The New War on Terror

Specialist Hawker[1] was thirty-seven years old when he fell from the tower. He was a military policeman tasked with training the Iraqi Army, and had over a decade of service as a soldier. His introduction to the military was Desert Storm, which he spent guarding nuclear missiles in-theater when he was barely out of high school. Now, he was the oldest man in his company. He saw himself as a mentor figure, looking out for the younger guys, and avoided promotion to NCO in order to stay closer to them. His team usually rode front or rear truck in every convoy-the most dangerous positions-with Hawker riding the gun. The reasoning was that he was experienced, and wouldn’t get jumpy on the trigger.

“I Rambo’d,” he says. “I got up, ran to the wall and started letting loose with my weapon.” He doesn’t remember any of it.

The IED that hit him consisted of two 220mm mortars and fifty pounds of explosive. It tore through a set of T-walls and blew Hawker and his partner twenty feet out of the watchtower. He remembers a bright flash, followed by someone telling him to get down, but in-between those events, there’s a blank space. “I Rambo’d,” he says. “I got up, ran to the wall and started letting loose with my weapon.” He doesn’t remember any of it.

Three weeks later he was ordered back to the tower. His reaction was immediate. “I flipped out. I had a real fear of being in a confined space.” It was the first indication that Hawker had developed Post-Traumatic Stress Disorder. Regardless, he finished his tour.

During that time, he took two more blasts from roadside bombs.

Six months ago, Hawker returned to the tower again, but this time he did it in Battlefield: Bad Company 2. His goal in doing so is to confront his PTSD by simulating the event that still haunted him, and to a certain degree, it’s working. In fact, Hawker is joining a growing number of veterans who use game simulations, both officially and unofficially, to treat their trauma.

“When I came back, I wasn’t the same person,” Hawker recalls. “I mean completely different. I was reclusive. I was quiet. I’d get angry at nothing and get depressed because my job went away while I was gone.” He credits his wife with holding the family together. “A lot of families have disintegrated because of a deployment like that. Obviously my kids were confused and upset. My two year-old didn’t know me when I came home.” Hawker had flashbacks and nightmares, triggered by everyday occurrences like staying in an enclosed room or seeing sandy colors.

Due to his injuries, he was unable to take pleasure in the same activities. Before his deployment, Hawker collected Warhammer 40,000 miniatures and had won several painting competitions. However, after sustaining a Traumatic Brain Injury (TBI) , he’s lost his fine motor skills and can no longer paint. That’s only one in a laundry list of physical problems that changed his life: “The arches in my feet have collapsed because of the the weight of the armor, my neck is messed up, my lower back is messed up, my center of gravity is back 20 degrees and to the left 20 degrees, and one of the small bones in my right ear was destroyed, destroying my sense of balance, so I start to fall over if I close my eyes.” Art was out, and sports weren’t much of an option.

“I lost control of things that I used to be able to do, so I got back to doing one of the things I love, which is playing games.” A fan of the Battlefield series, Hawker picked up Bad Company 2 only to find that the demons of his waking mind bled through onto the screen. He was unable to play the Recon class, since sniping by nature necessitated sitting in watchtowers and holing up in small spaces, two things he found intolerable-and then there were the suicide bombers.

Every Battlefield player knows the trick. Get a Specialist to slap a handful of C-4 onto an APC, drive up next to the nearest tank, jump out, and trigger the bombs. It’s a normal part of play, considered almost daring and cheeky.

It would send Hawker into orbit. When he first came home, he’d rage quit when it happened. It reminded him of Ed Dominguez.

Hawker had flashbacks of the event, and lived with a deep sense of guilt that his team hadn’t arrived in time.

“Ed wasn’t in my squad, but I knew him, I talked to him. I wasn’t his best friend, but I wasn’t his worst friend,” recalls Hawker. PFC Dominguez was 19 years old when he set out in a patrol out of Baghdad, riding the gun of a Humvee. Dominguez’s column rolled up on an IED and radioed the rest of the unit that they were backing off the standard 300 meters, then there were two explosions. Hawker and his team rushed to respond, pushing through Baghdad traffic and screaming themselves hoarse. When they arrived, they found a mangled Humvee. The first IED had been a decoy to make the column back into the kill zone of a second device. It was bad. The driver had a concussion. The Track Commander had a piece of shrapnel on the inside of his head. The weapon mount Dominguez had manned was completely gone. “There was nothing left of the front shield, nothing left of the weapon, nothing left of Ed.”

