The Virtual Body - Gaming, Chronic Illness & Escape : Episode 9

🎧 Episode 9: The Virtual Body: Gaming, Chronic Illness & Escape

When the body becomes a source of pain, unpredictability, or shame - where does the self go?

In this episode of Mind The Body, I explore gaming, chronic illness, and body image, and why virtual worlds can feel like relief when the body feels difficult to live in. For some, the virtual body offers a return to a self interrupted by chronic illness - something echoed in Gabrielle Zevin’s novel Tomorrow, and Tomorrow, and Tomorrow, where gaming becomes a space of identity beyond limitation. For others, it might resemble what psychoanalyst Esther Bick described as a ‘second skin’ - a way of holding the self together when an internal sense of containment feels fragile or underdeveloped.

Drawing on Winnicott’s idea of transitional space, I explore how virtual worlds can offer both refuge and restoration. Gaming can function in this way, but only when it allows movement between the virtual self and the lived body, rather than replacing one with the other.

In this episode, we explore:

• Why gaming can feel like a safe place to go when your body feels painful, unpredictable, or hard to be in
• How virtual worlds can act as a kind of ‘holding space’ when you don’t feel fully held within yourself (Esther Bick’s ‘second skin’)
• How gaming can become a bridge between identity, chronic illness, and the self you feel you’ve lost or can’t access
• What your avatar choices might reveal about identity, grief, and body image

Key Question:

When you step into a virtual body… What are you stepping toward, and what are you setting down?

Take a breath, stay curious, and explore what it truly means to Mind The Body.

