Virtual Healing: War Torn Teens Face Reality Post-Iraq Duty

virtual-iraq.jpgNov. 11, 2019 Veterans Day Update:

More new data on PTSD virtual healing with what’s called V-RET, virtual reality exposure therapy and some new VA data on accessibility issues in gaming that help vets heal as well as this specific post dating back on virtual reality being used in young soldiers with PTSD…

Also, adding some stats from today’s Twitter feed of Tim Fitzpatrick, CEO of Ikona Health, VR who cites this literature review from Mental Health and Family Medicine on The Effects of Virtual Reality on Mental Wellness: 

“20 percent of the 1.64 million US veterans who served in either Iraq or Afghanistan suffer from either major depression or post-traumatic stress disorder (PTSD)

19.5 percent of vets in these two categories have experienced a traumatic brain injury (TBI)

~50% of those who need treatment for these conditions seek it, but only slightly more than half who receive treatment get minimally adequate care.”

And finally, excellent points made in this MindShift feature on using virtual reality with children and adolescents.

As Stanford begins to explore the positive use of VR in psychiatry and educators begin to explore immersive journalism as empathy tools, one has to ask, if VR can help heal mental health problems, can it also help to create them? Hmn. Worth a ponder…research, anyone?

Nov. 11, 2015 Veteran’s Day: Adding new touchpoints on healing the war within, from the classic puzzle game Tetris to the role of veterans and videogames in Operation Supply Drop and this gamer’s lens about using gaming as a lifeline.

Also noteworthy in overcoming PTSD, the advancement of DOGS over drugs and my own post about award-winning kids’ literature created with an empathetic lens using the tale of a solider and his loyal service dog, in “Tuesday Tucks Me In.”

May 22, 2014 Update Since May is mental health month it’s apt to add this recent UCSF brain research “How Online Gaming Could Help Neuroscientists Research Most Troubling Brain Disorders”  as well as this Military Pathways recent post, “Can Video Games Help PTSD? and Science Daily’s “Using War Games to Treat Post-Traumatic Stress Disorder” and finally Using Virtual Reality Video Games to Treat PTSD.

Clearly I need to revisit this topic from scratch as so much has happened in a few short years…Colleagues, please add any links and research from your worlds to expound on this important conversation!

Original Post: As I said last year in my Memorial Day post, it’s odd that kids play online commando games with glamorized military might, without facing the very real toll that war takes on all sides…

Today we’ll exploring virtual world media simulations being used to help heal some of those wounds and scars.

From the psychological uses of immersive virtual worlds to Sesame Street Workshop’s TLC (Talk, Listen, Connect) dvd, tackling tough issues of war, media can be used pragmatically to help youth cope through adjustments of lost limbs and torn lives as a new generation of veterans emerge. (here’s an abc news video about their bold project, featuring the muppet Rosita)

Last time I gave you a glimpse into my own upbringing as a ‘global citizen’ and ‘military brat’ to zero in on kids’ confusion about the concept of Memorial Day vs. Veteran’s Day and the oxymoronic notion of using the word “happy” in either holiday context.

This Memorial Day, I’d like to look at ways we can HELP our civilization HEAL,using the power of media for positive change…(not about politics or candidates, capiche?)

flagphoto.jpgIn prior Shaping Youth posts on Memorial Day and on Veteran’s Day, I mentioned that kids often focus on the tidy 3-day holidays rather than a salute to soldiers that serve…So at the risk of fouling up folks’ ‘fun holiday plans’ I’m going to offer a bittersweet dose of meaningful reflection with a couple of caveats…

Since we’re a nonpartisan, nonpolitical, centrist little nonprofit, I’m going to beg ALL readers with vehement views about war and peace to ‘behave’ and self-rein with respectful input.

That’s right. Flamers and trolls are not invited to the ‘Q.