Hawker had flashbacks of the event, and lived with a deep sense of guilt that his team hadn’t arrived in time to stop the blast. He knew the thoughts were irrational, that he couldn’t have prevented Dominguez’s death, but he couldn’t shake them.

He started seeing a VA counselor at the urgings of his wife and doctor, but found it difficult to talk about his experiences until the counselor began discussing the need to confront, rather than avoid, his fears and guilt. Gradually, it dawned on Hawker that he was already using videogames to face his psyche. As a supplement to his therapy, he turned to Battlefield, where he forced himself into direct contact with the situations he dreaded. “I had to build up to it. I had a real hard time with it, but I forced myself through.” He began to play as a sniper so he would be required to use towers, or stand with his face to a corner and ride out the anxiety of feeling confined. When APCs exploded from suicide bombs, he played through the flashbacks and tried to concentrate on winning the game. “It gives me a feeling of satisfaction, when I push through, it releases that tension, it desensitizes me to [the triggers].”

That feeling wouldn’t surprise Dr. Albert “Skip” Rizzo, a clinical psychologist and Associate Director for Medical Virtual Reality at USC’s Institute for Creative Technologies. In 2004, Rizzo read a disturbing report on the prevalence of PTSD among Iraq War veterans and began experimenting with using virtual reality as a tool in the therapist’s arsenal. The result is a program called Virtual Iraq, a full immersion simulator used to assist veterans with reliving, processing, and discussing their experiences.

PTSD, in simple terms, is a disorder caused by an event that inflicts such emotional trauma on the sufferer that normal trauma responses like anxiety, emotional numbing, and panic responses don’t fade away naturally like they should, and instead remain in the background ready to reemerge when stimulated by “triggers.” When a trigger stimulates the sufferer, they’re transported back to the event either emotionally or mentally, losing touch with the things happening around them. As a result, many sufferers both consciously and unconsciously avoid the stimuli, which further buries and exacerbates the disorder, often leading to depression and substance abuse. The goal of exposure therapy is to decouple the trigger from the negative associations it carries, reminding the patient that the traumatic event happened in a specific time and place and that they are no longer in danger. “Exposure therapy is based on meat and potatoes conditioning and learning theory,” explains Dr. Rizzo, “You’re confronting stimuli, whether it’s virtual stimuli or your own memory of the event, confronting it in a safe place so it no longer elicits a fear or anxiety response.”

Another important detail is that Virtual Iraq participants aren’t able to use weapons during the simulation.

To create Virtual Iraq, Rizzo modded the Xbox game Full Spectrum Warrior, which ICT created as a training tool for the Army in concert with Pandemic Games. To participate, a patient dons a set of VR goggles and holds a rifle, either standing if the simulation is a foot patrol, or sitting down if the scenario takes place in a convoy. A pair of headphones delivers the sound, and a subwoofer under the floorboards or seat provides the droning vibration of a Humvee engine or the thump of explosions. Therapists can even pump in smells like diesel oil, cordite, or burning rubber to help trigger memories.

The revolutionary element of Virtual Iraq is its incredible customization. After meeting with a patient and talking through their experience, a therapist can quickly tailor a simulation that takes the patient through a simulacrum of their own trauma memory. If, for example, a patient was driving a Humvee one night, passed a dead dog, and suddenly came under fire from a sniper that killed his passenger, a therapist could craft that chain of events down to the dead dog. “We can manipulate an IED going off, a jet flying overhead, an RPG firing off a roof, the time of day, the conditions,” says Rizzo, “you then ask the patient to recount their trauma narrative and tell their story as if it’s happening right there in the first person.” During the experience, the therapist talks the patient through, warning him of each upcoming event before it happens and gradating their experience so that the simulation stimulates enough anxiety for the exposure to be effective, but not enough to overwhelm the patient. Elements are usually added one at a time-first the simulation will only be visual, then when the patient is ready, they add audio, eventually moving onto tactile and olfactory stimuli. Reenacting the trauma over and over, as well as reframing and discussing it in traditional talk therapy afterward, eventually erases the fear and negative emotions associated with the experience. The goal of ridding the patient of symptoms, or “extinction” as Dr. Rizzo calls it, is actually accomplished through talk therapy, but Virtual Iraq can help PTSD sufferers gain leverage and provoke the discussion.

