Unplanned Obsolescence: Rethinking Play Therapy

Recently I ordered a copy of Call Of Duty: Modern Warfare 3, which I plan to try this week.  As I have mentioned in a previous post, I am not easily interested by first-person shooters, but as a gamer-affirmative therapist I can’t let my low interest get in the way of educating myself.

I once calculated that by a conservative estimate I had played approximately 27,000 games of Uno in my decade working in a public school as a clinical social worker.  I drove around with a ton of board games and a sand tray as well.  I had learned the value of play therapy at the first placement I ever had as an intern, from Winnicott’s squiggle game to the infamous Talking, Feeling, Doing Game.  This is all a roundabout way of establishing my “street cred” for valuing play therapy.

Back then, I would go home from work, and many times play Legend of Zelda: Majora’s Mask on the Nintendo 64.  My roommate at the time liked to hang out with me while I played and we chatted about life, education (he was a teacher) and politics.  He also liked to imitate the fairy guide in the game, and would often cry out, “Listen!” and offer a couple of tips.

In all those years, it never occurred to me that I could have played those games at school if I’d had an office (and some years I did) or that there was a disconnect between what I was doing with the students (card playing) and what they were talking about (Nintendo, XBox, Playstation.)  I could hold a conversation with them about these things because I played them in my spare time, but the idea of playing them with my students didn’t register as, well, therapeutic.

I am not alone in this.  Many if not most play therapists are not inclined to play video games with their patients, and it is time to rethink this.  When 97% of the boys and 94% of the girls we work with play video games, it is no longer an outlier.  But there are a few fallacies which I think get in the way of play therapists integrating play therapy into the 21st century.

One I hear frequently is that video games don’t require imagination, or offer projections to explore.  But I think this is contempt prior to investigation for the most part.  The proliferation of video games is itself the best evidence that there is imagination going into each generation of games, which are produced by imaginative people who must have been able to develop their imagination in part through video games.  And we don’t start each session making our children build their own dolls and dollhouse from scratch.  We use available tools that do to an extent always structure and limit the imagination.  For example, why does the dollhouse have a pointy roof and two floors?  This is limiting, and in fact didn’t represent 90% of the urban population I worked with at all.  And few play therapists would avoid using Elmo puppets on the grounds that it limits the imagination of the child, even though Elmo is clearly an icon of popular culture.

In fact, play has often had its inception in the popular culture of the time.  We may take chess for granted now, but when it came into being it was a reflection of a medieval monarchy, with kings, queens, and bishops.  Yet play therapists often fall prey to nostalgia, if not luddism, and maintain that there are certain games and play that are relational and therapeutic, and others, usually the modern ones, are not.

This brings me to what I suspect is another reason we resist using video games in play therapy, which is the therapist’s fear of being incompetent or failing at the unfamiliar.  Years of training in a traditional educational model have taught us to silo down in our area of “expertise” as soon as we can.  We “major” in psychology or social work, go to graduate school for advanced specialization, and basically get to a point where we can work in a routine and structured environment.  For years we get in the habit of certain forms of play therapy: Candy Land, Chutes and Ladders, cards, chess, dollhouses and telephones.  These are easy and portable, but more importantly perhaps, we know how to play them, so we can not be “distracted” by the game, or lose by design if we want to build the kids self-esteem, and otherwise feel in control of the play situation.

It’s time we work through this resistance.  People can and do have conversations while they play video games, and video games are in themselves social media.  There are plenty of metaphors to explore in and after video gameplay.  Angry Birds is rife with themes of anger, different abilities, and protecting the innocent and defenseless.  Call of Duty can give rise to expression of competition, drives, and the hunger for destruction or cooperation.  And a recent (to me) favorite, Demon Souls, is a tone poem on isolation, yearning to connect, and persistence in the face of despair.

I’m sure I’ll get comments arguing that video games are inherently violent as well.  To which I would respond, just like Battleship and the card game War are inherently violent.  We have become insulated to the violence in them, and it may not have the graphic sophistication of video games.  But the next time you play Battleship ask yourself what you think happened to all the people on the battleships that sunk?  The game doesn’t come with little lifeboats, you’re drowning people.  Play therapy does not avoid violence in its expression.

Virginia Axline, one of the founders of modern play therapy, had 8 guiding principles for play therapists:

  1. The therapist must develop a warm, friendly relationship with the child, in which good rapport is established as soon as possible.
  2. The therapist accepts the child exactly as he is.
  3. The therapist establishes a feeling of permissiveness in the relationship so that the child feels free to express his feelings completely.
  4. The therapist is alert to recognise the feelings the child is expressing and reflects those feelings back to him in such a manner that he gains insight into his behaviour.
  5. The therapist maintains a deep respect for the child’s ability to resolve his own problems if given an opportunity to do so. The responsibility to make choices and to institute changes is the child’s.
  6. The therapist does not attempt to direct the child’s actions or conversation in any manner. The child leads the way; the therapist follows.
  7. The therapist does not attempt to hurry the therapy along. It is a gradual process and is recognised as such by the therapist.
  8. The therapist establishes only those limitations that are necessary to anchor the therapy to the world of reality and to make the child aware of his responsibility in the relationship.


Nowhere in there does it say, the therapist sticks with the tried and true games s/he grew up with.  To my colleagues who are ready to decry the death of the imagination and lesser play of video games, I think Axline said it best:  “The child leads the way: the therapist follows.”

Following in the 21st century means having Gameboys and Playstations in our repertoire.  If we don’t keep learning and using technology in our play therapy, we may find ourselves in a state of unplanned obsolesence.  Am I saying we should stop playing Jenga and Uno?  No.  But if our patients are looking for video games amongst the chess sets and dollhouses, perhaps they are telling us something we need to pay attention to.  Just because we don’t know how to play a game doesn’t exempt us from learning it.  And what a gift it can be for an adolescent to experience themselves as more competent and talented by an adult!  So many of them come to us having been labeled as “failed learners,” and we have the potential to help them experience themselves as successful teachers, of us.

Those of us working in agencies and schools need to resist the temptation whenever possible to use the excuse of needing to be mobile or budgetary constraints.  Video games are now as portable as a Nintendo DS PSVita or Smartphone.  And the price of a video game system is not so prohibitive as to be a given.  The real reason we often don’t advocate for video games at the agency or school is our own bias that they are somehow less valuable as therapeutic play media.

