The best, although perhaps not wisest way to start this article is with a confession. Well, more of an admission really. I was a depressive. From the ages of fifteen to thirty my mental state came in only two colors: black and a slightly darker black.

Imagine spending every moment of your life feeling an immense yet infinitesimal emptiness lodged in the space between your stomach and your heart. A feeling that has no beginning and no end. Think of being taken apart piece by piece, thought by thought until there is nothing left of you and then being put together again but not necessarily in the right order. It causes a gaping emptiness within you. Something is always missing and it’s always a different thing because a different part of you is absent each time you’re reassembled. Imagine the last thought you have before going to sleep and the first thought on waking up being how awful and worthless you are as a person, and having that thought run through your head every hour in between.

If you can imagine that then you’ve got a passable idea of what it means to live with depression. For fifteen terrible years I existed in that state without even the faintest glimmer of hope by way of reprieve. Yet even when my life was at its lowest ebb there was one thing I could count on to have a palliative effect on what at the time seemed like an endless plethora of insurmountable woes. That thing was gaming. More specifically online gaming. Whilst that might not seem like the healthiest of options, it was nevertheless a reliable source of comfort and engagement at a time when I could find either in little else.

I recently resubscribed to The Elder Scrolls Online shortly after the launch of its Morrowind DLC pack, after a long hiatus from the game – I’d not played the base product since about six or so months into its lifespan. I wasn’t simply drawn back by the fanboy nostalgia for one of the titles that helped shape my gaming tastes to this day. No, the decision was primarily taken because remembering what games like this meant to me back during my illness made me consider what it was that I found so appealing about them, and ESO in particular, in the first place.

Over the years I’ve played more massively multiplayer online games than I can count, let alone remember, and it took some doing but I’ve managed to narrow it down to a few gameplay elements that made MMOs so useful to me throughout my years of social anxiety and depression.

One of the things that most people look forward to about going on vacation is the chance to get away from the drudgery of everyday life by taking the opportunity to see, try and do new things. Essentially that’s exactly what MMOs offer, albeit in a digital form. The sad truth is that for the vast majority of us the extent of our experience of the outside world has become increasingly restricted to the route of our daily commute. We see the same things day after day, sometimes for years on end, with only the occasional construction of a new retail park or residential development affording any semblance of variation. Since money is becoming an ever more pressing concern for most of us, the chance to travel is a rare one, so when ordinary life becomes little more than a chore, it’s hard to resist the allure of exploring the unknown corners of an imaginary world. We might not be able to find the time or money to travel the real world, but from the comfort of our desks we can at least come close to an approximation of what such freedom is like. We play games for exactly the same reason that we read books or visit the cinema: they enable us to experience lives and times as far removed from our own as possible.

For those who feel the anxieties of life more keenly than most, the potential for instilling a sense of discovery and immersion is of incalculable value. The large scale environments that are a standard feature of most MMOs constitute an escape mechanism from the often unbearable and mundane pressures of reality. The limitations placed upon our ability to experience the real world fortunately have no influence over our ability to experience imaginary ones. By choosing to participate in an MMO, players are gifted the freedom to determine their own course in handcrafted worlds that are the product of arduous creative labor. Running around a corner only to be met with the sight of pastures draped in morning mist as sunbeams glitter off the slate roofs of a township in the distance, or stumbling across a verdant glade concealed between frost-crowned mountains, is something that never loses its charm.

Although most games will share the same few biome variations when it comes to their terrain thematics (usually based on the four cardinal elements or natural extremes of climate), there’s something about encountering a new location in a game for the very first time that feels deeply personal even though you may be playing the game with hundreds or even thousands of other people. Beyond aesthetic considerations this perceived freedom of movement is therapeutic in its own right. It encourages adopting a passively contemplative as opposed to actively critical state of mind. What I mean by that is rather than being consistently and detrimentally preoccupied with the trying minutiae of normal life, the player is presented with an environment that exists precisely in counterpoint to that reality and allows the mind to unburden itself in an engaging environment.

It’s not only the drive to discover and explore that makes such game worlds have a restorative effect. They are populated by a huge cast of non-player characters most of whom have some task to carry out or mission to complete; objectives that can only be achieved with a player’s help. These quests are generally designed to send you across the entirety of an area and provide a framework on which character progress can be built. Usually they will fall into one of three main categories: optional, area narrative and primary narrative.

Optional quests tend to involve minor objectives, like culling rogue wildlife, gathering various supplies, or killing a certain number of enemies. They exist to give you a wider range of choices with how you progress through an area and to showcase parts of it that you might not otherwise have seen. Area narrative quests task players with objectives related to the localized story and tend to require you to carry out more involved tasks than simply killing a random number of miscellaneous monsters. You might be embroiled in a conspiracy to unmask a traitor and their minions, hunt down members of an evil cult or battle a clan of wayward mercenaries but whatever the over-arching story line is, the narratives will be structured in such a way that you start off with small scale objectives that serve as narrative milestones on the path to a climactic encounter. Primary narrative quests share similar features to the area ones but they tend to focus on much larger events and are tied to the overall story line that guides players through the entirety of the game while framing your exploration and questing in an attempt to give them more immediate relevance to the gameplay experience as a whole.

