# Mental Illness

LLMS index: [llms.txt](/dvw/en/llms.txt)

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This is more of a game management thing, but I thought I should mention it here because it does impact on designers.

Some players really are crazy. If you accept that the word “crazy” can be applied to an individual, then statistically some crazy people will play virtual worlds. A user base the size of EverQuest’s will include several bona fide psychopaths. That’s assuming that virtual worlds mirror the general population: It could be, for example, that the nature of these worlds is such that fewer crazy people play them. Alternatively, they could act as magnets. I suspect the latter

I’m aware that the word “crazy” is emotive; I used it here to make a point. Most of the people who suffer from various forms of mental illness are not crazy by any definition of the word. Some, however, are—dangerously so. What does your virtual world say to them? Are you responsible if they take what it says to heart?

The “crazy people” quandary is not unique to virtual worlds. Film, television, and computer games all suffer from the same problem. If you dramatize a killing spree, there is a possibility that it could inspire a seriously disturbed person to go on an actual killing spree. Where virtual worlds are unique is that they blur the boundaries between fantasy and reality until the two become one and the same. For someone who may have difficulty separating reality from fantasy at the best of times, this could prove too much. In such circumstances, can virtual world designers still hide behind the “you can’t legislate for crazy people” argument? If not, how could virtual worlds as an industry ever be viable?

Most mentally ill people who play virtual worlds are not, fortunately, crazy. They may have serious issues, and could even be a danger to themselves [^17], but they will listen to reason.

System administrators accept a duty of care for players while they are in their virtual world, and if it is apparent that someone is behaving worryingly oddly then it could be best for them to be barred entry. Of course, this could well make the individual’s problems worse, so it’s always wise to seek external advice first if possible. I’ve only ever had to do this twice (once with MUD1, once with MUD2), but for large-scale games it’s going to happen more often.

Designers of small-scale virtual worlds who are panicking at having just read this can probably calm down. I can’t comment on the legal issues, but from an ethical point of view you’re on solid ground as long as you act in good faith. If you see that someone needs help, and you give what you (or any reasonable person in your position would) believe to be help, then you can’t be expected to do more. The alternative is to do nothing, which may be the legally sensible position, but it’ll feel worse if something awful does happen.

There is ample anecdotal evidence that virtual worlds can help with certain kinds of psychological problems. Sometimes, they merely make life easier—an agoraphobic may not be cured of their fear by playing a virtual world, but at least they “get out” a little. It’s the same as with many physical disorders: You can play a virtual world with both legs in plaster. More interestingly, though, are situations where people use virtual worlds to work through personality problems and come out “cured.” I know of no formal medical studies of this phenomenon, but I’m convinced it happens. Whether designers can claim any responsibility for effecting such changes is another matter, of course; I suspect it’s more to do with the fundamental nature of virtual worlds, rather than anything value-added by designers. That said, it’s perfectly feasible for designers to remove this therapeutic value by interfering with the way players progress; it’s obvious, for example, that any self-

realization that comes from completing a hero’s journey is not going to happen if the designer never lets anyone finish.

Tempting though it is to feel all warm inside about how virtual worlds can help people with mental illness, there is another side to the coin. If we accept that virtual worlds can have tangible positive effects on the minds of players, then shouldn’t we also accept that they can have tangible negative effects, too? Could they make someone’s condition worse? Or could they give someone a problem who wouldn’t have had it otherwise?

The answer to the first question is yes; we saw this in the Chapter 6 discussion concerning psychology and virtual worlds. People can relive the same issues the same way time and time again, hardening their views rather than changing them. In most cases this is unfortunate, and it means they’re not going to get anything out of the virtual world; for the mentally ill, it could be beyond unfortunate and make their situation worse. If this happens, then it’s time for the player to seek professional help. Normally it would be the player’s friends who raised the alarm, but it could be the live team who has to deal with making the real-life phone calls to find out what the best response is.

On the whole, I believe that many more people benefit from playing virtual worlds than suffer, but then I’m a virtual world designer so it’s not like I’m going to say otherwise.

The second question—whether virtual worlds can cause mental problems—is very disquieting. It is almost certain that the intense experiences that virtual worlds are capable of delivering will push some people over the edge. They may develop anxiety attacks, delusions, fears of persecution—pretty well anything. The virtual world acts as a trigger. The crucial point is whether this is something that would probably have happened anyway, or whether it was induced by the virtual world?

The standard defense, used in many industries, is that some people are predisposed to this kind of thing and you can’t blame the author, composer, artist, director, or news editor whose work tipped the balance. Virtual world designers could argue this too. However, it’s not quite that simple. Virtual worlds have a strong psychological element to their design. Could it be that with their huge capacity to promote introspection they might cause some people to become neurotic or worse when no other everyday experience would? I’m not suggesting that designers would attempt such a thing deliberately, but that’s not to say it couldn’t happen by accident.

If it did, this would be cause for concern. There would be a danger to playing virtual worlds that was not associated with any other leisure-time activity.

It’s impossible to gauge the possible extent of the problem without a formal study. However, given that anecdotally it’s difficult to say whether it happens at all, the incidence is likely to be low. It’s also quite likely that obsessive behavior will be picked up by friends or the live team before things come to a head, and that any potential catastrophe can therefore be averted. Designers of small-scale worlds where everyone knows everyone else can therefore probably rest easy. Designers of large-scale worlds can also probably do so if the mechanisms are in place for detection and prevention.

Virtual worlds with mental healthcare schemes? It could happen.


[^17]: Over the years, even MUD2 (which isn’t exactly large) has seen two suicides and at least one attempted suicide among its player base.