I anticipate that this will meet with resounding criticisms from the “play-is-going-to-hell-in-a-hand-basket” crowd, but I’m really interested in hearing from colleagues who have managed to successfully integrate video games into their play therapy.  What are your success stories?  What have been some challenges you’ve had to overcome?  Do you schedule online play sessions?  How do you manage the noise in an office suite?  I’m really interested in your experiences.

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Digital Citizenship and the Forward Edge Transference

Recently I had an opportunity to visit a school for a daylong workshop, where I got to meet with the kids during the day, and their parents at night.  I love it when this happens because I can then ask the children what they struggle most about with their parents regarding technology.  So during the course of the morning I asked over 425 5th, 6th, and 7th graders what I should help their parent understand about technology.  I got lots of great answers from them all, and my favorite one came when one 7th grader raised his hand and said, “can you please explain to my parents that multiplayer video games have no save?”

There are several reasons why that request is actually brilliant, but the one I want to focus on is how this statement, and a person’s frustration at being asked to log off in the midst of a multiplayer video game may be a forward edge transference.

The term “forward edge transference” comes from Marian Elson’s work in self-psychology.  She has described the forward edge transference as being akin to what Kohut was talking with his interns about when he described leading edge transference.  Forward edge transferences, according to Tolpin, are tendrils of psychological growth in the patient, often hard to see, if not completely overlooked, by the therapist because they don’t look like growth.  Often we consider “psychological growth” as in the eye of the beholder, whether it be therapist, parent, teacher or someone else other than the patient.  One of the example’s Tolpin uses is that of a patient who cuts to be able to “feel,” and to bleed.  The forward edge transference there in Tolpin’s estimation, is the self’s still healthy yearning for kinship, to “bleed like everyone else.”

I use this example because it very powerfully demonstrates how even an easily pathologized concern such as cutting, could indicate a tendril of healthy growth, easily overlooked.  The behavior forward edge transference travels concealed within is glaringly “obvious” to us, and because of that forward edge transferences may be misunderstood, and the striving for psychological health get stymied.

So what does this have to do with Massively Multiplayer Online Games?

As I mention in my book MMOs are a form of social media, and collaborative play, where the player is often cooperating with a group of others in a raid or guild to achieve something that could not be accomplished individually.  Whether it be downing a dragon in World of Warcraft, unlocking guild achievements, or building a city overnight in Minecraft, the player is part of a larger group.  They matter to the larger group.

Embedded in the comment “multiplayer has no save” is the forward transference for a sense of kinship, and more specifically the dawning of a concept of being a digital citizen.  Here is an adolescent saying that they understand their behavior has an impact on others, that they want to collaborate online, and that they feel responsible to the larger group.  Saying in fact what all the adults around them have been trumpeting for over a decade of their lives in most cases.

A digital citizen is defined in Wikipedia as “a person utilizing information technology (IT) in order to engage in society, politics, and government participation.”  To be a digital citizen requires “extensive skills, knowledge, and access of using the internet through computers, mobile phones, and web-ready devices to interact…”  And the elements of digital citizenship per digitalcitizenship.net include:

  • Digital Access:full electronic participation in society.
  • Digital Commerce:electronic buying and selling of goods.
  • Digital Communication:  electronic exchange of information.
  • Digital Literacy:process of teaching and learning about technology and the use of technology.
  • Digital Etiquette: electronic standards of conduct or procedure.
  • Digital Law:electronic responsibility for actions and deeds
  • Digital Rights & Responsibilities: those freedoms extended to everyone in a digital world.
  • Digital Health & Wellness:physical and psychological well-being in a digital technology world.
  • Digital Security (self-protection):electronic precautions to guarantee safety.

Here’s the rub:  If you look at those elements, many of the adults charged with caring for and educating the young aren’t necessarily competent digital citizens themselves.  I can tell you for a fact that I have participated over the past decade with professionals and peers on listservs and bulletin boards, and have seen appalling standards for conduct and procedure.  It rivals anything I’ve seen adolescents do to each other.

We live in interesting times, when we are entrusted to educate youth about a technology when we often don’t know how to use socially and effectively ourselves.  We tell them not to interrupt, then answer our cell-phones in the middle of them telling us about their day.  We tell them to pay attention to us even as we’re checking our emails on the Blackberry.  We stalk them on Facebook to censor them in one browser window, and post embarrasing pictures and comments of them in another.  And we pull the plug on them while they’re playing an MMO even as we tell them that they’ve been inconsiderate of their younger sibling who wants a “turn.”

Part of the problem here is our neophyte digital citizenship.  People from older generations tend to think of video games as this:

when they’re actually more like this:

When was the last time you showed up at your daughter’s basketball game in the 3rd quarter and told her, “you’ve been on the court long enough, you’re coming home?”  And yet, we do this to kids online all the time, and foil their attempts to be team players and group contributors.

There’s a lot at stake here:  Multiplayer has no save.  10-30 people, often from all over the world have come together to try to overcome an obstacle.  When you pull the plug, you’re pulling it on all of them.  It is great that our kids know this and care about it!

Most of us have wanted to be a part of something bigger than ourselves, to create something together, even if it is just one moment or memory with others.  We need to look at video games without the Pong Goggles, and see it as a form of society and an opportunity for digital citizenship.

To recognize the forward edge of a transference is never an easy thing.  It is small, fragile, the newest shoot of growth.  In a sense, all of us on this planet are in the midst of such a tendril of growth when it comes to technology.  But the time when digital literacy was optional has passed, and we need to do a better job with the next generation of digital citizens than we are doing.


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Worth a Thousand Words?: Infographics on Video Games

 For those of you who haven’t heard, Pinterest is a pinboard style of social media which emphasizes visuals.  Recently I was trying to learn more about it and how it might apply to the psychotherapy/psychology field.  So far I can see possibilities:

DBT- Using Pinterest to create worksheet boards, or better yet boards of images which provide self-soothing for distress tolerance.

Behavior Charts which are visual and available instantly from home instead of going home in a book bag and being forgotten.

Virtual Comic Books to help adolescents learn and practice sequencing and pragmatic speech.

Screenshots of video games that can be shared by gaming patients with gamer-affirmative therapists.

Psychoeducation Tools for a variety of issues, including the above example.  Click on the image to see my board on Infographics for video games and gaming.  They are not intended as professionally vetted research, and you’ll not the heading encourages viewers to check out the research.

