Transcript for Podcast 71 - Esports Medicine (Patreon)

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Jamie Madigan: Hey everybody. Welcome to the psychology of games podcast. My name is Dr. Janie Madigan, and I am your host. And every episode of this podcast, I talks about the intersection of psychology and video games with the help of a guest expert. This is the episode about e-sports medicine. This podcast is brought to you by the patrons of psychology of games.

If you want to join them and get ad-free versions of podcasts and some other benefits, you can go to patrion.com/p O G. Otherwise you can go to psychology of games.com and support me by following me on social media, checking out all the articles that I've written over there or buying. so it was a lot of people are probably aware professional e-sports teams have people on staff besides the ones who go out there and play the games.

These teams often. Coaches sports therapists, nutritionists, and other specialists to help give their teams an edge. Well, what about physicians full on medical doctors who are there to help players recover from or prevent injuries? Make sure they stay healthy and focus on physical and mental wellbeing and the pursuit of victory.

It's not as common, a role as some others, but it may become more popular in the future. Thanks to this success of this episodes, guest expert.

All right, everybody. Welcome to the interview portion of the podcast. I have got Dr. Lindsay Migliore. She's one of the foremast experts and e-sports medicine trusted by leading e-sports organizations and industry leaders through her work as gamer doc, she applies scientific principles to the field of competitive gaming to definitively improve performance and expand the lifespan of e-sports athletes.

Her handbook of eSports medicine. The first of its kind was published just recently in 2021 by Springer medical. And she's currently the director of player performance at the e-sports team, evil geniuses. Dr. Migliori is also has spoken at both national gaming and medical conferences on the subjects that I just mentioned.

And she has been featured in e-sports insider, wired UK, the eSports observer, PC gamer, and more Dr. Migliori Lindsay, welcome to the podcast. Glad to have. Thank 

Dr. Lindsey Migliore: you for having me, Jamie, how's it going? Doing 

Jamie Madigan: pretty well. So I'm, I'm excited to have, we I've had a lot of doctors, a lot of PhDs, but you're the first actual physician.

You're a medical doctor. 

Dr. Lindsey Migliore: I am. And I am friends with more psychologists and PhDs than I am medical doctors. So we get into this discussion slash debate more frequently than not. And I think that their job is harder. So just to, just for everyone listening at home, I agree. I'm 

Jamie Madigan: not sure I would not interest anyone like myself to, uh, anyone's health or a life-saving situation.

Uh, I be completely worthless, so I dunno, maybe we can agree to disagree there. 

Dr. Lindsey Migliore: Alright. Alright. But my job is just memorization, right? So like we go to med school, we memorize where like psychology and things like that. You have to address the problem in front of you with creativity. And I know that's why, that's why I love e-sports because I finally get to do a little bit more of that and less memorization.

Jamie Madigan: Right. So, yeah, I mean, while we're on that topic, I know a lot of e-sports teams will work with, you know, coaches or the work with psychologists and sports therapists and that kind of thing. But what does it mean to be a medical doctor working in e-sports like, let's just start at the top there. Like, what do you do and who do you do 

Dr. Lindsey Migliore: it for?

Great question. So if you asked me that question. Three years ago, three and a half years ago when I started it would be different than my answer today. My answer last month was different than my answer. The month before everything is changing, everything is evolving. What it is really is up until recently in competitive video gaming, the support services that these players received was.

Irregular. Right. So if you go to a hundred thieves, you get to work with one HPS awesome chiropractor, and you get those chiropractic services. He does a lot of like Eastern medicine stuff. Really interesting to see on his Twitter, um, you go to CLG and you get to work with summer Scott, who is a master of psychology and you get to do I'm warming up with Jake Middleton of Adams.

E-sports right. So all these wonderful things that people were getting. But there's no standardized approach to e-sports medicine, right? So if you're a football player and you get signed to the Detroit lions, best football team in the world, and you show up, there's a protocol, you get your athletic intake.

Are you taking your athletic, physical? They do some blood work. Um, you get, you, you have already gone through the NFL combine, so we know your stats and then you get a trainer, get a nutritionist, you get massage. Access to all of these resources and you know how to use these resources because it's been used before and someone is overseeing it.

That's not happening in e-sports right now. So what I'm trying to do is say, what are the needs of these players and how can we approach that in a systematic or based way? Okay. 

Jamie Madigan: So, so what does that involve, you know, on, on a day-to-day basis is that it must be some sort of scientific approach to it. And I assume.

Data. And that's sort of what I'm used to when I work with my doctors and other therapists. So like what, what specifically does that involve? 

Dr. Lindsey Migliore: So when I first joined evil geniuses, I had worked for two years as a consultant. One-on-one with e-sports and individuals, athletes, coaches, um, I've been giving talks and things like that.

Um, so when I showed up to EEG, I said, I w I went around and I interviewed. All of the coaches and some of the players and staff members. And I said, okay, what's our, what's our culture. What are we doing? What do we think our biggest player needs are? What are we doing to address those player needs? And what do you think needs to be done?

