As an avid video-game player from his college years, Simon Parkin, author of a new book about gaming culture, was intrigued to discover that they were being blamed for a string of deaths in Asian internet cafes, and that one government had even legislated against them. Can the peculiar form of obsession they inspire in people sometimes prove fatal?

Chen Rong-yu died in two places at once. At 10pm on Tuesday, 31 January 2012, the 23-year-old took a seat in a corner of an internet cafe on the outskirts of New Taipei City, Taiwan. He lit a cigarette and logged on to an online video game. He played almost continuously for 23 hours, stopping occasionally only to rest his head on the table in front of his monitor and sleep for a little while. Each time that he woke he picked up his game where he had left off. Then, one time, he did not raise his head. It was nine hours before a member of the cafe’s staff tried to rouse the motionless man, in order to tell him that his time was up, only to find his body stiff and cold.

Chen died there in the Taiwanese cafe, with its peeling paint and cloying heat. And he died in Summoner’s Rift, a forest blanketed by perpetual gloom. Summoner’s Rift has the appearance of a remote, unvisited place, but each day it is frequented by hundreds of thousands of people, players of the online video game League of Legends, arguably the most popular online video game in the world. Summoner’s Rift is the pitch on which they do battle.

Chen had died here many times before. He had been speared, incinerated, or otherwise obliterated by rivals as he scrambled through its thickets and across its river in an endlessly repeating game of territorial warfare.

Many games are metaphors for warfare. The team sports – football, hockey, rugby and so on – are rambling battles in which attackers and defenders, led by their captains, ebb and flow up and down the field in a clash of will and power. American football is a series of frantic first world war-style scrambles for territory measured in ten-yard increments. Tennis is a pistol duel: squint- ing shots lined up in the glare of a high-noon sun. Running races are breakneck chases between predator and prey. Boxing doesn’t even bother with the metaphor: it’s a plain old fistfight ending in blood and bruise.

So it is with League of Legends, a game in which two teams attempt to overwhelm one another. In warfare, real or symbolic, there are inevitable casualties. To date, Chen’s deaths in the virtual forest had been symbolic and temporary, like the toppling of a pawn from a chessboard, a griefless death, easily undone. That night, however, his virtual death was mirrored in reality. It was true and final.

When the paramedics lifted Chen from his chair, his rictus hands remained in place, as if clawed atop an invisible mouse and keyboard. Like the pulp detective thriller in which the lifeless hand points towards some crucial clue, Chen’s final pose appeared to incriminate his killer.

Facebook Twitter Pinterest An internet cafe in China. Gamers often spend many hours glued to their screens. Photograph: Martin Puddy/Corbis

Chen’s story is unusual, but not unique. On 13 July 2012, another young man, 19-year-old Chuang Cheng-feng, was found dead in his chair at a different Taiwanese internet cafe. Chuang, a 5ft 5in tae kwon do champion, had settled down to play the online game Diablo 3 after a friend he was supposed to meet failed to show up. He played the game to pass the time: 10 hours of uninterrupted questing. Then, mind hazed by the room’s thick cigarette smoke and eyes stinging from the monitor’s flicks and throbs, he decided to step outside for some fresh air.

Chuang stood, took three steps, then stumbled and collapsed, his mouth foaming. He too was pronounced dead at the scene.

There are others. In February 2011, a 30-year-old Chinese man died at an internet cafe on the outskirts of Beijing after playing an online game for three days straight. On 2 September 2012, a 48-year-old man named Liu died in Kaohsiung City following a seven-hour stint at the controller. His was the third game-related death of the year recorded in Taiwan.

In 2015, the deaths came sooner. On 1 January, a 38-year-old man was found dead at an internet cafe in Taipei, apparently after playing video games for five days straight. A week later, another: a 32-year-old man, known as Hsieh, entered a cafe in Kaohsiung on 6 January. Two days later, employees found him slumped on the desk at which he’d been playing an online game. He was pronounced dead on arrival at the hospital.

In May 2015, a man in Hefei, the largest city in the Anhui province of China, reportedly collapsed after playing a game for 14 days straight. When the paramedics arrived, one newspaper reported him as saying: “Leave me alone. Just put me back in my chair. I want to keep playing.”

The deaths aren’t limited to south-east Asia and they aren’t only contemporary.

In April 1982, an 18-year-old American man, Peter Burkowski, walked into Friar Tuck’s Game Room, a popular video-game arcade in Calumet City, Illinois. According to the arcade’s owner, Tom Blankly, Burkowski and a friend arrived at 8.30pm and began playing Berzerk. Within 15 minutes, he’d posted his initials next to two high scores on Berzerk’s leaderboard. Then he took four steps towards an adjacent machine, dropped a quarter into its slot and collapsed, dead from a heart attack.

