Repetitive Same Injury - How I fell out of love with video games and then learned to love them again

My so called MMO life

If you're a gamer, like me and you've been playing games for most of your youth and adult life, then chances are you have at one point suffered from wrist, finger or elbow pain caused by RSI (Repetitive Strain or Stress Injury). I had it so bad in 2005/2006 that I had to have intensive physiotherapy in an attempt to improve the mobility in my right hand. (And no it wasn't caused by you know what!) The problem was, I had a job that involved using a computer all day - I was a web designer - and when I used to go home in the evening, after 8 hours work, I would carry on using a computer while playing an MMO called Final Fantasy XI for another 5-6 hours. This was, as you can easily imagine, a recipe for disaster when it came to managing my physical health.

Any of you who have played MMO's for any length of time know just how strongly they rely on what I call cyclical mechanics. This basically means that you once you've levelled your character or avatar to a certain point and unlocked his or her main abilities you simply cycle through a set number of abilities which translate into key presses or controller button sequences. And you repeat this process. Over and over...and over..

In FFXI I would try to make things easier for myself by exploiting the game's very clever and efficient macro system which 'chained' all the component parts of my character's attacks or spells into one or two simple buttons on the controller. I would use a PS2 controller for FFXI and all my macros were stored on the L1 and R1 buttons which simply meant I pressed two or three buttons to access and execute them; either of the shoulder buttons to bring the list up and left or right on the D-pad then X to select them.

When I graduated from FFXI, I felt a sense of relief. The game had sucked me in for the best part of two years and I felt some regret about how much time I had dedicated to it. Regret and disappointment that I had lost the ability to recognise how much I had let it intrude and effectively dictate my leisure time. I used to chuckle at the warning the game displayed before it loaded up:

A Word to Our Players

Exploring Vana'diel is a thrilling experience.
During your time here, you will be able to talk, join,
and adventure with many other individuals in an experience
that is unique to online games.

That being said, we have no desire to see your real life
suffer as a consequence.
Don't forget your family, your friends, your school,
or your work.

And yet, I happily let it take over. I acquiesced to the game's horribly outdated design ethos - a leftover from Sony's popular MMO Everquest. This design ethos forced players to cooperate for long periods of time to achieve anything of note. In Everquest, you could spend 24 real life hours (yes real life hours) camping a remote spot on the game world map on the off chance that a rare dragon would spawn and on the even rarer chance that if it did appear and your group managed to claim it and beat it, you might have a 1% chance of getting some cool pixel based item to enhance your character. It was as if FFXI, looked to Everquest, adopted its difficulty and ludicrous time sinks and then took to punishing you for your mistakes. Everything in FFXI seemed to require a group of 5 or 6 players to traverse through dangerous areas where a wrong turn could mean death. And in the first few years of FFXI, death meant you lost experience points and, sometimes, your character could lose a level. And they had the cheek to put that warning on screen before loading up the game!

Instead of questioning whether it was right to invest all my spare time just so I could watch my virtual avatar grow just a little more attractive than the week before, I happily skipped through the tulips singing the praises of the game vigorously on internet forums. FFXI had this strange ability to garner fierce loyalty amongst its advocates. Probably because they knew how much time it demanded of them and they felt determined to justify to themselves why it was all worth it. I

So what does all that have to do with RSI and video games? Well, it's partly to give you some background as to what it was like playing an MMO that had such very demanding requirements. Often the game would create a lot of tension in me which probably caused me to grip my controller way too hard. I have heard people say that they felt that their relationship with FFXI was a complicated one. Some would even go as far as to say it was like a relationship with an abusive spouse. I don't know about that but so much of the game was incredibly tense, mostly because it required such a fine balance of mechanics for you to progress. Every party member had to be on the ball and know their job (as classes were known in the game) as well as possible. Useless, inexperienced members could be kicked out of groups and get a bad reputation on their server. This could sometimes mean they would struggle to get groups in the future although the nicer parties would stop and help less experienced players get better with advice and suggestions.