What, what are you seeing in other orgs that have been done that you would like to do here? And from there I put together this like 60 page research document of everything I thought that could be improved and all of the ways that I thought I could improve it. So since then I've been working on adding in.

Those principles. So basically we know what are the pillars of performance? How do you, if you want to be a high performer in any area of your life, whether it's chess, rugby league of legends, what do you need to do to be successful? And it's this even not even podcasting, right? What do you need to do to be successful?

How do you put your brain in the optimum performance state? And that's optimizing your sleep, thinking about the things you put in your body, right? Nutrition. Exercising, both aerobic and strength training and then mental health. So those are the things that I address. So, uh, each of those has 5,000 things underneath it that we're doing, but it's sure it's putting org based insert protocols in place to where those pillars are getting addressed for all of our players.

Jamie Madigan: So what does that mean? Org based principles? 

Dr. Lindsey Migliore: Yeah. So the way that, uh, e-sports organizations are set up, it's, it's strange to understand because you know, the, uh, Patriots are owned by Bob craft, right? And, but the Patriots don't also in a basketball team, the Patriots don't also want a soccer team, right?

Bob Kraft might, but Patriots don't e-sports org. So evil geniuses. We have a league of legends team, a Counter-Strike team, a Dota team, a rocket league team of allergens. And if I am forgetting another TMI, I'm so sorry. Probably like two 

Jamie Madigan: more have formed, 

Dr. Lindsey Migliore: right? Yes. We've last spoken the way these words works.

So it's like how other organs work is. One of their teams will get a sports psychologist, right? So the sports psychologist is working with the cloud nines LCS team. Is there a rocket league getting any attention? Probably not. So it's, it's treating all of the players the same and giving them all the same access to resources and care, no matter which team.

Jamie Madigan: Okay. So you mentioned things like sleep and, uh, exercise and diet and all those other kinds of things. So, how does your experience and training as a physician help do better than say having a separate, you know, nutritionist and a separate sports psychologist and a separate, um, you know, personal trainer for all these kinds of things.

Do you see yourself like filling multiple roles? 

Dr. Lindsey Migliore: No, I actually work with those individuals. So have a great physical therapist, Jordan, Dr. Jordan says. Of response therapy doing excellent work for us. Um, so he, you know, the thing is, I'm a, I'm a medical doctor and I have training in sports injuries, right?

So I can recognize a wrist injury. I know how to prevent it, and I know what to do to treat it, but I'm not going to be better than a physical therapist who is seeing this every day, every hour of his life for the past 10 years, I'm not going to be better than Jordan sigh at treating wrist injuries. So it's.

How, how are we picking up wrist injuries before they happen? How are we preventing them with stretches exercises? And then having people like Jordan that we can send them to when they get injured or when they need more attention. So it's, it's. I think one of the things that I learned in medical school was to appreciate understanding and not just memorize it.

I know I started off with the memorization thing, but. Why does disease happen? Why do, why does illness happen? Why do injuries happen? And once you understand that, you can understand how to prevent them. And I think that's why I'm uniquely situated to be in this job. It's like understanding the mechanism of how things work so we can prevent that mechanism.

Yeah, 

Jamie Madigan: I think in psychology and other disciplines, you think of that as like a systems approach, you know, where each little piece is part of a connected whole, and one thing you do in one part of the system could affect others and vice versa. Yeah. So do you have any sort of, do you make any sort of attempt to measure the effectiveness of these, these interventions in these programs?

Like, do you have to show data to your bosses or investors or just anybody to say like, no. When we started doing these sorts of things, performance in these athletes improved in this way, in that way and injuries decreased or what have you? 

Dr. Lindsey Migliore: I love that question so much. Up until like two months ago, no one had e-sports cared about anything that you just said because they hadn't been given that option before.

Right. So there have been, I know 95% of the performance coaches who work in e-sports right now and 75% of them are awesome, but there is a smoldering 25% who have just been bull crapping the industry into, into saying that they're making improvements, but have. Not doing anything because no one has ever asked them for data or.

Jamie Madigan: And honestly, 25% sounds kind of nice low, like a nice low number. I'm familiar with some other industries with that number is a lot higher, but yeah. Yeah. 

Dr. Lindsey Migliore: So, you know, when, when you see something like an ankle sprain in basketball, right? So we, if we wanna, if we want to prevent ankle sprains in basketball, well, there's a lot of steps we can do before.

We can figure that out. We need to figure out why ankle sprains are happening. Right. So athletes get fatigued and when they get fatigued, Ankle muscles weaken and you rely more on the support structures. Um, so if you are at the end of the game and you fall in twist your ankle, this sports structure structures or weekend, so the ankle twisted in a certain way.

