Interestingly enough, DCoE is testing out a simulator similar to VBS/Arma for the purposes of treating PTSD. So while they aren't causing PTSD on their own(who would want that?) they can recreate somewhat similar situations to the ones causing the disorder and help service members to talk about it and treat it.
http://www.dailymotion.com/video/xsz16r_virtual-reality-system-tackles-ptsd_news
As someone who often plays military simulators in a social setting, I do not see any use in discussing the "100% realistic game" where you get killed if you loose. Its a dead end which isn't very productive to talk about. The question is how many % of punishment is viable to use for different gamers.
You can introduce "harsh" punishments in Arma, like a 30 minute wait when you die and wait for your buddies to fail or succeed in the mission. It makes you hug that cover so much more and it makes you terrified whenever you hear the sonic crack of a bullet being fired in your general direction.
If you crash in Iracing, or even get taken out by somebody else, you might loose rank and fall down to a lower class of racers next time you want to race. And again it works to a certain degree, rewarding people for not driving like mad men.
I like to differentiate between feeling authentic and being realistic. Games like COD can feel authentic with its high-budget campaigns, which Arma often lacks with its cheap rigid animations. But when it comes to realism, Arma has a much bigger potential.
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