Another important detail is that Virtual Iraq participants aren’t able to use weapons during the simulation. The point of the therapy is to explore and come to terms with traumatic memories, not vent aggression on them and try to change their outcome. Dr. Rizzo points out this fact when discussing the sort of informal self-treatment taken on by veterans like Hawker: “If somebody claims they got some benefit from [playing games] and there’s something measurable that documents that, then I would say, ‘Well, you know, that may be something.’ Perhaps when playing a game they’re getting sensory stimuli and confronting anxieties, but I wouldn’t recommend that as a ‘treat yourself’ option. The problem is that with some patients, they might see that and freak out, or they might not arise any of the anxiety because it’s a game where they foster a sort of revenge fantasy. Maybe [playing games] will help them a little bit, but if they’re still having problems, the best bet is a professional.”

When I ask Hawker if he believes that playing military games has helped him, he answers, “In some respects yes, in some respects no.” He’s seen an improvement since he began facing his trauma in virtual space; he’s become better at coping with triggers, which still occur, but are less intense. He has fewer nightmares. He doesn’t solely attribute his recovery to his activities in-game, but feels that it plays an important role along with talk therapy and medication. “It’s gonna be a long process,” he says, “I still can’t get myself to be that suicide bomber in the truck, I just can’t do it, but I can sit and watch it and laugh about it now-the more I saw it, the more I processed it, the more I played, the more it just became part of the game. It allows me to talk about it, which is what I really need to be able to do.”

For those that complete the program, Virtual Iraq has around an 80% success rate.

His counselor has been urging him to try Virtual Iraq, but he remains skeptical. “I’ve been balking at it because the things I saw over there I don’t want to relive, but I relive them every day. I like Battlefield, since I can do it on my own terms.”

This reluctance is something Dr. Rizzo has struggled with. Getting patients to agree to the treatment and consistently show up for appointments has been an ongoing challenge, but for those that complete the program, Virtual Iraq has around an 80% success rate for eliminating all symptoms of PTSD within six weeks. Regardless, mental health disorders are still heavily stigmatized in the military community, and dropout rates remain high. However, the program has been successful enough that the government has provided pilot funding so that Virtual Iraq can be rebuilt on the Unity Engine, in order to add customizable elements that make it relevant to veterans of Afghanistan, as well as members of the Air Force. Dr. Rizzo is also in the planning stages of retooling the simulator to create a training program troops experience before they deploy overseas. The idea is to use the program as both a standard introduction to coping strategies before combat, and a normal part of debriefing after returning from deployment, rather than something troops are assigned to after being diagnosed-hopefully removing the stigma. “The mission here is to do this on the front end,” says Dr. Rizzo. “Then perhaps we can lower the PTSD rate in the first place. This is one area where we can say with a straight face that it really does work. People achieve benefit if they stick with the exposure approach.”

Thankfully his message seems to be getting through to a military establishment increasingly alarmed by the psychological toll asymmetrical warfare and multiple deployments are taking on its troops. It is difficult to obtain hard data about PTSD rates due to underreportage and delayed affects, but ten years after September 11th, some studies indicate that up to 35% of veterans may be fighting a personal war on terror.

Hawker plans to continue going it alone in the virtual warzone, “I can honestly say that playing videogames has helped, it’s not going to work for everybody, but it’s worked for me. It allows me to express my sorrow, and my pain, and my guilt. If there’s veterans out there that haven’t gotten help in some way, they need to deal with it. Drinking and doing drugs is not going to make this go away. Whether they realize it or not, everybody that’s been there has some form of PTSD. They need to reach out to the VA, or a counselor, IAVA, VFW, American Legion, they have people that understand. You’ll always be able to understand a vet before you understand a civilian.”

Robert Rath is a freelance writer living in Austin, Texas. The Iraq and Afghanistan Veterans of America (www.iava.org), a nonpartisan nonprofit group, provided veteran interviews for this article. If you are a veteran of the wars in Iraq and Afghanistan, the IAVA can provide resources and advocacy to assist you and your family.