There are obviously things to be concerned about, such as privacy and how best to bring Pinterest into the therapeutic session, office and process.  Pinterest is not HIPAA-compliant, for example, so would a link sent via hushmail be secure enough for some uses?  How might we make sure our patients could use this powerful visual tool in a way that did not disclose what health information described what they were using it for.

What do you think?  How might we use this powerful visual medium to enhance our treatment with patients in an best-practice way?

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The Kids Are All Right

image courtesy of gamerfit.com

image courtesy of gamerfit.com

Last week some family friends came over to our house for dinner. The children, we’ll call them Larry, Curly and Moesha, were ages 12, 4, and 8 respectively. As you may imagine, children enjoy coming over to the Gamer Therapist house, which has 3 gaming consoles and a dedicated big-screen TV. After a quick tour of the gaming room, Larry and Moesha sorted through my games and located Portal 2, and within minutes had set themselves up to play cooperative mode. Curly was content to sit between them, and the adults retired to the first floor to hang out and prepare dinner.

Throughout the evening we could hear the sounds of the happy gamers and the game, while my friend Rebecca talked frankly about her ambivalence about their gameplay. The ambivalence sprang primarily from a well-meaning friend who had criticized her parenting style. Another set of parents had told them that their children wouldn’t be able to play with them anymore because they thought that the children were picking up bad messages from video games.

This conversation was interrupted by the children twice, both by Moesha. The first time she came down to inform us that Larry had succeeded in unlocking a very difficult achievement. The second time she came down to ask me if I could join them and help them solve a puzzle in the game they had been struggling with. I went up, and within a few minutes a fresh perspective and Larry having some patience as I familiarized myself with the controls had advanced them to the next level. A polite thank you let me know that I was no longer required, and I returned to our conversation.

A discussion about education and video games was in full swing, and a debate about how much screen time is too much. At this juncture I pointed out how hard it is for us to catch children when they are doing things right. I observed that for the past 2 hours children, siblings, spanning an age difference of 8 years had been engaged in cooperative learning. What’s more they had voluntarily engaged with the adults on two occasions. The first was for one child to express pride in the achievement of her sibling. The second was to request adult assistance with some problem solving. And all along our parental ears had heard not one whit of conflict or argument. Yet all of this would have been easy to miss, or worse, dismiss as “parking the children in front of a screen.”

Every day, parents like Rebecca are bombarded with much-hyped exposes on how dangerous video games are to children. Horror stories like the one my colleague at BC psychologist Peter Gray blogs about are touted, in which a South Korean young man plays for 50 hours straight and dies after going into cardiac arrest. Gray goes on to put this tragedy in perspective: There are 7 billion people on the planet, and this incident represents 0.000000014% of the population. It is by contrast far more difficult to catch the number of children and adult gamers doing things like learning physics, researching a vaccine for HIV, or gaming to raise money for hospitals.

And although studies linking the dangerous connection video games have to childhood obesity, the media somehow never manages to pickup ones like this that showed that children who had electronic devices in their room were more likely to engage in outdoor play. Perhaps the Obama administration did read this study though, as they are moving to a more gamer-friendly position with the appointment of Constance Steinkhueler to study the civic potential of playing games (Thanks to my colleague Uriah Gilford for calling my attention to this.) The video game danger is overhyped.

Parents are playing a game far more dangerous than any video game, and that is the “Who Is Parenting Best” game. Over and over I hear conversations about what the best school district is, how to set privacy settings and enrichment activities. This despite, as Rob Evans EdD. points out in his book Family Matters that by age 18 children and adolescents will have only spent about 10% of their total lives in school. Setting privacy settings is the first and most minimal step to helping children navigate the 21st century community that relies on the internet. And enrichment activities are unfortunately often activities that appeal to what a parent wants quality time to look like, rather than what a child enjoys.

In discussing school districts, privacy settings and quality time, parents are often missing the point. Worse, they are confusing worry with effort.

We need to stop “phoning it in” with our kids, finding the “right” school, program or setting to park them on so we don’t need to worry. It is human nature to want to get to a safe spot to relax and stop changing: We need to fight it.

Often when I speak with parents who complain about the amount of time their offspring are spending playing I ask them if they have ever played the game with their child. The answer is invariably that they haven’t, even though a recent study showed that girls who gamed with their fathers reported lower levels of depression. Quality time always has to be some Puritanical ideal: a bracing hike, the symphony, or a museum. I love doing all of those things, which is why I do them. That doesn’t mean that a child or adolescent will have them as a preferred activity.

I know, I’m criticizing your parenting, please bear with me. Because you can take it, and your children need you to stop playing the Who Is Parenting Best Game. They need you to try playing Portal 2 with them if that is what they’re into. If you fumble with the controller, all the better, because we adults have forgotten how clumsy and awkward learning makes children feel. Education has gone taught us to find a safe spot and stop learning about anything that is outside that comfort zone.

We have long known that one of the strongest protective factors for children is an involved parent, but somewhere along the line we have gotten the mistaken idea that that means control. To be clear, parental control does not equal parental involvement. At best it is one element of involvement, at worst it is phoning it in.

Does this mean schools have no responsibility? Absolutely not. But I would like to suggest we return to Larry, Curly, and Moesha for a different example, namely a curatorial model. That means setting up a place for them to explore and negotiate things on their own for the most part, while we are constantly available for engagement. Yes that is a tall order, and one that requires that we think beyond the nuclear family and school as factory models.

I am fortunate to belong to massivelyminecraft.org a server where children and adults from the UK, US, Australia and other places play the sandbox game Minecraft together. It is not segregated by age, but vetted by the server moderators, who require parental permission for children to join. Within the game world, you can see adults and children learning and playing together at any hour of the day or night. They are voluntarily learning about geometry, math, physics, animal husbandry, chemistry, geology, economy, social skills, communication and a host of other things, in a way that is curatorial rather than proscriptive. Adults are there and occasionally on chat or via Skype will step in to mediate a conflict between two children, or if help with a task is requested.

Why can’t 21st century education be like this? Imagine a virtual classroom where parents and teachers can privately chat while both observing unobtrusively a child’s progress. Imagine homework at the table replaced by building a virtual pyramid together. Imagine virtual trips to Paris in Second Life, where no one is too poor to come along. Imagine time on learning that is maximizing the child’s engagement and minimizing unnecessary supervision. Imagine adolescents finally having educational settings that run synchronously with their biological clocks. Imagine a collaborative effort that doesn’t segregate human beings by rigid grades, parent/teacher roles or socioeconomic status. Imagine recess that can happen year-round, sometimes in a field, sometimes on the Wii Fit or Kinnect.

