My Free-to-Play Gaming Postmortem

So there was this period of time from mid-September 2015 to mid-October 2017 in which I didn’t write a single blog post. What happened? This post is my attempt to reflect on my hiatus from blogging.

The most convenient answer—and the one most friendly to my ego—is that I had simply gone through some Major Life Changes that got in the way of devoting time to this blog. However, if I dig deeper, I must admit to myself that October 2015 is when I started playing a free Japanese mobile game called Puzzle and Dragons (PAD), and October 2017 was when I started to get tired of playing it; I finally deleted the game from my phone last week.

Left: A random person's monster collection. Right: a monster card in all its glory.

The basic gist of PAD is that you assemble a team based on different “monster cards,” each of which has different properties. You obtain the best cards by spending “magic stones” on a Rare Egg Machine, which pops out a random monster card at a cost of 5 stones. The stones can be earned for free by beating levels in the game or purchased for $0.99 each (or only $59.99 for 85!). With your team, you fight your way through various dungeons, doing damage to the enemies based on how many orbs of the same color you can match in rows or columns of at least 3 on the game’s puzzle board. As with any decently fun game, it felt rewarding to finally beat a difficult level after multiple tries. And the artwork and graphics, hand-drawn by Japanese artists, were top-notch. But in addition to these basic features shared with most games, PAD has many mechanisms that increase its ability to grab ahold of players’ attention, time, and money, and these psychological manipulations are very clear for me to see in retrospect.

Left: Narrowly escaped death from the enemy's attack. Right: My team doing some serious damage to Kali.

The game frequently gives away magic stones and other goodies for free, using reciprocity to make a player feel motivated (or obligated) to keep playing. Also, you get more rewards the more consecutive days you log in, which helps players make the game a daily habit à la Snapstreaks. The most powerful cards, of course, are very rare, so there’s intermittent variable interval reinforcement when you get lucky and land a good card. There are special events every few weeks called “Godfests,” which are the only times players can get certain rare cards, creating some serious FoMO. Once you’ve invested time and energy to assemble a nice collection, there’s a strong tendency towards loss aversion, as no one wants to feel like they’ve wasted all this time for nothing. Since most of PAD’s players are young men, many of the most desirable cards feature scantily-clad female characters, a.k.a. “waifus.” And there’s a community aspect as well, with multiple forums devoted to the game where players share their accomplishments and good Godfest luck, leading to upward comparisons and social reinforcement.

Despite all that, I’m not sure I would say that I was addicted to the game in a clinical sense. I was spending ~30-60 minutes a day playing the game, and maybe another half hour a day reading about it. My personal relationships and work did not suffer, as far as I can tell. Over the course of 2 years, I spent a grand total of $10 on in-app purchases of magic stones. On PAD forums there are reports of “whales” who've spent upwards of thousands of dollars on the game, so I got off relatively easy, at least in a financial sense.

Still, how PAD affected my mind is undeniable. Instead of reading blogs related to psychiatry and mental health, I was reading blogs and watching YouTube channels related to PAD. I stopped even thinking about my blog, and every time I had a spare moment, I would open the PAD app instead of taking in my surroundings or reading a book. In fact, I read far fewer books in 2016 and 2017 compared to any other year in my life since I learned to read, though part of that may be due to reading more on the web. It wasn’t all bad, though. I wasted far less time on Twitter, and I was no longer waking up in the middle of the night with ideas for blog posts. I had a convenient and pleasant distraction from politics. And I’ve spent much less mental energy these last 2 years obsessing about my fantasy football teams than I have in previous years.

So what finally made me stop? A part of it was the fact that PAD’s creators are constantly adding more difficult dungeons, which in turn require ever more powerful (and rare) monster cards to deal with. Playing the game started to feel increasingly like a Sisyphean task. I’d also like to think that a part of me missed blogging and reading books. Recently, I came across the philosophically-oriented Slate Star Codex blog, written by a young psychiatrist, and I thought, “If he can write several 2000 to 5000-word blog posts in a week, then why can’t I be even 3% as productive (i.e. roughly a 1000-word post per month)?”

Lastly, some advice for parents out there: as fun as Super Mario Bros was for us in our youth, it does not remotely compare to the reinforcement mechanisms that today’s microtransaction-driven mobile games employ. I’ve heard multiple stories from parents about their kids stealing their credit cards to spend hundred of dollars on in-app purchases for games like Clash of Clans and Clash Royale. I now believe that parents should not be letting their kids play games like these, which all tend to use similar attention and money-grabbing tactics. As a general rule, this applies to any of the mobile games that you see advertised on TV; how else would those game companies have so much money to spend on prime time ad spots? Recently, regulators in The Netherlands have started investigating whether games that have “loot boxes” (a similar idea to the Rare Egg Machine) are a form of gambling and should be regulated as such. In my mind there is no doubt that these games can work very similarly to gambling, except you can’t actually win any money, so it’s in a way worse than gambling.

