focus-video-games – medhum.org

Forspoken – A Tale of Chronic Trauma

Dustin Brinker — Tue, 19 Aug 2025 13:10:29 +0000

Our first video game commentary begins with Forspoken, a 2023 open-world action role-playing game. For those not regularly interacting with video games, I assume that these terms mean little to you, so let’s take a moment to define them from my vantage. (Please note that I will hereafter refer to video games simply as “games,” unless specified for clarity.)

Let’s start back to front. First, role-playing. This likely brings to mind Dungeons and Dragons from 1974, a tabletop game that is, indeed, still wildly popular (and even used clinically in the psychotherapy space). While the games are similar, the term refers to something slightly different in video games. In both, you assume the role of a character and enact the narrative of that character; yet, in video games, you are most often playing a pre-set character with a relatively established narrative path using scripts provided for you instead of creating the scripts yourself. In Forspoken, you play as Alfre “Frey” Holland, a young adult woman who grew up in New York City. Her role, as we will discuss, involves being transported to an alternate medieval-esque world of magic and monsters, Athia, and discovering her connection to said world and its people. The role-playing element occurs as you vicariously live through Frey’s experiences in Athia.

Next, and probably most self-evident yet confusing, is the term “action.” You may be thinking, “Aren’t all video games action?” After all, are you not taking actions in Pac-man as you consume fruits and ghosts, or in Space Invaders when you move the cannon on the bottom of the screen and shoot the aliens? You’re absolutely right, but there are plenty of games that involve slow, careful deliberation. I won’t get into this too much, but I find the easiest way of thinking about this is the difference between soccer and chess. Forspoken is much more in the camp of soccer; you make in-the-moment decisions as you play as Frey. In this case, these actions are restricted to moving around the screen and fighting the aforementioned monsters. Paradoxically, other than progressing the game, these actions have no direct bearing on the narrative of Forspoken, merely on the elements surrounding the narrative. For example, a quest (i.e., a portion of the overall plot) could ask you to save the father of one of Frey’s new friends in the new world of Athia. You must then travel to the specified destination, locate her father, and fight monsters on the way using magic. While the contents of the quest (i.e., saving the father) are core elements of the overall plot, how you carry it out (e.g., what path you take, what monsters you fight) usually does not matter more than being a conduit for the action elements of the game. Essentially, action games are a test of hand-eye coordination, dexterity, and processing speed.

Finally, the term “open-world.” Games under this moniker allow players to take their character wherever they want in the game world. Traditionally, games followed a relatively constrained pattern––you could go only where the narrative was actively occurring. The open-world concept expanded this to allow players to explore areas other than those pertinent to the primary narrative. In the truest form, this allows players to access the entirety of the game’s area from the start. Most games, however, follow a variation of the traditional linear approach wherein new areas are locked by the progression of the main story but previous areas are accessible after they have first been explored. Forspoken follows this latter pattern. As you––Frey––complete the main story quests, you unlock new areas of the map. Subsequently, you unlock more powers that you can then use to more deeply explore the areas you’ve already been by accessing areas you could not get to without the new powers (e.g., the ability to cast water magic and glide on the surface of water). This game highlights a core element of video games, particularly in relation to other genres: the narrative is only one piece of the puzzle; some people mainly play for the story, others primarily enjoy the exploration and action, and the majority come for a combination of them all.

Forspoken combines these three elements––role playing, action, and open world––to immerse the player in a fast-paced journey through Athia and Frey’s place within it. After being transported to Athia from New York City, Frey gains the ability to use nature magic and discovers the last bastion of human civilization in Athia. Her original goal is to find a way back to New York, leading her to help locate key individuals who may help her do so. As she learns more about the land’s history and politics––particularly the landscape as influenced by a magical and biological blight she calls the Break––Frey becomes the target of the former, all-powerful leaders of the world, the Tantas. These four women were once the saviors of the land, protecting its people from all threats. Yet you learn that they seemingly lost their minds around the time the Break started to devour the people and landscape; the Tantas turned against their people, their benevolence morphing into tyranny. They remain in their respective domains while the Break consumes more and more of the landscape, invading the people’s last city at the center of the landmass. Frey appears to be the only one unaffected by the Break. As such, she assumes the begrudging role of exploring beyond the limits of the city to confront the “evil” Tantas. Without getting too caught up in the finer details of the story, you learn the cause of the Tantas’ madness as you defeat them one by one. Eventually, Frey must also confront the instigator of their insanity while questioning her own place in her original life and the new life thrust upon her.

As a psychiatrist and fantasy lover, I highly enjoyed this game, not only for its technical elements but also for its poignant examples of chronic and complex trauma. I’ll discuss three examples of trauma experienced by the following characters in the game: Frey, Athia’s populace, and the Tantas.

