Gaming disorder? On throwing the digital baby out with the bathwater

Recently, the World Health Organization (WHO) announced that its latest draft of the 11th International Classification of Diseases will include #gamingdisorder. Take This, a non-profit dedicated to the fight against mental illness, recently published a enlightening post on the topic. They point out that the draft clearly states on the website that it is not official, and that gaming is not an official disorder recognized by the Diagnostic and Statistical Manual of Mental Disorders (DSM); the guide used by the American mental health system.

As the BBC reports, there is an advantage to singling out and labeling different types of addictions as diseases with standalone diagnoses. It quotes Dr. Richard Graham as saying "It is significant because it creates the opportunity for more specialized services. It puts it on the map as something to take seriously." Labeling gaming addiction as an illness will likely increase its sufferers ability to obtain coverage for services, and increase the market for those services, as well as for funding for research.

Addiction is a disease. As the National Center for Addiction and Substance Abuse reports, "Choice does not determine whether something is a disease. Heart disease, diabetes and some forms of cancer involve personal choices like diet, exercise, sun exposure, etc. A disease is what happens in the body as a result of those choices."

According to this reasoning, gaming can certainly become a disease. When I was 16 and living in Jerusalem, Israel, I saved up my money to purchase the game Creatures 2. I loved that game with all my heart. I had read so much about it prior to picking it up, and continued reading about it and experimenting with the open world and the little adorable, breedable creatures for months. I often played until sometime between midnight and 2 a.m, possibly later. As my commute to school required me getting up before 6 am, I was not getting enough sleep.

An adorable Norn from Creatures 2

Did my grades suffer? I honestly do not remember. I imagine that it impacted my schoolwork to some extent. However, after graduation, I received a letter from the ministry of education congratulating me for my extremely high matriculation exam scores. I am also currently completing a psychology PhD as a National Science Foundation fellow. In the long run, while my intense emotional attachment to my little creature buddies certainly had a deleterious impact on my sleep, I survived, and some might say thrived. I am not sure I would classify my gaming as an addiction; despite it consuming much of my time--both physically and emotionally.

And yet, if my parents were the type to read up on mental health, or keep track of my activities and sleeping habits, this sort of announcement may have led them to wonder whether their oldest daughter had an addiction problem. Especially for teens, the acceptable/maladaptive continuum is not crystal clear, and is dependent on so many cultural factors, as well as individual differences. 

For example, I have a tendency to be become extremely engrossed in an activity--be it gaming, reading, drawing, writing, running, or silly face making contests with my offspring. These can throw my life a little off course, since I insist on perfection and utilizing every opportunity there is for improvement. Creatures 2 impacted my life, and by the WHO's standards, I may have been a borderline case of mild addiction. What no one seems to be asking is what was the value that the game added to my life.

I recently asked members of a Blizzard Facebook fan page to share with me their positive (specifically online) gaming experiences. I thought I would get some nice stories about how life can be hard and annoying, and gaming provides adequate escapism. After all, that is what I had listed as my response. Between being raised in an extremely conservative environment that I never quite fit into, and experiencing divorce and single parenting in graduate school, games provided me the necessary outlet from reality. 

#Blizzard fans' stories blew me away. There were stories from coping with disorders, addiction, and #depression, to finding true friends and significant others. In fact, I am thinking that I should begin playing World of Warcraft (WoW) and abandon internet dating. Although I did not ask the gamers how many hours they spent playing, I assume that it was a significant investment of time. I do not know if it has led to their careers suffering, or if it harmed their relationship with their parents growing up. However, what if it led to them finding the person they love and married? What if it helped them cope with their feelings of self-loathing? How do we determine what level of distress as a function of gaming is unacceptable when gaming also provides many benefits?

What worries me, is that identifying gaming addiction appears to be a delicate art form, far more than identifying substance addiction. There are so many shades of grey that enter once a family member, friend, or clinician tries to determine whether the play is disabling a person to the extent that it should be pathologized. Creating a label may lead more people to get diagnosed in ambivalent situations; when you have a hammer, everything looks like a nail. Furthermore, forcing labels upon those who perhaps do not deserve it, can cause them serious harm. 

In Rosenhan's 1973 study, a number of pseudo-patients pretended they were hearing voices, and managed to gain admittance into a psychiatric facility. Once they were there they explained they felt completely normal. However, it still took an average of 19 days for them to be released, despite behaving normally once they were admitted. Upon discharge they were all diagnosed as schizophrenics in remission; the doctors were certain that their original diagnoses could not have been wrong. The other patients who did not have a vested interest in conceptual categories of diagnosis knew that the pseudo-patients were faking it.

I no longer play Creatures 2. I quit one day after vividly dreaming about them. I decided it was too much, and I quit cold turkey. However, in a world where gaming disorder is dangerous enough to receive a label, I think I have been urged to seek treatment by my parents before I quit on my own.

Sadly, for those afflicted with disorders such as Sensory Processing Disorder (SPD), whose basic inability to deal with the world's stimulation is clear, there is no label. SPD is not an officially diagnosed disorder. I am troubled that we are spending more resources on debating whether or not to label addictive gaming as a stand alone illness when  children/people with disorders like Sensory Processing Disorder cannot get therapy, because they can't be officially diagnosed.

None of this is to say that gaming cannot be truly addictive to a degree that it requires serious medical intervention. However, labels have both good and bad powers, and considering the scope of gaming additions, I am unconvinced that the gains outweigh the losses here. Most pastimes can become addictive; perhaps gaming addiction is better off as an addiction subset.

The question of what can we do about addictive gaming remains regardless of whether or not we believe it deserves its own label. #Addiction often has a biological component--a predisposition. And yet, we know that with alcohol, #children who are exposed to responsible drinking are less likely to become alcoholics later on.

Perhaps as a society we should ask how are we portraying #gaming. If gaming were as normalized and as widely accepted as reading, would there be as much of a need to cure people of it? Similarly, if parents played video games with their children who were interested in it, and demonstrated responsible conduct, might that curb not only #toxicity and #harassment, but addiction as well?

By focusing on all the ways in which gaming can be deleterious, we are limiting our scope to a micro analysis. This likely means that even when attempting to alleviate the addiction, we will focus on the addicted individual, and the games surrounding him or her. I suggest we take a few steps back and examine it at the macro, so that we might adjust the system rather than blaming a simple mechanism.

Playing #VideoGames is an incredible way to bond with children and encourage their #creativity. In my anecdotal experience with mothers, they avoid playing with their children because they either do not find it interesting, or they find it too confusing to jump in without prior experience. However, many of the mothers I know would love to participate in an activity that their children relish if they felt comfortable doing so.

#Nintendo #SuperMarioOdyssey 's The ability to play with two players, and with an assist mode is a wonderful way to empower these parents to partake in the experience. Adding classic games that parents grew up playing is another way to transition their view of gaming into a fun, familial activity. Rather than being an activity that parents use as a way to quietly amuse their children, gaming should be transitioned into a family activity, just like reading or playing board games together. 

Often when properly approached, video games can prove an inspiration for more traditional, socially acceptable past times. For example, my 5 year old is excited to learn how to read so that he can play better and more games. My 8 year old is writing his first fan fiction; it's a story about #SuperMario (the classic one). We have plans for the older one to start making his own games, which will likely engender an early interest in coding. Many schools already embrace project based learning as a superior method for teaching skills. That is how I conceptualize the role of gaming in my children's lives. That, and a lot of fun. Like most things in life, gaming is what you make of it.