The next day, one newspaper headline read, “Video Game Death”, the earliest report of its kind. Similar incidents have continued through the years.

In July 2011, a young British player, Chris Staniforth, died from a blood clot after a prolonged session at his Xbox console. “When Chris got into a game he could play it for hours on end,” Staniforth’s father told reporters at the time. “He got sucked in playing Halo online against people from all over the world. I’m not for one minute blaming the manufacturer of Xbox. It isn’t their fault that people use them for so long.”

Staniforth’s father absolved Microsoft, Xbox’s manufacturer, and Halo’s publisher, of blame for his son’s death. We are, he implied, each responsible for the way in which we spend our time. And yet, when Microsoft’s rival Nintendo launched its Wii console, it included a warning that would interrupt many of its games. It read: “Why not take a break?” and was accompanied by an illustration of an open window, wind blowing the curtains inwards, calling the player outside.

The death-by-video-game story occupies a peculiar place in the modern news cycle. We don’t read of “death by cinema”, “death by literature” or “death by crossword”, even though humans must surely have died while engaged in any one of these mostly inactive pursuits. But with video games, news of a fresh tragedy arrives, usually from Asia, with grim regularity. The circumstances are always similar: a young man found dead at his keyboard, seemingly killed by an unhealthy relationship with this sedentary hobby.

For video-game players, the news reports act as a cautionary tale, the kind of story mothers might tell their children to warn them off playing a handheld game beneath the sheets after lights out: “Look what might happen to you if you play a video game for too long.” For the newspapers, often staffed and read by a generation of people who grew up at a time when video games weren’t a fixture on the cultural landscape, these tales fortify a generational distrust of the newest (and therefore most treacherous) entertainment medium.

You could also die while sprawled on the sofa, chain-watching the latest television serial. You might also perish after a 400-page Tolstoy binge, or while you endure Abel Gance’s nine-hour-long film Napoléon, or when caught up in an especially engaging cross-stitch pattern. People have been known to die during a 12-hour, blood-clotting, long-haul flight. Any activity that compels a human being to sit for hours on end without moving is, arguably, a mortal threat. In the 1982 Burkowski case, Mark Allen, Lake County’s deputy coroner, said, sensibly: “Peter could have died in a number of stressful situations. We once had a boy who had a heart attack while studying for an exam. It just happened that he died in front of a video game, but it’s also quite interesting.”

Nevertheless, video games appear to have a better hit-rate than film, literature, exams or any of the others. Video games, it seems, are something else.

Facebook Twitter Pinterest Simon Parkin, the author of Death By Video Game. Photograph: Phil Fisk/Observer

During my first year of university, my friends and I became partially nocturnal. We’d stay up late for the 9am lectures. We’d get up early for the 9pm parties. The rest of our waking hours were, as with so many students, given over to lounging in reeking halls, eating cheap pizza and playing video games. My friend Alastair provided our gateway getaway: GoldenEye 007, the video-game adaptation of the 1995 James Bond film. Each night (which was, for our skewed body clocks, closer to day) we’d assemble in the front room of his shared apartment, pick teams and then sprint through ancient cave systems, creep through Russian military bunkers and teeter along cranes as we shot each other in a kind of armed-combat wide game. Most nights, at around two in the morning, someone would point out that it might be time to think about ordering some food in. We’d mournfully set down the controllers and head out to the local pizza takeaway.

“Er, guys, it looks like it might be shut,” said Ian, as we rounded the corner on one such night.

“Lucky Pizza is never shut,” said Clare.

“What time is it anyway?” I asked.

“Oh,” said Alastair. “It’s half past four in the morning. How did we not notice that?”

A few years later, I left my wife playing the video game Animal Crossing in our apartment one afternoon.

In Animal Crossing, you assume the role of an immigrant who moves into a village to build a new life. When you disembark from the train, you’re greeted by an officious raccoon, the local shop owner and landlord, Tom Nook, who offers you a small house to call your own. Once you’re settled in, you get to know the neighbours, write virtual letters, attend local festivals, fish, catch bugs, excavate fossils, buy clothes and, of course, service your virtual mortgage. The game follows the console’s internal clock and calendar: when it’s night in your world, it’s night in Animal Crossing. The shops open at nine and close at six, and Christmas falls on 25 December.

Despite the fact that talking animals populate the game and despite the fact that your work is primarily to collect fossils and catch bugs for the local museum, Animal Crossing mimics life’s rhythms, domestic pressures and timetable.