First, our main character. Frey’s life experience falls under the “prototypical” model of chronic, complex trauma. She is a woman of color who grew up in the New York City foster care system after being found by the Holland Tunnel as an infant. The story starts in a courthouse where Frey is undergoing a hearing for petty theft, apparently a repeat offense. We learn that she has been doing small-time criminal jobs to get by after aging out of the foster system. Just when she has amassed enough money to leave the city, the derelict apartment she’s squatting in gets set on fire by former criminal associates with a grudge. She escapes, but the fire engulfs her cash savings. With nowhere left to go, she wanders to the Holland Tunnel to sit with her sorrow. As her hopelessness seems to peak, she sees a golden armband in an abandoned shop window, and upon touching the armband, she is whisked to Athia against her will.

Frey has not had stability her entire life. Passed from family to family, she did not have a caregiver she could trust. She learned to take care of herself without relying on others, shunning––and, at times, backstabbing––all those who tried to get close to her. The feeling of abandonment from her family of origin colored all her interactions. She even believes that her world of origin abandoned her, stripping her of her future plans and allowing her to be shipped to a new world without any apparent means of returning. The people Frey meets in Athia initially serve only as a means of getting back to her world of origin. While she could be their protector, she vehemently resists this, at first covertly to delude those around her and then overtly as they expected more from her. Had Frey not been individually targeted by the Tantas, she would not have engaged in the plight of Athia’s people. She appeared selfish in her self-preservation, preventing these strangers from having the opportunity to hurt her. The narrative of the game is, in part, a restorative arc in which Frey learns to form stable, secure attachments, albeit through significant suffering. For example, Frey comes to trust the Athian governors, who initially jailed her and sought to kill her, after they gradually revealed their own trust in Frey’s ability to combat the Break. In a sense, Frey’s healing is the core of her hero’s journey. She saves the world, but only by confronting the recurrent scars left by the chronic trauma of her upbringing.

The surviving people of Athia experience a different form of trauma, more classically related to post-traumatic stress disorder (PTSD). In less than one generation, their entire world fell apart and their leaders turned against them. They had to fend for themselves to survive. They banded together as refugees against the onslaught of the Break––nearly the entire population lost their homes, families, and livelihoods. The Break spread from the coasts inward, pushing the surviving population to their last, central city. As the Break slowly encroached on society’s last home, they faced the potential for death with every passing day. Their fight-or-flight system could never shut off. The chronic, inescapable trauma wore on their minds, manifesting as complex PTSD for most––if not all––of the population. It re-shaped their worldview, affecting their relationships with themselves, with each other, and with their world. Despite Frey’s deus-ex-machina-esque appearance and resolution of the world’s conflict, the people must confront the terrors from their pasts to restore Athia. In this way, the populace of Forspoken embody chronic societal trauma.

Finally, the Tantas. Over the course of the game, you learn that these rulers had made a major sacrifice––they had to contain the power of an evil entity, a demon summoned by an enemy nation to destroy Athia. The Tantas defeated the demon and contained it, but the process of doing this split their attention, and, more importantly, the incessant voice of the entity in their heads poisoned their minds. The entity’s whispers forced the Tantas’ magic to run wild and uncontrolled, ultimately causing the Break. The Tantas’ trauma is thus twofold: the constant attacks on their consciousness by the entity, and the constant moral injury engendered by their actions. They sought to protect their people from the imminent threat of the entity but, in so doing, caused irreparable harm as this burden drove them to break from reality. Through these repeated traumas, the Tantas developed psychosis. This did not occur immediately. Rather, it took years of psychological trauma to culminate in their psychotic breaks, which was the ultimate goal of the entity. Just like the previous two examples, the Tantas could not escape. Only through their defeat by Frey could they find redemption and release.

As I hope these examples have demonstrated, trauma permeates Forspoken. This is not an uncommon motif in role-playing games; however, most games focus on singular traumatic events, more in the realm of classic PTSD. Forspoken shifts focus to the chronicity of trauma, highlighting the multi-faceted ways that trauma can occur. To the player, the trauma is understandable––if delivered in a stilted narrative at times––and allows for exploration of this concept in the safety of a magical world. Unlike the characters in the game, the player is empowered with the means of fighting against it, thus highlighting a critical element of trauma that leads to morbidity: the feeling of powerlessness.

To the astute player, Forspoken is as much a psychological case study as it is an enjoyable way to pass the time. You zoom around the map with fantastical power and control, all the while healing a trauma-scarred world and people. Forspoken comments on the richness of the human experience and is, without a doubt, a prime example of video games’ place as a health humanity.

The Remarkable Life of Ibelin

Dave Hsu — Thu, 17 Apr 2025 12:28:42 +0000

From Apollo on Call–a Medhum Podcast

Mats Sheen

The Remarkable Life of Ibelin is a 2024 documentary about the life of Mats Steen, a Norwegian man who died from complications of Duchenne Muscular Dystrophy. The movie explores how Mats, unbeknownst to the people around him, adopts a full online persona that allows him to experience the fullness of the human experience through a video game, experiences that were denied to him in the physical world because of his illness.

