In 2010, Caleb Springer, then 23, was riding a friend's scooter in his home state of Alaska. He didn't realize that the gas cap was missing, and after he tipped the bike over, gasoline spilled onto his pants. An errant cigarette spark hit the gas, and Springer was quickly engulfed in flames from the bottom up. More than half of his body was burned.
Springer was airlifted from Valdez to Seattle's Harborview Burn Center, more than 1,000 miles away. He would stay there for two months.
Third-degree burns are one of the most painful injuries a person can go through and survive. With other traumas—childbirth or surgery or breaking a limb—there's a one-time event and then, if all goes well, the pain begins to ebb. In the aftermath of a severe burn, nurses are tasked with scrubbing away dead, damaged, and infected tissue to improve the odds that the living tissue survives. Physical therapy can be even worse. Other than knocking out patients entirely, there's little dulling of the pain.
Springer is Alaskan: He fells trees, rides snowmobiles, drinks Pabst, shoots guns, and works on a dock. He's tattooed and bearded, and he's been in plenty of fights. But this recovery was "excruciatingly bad," he said. This was especially true during wound care, when nurses peeled off old dressings that had dried to the skin grafts covering his legs, back, and arm. Later, during physical therapy, his new skin had to be stretched out. "I could barely handle it even with all the pain meds they were giving me," he said.
Even on drugs like morphine and fentanyl, 86 percent of burn patients report "severe to excruciating" levels of pain during this process, just like Springer. But unlike most burn patients, Springer's doctors at Harborview were working with a novel way to manage pain: virtual reality.
Virtual reality (VR) may seem like an expensive, silly-looking toy—something that spoiled teens and bored yuppies buy for playing video games or watching porn. But Springer's doctors were on the front side of the burgeoning trend of using virtual reality as therapy.
Today, seven years after Springer's accident, the virtual-reality industry is booming and Seattle is its nexus. In 2016, the Washington Interactive Network estimated that 40 virtual- or augmented-reality companies are headquartered in the region, in addition to outside corporations with VR teams based here. This includes monoliths like Google, Facebook, Amazon, and Microsoft, as well as gaming giant Valve.
There are also small game developers like Endeavor One, a five-person team building a virtual-reality game set in a 1980s-era arcade. The world they've created is both familiar and surreal, with neon lights, dotted carpet, Street Fighter, and a ceiling that opens into a brilliant night sky. Independent and self-funded, cofounder Tom Doyle called his start-up the "punk" of the gaming world as we sat at a glass table in his immaculate town house on Capitol Hill. He and his team all came from big corporations, and now they work out of his garage downstairs. Doyle said he'd love to see more VR start-ups in the neighborhood.
Seattle also has software and hardware developers, content creators, and other companies working in logistics, commerce, education, social media, and more. And where VR goes, VC goes as well: Local venture capitalists like Maveron, Madrona Venture Group, and Trilogy Equity Partners have all begun investing in virtual, augmented, and mixed reality (an emerging technology that superimposes graphics onto your view of the world). With mixed reality, you could be walking through Seattle on a gloomy winter day, but inside your headset it looks like summer.
Some of these groups are investing locally. Pixvana, a Fremont start-up making software that will let anyone with a headset edit VR videos, raised $6 million from Madrona and Vulcan, Paul Allen's investment group. Ballard-based Pluto VR, which is developing an app to help users communicate within virtual reality, recently secured nearly $14 million in funding. And Magic Leap, a notoriously secretive augmented-reality start-up with offices in Georgetown, was valued at $4.5 billion last December, and they still haven't released a single product. Venture capital is still easier to come by in Silicon Valley, according to many local start-ups, but there's plenty of incentive to base in Seattle: There is no income, corporate, or capital gains tax in Washington State. From a start-up's perspective, this could be a benefit worth billions. For everyone else, the upside is less clear.
But before Seattle became a hub for virtual reality, before there were Oculus Rifts or HTC Vives or thousands of developers moving into shiny new high-rises, there was the Harborview Burn Center and SnowWorld.