I believe the research is showing more and more that these things are possible. And I believe that our children are counting on us taking a leadership role in technology and education rather than a fear-based ones.

I leave you with this image. As he was leaving my house, Larry looked at me and declared that I “wasn’t entirely horrible” for an adult. What parent wouldn’t love to hear such high praise from their tween?

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The Uses of Disenchantment

Magic fulfills the wish that we could have powers to be beyond who we sadly suspect we are. As children, magic explains the inexplicable nature of external forces (i.e. parents, teachers, death) and internal ones (unconscious drives, nameless attachments, inconsolable sorrows and consuming rages.)

Anyone who plays WoW, Elder Scrolls, or Dungeons & Dragons, knows that enchanted weapons and armor are valuable items to be gotten. They raise our stats, make us stronger, more intelligent agile, or resistant to harm. They fulfill the wish that we could be more than we are.

That being the case, the profession of Enchanting is a very valuable one to master. To do so is to be able to craft our own items for use or to sell. And to master the skill requires not only enchanting practice, but also the act of disenchantment.

Disenchantment is the breaking down of an enchanted item into its component reagents. In Skyrim this consists of taking the enchanted item and destroying it, which allows you to discover the enchantment. So, for example, if you come across an Iron Battleaxe of Scorching, you have a choice. You can enjoy your new battleaxe which will add fire damage to the physical damage you do using it. Or you can disenchant it, and learn how to imbue any weapon with the ability to do fire damage.

In World of Warcraft disenchanting items is necessary to provide you with the reagents, or raw materials, to do other enchantments. Learning the enchantment is done separately, by training or reading a recipe, but disenchantment is still necessary to break down enchanted items into components you can use for other enchantments. Enchantment operates in the domain of creation and destruction, attachment and loss. I can remember feeling many the hesitation as I was about to take an Epic staff I’d used for months and dissolve into Abyss Crystals. Even though I knew that I was going to get a new weapon with a strong enchantment out of it, disenchantment required sacrafice.

Many patients labor under the illusion that the purpose of therapy is to make you feel good. I have always maintained that that is not true. Therapy is not about making you feel good, but rather about learning how to not to feel good. It’s about learning how to experience and tolerate those unpleasant feelings in a different way than we’ve learned to previously. People abuse substances, food, sex, and yes, occasionally video games because they cannot tolerate feelings that don’t feel “good.” Who wants to feel inconsolable sorrow, thwarted passion, grief, terror, or hopelessness?

And so people come to us wanting symptom reduction, not character building; relief, not the raising of unmentionable wishes and fears to consciousness. At first, we often provide those other things to be sure. A compassionate ear to listen, a calming influence, a holding environment. But in the end, therapists are alchemists and enchanters: Nothing new can be created by our patients without something being destroyed. Something must be given up to create something else.

Consider this: Neurosis is like an enchanted armor that we can no longer use. Maybe we have outgrown it. Maybe it never really fit well but it was the best compromise we could come up with. Maybe it buffed up our strength stats when we really needed more intelligence to play our class effectively. For whatever reason, it is no longer helping us, in fact it has created distress.

Symptom reduction alone won’t solve this problem. It may alleviate our distress for the moment, relieve pain enough to create the “space” between feeling and behavior so that we can begin to do the longer-term work.

That’s where disenchantment comes in. We need to take the item, the neurotic conflict, and break it down into the components that create it. What is the wish and the worry? What causes the guilt? Just what are we so afraid of that we can’t look at it directly?

This doesn’t always have to be painful, and therapists shouldn’t use this as a justification for brutality. But to think that the process of therapy is not going to be uncomfortable and difficult; is not going to take some time and hard work is pretty much delusional. If our enchantments could have gotten us any farther we wouldn’t have given them up. Most addicts and alcoholics would have used longer if they could have. If they could have enjoyed one more binge, party or high, they would have.

Insurance companies love to focus on symptom reduction, and a narrow view of what evidence-based treatment really is. Symptoms are problems to be solved, rather than signposts pointing towards underlying issues. And although this is short-sighted, it is understandable: 10 sessions costs a lot less than weekly sessions. And yet, the most recent research I’ve read indicates that psychodynamic therapy is as effective as CBT and other therapies, and in fact more effective in sustaining longterm change.

Bruno Bettelheim, a psychoanalytic thinker, is perhaps best known for his book The Uses of Enchantment. In it he discusses how the themes of fairy tales often symbolize the real emotional and psychological struggles that children go through. Through the projections of stories, children are able to work through their fears in remote and tolerable ways. In a similar way, Klein speaks of the paranoid-schizoid position where the parent is split into good and bad objects, the fairy godmothers and evil witches of fairy tales.

Disenchantment, from a Kleinian lens, leads to the depressive position. It is where we hopefully get to, despite the depressing name, that point when we realize that people are not either all-good, or all-bad, but both good and bad, nurturing and depriving, gratifying and frustrating. In other words, human. The world seems less magical in some ways, and that is experienced as a loss. Sounds depressing, eh? So what is gained?

There is a practice in Tibetan Buddhism called tonglen. In this form of meditation, you begin by touching the tender spot of whatever is sorrowing or distressing to you. Say you’ve lost your loved one. Allow yourself to feel that grief for a moment, really feel it. What an awful wrenching feeling that is. You may reflect that nobody should have to feel what you’re feeling right now. And yet, all over the world, there are those who have felt that, may be feeling it even as you are right now. So you breathe in, and imagine breathing in all of that grief as if for that moment you could take it into your heart so that nobody else would have to feel it. And then you imagine yourself breathing out comfort and security and everything that is the opposite of grief and suffering to the world and to all those in it who need it. You reverse the cycle of trying to avoid pain and grasp pleasure, and in doing so generate compassion.

That is the use of disenchantment; breaking down our fantasies that we can avoid pain and transmuting it into compassion for others. Imagine if you were to really accept that everyone is human and fallible and mortal. If you were able to walk around tomorrow and remain conscious that everyone you meet is dying, would you treat them in the same way as you did today?

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Not All Failure Is Epic

In gaming there is a concept known as the “Epic Fail.”  Roughly translated this means, a failure so colossal, so unbelievable in its nature, that it will go down in history as epic.  Epic failure can be extremely frustrating in the moment, but is almost always funny in retrospect.