When I returned home later that evening, the flat was dark except for the quivering light of the TV screen. My wife sat on the floor, exactly as I’d left her hours earlier.

“Is everything OK?” I asked.

She turned her head stiffly, eyes hooded, as if awakening from a coma.

“Woah,” she said. “I am cold and hungry.”

A friend of mine has coined a term for the unique way in which video games cause their players to become oblivious to time in this way: “chronoslip”. It’s not a new phenomenon. We speak of becoming “lost in a good book”, of “losing track of time”, of “pastimes” (or, originally and more explicitly, “passe-tymes”). The phenomenon is ancient. Tempus fugit, it turns out, especially while you’re having fun.

But with video games, these phrases don’t quite suffice. What book or movie could keep the average viewer’s attention for six uninterrupted hours? The titans of modern mainstream entertainment such as the Harry Potter films, Star Wars, Lord of the Rings, the Sopranos et al may boast expansive cumulative running or reading times, but they are broken into discrete, palatable chunks. With movies and TV series, we seem to reach our consumption limits sooner than with video games, into which we can descend for ceaseless hours.

Perhaps the difference is that games are active rather than passive media. They do not temporarily suppress our free will. Rather, they demand it. We step into a game world and emerge, hours later, with little sense of where the time has gone. Sometimes, the immersion is so complete that our bodies’ physical signals do not penetrate the unreality: we forget to eat, to shift position in our chair. Time becomes yoked, not to the ticking of the clock, but to the pattern of our interactions, the pleasing rhythms of cause and effect. In strategy games, time is divided into the number of seconds it takes to build a barracks, train a soldier or to mine the earth for resources. Seconds and minutes have no relevance here; time is calculated in units of action. By contrast, in a puzzle game time works like an egg timer: crack a level before your patience runs out and the timer is flipped; your store of patience is renewed. Games achieve chronoslip because they replace the real world with a new one that moves to its own laws of physics and time.

This reality engages us totally and we synchronise with its tempo. Video games, from the simplest card game through to the most vividly rendered fantasy world, consume our attention. When we become lost in a book, we enter a state where the fabricated world and its characters seem so real and pressing that we lose all sense of time. Small wonder it’s so easy to lose oneself in a good game, where we become not only an eavesdropper or onlooker on a world, but an active participant in its action and drama. Video games go further than other fiction: they revolve around us and react to our every choice and input.

No, video games are not mere time-wasters. This label, so often and gleefully applied, implies a certain idleness on their part. Rather, they are time-killers: they destroy time. And they are accomplished killers, often leaving little trace of their handiwork; we remain oblivious to time’s passing.

Facebook Twitter Pinterest Martin Amis, an early and unlikely video game addict. Photograph: Antonio Olmos/Observer

Video games did not grow into the role of time-killer. They emerged, fully formed, fully capable. In his 1982 treatise on the emergent video game, Invasion of the Space Invaders, Martin Amis explained his first encounter with the titular Japanese arcade game, a summer romance that blossomed in a bar in the south of France during the summer of 1979:

“Now I had played quite a few bar machines in my time. I had driven toy cars, toy airplanes, toy submarines; I had shot toy cowboys, toy tanks, toy sharks. But I knew instantly that this was something different, something special. Cinematic melodrama blazing on the screen, infinite firing capacity, the beautiful responsiveness of the defending turret, the sting and pow of the missiles, the background pulse of the quickening heartbeat… The bar closed at eleven o’clock that night. I was the last to leave, tired but content.”

Amis then describes the video-game player’s descent into obsession: “Your work starts to suffer. So does your health. So does your pocket. The lies increase in frequency and daring. Anyone who has ever tangled with a drink or drug problem will know how the interior monologue goes. ‘I think I’ve got this under control at last. It’s perfectly okay so long as you do it in moderation… ’

“The addict then indulges in a wild three-hour session. ‘I’m not going to touch that stuff again,’ he vows. Twenty minutes later, he is hunched once more over the screen, giving it all his back and shoulder, wincing, gloating, his eyes lit by a galaxy of strife.

“You think I exaggerate? I do but only slightly. After all, the obsession/addiction factor is central to the game’s success: you might even say that video-dependence is programmed into the computer.”

In Taiwan, there have been enough cafe deaths that the government is no longer content with issuing mere recommendations for players to, as Scientific American puts it, “make this their last game”. Government officials have developed measures to help curtail the amount of time that people play games: a more forceful kind of intervention than Nintendo’s gentle reminder of the great outdoors.