We’re ALL well aware there are very real wounds to kids’ blown apart psyches returning from Iraq, Afghanistan, and points hither and yon serving under the U.S. flag…we don’t need to compound them with inflammatory rhetoric. So here goes:

newyorker2.jpgSue Halpern’s New Yorker article of May 19th talks about the clinical trials of virtual worlds using “sights, sounds, even smells to evoke, and subdue, painful memories” of war in the annals of psychology section of the magazine.

Much of her insightful piece focuses on therapy potential for post-traumatic stress disorder (PTSD) in a computer-simulated environment, complete with 3D helmet head, video goggles, earphones and scent-producing machine. (sounds a bit surreal; like a mashup of Disney’s state of the art California Adventure orange fields and the rudimentary jungles, Hueys and hot zones of ‘virtual Vietnam’ which was tested 20 years after the fact, yet still had some healing PTSD effect…)

3d-visor.jpgSupposedly, the therapeutic Virtual Iraq is a modified version of the video game “Full Spectrum Warrior” being tested by the Department of Defense as one of three virtual-reality programs funded for PTSD and the ONLY one aimed at “ground pounders,” who have faced direct conflict resulting in flashbacks, depression, hyper-alert responses or withdrawal.

Paul Rieckhoff, the executive director of Iraq and Afghanistan Veterans of America, was quoted as saying,

Most PTSD therapies that we’ve seen don’t seem to be working, so what’s the harm in dedicating some money to R & D that might prove valuable?”

“We’re a video-game generation. It’s what we grew up on. So maybe we’ll respond to it…”

invisible-wounds-of-war.gifHis group also issued a lengthy mental health report called “The Invisible Wounds of War,” which cited research suggesting that “multiple tours and inadequate time at home between deployments increase rates of combat stress by 50%…

The New Yorker article reports that only prelim results are available so far, but it’s being tested in six locations, including the Naval Medical Center San Diego, Walter Reed Army Medical Center, in Washington, D.C., and Weill Cornell Medical College, in New York, and if clinically validated could be a big boost to encourage those in need to seek help.

Virtual worlds sure seem worth a solid shot as a healing institution.

second_life_logo.jpgSecond Life is one that has been known to give hospice patients the will to live, cancer survivors an important sense of community removing isolation and fear, and licensed psychologists have even set up cybertherapy offices for avatar appointments. (SL visuals here)

There are numerous virtual world successes ranging from SL lifesaving sims to therapy progress with Asperger’s syndrome, agorophobia, pain and burn therapy and cognitive-behavioral change…

This is all promising, and useful techno-news for 3D immersive worlds.

vw-wtc.jpgWhether it’s avoidance of towers and staircases from someone who has had to climb down the virtual World Trade Center umpteen flights, or a date rape flashback, the theory is to use virtual worlds to lessen the trauma by reliving the ordeal until it loses its heat.

As Halpern’s article describes, “Prolonged-exposure therapy, which falls under the rubric of C.B.T., is at once intuitively obvious and counterintuitive: it requires the patient to revisit and retell the story of the trauma over and over again and, through a psychological process called “habituation,” rid it of its overwhelming power. ”

“The idea is to disconnect the memory from the reactions to the memory, so that although the memory of the traumatic event remains, the everyday things that can trigger fear and panic, such as trash blowing across the interstate or a car backfiring–what psychologists refer to as cues–are restored to insignificance. The trauma thus becomes a discrete event, not a constant, self-replicating, encompassing condition.”

cybertherapy-sl.pngPersonally, if I’d had my keister fired upon umpteen times and watched my pals die, I think I’d still be pretty edgy even if I figured out how to reach a Zen-like state, on some virtual island in the most peaceful part of the SL grid, but hey, I’m not a psychologist nor a soldier, so I don’t get to vote. (that’s Dr. Kerley’s SL avatar, ‘Craig Kamenev’ at left, btw…)

Instead, I asked my friend Tom, an MSN and former Iraq/Desert Storm elite pararescue special forces PJ how he felt about the New Yorker article and the use of Virtual Iraq as a healing tool…(especially since he now works in a VA Hospital as a clinical simulations coordinator.)