So how do you prevent that? Okay. I'm going to train those support structures. And if they're weakened past the point of, if they need extra reinforcement, I'm going to put an ankle brace on them. Right. And so then you, you do that to your athletes and then you measure the incidents of ankle sprains after that intervention, right.

It's called the it's called the trip method. It was developed by physical therapists and it's the basics of evidence-based practice in injury prevention in e-sports. We don't even know what injuries they get. 

Jamie Madigan: So, yeah, that was going to be one of my followup questions is like what injuries and diseases are we talking about?

But yeah, go 

Dr. Lindsey Migliore: ahead. So you get an ankle sprain, right? And it hurts like heck and you have to go to the doctor and get x-rays and get treated to get diagnosed. Someone saw you fall and twist your ankle. They know it happened in basketball, right? So when you go to the hospital, all that data gets reported to the gut.

And so at the end of the year, we get a nice little report that says, okay, of the injuries that presented to the ER, because of football, 75% of them were concussions. 10% of them were MRI, tears, writers, uh, MRI. We tore the whole MRI 

Jamie Madigan: or your 

Dr. Lindsey Migliore: brain 25% of them were ACL tears. Right. So we know the incidents of injuries that have.

In, in traditional sports because we see it happen on the field and it gets reported because they go to the doctor in e-sports. It doesn't happen on when they're playing video games or they don't notice it. When they're playing video games. They noticed that when we're doing something else that puts a bigger strain on their wrist, like go to the gym for the first time, going rock climbing, going bowling as a team activity.

And so it doesn't happen when they're gaming and then they don't present to the doctor. So we don't know all of the data. We have, you read my book about all of the e-sports injuries. That data is based on like a hundred people. 

Jamie Madigan: That's a small number for yeah. That relative to other diagnoses. Yeah. Yeah.

Dr. Lindsey Migliore: So in order to, in order to figure out how to prevent these injuries, we first need to figure out the incidents of this injury, which we're so far off of. So the data that I operate with is. We're making it out. Like we're, we're, we're like, what data do we want to collect? There's nothing to compare it to.

Right. So I I'm using, um, biometric data, so steps, um, heart rate, variability, sleep. Um, I'm using self-reported fatigue studies. Um, I'm, I'm extrapolating a lot from what exists in the current traditional athletics. So like, how do you assess sleep quality? And in traditional athletics, it's called the athletic sleep screening questionnaire.

And so we use that for e-sports athletes. So the data that I'm getting is mostly self-reported right now, which is unfortunate. And we're trying to definitely improve. That's the very long answer. That 

Jamie Madigan: seems like a situation that's right. For collaboration amongst people like yourselves at different organizations, right?

Like if you could get some sort of consortium together and overcome maybe any professional rivalries or, or bias towards competition and share that information, it seems like that would benefit everybody. I agree with you, but I can tell from your facial expression and the way that maybe listeners can't that maybe that is not happening at the, at the rate that one might hope.

Dr. Lindsey Migliore: Yeah, I mean, evil genius. This has never, ever not encouraged collaboration. I just know how other orgs are, and I know how closed other orgs can be too. So let me give you an example. So for, for league of legends, you, um, the way that these guys practice is you don't have a practice squad, right? So there's no, there's five players on your team.

If you want to practice the game, there's not five other players on your team to play against. So you have to scrim against other teams. So we're screaming, it's teams that we play against on the weekends. So if we want to say, Hey, like let's try this training method, uh, that, that might work better. You have to do it in scripts and you have to do it against the other team.

If we want to try something that might improve or grow this. We're not guaranteed that that Tate team will agree to it because they don't want to mess with their structure. They don't want to collaborate with us. So it's like, it's, it's, it's, it's a hard process. Yeah. 

Jamie Madigan: Like you said, a lot of organizations don't have a, and B teams for example, or a bench deep enough that they can scream against each other.

So that's, that's all fascinating. Let's back up a little bit and ask. Why did you choose this career path? You know, why did you choose to work with professional gamers instead of other types of athletes, maybe more traditional types of, of athletes and sports? Cause it, my understanding is that you went into this pretty much out of medical school, right?

Like you didn't come to this from a more traditional medical, uh, occupation. 

Dr. Lindsey Migliore: So I came, I didn't get a job after residency in traditional sports. I went right into e-sports. So you're, you're, you're mostly correct in that. It's a great question. And if you read, so this story is out in the internet, right?

It's in like PC game or wired in different forms. The truth is there is not like one aha-moment there wasn't one, a hot moment that I was like, yes, this is what I'll be doing with my life. It was a lot of little tiny changes and that's how real change and growth happens in life. It's lots of little tiny moments and events and not just like at a hot moment.

Um, and it was a culmination of realizing that life is way too short, not to do exactly what you love and are passionate about and not wanting to waste my time. Speed seeing 40 patients in one day who I wasn't making a big impact on their lives. And it was another fact that I saw this huge need that wasn't being addressed.