Even if there are kids who can responsibly play these games without spending too much time or money, I would still strongly suspect that these games have an outsized influence on what their players think about—and stop thinking about—even when they’re not playing. And for me, that was ultimately the biggest negative impact.

My Favorite Blog Posts From 2013

As we approach the new year, I would like to reflect on some of my favorite posts from 2013. If you're new to this blog, I think these articles should hopefully give you a sense of what I enjoy writing about. Here they are, in chronological order:

A Most Influential Professor (5/19/13)
I probably would not have become a psychiatrist if not for how my undergrad Abnormal Psychology professor made the class so fascinating. And yet, the more I learn, the more I feel he had a very limited perspective.

Psychiatry Leadership: Uneasy Lies the Head that Wears a Crown (6/7/13)
I was disappointed — but not all that surprised — by how much more cogent psychologist Gary Greenberg was compared to APA president Jeffrey Lieberman and NIHM director Thomas Insel during an NPR Science Friday debate about the DSM-5.

A Chilling Encounter (6/11/13)
A story about interviewing a teenage psychopath in the psych ER. I hope I was able to convey why I felt chills down my spine during the encounter.

Movie Review: The Bling Ring (7/12/13)
I really enjoyed this movie and found it to be a funny satire of adolescent vanity and vapidity. I was surprised that some reviewers thought Sofia Coppola took a neutral stance toward her subject matter. I thought she was anything but neutral, and I even found some YouTube evidence supporting my view.

Hmm…looking at this list, perhaps I should stick to blogging during the spring and summer months…

Thanks to everyone for visiting this blog, and I wish you all a Happy New Year!

Challenges of Psychiatry Blogging: Why Start? Why a Pseudonym?

This is part 4 of my series on the challenges of psychiatry blogging. Previous posts covered content, audience, and design.

Why Start?

I'm sure everyone who blogs does so for intensely personal reasons; thus, I will not speculate on anyone's motivations but my own here. I've always enjoyed writing but have not done much of it since college. I enjoy reading other psychiatry and neuroscience-related blogs, and I've long wished that there were more blogs focused on the many important issues related to child psychiatry. Eventually, I decided to start a blog myself for that niche. I hope to be critical in the sense of "involving skillful judgment as to truth, merit, etc.; judicial," rather than being "inclined to find fault or to judge with severity, often too readily." Though I've focused a lot on the DSM thus far, it is no accident that my first post was a movie review, and I hope to write about a broad range of topics, including vignettes from my own clinical experiences.

Why Now?

Why did I choose to start the blog last month, instead of at some other time? This question is harder to answer, and so let me examine it as I would any complex human behavior. Could it be that some life change increased the free time I have? Could I have been inspired by reading other blogs and being caught up in the zeitgeist with the DSM-5 about to be released? Is it that I finished writing a self-reflective piece offline, and encouraged by how rewarding it felt, managed to overcome previous inertia? Does it have anything to do with the fact that, after having knee pain for the last few years, I finally found a way to deal with the pain in April, thus allowing me to run again (and I'm getting good ideas while running)? Could it be the increased daylight and seasonal change helped me be more alert and focused? Is it that I've been drinking stronger coffee? I can't give you a simple explanation for why now, except to say it's likely a combination of several of those factors.

The Name Thing

Why am I using a pseudonym instead of my real name? Well, first let me say it's not so that I can vent my frustrations or write mean things. I'm more likely to use profanity in real life than on this blog. I'm fully aware that there is no true anonymity on the Internet, so I write everything as if it were under my actual name. I treat a blog post like I would an essay, refining each one until I am somewhat satisfied with the result.

Neuroskeptic has actually written a paper on the topic of anonymity in science, and how it can "facilitate the free expression of interpretations and ideas, and can help to ensure that suggestions and criticisms are evaluated dispassionately, regardless of their source." I'd like to think that's one of the main reasons why I use a pseudonym. Another reason is simply convenience. It's much easier for someone to Google "psycritic" to look up my blog (as well as my comments on other blogs), than to search for a name that belongs to many people. It helps me compartmentalize; though my patients are unlikely to bring up this obscure blog, I would still prefer to not have to chat about the blog during our sessions, and instead focus on what is going on in their lives.