Hunter Hoffman, an experimental psychologist and the founder of the University of Washington's Human Interaction Center, pioneered the use of virtual reality in medicine 25 years ago, back when VR headsets were as heavy as a human head and cost tens of thousands of dollars apiece.
Hoffman first started using VR to treat arachnophobia, and then, in collaboration with Harborview Burn Center psychologist David Patterson, he turned his attention to pain. The two have now treated hundreds of patients, as well as healthy volunteers, using a VR program Hoffman developed called SnowWorld in clinical trials—the same trial Caleb Springer participated in.
During wound care and physical therapy, patients like Springer used Hoffman's VR program to lob snowballs at slightly menacing snowmen as Paul Simon's "You Can Call Me Al" played in their headphones. (Simon apparently granted his permission during a visit to the burn center.) When you hit the snowmen twice, they shatter like ice. When you hit a wooly mammoth instead, they trumpet back.
And this works: Before SnowWorld, said Springer, "my pain level was at an 8 or a 9 out of 10. When I used the VR, the levels dropped to around a 3 or a 4 because my mind was focusing on that instead of on the pain all the time."
In addition to burns, VR has been used to treat phantom limb pain, post-traumatic stress disorder, depression, Parkinson's disease, brain damage, autism, dementia, schizophrenia, the side effects of chemotherapy, as well as an array of anxieties. Brenda Wiederhold, a psychiatrist in San Diego, uses VR-based cognitive behavioral therapy to help people work through phobias, including the fear of driving and flying. After seven years of using VR, Wiederhold said, her success rate is 92 percent.
It's easy to see how VR would be useful in treating fear. My first experience with VR was at Portal, a virtual-reality arcade and bar that opened in Ballard in April, one of just a handful of such businesses in the world. Owner Tim Harader strapped a headset on me and placed two controllers in my hands. All of a sudden, I was in an elevator, moving up. The world in my headset didn't quite look like ours: It was too cartoonish to be photorealistic, and yet, when the elevator doors opened and I saw a narrow wooden plank stretching into sky, my palms began to sweat and my heart started to race. I knew, cognitively, that I was safely on the ground in Ballard, and yet I felt like I was about to walk off a skyscraper. I could even hear the wind in my headphones. I grabbed Harader's arm, and he tried to guide me out onto the plank—but there was no way. I slunk back into the elevator and pressed the down button. But, I thought, if I had any desire to conquer my fear of heights, this might be able do it.
Researchers think it's this immersive quality that makes VR so effective when used in medicine: It's the ultimate escape. While visiting VR start-ups in the area, I shot fireballs at robots and arrows at angels. I saw massive, terrifying spiders and an eclipse from outer space. I tried to find my way out of a locked room (I could not), and I attempted to pet a blue whale the size of a school bus (that didn't work, either). I stood on top of the Statue of Liberty and looked over at Manhattan. I flew a mile over Nevada's Black Rock Desert, as close as I'll ever get to Burning Man. An hour in VR went by in minutes. Each time I did VR, I'd later try to describe the experience, but there was no way to do it justice. It was like tripping without drugs.
But while this total immersion might be good for burn victims or gamers or anyone who can't leave the house, some experts say that's exactly what could make it such a threat.
There's no sign for reSTART. Founder Hilarie Cash gave me directions over the phone—she's hard to reach on e-mail—and said to make sure I wrote them down. "Your GPS," she said, "might not work."
With the help of Cash's directions, I found it in a quiet neighborhood 17 miles east of Seattle. The neighborhood is on the woodsy side of suburban, and the house looks like a typical middle-class family home. And it is a home, albeit one with no internet, no cable, no cell phones, and very few women. Because reSTART is a treatment center for internet, video game, and VR addicts.
The center can house up to six clients—or "guys" as Cash calls them—and when I arrived, the four current residents were just getting back from their therapy appointments with staff counselors in town. One of the guys stretched out his hand. "Greetings," he said, "most pleased to make your acquaintance."