Tom said, “Virtual worlds sound like a great step in the right direction. PTSD is a label, and as with most labels it identifies you as a ‘disorder or disease’ vs. an individual. Who would choose to have that occur to them? This is the greatest challenge; society categorizes you as mentally unfit, incapable, damaged goods once you allow for the powers that be to open that door and place your name on it.”

Bingo. Whether kids are ‘classified’ in school as ‘dyslexic, learning disabled, sensory impaired, ADHD’ or are 18-year old soldiers avoiding therapy, it’s still all about ‘stigma’ as archaic as it may be.

A recent study by the RAND Corporation revealed that nearly 20% of Iraq and Afghanistan war veterans suffer from PTSD or major depression but almost half won’t seek treatment.

Ironically, Tom’s concern is echoed by the young Marine in the article,

“I didn’t want to have it on my military record that I was crazy…Infantry is supposed to be the toughest of the tough. Even though there was no punishment for going to therapy, it was looked down upon and seen as weak. But V.R. sounded pretty cool. They hook you up to a machine and you play around like a video game.”

Halpern wrote, “Telling his buddies that he was going off to do V.R. was a lot easier than telling them he was seeing a shrink.”

As Neanderthal as this may sound, it’s remarkably common in some circles for therapy in its various forms to still carry some stigma.

secondlife-phobias.jpgSeems hard to fathom in this day of new media ‘transparency,’ media couch-show hosts, Dr. Phil, e-therapy, community forums and MySpace mind-meshing with people letting it all hang out in various virtual worlds…but okay, I’ll go with it…

All the more reason to validate virtual worlds as a positive testing ground for human behavior…from curing phobias to pathological afflictions.

If we can embed positive cues for kids and teens to learn ‘in-world’ why not try to push negative mental relays into remission to master a healthier worldview?

I realize this is starting to sound like Jim Carrey in the movie, “Eternal Sunshine of the Spotless Mind” but bear with me…

post-deployment-stress.jpgWe’ve got plenty of ‘walking wounded’ in numbed zombie states of avoidance, it seems like busting through the steel walls of compartmentalization might be a solid way to ‘work through it’ in virtual worlds and treat the whole human being…

Again. Not a shrink. Not a soldier. No rights for conjecture here…Just optimistic thinking about positive uses of technology and “serious games” with worthy outcomes.

Seems there are strong indications that virtual world PTSD therapy could have merit for video game-driven teens who left to serve in one frame of mind and came back in another…

Dr. JoAnn Difede, the director of the Program for Anxiety and Traumatic Stress Studies at Weill Cornell, helped create “Virtual WTC” along with the Virtual Vietnam developers. She explained that the idea is to disconnect the memory from the reactions to the memory, as the article said:

“Although the memory of the traumatic event remains, the everyday things that can trigger fear and panic, such as trash blowing across the interstate or a car backfiring–what psychologists refer to as cues–are restored to insignificance. The trauma thus becomes a discrete event, not a constant, self-replicating, encompassing condition.”

My VA pal, Tom summed, “In reality, PTSD is here to stay. We avoided it from the Nam era, and labeled most individuals as slackers, sponging off the system looking for a hand out vs. getting their act together and getting a job…Maybe for some situations it was true, but what about clinical cases pathologic in nature? Our screening process is a difficult one and needs further evaluation to help refine this…I’ve already seen it coming into the system, but it won’t really be visible until they separate from active duty in order to receive VA benefits. Active duty cases are required to be seen on bases with active duty staff, so I won’t see direct reverb for awhile.”

Sigh. Someday our planet will heal itself by learning that war is not a game…Meanwhile, let’s hope these clinical trials work wonders.From avatar language learning to virtual summer camps, jam sessions and rock bands, it’s amazing that we can now add virtual healing…May it prove to be deep and be real.

PTSD Defined: (From New Yorker article)

“What is PTSD? It’s been called battle fatigue, shell shock, and been recognized as an official medical condition since 1980, when it entered the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders as “post traumatic stress disorder” precipitated by any terrifying event or situation–war, a car accident, rape, planes crashing into the World Trade Center–characterized by nightmares, flashbacks, intrusive and uncontrollable thoughts, as well as by emotional detachment, numbness, jumpiness, anger, and avoidance.”

