Therapists and Researchers Take Note: Excellent Gamer Vignettes
I wanted to share Dr. Jerald Block’s excellent case study vignettes which may be of particular use to therapists new to gaming problems (as well as the intrepid researchers who read 5 articles per day). These vignettes are tailored towards helping mental health professionals, though they do show some of the complexities inherent to treatment. Is it always safe to cut gaming out of the loop? Certainly every case is different.
Something that I’ve wondered for some time is whether gamers reporting problems would have experienced problems regardless (with other problems – drugs, alcohol, you name it). Dr. Block thinks that a pre-existing disorder is the “rule rather than the exception,†and in that regard joins a number of seasoned therapists whose opinions I respect (namely my co-author and good friend Shavaun Scott). That said, I’m (very respectfully) still not convinced that it’s the rule or the exception. My brain needs concrete data, although I do recognize a few problems in proving or disproving the proposition.
In fact, we probably won’t have that data within the next couple of years, if ever. If we collect data from people qualified to assess an individual as having a disorder, then (1) It’s hard to combine data from many therapists, (2) many therapists are not yet sensitized to, or even aware of even the basics of these games, and (3) not every problem gamer elects to seek therapy. I think that the last is the most important. There are a lot of gamers out there who might need to get a grip, but of those, each will have their own reasons for seeking or avoiding therapy.
I still see the problem developing as a process. It’s not just games, nor the gamers. Each brings to the table certain goods and bads, of which assessable disorders are one of many learnable and identifiable factors.
That said, read on!
Neils Clark :: Apr.25.2007 :: Game Addiction, Research ::
Thanks for the kind write-up.
With regards to pre-existing diagnoses, what I meant is that one finds something else that led to the game playing - OCD, depression, anxiety, Axis II personality disorder, etc.. The computer helps the individual deal with that issue. Thus, the depressed person might feel less isolated, the anxious person might feel safer, the OCD patient has a predictable, well-controlled place to play, and so on.
There is no rule, though. With the different types of disorders, the computer can be used defensively in unique ways to help that individual cope. The danger one sees when abruptly discontinuing the computer use is that we do not recognize the purpose behind the gaming. Thus, the computer is disconnected and with it the coping mechanism - the defense - is suddenly removed; the patient is then flooded with aggressive/self-destructive emotions. Some patients then seek out more destructive “aids” to help them avoid the unpleasant emotions.
I have never seen someone who just came in for excessive computer gaming and who did not have other issues that the gaming helped with. The symptom exists for a reason.
Incidentally, I agree with you. There is a need for better data and obtaining it will take some time.
Regards,
Jerald
Thanks for taking the time to post, Jerald.
Absolutely, computers can be and are used in unique defensive patterns. If a piece of software keeps somebody from committing suicide, then I’m all for it. It’s certainly not something to remove lightly. At the same time, and I’m sure you’d probably agree here, a good therapist is going to weigh the pros and cons of an individual’s computer use. Sometimes the gaming is causing more problems than it’s solving, and sometimes a gamer is going to need competent help in separating themselves from playing badly.
You note that in all likelihood, when removing games we play with fire, “the patient is then flooded with aggressive/self-destructive emotions. Some patients then seek out more destructive “aids” to help them avoid the unpleasant emotions.â€
This is certainly the case. At the same time I’ve spoken with gamers who, after quitting MMO games, feel incredibly relieved. Maintaining functionality inside of a game world seems to consistently encroach on functionality for people’s real lives. At some point after quitting (maybe the day they quit, maybe six months later), they feel the draw of games, probably for a number of reasons all likely unique and based on what the game satisfied for them initially. That said, those who experience this, all likely feel a similar sensation of pull. It’s the dopamine reward button, and they want the game to be able to push it again.
It seems like we have a construct that is of immense value to some, like functional gamers as well as people with the Axis II disorders. At the same time, I can’t help but wonder if there are hooks in these games that can cause reasonably functional people to begin playing excessively.