Lastly, we come to the name itself. Why Psycritic? Well, as I said on Twitter:

Hoping to have a productive time blogging, emulating @neuro_skeptic & @neurocritic, with an emphasis on child & adolescent psychiatry.
— Psycritic (@psycrit) April 28, 2013

What can I say? It's certainly not original, but the domain name was available. Now, we just need a psychskeptic who blogs, and we'll have a complete tetrarchy!

Challenges of Psychiatry Blogging: Design

This is part 3 of my series on the challenges of psychiatry blogging. Previous posts covered content and audience.

As a long-time fan of Apple products, I've believed in the simple, not the complex when it comes to design. I also believe that design is how something works, not just how it looks. My favorite technology blogs are ones that are clean, uncluttered, and draw your attention to the content. They do not tend to have anything extraneous, like stock photos. For me, there's an inherent pleasure in using a site that is well-designed, while even little annoyances can add up and detract from the overall experience.

Not surprisingly, I frequent many psychiatry blogs, and unfortunately I often find myself wishing for better design on some of those blogs. First though, I would like to point out Roger Lewin's blog, which still strikes me as one of the best designed psychiatrist blogs. Of course, his site was made by a professional, and I recognize that most people, myself included, just want a free blog. Fortunately, even mainstream blogging sites like WordPress and Blogger have good default templates to choose from these days. Another nice example is Reidbord's Reflections, which is very readable and well-organized.

I recognize that most psychiatrists do not have the time or inclination to endlessly tweak their blog's design, but I would like to present some simple tips that can really help improve the usability of a blog. Wherever possible, I've tried to use examples from non-psychiatry blogs to illustrate my point.

Layout & Navigation

The most basic design question is what happens when a person arrives at your blog for the first time. What will she see? Will it be obvious what content is on the blog and how to get to it? Is he going to have to scroll down right away or click on something in order to start reading the blog? For example, let's take a look at this site:

If I am there for the first time, I am treated to a view of the blog's big fancy name. However, the useful content only takes up a small fraction of the screen, so every time I visit, I would have to immediately scroll down in order to read anything beyond the first bit of the top article. Another example is if a blog uses a "dynamic view" with many pictures, which looks nice at first glance:

However, I have no idea looking at this what any of the posts are about, and in order to actually read anything, I'd have to mouse over each picture to see the title of the post, and then click to read the post itself. I do not think this is a very user-friendly design.

Fonts

This is probably really obvious, but having a font size that is too small makes the blog harder to read. Conversely, a font size that is too large can also diminish usability by decreasing how much one can read on a page before having to scroll down. Too many different typefaces can also be distracting. One major pet peeve of mine is text justification: It looks nice in books because most published books (in paper form, not e-books) are laid out by hand, and long words can be hyphenated. This doesn't ubiquitously happen on the web yet, so unfortunately you can end up with a paragraph like this:

Please, just don't do it! (My apologies to Thought Broadcast, as I couldn't easily find a similar example elsewhere.)

Color

The use of color, I believe, should be sparing and help draw your eye towards certain important elements, but not get in the way of the actual content of blog posts. One might argue that lack of color is boring; I would respond that it's better to focus on the writing and the topic at hand than to try to use lots of colors (or colorful clip art, for that matter) as a way of drawing people in.

I hope that the above tips were helpful and showed that better design does not have to take a ton of effort. I welcome any constructive feedback, so please let me know in the comments how I can improve the design of this blog.

Challenges of Psychiatry Blogging: Audience

Part 1 here, about the challenges of psychiatry blogging when it comes to content. Closely related to content, of course, are the questions of who is the intended audience of a blog written by a psychiatrist, and how does a blogger reach this audience? Along those lines, I found this post by Dinah over at Shrink Rap reminiscing about their blog being almost 7 years old to be very interesting:

Seven years later, and I want to say that Shrink Rap life remains distinctly different from my real life as a clinician.  Before Shrink Rap, the concept of anti-psychiatry was a foreign one to me.  The idea that there were people out there who saw psychiatry as bad, that psychiatric medications cause more harm than good and should be made illegal for all, that psychiatry was about power, that the patient and doctor were anything but on the same side, that diagnosis -- a word -- was inherently stigmatizing or life-destroying, this all was news to me.  Maybe I was in my own little bubble.

Shrink Rap, according to its description, is "A blog by psychiatrists for psychiatrists." Yet judging by Dinah's post and what I've seen over the years, almost all of the comments are from non-psychiatrists, and some are from a vocal minority who have strong views against various aspects of (or anything to do with) psychiatry. Their own poll (n=45, so probably a biased sample) shows that only 20% of respondents identify themselves as psychiatrists, while 51% say they're "Someone who uses Mental Health Services" (I wonder if going to a spa or getting a massage are included in this category). Granted, there are around 50,000 psychiatrists in the U.S. and millions of folks who use mental health services, so psychiatrists are certainly over-represented. The more surprising thing to me is that only 8% of those polled said that they are "A random interested person."