Questing is an absolutely essential element in these games. Without quests players would be limited to mindlessly slogging their way through waves of generic monsters with little payoff, and frankly there’s enough grind in daily life to make that more than off-putting. Beyond their technical function though they have a secondary purpose, at least for people enduring depression as I once did. In life it can at times be almost impossible to find purpose and motivation; our goals are often nameless and nebulous, without us not even realizing they were what we wanted until we’ve achieved them; or not as the case may be. MMO quests though, no matter how seemingly pointless they may be, foster a sense of direction that often eludes us in reality because they state clearly what is to be done and how to go about doing it. You might think that this counteracts the apparent freedom created by the presentation of an ostensibly endless game world but instead they serve to give it form. They make otherwise disconnected actions feel like part of a coherent whole and when all of the disparate aspects of real life are hopelessly mismatched, this structured activity provides a clear method of gauging the personal progress we all seek and struggle to find.

Although there is a caveat to consider regarding this cartographic and adventuring free-for-all. During the course of wandering, riding, flying or fighting through your quests, it’s not unusual to come across areas that are too well-defended or, indeed, too foreboding, to traverse alone. Whether it’s a monstrous fortress of scorched stone guarded by bloodthirsty legionaries, a twisted maze of subterranean tunnels overrun by vicious beasts, or a decrepit network of crumbling ruins infested with vermin and the unquiet dead, chances are you’ve just found yourself a dungeon.

Anyone with even the most passing of interests in fantasy will be familiar with the concept of a dungeon, but the traditional image is slightly different when it comes to games. In MMO terms a dungeon is a location within the world that, rather than being accessible to the general population, is reserved entirely for a single group of players. Due to the localized nature of these areas the level of environmental detail is often much more intensive than in the overworld. Due to the restricted nature of these locations, they’re good opportunities for the artists to demonstrate their skills in creating digital mise-en-scene in what might otherwise be an unremarkable assemblage of rooms and corridors. Every nook and cranny will have some form of highly decorative features tailored to the dungeon. From waterfalls pouring through starlight as they stream out of a cave opening; lush foliage and fungi growing over an intricate frieze depicting legendary figures framed by stuttering torches; or a crumbling shrine adorned with ancient tomes and the scattered bones of sacrificial victims, there is always an enticing visual accompaniment to your passage through the dungeon and for any ensuing battles.

There will no doubt be plenty of combat because contained within these private instances are enemies that tend to be more numerous and powerful with the ability to utilize more complicated attack patterns than those you’d see elsewhere. What would be an almost impossible encounter for a lone player becomes an opportunity for a group to co-ordinate their efforts by contributing with skills and abilities that compliment those of the other participants to overcome a shared challenge. Usually these groups of enemies serve as the primary obstacles to the final encounter of the dungeon and are often a form of practical tutorial for teaching players the basic technical mechanics of the latter encounters. Once the other denizens of the dungeon have been slain players will often be required to kill one last enemy before they can complete the instance and any associated quests. Typically these enemies tend to make use of enhanced versions of the attacks used by the preceding lesser creatures and require quick reflexes and situational awareness to avoid taking significant damage or even being outright killed. They will attack in patterns and phases meaning that a good memory is essential in order to succeed; even just standing in the wrong place at the wrong time can make all the difference between victory and defeat.

After you’ve plumbed the depths of various dungeons and managed to get your character’s hands on all manner of treasure and equipment you may find yourself in the position of being able to take part in what the community generally refers to as a raid. Each game will have its own frame of reference for these activities but what they all have in common is that they are basically mega dungeons. The challenges players encounter are even more significant and daunting than ones you’d see in smaller dungeons and require much more in-depth understanding of a character’s abilities and group role than was previously called for. Overcoming the enemies in these larger instances necessitates very close team work and clear communication between participants, otherwise failure is absolutely guaranteed. In most cases they can take hours to complete with co-ordination maintained throughout.

A raid group is required to synergize and function as a coherent unit to prevail, which is why this element of MMO gameplay can appeal particularly to people with chronic difficulties finding social integration. The common purpose and mutual goal of the raid group offers welcome respite from the relentless “me first” attitude that has become aggressively prevalent in the real world. It’s a persistently problematic stand point that almost universally causes more harm than good, and is the prime factor that so often precludes the idea of making meaningful connections to people around us. Of course as everyone knows, the internet is probably the furthest thing from being a “safe space” it could possibly be, and distinguishing between genuinely decent people and outright trolls never is a simple task, but if you manage to make a good impression on enough people then you could find yourself being invited to join a guild.