More Resources:

Virtual Reality Treatments for Post Traumatic Stress Disorder

Cornell University: Program for Anxiety & Trauma Stress Studies

Virtual Reality Exposure Therapy: WTC Report (7 pp. pdf)

Interactive Media Institute, San Diego, Virtual Healing, Designing Reality Paper

Center for Really Neat Research (seriously! check out this article on medicine meets VR for kids with disabilities)

RezEd: The Hub for Learning & Virtual Worlds (in beta; fabulous comunity of educators and innovators, highly recommend! -AJ)

More Resources for Familiestlc_elmo_and_rosita_long.jpg

Sesame Workshop’s TLC: Talk, Listen, Connect

Sesame Workshop’s Deployment, Homecoming, Changes
(videos, downloads, music, and materials on a wide range of topics, from prosthetics, wheelchairs and adjustments to the ‘new normal’ to behavioral angst and reuniting traumas)

Sesame Street Workshop: Talking to Kids About War

Elmo Helps Kids Deal With War

Politically Tickled Pink: Puppets Take on the Harsh Realities of War

Post Deployment Stress: What Families Should Know, What Families Can Do

Mental Health & Cognitive Needs of America’s Returning Veterans

Donna Musil’s documentary ‘Brats, Our Journey Home’

Editorial P.S.: The ‘Brats Journey’ film became a controversial Christmas conversation starter among our family as Kris Kristofferson’s raspy voice put forth the premise that even children ‘serve’ by de facto ‘duty.’ (trailer/clips here)

Every family will have a different ‘take’ on their own experiences, but I found it to be yet another productive use of media for opening a multi-generational dialog and touching some hot buttons. Next time, maybe we’ll convene in a virtual world…or make a cybertherapy appt. with Dr. Kerley in SL!

Visual Credits: Dr. Craig Kerley’s SL site, HITLab (Human Interface Technology Laboratory), Rand Corporate Publications Lead visual: The New Yorker; article by Sue Halpern



  1. Amy,

    What a great post. It’s cool that they are being more proactive and using technology to get past the macho attitudes around counseling.

    Keep up the good work.


  2. In light of the content of the post, I recognize the need to tread lightly. At the outset, allow me point out 2 of my uncles served in WW-II, one of whom went just shy of 4 years without a furlough, another uncle served in Korea, and that I am employed by a defense contractor; I am not ignorant of the military or the sacrifices surrounding those who are members.

    All of the technology and the like is fine, but I have to wonder what has changed in the American psyche over the last 60 years. Comedian George Carlin has written extensively on our use of euphemisms to make things seem softer, and hits the nail on the head with how the WW-I era ‘Shell Shock’ has evolved into ‘Post Traumatic Stress Disorder.’ Readers of the Tom Brokaw series of ‘Greatest Generation’ books will come away with how those WW-II vets never shared their experiences with their loved ones, whether they were heroic and celebratory or tragic and horrific.

    And yet, we’ve never heard of the fear and panic that many of today’s vets experienced (and those who have suffered other traumatic experiences) until after the Vietnam era.

    Recently, a group of high schoolers died in a weekend auto accident (speed and drinking were blamed). The following Monday, classes were canceled on account of counselors being called in to meet with anyone who felt they needed it.

    Kids in my class died when I was growing up, and under some pretty tragic situations, but we never held full-day counseling. In my sophomore year of high school I sat behind a guy in three classes who was shot and killed. The week following his death, his seat was left open; that Friday an assembly was held where he was remembered, and the following Monday I moved up one seat. The Guidance office was available, and for all I know students went to discuss their feelings, but there wasn’t a blanket approach. Are we over-compensating in meeting a need that may not exist?

    The questions that I believe needs to be asked: what is it we’re doing today that wasn’t being done 60 years ago? And for what reason are we doing it?

