Coming Soon: War Video Game Post-Traumatic Stress Disorder?
Published November 10, 2009 @ 11:50AM PT

[REVISION: After the first two responses below, I revised this post slightly to clarify the question posed. I've added some notes below on sources and will follow this tomorrow with a post reviewing psychological research on the subject.]
With the holiday launch of Infinity Ward's Call of Duty 2 and Bungie Studio's HALO 3, you might want to prepare your kids for more than their new game boxes. Prepare them for dealing with potential trauma, and reality. While the US military uses war video games to help returning combat veterans cope with post-traumatic stress as they ramp down from the psychological challenges of war, many adolescents are ramping up with exciting and tense shooting games of a different nature.
For starters, watch the many long trailers game makers offer on the sites to get a feel for what players see. The games are more powerful, life-like and gorgeous than ever. A scrawny thirteen-year-old with keen eye sight and a nimble thumb can now very quickly master the Mark-19 automatic grenade launcher, rapel from a helicopter, and kill about three hundred and fifty strangers without leaving the comfort of his Harry Potter bean bag chair. But what will be the toll?
Now I jump in here with proud video war game experiences from my youth. But perhaps the most illuminating moment came a few years back when I was helping a teenager who was quadraplegic. The boy had just gotten into the university and quickly fallen for a girl across the hall. He also had spino-muscular atrophe, so his body and hands were not capable of hugging or gripping, much less wooing the girl of his dreams. And so he absolutely loved escaping that tension by getting on his Wii and blowing the Hell out of space troopers, battleships, tie fighters, commandos, and anything else he could do digitally. Visually it was stunning, and no one was getting hurt.
When I met him, Rockstar Games' Grand Theft Auto II had just come out, so I stood in as his surrogate hands. He would shout "Go in there! Turn! Okay, now steal that car!" We'd have a blast driving through the city. "Okay now get out of the car and go in that building. There's a sniper rifle." Okay, so I pick up the rifle. "Go to the roof. This is cool. Watch!" I move up to the roof. Down below are the cops trying to bust us for stealing the car. "Shoot that cop!" It's a game, I aim in, pull the trigger. That's when I realized how different the new games had become. We could see the bullet enter the character's head and blood explode out the back. I turn to my young friend. "Why don't we just steal cars or rob banks or explore?" He became furious. "Take the gun and shoot that old lady!" "No!" I argued. "Shoot her!" "No!" That was it, maybe the end of the friendship. "Mom!!!" He yelled. "Daniel won't let me play my game!"
Question is, are these games going to keep getting more real and more bloody to the point that players can experienced prolonged hyper-vigilance or even trauma? (See sources below and in a follow up post which will be linked here shortly)
Teenagers may want to learn about violence perhaps to find some power they don't have in real life. Banning or prohibiting the games will only drive the games overseas or underground. The game makers explain that they try to make the games so that the player can choose to do good, like save hostages. If the players choose to kill indiscriminately, that's not necessarily the game makers' intentions.
Parents and concerned people who wonder whether kids bring the violence to the game or whether the game plants a seed in their mind that wasn't there beforehand would do best not necessarily to commit themselves to banning such games but perhaps to finding better games which give kids that chance to be a powerful adult, perhaps even see some fireworks, but which are more about saving lives, exploring new worlds.
According to reader Kelsey Atherton (below) and game sales rankings, war shooter games are not the most popular games among the player population, so other games are out there. Another way parents and concerned people can counter whatever potential effects these violent games have is to talk to the kids about the affects of violent video games which may include heightened tension, aggression, re-experiencing of previous traumas related to violence. Considering the literature, I pose the question. Although video-games obviously do not physically traumatize the player, could prolonged hyper-vigilance, tension, and exposure to gore not only numb the player but also lead to a new variant form of PTSD? (Sources below)
War video games are not all bad. They can be great fun. The point here, like with whether to allow your kids to see war films or join the military (yes, seventeen-year-old kids), is how to introduce it to them so that they get the most productive experience rather than the rare but well-documented side effects. It's a complex topic and like anything else could be healthy or unhealthy depending on the kind of experience.