And I mean, ideas. True, good ideas and true good projects come from seeing a need and responding to it rather than just. Trying to force your will on onto the world. So I saw this untreated population of gamers who were getting injured physically and mentally, and had nowhere to go, nowhere to go. You go to your doctor and said, Hey, my wrist hurts.

When I play video games, every single physician is going to say, well, then don't play video. 

Jamie Madigan: Sure. Right. It's like the old joke of doctor. It hurts when I raise my arm above my head and they say, well, well, don't raise your arm above your head. Yeah. Yeah, exactly. And I'm going to charge your insurance 4,000.

So, 

Dr. Lindsey Migliore: I mean, that's really, that's really how it it came about was when I finally was interviewing for a sports medicine job and the woman looks at me I'm at, and I remember this woman, I remember I'll always remember. And I'm talking about e-sports and I'm talking about what I've been doing. Cause I've been doing it on the side, right?

Like just growing my brand and growing my awareness. And she looks at me and she goes, why are you here? Because I'm applying for the sport medicine job. She's like, no, why are you doing this? She's like, you have what you need already. She's like, just go do that. I was like, oh, she said, we'd love to have you, but like, you know, like why would you come here?

And that's when it really clicked for me. It's like, why would I do anything else other than the thing that I love doing that I'm good at doing that I want to do that is needed. And that's how I ended up here. Yeah. 

Jamie Madigan: It's you don't always find that combination of, I really want to do this and people will pay me to do it and I'll be having a positive impact on other people's lives.

So. It seems to make makes yeah. What were you doing there? I honestly don't know either. I have been right 

Dr. Lindsey Migliore: there, but he's in New York free trip to New 

Jamie Madigan: York. True. Yeah. Uh, so how's it been going? I mean, you've D you've been doing this for a few years at this point, right? I mean, you're, you're with evil geniuses, so it's obviously going well, do you feel like you are blazing, any kind of trail?

Are there other people. Are looking at what you're doing and saying, yeah, I actually, like I should do that as well. It is 

Dr. Lindsey Migliore: remarkable. The amount of emails I get about people saying, I want to do this. How do I get it started in e-sports I it's, I, I would say I get three or four a week since for the past three years from med students, psychology students, people in high school, people in college who are interested in pursuing e-sports medicine, a career path, and the issue is.

So if you're a, I'm sure it was the same for you, but, so I graduated from med school and had a job, right? So like I was placed into a job for four years and told this is your job for four years. And then when you, if I had chosen to go continue in traditional medicine, after that, I had 10 job offers, right?

There's like such a scarcity of physicians in the world that like, you always have a job, you always have a path. And someone is always going to tell you where to go now. There is no path to e-sports medicine. There is no way to get into e-sports medicine other than literally like Kool-Aid man smashing through the wall of the courthouse and being like, oh yeah, 

Jamie Madigan: like,

Dr. Lindsey Migliore: like, and that requires a certain type of person that isn't always encouraged to develop in medicine because. You know, you have to follow the line, you have to follow the hierarchy, you have to do what you're told, you know, plug in the prescription. Don't piss anyone off, move on with your life. And that is not the type of person that you have to be to get involved in e-sports medicine because no one wants, no one is going to ask you to come to them.

Right. You have to be like, Yeah, I see that some of your players are having neck pain. They're talking about it on Twitter. Like, what are you doing to address that? Do you think you would like some help? Here's how I can help you. Uh, you want to set up a call next week and that type of like rejection, right?

I would, I sent emails to people every week asking them to be on their show to, to, to, to come talk to their players. And no one ever was like rejection over and over and over again. And it, you can get pushed away and then all this. You do one good job and everything clicks and people trust you. And then everything snowballs from there.

Jamie Madigan: Did people give specific reasons for not wanting to talk to you in the beginning or they say, no, thank you. Because we're just, yeah. 

Dr. Lindsey Migliore: Oh, I think my two favorite stories are I applied to be a speaker at a convention. Um, and I filled out the form and they're like, oh, you'll hear back from us in like two, three weeks.

Never heard back from them. Never got asked to be on the. Two years later, they, they emailed me and asked me to be their keynote. And it was like the best moment. And of course I said, yes. And of course I didn't bring up two years ago. You didn't respond to my birthday. I wanted to, but you know, it's, it's, it's that it's just trusting in yourself and trusting in the process that like, I know this is needed.

I know this is going to be a thing and I just need to keep. 

Jamie Madigan: So do people generally, once you start working with them and get in either doing consulting or working on a more permanent basis, do gen people generally come around to that point of view or do they, they resist and be like, what, what is she doing here?

And no, I'm not going to follow your recommendations or I'm not going to cooperate, or I'm not going to take time to do any of this sort of stuff. How do people generally react to your overtures of. 

Dr. Lindsey Migliore: So when I was in my spiritual medicine practice, I would joke to work and see my schedule for the day. And usually it was 15 or 20 minute blocks, um, to see one patient, usually 10 to 20 in the morning, 10 to 20 in the afternoon.