According to the section chief for the economic development bureau of the Tainan city government, the police routinely carry out spot checks after 10pm on cafes to see whether there are any under-18s on the premises. During the summer holidays, the local government now runs a youth project that warns young people about the dangers of playing games for too long. The government is even in the process of drafting new regulations for internet cafes that will decree when and for how long teenagers will be allowed to play on the premises. Similar legislation is already in place in South Korea where, in 2011, after a spate of similar deaths, the government introduced the youth protection revision bill (sometimes known as the “Cinderella law”) which prohibits teenagers from playing online games in internet cafes after midnight.

Films are awarded certificates that dictate the age of those who are allowed to view them. But video games are perhaps the first entertainment medium in history to inspire legislation with regard to how long a person is able to interact with them before taking a break. Amis was right: games are somehow different. We consume a book, but a game consumes us. It leaves us reeling and bewildered, hungry and ghosted in the fug of chronoslip.

Since the 1970s, doctors have believed that it’s possible for a video game to trigger a heart attack in a person with a weak heart. In 1977, the cardiologist Robert S Eliot used Pong to replicate stressful situations for his cardiac patients at the University of Nebraska medical centre. He studied more than 1,000 patients, monitoring the game’s effect on their heart rate and blood pressure.

We have had heart rate increases of 60 beats per minute and blood pressures as high as 220 Cardiologist Robert S Eliot

“We have had heart-rate increases of 60 beats per minute and blood pressures as high as 220 within one minute of starting a computer game,” he said at the time. “It happens quite a lot but the patients have no awareness.”

If Chen Rong-yu’s death in that New Taipei cafe was a failing of self-discipline or some other non-biological defect, then it’s important to establish that his heart attack wasn’t due to a pre-existing medical condition.

I visit Dr Su Ta-chen, attending physician and clinical associate professor at the department of internal medicine at National Taiwan University Hospital (NTUH), who treated Chen. “It wasn’t reported, but last year Chen had a heart attack and was transferred to the hospital for evaluation,” Su tells me. “During his hospitalisation the checks included echocardiography, 24-hour electrocardiography, cardiac catheterisation, coronary angiography and cardiac electrophysiology.”

But the test results showed no signs that Chen had a heart problem that might lead to sudden death. The young man’s unexpected heart attack was something of a mystery. Chen refused the doctor’s recommendation to have a cardioverter-defibrillator fitted. Moreover, when he discovered that there was nothing wrong with his heart, he declined to have any more cardiovascular track- ing, which might have explained the attack. Three months later Chen was dead.

Su believes that there are multiple possible causes of death for Chen, as for the other people who have died while playing video games in internet cafes.

“Acute autonomic dysfunction is the first potential cause of death,” he says. “Video games can generate a great deal of tension in the human body. The player’s blood pressure and heart rate rise. If this excessive tension is maintained for more then 10 hours, it can result in cardiac arrhythmia and sympathetic-parasympathetic imbalance, also called acute autonomic dysfunction.”

Horror games such as Resident Evil maintain high levels of tension for the unfortunate gamer.

Video games deal in tension and peril. This is true of most fiction, in which conflict is necessary to create drama, but in most video games the player is the subject of the stress and conflict. The conflict is necessary for the sense of triumph, release and learning that comes when it’s overcome. “Even if the game is not especially stressful in this way, simply playing for such a long period of time can prove fatal,” says Su.

Another potential cause of Chen’s death, according to Su, is what doctors refer to as “economy-class syndrome”: “Many studies show that maintaining the same pose for hours at a time without moving your body, especially your legs, can cause deep vein thrombosis. Moreover, if you don’t drink and eat properly while in this position, your blood can become sticky, leading to a pulmonary embolism and sudden death.”

The final potential cause is linked to the cafes themselves, specifically their conditions. Taiwanese internet cafes typically have poor ventilation and offer players only a cramped space to play in. One recent study found that the air pollution index in internet cafes often exceeds safe levels. Most establishments have dedicated smoking zones on the premises, but while air conditioners cool the air temperature, they don’t improve its quality.

Taiwan is a humid country. Relative humidity usually remains at 60-90%, conditions that help fungi, bacteria and dust mites to flourish in a confined space, which in turn can stimulate asthma and other allergic syndromes. Severe air pollution can have a devastating impact on a human’s heart and blood vessels, increasing the possibility of blood clots, raising the heart rate and blood pressure, stiffening the arteries and having a negative impact on haemodynamics (blood flow).

None of this completely explains the apparent rise in these deaths, however. “It’s because more and more internet cafes are opening and the number of people taking up online gaming is increasing,” says Su. “The content of online gaming is improving and growing more attractive than ever. I believe that if cafe conditions don’t change, we are going to see more deaths.”