I grew up during the nascent age of video games and home computers. While our parents looked at computers as tools that might help us in the future, as children, we looked at computers mostly as a source of fun. We crowded around arcade machines at convenience stores and arcades, throwing away quarters until our pockets emptied. We congregated at our friends’ houses after school and on weekends, befriending whoever was fortunate enough to have a console or a computer powerful enough to support the latest graphics.

Mats’ online profile image (Ibelin)

Now though, as a parent and physician, my nostalgic view of video games is tempered by a mixture of skepticism and fear when it comes to games and internet technology. To hear the skeptics discuss it, video games are one of the root causes of the obesity epidemic, and online games and social media are part of the teen mental health crisis. Schools bring in experts to teach parents the perils of children spending time online while pediatricians pound out guidelines that describe “healthy limits on screen time.” 

This month, on Apollo On Call, we sit down to talk about video games and how there is another side to this narrative. We look at the story of Ibelin and talk about how video games may add to our lives in ways that many of us have never considered.

Thank you, Mats, for showing us a different way to think about the online world.

Luki and Dave

TRANSCRIPT FROM THIS EPISODE

A Missing Genre: Video Games in the Health Humanities

Dustin Brinker — Wed, 16 Apr 2025 12:58:45 +0000

Like all professions, medicine is not immune to social norms and biases that influence what are considered valid forms of knowledge, who are its purveyors, and through what formats it is communicated. To take an apolitical stance (if such a thing is possible), this piece calls attention to an aspect of the humanities––medical and otherwise––that has long been pushed to the fringes: video games.

Herein I argue not only that video games are an epistemically valid artform but also that the health humanities should actively incorporate them into critical discussions. As any diligent qualitative researcher would say, such arguments must position the writer, so I’ll begin by briefly describing how I came to this topic.

At the time of writing, I am a resident in psychiatry in New York City. I grew up and completed my formal education in the Middle Atlantic region, and video games have been a part of my life the entire way. As a child, I was fortunate enough to play both handheld (e.g., Nintendo Game Boy) and console (e.g., PlayStation) systems. I gravitated toward role-playing games (RPGs), those in which the player acts as a particular character to live through that character’s narrative (often a hero’s journey). I especially loved fantasy and science fiction RPGs, which mirrored my passions in literature. Aesthetically, they transported me to rich worlds with stunning visuals. Practically, they taught me skills I didn’t realize I was learning (e.g., map reading, orientation in a digital space, manual dexterity). Emotionally, they carried me through incredibly challenging moments, providing a mentally stimulating escape when my child and adolescent brain needed time to process.

Yet, I carried––and, at times, still carry––immense shame for video games’ presence in my life.

The messaging had always been clear: if you want to do nothing with your life, then go ahead and play video games in your parents’ basement. Whenever I heard this, I became smaller. Despite my life aspirations and dreams of being a physician, I couldn’t help remembering that I was indeed the child living in his parents’ basement playing video games. I felt I was one step away from failure at any moment. I still enjoyed my games immensely, but I constantly created timelines for when I would “give them up.” Video games became a vice, a tumor that I needed to excise lest it devour me.

But I couldn’t.

Every time I attempted to leave video games in my past, something brought them back: the newest installation in my favorite series, a need for variation in my leisure activities, an offer to play a collaborative game remotely with new friends, a need for active escape. Still, I kept it secret. I talked about it with my closest friends, but only if they too struggled with the same addiction.

Until one day I stopped. I made the active choice to talk about it with my peers, co-residents, and supervisors if it naturally presented itself. And, miraculously, the shame started to ease. I realized that video games nourish my life in ways that other activities do not. In some respects, they offer the narrative of literature, the visuals of movies, and the interactivity of board games all wrapped in one beautiful image. I started to question why I could spend countless hours reading or watching shows without concern but immediately felt guilty when I played a game. This piece, and subsequent series, seeks to challenge this socialized notion that video games are a waste of life force.

Just like other forms of media, video games both comment on and transform the human experience. Video games have expanded into innumerable genres and formats. Gone are the days when you needed a desktop computer or a gaming system to play; the size and pervasiveness of the mobile game market is near incomprehensible. Video games have become a part of mainstream culture. It’s time we change our viewpoint on them and treat them like the critical pieces of media they are. Through MedHum, we will join in rewriting this narrative, highlighting the value of video games within the health humanities. First on our docket is an open-world game called Forspoken, a game with a bit of controversy in its reception. Stay plugged in to read it soon!