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Transcript

0:48

Hello and welcome back to Mind The Body. Last episode, I talked about chronic illness and body image and what it does to your relationship with your own body, how it can make you feel like a stranger to your own body today. I wanna follow that thread somewhere, perhaps unexpected. I wanna talk about gaming. And I've been wanting to talk about this for a long time because here is the question that interests me. When the body becomes a source of pain, unpredictability, grief, or shame, whether through trauma, through illness, through the accumulated weight of early relational messages, where does the self go? For many people, the answer involves a screen, a controller, a character who moves through the world without flinching. This episode is for anyone who games, but it's also perhaps, especially for anyone who has ever longed to be somewhere else in their body, anyone who knows what it is to experience your physical self as something to be tolerated rather than lived in. We are gonna cover three things today. First, the virtual body as refuge and what it is actually doing for the people who find their way there. Second, what Avatar Choice tells us about the self we are grieving or the self we have never quite been allowed to be. And third, when escape becomes avoidance and why that question requires more care than it might first appear. So let's begin. When someone steps into a virtual body, the easy explanation is that they're escaping reality. And sometimes, let's be honest, that's exactly what's happening. The world is too much, the body is too much, and for a few hours, and none of it has to be faced. But I don't think that's the whole story. And I think when we stop there, when we reach for escapism and move on, we miss something that is actually quite extraordinary. When we enter a visual space, we are not simply leaving the body behind. We are entering a different relationship with it. A relationship in which the body can be reimagined, reconstructed, or temporarily set aside. And that is never a neutral act. It always tells us something about the relationship the person has with their actual physical felt self. And sometimes that relationship is more surprising than we might think because for some people, the virtual body is not where they go to flee. It's where they go to arrive. To inhabit a self that moves without apology, that occupy space without anxiety that exists without the constant low level management that the real body demands for someone whose body has become a source of pain or shame or grief, genuine unselfconscious embodiment may be something they have rarely, if ever been able to feel the game gives them a version of it. Not fantasy. Exactly. More like rehearsal. The first time the self gets to practice what it might feel like to simply be without consequence, without history, without the body demanding to be attended to. And I think it's worth taking seriously. So I wanna start with chronic illness because last episode, that's exactly where we were. And because over the years I've been fortunate to sit with many people who found their way to gaming some in the early days after a diagnosis. Others after living with illness for a very long time, what they've described to me has stayed with me. You see, when you live with a chronic condition, something very particular happens to your relationship with your own body. It isn't just that the body becomes painful or limiting or unpredictable, though it is all of those things. It's that the sense of yourself over time starts to break down. There is a before and an after. And the self that existed in the before, the one who moved through the world without having to negotiate with their body. At every turn, that self becomes harder and harder to locate. What I've heard people describe when they talk about gaming is not escapism in the way we tend to dismiss it. It's something less obvious than that. A temporary restoration of that connection to who you were. A chance to inhabit a self that moves without flinching, that doesn't have to manage or monitor or accommodate, not entirely the body they had before. Not a fantasy. Something in between a space where the self, that illness interrupted is still allowed to exist. And this isn't something I've observed clinically. It's there in fiction too and in a novel. I think many of you will know. Gabrielle Evans tomorrow and tomorrow and tomorrow, which opens with two children meeting in hospital. One of them, Sam, living with chronic pain and disability from a childhood injury that will never fully resolve. Gaming is where Sam first finds itself that isn't defined by what his body can't do. Zon describes what games offer as a possibility of infinite rebirth, infinite redemption. The idea that if you keep playing, you could win. That is an escapism. That is the self refusing to be reduced to its limitations. And for someone who has spent months or years negotiating with a body that keeps changing the terms, that refusal really matters and it deserves to be taken seriously, not pathologized, not treated as avoidance witnessed, Now the picture looks quite different for someone whose body image distress is rooted, not in illness, but in early relational experience. And this is where I wanna bring in a psychoanalytic idea, which I find really useful. The British psychoanalyst Esther Pick was interested in what holds us together at the most primitive level. Her argument put simply is this in early life, the parts of the self have no inherent binding force of their own. They need something to hold them, and that's something at the beginning is the experience of being held and contained by another person. A caregiver who's reliable, attuned presence creates the felt sense of having a boundary of being coherent rather than scattered. When that early experience is inadequate, when the environment is unpredictable or frightening or simply not present enough, the self finds something else to do that job., A substitute container record this a second skin. It might be the rhythm of rocking or a fierce focus on a sound or a light, something concrete and external that the body can orient towards. Hold onto when the internal container isn't there. I've sat with people, adults for whom this pattern is very alive, who describe a kind of internal fragmentation when they are not engaged with something that holds their attention completely and who have found often without quite understanding why that gaming does something nothing else quite does. It contains them. The world of the game has edges, rules, a known texture. It doesn't surprise them in the ways that people do for this person. Gaming is not entertainment. It is a structure. It is skin. Bick went further and described a phenomenon she called adhesive identification. When the person doesn't so much find a container as clinging to a surface, not taking something in, but sticking to its outside. The rhythm of a familiar voice, a game returned to again and again, not for challenge, but for the comfort of its textures and sounds. If you've ever found yourself going back to the same game, not because you are particularly enjoying it, but because something about its familiarity feels like it holds you, that is what Bick was pointing at, and it's not a small thing. It is the self doing its best with what it's been given. So we have two distinct pictures here. The person with chronic illness, seeking a restoration of that kind of connection to who they were, that illness interrupted briefly allowed to exist again, and the person with early relational wounding seeking a container, something to hold them together when the internal structure for doing that was never adequately built. Different needs, different histories, but both finding something in the virtual body that the real body for different reasons cannot currently provide. And what both have in common is this. The avatar offers unconditional permission to exist without history, without limitation, without the weight of what has happened to the body or what was done to it, or what it can no longer do. Winnicott wrote about the capacity to be alone. Genuinely alone in peace as one of the most important signs of emotional maturity. But he was clear that this capacity has to be built in the presence of a reliable other. It is not something we arrive with. For many people that capacity was disrupted early or disrupted later by illness, the virtual space. At its best offers a version of that experience, A place to simply be without demand, without the constant background noise of bodily self-monitoring. And that is not nothing that is rest. And sometimes rest is exactly what the self needs before it can do Anything else. So now we move on to the second point here is where it becomes genuinely fascinating from a psychodynamic perspective. When a person chooses an avatar. They are making a series of decisions that are rarely as conscious or arbitrary as they appear. Each choice carries psychic weight. And what I want to suggest is that the avatar is in a very real sense, an idealized body. A body that carries none of the history that makes the real body feel unsafe, limited, or insufficient. For someone whose body image distress is rooted in relational experience