FFXI did have a very strong community because everything required such close cooperation. There was a sharing mentality. It has to be said, that of all the online games I have played over the years, FFXI had easily the best community of players I had come across. Square Enix, the game's publishers, built the foundations of the game on a strong sense of community. Players would help each other out, discover new mechanics or secrets and then share them with everyone else. It was something rare and of its time. Sure, there were 'difficult' players who didn't want to play ball but they were quickly weeded out. In general FFXI had a kind of 'pay it forward' mentality that meant people leaving the game would often happily give their high value gear away to friends or, sometimes, random players that they happened upon in the game's many starting areas.

The bite of RSI

FFXI contributed to my RSI because its long, demanding play sessions and cyclical mechanics would take its toll on me. One morning I woke up in a lot of pain and had to call in sick to work. My right elbow was sore and inflamed and there was intermittent shooting pains that extended from the middle of the ligaments on the top of my hand, up my forearm and could sometimes be felt past my elbow and behind the shoulder. I likened it at the time to feeling like I was a victim of a poisonous snake bite that was paralysing my arm. That’s what it really felt like.

I went to the doctor who signed me off work for a week and referred me to an excellent physiotherapist who gave me 5 free sessions that worked on massaging my arm, fingers and elbow, trying to loosen the two years of accumulated MMO tension! It helped a lot. As did careful management of both how long I used a computer for in a given day and stepping away from video games for a while.

MMO's I feel are a real problem for gamers. They start out as such a fun experience but can quite easily shift their perception in a gamer's head and suddenly they become too much like busy work. The strangely patronising design blueprints of the games don't help themselves at times because they will send players off on these ridiculous quests to fetch x amount of something arbitrary for the umpteenth time. When I moved from FFXI to World of Warcraft (WoW) I found myself both marvelling at the freedom - 'My God, you can actually do stuff in this game solo and progress! Not only that, you can travel everywhere and anywhere without some artificial quest related barrier to unlock first.' - but also drooling into my jumper and falling asleep at some of the banal, uninspired quests that gave scant regard to story and lore. I quickly realised this was a necessary evil and a result of Blizzard, the game’s creator, attempting to make the game appeal to as wide a demographic as possible, including those who didn’t really play many video games.

While it took a long time to work your way through FFXI's demanding main story or class related quests, when you did complete them you were rewarded with some truly stunning exposition cutscenes (Chains of Promathia anyone?). WoW was seriously lacking in this but it made up for it in lots of other ways. WoW, as I have said, was pure freedom. The problem with that was that this freedom meant I would play the game just as obssessively.

Even though I had taken a break from gaming, on medical advice for 6 weeks after the crippling attack that rendered my right arm useless, I soon found my way back. I began working my way through WoW with a female troll priest called Saraya. I also fell in love with PvP, especially battlegrounds and it was while grinding my way through the PvP ranks in Battlegrounds and the game's larger 40 v 40 zerg fests of modes like Alterac Valley that I felt the creeping doom of RSI clawing its way back in. You see, WoW wasn't a friendly game for RSI sufferers. It too relied on a cyclical series of standard attacks and key presses, only there were no real macros to help you - well, none that could easily be implemented. No, WoW relied on people taking advantage of its highly customisable UI instead, although its core mechanics boiled down to, in essence, either click an attack button with your mouse or press an assigned ability button on the keyboard. On the surface, this was a more simplified version of FFXI's interface. That required numerous button presses because it was hampered by a UI that was tied to the Playstation 2 version of the game. WoW was first and foremost a PC/Mac game so it was built around a mouse and keyboard. So, yes, on the surface WoW was easier to manage but there was something in me that found it difficult to adjust to just mechanically pressing keys on my keyboard. I seemed to masochistically and nonsensically like clicking abilities directly, which put just as much strain on my wrist as it meant 4-5 more hours a day of clicking a mouse. From web design to gaming.