Before participating in the discussion below, I again highly recommend going to Call of Duty 2 and watching four or five trailers in a row so that you can feel what players enjoy, what the sustained exposure feels like, if you don't have the game at home. The trailers go from abstract violence to some pretty ugly hand-to-hand combat. They're visually stunning.
[Photo by Simononly.]
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Comments (17)
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Daniel J Gerstle is a creative long form crisis journalist, human rights researcher, and humanitarian aid consultant who's covered Bosnia, Croatia, Karabakh, Chechnya, Ingushetia, the Ossetias, Iraq, Afghanistan, and Somalia very deeply, spiced with highlights of Sudan, Palestine, Jordan, Tajikistan, and Georgia. Prior to all this, he served as a US Marine reservist stateside.

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Is there any medical evidence this could actually happen? I'm skeptical.
Posted by Una M. on 11/10/2009 @ 11:58AM PT
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I've revised the post above to clarify the question and am adding notes below Kelsey's response as well as psychological study sources on my next post...
Posted by Daniel J Gerstle on 11/10/2009 @ 09:21PM PT
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There's a lot to talk about here. Firstly, of the top-10 best-selling console games of all time, the first 8 and the 10th are all ESRB-rated E. Number 9 is indeed Grand Theft Auto: San Andreas, but it's the only shooter of any variety in the top 20. Heck, it's the only one in the top-20 with a rating that isn't E. This makes sense - the majority of games sold are not shooters, but are aimed at the wider audience of gamers, teenagers, parents of teenagers, and children themselves. Much more money can be made catering to that audience than is possible designing games for only 17-35 year olds (which is the age-range that first person shooters target). Shooters get the most coverage, thanks in no small part to the exciting controversies of GTA-obsessed former lawyer jack Thompson, but by and large they aren't what people play. On the PC, for example, the best-selling game of all time is The Sims. That game doesn't even offer a do-gooder hero, or heroics of any kind. It's just household management.
Secondly, what's really interesting about PTSD and video games is the new research done showing that playing some video games reduces some instances of PTSD. There has been some evidence that playing tetris after a stressful event can lessen memory of the stress, and therefore lessen the trauma. Also, there is research being done into combat-specific virtual reality therapy, to help returning veterans cope with PTSD.
Lastly, all but the youngest children are really quite good at separating reality from fiction. People are aware of the differences between norms in a world with no consequences (like GTA) and a world with them, and people respond accordingly. VR therapy for soldiers is useful not because it is identical to combat, but because it is distinguishable from it. A game that let them re-experience combat as it was would be re-traumatizing and cause more harm than good. That disconnect between a game (no matter how convincing the graphics) and life is what makes such therapy possible.
Posted by Kelsey Atherton on 11/10/2009 @ 03:34PM PT
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Great points. Thanks Kelsey and Una. I've gone ahead and revised the post to clarify my question and respond to your posts. And I'm going to follow with another post citing studies on these topics. Here are some follow-ups not just to your responses, but just my homework on the subject...
ON GAME SALES. Of course there are a lot of games out there. I should have clarified that my question is posed specifically about adolescentse who focus primarily on war and shooter games, not the game world as a whole.
ON VIDEO GAMES FOR PTSD & MEDICAL TREATMENT. According to studies I've read (some links here), virtual war games put the veteran back into the environment of their trauma to one-by-one isolate each of the factors - sites, sounds, views, situations, soon smells - to see which one does cause hyper-arousal in the game, not to remove tension. It's also a way of ramping down.
http://www.pn.psychiatryonline.org/cgi/content/full/40/20/23-a; http://wwwx.cs.unc.edu/~gb/wp/wp-content/uploads/2006/10/gameshealth.pdf; http://www.springerlink.com/content/p42851h541381358/
ON CHILDREN'S EXPERIENCE WITH VIOLENT VIDEO GAMES. Studies I've read show that some children, particularly those who have already been exposed to violence, experience hyper-vigilance, prolonged tension, increased risk of social aggression after the game, and potentially a desensitization to real life violence. But of course, much is yet to be studied and much is still in debate.