  3. Hi Charlie, figured I’d hear from you on this post! 😉

    First thing I’d answer is you might want to talk to Joe (above commenter) who works heavily with the Boys & Girls Clubs on a national level to see how ‘things have changed’ from 60 years ago coming from a youth perspective in the USA…

    Joe’s got a great leadership blog and can uncork the way things have changed significantly, particularly for the urban youth and ‘stoic’ psyche of what happens when kids ‘bottle up’ anger and trauma without an outlet to safely vent and emote, becoming hardened and desensitized which can zing out sideways toward society as a whole.

    To address your ’60 yrs’ question though, I’d say that warfare is no longer confined to adults, nor to war…

    There’s a scattershot approach and random feeling of safety being compromised that wasn’t there 60 years ago…whether it’s kids under siege in schools, via gang drive-bys/ neighborhood paybacks, road rage, or on the homefront for that matter. People aren’t ‘playing by the rules’ anymore…and that’s unsettling at best.

    This goes for war itself, as you know.

    In WWII allies were clearly defined, the goal was a united one, and there was clear conviction of purpose. By the Vietnam era, decision-making got squishy and surreal, not to mention the fact that MEDIA entered the scene, and started putting faces and personas to the formerly stoic battlefield of unreported horrors…

    Whether that’s a good or a bad thing, is like arguing the merits of Web 2.0 today. By its very existence its changed the world landscape forevermore…

    Similarly, we can’t compare schools of yesteryear to schools of today. Counseling/the guidance office no longer exists in most schools due to cutbacks, nor do school nurses, or anyone w/the clinical chops or licensed credentials to truly add value to a traumatized child; that’s all outsourced, and usually only brought in when there’s ‘an incident’ of some sort.

    In fact, I’ll make a sweeping generalization and say that kids don’t appear to have much confidence in the ‘external’ support systems they once had, turning to media as an influential ‘super peer’ both to process information and as a numbing agent…I have my own opinions on how THAT has fouled up the works in “over-compensating and meeting a need that may not exist” to be sure. (even seeding ideas that weren’t there before for the sake of drama/trauma ratings)

    And you’re right, I’m not seeing the ‘coping skills’ that kids ‘should’ have to thrive as resilient adults. I wrote about this a lot in this post here:

    As for Brokaw’s tome on the Greatest Generation, etc., yep, I’ve read the book too, lived the era via my parents with some of the most noble and honorable souls you’d ever want to meet (and yes, many were ‘military’ ones/pacifists to boot, which as you read in my prior post is NOT an oxymoron)

    But did keeping the cards close to the vest ‘help’ the development of those soldiers?

    Did keeping their experiences sealed off in crusty, ‘locked and hunkered down’ unavailable remoteness help the emotional landscape of those around them? Their children? Partner? Families? Their attachment with the larger world as a whole?

    There must be some ‘middle-ground’ between the pendulum swings of pent up trauma and blathering psychobabble where folks power whine every time they’re scarred by life’s nicks and cuts that many of us (and I may join you here) say, ‘get over yourself, buck up and deal’—

    Like you, I’m not a big fan of the collective sigh where ‘full day counseling’ is provided for pals of a kid that made a bad choice…If it were reframed in a preventive education capacity like the ‘energy drinks/alcohol’ deaths recently, an assembly makes more sense than a full school day, and carrying that conversation home to a caring adult, to ‘talk, listen and connect’ even moreso…

    So I hear what you’re saying…

    I don’t think coddling kids with over-amped drama to purge feelings that may not be there (e.g. students not directly impacted personally) equates to the horrors of war.

    But I do think the machismo underpinnings of stoic silence and ‘stuffing feelings’ hasn’t done males (or females) many favors. (either in the soul department of authenticity, OR in healthy relationship development!)