How game design could help RSI sufferers

When I finally walked away from MMO's in 2007 after a second, ill fated return to FFXI, I did so having grudgingly accepted that I just couldn't really play games effectively anymore and still do my day job. I felt my gaming days were pretty much done. They weren't but I just couldn't see that at the time. Unfortunately, playing MMO's had systematically removed my enthusiasm for video games and flushed it down the toilet. What felt especially sad about this state of affairs was that I didn't really even see MMO's as proper video games anyway. They have some of the mechanics and design aesthetics of games but they are so watered down and simplified that they effectively become little more than glorified 3d chat rooms after a short while of playing and getting used to them.

RSI had provided the impetus to stop gaming and MMO's stripped my love for gaming away. Thankfully, this wasn't a permanent thing. Experience and management of my condition meant that I eventually returned to gaming properly in 2014, picked up a PS3 and a copy of The Last of Us and wondered why I had stayed away so long. Oh yeah, I remembered. It was because I couldn't do my job as a web developer and play games. My poor battered wrist couldn't manage it. Also, I was with a partner who didn't like games or see their value as entertainment. When I decided I could no longer work in the IT industry and my relationship fell by the wayside, I found a way back to games. But I have to be careful because I know, from experience, that I can only play for so long each day without feeling the consequences.

I also feel that game designers could do a lot more to help people with RSI who still want to play their games. Of course, not all games will be suitable anyway because they demand quick reactions as well as make you perform repetitive actions. Multiplayer shooters are a prime example of this and from my 2 months or so of playing Star Wars Battlefront, I realised that I couldn't kid myself about how effective I could be at that type of game. As much as I enjoyed it, I had to step away and realise that if I was to carry on gaming then I had to consciously manage my condition and play games that were a lot more suitable.

How I learned to love games all over again

The PS3 and games such as The Last of Us really reinvigorated my love of gaming. I saw how much the industry had evolved in terms of storytelling, narrative and mechanics. It was like my eyes had been opened all over again about the possibilities of gaming. Not only that, I found myself carving out a niche of games I knew I could manage and play in short spurts. The pause button became my new favourite way of saying stop, take a breather. Be mindful.

Maybe in future we will see games that are more mindful of RSI sufferers. There are heart warming stories of game companies such as Sony adapting controllers to accommodate people with certain disabilities, allowing them to play their favourite games that otherwise might be out of reach. So it is certainly not out of the realms of possibility that games might incorporate a simplified or adjusted set of mechanics or control systems into the heart of their games to aid RSI sufferers. Arguably some mobile games do this now by being very simple in nature to begin with and not requiring the mechanical press of a key or the click of a mouse.

In the meantime, there is a way to play your favourite games if you are an RSI sufferer. Be mindful. Manage and limit how often you use a computer or anything else that requires repetitive hand, wrist and elbow movements in a day. If you find it helps, use a gel support on a mousepad or a wrist support to cushion your ligaments.

And don't play MMO's. Really. Don't play them. Not only can they suck away your love of proper video games but they can chisel away at the raw edifice of your ability to do even the simplest tasks in life if you disregard how their droolingly stupifying mechanics can draw you in.

Video games are quite amazing really. You can genuinely fall in love with their worlds, their stories and the sheer satisfaction of getting to grips with their mechanics. You can do this by playing them, enjoying them and creating memorable moments with them. If you only play MMO's then, in my experience, you are in danger of arguing for the limitations of video games. And that doesn't help anyone in the long term.

Are video games finally starting to grow up?

If, like me, you've been playing video games for a long time then no doubt you have seen how impressively the industry has evolved from its very basic and rudimentary beginnings to the global, multi billion dollar behemoth industry it is today. Video games have become impressive, expensive spectacles and today's AAA titles cost many millions of dollars to develop, outstripping the budgets of some top Hollywood movie releases.