And I am at the time it was, uh, in my twenties. Um, don't wear makeup. Don't like to wear professional clothes. I'm in scrubs. Maybe I'm wearing a white coat, but they're disgusting. No one ever washes them. No. I walk into the room and I got tattoos on my arm. I walk into the room and it's like a 60 year old man with back pain.

Right. And he looks at me and is like, who is this? I've already seen a nurse. I don't need to ask for another nurse. And in that 15 minutes, I have to understand their thought processes. I have to get them to trust me. I have to get them to tell me everything that's wrong with them. Even if there's weird side effects that they don't want to discuss, I have to diagnose them.

Give them a treatment plan and make them buy into that treatment plan. At the end of the 15 minutes, that was something that I developed over eight years of training. Right. And so what I meet someone and when I talk to someone and when I have an idea, I meet them where they are. I am not going to take someone who doesn't believe who's never exercised in their life who were to Chick-fil-A for lunch every day.

I'm not going to be like, Hey dude, you need to be doing an hour and 30 minutes of cardio every week. I'm not going to say that the whole time. Right. So I will meet people where they are. And so I will, I always get buy in because it's science, right? Science is facts. And at the end of the day, people want to be better.

People people want to improve themselves. They're just scared or they don't 

Jamie Madigan: know how. And that's generally, it sounds like it's working out at least. So this is often a show and a, and a website about psychology. So does psychology and your experience like fit into the picture? You mentioned that you sometimes work with maybe sports psychologist or coaches that may try to leverage some, you know, training psychology or any of that sort of stuff.

How does psychology fit into this picture or does it. 

Dr. Lindsey Migliore: Psychology is every psychology is in every conversation I ever have with anyone it's rooted in my understanding of the space. It's rooted in my response to this space, an understanding of psychology is more important than any understanding of anything even of e-sports itself.

Right? So like I would, if someone asks me like, what is the number one thing you need to be successful in e-sports it would be a basic understanding of human psychology. 

Jamie Madigan: Okay. So unpack that. What 

Dr. Lindsey Migliore: does that mean? And like, my understanding and my interaction with psychology is probably, you know, like I, we took courses in med school, like, you know, doctors become psychiatrists, but psychiatrists are just not going to say what I should have said.

Um, so I think understanding of how the brain works of how. Our minds, think of why we make the choices we make and why we don't make the choices we make. Like, I think Freud was an absolute idiot, but you know, the ego rules, the Eagle rules, most things that we do in life, right? Like, especially in e-sports, especially in e-sports because you cannot be successful with this level of scrutiny as an.

Without having a little bit of an ego because it's, it protects you against people who want to bring you down. And so understanding how to work with ego around ego, understanding how to put mine to the side and, and listened to other parts of me, I think has been incredibly huge. Um, understanding human motivation, I think has been cause, cause it's like, why is someone acting the way they act.

You know, when, when I district, when someone disagrees with someone, especially on the internet, we immediately are like, oh, that's my enemy. I hate that person fundamentally, because we have different opinions on pizza toppings. Right. But it's like, why do people say and act the way they do? And when you understand that you don't feel anger or fear anymore, you just kind of feel understanding.

And sometimes. It makes it so much easier to operate. 

Jamie Madigan: Yeah. So it sounds like a lot of understanding how to influence people, how to, like you said, meet them where they are and, and figure out where they are and then motivate them to do what it is that you're trying to get them to do or understand what you're trying to communicate.

Dr. Lindsey Migliore: And it's not even like what I'm trying to get them to do. It's like aligning goals. So what are their goals as a human right? It's to be better at the video game. And it's like, okay, that's my goal. Right. Like, I want you to be better at the video game. It's like, I don't, I never want people to say, like, I agree with you.

I want them to say, I agree with that. Cause it's not my idea. Right? It's like, it's like, oh, I agree with that. I agree with that. I heard that idea. I'm going to follow that idea now. So that really has been like the most helpful thing to me is just getting people to align goals and realize that. Yeah, what I want is the same as what they 

Jamie Madigan: want.

And as you were saying before, that's gotta be similar to other, you know, health and other physician work, where you're just trying to help somebody deal with an illness or become more healthy or recover from an injury in any other context as well. So yeah, 

Dr. Lindsey Migliore: it's like people come in with back pain, right?

I used to be a physical medicine rehabilitate while still am physical medicine and rehabilitation doctor and we treat. And so people come to me with back pain and the two clinically proven ways to decrease back pain. And the only two clinically proven ways to decrease back pain are core strengthening and weight loss, not opioids, not steroid packs, not heating, not acupuncture, not massage.

Right. And those are the two things that people don't want to do. They don't want to do it. So it's like, they're hard things to do. So it's like, you know, they want, they want the pills. They want, they want a prescription and they want it to go away, but it's like, you have to put in. Just to get the thing you want.

