Thursday, 21 August 2008

Pathological computer use is a real problem, a psychiatrist argues

Standpoint magazine, the new right-wing intellectual monthly published by the Social Affairs Unit, has a thoughtful, if tendentious, essay on pathological computer use.

Psychiatrist Jerald Block believes more should be done to recognise "pathological computer use" (PCU) and to devise ways to treat it. PCU is not yet formally recognised as a psychiatric diagnosis but the "condition" may find its way into the next edition of DSM - the psychiatry's diagnostic bible.

Block says it's been proposed that four criteria be met for a diagnosis of PCU: Computer use must be excessive (taking context into account); there must be signs of tolerance (a need to spend more time on a computer or games console to achieve the same level of satisfaction); the computer use must be mood altering; and finally and most importantly, the computer use must have led to problems, for example with relationships.

Block believes that because therapists are generally interested in people rather more than technology, they are often ill-equipped to help people suffering from excessive computer use. "As a result," he warns, "the therapist will readily find the concomitant diagnoses without realising there is the compounding issue of pathological computer use." Radical interventions in Korea apparently involve sending people to technology-free rural retreats. Yet a week of bucolic bliss has been found to provoke a computer binge on return.

One reason some people spend hours at a computer is to play massive online role-playing games. Block says the ways these games blur the distinction between reality and fiction reminds him of the difficulties faced by people with schizophrenia:
"Given enough exposure to virtual reality, people cannot help but begin to question whether their real lives are merely simulations of life. The concept is subversive and potentially toxic to the human mind. More-over, it combines in a particularly noxious way with compulsive computer use. When technology is used compulsively, it soaks up at least 10 to 12 hours a day; it redefines relationships to include virtual entities and objects, like the computer itself; it encourages processing emotion through the computer."
Block is also concerned by the ethical issues raised by the concept of virtual sex, which often involves players' digital representations (their "avatars") meeting in a virtual bedroom to watch real-life blue movies together. But as Block explains, things can get ethically messy:
"...people sometimes prostitute out their avatars. They participate in sex for virtual money. What if someone only selected virtual prostitutes that were designed to look like children? Certainly this is an enactment of which a therapist should be aware. Would this suggest a risk of paedophilia in real life? Or does discharging the impulse in the virtual world in effect prevent it from emerging in the real world? We can theorise, but we do not actually know. This is not some thought experiment; it happens and we need answers."

Post written by Christian Jarrett (@psych_writer) for the BPS Research Digest.

Link to Standpoint essay (open access).
Link to Mind Hacks post on why there is no such thing as internet addiction.

3 comments:

CherryPal Brand Angel said...

Overusing the computer for any reason, be it sexual or supposed work related, or blogging, or commenting on articles....bottom line, people, this behavior is not the problem, but rather a symptom of the person's life dysfunction. Do not treat the behavior, treat the wholistic personality. If only curtailing a behavior was the cure...have you ever met a "dry drunk"? They don't drink, but they still behave irresponsibly in their lives. I say, cure that person's underlying issues, problems, and dysfunctional thinking. Of course, the real fix takes time, is a process, and may not be readily obvious. It is much easier to stop a behavior, than to cure the person of the dysfunction that they experience of themselves.

British Sceptic said...

This post describes me to a tee! Not pc addiction, more internet addiction. Definately damaging my family relationship!

Blogger said...

I find this article so typical of psychiatric ideas that pollute the perception of almost all repetitive behaviours as chronic addictions, a view that is ludicrous.

As with the author, let me state my own credentials also. I am 30 years of age, an avid 'gamer' and intense internet user. I have gamed since age 4, programmed, built pcs and designed games. I have a PhD in behavioural economics and addiction, and I am currently studying my second doctorate in clinical psychology. I am married with two children.

Firstly, the view that compulsive internet or gaming is an addiction. (I will focus mainly on gaming in this response) The term 'addiction' is getting more exposure every day, it is simply attached to almost every self-defeating behaviour that humans have. EBay, internet, shopping, sex, eating, running.. you name a repetitive behaviour, and somewhere a claim will be found that this is an addiction. Well, someone step back and read about what addiction is, and then wonder why this label fits. The reason it does is because 'addiction' as a concept is so weak that it can almost be applied to any behaviour that humans display - as long as it harms. And, that includes a lot of our behaviours, including credit card use, television watching and many more.

The use of this term simply masks the underlying behaviours, and the complexities of why we engage in them. We are left to view addiction as 'a disease', rather than a behavioural trait common to all humans that has simply got out of hand a little. Let's be frank, heroin, cocaine etc.. most addicts who quit do so without treatment, and most addicts quit at some point in their lives. Psychiatrists have done little to win the war on drugs, and don't like to admit it. So, rather than focus their attention on why, they seek to add more targets to hit with their stringless bow.