All of the current clients were there specifically for gaming addiction, and their in-town therapy sessions are a big part of their treatment. Clients also attend 12-step meetings—sometimes specifically for their addictions, but more often the only meetings available are Sex and Love Addicts Anonymous or even Alcoholics Anonymous.
It may seem incongruous, gamers going to AA, but Richard Ries, director of the addictions division at the University of Washington School of Medicine, said there are plenty of similarities between drinking and gaming. For one, both can clearly ruin your life. And like drugs and alcohol, gaming causes a flood of the pleasure chemical dopamine in the brain. Eventually, you may develop a tolerance and seek more and more of your desired stimulus—be it gaming, gambling, drinking, or drugs—with less and less reward. When you start to need a substance or a behavior instead of simply liking it, you may have a problem.
Still, there is some debate in psychological circles as to whether or not tech addiction even exists. The American Psychiatric Association declined to add it to the latest addition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 2013, but they did note in the appendix that "Internet Gaming Disorder" requires further study. Many in the field, like Cash, think it's only a matter of time before tech addiction is officially recognized in the DSM—at least, if the gaming industry doesn't interfere first. The worldwide gaming industry saw revenues of $91 billion in 2016, and the lobbying arm of the industry actively resists the idea that problem gaming can be an "addiction." The insurance industry, too, has reason to fight it: Right now, insurance companies won't touch reSTART, but if tech addiction were included in the DSM, they would have to.
Instead, reSTART's current four residents and the hundreds who have come before them pay out of pocket—and handsomely. The first phase alone, a seven-week stay at the reSTART house, is around $30,000. Completing all three phases can cost up to $75,000.
One current client, Mason (all reSTART clients' names have been changed), took a medical withdrawal the final semester of his senior year in college so he could get treatment. Most of the guys looked like the stereotype of gamers—a little awkward and ill at ease—but Mason, wearing a Duke Ultimate Frisbee shirt, was sociable and fit, and looked like he could have pledged a frat.
At his lowest point, Mason hid away in a campus library, ignoring his family and friends for three days and bingeing on Defense of the Ancients, a multiplayer game where teams battle to destroy each other's castles. Unable to find him, Mason's friends reported him to the police as a missing person, and his dad flew in to pick him up.
In the first phase, the inpatient portion, residents give up tech entirely—aside from movie night once a week. Cash called this the "detox" phase and said withdrawal typically lasts three weeks. Symptoms include anxiety, depression, agitation, and restlessness.
Instead of gaming, the guys go to groups, exercise, take hikes, play outside, read books (no fantasy allowed), and learn some of the skills they'll need to live on their own: cooking, laundry, taking care of the house therapy dog. That's Cash's goal: for her clients to live normal, independent lives where they have healthy relationships with both technology and other people.
"We are social animals," Cash said. "It is our birthright to be in intimate, safe, loving relationships, and if you don't have that in your life, you will become dysregulated, emotionally and physiologically. So many people are seeking connection online, but it's a paltry substitute."
Mason hopes to return to school, complete his last semester, and go on to get a PhD in biology, but other reSTART clients choose to stay in the area after they're done. One former client, Ryan, told me his gaming addiction caused him to drop out of college three times and cost him his job in real estate. After quitting gaming cold turkey and then relapsing twice, Ryan gave into his addiction and started playing nonstop. Eventually, hopeless and depressed, he decided to kill himself. "I was going to do it on the anniversary of my grandmother's death," he said. "That way, my mom wouldn't have to be sad twice a year."
Before that date came, Ryan's family unexpectedly visited and saw that something wasn't right. He'd gained weight, his house was a wreck, and he'd stopped bathing. His family convinced him to go to reSTART, and he went through all three phases in the course of a year. Each stage has less and less oversight by reSTART staff—in phase 2, the clients start to live independently and get jobs at places like Costco and Target—but even now, totally out of the program, Ryan lives in an apartment with friends he met in reSTART and is still deeply involved in the community. He started a 12-step meeting for gaming addiction on the east side of the county.
