American Medical Association Videogame Report: Why They Could be Putting the Public in Danger
The American Medical Association recently finished its survey of game violence and addiction material, and they have suggestions for the DSM 5, scheduled for release sometime around 2012, the year in which the Mayan calendar ends. Arts Technica gives very excellent coverage of the AMA’s report here. Being rancorous in nature, I of course have some negative comments on the AMA’s conclusions.
And thanks to Mike of Modern Dragons for linking this article to me.
From Arts Technica’s review:
In terms of “gaming addiction,” the report suggests that it is likely to be a subset of internet addiction, as it most frequently occurs in players of MMORPGs (footnote 1). In both of these addictions, the current definition is currently informal—the described symptoms actually most closely resemble pathological gambling, rather than an addiction. In either case, the report notes, “there is currently insufficient research to definitively conclude that video game overuse is an addiction.”
…the AMA is called upon to include Internet/video game addiction as a formally described disorder in its upcoming revision to the Diagnostic and Statistical Manual of Mental Disorders. This description would include diagnostic criteria, which should improve not only the ability of physicians to treat it, but also the ability of researchers study it in a formalized manner…
This cannot happen. The AMA cannot formally include game addiction criteria in the next DSM. That should seem surprising to hear from me, since this blog is about raising awareness, but there are very good reasons. It’s not that I’m in gamer denial. You know, “Games aren’t addictive! They just aren’t! They’re just fun! Waaahhhh…†It’s also not that I don’t think it’s a good idea, in theory, to give therapists criteria for game addiction. The DSM has a very far reach. Many, many therapists and medical professionals get their hands on it, and in theory, I would like them all to know what to do, and how to help somebody who has a gaming problem.
Why shouldn’t criteria make it into the DSM, then? Because this report focuses on “Internet Addiction†criteria that, 1) does not actually reflect “game addictions†(let alone probably Internet addictions) 2) could cause individual and societal harm and suffering if used in relation to game players. Giving “Internet Addiction†criteria to tens, perhaps hundreds of thousands of therapists and medical professionals will intensify this problem severely.
As was suggested earlier on this blog by Dr. Jerald Block (see our discussion in the comments section), the Columbine shooters only began planning to siege their school after the game was removed by parents on the advice of a therapist. Medical professionals need to understand the underlying reasons for excessive or strange gaming on the part of their patients or clients, rather than seeing all heavy gameplay as a malignancy that should be removed when found. The problem is that this requires not only a deep knowledge of gaming (and technology in general, a topic that some, especially older medical professionals are loathe to examine), but it also requires that medical professionals understand their clients and patients more deeply, looking at how their interactions with a game serve negative, but also positive (and even theraputic) ends. The popular “internet addiction” criteria confirms societal fears and misgivings about technology, and it’s almost definitely the one we’ll use if criteria make it into the DSM-V.
All that said, implementing “internet addiction†style criteria would reflect badly on the AMA for a three more key reasons:
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1 The criteria were, and generally still are, copied nearly verbatim from Gambling addiction.
2 These criteria were created over 10 years ago, before current MMO games even existed. Moreover, “Internet Addiction†criteria were copied almost word-for-word from gambling addiction criteria which were made, what, 20 or 30 years ago?
3 These criteria largely only reflect elements of “behavioral addiction,†but these “games†are actually fully functional worlds. These worlds very accurately reflect human experience, and present a number of other sophisticated non-addiction reasons to play excessively.
(footnote 1) rofl, go play some games Dr. AMA. Gaming and teh internets are separate entities.
Neils Clark :: Jun.14.2007 :: Game Addiction, Games ::
Thanks for the bloglink!
I suppose the strongest case for going easy on the AMA would be if one subscribes to the “syndrome model” of addiction– e.g., the same abstract ‘brain stuff’ happens across all behavioral and chemical addictions, and this produces similar *symptoms*, so it’s OK to cut some corners and lump some potentially disparate things together because they significantly involve the same ’syndrome’.
I think there’s something to this, but it seems to take away much of the utility of diagnosis: the only thing that can come from such a diagnosis is the advice that “yep, you have an addictive personality; distance yourself from things you get addicted to.”
Which is fine advice, as far as it goes. But we have fine-grained, scientifically-informed advice for heroin addicts, alcohol addicts, suntanning addicts, even sex addicts, all based on the nuances of the potentially-addictive chemical/physiological ‘hooks’ each has.
So yeah, I’m totally with you that lumping gambling, internet, and gaming addiction is really not the way to go.
It may or may not be old news, but FWIW, I cribbed the ’syndrome model’ concept from Howard Shaffer via this NYT article:
http://www.nytimes.com/2006/06/25/magazine/25addiction.html?ex=1182052800&en=86640948153fa1b0&ei=5070
Mike - YVW! Thanks again for the article link!
And yeah - There’s some credibility in the “symptom model.” Some chemicals associated with addiction are bound to be floating around in gamer brains, and many of these things are likely to apply. That’s a good article, and it succinctly gets to the core of a few different arguments. Shavaun and I get particularly into the usefulness vs. the societal damage of looking at addiction as a “disease,” as made popular by 12-steppers, but that’s the topic for another post.
Here’s the rub with the symptom model for this post. Say you’re joe-average healthy gamer and you ding 70 (reach the highest level in World of Warcraft). You’ve shown no “symptoms,” which with internet addiction criteria would be pretty hard for most level 5s. All the sudden, your best friend needs a druid for BLACK TEMPLE, and since you’ve partied with some of these Death and Taxes people, they’re super cool and ask you to come raid the following night. You cut off from work a little early even though it’s a busy day, mostly because you’ve been thinking all day about raiding with a really cool guild. You lie to your wife about what you’re doing so that you don’t have to cook dinner, and when she discovers that it was all over a game she decides to leave you! A far-fetched situation, but if you do even one of the above, you’ve qualified as an online gaming addict… Check the criteria - from its creator’s site:
http://netaddiction.com/resources/online_trading.htm
This criteria, especially when used by practitioners with no idea what a game is, could cause a huge crisis of mislabeling. It’s going to be the overdiagnosis of ADD and ADHD all over again.
But that’s not the really huge problem. Even if we can create criteria to diagnose problems correctly, this assumes that gaming is a deviant behavior worth erasing. In many cases, it could be. If someone is troubled enough that they’re seeing a therapist or a medical professional, then the gaming is probably something that’s on the way out. If all we do is yoink it, without understanding the purpose that it served, then we risk some serious problems for the individual as well as the general public.
I think the key to why this is troubling, however, is that these games represent a medium that’s already permeating our real world existence. These secondary worlds present people with an experience that, even in terms of how our eyes work, can pull people in and immerse them. There are thrilling stories, exhillirating interactions, and real live people (ones who we often know in the primary/real world). When people are pulled in by these things, are they also addicts?
If we start to use these technologies on a daily basis - for social, political and business reasons… Have we become addicts?
Look at those criteria in the context of second life, and you’ll pretty quickly see that they just see a game as a single behavior. The problem is that within these worlds that live on screens, there are a thousand behaviors.