When a mainstream publication like the New York Times publishes almost 100 articles in the past year involving the DSM, chances are that mental health issues have broad interest. For a blog to reach such a wide audience, I don't believe that there is a magic formula, but I think most important factors are having a consistent output of posts and a variety of content. Blogs often die when the neophyte blogger becomes discouraged by lack of pageviews, or if the blog is already established, when the blogger becomes too busy in other areas of life to blog regularly. Some blogs, like 1 Boring Old Man, are very opinionated and focused, and thus seem to attract people who harbor the same points of view (I count myself amongst them, but I wish I could see more comments there from folks who are pro-DSM-5 and biological psychiatry, so there would be more interesting debate).

I will aim for about a post a week, and I am hoping to write articles that would be interesting to a broad audience, but especially those in the mental health field. I hope to elicit comments from those who both agree and disagree with me, while weeding out the trolls. Of course, since this is a hobby, the most important aspect of blogging for me is just getting to write on a regular basis.

Challenges of Psychiatry Blogging: Content

Some of my favorite blogs written by psychiatrists are no longer being updated; of course, this happens all the time on the internet. But starting a new blog has made me think more about the challenges involved in maintaining a "psychiatry blog," what it was that I liked about certain blogs, and what I'm hoping to do with this one. Thus, in this series of posts I will look at some of the different aspects of blogs written by various psychiatrists, and hopefully conclude with some lessons for my own blog.

Of course, the most important aspect of any blog is its content. As psychiatrists, we are privy to the most treasured memories and darkest secrets our patients, not to mention the full range of human emotional expression. My very favorite psychiatry blogs in the past have been ones focussing on stories of interactions with patients. This kind of blogging poses a special challenge, since we must protect the privacy of our patients, so these stories usually have names and other identifying details changed. My favorite blogs of this type have been Roger Lewin and pontificatrix's blog, and sadly neither have been updated in years (I have more to say on blog longevity in another post).

The most important blogs, in my mind, are the somewhat anti-establishment blogs that focus on hot-button issues in psychiatry, which over the last decade have mainly revolved around the relationship of academic "key opinion leaders" to big pharma, over-medicalization and over-medication, and the quagmire of the DSM-5. The very best blog of this genre has been The Carlat Psychiatry Blog, which had a very successful run from 2007 to 2012. It was so successful that Dr. Carlat has gone on to bigger and better things. Recently, the mantle seems to have been taken up by Dr. Nardo at 1 Boring Old Man, and I believe his blog has become vastly more interesting since he started to focus with passion on these topics. Thought Broadcast, though less focused, has a similar independent spirit, along with a level of thoughtfulness that is very appealing.

There are the psychiatrists who cover general topics for psychiatric publications, such as the Psychiatric Times blog. I don't tend to read these, because it makes me feel like I'm doing work. Well, actually I sometimes do read these when I'm at work, so that I feel like I'm doing work. Joking aside, these blogs are useful vehicles for fostering debate within the profession.

Then there's always cultural criticism from a psychiatric perspective, of which The Last Psychiatrist is the exemplar, with his messages of "you are being lied to, by yourself," and "you cannot escape the system." I think I understand, but now I will move on so I don't think about those things too much.

And of course, there are the more generalist blogs that cover anything and everything related to psychiatry. Shrink Rap is one of the earliest and most successful, spawning a book of the same name. I used to read it daily, and I greatly admire the consist productivity of the authors in their postings. I eventually cut back because the blog felt a bit unfocused to me. Plus, the design of the blog feels way too busy. I think The Amazing World of Psychiatry used to cover mainstream psychiatry topics, but the main articles have grown so esoteric that I rarely read them these days. However, Dr. Marley still provides links to interesting articles that he has come across, which remains a valuable service. My favorite general psychiatry blog in the last few years was Peter Kramer's In Practice blog, which was active mainly from 2008 to 2009. Dr. Kramer has a history of being a successful author, publishing several books, and I think his writing skill contributed greatly to this blog's appeal. No matter what he write about, I found myself reading the article and feeling more informed afterwards.

Closely related to content of blogs are the "voice" of the bloggers. The blogs I seem to like best are the ones written by a single individual, rather than an amalgamation of different voices. They seem to have more of a personality and perspective, which makes repeated viewings more interesting and encourages conversation with the blogger via the comments system.

In my next post, I will discuss the challenges related to the audience of a psychiatry blog.