Recently I was playing Dark Souls, and I was trying to down two bosses known as the Belltower Gargoyles.  Just as you get one down to half health, the other, who likes to breathe fire on you, shows up.  Oy.  I kept getting killed, which sent me back to a save point, running back up the belltower, and trying again.  What kept me going up there was that each time I was surviving a few seconds longer, and each time I was getting the gargoyle’s health down a little more.  At one point I started to consistently kill the first gargoyle before the second one finished me off.  Finally, through an unbelievable feat of mashing all the buttons, luck, and strategy, I beat them both.

The failure that kept happening was not what I would call Epic Failure.  It was certainly what Jane McGonigal et al call fun failure though.  It was failure with just enough progress mixed in that I’d say, “Oooh, you’re going to get it,” to the gargoyles and try again.  And again.  Fun failures in video games are designed to work that way.  The game can’t be so hard that the person gives up, but can’t be so easy that you don’t feel challenged.  Because if you don’t feel challenged then there is little or no sense of accomplishment.

Heinz Kohut, one of my favorite psychoanalytic thinkers, would probably have a lot to say about video games if he were alive today.  Kohut knew that failure was a part of life and human development.  In fact, he thought that therapy was full of failure.  He talked about empathic failure, when the therapist fails to respond empathically to the patient in some way.  Maybe we don’t pay attention enough to a story, or don’t remember something, or start 5 minutes late.  These are all parts of the therapist being human, and therefore being unable to stay absolutely in empathic attunement with the patient.  This kind of failure is inevitable.

Kohut goes on to say that it is not necessary to deliberately make mistakes and empathically fail our patients, because we are going to do so naturally in the course of our work with them.  In fact, to deliberately fail our patients is rather sadistic.  But usually we aren’t being sadistic when we forget something, or run late a few minutes, even though the patient may experience it that way.

So first a note to therapists here.  In the course of your work with patients you are going to fail a lot.  But not all failures are epic.  That is not to say that your patients won’t experience it that way.  That vacation you’re going on may be an epic failure on your part, as far as they are concerned.  Does that mean you cancel your flight plans?  Of course not.  Our job is initially to help the patient by understanding by empathy the epic nature of our failure from their point of view.  We try to imagine ourselves into that moment they are having.

But that doesn’t mean that we stay there.  We need to maintain some perspective, have some sense of fun failure, to keep doing our work.  By that I don’t mean have fun at our patient’s expense, but rather be able to be lighthearted enough in our introspection to say “Oops, I missed that one,” or “there I go again.”  If we can do that we are able to then refocus on the patient.  If we instead get sucked into the idea that this is an Epic Fail we will lose all perspective, and actually start focussing on ourselves rather than the patient.

Do you ever say to yourself, “I’m such a bad therapist?”  I don’t.  Of course, I also don’t say, “I’m such a perfect therapist” either.  I do frequently think, “I was not at my best today,” or, “oooh, how come I keep missing that with patients!”  This helps me keep perspective so that I can get back in the game as soon as possible.

Whether you are a therapist, a gamer or someone else who is still breathing, chances are that you are failing sometimes.  In fact, this time of year with all its’ hype and expectations about being joyful and loving families can make you feel even more like a failure.  Some examples of Epic Fail statements that we think consciously or unconsciously include:

  • I’m a terrible parent.
  • I’m a terrible daughter/son.
  • I’m a terrible sex partner.
  • I’m a terrible worker.
  • I’m a terrible cook.
  • I’m a terrible student.

and the list could go on.

If any of those sounds like you, take a moment to reflect.  Is this really an Epic Fail?  Or are you distorting things?  Chances are you are not a perfect parent, child, worker, sex partner, student or anything else.  But if you really identify this as an Epic Fail, chances are you are solidifying a form of self-identity rather than accurately appraising yourself.

Why would we do that?  Well, one reason is that we learned those messages of Epic Failure as a child.  You probably still remember a few failures that can make your stomach churn if you think of them.  But as often, I think we grasp on to solid identities, even negative ones, so we can stop working on ourselves.  I’m just X, I’m the kind of person who can’t Y, Nobody ever thinks Z about me:  These all kill our curiousity about ourselves and help us stay stuck.

Mindfulness is about fun failure.  It is about being able to look at ourselves and reflect on ourselves without going to extremes.  Mindfulness is about being able to be curious rather than judgmental, having roominess in our minds and souls rather than rigidity.  This perspective leads to “Ooooh, I’m going to get that boss down this time.”  The other leads to hopelessness.

So try to remember this as the days are getting shorter and tensions may be rising:  Not all Failure is Epic.  And if we can be right-sized about our failures we can learn from them.  We can take an interest in our thoughts, feelings and behaviors rather than judge ourselves.  If we catch ourselves saying “what kind of monster I must be to hate Aunt Myrtle,” we can perhaps think, “oops, there I go again. Isn’t it odd/interesting that I feel hatred towards Aunt Myrtle, what’s THAT about?”

Eighty-five percent of the time gamers are failing.  And yes some of those are Epic, but the gamer attitude is to view those Epic Failures as moments of camaraderie and learning.  In life outside the game, do you treat the Epic Fail that way?  Do you seek out others and try to learn from the experience, or do you isolate?  There is always some observing ego in the game Epic Fail that is often lacking in our non-game life.  And in some ways that is understandable, you can’t always reset in life outside video games.

But consider this:  Where there is life there is hope.  If this was a true Epic Fail in your life you can still learn from it in time.  Failures are inevitable, but with time and perspective they can be instructive as well.  In the end I’d say that whether you think you’ve had an Epic Failure or not what matters most is how you move on from it.  Who knows, maybe the only real Epic Fail is the one where you give up..

Note:  No real Aunt Myrtles were hated in the writing of this post.

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Dopey About Dopamine: Video Games, Drugs, & Addiction

Last week I was speaking to a colleague whose partner is a gamer. She was telling me about their visit to his mother. During the visit my colleague was speaking to his mother about how much he still enjoys playing video games. His mother expressed how concerned she had been about his playing when he was young. “It could have been worse though,” she’d said, “at least he wasn’t into drugs.”

This comparison is reminiscent of the homophobic one where the tolerant person says, “I don’t mind if you’re gay, as long as you don’t come home with a goat.” The “distinction” made actually implies that the two things are comparable. But in fact they are not.

