Illustration: Jim Cooke / GMG
Elizabeth E. looted everything in Fallout 3's Raven Rock. She collected three units of vodka, five stealth devices, four cuts of mirelurk meat and 88 Stimpacks, which weighed her down a considerable 1,437kg. Her pack was so heavy that travelling from Raven Rock to Fort Independence took four hours. She was over-encumbered and couldn't fast-travel. Elizabeth didn't mind; that way, she could talk to all the non-player characters on the way. After three playthroughs, her save file recorded over 500 hours.
"The psychologist who diagnosed me called me an 'information hoarder," Elizabeth told me. When she was 33, a doctor recognised in her several traits common among people with autism. She's 35 now and a voice-over producer who games, she estimates, around 30 hours a week. Routine and structure rule her life. Sometimes, the unpredictability of other people disorients her. Also, she's a passionate collector, both of information and items. In Fallout 3, she says, she could find a location, systematically explore it, collect anything of value and talk to every NPC. After that, she'd read each terminal to piece together lore and, finally, move onto the next location.
"Fallout had so much lore spread across the series and the world that it feeds my desire to know more," Elizabeth told me. "I could exhaust conversation trees with the NPCs, then read their diary entries on their terminals, and learn so many things about them and their world."
For people diagnosed with autism, video games can offer special satisfaction in a world that is unpredictable and unfathomable. We spoke to several gamers with autism about what the medium means for them. For some, games offer structure, for others escape. Still others find themselves inspired to dive to depths in games that would go unexplored by others.
Autism Spectrum Disorder, or ASD, refers to a group of characteristics shared by people with autism. Until 2013's fifth edition of the Diagnostic and Statistic Manual, the psychologist's bible, more mild autism was referred to as "Asperger's," a term many sources still use to describe themselves. Clinical psychologist Micah Mazurek says that, to diagnose somebody with ASD today, she looks at two main categories: social communication skills, like reading facial expressions, and repetitive behaviours or restricted interests. A lot of people with autism are passionate collectors, laser-focusing on one fandom or game in ways most neuro-typical fans might not.
Years ago, Mazurek helped one of her college-aged patients, who was originally diagnosed with Asperger's, through a video game addiction. That's when she became interested in ASD and "screen time." "A lot of people with autism have really strong visual skills and prefer to gather information visually," Mazurek told me. "Games are obviously very stimulating in that way." In 2015, Mazurek interviewed 60 gamers with autism. She learned that games, and especially role-playing games like Skyrim or Fallout 3, can satisfy wants common among people diagnosed on the spectrum. Her study on under-18 autistic boys indicated that they spend nearly twice as much time gaming as typically-developed boys, with 31% preferring role-playing games to all other genres.
"It's just more comfortable if you know what to expect [in games]," Mazurek theorised. "If this behaviour is gonna get this response in the video game world, in the real world you can't always predict how people will react to you."
Across the internet and, now, in several IRL gaming circles, gamers who betray a level of enthusiasm beyond the norm are referred to offhand as "autists." An eye for specifics or a remarkable memory for lore draws the same toxic stereotypes of the outdated insult "retard." On /r/gaming a year ago, a poster asked why "autistic" has become a meme used "to describe people who like a certain series." On 4chan last week, a poster asked which "autistic OCD cringe shit" players do with games. Responses ranged from pursuing a Halo achievement for killing an entire level's enemies without being touched to "obsessive" trophy collection or following real-life food safety rules in-game.
Autism came to be associated with impassioned gamers, in part, because of a Sonic the Hedgehog megafan referred to as Chris-Chan. In the mid-2000s, Chris-Chan, who was diagnosed with autism early in his life, illustrated the first issue of his Sonic fan comic, Sonichu, from his Virginia home. In it, his Sonic goes on adventures with his friends, as he does. It was unpolished and unapologetically earnest, just the kind of thing to surface on mid-2007 4chan. After discovering his Encyclopedia Dramatica page, which contained a mocking portrait of his habits and online history, Chris-Chan began fighting back against his trolls. On YouTube, Chris-Chan tried to reason with them. But it just added fuel to their malicious little war. A 10-year harassment campaign followed, which is still playing out on Chris-Chan's social media.
The gamers I interviewed had uniformly faced the stereotypes he did. Using "autistic" as an insult excludes autistic people from regular society. It contributes to the stigma around neurodivergence. It equates difference with something disgraceful. And Elizabeth E. sees it all over the internet. It infuriates her. "They latch on to the one thing about autism that they heard and misuse the word and try to turn it into an insult," she said. "I cannot understand people who lack basic human compassion and think it's funny to tear others down."