I wonder if you have any opinions on this? I don’t really think that there are any right or wrong answers, because we have so many people doing work that is the opposite of helpful. One thing that’s really valuable is what you and Sara E. Allison, et. al. (that article discussed here, just scroll down a bit) are doing, in presenting the complexities. In this way we can begin going beyond Young’s base and basic criteria, presenting therapists with material that can actually help sharpen them to the nuances that lie in every patient.
Just one last side note. Something that seems implied by you, Shavaun, Nick Yee and a few others, is that a person can be highly functioning inside of the game, but the same may or may not be true for this person’s real life. I’m not sure that I would suggest an inverse relationship, but it’s fascinating, I think, that someone can shift their focus onto maintaining functionality in a secondary world. In so doing, they can very often give their primary life the bare necessities.
But here I go, opening a dozen different cans of worms…
Very well said. I don’t disagree with any of this, except perhaps one point.
You note that a “good therapist” will weigh the pro and cons before stopping their patient’s game use. That implies a certain degree of knowledge on the part of the therapist - they have to understand how and why computers and the games are used. In my experience, some of the best therapists I know have scant knowledge in this area. Call it temperment or whatever, they are computer-phobic. I can’t tell you the number of case conferences that I have been to where the issue has been overlooked.
Thus, I believe most therapist never screen for or detect pathologic computer use in their patients. And, for those that do, I would guess that most consider the game (or internet) use a problem to be eliminated - not a psychological defense mechanism that may have value.
The Columbine shooter, Eric Harris, only began making actual plans to blow up his school after his parents banned him from computer access for about a month, on the advice of a therapist.
As for your theory on virtual vs. real life success, I believe they are generally inversely related. There are exceptions, like the people who have made a good living from their ebay stores or farming in MMORPGs. At any rate, success in the virtual may lead people to be confused as to where they exist… or prefer to, at any rate.
“The Columbine shooter, Eric Harris, only began making actual plans to blow up his school after his parents banned him from computer access for about a month, on the advice of a therapist.”
Well butter my bread. That is fascinating. I need to find a source for that!
In terms of a preference for existence, well put. I think that we ultimately need to begin seeing MMO games as a media which adds another layer to culture. Just as television, cellphones, and other technologies give us very unique forms of experience, i.e. we watch Barney the Dinosaur, or we talk to Fred on our cellphone, games continue our human tradition of storytelling and experience. We have a desire, as JRR Tolkien said, “to survey the depths of space and time, and to hold communion with other living beings.” Games extend on old techs by giving us interaction with worlds, whether populated by fake people, real people, or rotating blocks.
They’re what I’d call a ‘real illusion’ It’s a world, but it sits in this interesting half-life (Isn’t that right Dr. Gordon Freeman). I think that as we get a research, and then societal understanding of what underlies problem play, that we may (depending on what we find) start to see games meant to balance a player’s success in the primary and secondary world. If not that, then at least have therapists who know what the hell a game is. =P
Absolutely terrific post and comments (since it’s my particular area of interest…).
This is an important point from Jerald:
“Thus, I believe most therapists never screen for or detect pathologic computer use in their patients. And, for those that do, I would guess that most consider the game (or internet) use a problem to be eliminated - not a psychological defense mechanism that may have value…”
RIGHT ON!!
The behavior is serving a purpose, and it’s critical that we understand what that purpose is.
From what I have observed, clinicians with established practices tend to be a bit older than the average gamer (okay, sometimes a lot older) and most are somewhat (or a lot) tech-illiterate. In my private practice I see people with obsessive game play (or other problematic behavior they are engaging in over the net) and family members are often entirely ignorant. Therapists don’t even ask about it, and don’t know what they’re hearing if the topic does come up. It’s almost willfull ignorance, as if the subject is frivolous and not worth discussing.
In my part-time clinic position, I regularly review charts and treatment plans done by other clinicians and often see “good at computer games” listed as a strength. They don’t even know what they’re writing about, how can they know the way that the gaming process is affecting this individual?
I’ve been saving stories from recent crisis contacts involving teen/parental violence precipatated by parents attempts to get them off the game. Maybe I’ll write up a few vignettes when I get a little time.
Good job Neils, and thanks Jerald.