in early messages about being too much, not enough unacceptable. The idealized avatar is often the body freed from shame. The body that occupies space without apology, the body that is seen and perhaps found worthy. For someone living with chronic illness, the idealized avatar is something else. Again, it is often the body that was the pre-diagnosis self. The person who ran or danced or didn't think twice about stairs. Playing as that body is not denial. It is something closer to what we might call continuing bonds, a way of staying in relationship with a version of the self. That illness has made harder to reach. The avatar as a kind of memorial to a lost physical life. And then there is the third possibility one I find particularly striking, and one I don't think has been named clearly in the clinical literature. Some people with chronic illness consistently choose avatars who are not just capable, but invincible. The warrior, the hero, the character who cannot be brought down. And I wanna suggest that what is happening here is not simply wish fulfillment.. It is something more purposeful than that. It is an unconscious attempt to have victory over the illness itself. The avatar wins the battles the real body keeps losing. The avatar is never ambushed by symptoms. The avatar does not have to cancel. Plans, manage energy, explain limitations. The avatar fights and prevails. There is something both deeply poignant and psychically purposeful in this. It is, I would argue, a form of protest, a way of insisting in the only space available that this self has power, that this body, even if only virtually. Cannot be permanently defeated. The clinical question is whether that protest is finding its way into the real relationship with the body, or whether the game is the only place where it is ever allowed to exist. And yes, many avatars do have a backstory. An original wound, the orphan hero, the warrior, forged by loss, the character whose suffering is ridden into their beginning. But what's different here is the backstory is chosen, it is contained. It does not keep arriving uninvited, and the character is powerful because of it. Not in spite of it, not ashamed of it, not still living inside it. The wound is part of the myth in real life. For many people I work with, the wound is just still the wound. The avatar is in a very real sense, the self in draft form. The self that grief has put on hold or the self that refuses somewhere deep to accept the verdict of illness. But I want to add one more dimension here, because gaming is increasingly not a solitary activity. It is social. And when you play online, other people encounter your avatar self. They respond to it. They form relationships with it. In gaming communities, discord service, multi-player worlds, the avatar has a reputation, a history, a presence that others know and recognize. And this is where something quite particular can happen. The online persona gets seen. It receives recognition, status, care, belonging. Other people laugh with it, rely on it, even celebrate it, and the real self, the offline body with its history and its limitations, and its chronic pain or its shame, watches all of this from behind a screen unseen. Unreached increasingly convinced that what is lovable about them is only the version that isn't quite real. This is one of the more quietly painful dynamics I have encountered in my work. Just a slow, steady widening of the gap between the self that is valued and the self that actually has to wake up in the morning, and it can deepen body image distress considerably because the implicit message the person receives again and again is that the real body is the problem. That if people knew the whole truth of who they were, the body, the limitations, the history, the belonging would disappear. This is not a reason to abandon online connection. It is a reason to bring it into the therapy room to ask who knows the real you and what would it mean to let them. So here we move on to the last point, and this is the harder conversation and I want to hold it mindfully because I think it is not always handled well in discussions about gaming and mental health. The easy version is too much. Gaming is bad. It's avoidance. People should engage with real life, and that can be true, but it's far too simple and applied without nuance. It misses what is actually happening and can inadvertently shame people for a coping strategy that may be doing genuinely important psychological work. So going back to Bick, she is very clear that second skin formations are not failures. They are adaptations. They developed because the original containing environment was insufficient, and the task is not to rip them away. That would be destabilizing, even risky. But to slowly build something more primary in their place. A real relational container that can do what the second skin has been doing, that is the frame I wanna bring to gaming. When gaming is functioning as a genuine transitional space, in winnekot's sense, an immediate area, uh, that bridges inner and outer reality, there is movement. The person returns from the game with something, a sense of capability. A moment of contact with the self they were or the self, they might still become the game is doing real psychological work and something of that transfers back into daily life. When gaming is functioning as avoidance, there is stasis. An idealized body and the real body move further apart rather than closer together. The real body with its history, its vulnerability, its unprocessed. Grief is not resting while the person plays. It is being left behind and in the context of chronic illness. Because for someone in significant physical pain or navigating a diagnosis that has upended their sense of self, whether recently or over many years, relief is not the same thing as avoidance. Sometimes relief is simply what is needed. The nervous system cannot be in a state of integration and processing. All the time, gaming can be a legitimate, even necessary form of rest. The question is not whether someone is seeking relief. The question is whether relief is becoming the only available state. What I would like to offer, and this is where I think the existing, research has not yet gone, is that the most useful frame here is not addiction or disorder, but attachment. The person who games compulsively is not simply seeking stimulation. They're seeking a relationship. A relationship with a container that does not disappoint, does not withdraw, does not impose conditions on their right to exist within. It the idealized body. It is not just an idealized body here. It is an idealized attachment, a container that never fails, and that is an attachment need one that almost traced back to an early relational environment that could not reliably meet it or to an illness that severed the person's trust in their own body as a reliable home. The virtual body does not need to be surrendered. It can become a bridge rather than a home. So we've covered a lot of ground today. We started with the virtual body as refuge and why? For two very different groups of people, it offers something the real body currently cannot. For those living with chronic illness, a temporary restoration of the self, that illness interrupted. And for those carrying early relational wounding, a container, a second skin, when the internal structure for holding together was never adequately built. We then looked at what avatar choice tells us, the idealized body, the pre-illness self, and the fighter who refuses to accept the verdict of illness. And we sat with the more uncomfortable question of what happens when the avatar self becomes the self that others see and value and the real self watches from behind it unseen. And lastly, we sat with the harder question, when does refuge become avoidance with the answer that the most useful frame is not disorder, but attachment. The person who games all the time is not seeking stimulation. They are seeking a relationship that does not fail them. What I hope you are taking away is a different set of questions. When you step into a virtual body, what are you stepping toward and what are you for a little while setting down? Because what we reach for in moments of distress always tells us something about what we haven't yet been able to bear. Whether that is unprocessed trauma or a grief of a body that has changed in ways you didn't choose. The virtual body at its most honest, is a map of the real body's unfinished business, and that unfinished business is what therapy is for. It is what healing asks of us, Not that we stop seeking refuge, but that we gradually carefully learn to find some of that refuge inside ourselves and in the presence of people who can bear witness to it alongside us. The body you live in has a history. It has been shaped by relationships, by experiences, by losses, both named and unnamed. None of that makes it permanently unsafe, but it does mean that safety real embodied safety has to be built, and it is built relationally in connection. In being seen, that is what Mind the body is always moving toward. Next time I'll be talking about the connection between adverse childhood experiences and body image and why the body we try to change is so often a body that has already been hurt. Until then, stay curious. I.