turning to them in times of crisis, why not offer in-game resources for those players?
The Case for In-Game Intervention
Currently, there are no resources — in-game or otherwise — for players suffering with mental health issues. A player could technically report another player who, for instance, made a statement about harming themselves in a game, but the instrument in this case is rather blunt. I have no evidence that Epic Games or Riot Games (the developers of Fortnite and League of Legends, respectively) could do much other than ban the player. In my research, I found no game developer that offers these kinds of resources.
That is to say, there’s ample room for a pioneer in this space. “I have exactly the kinds of things they could use in their games, and it would not make their games any less awesome,” Dr. Granic says.
“You can have a side place where you go not to a therapist’s office but to another part of the game that’s super-cooperative and connected and does something different for just a little while,” she suggests. “I think there are lots of opportunities.” This kind of intervention could have a massive impact in a country like America, where tens of millions of people experience mental illness each year and many find treatment unavailable, inaccessible or unwelcome. The consequences of untreated mental illness can be extreme. Particularly alarming is the rising suicide rate, particularly among males. Meanwhile, Fortnite‘s reach is massive, boasting nearly 80 million players in August 2018, according to Epic Games.
Still, players with mental health issues say games like Fortnite and League of Legends are, for the most part, a positive force. Tyler Barstow says he wouldn’t be here without League of Legends. When he spoke with a recruiter at Riot Games (League‘s developer) about possibly going to work for the company, he says, she asked him why he wanted to work there. His answer was simple: “This game saved my life. … It just feels weird that I wouldn’t go help work on it.”
“That doesn’t sound weird at all,” he says she told him. “We hear stuff like this all the time.”