Web image by Aditya Sethia

The Anxious Generation by Jonathan Haidt

Shawn Thomas — Tue, 07 Jan 2025 18:22:16 +0000

The world as we know it can be divided into two eras – before and after 2007. This was the year that Apple released the iPhone, a revolutionary computing device which harnessed immense computing power and the connectivity of the internet into a palm-sized gadget. Today, these devices and their associated software applications have become ubiquitous and have transformed the nature of life itself.

These changes have not all been for the better. Perhaps you have noticed such unsettling changes yourself. A child in a restaurant is glued to a tablet screen, probably the last resort of a weary parent trying to enjoy their first peaceful meal in days. A group of tourists in Paris marvels at the Eiffel Tower, not as it is, but as it appears through their phone camera and on their phone screen. Neighborhoods have become quieter and less lively, as children have retreated from the streets and hunkered down at home with their phones.

Jonathan Haidt, a social psychologist at the NYU Stern School of Business, elaborates upon these ideas in his book The Anxious Generation. In this book, he describes the dual trends of increasing smartphone/screen-based engagement, driven by perverse economic incentives of technology companies, and decreasing real-world, human-to-human play, driven by over-protection from modern parents. The collision of these forces has defined Gen Z, born between 1997 and 2012, as the most anxious and depressed generation of our time.

In the book, Haidt notes that the tactics of technology companies to drive increased user engagement have been well documented by activists such as Tristan Harris. Much like tobacco companies in the mid to late 20^th century, modern technology companies prey on young users (e.g. children) as a source of future/recurring revenue, and fight off consumer protections through aggressive lobbying campaigns at the government level. As a result, children are spending record numbers of hours on smartphones, increasingly isolated from the real world and irritable when deprived of their digital drugs. Haidt also observes that the technology problems of girls and boys are unique. For example, girls are significantly more prone to social media addiction and the associated psychological disturbances such as distorted body image and self-worth. On the other hand, boys are much more avid users of video games and pornography, which reduce their desire for real-world play and romantic relationships.

Haidt also notes that over a longer but overlapping time period, children have been overly protected from real-world responsibilities and real-world play. He attributes these new attitudes to the changing media landscape and how crimes are portrayed in the news, as well as legal challenges which have incentivized parental overprotection. In one example, he describes a pitiful incident in which an eight-year-old child was seen walking the streets alone, and a concerned passerby called the police to report an “abandoned child.” In this case and many others, parents have been held responsible for this absurd new “crime”, a sight which would have been entirely commonplace 30 years ago. Haidt highlights the irony of how the real-world, full of rich experiences, appropriate risk-taking, and character-building responsibilities has been overly regulated by our society, whereas the digital world, rife with dangers for growing adolescent minds, has been almost entirely unchecked, unregulated, and ignored.

Bringing people out of the digital world and into the real world is a formidable task. One strategy that Haidt found success with was to encourage people to reconnect with a sense of awe in the world. Awe is a vague concept, but can be defined as a feeling of wonder inspired by the sacred or sublime. The real world is full of such awe-inspiring moments, if only we could stop to notice them. In a comically simple exercise, Haidt encouraged students in his university course to take a walk through Manhattan without their phones or headphones, and then to write about their experience on this “awe walk.” The written reflections were so beautiful that he included excerpts of his students’ work in the book to illustrate how such simple measures could have such a profound impact. One such excerpt is reproduced below:

“It was a perfect April day when the cherry trees were in full bloom. I was so overwhelmed with how beautiful the park seemed in the spring, that I took time sitting on a bench, contemplating its beauty, and finding moral delight and affection to the people I see walking around, smiling at each of them as they look at me. “

For children who have no choice but to grow up in the digital era, Haidt attempts to boil his recommendations down into four rules for a healthier childhood:

No smartphones until high school.

No social media before the age of 16.

No phones in schools.

More independence, play, and responsibility in the real world.

He recognizes that while these solutions are simple, their implementation is anything but. As a society, we face a daunting collective action problem as it pertains to technology and real-world experiences. Such problems require collective solutions, and Haidt encourages parents to get together, organize, and raise their children together in a real-world oriented manner. While broader changes in school policy may seem out of reach, Haidt encourages struggling schools to get inspired by the numerous case studies of schools that went phone-free and experienced positive changes by almost every metric, within a matter of two to three years.

Some may say that our society is too far gone to reverse these negative changes, but this is certainly not the case. In fact, people are more skeptical now than ever of the negative role of technology in our lives, and collective action on this problem may be easier now than it ever has been before. As we sit perched on the precipice of a new technological revolution in artificial intelligence, this sentiment has already garnered potent opposition to unchecked technological advance and implementation. Will we learn from our past mistakes? Unfortunately, our track record is not encouraging. Only time will tell how far we go before we decide we need a detox.

The Anxious Generation
Jonathan Haidt
Penguin Press, New York City, March 26, 2024, 400 pages
Web Photo by Joel Fulgencio