Just one of many: http://74.125.155.132/scholar?q=cache:Of_ZyPtO3eIJ:scholar.google.com/+%22ptsd%22%2B%22video+games%22&hl=en
GAMES LEADING TO PTSD? Obviously, games don't physically traumatize a player, nor do the vast majority feel any real fear. But there are new theories out about child and adolescent development and about the effects of prolonged hyper-vigilance and tension in association with fear, etc. So lots of theories, hard to prove, but so interesting to consider...
Posted by Daniel J Gerstle on 11/10/2009 @ 09:42PM PT
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The debate about the effects of video games on kids go back to Space Invaders and shoot 'em up games that followed. Debates rage on whether really gory graphic movies effect the lesser hardened psyches of kids, especially younger ones.
I can't help but believe that a barrage of horrific images entering a kids mind may have a desensitizing effect to violence. Current war video games get as gory as it gets. Gushing blood, sucking chest wounds and splattered brains, in a very realistic setting.
The difference between the blood bath movies and war vid games? The kid is making the gory violence happen. He is pulling the trigger and blowing away other humans.
I remember back to the era of the war in Viet Nam when a flood of "war toys" hit the market. Not just the GI Joes, but Green Beret get-ups with poncho/beret and machine gun.
I later looked back and wondered if that surge of war toy sales had deeper purpose, or was an effect of the times. Since the Nam conflict stretched out so long, kids who got those toys at 12, found themselves wearing the real regalia and toting a real automatic rifle, 5-6 years later.
Now we see the US Army in the video game business, sort of. Do they develop the war video games (at taxpayer expense) as just a friendly gesture to help kids have fun, or as I suspicioned in the late 1960's, a deeper purpose.
Here is a wikipedia description of that vid game, Americas Army. http://en.wikipedia.org/wiki/America's_Army
"America's Army (also known as AA or Army Game Project) is a series of video games and other media developed by the United States Army and released as a global public relations initiative to help with recruitment."
To help with recruitment? Do they convey that maybe going to the mideast, gun in hand, might also be fun? The video game has proved so effective that the Army uses it in actual training programs.
So, the connection can be drawn that 10 year kids are being trained for war, be desensitized to shooting a human in the head and all in "good fun". Quite a leap forward from the Mattel Green Beret "Complete Set".
In my poem Another Mothers Son, the line "Take 'em young, Make 'em think that it's fun" I had the Army video game in mind as I wrote those words. Someone told my my Tube version of that poem was "too graphic". Obviously she hasn't seen the video war games kids play.
http://www.change.org/ideas/311/view_video/another_mothers_son
As I previewed archival photos of the mideast conflict, I took a pass on a LOT of photos because they were just as gory as those video games. I didn't want the video to be THAT disturbing to adults.
Maybe adults think it would be just fine for kids though.
Posted by Patrick Webb on 11/11/2009 @ 05:04PM PT
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Important considerations, Patrick. Thanks. Yeah, I'm actually someone who loves war games, video games, and grew up playing soldier.
Look where it got me, now I'm a lily-livered peacenik, ha, ha. Anyway, it's complex. I prefer to argue the point pro-game, just with caution.
Another illuminating example responding to the points above: My long time friend had an interesting debate with her war video game-obsessed son. Obviously, he was escaping real-life drama by joining his friends in some battles online with Warcraft a la South Park. (Best episode ever)
From what I understand, and I've seen this in other kids, he had become so much a part of that online, virtual platoon that he felt that when his mother grounded him from the game that she was preventing him from "being there" for his friends in battle.
For her, it was simply, do your homework, you're too young, etc. But for him, it had become this real-life comraderie with his friends and if he didn't show up at the rally point (battle-axe wiedling dwarf on thermalmador) for battle, he was afraid his friends would get slaughtered.
Obviously, he knew they would be safe, but he seemed to actually have absorbed a physiologically-real sense of duty tension, then the beginnings of a kind of survivor's guilt. And it manifest in anger. He started cussing her out, threatening her, and sending her unfair text messages.