Chen’s death is a whodunnit of sorts. It’s not a crime that can be easily pinned on any one person or thing. There’s Taiwan’s local economy and infrastructure, which promote the extended use of internet cafes. There are the natural conditions of the country’s humid climate. There’s the lack of regulation with regard to how long people can use these cafes and, of course, there are the video games themselves, which promote prolonged engagement through their elegant, compelling design.

But there is another, more pressing, more interesting question that arches over all of these, one that is, perhaps, more relevant to the billions of people around the world who play video games and don’t wind up dead from doing so: whydunnit?

What is it about this medium that encourages some people to play games to the extremes of their physical wellbeing and beyond? Why do video games inspire such monumental acts of obsession? Is it something within the game’s reality that proves so appealing or is it external circumstances that push certain people to take refuge in a cosy unreality? Games offer conflict within safe bounds, so perhaps it is to do with the human desire to be heroic, to perform acts for which they might be remembered, a way to stave off death’s great whitewash. Or is it the competitiveness of the athlete: the desire to win and assert dominance over our peers and rivals? Or is it to do with friendship and community or showboating and braggadocio?

Video games offer the intrigue and joy of solvable mysteries. They also grant access to mysterious places in need of discovery. Through them, we have the opportunity to, like our ancestors, become explorers when Google satellites have mapped every inch of our own world, leaving few places where we can truly explore the unseen. Glory, justice, immortality; a chance to live over and again in order to perfect our path, a place in which change and growth in us are measured in the irrefutable high-score table. Video games offer all of this and more. The allures of the video game, and the ways in which it salves our internal problems and instincts, are myriad.

Is it so curious that a person might become forever lost in this rift between the real and the unreal?

Combat zone: gaming in Iraq

“Video games are the only viable entertainment we have here,” says Mohammad Abdulla, a 25-year-old network administrator for Baghdad’s main internet service provider. He’s been playing games since he was a teenager; a poster of Captain Price, a fictional British army officer from the video game Call of Duty, hangs on his wall. “Other hobbies are just too dangerous because of terrorism. We don’t have clubs, so games are the only way to have some fun with friends and stay safe at home, where there is no risk of being killed by a suicide bomber. For many of us, video games are our only escape from these miseries.”

Some of the most popular video games in Iraq, as in the west, are military-themed shooters, in which the player assumes the role of a soldier and blasts through waves of virtual enemies. “Almost all of my friends play video games like World of Tanks [and] Battlefield 3,” says Abdulla. “In fact, we have some of the top- ranked players in the world here.”

This interest in military games stems from the local environment as much as, in the case of many western players, male vanity. “Growing up, my life was completely military-focused,” Abdulla says. “It is the way we are raised. For example, I was taught how to use an AK-47 when I was in elementary school.”

Many of these first-person shooters, often created with input from US military advisers – a handful of Navy Seals were punished for consulting on the 2012 video game Medal of Honor: Warfighter – are set against the backdrop of fictionalised conflicts, often within Middle Eastern countries. Some have entire sections set within Iraq, such as the Battlefield series. For Abdulla, playing these games in their real-world settings isn’t problematic.

“Any video game that’s set within Iraq and involves killing terrorists becomes instantly famous here,” he says. “Everyone wants to play it. We have been through so much because of terror. Shooting terrorists in a game is cathartic. We can have our revenge in some small way.” Omar M Alanseri, the owner of the Iraqi Games Centre, agrees: “Any game that has a level set in Iraq is popular. They always sell more copies than other games because they are related in some way to our lives.” The games have even established a kind of empathy for foreign gaming partners that Alanseri said he would not otherwise have. “I have learned a lot of things, like western world values, culture, lifestyle, and even the way that they think through video games.”

Abdulla believes that the friendships he has formed through online gaming have had a transformative effect on the way in which some people view his country. “Some people told me they were scared of Iraqis,” he says, “thinking that they are all terrorists. But in reality, we are victims. When they got to know me, they saw the truth and changed their minds about Iraqis. It removed the fear.”

Michael Moe, a 22-year-old Norwegian, is now one of Abdulla’s closest friends. The young men met online while playing Battlefield 3 and now speak on the phone or over Skype every few days. “I become worried about Mohammed if I do not hear from him for any more than two days,” says Moe. “I always check up on him when that happens.”

“I used to object about video games,” says Amna, Abdulla’s mother. “I wanted Mohammed to spend more time studying. But I’ve come to see the strange benefits. Video games have broadened his relationships outside of our borders and formed new bonds. He loves his gaming friends and, from what I can tell, they love him too.”

Death By Video Game by Simon Parkin is published by Profile on 13 August (£12.99). Click here to order a copy for £10.39