Dear Dr. Kline, I have spent most of my life struggling with depression to some degree or another. In recent years, I have come to accept some things about myself: 1. I am attracted to female-bodied individuals.

2. Although I am male-bodied, I am female, and intend to undergo surgery.

3. I am a gamer. Accepting these things has greatly improved my life. I used to think there was something wrong with me for gaming and was embarrassed to answer questions about it. When I accepted that I was a gamer, the first two issues became much easier to handle. I could accept the fact that I was different. I didn't care what others thought. I didn't care that my parents didn't believe or support me. I knew who I was, and I knew where I could escape to. I think gaming helped me accept who I am and helped me tolerate it when others couldn't. What do you think?

Something about gaming and accepting that you are a gamer seems to have helped you deal with bigger questions about yourself, and this has provided tremendous relief. You say you've spent "most of your life struggling with depression." This is no small matter--it can greatly impair a person's ability to live a productive and satisfying life. While we tend to emphasize the neurobiological roots of depression these days, there is no question in my mind that basic identity issues like the one you describe can create extremely profound despair and depression.

So how could gaming have helped you deal with all this? Games provide a powerful kind of escape from real life, and the chance to simply get away from yourself and all the conflict and pain may have eased your burden considerably. Games also provide opportunities for people to relate to others in which only some aspects of their real identities are shared. So you may well have developed a community of fellow gamers who knew only parts of you and found those perfectly acceptable.

Gaming also allows players to experiment with alternative identities. You could easily have created female personae in many games and essentially lived and played as female within these worlds. Something about this experience may have verified a thing you suspected about yourself: that you are more comfortable as a female, that you genuinely feel "female," and that, from your point of view, while you are physiologically male, you are "actually" female. This revelation may well have been confirmed when you "played female" in gaming worlds and liked the way it felt--you may have found acceptance and validation as a female in these worlds where other players would have no reason to conclude that you were physically a male.

But you have also made another interesting point. The identity of being a gamer was something that caused embarrassment and a feeling that something was wrong with you. You note that your ability to accept that you are a gamer helped you accept other things about yourself. What enabled you to accept this identity?

Within gaming communities, both online and otherwise, gamers spend lots of time with other people who have an interest in the hobby, think it's okay to play, or at least have gotten away with it, and want others to feel okay about it too for a kind of consensual validation. Even though the external world often fails to understand gamers and in some cases, unfairly pathologizes them, within the gaming universe, it's possible to get a real sense of validation. Feeling okay about yourself in spite of what some might see as an odd hobby may truly have been a very powerful pathway to accepting a divergent sexuality.

For many adults and people who don't play, the gaming world is a bizarre, strange place populated by addicts, people obsessed with violence, and losers who aren't able to make lives for themselves in reality. However, like any other kind of space in which people play, it is also a place where psychological issues are dealt with--sometimes very directly, and sometimes indirectly.

In my practice, I have the wonderful opportunity to see young children work out various issues in their lives through play. They play about what they can't necessarily talk about or understand, but it somehow helps them deal with it, often in a symbolic or metaphoric way. For example, recently a young boy spent a whole session building two big towers. One was the House of Evil, and one the House of Good, and their identities seemed to shift in the course of our play. I had the distinct feeling that this struggle had something to do with his parents' divorce and an internal dilemma about who had a good house and who had a bad one.

We can't always see how this play is going to turn out, but it often helps kids metabolize a struggle in some way that allows them to move on. Of course, I could have just told this little boy that both his mom's and dad's houses are good and there is no house of evil, but he would have looked at me blankly and kept doing what he was doing. He probably knows better--when your parents break up, there is usually some evil and it has to live somewhere.

In a very complicated world, even bigger kids need places to play and work out their issues. Video gaming seems to have provided those locations for you and helped you resolve some very critical questions.

Dr. Mark Kline survived a complete meltdown of his laptop's logic board this week, requiring major surgery with no anesthesia. Have a question for Dr. Mark? Send it to [email protected]. Your identity will remain confidential.