Again, this is anecdotal and largely the manifestation of what was happening outside the game, but I think it's common and I would love to see studies on this.
Posted by Daniel J Gerstle on 11/11/2009 @ 06:09PM PT
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OK, I am sick of people thinking that violent video games can make people violent. Violent video games, music, and movies do not have any effect on how violent people are, some people are just violent, it's as simple as that.
I know from experience, I know people that play GTA and are violent, and they were violent WAY before they ever picked that game up. As a kid I watched some of the most violent movies, and played violent games, I was one of those kids playing Grand Theft Auto 3 running over old ladies with glee, watching the blood splatter, and hearing the screams of fear, and it was wonderful. I am also one of the most peaceful people you will ever meet, I hate violence (unless it's FAKE, like a video game, or movie).
It doesn't matter how REAL the game seems, it doesn't change the fact that it's FAKE, and games, music, and movies DO NOT CHANGE THE WAY PEOPLE ACT.
Posted by Tory Gaurnier on 11/15/2009 @ 12:03PM PT
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Also, I think it's stupid that people even need studies for this, because it doesn't take much more than COMMON SENSE, if you actually go out and MEET a lot of these gamers, and see how they are, and learn how they've been their whole lives, you'll see that games have NO effect on how violent their personalities are.
Posted by Tory Gaurnier on 11/15/2009 @ 12:06PM PT
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Hey Tory,
First of all, I don't want to come out as anti-game. It's like with war movies. I love them, you love them, and most of us are fine. But I've seen guys when I was in the Marines who had turned war into a romantic thing and they talked about how they couldn't wait to blow someone's head off while quoting from their favorite movies and games. Maybe a coincidence, maybe not, I don't know.
Also, re-read your messages. The theory makes you "sick" and you think it's "stupid" that people need studies for this. Consider how dramatically you're lashing out at me and others just at the thought of the subject? Funny, cause the studies I listed on the follow up post show an association of aggressive behavior with violent video game playing. (Link below)
However, I think there is a possibility a lot of this is coincidence, that many gamers come to the game with aggression or post-trauma stress. But I also think we should consider the possibility, not lash out and vomit all over the place just at the thought of it.
http://war.change.org/blog/view/the_latest_views_on_ptsd_and_war_video_games
Posted by Daniel J Gerstle on 11/15/2009 @ 12:20PM PT
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Potential side effects of gaming would of course be rare. Like with rates for combat PTS or swine flu, even if it's a high rate of 5 per 10,000, that doesn't mean that you'll ever meet someone in your life that has it. So you can't disprove something, just like you can't prove something, just by saying look at all the people I've met. The stories are good for anecdotal consideration though, so thanks.
Posted by Daniel J Gerstle on 11/15/2009 @ 12:23PM PT
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First of all I didn't say it "makes me sick", I said "I'm sick of people thinking that violent video games can make people violent."
And I seemed like I was lashing out, but I have heard to many people think that if their kid plays GTA3, he's gonna start taking drugs and getting violent, and there have been studies showing that violent video games make kids violent, but there have also been studies showing that second hand smoke is more harmful than first hand (which is bull, you just have to see HOW those studies are taken).
OK, now you were telling me about "Marines who had turned war into a romantic thing", but really, that isn't because of movies, people have been doing that WAY before movies ever came around, people have been turning war into a "romantic" thing for centuries.
I really do not believe that a game will make anyone violent, I believe that ANYONE who becomes violent because of a video game already had traits like that, all the game did was give them the idea. However I don't think those studies are going to adress that. Just like the studies on second hand smoke didn't mention that they were taken in condemned buildings with asbestos (and they were probably hot boxing monkeys to simulate second hand smoke). A study means NOTHING unless you take in every aspect of it, and anything it may be leaving out.