So it's like getting people to put in the work. So 

Jamie Madigan: have you had to rethink any of your assumptions? You know, we've talked about how a lot of the stuff you learned has transferred to the work that you're doing now, and the skills that you've developed are still being put to use. But is there anything that you had to rethink and reevaluate about doing this kind of work relative to what you learned in your time as a medical student or resident?

Dr. Lindsey Migliore: Every single notion that I had. Prior to joining e-sports about what I thought I was going to be doing has been wrong every single 

Jamie Madigan: one, but that's a lot, 

Dr. Lindsey Migliore: but that's the good thing, right? Cause it's like, some people don't realize that, right. They go into a situation with assumptions and plans and then the scenario changes and they stick to their original assumption and plan.

And that's why a lot of people fail. I mean, I think one of the most successful traits that I've met, if people. I've worked with who I, I admire has been the constant ability to readapt and readjust and constantly be learning from the situation around you. So, I mean, like I, I had an idea for what I wanted my life to be like, and it it's completely, it was completely wrong and I'm happy.

It was completely wrong because this is so much better. I mean, just like everything is always changing. Everything is always changing. And every moment in e-sports about, especially during a pandemic. You constantly have to be reorganizing and readjusting and readapting and I think that's why I love it so much.

Jamie Madigan: Cool. So let's pull on that thread a little bit more. Are there, are there characteristics of the people that you work with that make them better or more receptive to what you're doing and make them better? You know, e-sports athletes, 

Dr. Lindsey Migliore: the best people I've ever worked with are experts in their own field, but no one to give them microphone to another area.

And their own. Okay. You know, so it's like, you know, your, so let's, let's take Danny angles. Danny angles is the, is our director of gaming excellence. He is a former mathematician. 

Jamie Madigan: So he has some job title by the 

Dr. Lindsey Migliore: way it is, isn't it. So he's, he's, he's a former mathematic. He went and did professional SIM racing and was very successful.

He won a, I think it's a Ferrari. Maybe it was a Maserati, like from some, I don't remember what it was, but he won. He's won a bunch of crap, how good he was at SIM racing. He went in and led G2, which is a European e-sports organization. And now he's here. This man knows everything there is to know about e-sports right.

But he's also got that math brain. So he's constantly thinking metrics, numbers, data, right. When we're in a call about anything health-related he says, ask Lindsey, let's see what Lindsey says. Doesn't, doesn't try to answer the question on his own because he knows in that situation, he is no longer the expert and he passes it immediately off to me.

And, and that, because I think I'm great at my job. I think I know a lot, but I will never be more effective than me and Danny. Right. So like the team-based focus is something that is just so strong at EG and it's, it's, it's amazing because we have all of these experts and we have all these experts who are very strong-willed, but we're all stubborn.

We all think we know exactly what we need to know, but we know when to trust other people, because these people we're surrounded with are also very good at their jobs. So I think the ability to pass off the microphone and trust experts is like one of the biggest things that I think. 

Jamie Madigan: Yeah. And that resonates with a lot of what we know in industrial organizational psychology, which is my field that I've trained in, what my PhD is in and so forth is that the most effective leaders are the ones that know when to pass the reins to somebody else.

And, and my favorite definition of leadership is just getting work done through other people, right. It's not necessarily doing it yourself. It is getting things done. Through other people and knowing who to call on. So yeah, that's a, that's a great anecdote. You writing that down? I can't take credit for it.

I forget where I heard it. It's probably one of my professors or some book I read once, but. No, I'm going to give you credit. So anything else you want to talk about in terms of the work that you do that we haven't discussed yet? Or haven't had a chance to bring up yet? 

Dr. Lindsey Migliore: There's a thousand things we haven't discussed about the work I do, but, um, it's, there's, there's only so much time in the day.

I think my crowning achievement this month though, was so our LCS guys had their first game of. The season last Saturday. And we, a bunch of people of us flew in to LA format from all over to like support them and show them that we were behind them. And they wanted to do something that I before like go out to dinner with the guys.

And I was like, no, no, no, no. I was like, you guys, you're a bunch of like 30 year old nerdy. And we're about to hang out with a bunch of like 18 to 23 year old pro video gamers. I was like, no one wants to sit at a dinner table and like, talk about the weather I'm telling you that right now, no one wants to do that.

I was like, we're going laser tagging. So we rented out a laser tag space and play. Us the gaming staff versus our LCS team versus our academy team. And like, when I tell you that these people, these guys put excellence into every single aspects of their life, they were so bad at laser tag and like, Th th the, the team building and like the, the aspects and the sides of these guys in my, in my coworkers that I saw, it was just like outstanding and amazing.

And I was just like, my cup was so full after that event. I was so happy. 

Jamie Madigan: Nice. Were there any injuries, any fistfights, any twisted ankles, people diving for. 

Dr. Lindsey Migliore: There were, there was some shoving, um, but it was mostly me doing the shoving. So I figured I, you know, I, I knew the exact, you know, load of the tendons and the muscles that I was.

Yeah. 