Our culture uses the word addiction pretty frequently and casually. And gamers and opponents of gaming alike use it in reference to playing video games. Frequently we hear the comments “gaming is like a drug,” or “video games are addictive,” or “I’m addicted to Halo 3.” What muddies the waters further are the dozens of articles that talk about “proof” that video games are addictive, that they cause real changes in the brain, changes just like drugs.

We live in a positivistic age, where something is “real” if it can be shown to be biological in nature. I could argue that biology is only one way of looking at the world, but for a change I thought I’d encourage us to take a look at the idea of gaming as addictive from the point of view of biology, specifically dopamine levels in the brain.

Dopamine levels are associated with the reward center of the brain, and the heightened sense of pleasure that characterizes rewarding experiences. When we experience something pleasurable, our dopamine levels increase. It’s nature’s way of reinforcing behaviors that are often necessary for survival.

One of the frequent pieces of evidence to support video game addiction is studies like this one by Koepp et al, which was done in 1998. It monitored changes in dopamine levels from subjects who were playing a video game. The study noted that dopamine levels increased during game play “at least twofold.” Since then literature reviews and articles with an anti-gaming bias frequently and rightly state that video games can cause dopamine levels to “double” or significantly increase.

They’re absolutely right, video games have been shown to increase dopamine levels by 100% (aka doubling.)

Just like studies have shown that food and sex increase dopamine levels:

This graph shows that eating food often doubles the level of dopamine in the brain, ranging from a spike of 50% to a spike of 100% an hour after eating. Sex is even more noticeable, in that it increases dopamine levels in the brain by 200%.

So, yes, playing video games increases dopamine levels in your brain, just like eating and having sex do, albeit less. But just because something changes your dopamine levels doesn’t mean it is addictive. In fact, we’d be in big trouble if we never had increases in our dopamine levels. Why eat or reproduce when it is just as pleasurable to lie on the rock and bask in the sun?

But here’s the other thing that gets lost in the spin. Not all dopamine level increases are created equal. Let’s take a look at another chart, from the Meth Inside-Out Public Media Service Kit:

This is a case where a picture is worth a thousand words. When we read that something “doubles” it certainly sounds intense, or severe. But an increase of 100% seems rather paltry compare to 350% (cocaine) or 1200% (Meth)!

One last chart for you, again from the NIDA. This one shows the dopamine increases (the pink line) in amphetamine, cocaine, nicotine and morphine:

Of all of these, the drug morphine comes closest to a relatively “low” increase of 100%.

So my point here is twofold:

1. Lots of things, not all or most of them drugs, increase the levels of dopamine.

2. Drugs have a much more marked, sudden, and intense increase in dopamine level increase compared to video games.

Does this mean that people can’t have problem usage of video games? No. But what it does mean, in my opinion, is that we have to stop treating behaviors as if they were controlled substances. Playing video games, watching television, eating, and having sex are behaviors that can all be problematic in certain times and certain contexts. But they are not the same as ingesting drugs, they don’t cause the same level of chemical change in the brain.

And we need to acknowledge that there is a confusion of tongues where the word addiction is involved. Using it in a clinical sense is different than in a lay sense– saying “I’m hooked on meth” is not the same as saying “I’m hooked on phonics.” Therapists and gamers alike need to be more mindful of what they are saying and meaning when they say they are addicted to video games. Do they mean it is a psychological illness, a medical phenomenon? Do they mean they can’t get enough of them, or that they like them a whole lot? Do they mean it is a problem in their life, or are they parroting what someone else has said to them?

I don’t want to oversimplify addiction by reducing it to dopamine level increase. Even in the above discussion I have oversimplified these pieces of “data.” There are several factors, such as time after drug, that we didn’t compare. And there are several other changes in brain chemistry that contribute to rewarding behavior and where it goes awry. I just want to show an example of how research can be cited and misused to distort things. The study we started out with simply found that we can measure changes in brain chemistry which occur when we do certain activities. It was not designed or intended to be proof that video games are dangerous or addictive.

Saying that something changes your brain chemistry shouldn’t become the new morality. Lots of things change your brain chemistry. But as Loretta Laroche says, “a wet towel on the bed is not the same as a mugging.” We need to keep it complicated and not throw words around like “addiction” and “drug” because we want people to take us seriously or agree with us. That isn’t scientific inquiry. That’s hysteria.

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A Follow Up to Dings & Grats

My last post, “Dings & Grats,” generated quite a lot of commentary from both therapists and gamers alike.  I was surprised at many of the comments, which tended to fall into one of several groups.  I’ll summarize and paraphrase them below, following with my response.

1. “I haven’t seen any research that shows video games can increase self-confidence, but I have seen research that shows they cause violent behavior.”

Fair enough, not everyone keeps up to date on research in this area, and the media certainly hypes the research that indicates “dire” consequences.  So let me direct you to a study here which shows that using video games can increase your self-confidence.  And here is a study from which debunks the mythology of video games causing violence.

2. “I find gamers to be generally lacking in confidence, introverted, reactive and aggressive, lacking in social skills, etc.”

These responses amazed me.  Gamers are part of a culture, and I doubt that many of my colleagues would say such overarching generalizations about other groups, at least in public.  Would you post “I find women to be generally lacking in confidence,” or “I find obese people introverted,” or “I find African American people lacking in social skills?” And yet the open way many mental health professionals denigrated gamers without any sense of observing ego was stunning.  I was actually grateful that most of these comments were on therapist discussion groups, so that gamers didn’t have to read them.  This is cultural insensitivity and I hope that if my colleagues aren’t interested in becoming culturally competent around gaming they will refer those patients out.

3. “Real relationships with real people are more valuable than online relationships.”

This judgment confused me.  Who do we think is behind the screen playing video games online, Munchkins?  Those are real people, and they are having real relationships, which are just as varied as relationships which aren’t mediated by technology.  Sure some relationships online are superficial, and others are intense; just like in your life as a whole some of your relationships are superficial and others are intense and many between the two.  I’ve heard from gamers who met online playing and ended up married.  And if you don’t think relationships online are real, stop responding to your boss’s emails because you don’t consider them real, see what happens.

4. “Video Games prevent people from enjoying nature.”