Posted by Tory Gaurnier on 11/15/2009 @ 03:05PM PT
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studies can mean a lot without taking everything into consideration. A good study isolates one or two variables to measure the effect they have on another variable. Violent video games are not a direct cause of violence, but that is because this is behavioral science we are dealing with, not physics. Each person is going to respond differently based on genetics, upbringing, experience during the game (e.g. parents are around or they are playing alone in their room... I know of one study where parents co-viewing violent films lessened some of the negative impacts. Unfortunately I don't have the original study off-hand, but here's a site with a very brief overview http://www.aacap.org/cs/root/facts_for_families/children_and_tv_violence). Performing a study on children with pre-existing behavioral problems will still tell you the truth about that sub-population. However, it will not mean that the effects will generalize to the general population.
I agree that in many cases a person might have the potential/traits to head toward violence, but if more non-violent options were available, could this route be avoided? Obviously not in all cases, but decreasing violence by certain percentages is still moving in better directions.
I've spent my time playing Unreal Tournament, Warcraft, GTA, and other games. The thought of violence in the real world boggles my mind. However, one person's experience does not tell the final story of whether the games have a positive, negative, or null impact. Studies on both sides of the argument are used to say that video games are 100% ok, or 100% bad, but that's missing the point of scientific research. The reason that research continues is because we do not have a definitive answer on how and when violent games are bad, versus how and when they can be a healthy activity (increasing visual processing speed, understanding team dynamics, creating friendships).
"A study means NOTHING unless you take in every aspect of it, and anything it may be leaving out"
Psychology finds trends. It does not give answers on the same level of gravity (release the pencil, and it will fall toward the earth). Just because you are part of the percentage who is relatively unaffected by video games does not mean that you can disregard the studies. For you to ignore it because of one person's life experience is to leave out or ignore more variables than the original researchers did. Yes, there are times when individual researchers will miss something, skew results, or otherwise miss the correct answers.
While developing PTSD from playing a video game seems unlikely, it should not be discounted easily. However, I'd definitely agree that there is an overabundance of negative role models (real and fictional) who are poor examples of how to behave.
Posted by Victor K on 11/16/2009 @ 08:57AM PT
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You still have to take into consideration how these studies are taken, people get PTSD, and I'm sure certain extra violent video games probably effect it, but I do not think they CAUSE it, how do you know the people in these studies did not allready have traits of it before they played these video games? For example, with the story about the kid who played GTA2 and was freaking out when someone woudn't shoot an old lady, he was probably a very spoiled child, which causes this kind of behavior, NOT playing GTA2.
I think this is a little more of complex than some people think. These studies are still very biased, you say "A good study isolates one or two variables to measure the effect they have on another variable.", which is true to an extent, but you can take "one or two variables" that have nothing to do, or very little, with the third variable, and make it look like they are brothers. For example, a study shows that majority of crime in America is committed by black and hispanic people, it takes in the variables of crime rate, and numbers of crimes by which races of people, and it gives majority of the people who hear it the impression that they commit crimes BECAUSE of their race, and this helps breed racism, however the variables it DOESN'T take into consideration is the fact that it is PEOPLE IN POVERTY that commit majority of the crime in America, and because of the way our system is set up (education system, mostly), it is these minority groups that are in most poverty.
So relating to games, a lot of the studies take into consideration the variables group A plays these kinds of video games, group plays these games, etc., and more people in group A have PTSD, therefore these games cause it in ____ percentage of people, however they don't take into consideration the very important variables that the people with PTSD may have been abused, neglected, teased at school, etc., there are a number of things that cause it. I have not seen any evidence in studies that it is the GAME that causes PTSD.
Posted by Tory Gaurnier on 11/16/2009 @ 11:46AM PT
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Actually, I was just reading your what you said above: "ON CHILDREN'S EXPERIENCE WITH VIOLENT VIDEO GAMES. Studies I've read show that some children, particularly those who have already been exposed to violence, experience hyper-vigilance, prolonged tension, increased risk of social aggression after the game, and potentially a desensitization to real life violence."
And this is what I'm talking about, children who have already been exposed to violence, I've known people like this, and they experience "hyper-vigilance, prolonged tension, increased risk of social aggression" after just about ANYTHING competitive, and just get into fights easilly in general, no JUST after a violent video game.