Jamie Madigan: Just you put right up to the edge, but not over. Yeah. So that, that's all fascinating, but I want to make sure that we have some other time to talk about. Some of the work you're doing and queer women of e-sports and other projects that you know, where you're acting as a mentor or doing some outreach, that kind of stuff.

Like what, what else are you. 

Dr. Lindsey Migliore: What else am I doing? That's a really good question. I met with our PR firm at EG and they're like, so what, what else are you like, what are your other roles? And I listed them off. And it's just so funny to list off your roles because, you know, once you get one of those roles, you might've done one or two things and then it's just there.

Right? So like, it seems more impressive on paper sometimes. So it's like people at home. If you're looking at someone's credentials, just know that you too can have those credentials with some amount of work and it's not overwhelming. So right now, I would say we're going to be sports. His mine is my number two project.

Um, so I started this organization two years ago. It's a 5 0 1 C3 nonprofit designed to increase advocacy for marginalized individuals and competitive video gaming. So how do you get good at video games? Right league of legends. It's a PC-based game that requires a really fast internet connection. As a kid.

So one of the players on our team is his name is Danny is his in game name. And he's, he's considered the best player. One of the best players in the world right now, he started playing Levi's when he was six years old, six years old, right. At six years old, you have to have access to a personal computer.

With a high-speed internet connection that no adults in the house are using for work that no of your siblings are using. And you have to have like access regular access to that for hours at a time hours at a time. So finances is a huge barrier to getting involved in competitive video gaming. Another one is in order to be the best you have to compete against the best.

And in a team-based game that requires open communication, right? You have to be on voice comms to be good at a game. So if you're trying to get good at call of duty and you are exclusively training in a male environment with a high toxicity level where they're constantly throwing out slurs and Texas jokes and comments, when you're a developing teenager, that is terrible for your brain.

And that's what happened to me. I was getting really good at call of duty was, was doing some circuits. Was. Thinking about trying to go pro starting to stream. And it's just like all built up and just was too much for my 19 year old brain. And so I quit call of duty and that's just like, not an acceptable scenario to me anymore.

Now that I have the resources to change. Yeah. 

Jamie Madigan: I mean, a lot of lost potential talent there, right? Like this could be some great players that decided, Nope, this is not for me. I'm out. 

Dr. Lindsey Migliore: It's not for me. And the thing is, it's not just happening to women. It's not just happening to queer individuals. It's happening to all of the people who have a lower tolerance for that type of behavior.

So as a result, we're, self-selecting people who thrive in toxicity, which makes it more toxic. 

Jamie Madigan: That's an interesting point. I never thought about it that way, or even looked up any research. Cause you know, I I've thought a lot about the psychology of toxic behavior, but the fact that it's a self reinforcing environment that you own people self-select out of it just like they self-select out of any culture in any kind of organization or, or seen.

Dr. Lindsey Migliore: Speaking of research. I think you're going to, this is a study that I am very excited to share with you now. So they did this study on, um, halo and halo is a multiplayer online first person shooter game. You have a controller it's X, it's an X-Box exclusive. You have control or you play in teams of like four or five to kill the other team as many times as possible voice.

You use voice comms to communicate, oh, enemy over there. I mean, this way I'm pushing the flag, whatever. So they took. To computers who could play the game at varying levels of skill, so easy, medium, hard. Um, and then they recorded men and women saying the same phrases. Like I like this map or enemy to the right or I'm pushing flag.

And so they had the computer play the game at the various skill levels, and they would say the phrases in a male or female voice at the same time throughout the day or throughout the day. And what they found was that the most toxicity was directed against the female voice regardless of skill level.

Right? So like 

Jamie Madigan: th this is my shocked face. This is my surprise face. Right. 

Dr. Lindsey Migliore: But the most interesting thing was the toxicity came the most from men in the game who were lower skill level. So the higher skill level male players, and these were just like the random people who were in the map. Would respond favorably towards the women when they did well.

And neutrally, when they did poorly, the poorly skilled men became, were toxic every level, but were increasingly toxic. The better the woman was. Yeah. Who is benefiting from exclusion, who is benefiting from keeping the competitive pool. Small. And it's low skilled individuals, right? If you increase the talent pool, you expand, you, you create inclusion, then they have more competition and they're going to lose.

So part of what I did, part of what we're doing at crewman of e-sports is creating a toxic free environment for any individual to train, right? Like it doesn't matter what you identify, how you identify. Everyone is welcome in our space. The only rule is you can't be a Dick. And the second thing we're doing is, um, creating an active sponsorship and mentorship program.

So we pair young queer individuals with industry leaders, um, at, at, at, you know, riot, Activision all over, um, pairing them up and having them we're going to active projects that they can do with the current resources. They have to make this space more. 

Jamie Madigan: That's awesome. Yeah, the it's one thing to, to talk about it and say we support it, but then to actually take that additional step and do something about it and pair people up and make a potentially a huge change in somebody's life, or even just a small change that makes their life a little bit better.

