My first experience with carpal tunnel happened after a five-hour marathon of indie Japanese shoot ‘em ups called Touhou Project. A semester, later, and I couldn’t even move my wrist — too much arrow key smashing. I was shocked that something I did for fun ended up physically injuring me in the end. What I didn’t know was that this painful episode would begin my trip down the rabbit hole of a notoriously difficult genre of games — or that the the love-it-or-hate-it world of “bullet hell” would come to help me work through my anxiety issues. As it turns out, the genre’s emphasis on dodging threats, recognizing patterns and acting on them isn’t unlike how certain forms of anxiety are treated in therapy.
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Your Pretty Face is Going to Bullet Hell
The Touhou Project series has been around since 1995, with the release of Highly Responsive to Prayers, which was essentially a copy of Breakout. Later Touhou entries transitioned into the overhead shooting and dodging games fans love today. Fans of the Touhou series are, for lack of a better word, notorious in their dedication to the fictional world of Gensokyo, where the protagonist Reimu resides protecting the mystical gate separating our world from a myriad of ghouls. Touhou is filled to the brill with cute girls shooting Dragon Ball-esque lasers, energy beams, and of course, bullets — all while wearing frilly hats and dresses. The series’ success is partly due to the popularity of “cute-em-up” games featuring big-eyed anime girls in traditional shoot ‘em up titles. There’s a very specific market for this type of aesthetic — folks who can appreciate cuteness as well as nail-biting difficulty.
These games have always been a bit eccentric when it comes to their appeal. The series is a niche anomaly in the West, but a fully fledged, beloved franchise in Japan. However, the appeal of Touhou‘s gameplay mechanics is universal — titles such as Gradius introduced many to the genre, and contemporary shoot em ups like Jamestown are now cult classics. Games such as Undertale also borrow from classic shoot em ups. What these titles all have in common with Touhou is an emphasis on the basic mechanics of shooting and dodging. These are games about repetition, exposure, and resolution.
Games ~ Illusive Coping Mechanism
After middle school I was in a transitory period, not quite sure what my place was in the world, how I’d make friends, who I wanted to be. So naturally, like most awkward, sad, depressed, confused, anxious, and horny teenagers, I buried myself deep in the world of games. Even from my Western context, I understood Touhou was very special — how it thought about its characters, its world-building, and the crazy mechanics of its universe as a kid.
I would revisit this old habit of playing Touhou into the dead hours of the night in my mid-twenties, just as I had done when I was a teenager. Perhaps it was inevitable that the series would follow me into therapy when I finally decided to address my overwhelming anxiety issues, just as it had helped me cope with them before.
I started cognitive behavioral therapy (CBT) at university in 2017. According to the American Psychological Association, CBT is all about “plac[ing] an emphasis on helping individuals learn to be their own therapists” through exposure to triggers, role-playing, pattern-learning, and using problem-solving skills for uncomfortable situations. It seemed worth a try, because my anxiety had been only getting worse for years. It was ruining my life, my grades, relationships, health, everything.
One of the first strategies you’re taught in CBT is how to handle stressful triggers through exposure — how to mitigate your panic and palpitations to accomplish a task. To me, this kind of anxiety feels like there are flashing bullets surrounding you, leaving you nowhere to move. It’s as though you were frozen in place only seconds to act. It sucks, but for most people dealing with chronic anxiety, it’s the reality we have to deal with.
Scarlet Devil Anxiety ~ Depression Miasma
From my experience, the most important part of CBT is the exposure part. That doesn’t necessarily mean putting yourself in dangerous situations, but it does mean actually confronting anxiety-inducing tasks. As appointments with my therapist continued, I realized that the type of games I gravitated towards began reflecting my mental struggle. The pixel-perfect precision bullet hell games demanded of players gave me something to hyper-fixate on besides my anxiety. I wasn’t running away from my real-life issues, either — I was practicing patience, control of a task, and completion, slowly chipping away at my anxiety.
Although my therapist knew little about video games, she definitely saw the association between gaming and my anxiety as a positive thing. Which was surprising — most mental health experts in the media would’ve called it simple escapism. Documentaries like Juan Carlos Pineiro’s 2008 Second Skin depict rehabilitation homes for those consumed by MMORPGs and fantasy lives that make their family lives miserable. I saw these movies as a kid playing shoot ‘em ups and wondered how pathetic those people must be. These are the sort of images the media presents when it comes to mental health and coping through video games.
For those who never played shoot ‘em up games because of their perceived intensity, it might be difficult to imagine them being anything other than anxiety-inducing. However, beneath the stressful surface there’s In 2013, the PBS Idea Channel published a video titled “Can Bullet Hell Games Be Mediative?” It proposes that “the look alone of bullet hell games is so intense, so crowded and nuts, that actually ‘paying attention’ is tough from the get-go,” meaning the player has to shift into a kind of autopilot mode to deal with the visual complexity.
Take a deep breath, and somehow figure out how exactly you’re going to finish this paper due next week, how to weave through this bullet pattern, how to beat this boss, how to leave the house after a whole week of staying inside. It takes failure, trying again, and failing, failing, until you get it right. Those are the mechanics of high-intensity games like Touhou, Nier Automata, and other titles with a heavy bullet hell influence. No one gets it right on the first try, and that’s okay! Exposure to complex bullet patterns is like exposure to complex real-world tasks, even if it’s just taking out the trash after a week of depression.
You could say the same of games like Tetris — but it wouldn’t be the same compared to playing a shoot ‘em up game based entirely on the concept of dodging, a mechanic called “graze” in Touhou. But the “graze” mechanic is metaphoric, too. A frame-by-frame analysis of Touhou would only reveal the masochistic playerbase at the receiving end of bullet-hell. But it’s the truly dedicated emphasis of Touhou’s pattern-learning that make it such an excellent candidate for breaking anxiety — it prioritizes a goal above all else, a specific target that needs to be fought and defeated. It helped me break the pattern of worrying about my anxiety by breaking away from real-life and focusing on the immediate problem of rainbow-colored pixel bullets. Touhou is a game of alleviative distraction — a temporary escape from the anxiety of reality for fantasy.
I remember finally breaking through the last boss of Embodiment of Scarlet Devil, Remilia, and feeling a wash of relief as I finally mastered her bullet-patterns. I finally defeated Remilia — and put away my bulky keyboard for maybe a few days before doing it all again. I allowed myself to mess up, and in retrospect, I can see why I gravitated towards these high-difficulty games. Not for the sake of replayability, but for their emphasis on exposing yourself to repeating patterns until you manage to break through. They forgive you, momentarily, but hook you back in when the time’s right. When you see a barrage of rainbow bullets aimed at your face, it’s alright to be anxious. But that doesn’t mean you’re too afraid to act, to get out of the way, to bomb and eliminate those fears. Learning to breathe and dodge is just the first step.