Posted by Tory Gaurnier on 11/16/2009 @ 11:57AM PT
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You are right to question the chain of cause-and-effect for correlational studies. The ones where they just gather information about two variables and say "violence is higher among people who play violent video games."
When you combine these findings with experimental results, the case grows stronger. I'm going to use another example about watching violence rather than violent video games, but I think it is relevant. Experimenters brought in kids. Some of them saw an adult beat up a Bobo doll, some watched the adult play non-violently. The important part is that both groups of kids were randomly put into these groups, so we know that the groups are (more or less) only different in what they watched (violent adult, non-violent adult). As you might expect, the kids who watched the violent adult then played violently with the doll. Based on the experimental method, not just surveys, correlations, and stories, we can be quite certain that the cause of the violence was watching the violent adult. Violence may happen with and without violent video games, but we can still see specific instances of A causing B.
Again (for other studies with weaker results) in psychology we often don't find 100% of the cause. In physics, you can calculate the velocity of a pencil falling to the ground by only measuring the pull of Earth's mass. Now if you remember back in physics class, everything with mass is "attracted to" everything else with mass. The pencil has a gravitational pull toward the building that you stand next to, which you would need to account for if you were to describe the trajectory with 100% accuracy. However, Earth is huge, so the amount coming from the building is negligible. Imagine dropping the pencil between the earth and the moon, and now Earth affects the movement of the pencil less, and the role of the "building" (moon) next to you will play a stronger role in where the pencil moves.
So, to explain my physics metaphor: yes, more than JUST video games play a role in establishing violent behavior. Some of the larger factors might be genetics and hormones (more testosterone = more physical violence), family and general environment during early development (not sure of any relevant studies off-hand). However, there is a certain "pull" toward violence that comes from video games. When performing a study, many researchers aren't just looking for "yes or no," they are trying to measure exactly how much violent media (video games, movies, news) increase violence.
Here is another, longer article summarizing a lot of the research done on violence stemming from video games. http://www.apa.org/science/psa/sb-anderson.html
Even assuming that you are right -- violent video games don't cause violence but only give people ideas -- wouldn't it be better if the ideas they received were a bit calmer? For example, "poke this person in the eye" compared to "blow this person's brains out." If someone feeling overwhelmed walked into your supermarket, which idea would you prefer they had bouncing around in their skull?
Posted by Victor K on 11/16/2009 @ 02:06PM PT
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First of all, it isn't just that it gives people ideas, people are attracted to the game BECAUSE of the violence in it, there are plenty of games without as much violence, but those games will never give those people ideas, like the violent video games do, because they are not as attracted to the game.
Here is an example, 50 cent does not cause his fans to be violent, he is violent, has violent lyrics, and his game is supposedly extremely violent (never seen it, so don't know first hand), but that doesn't mean he is making others violent. His fans are violent, into the rap genre, and a lot of the time, gangs, and they lean towards him BECAUSE of his violence.
So I guess part of my argument is that people aren't violent because of media, they lean towards media BECAUSE it's violent.
However I DO agree when it comes to children of a certain age, they are VERY impressionistic, and however I would not say thata it causes PTSD (which is what this was sort of about), it is litterally just giving kids ideas, only at that age they follow through with thier ideas much more. Of course kids at THAT age shouldn't be playing violent video games, at THAT age you want them to be learning peaceful things, watching POSSITIVE media. Of course, like everything, it is always a lot more complicated, there is a whole science to raising kids to be good, you can actually have violent media in their lives as long as there is a whole lot more peaceful media.
Posted by Tory Gaurnier on 11/20/2009 @ 10:10AM PT
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Gawd, as a Military Veteran I just laugh at this stuff.
PTSD? I actually know Military Veterans with PTSD and they didn't get it from video games! If I told you what happened to one guy you'd have nightmares for a week.
Could this be another ploy by the therapeudic community to go after tax dollars?
Posted by Thomas Porter on 12/03/2009 @ 08:24PM PT
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