There have been no studies on the long-term efficacy of reSTART—or of most other treatment centers for either substances or behaviors—but when I asked Ryan if it was worth the cost, he said, "Yes. It saved my life."
Ryan and the other gamers purchased many of their games from Steam, a distribution platform owned by Bellevue-based gaming company Valve. Steam is essentially the gaming world's version of iTunes. It's huge. Valve doesn't disclose sales or earnings, but Steam took in an estimated 15 percent of global PC game sales in 2015, according to Spy Steam, a site that analyzes game sales based on public information. Valve's CEO, Gabe Newell, is worth an estimated $4.1 billion.
Valve became famous among gamers for blockbuster first-person shooter games like Half-Life and Counter-Strike, but last year, in partnership with manufacturer HTC, it released its first VR headset, the Vive. The HTC Vive now retails for about $800 and is a direct rival to the Oculus Rift, a VR system designed by a teenage libertarian now worth $730 million. (Oculus, which was acquired by Facebook for $2 billion in 2014, leases more than 50,000 square feet of office space in Sodo.)
Valve employees Nat Brown and Greg Coomer showed me around the Bellevue headquarters, which is scattered about with lasers and robots—real ones, not toys. The space takes up five stories in a glass tower right next door to Microsoft, and when I asked my tour guides what their job titles were, they shrugged and said they didn't really know. Except for Newell, there's no hierarchy at Valve, and employees don't have titles, bosses, or seating assignments. Their desks are on wheels.
Brown and Coomer—both dads in their 40s—were optimistic about the future of virtual reality and its impact on the world. In fact, all of the VR developers I interviewed were optimistic about tech. They see only the good. Facebook, to the optimist, isn't a place where people live-stream murders and suicides, and Twitter isn't the platform that led to President Donald Trump. It's a way for people to connect.
When I asked VR company founders and employees about the potential for addiction or abuse, more than one reminded me that people were wary of television when it first came out. The printing press, too. Instead, they believe in "better living through tech," as one founder told me—that technology won't usher in the demise of our planet, but that it could actually improve it. Forest Key, the founder of Pixvana, thinks that VR could cut out the need for air travel. Instead of flying to distant locations for meetings or vacations, we could just put on our headsets and stay home. "Think of the carbon emissions we'd save," he said.
Others say VR could even improve our species. Tom Doyle, cofounder of Endeavor One, told me that VR could make users care about racism or deforestation or wars happening far away by giving us the chance to experience the way other people live. Bill Gates, apparently, agrees: In April, he introduced his Samsung VR channel, which allows users to "visit" developing nations to learn about issues in public health.
"If you think about it," Doyle said, "it's actually an engine of empathy."
Hilarie Cash, from reSTART, on the other hand, imagines the worst: a future where we're all plugged in all the time, stuck in our headsets while the world falls apart around us. "Sure," she said, "there are some positive implications for VR. Maybe once in a while a burn victim won't feel them scrubbing their wounds. But that's not how it's going to be used. It's going to be used for gaming. All this stuff is commercially driven. People want to make billions," she said. "And they do."
As more and more people invest in virtual reality, Cash thinks we're facing an epidemic of addiction. And the best way to prevent any addiction, she said, is to stop it before it starts: Parents should limit their children's exposure, keep gadgets out of their rooms, and encourage kids to develop responsible tech habits before it's too late. Soon that could become more difficult: In May, Microsoft announced an initiative to bring its latest headset into schools.
As for Caleb Springer, he hasn't seen VR since SnowWorld, but he said he'd love to try it sometime. He's still in quite a bit of pain—seven years after the accident, there are staples in his legs and sometimes they hit a nerve. He plays a lot of video games these days, some of them made right here in Seattle. Springer laughed when I asked if he's worried about a dystopian future where we're all addicted to technology. He's not scared of virtual reality—he survived a fire.