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Psychologist says rush to pathologize ‘video game addiction’ is dangerous (update)

Diagnosis isn’t based on good science, instead it’s being fueled by a climate of moral panic and political pressure

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Charlie Hall is Polygon’s tabletop editor. In 10-plus years as a journalist & photographer, he has covered simulation, strategy, and spacefaring games, as well as public policy.

Dr. Anthony M. Bean, a licensed clinical psychologist in Texas, thinks that the idea of “video game addiction” is misguided at best, and dangerous at worst. He and his colleagues suggest that efforts to include this new category of disease in diagnostic manuals is driven not by sound science, but by a climate of moral panic and political pressure.

This week, Bean and three other psychologists published a paper with the American Psychological Association, the largest scientific and professional organization of psychologists in the United States. Video Game Addiction: The Push To Pathologize — Not Recognize calls into question the underlying research behind this new diagnostic category as well as the motivations of those who are trying to institutionalize it within the psychological practice.

In the paper, Bean and his co-authors raise the issue of two new proposals to include so-called “gaming disorder” in the Diagnostic and Statistical Manual (DSM) and the International Classification of Diseases (ICD). The DSM is effectively the encyclopedia of recognized psychological disorders in the U.S. and carries weight in things like clinical practice, health insurance coverage, criminal litigation and governmental legislation. The ICD, while a much broader document, carries similar weight internationally.

Bean and his co-authors believe that there simply isn’t enough research to support the addition of video game addiction in either document.

“In the whole field of ‘video game addiction,’” Bean told Polygon, using air quotes for emphasis, “the incidence ranges all the way from 0.8 percent all the way up to 50 percent of the gaming population, depending on which study you decide to look at.”

That means that in a group of 100 self-described gamers anywhere from less than one to half of them could be classified as having an addiction. To Bean and his co-authors, that’s not evidence of a new type of disorder. It’s evidence of bad science. Bean and his co-authors argue that by creating such a broad and opaque definition of gaming addiction, psychologists have summarily dismissed an entire hobby as destructive.

“One of the major concerns that we have is that we're putting the cart before the horse on his one,” Bean said. “We don't know what video game addiction is. ... The psychology and medical fields took the concept of addiction — whether it's substance abuse or anything like that — and just switched it out with video games. The thinking was, ‘Oh, it's a form of addiction. It's like any other addiction.’ But it’s not the same.

“You could do the whole process over again with football, especially with August right around the corner. ... Why are we not considering that an addiction? What about someone who really likes to go into a library and read books, and they just can't put that book down because they're at that great part that they want. You force them to put that book down, [and] their mind's just going to be on it. Why isn't that a form of addiction?”

By stigmatizing games in this way, Bean said, clinicians may actually be doing more harm than good.

“Maybe that person's anxious,” Bean said. “Maybe the person's actually depressed and using video games as a coping mechanism, or a mechanism with which to deal with some personal stress in the world. The better questions that we'd be able to ask them is, ‘Are you able to still go to work? Are you paying your bills? Are you still being a productive member of society on some level?’

“These are all things that are not asked right now. People just at home and they say to their kids or their spouse, ‘Oh my god! You're addicted to video games. You can't put them down! What are you going to do? Gosh, man. I don't want to be around you while you're playing those games.’ Putting those types of opinions on someone has been shown to depress them and to make them feel not worthy. ... It really can screw with their entire psyche, their entire self-esteem.”

In the paper, Bean and his co-authors point to a rising moral panic surrounding video games both here in the U.S. and abroad. Recently ABC’s 20/20 spent a year tracking so-called addicts through various kinds of recovery programs. In China, Tencent voluntarily added time limits to one of its most popular games amidst fears that children were becoming addicted.

Bean and his co-authors argue that one of the reasons gaming addiction is being thrust into the public eye is to drum up support for individuals and organizations who want to profit from its existence.

“We raise the potential that video game addiction is a ‘thing’ for the psychiatric and medical community less because empirical research has demonstrated a clear foundation,” the paper states, “but rather because video game addiction is a ‘thing’ in the general public’s eye. That is to say, video game addiction offers the potential for grant funding, practice opportunities for members of professional societies and political influence not offered by other potential behavioral addictions.”

With regard to the World Health Organization’s ICD, the paper says, the rush to create a formal diagnosis for gaming disorder may actually be coming from a much higher level.

In an email shared with Polygon, Dr. Geoffrey M. Reed — a member of the WHO’s advisory group tasked with creating the next iteration of the ICD — says that he is being petitioned by politicians to make sure gaming addiction is included.

“Not everything is up to me,” Reed wrote to one of Bean’s co-authors in an email from August 2016. “We have been under enormous pressure, especially from Asian countries, to include this.”

Dr. Reed did not immediately respond for comment on this article, but his email is cited in the paper published by the APA.

The ICD-11 is expected to be released in 2018. Gaming addiction currently exists in the DSM-5 as a “condition for further study” and is not currently scheduled to be added, but revisions are delivered on a semi-regular basis. Until then, Bean says, both clinicians and rehab programs are in uncharted territory.

“If you Google ‘video game addiction,’ there’s camps here in the United States,” Bean said. “You'll just see hundreds pop up. It's insane, and people will send their kids to these wilderness programs for the summer thinking, ‘Oh, they're going to cure my video game addiction, oh my god!’ But they don't.

“For one, they don't understand the idea of video game addiction. They don't understand that's not really a thing. And so people are preying upon families on that context and they're taking them out into the wilderness, and yeah, sure, they learn some skills in there. But once they're back in society or back in the city or back in their town, what do they do if they want to play some video games? There's no real basis for any of it.”

Update (Aug. 2): Reached for comment, World Health Organization advisory board member Dr. Geoffrey M. Reed declined to respond to Polygon. Instead, he referred us to Dr. Vladimir Poznyak, coordinator of the Management of Substance Abuse department of Mental Health and Substance Abuse for the WHO.

Poznyak said that Reed’s email was simply misunderstood.

“There was not any pressure from WHO Member States to include ‘gaming disorder’ in the [ICD],” he wrote Polygon in an email, “and the decision made was based entirely on the available scientific evidence and experiences with such health conditions in different countries, not limited to Asian countries.

“At the same time, indeed, health conditions associated with excessive video gaming had been well documented and researched in a number of Asian countries such as Republic of Korea or Japan, and, in line with their professional experiences, many clinicians and researchers from those countries have strong views with regard to existence of ‘gaming disorder’ which was presented in personal communication between WHO consultant Dr. Geoffrey Reed and Dr. Chris Ferguson as ‘enormous pressure.’

“At the same time let me reiterate that there was not any formal request or pressure expressed by any of WHO Member States to include ‘gaming disorder’ in the classification, and the decision made was based entirely on technical considerations and not political ones.”

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