I am not sure where the all or nothing thinking here comes from, but I was certainly not staying that people should play video games 24 hours a day instead of running, hiking, going to a petting zoo, or kayaking.  I know I certainly get outside on a daily basis.  But even supposing that people never came up for air when playing video games, I don’t think that would be worse than doing anything else for 24 hours a day.  I enjoy running, but if I did it 24/7 that would be as damaging as video games.  What I think these arguments were really saying is, “we know what is the best way to spend time, and it is not playing video games.”  I really don’t think it is our business as therapists to determine a hierarchy of leisure activities for our patients, and if they don’t want to go outside as much as we think they ought to, that’s our trip.

5. “I’m a gamer, and I can tell you I have seen horrible behavior online.”

Me too, and I have seen horrible behavior offline as well.  Yes, some people feel emboldened by anonymity, but we also tend to generalize a few rotten apples rather than the 12 million + people who play WoW for example.  Many are friendly or neutral in their behavior.  And there is actually research that shows although a large number of teens (63%) encounter aggressive behavior in online games, 73% of those reported that they have witnessed others step in to intervene and put a stop to it.  In an era where teachers turn a blind eye in”real” life to students who are bullied or harassed, I think video games are doing a better, not worse job on the whole addressing verbally abusive behavior.  Personally, I hate when people use the phrase “got raped by a dungeon boss,” and I hope that people stop using it.  But I have heard language like that at football games and even unprofessional comments at business meetings.  I don’t think we should hold gamers to a higher standard than anyone else.  Look, we’ve all seen jerks in WoW or Second Life, but we’ve seen jerks in First Life as well.  Bad behavior is everywhere.

6. “Based on my extensive observations of my 2 children and their 3 best friends, it seems clear to me that…”

Ok, this one does drive me nuts.  If you are basing your assertions on your own children, not only do you have a statistically insignificant N of 2 or so, but you are a biased observer.  I know it is human nature to generalize based on what we know, but to cite it as actually valid data is ludicrous.

7. “I think face to face contact is the gold standard of human contact.”

Ok, that’s your opinion, and I’m not going to argue with it.  But research shows that it is not either/or, and the majority of teens are playing games with people they also see in their offline life.  And let’s not confuse opinion with fact.  You can think that video game playing encourages people to be asocial, but that is not what the research I’ve seen shows.  In fact, I doubt it could ever show that, because as we know from Research 101 “correlation is not causation.”

By now, if you’re still with me, I have probably hit a nerve or too.  And I’ve probably blown any chance that you’ll get my book, which is much more elaborate and articulate at this post.  But I felt compelled to sound off a little, because it seemed that a lot of generalizations, unkind ones, were coming out and masquerading as clinical facts.  Twenty-First Century gaming is a form of social media, and gamers are social.  What’s more they are people, with unique and holisitic presences in the world.  I wasn’t around to speak up in the 50s, 60s and 70s when therapists were saying that research showed all gays had distant fathers and smothering mothers.  I wasn’t around when mothers were called schizophrenogenic and cited as the cause of schizophrenia.  And I wasn’t around when the Moynihan Report came out to provide “evidence” that the Black family was pathological.  But I am around to push back when digital natives in general and gamers in particular are derided in the guise of clinical language.

To those who would argue that technology today is causing the social fabric to unravel, I would cite a quote by my elder, Andy Rooney, who once said, “It’s just amazing how long this country has been going to hell without ever having got there.

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Dings & Grats

I am convinced that if more people played video games, in particular massively-multiplayer online games, the human race would become kinder and self-confident.  Here’s one reason why:

In MMOs like Warcraft, you have a social chat text window that is in the lower corner of your screen, constantly streaming messages.  These messages are color coated so you can identify those you want to be reading, and screen out or hide those you don’t.  For example, I usually have my guild chat “on” so I can talk and listen to guildies, but I rarely have the world “Trade” chat on, because I’m not a big shopper.

As you progress through the game, you level up.  And when you level up, that’s an accomplishment.  So you type into guild chat: “Ding!”

Ding, reminscent of the bell on a game show, is a way of calling attention to the fact that you have accomplished something.  It’s tooting your own horn.  But in gaming, dinging is socially acceptable!  So when you announce over chat, “Ding!” You usually get a stream of “Grats!”

Grats, you may have guessed, is short for “Congratulations!”  It is the public acknowledgement in gamer culture of your achievements.  And if you are in a big guild and there are a lot of people online, you will sometimes get a stream of 50 or more “Grats.”  This also means that if you are logging on or only half-paying attention you will catch on that somebody just achieved something.

Since everyone goes through the same levels, everyone recalls what a sense of accomplishment they often had when they dinged, and they pay it back or forward because they know how great it felt to get those grats.  What emerges is a culture where achievements are announced and mirrored, which makes for a heightened sense of community and self-esteem.

When gamer patients announce they’ve hit level 85, or downed a major boss, or rolled and won on a piece of Epic loot, I am often quick to Grats them.  I also encourage some coaching clients to get better at dinging when they have hit an achievement.  “I finally rented my own office, Ding!” “I have 10 new patients, Ding!”  Each of these is worthy of a quick energetic announcement of accomplishment.

By now some of the naysayers are probably thinking, “How corny.”  And who has time to congratulate someone for every little achievement?  We’ll just end up raising a generation of narcisists who overstate every accomplishment.

Obviously I disagree.  First off, you don’t have to Ding on world chat, so to speak.  Who is your guild?  What group of people form your supportive circle that want to know when you’ve accomplished something.  Second, there is always some self-regulation when Dinging.  I don’t ding every time I mine some ore or pick an herb in WoW, but when I hit level 85 you bet I Dinged.

Third, when did we get so miserly with compliments?  Is it some sort of holdover from the Pilgrims and the dour work ethic?  It takes a second to Ding and the same to Grats.  What is lost in that second pales in comparison to the affective shift in our psyche and the change in our neurochemistry.  Think about any day you went into a job you hated, and the number of decision moves you made to do it even though you didn’t want to.  If that didn’t deserve a Ding as you passed a co-worker’s cubicle, I don’t know what does.

Lately I have been trying to increase my Grats as well.  Whenever a colleague posts on Twitter that they published a book, or finished a course, or got their license, I try to retweet with a big “Grats!”  I try to amplify their achievement, not ignore it or dismiss it.  One of the great powers of social media is how it can amplify things.  And one thing many of us need practice with is unlearning a depressive stance, where we only see the negative.  Now I am not a positive thinker, in fact positive thinkers make me feel uncomfortable, because I think they’re a bit deluded.  But that doesn’t mean that I can’t get better at noticing and acknowledging the achievements and positive contributions others make.