The topic of internet or gaming use is controversial, but only because it is new. Is it any wonder that an amazingly rewarding activity is over consumed by some? If I handed alcohol to my child, or a credit card.. would they learn on their own to develop behaviours that best avoid harm.. hardly. The issue is simply that whenever a new rewarding commodity is introduced to any society, some of the consumers go wild. They 'go wild' because society has not taught them the rules of use, and no rules exist in regards to internet or gaming. Or do they? I'll return to this, after I review the four criteria for addiction identified by the author:

- Excessive use (taking context into account): What an abstract concept. How is one to realistically put a timeframe on 'excessive use'. Is it excessive if it interferes with homework, sleep or outdoor play? Probably, in the view of the author. But this is such a subjective concept. I would argue that the length of use is dictated by the design of the game, and so it might appear excessive to the watcher.. but far from excessive to the player who needs to progress. Is progress not a trait we wish to install in our children? Ask yourself why people sit for 12 or 60 hours in games. Is it perhaps because a game requires that much investment? The term 'Excessive' is extremely dependent the frame from which it is judged.. from inside the game, 60 hours can be but a fleeting moment. Let’s not ignore the importance of game progression and social networking. Companies exist which will continue to play for you when you can’t play, so as to progress your character. Heroin addicts don’t ask friends to use for them, and that’s because we aren’t talking about addiction – we are talking about status.

- Signs of tolerance: I find this a ridiculous analogy, "a need to spend more time on a computer or games console to achieve the same level of satisfaction". Spoken from the view of a serious non-gamer. Could it not simply reflect the fact that increased time in a virtual world reaps increased social reward, skills increase and game progression. More in equals more out.. simple matching law, as predicted by behavioural economics. I.E. a human trait common to us all. Ask how many gamers play any new game for a short period, and the answer is 'few'. Most gamers max out initially in a game, because they wish to maximise reward right off the bat.

- "the computer use must be mood altering". Seriously, is this a joke? TV, cinema, theatre.. do they not alter mood? Why play games if mood is not altered? It is beyond me to wonder how this can be seen as a requirement for addiction, all you are saying is that the activity is rewarding in some way. Basic Law of Effect.

- "the computer use must have led to problems, for example with relationships". So, you truly believe that individuals with healthy, rewarding relationships are lured into excessive gaming to the extent that they ruin these relationships. Perhaps you should read Rachlin's theories on this, and consider that poor relationships may in fact underlie the shift in behaviour towards gaming. Also, you might want to consider that gaming is perhaps perceived as a threat to non-gaming partners who may experience some level of envy at the level of immersion and complete engagement in an activity that does not include them. There are so many possible views on this.

In summary, there is no concrete evidence that any of these conditions are met.. except if you choose to pick a biased view of behaviour and apply it to the criteria (a common criticism of DSM diagnostic procedures).

I'd like to respond, perhaps with a little humour, to a number of statements made by the author.

"Given enough exposure to virtual reality, people cannot help but begin to question whether their real lives are merely simulations of life."
So, it is wrong to question the nature of life? Do Buddhists not hold a view not too indifferent to this one? This does not suggest that they fail to function, just that they perceive the context differently.

"When technology is used compulsively, it soaks up at least 10 to 12 hours a day; it redefines relationships to include virtual entities and objects, like the computer itself; it encourages processing emotion through the computer."
We have many avenues for processing emotion, including creative writing, diaries, poems, art and letter writing. Technology provides an avatar based medium and we cry wolf. The 'compulsive' use of computers are likely reflecting an emotion block or issue that existed earlier than the behaviour, and as such fills a gap. Don't blame the medium or the behaviour - which simply acts to highlight an issue.

"They participate in sex for virtual money. "
And so what? This is a game. As a psychiatrist you surprise me with your concern in non-deviant sexual human behaviour. When two adults consent to a behaviour, and engage in that behaviour for mutual reasons, are we to judge them?

"What if someone only selected virtual prostitutes that were designed to look like children?"
What if? What if sex shops or websites sell school uniforms for wives to wear for their husbands? Are these to seek out a psychiatrist, or are we to think that some adult couples engage in non-harmful behaviours that are mutually pleasurable even if not the case to others.

"does discharging the impulse in the virtual world in effect prevent it from emerging in the real world?"
Or do you lack any evidence to suggest that this is an impulse, rather than a chosen behaviour entertained by two consenting adults, who seek to tickle their fancy.
Behaviours that disgust us, are not necessarily wrong, many politicians make many decisions that make me sick to the stomach.

So, where am I taking this?
Gaming and computer use, and the rules that should surround their use. As a claimed former gamer and computer engineer.. why not apply some of the self-restraint you learned to the development of social constraints that educate our children on how to enjoy, learn and grow with technology. If you seek to scare them off you'll only lose them.
Maybe games companies need restraining in games they design, or maybe we need to restrain our children a little. We don’t hand toddlers 18 rated movies, and so maybe we need to rate games on how much input they require or are likely to induce. A game based on social progression will only lead to increased use by all parties, as each seeks to out perform his/her peer.
As a designer myself, I consider that games can be adapted to encourage healthy social interaction, limit themselves and even assist in learning and real world skills. Its just that games companies have no financial need to be interested, and medical bodies prefer labels than real world obvious solutions.

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