Whilst the technology involved in both playing and developing games has improved exponentially, for a long time gaming, as a leisure past time, was not 'mature' in terms of how willing it was to explore more universal themes that affect a lot of us in our everyday lives. The narrative structure and plot of many video games (if they even had a plot!), was usually incredibly basic and closely aligned to that of many popular fairy tales or children's stories. The reason for this is because, in the first 20-25 years of video gaming, children (between the ages of 7 and 16) were the primary consumers of games both in the Arcade and at home. Home games consoles such as the Nintendo NES and Sega Master System were popular in the 8 bit era and the Nintendo SNES and Sega Mega Drive (Genesis) ruled the roost in the 16 bit era. As is now commonly known, it wasn't until the release of Sony's PlayStation console in the West before gaming as a hobby started to be seen as 'cool' and 'acceptable' amongst older gamers (16-35 age group).

Interestingly enough, it seems that the popularity of gaming as a hobby in recent years is now most dominant in older adults. A 2014 study confirms this:

"The average age of someone who plays games is 31 years old. In fact, more gamers are over the age of 36 than between the ages of 18 to 35 or under the age of 18"
(Entertainment Software Association)

That is a surprising statistic - namely that there are more gamers over the age of 36 than under the age of 18. However, this may well be connected to the fact that games consoles are now more sophisticated and, subsequently, more expensive than they've ever been, so adults with a higher disposable income are more likely to own them.

Because of this trend in console gaming - something that is also somewhat true for the PC gaming market - there is an argument that this demographic are starting to demand something beyond the more traditional video game plot and narrative. In the video at the top of the page, I present the argument that gaming as a medium is starting to grow up and offer the older gamer a lot more. There is a willingness to go beyond the surface of character motivations and relationships in games, as well as a desire to expand the arena of subjects not normally covered in games. It is now not uncommon to find games that explore disability, discrimination, terminal illness, bullying, the list goes on. Whereas previously you would normally have to rely on television, cinema and literature to find these topics, it is arguably a welcome sign of maturity that we are now given the opportunity to explore these subjects in games as well.

Male Suicide: Why Men Need to Talk More about their Feelings

I find myself becoming increasingly upset with each story I read ,or that is relayed to me, regarding another male suicide victim. A couple of months ago, a good friend of mine told me how his step brother committed suicide out of the blue at the age of 45. On the surface, he seemed to have a life of abundance and happiness. He was financially secure with a good job, a wife and family that loved him and plenty of holidays abroad each year. Basically, he sounded like he had a lot in common with many men who have reached middle age in the west. Sadly, though, it wasn't just these surface things that he had in common with these men of a similar age. Just from speaking to my friend, it was clear that he was keeping a lot of his internal angst, strife and pain bottled up inside of him, not letting enough of it out to relieve the deep hurt and pain that was clearly eating away at him. While I do not pretend to have known him in any meaningful way - we met at my friend's wedding and shared a cab ride back to the hotel together - I can say that he was clearly in a lot of pain. Nobody commits suicide unless they are in a high degree of emotional (and sometimes physical) pain. What troubles me, is that this pain can be dealt with. But it requires the person to put their hand up and admit they need help in the first place. This is something I believe that men find especially hard to do.

So why is that? Why do men find it so difficult to ask for help? Well, we as a culture in the west seem to see it as a sign of weakness. I am not saying this idea is endemic in all parts of society but, when you consider how much of our values as individuals is handed down to us by generations of family members, then you can see why, for some vulnerable individuals, this can be a real problem. First of all, there is a culture in the UK that still persists to this day that used to be called "the stiff upper lip". It is the stupid, ingrained idea that men should put up and shut up. If you've got personal problems, are depressed or are struggling with how to express or handle the intense emotional difficulties you're experiencing, then the answer in this case seems to be - suck it up. Which basically equates to, stop complaining and get on with your life. This pathetic and deeply damaging attitude is synonymous with that hopelessly patronising platitude "Cheer Up! It might never happen". I don't know about you but anyone who has ever said that to me I have always wanted to universally punch into next week.

And that's coming from someone who is pretty much a pacifist.