    There are somber lessons that can be learned upon quiet reflection and self-analysis as humans think hard about their decision-making…

    Ultimately, the goal is to explore ways to heal, be resilient and cope, and become whole human beings with empathy and emotion that’s REAL rather than emotional detachment, rote objectification and role play that could just as easily take place in a virtual reality or altered state rather than make a contribution to society as a whole.

    p.s. Cool organization here for kids’ mental processing, which may sound uber-intellectual and wonkish, but has roots in solid ground:

    Decision Education Foundation:

  4. Amy,

    As I am involved in Boy Scouts and Venture Crews (altho on the latter I am only on the fringe, as I intend on increasing my involvement in the next few years), I look forward to Joe’s insight and so will add his blog to my daily reads (here’s hoping his laptop issues are resolved soon!). DEF as well, thanks.

    I keep finding myself connecting the media bias of the what our military has done continuously

    We could debate how the allies in our current wars (or combined war effort) are, in fact, clearly defined – or Vietnam’s formerly stoic battlefield of unreported horror – if not for the over-the-top media bias, but that would probably send this thread into a debate way off-topic.

    Earlier I read your response and was thinking I would have to plead ignorance about the state of school guidance offices in 2008; my oldest boy, 12, is enrolled in a cyber school, and while he and every 6th grader has an online session with a guidance counselor 2x each month, I took it from your comment that may have been unusual. However I took the liberty of polling several boys aged 14-17 one night last week and found their brick-and-mortar school had guidance counselors with open-door policies. And school nurses. In a sad commentary, one boy told me, where else would I get my Ritalin?

    So while many schools may, indeed, lack guidance offices and nurses, that doesn’t appear to be the case, at least in my local, Pennsylvania school district (I could argue for hours about the wasted dollars in public education if, indeed, these important departments are being sacrificed in favor of wasteful spending, but again that would be off-topic). On the point that schools lack these resources, we will agree wholeheartedly.

    =Did [WW-II vets] keeping their experiences sealed off in crusty, ‘locked and hunkered down’ unavailable remoteness help the emotional landscape of those around them? Their children? Partner? Families? Their attachment with the larger world as a whole?=

    I’m inclined to say, for the majority of them, yes. Evidenced by their apparent healthy relationships. Yes, there are exceptions, but the majority of these greatest generations fell into their own support groups – VFWs, Elks/Moose/Other-Antler Clubs, church groups, the local bowling alley – and from these support centers they had the camaraderie and local contact that supported them and healed their wounds. Perhaps in the 21st Century these organizations wouldn’t be considered acceptable any longer, for whatever reason, and that may well be a big part of the recuperation problem Vets today face. Once again, the media can shape whether the public (and veterans) believe the soldiers are doing a noble job or are simply ‘baby killers’.

    Years ago, school assemblies near federal holidays used to feature soldiers/sailors/airmen/merchant mariners – veterans or active duty – who stood before the students in their uniform and spoke of their duty and service. Soldiers used to be thought of as men who have earned respect. Now, ROTC are all but banned from high school and college campuses, and the armed forces are often considered lucky if they’re able to have a table display at a local Fair. How are the youth served if their view of the military is confined to video games and media?

    =But I do think the machismo underpinnings of stoic silence and ‘stuffing feelings’ hasn’t done males (or females) many favors. (either in the soul department of authenticity, OR in healthy relationship development!)=

    While I am – far and away – not as heavily involved in this youth arena as you are, I am inclined to disagree with you on this point as well. I work with a Troop of Boy Scouts wherein several moms will protest to the leadership if their sons go camping when there’s even a chance of rain. I’m not talking about winter camping, either. Based on that limited subset of youth, when there is a problem with over-coddling on such a comparatively trivial issue, it isn’t difficult for me to assume an important issue (i.e. death) is handled in an equally over-bearing manner.

    We will agree on the common goal to make our youth more resilient and able to cope with life; we may have different views on how to get there, but fortunately there’s venues such as yours where these things can be discussed. And I thank you for allowing me this space, and I hope I haven’t gone against your ground rules for this post.

  5. Hi Amy! It’s really hard to cope with war-related psychological and psychiatric problems. I hope these boys get all the help they should have. Best regards.

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