Either way they win know 

Dr. Lindsey Migliore: we have a 25% attrition rate to a full-time e-sports job with our mentorship program. Really. 

Jamie Madigan: Wow. That's pretty impressive. You know? Yeah. So you mentioned this briefly earlier, but I also wanted to ask about the handbook of e-sports medicine that, uh, came out last year, 2021, right?

Uh, at some point. Yeah. Um, which you, I think it looks like co-edited and wrote some chapters and you collaborate with a bunch of other people, including a couple of friends of this show, Rachel cohert and Christopher Ferguson who wrote a chapter about the psychology of e-sports. But what is, what is that handbook like?

Who's it for? And what kind of stuff is in it? 

Dr. Lindsey Migliore: Yeah. So you and I probably operate similarly. And when we want to learn about something, we go to research papers. Right. But then when we want, we want to learn about a new subject. We get a textbook or you get a handbook, right. Cause it's like, that's where you can find all the concise information that they take information from papers.

Three years ago when the textbook is published, that's how long it takes to book, but it's in a concise info. It's in a concise area. It's all there. Like if you want to learn about the industrial organism, if I want to learn about industrial organizational psychology, I will buy a book on industrial organizational psychology and I'll read it from cover to cover it.

I'll learn about it. If you want to learn about e-sports medicine, you can go to like two people's personal websites and read their blog posts. Right? There's no resource for it. Well, there was no resource for, there was no place to go. That was peer reviewed. And you could and backed by science that you could learn about e-sports medicine and not 

Jamie Madigan: just anecdotes or 

Dr. Lindsey Migliore: opinion.

Yeah, exactly. And so for me, that was the first step to make any field legitimate was to take a summary of the research that's out there and put it in one place. So that's what the book is. It's targeted towards, um, healthcare providers, medical professionals, people with a scientific background. It is not for your lay person.

There's way too many scientific terms in there. You will hate it. If you're listening at home. Yeah, go ahead. But you're not going to enjoy it and there's no refunds, so 

Jamie Madigan: yeah. So not necessarily a popular science book, but for the people working in that field or potential want to work in that field and know more about it.

Exactly. Yeah. Cool. So where on the internet could people, or should people go to find out more about you, your business and the work that. 

Dr. Lindsey Migliore: Don't go to my website because I haven't updated that in at least a year. I just need to pay someone to do it. So don't go there. Uh, I would check me out on Twitter. It gamer doc underscore is my username.

That's where I am the most active and you'll get 25%. E-sports twenty-five percent hockey, 50% memes. If that's your vibe and then hockey games, hockey games. Yes. Occasionally there the V that's a Venn diagram that I described, so there's going to be overlap. And then, uh, I'm on Instagram, the game or DACA.

It's not really, it's more motivational stuff there. And then a Tik TOK for the Fortnite clips is now I'm a 12 year old. So those are the places you can find me on the other. 

Jamie Madigan: Yeah. So w what do you play when you get a chance to play games? Steve, do you play what you deal with at work, or is it others? 

Dr. Lindsey Migliore: I developed, I went from call of duty to call duty, to call of duty, to fortnight, and I have been on, and when I was on the Fort, I train for a while and I still kind of am on the Ford, straight Ford, I train.

But, um, I've, I'm reasonably developing an obsession with league of legends. Just remarkably complex and just so Surrey role to play. Um, and I'm, I'm really loving it. So that's what I'm, that's what I'm doing right now. 

Jamie Madigan: Yeah. That's been one of those that I, I felt like I should get into and it, you know, it's almost like you're a film critic and you've never seen the godfather or something like that, you know, like it's so massively popular and influential and important to.

Video games that, you know, if I'm covering video games in any way, I feel like I should get into it. And, you know, I played a couple of matches, but you're right. It's just like, whoop that learning curves go straight up and, you know, I've, I've dabbled in some other, other MOBAs that were a little bit easier, a little bit more casual scene.

So maybe, maybe I'll make that a project. 

Dr. Lindsey Migliore: That's the trick to any truly successful game, right. Is like you, it takes hours to achieve mastery day. Years to achieve mastery. And that is what makes people like the game so much. So the harder it is for new people to join the better the game, 

Jamie Madigan: maybe the more longevity and complexity has.

Yeah. And potential for something like e-sports. Very cool. This was a fascinating conversation. I love breaking outside of the little psychology bubble and talking to neighboring fields and neighboring experts like yourself. So thanks so much for your time. This was a really interesting, I'm sure that people listening will also find it interesting and anybody out there listening should also remember.

They can go to psychology of games.com. The find out more about the show. There's literally hundreds of articles that I've written over the years that are there for your perusal for free as well as many, many episodes of the podcast. And you can subscribe to get future episodes. Support me on Patrion at patrion.com/pog.

Otherwise, I'd love to have you come by the website and, uh, thanks Lindsey. And I will talk to everybody else next time.