I’m sure you can begin to see how this is applicable to therapy.  Help your couples patients practice dinging and gratsing.  Work with school staff to set up a Ding and Grats system in their classroom.  Can you imagine how amazing it would have felt in middle school to finish your presentation with a “Ding!” instead of “The End,” and hearing 25 voices say “Grats!”

Dinging and Gratsing are expressions of enthusiasm, and sometimes it seems to me that there is some silent war being waged on enthusiasm.  We’re supposed to play it cool, be “laid back,” and never indicate we care that strongly about anything.  Is that really the apathetic and guarded culture we want to pass on?  Let’s get off Plymouth Rock for goodness sake, and start calling out with some enthusiasm!

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Innovation is Dangerous & Gaming Causes Asperger’s

At its heart, diagnosis is about exerting control.  Clinicians want to get some sense of control in understanding a problem.  We link diagnosis to prognosis to control our expectations of how likely and how much we will see a change in the patient’s condition.  Insurance companies want to get a handle on how much to spend on who.  Schools want to control access to resources and organize their student body.  And with the current healthcare situation, the government is sure to use diagnosis as a major part of the criteria in determining who gets what kind of care.

Therapists and Educators do not like to think of ourselves as controlling people.  But we often inadvertently attempt to exert control over our patients and entire segments of the population, by defining something as a problem and then locating it squarely in the individual we are “helping.”

This week has been one of those weeks where I have heard from several different colleagues about workshops they are attending where the presenters are linking Asperger’s with Gaming Addiction:  Not in the sense of “Many people on the Autism Spectrum find success and motivation through the use of video games,” but rather in the sense of “excessive gaming is prevalent in the autistic spectrum community.”

This has always frustrated me, for several reasons, and I decided its time to elaborate on them again:

1. Correlation does not imply Causation.  Although this is basic statistics 101 stuff, therapists and educators continue to make this mistake over and over.  Lots of people with Asperger’s play video games, this is true.  This should not surprise us, because lots of people play video games!  97% of all adolescent boys and 94% of adolescent girls, according to the Pew Research Center.  But we love to make connections, and we love the idea that we are “in the know.”  I can’t tell you how many times when I worked in education and clinics I heard talk of people were “suspected” of having Asperger’s because they liked computers and did not make eye contact.  Really.  If a kiddo didn’t look at the teacher, and liked to spend time on the computer, a suggested diagnosis of Autism couldn’t be far behind.  We like to see patterns in life, even oversimplified ones.

2. Causation often DOES imply bias.  Have you ever stopped to wonder what causes “neurotypical” behavior?  Or what causes heterosexuality for that matter.  Probably not.  We usually try to look for the causation of things we are busily pathologizing in people.  We want everyone to fit within the realm of what the unspoken majority has determined as normal.  Our education system is still prone to be designed like a little factory.  We want to have our desks in rows, our seats assigned, and our tests standardized.  So if your sensory input is a little different, or your neurology atypical, you get “helped.”  Your behavior is labeled as inappropriate if it diverges, and you are taught that you do not have and need to learn social skills.

Educators, parents, therapists and partners of folks on the Austism Spectrum, please repeat this mantra 3 times:

It is not good social skills to tell someone they do not have good social skills.

By the same token, technology, and video games, are not bad or abnormal either.  Don’t you see that it is this consensual attitude that there is something “off” about kids with differences or gamers or geeks that silently telegraphs to school bullies that certain kids are targets?  Yet, when an adolescent has no friends and is bullied it is often considered understandable because they have “poor social skills and spend too much time on the computer.”  Of course, many of the same kids are successfully socializing online through these games, and are active members of guilds where the stuff they hear daily in school is not tolerated on guild chat.

Let’s do a little experiment:  How about I forbid you to go to your book discussion group, poker night, or psychoanalytic institute.  Instead, you need to spend all of your time with the people at work who annoy you, gossip about you and make your life miserable.  Sorry, but it is for your own good.  You need to learn to get along with them, because they are a part of your real life.  You can’t hide in rooms with other weirdos who like talking about things that never happened or happened a long time ago; or hide in rooms with other people that like to spend hours holding little colored pieces of cardboard, sort them, and exchange them with each other for money; or hide in rooms where people interpret dreams and talk about “the family romance.”

I’m sure you get my point.  We have forgotten how little personal power human beings have before they turn 18.  So even if playing video games was a sign of Asperger’s, we need to reconsider our idea that there is something “wrong” with neuro-atypical behaviors.  There isn’t.

A lot of the work I have done with adults on the spectrum has been to help them debrief the trauma of the first 20 years of their lives.  I’ve had several conversations where we’ve realized that they are afraid to ask me or anyone questions about how to do things, because they worried that asking the question was inappropriate or showed poor social skills.  Is that really what you want our children to learn in school and in treatment?  That it is not ok to ask questions?  What a recipe for a life of loneliness and fear!

If you aren’t convinced, please check out this list of famous people with ASD.  They include Actors (Daryl Hannah,) bankers, composers, rock stars, a royal prince and the creator of Pokemon.  Not really surprising when you think about innovation.

3.  Innovation is Dangerous.  Innovation, like art, requires you to want things to be different than the way they are.  Those are the kids that don’t like to do math “that way,” or are seen as weird.  These are the “oversensitive” ones.  These are the ones who spend a lot of time in fantasy, imagining a world that is different.  These are the people I want to have over for hot chocolate and talk to, frankly.

But in our world, innovation is dangerous.  There are unspoken social contracts that support normalcy and bureaucracy (have you been following Congress lately?)  And there are hundreds of our colleagues who are “experts” in trying to get us all marching in lockstep, even if that means killing a different drummer.  When people try to innovate, they are mocked, fired from their jobs, beaten up, put down and ignored.  It takes a great deal of courage to innovate.  The status quo is not neutral, it actively tries to grind those who are different down.

People who are fans of technology, nowadays that means internet and computing, have always been suspect, and treated as different or out of touch with reality.  They spend “too much time on the computer,” we think, until they discover the next cool thing, or crack a code that will help fight HIV.  Only after society sees the value of what they did do they get any slack.

Stop counting the hours your kid is playing video games and start asking them what they are playing and what they like about it.  Stop focusing exclusively on the “poor social skills” of the vulnerable kids and start paying attention to bullies, whether they be playground bullies or experts.  Stop worrying about what causes autism and start worrying about how to make the world a better place for people with it.

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