The word “guild” might sound fancy. It might even call to mind all manner of skullduggerous escapades in some parody of 15th century Venice, but it is just the most common name for a player-curated friends list that allows players to keep in touch to more easily arrange in-game activities. Each guild will cater to different types of player (from the hardcore to casual), but no matter the type of player you are, or the type guild you’re in, it will serve as a hub that more readily allows you to share your time in-game with others. More dedicated guilds will even take things a step further and arrange non-scripted in-game events, such as role playing sessions, races, raffles and competitions all in the name of building stronger ties between the members of their virtual community. This is obviously invaluable to someone who has issues with forming social connections in real life, as I did. The main reason for this is that your value to the group isn’t judged in the same way as it is in reality. In life, your worth as a person is often seen to be the product of a combination of your physical appearance and your earning potential. Social success is largely beyond your control as even the most insignicant detail about you (such as what kind of school you went to) restricts the kind of places you can go, the type of job you can get, and even who you’re allowed to fall in love with.

However, in an MMO your value to the group is determined strictly on who you are not what you are. Who someone chooses to be in game, regardless of who they might be in actuality, is of far more importance and allows players to exert a greater deal of control over how people perceive them than is usually afforded them in face-to-face interactions. For example, most of my working life has been spent in either retail or low level adminstrative positions; the kind of occupations that people like to look down on as “non-jobs.” There are times when I have earned nothing but glares of derision and bemusement from people who treat me as little better than a servant. For the members of guilds I’ve been part of over the years, nothing about me mattered other than my ability to play the game. My value to them was not determined by factors like genetics, family connections or dumb luck. They knew I was a good player who could be counted on to help when asked and, as such, treated me with the respect and courtesy that I was rarely (if ever) shown in my dealings with people in reality. In the past I’ve spent hours riding in circles gathering materials to help guild members to make new equipment or for supplies to assist in dungeons or raids. Back when I played Warhammer Online I was so well known for my knowledge of the game world that when members of my guild wanted to find out the exact location of a quest objective or how to find a rare enemy they didn’t ask the internet, they asked me.

Perhaps that seems absurd and even a little sad, in truth it’s both. However, at the time, nothing really meant more to me than knowing that even if I had no one else to turn to I could log in to whatever game I was playing at the time and be welcomed on my own merits for who I am rather than out of the perception of what I could or should be. That’s what makes guilds such an integral element of MMOs when it comes to people with social anxiety and depression. They create an environment in which people can flourish without fear of being judged based on irrelevant factors that have no bearing on their worth as individuals. The years I spent as an active member of guilds across multiple MMOs were perhaps some of the most enjoyable of my gaming life because not only was I able to share an activity I enjoyed with other likeminded people but also because, as indicated above, there was only one condition placed on their acceptance of me: my ability to play. The meritocracy that supposedly exists in the real world is largely a sham, as most of us can attest from bitter experience. The respect, apprecation and understanding that are meant to be extended to all of us by default as part of the social contract can he hard to come by in actuality, but in an MMO guild as long as you’re good company and can prove yourself useful then your estimation as a valued member is assured.

Clearly, any social activity that involves large groups of people will often also entail drama and entire guilds have been known to disband for such petty reasons as who got what piece of loot in a dungeon or just misplaced interpersonal rivalry. That’s not something I have ever experienced and overall my online interactions helped me to acquire a better sense of humor, more tolerance for different mindsets and personality types, and offered a kind of stability that was of enormous importance during the years of my illness and without question contributed, in however small a fashion, to my eventual recovery.

By no means am I claiming that MMOs or online gaming in general is a sure fire method of overcoming social anxiety and depression. To even think of making such a claim would be completely ludicrous. As much as I believe in games as entertainment and art, they are obviously not a viable medical treatment for chronic psychological difficulties or conditions. But where conventional methods failed for me, as they do for many others, I found that online games, what I experienced as I played them, and the people I met whilst doing so helped to make me more open-minded, more appreciative of my surroundings and willing to look at the real world in ways that perhaps I hadn’t considered before. All the subscription fees, micro-transactions, DLC purchases, not to mention the hours spent hunting for loot and gold were a small price to pay for contributing to the cultivation of my present day peace of mind.

The sense of awe instilled in me by the artificial environments of game worlds made me curious to explore the real one even more. Completing endless quests to help those who couldn’t help themselves made me realize that the code of honesty and decency I try to live by isn’t just nonsense. Those evenings I spent delving through dungeons, working together with a group to defeat impossible monsters reaffirmed my belief in the worth of co-operating for the mutual benefit of all. Being part of guilds and talking to people from all over the world put just enough of a dent in my inherent cynicism to make me realize that people aren’t always as bad as I once believed. So if you yourself or someone you know is unfortunate enough to be experiencing the sort of difficulties that I once did then I would recommend trying out an MMO. It’s not a perfect solution and may have no immediate impact whatsoever but these kind of games can provide the mental breathing room that your psyche needs to help itself recover. That help, however insignificant it might seem or how ridiculous its form, might just be what you need. I know I did.

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Chris is a Cambridge, UK based freelance writer and reviewer. A graduate of English Literature from Goldsmiths College in London he has been composing poetry and prose for most of his life. More than partial to real ale/craft beer and a general fan of sci-fi and fantasy. He first started gaming on a borrowed Mega Drive as a child and has been a passionate enthusiast of the hobby and art form ever since. Never afraid to speak his mind he always aims to tell the unvarnished truth about a game. Favourite genres: RPGs, action adventure and MMOs. Least favourite genre: anything EA Sports related (they're the same games every year!)