An interesting look at writer, Ian Bogost's thoughts on Gaming Disorder. Clearly, he has not had first hand experience with a gaming addict when he argues that "games don't provoke physical reactions like tolerance and withdrawal the way narcotics do." I would suggest that he spend time in a room with a child who has visible tremors, brain exhaustion, and erratic and sometimes violent reactive behavior when withdrawing from gaming. What are your thoughts on his idea that a "Behavioral Overuse Disorder" would be more appropriate for those who dance or use tanning beds excessively, or scroll too much on social media sites; it seems he wants this disorder to be more inclusive.
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Bogost's article raises some interesting questions about behaviours such as internet, smartphone, and social media overuse. Perhaps we need more research on these behaviours to better understand the similarities and differences?
Thank you so much for sharing the article, Elaine. It was very thought provoking. I had some initial responses to his article (in italics).
My Responses to “Why Is There a ‘Gaming Disorder’ But NO ‘Smartphone Disorder’ article in The Atlantic by Ian Bogost on June 28, 2018.
- The ICD has not "decided" that if you play video games a lot, you might suffer from a mental health issue: Gaming disorder.” They have determined based on research and consultations with experts that those that are severely negatively impacted by their gaming over a prolonged period of time have gaming disorder.
- The writer, Bogost asks why not include chess or a board game? Playing a board game or chess is different, they are not fast paced, highly immersive digital worlds where people can get many different needs met including their social needs that may prove very difficult to meet offline. Those games do not include levels, are not infinite and do not continue even when you are not there (online).
- Bogost wonders why other forms of technology are not considered disorders. Gaming is the only official computer-related Behavioural Addiction right now because it has the most research and it impacts a particularly vulnerable sub-set of the population. There are proponents of Internet Addiction and Smartphone addiction and there are validated screening tools for those things as well as social media use.
- Bogost asks, “But wait: Can people truly be addicted to games, like they can to gambling, or to heroin?” Firstly, gambling is mostly comprised of games such as poker and if there is a thought to gambling being different because of the financial component and randomness, many video games include that too (i.e. loot boxes). Also, why do you have to compare addictions? Not all forms of cancer have the same symptoms or lethality, there are different types and they are still called cancer.
- I do agree with his statement, “…the public is so willing to assume negative behaviors are the result of individual mental defects, rather than more complex social, political, and economic factors. We are dealing with powerful industries here (gambling and gaming) and there are many factors that can put people at greater risk for addictions that are not related to individual pathology including a lack of affordable housing, poverty, unemployment, social isolation, etc.
- He goes on to say, “Should the ICD-11 be adopted, gaming disorder would become coded internationally as an acknowledged mental-health condition, possibly paving the way for better support for its treatment—whether or not that treatment is warranted. I am just wondering who would opt for treatment when it is unwarranted? It is time consuming and can be stigmatizing. In my clinical experience, people are reluctant to attend treatment even when it is free and they often end up there because of family pressure. For the most part, people seek treatment because they or someone they love recognizes the devastating impact the behaviour or substance is having on their life. Also, any clinician with ethics would assess an individual prior to initiating treatment and if there is no identifiable harms caused by the behaviour, treatment would not be recommended. There is a lack of regulated treatment providers in the private sector who may treat people that don’t really need it regardless of the problem but that is a whole different issue.
- Again with the comparisons he writes, “Psychologists also worried that comparing gaming to substance abuse amounted to a mixed metaphor, because games don’t provoke physical reactions like tolerance and withdrawal the way narcotics do.” It may be true that tolerance and withdrawal symptoms vary between addictions (even withdrawal from substances can vary depending on what the drug is), but this comment negates the lived experience of people impacted by gaming disorder who describe and/or display symptoms and experiences that look and sound very similar to our traditional understanding of withdrawal. So yes, I will concede that maybe withdrawal can be different if you are not taking psychoactive substances, it does not mean there are no withdrawal symptoms from a fast paced, highly immersive, dopamine inducing behaviour that people do for hours at a time over long periods of time. Like drugs, people with gaming disorder often use games to escape negative mood states or difficult situations so what happens when they just stop?
- If you concede that gambling has withdrawal symptoms and it is a behaviour (that research has shown has a similar impact on the brain as drugs), than why would gaming be different?
- I don’t know if anyone is saying games are inherently addictive as I think there is wide recognition that likes gambling, most people who play do not become addicted. I think what some experts are saying is that there are structural features in both gambling and gaming that can make it addictive for some people. Not everyone that drinks alcohol becomes addicted. Should we take that out of the DSM?
- The jury is still out about tolerance and withdrawal when it comes to gaming, at least in the scientific research anyway, but that does not mean that there are not recurrent themes that are emerging in the scientific literature and clinical observation that need to be addressed. The ICD-11’s inclusion of gaming disorder attempts to capture those phenomena to increase awareness and access to help. This does not mean that we will not amend or expand our understanding over time with further research. This happens all the time. A consensus on diagnostic criteria will help inform better research.
- He speaks about ‘varied social contexts’ that can impact the way we conceptualize behaviour addictions unlike viral infections or autoimmune conditions but I am pretty sure varied social contexts influence other types of maladies too such as mental illness! In some cultures, mentally ill people are constructed as being possessed or as an opportunity to receive divine messages. The reason the ICD-11 included gaming disorder is because they noted research and advice from experts all over the world who were saying the same thing.
- The notion that seeing certain behaviours as addictions creates moral panic is something to check ourselves with but for anyone who has seen a person seriously impacted by gaming, that notion would not hold a lot of water. I have had clients who dropped out of school, have serious depression and anxiety, have withdrawn from society, are not sleeping or taking care of their hygiene and at worst, are suicidal. If you find me someone who using tanning beds or dancing (he talks about these forms of excess) with similar consequences, then yes, I would offer them treatment too!
- “Some critics of gaming disorder, including Ferguson, also worry that unhealthy gaming is merely a symptom of more serious underlying conditions, like depression, anxiety, or autism-spectrum disorder. “If these people have real mental illnesses,” asks Ferguson, “why do we need this one?” In all of my years working in addiction (including substance use and gambling), I have yet to meet someone who was not dealing with an underlying issue whether it was childhood abuse, grief or depression and anxiety.
- “The opportunity to pathologize certain behaviors is appealing. To make a behavior a mental illness also gives the individual—or a parent, or another interested party—some control over it. A diagnosis pinpoints what’s “really going on,” and thus it offers an answer, and a possible path forward, too. To have an “addiction” to smartphones or a gaming “disorder” also implies a way to wrest oneself from the grip of those activities.” This sounds very moralizing which is something we have strived to get away from due to the heavy stigma addiction carries with it. It is up to the individual and a trained professional to determine what function the behaviour is serving(including the desire to pathologize it).
- There are too many other points to address but you get the idea.
Thanks for your insightful responses, Lisa! You provide a lot of food for thought.
Thank you for your thorough and excellent response Lisa. It's good to be prepared with the right kind of information when experiencing the backlash that can come from the WHO's decision. Your statements are truly helpful.
This is truly insightful, Lisa! Although the backlash exists, it's important in that it forces us to have conversations, debunk myths and stigma, as well as ensure the right evidence is getting out there.
What I liked most were the ways in which Bogost negotiated the "pathology" of gaming, to demonstrate how it is received and/or accepted in the medical profession.