And yet, some said the stereotype isn't entirely without truth, although its application is toxic. Alwin, who was diagnosed with autism in college, says it's true that people with autism can get over-excited. "It maybe has to do with feeling emotions a bit more intensely," he said. When he feels an emotion, it's "like a full-body thing." It can be about games; or about music or books. If he's excited about Horizon Zero Daw, though, and someone tells him "don't be so autistic about it," he might just laugh. It's ridiculous, in his opinion, to make "autism" a gross synonym for "nerd," or something worse. It doesn't make any sense, he says. Autism means a lot of things.
"All people have hobbies and interests we gravitate towards," Mazurek said. "It's not necessarily the case that if someone has a strong interest and spends a lot of time on it its pathological. To meet that criteria when we're thinking about a disorder, it has to impair your functioning."
A love of structure and rules is common among people with ASD. It ties together the DSM's two ASD-defining categories: difficulties in social communication and a tendency toward repetitive behaviours. So, for example, it can be a challenge to pick up irony cues from a straight-faced friend because, in any other instance, their behaviour would signal earnesty. It's out of the norm. Or, when there are train delays, somebody with ASD might become quite agitated. Likewise, folks with autism often exhibit an uncanny mind for rules, memorising the most trifling details of enormous RPG tomes. That's what's referred to as "special interest," a term that describes Elizabeth's Fallout 3 run-throughs.
For people with autism, games' structured dialogue options can be be comforting. A tender conversation with an NPC leaves less room for interpretation than one with a real-life person. The player doesn't have to worry about missing nonverbal signals, or not knowing what to say. Elizabeth said that, in Fallout, she can express herself clearly and without consequences. "I screw up in a conversation, I can reload the save instead of feeling crushing embarrassment because I said something wrong," she explained. "My conversation options are laid out in front of me, allowing me to choose what I want to say without tripping over my words or saying it in a way that could be misinterpreted."
Elizabeth much prefers single-player games to online multiplayer ones; she says other people are too unpredictable. "NPCs follow the rules. Other players don't," she added.
Alwin Nijsen, a 32-year-old student who writes on accessibility in gaming, gets the same benefits from the predictability of conversations in games. Sometimes, he can get confused when people send contradicting signals. When another person's talking to him conversationally, he sits back, thinks and narrows down all possible meanings into just a few of the most likely ones (other sources described conversations as a "choose-your-own-adventure book"). He can take things very literally. In these situations, responding to others heightens his anxiety. "With a social experience, there are an infinite number of replies, which can lead to an infinite number of reactions to another person. It's a lot less predictable," he said. "Even in more complex games, like Mass Effect, you can easily tell what kind of response you are going to give. There's no chance of accidentally being rude to someone."
Structure is a big draw for gamers with autism, and it exists on a more abstract level than dialogue. Skylar, a Canadian streamer who also works in insurance, says she's often overwhelmed by open-ended situations, both in conversation and life. She'll short-circuit, a feeling she describes as "choice paralysis." She turns to "treadmill games" like Diablo and Destiny, which churn her through pre-determined goals, to relieve some of the stress of life. It's easy to plan efficient run-throughs. The loot systems are structured. "Since video games have, by nature, rigidly defined rulesets a lot of that fear goes away since I know exactly what I'm capable of and what I'm not," she said.
Sometimes, loving games is just about pure escapism and stress relief. It doesn't have to be complicated. "I'm just like anyone else," Leonard Johnson told me. He games 20 hours a week on top of his day job as a QA tester. Right now, he's playing Nier. "I work 40 hours a week, pay my bills, and game when I have the chance." He's in a healthy romantic relationship and runs a YouTube channel. Although he says he's a "slave to routine," he's firm in his belief that he gets enamoured of games the same way anyone else would, and not necessarily because of qualities associated with autism.
Elizabeth embraces what having autism means for how she games. "It's who I am, and I can't change it and I won't change it," she told me. She's happy indulging her interests and embracing what she calls her "autistic tendencies." She doesn't want to "perform." If she worried about everything that made her different, she would be swimming in a sea of anxiety. The worlds of her favourite video games were made to be explored; why shouldn't she appreciate them to their fullest? "I'm just going to do what makes me happy. If that means playing my favourite game for hours on end because that's my happy place, then where's the problem?" she said.