This "Stiff Upper Lip" mentality is one of those that seems to have been accepted by large swathes of families who have passed it on as a key life value to their children, effectively damaging them by proxy emotionally. Why? Well, because you don't need to be a scientist or a doctor to know that if you constantly bottle up your emotions, especially feelings of sadness and anger, they are known to be contributing factors to crippling emotional and (sometimes) physical illnesses. Some cancers, for instance, are increasingly thought to be a product of repressed anger or emotional pain in more enlightened medical circles.

We are, each of us, different as individuals. While some may be able to cope with emotional difficulty because they have a strong, resilient character and the ability to switch off emotionally when they need to, others of us are not made this way and will be affected by their life experiences in a decidedly profound manner.

I think one of the saddest aspects of suicide that I hear with regards to male victims is this idea that they don't share how they are really feeling inside because they don't think they will be properly listened to or understood. If you join this together with the above mentioned cultural and generational aspects, as well as the often prevailing notion that men should always be the strong ones, then we are left with a depressingly dark picture of why so many men commit suicide. However, it really doesn't have to be this way.

When I was facing profound difficulty in my own life because of problems relating to addiction, I remember feeling that I didn't really want to reach out and ask for help - partly because I felt I was being a burden due to the nature of my own problem feeling self inflicted, but also because I was acutely aware of how I shouldn't have to ask for help as a man. Fortunately, I chose to listen to those people around me who showed me that I did deserve to receive help. We sometimes trip up as human beings and, when we do, we are fortunate that, in the wealthier western countries, there is a lot of (sometimes free) help out there. And it's out there precisely for that reason. I think the problem is that there is a big gap between the help that is available and convincing especially men that it is actually a sign of strength to reach out and ask for help, not weakness. While I am aware that the help available is often adequately advertised, the trick comes in convincing men, especially, to grasp it.

Let's think about that for a moment because it helps to deconstruct this very old, inaccurate view that men asking for help are eroding a sense of their own masculinity. If we try and look at ourselves holistically we realise that we are not robots as men. We are much more than the singular idea of masculinity that dominates certain cultural viewpoints of men. Human beings in general are physical, mental and emotional beings. And yet the emotional aspect of our make up is often overlooked and, at worse, sometimes ridiculed. I think this is slowly changing but unfortunately it's not changing enough to have permeated into the heart of society so men can feel more comfortable with the idea of themselves as emotional beings who can express themselves emotionally.

If men can accept the importance - or at least - relevance of the emotional aspect of their characters then they are much more likely to reach out and ask for help and, therefore, talk about the fact that they are struggling emotionally. I know from experience that when you do acknowledge how important it is to talk about your own, personal emotional strife and can share it with another, empathic person - professional or otherwise - it helps you at least come to terms with it. Sure, it may not necessarily make it easier to deal with in the short term but it can help put it into perspective more. That perspective can sometimes make a real difference because sometimes, our problems seem so insurmountable that they are like the Sword of Damocles, hanging by a thread over us and always a fraction away from completely overwhelming us.

Even if, by talking to someone about your problems you don't feel much relief in the short term, it can be an important first step in the process of healing. The more you share, the easier it becomes to sometimes find solutions that you might not have considered; something that can appear impossible if you are just running the same, damaging thoughts round and around inside your own head.

One of the most valuable growing experiences I have had, as a man, is by facing up to my own vulnerability and accepting it, I could be free to not only ask for help but also realise the importance of acknowledging both my feelings and my emotional side.

Give a voice to your anger and sadness as a man. Let this voice be heard by those that are able to really hear it empathically and reflect it back to you. In this process we are able to heal ourselves and, most importantly, this process can help prevent men who are suffering from thinking that the only way out of their pain is in suicide. Suicide is a permanent answer to a temporary problem. It may be a well worn phrase but it is also a very true one. We go through a lot of different phases of our lives as human beings, but our pain does not have to be a permanent truth, if we can learn the benefits of how to accept it and heal it.