WHO's recognition of 'gaming disorder' upsets video game enthusiasts, makers, but could usher in necessary reform
Last month, after several years of consideration, the World Health Organisation released the 11th edition of the International Classification of Diseases (ICD-11) which added “gaming disorder” to its official list of identified mental health conditions
On 6 January, 2015, a 32-year-old man walked into an internet café in Taiwan. On 8 January, three days into a gaming binge, the man, identified as Hsieh, was found unconscious by a café employee.
Hsieh would be pronounced dead on arrival at a nearby hospital a short time later. Hsieh ate, drank and slept little during his time at the café. The cause of death was determined to be cardiac arrest brought on by exhaustion.
While cases like Hsieh’s are exceedingly rare when you consider the total population of active gamers, it was by no means the first or the last. Similar cases have been gaining media attention since 2005 when Seungseob Lee died in what would be the first widely reported case of a death directly attributed to “gaming addiction”. The South Korean national went into cardiac arrest after playing video games for over 50 hours.
At the time, gaming addiction was not widely recognised as a medical condition. In the years that followed, private rehabilitation facilities that purported to deal with the addiction to the internet, social media, gaming and every other conceivable information-age vice would become commonplace across multiple countries. But with the majority offering limited treatment options, often at high costs, and with dubious success rates, patients seeking relief are frequently left disappointed.
However, things may be set to change for the better. Last month, after several years of consideration, the World Health Organisation released the 11th edition of the International Classification of Diseases (ICD-11) which added “gaming disorder” to its official list of identified mental health conditions.
The hope is that formally recognising gaming disorder will make it easier for those in need to get diagnosed, and where applicable, be able to use medical insurance to cover treatment costs; something that is currently not possible in most countries.
Not a universally popular move
Understandably, not everyone’s thrilled with the inclusion. Since December of last year, when a draft of ICD-11 was publicly released, large sections of the gaming industry, the community and even a number of researchers and academics have, for a variety of reasons, been highly critical of the choice to recognise gaming as being potentially addictive behaviour.
For the industry, the logic of resisting the WHO’s plans is easy to follow. To have gaming associated with other forms of addictive behaviours such as alcohol or drug abuse would be a publisher’s worst nightmare. Particularly for a form of entertainment that is heavily marketed towards children and young adults.
But beyond the profit-driven fears of the video game industry, mental health experts and researchers have questioned the methodology and quality of the research conducted by the WHO prior to reaching its conclusion.
Some, like psychologist Andrew Przybylski, have argued that this move may be too focused on the superficial — viewing gaming as the problem while possibly ignoring underlying factors such as trauma, anxiety or depression for which gaming has often been used as a coping mechanism. Cutting off at-risk persons from using gaming as an outlet could cause them to seek relief by indulging in behaviour that is even more unhealthy or dangerous.
Others have also argued that treating gaming disorder as a full-blown health condition on par with alcoholism and drug abuse could cause already limited healthcare resources to be diverted away from those programs.
What constitutes addictive behaviour?
That’s the key question on the minds of most people, especially gamers themselves. How much is too much? Where do we draw the line between a passionate enthusiast and an addict?
For what it’s worth, the guidelines set down by the WHO when it comes to determining what constitutes gaming addiction are reasonably well conceived.
Rather than attributing a numerical figure such as hours played per week as a marker of addiction, the WHO has proposed a number of qualitative behavioural indicators that include:
1. Not being able to resist the impulse to play games.
2. Prioritising gaming over daily activities and other interests.
3. Continuation or escalation of gaming despite understanding and experiencing negative consequences.
Their guidelines also place additional prerequisites that must be met prior to diagnosis stating:
“For gaming disorder to be diagnosed, the behaviour pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months.”
Time for the industry to get on board and help find solutions
Traditionally, gaming, like other forms of entertainment, has been largely self-regulated. Bodies such as the ESRB or PEGI, which determine content guidelines and age ratings for games, are usually run by a trade association comprised of major video game studios and publishers.
Now, the video game industry is no stranger to controversy. Over the years it’s often been accused, both justly and unjustly, of promoting real-world violence, misogyny, and toxic or self-harming behaviour. However, on the whole, all of this has always amounted to little more than an ‘image problem’ for an industry whose total revenue surpassed $108 billion dollars in 2017. (For perspective, global box office receipts were $40.6 billion during the same period.)
But with the recognition of gaming as being potentially addictive, the industry’s relative freedom from government oversight, the same freedom that enabled them to grow at an incredible rate for years, might be short-lived. That is unless steps are taken by the studios and publishers themselves to show that they are making efforts to responsibly self-regulate.
The conversation around gaming disorder is starting at a particularly delicate time for the industry which just last year found itself embroiled in a controversy regarding the in-game purchase of “loot-boxes” and whether or not their functioning would constitute a form of gambling that minors were both able and encouraged to participate in.
As a result of these ongoing debates, there is a real possibility of new legislation regarding video games being put into place. By moving beyond denial and working responsibly with governments and legislators, game makers will be better positioned to reduce the risk of rushed and poorly conceived new laws from being enacted.
For an example of the sort of heavy-handed legislation that could soon threaten the industry once again, we need to look no further back than 2002. This was the year that Greece’s lawmakers approved Law 3037/2002 which, as part of an effort to combat illegal gambling, banned all electronic games from all devices in public or private spaces. This law applied to home consoles, handheld devices, and even personal computers. The ban remained in effect until 2005 when it was suspended and later fully repealed in 2011.
A turning point, or nothing but a footnote?
It’s too early to say what form such measures would take or what steps would be considered acceptable. It could mean that gaming becomes a restricted activity, available only to adults, although hopefully, it doesn’t come to that.
But putting pressure on video game makers to reform could have upsides too. For one, it could mean the end for some of the more insidious game design mechanics that we see today. These are most commonly seen in online and free-to-play games that are carefully crafted to try and keep you playing compulsively for hours on end, often beyond the point where it ceases to be any fun at all.
Naturally, that’s unlikely to happen since those ‘Skinner box’ game systems are a big part of what makes online and mobile gaming so profitable, but a man can dream.
It’s going to be a while before clinical practices and national health systems change to better accommodate the needs of those seeking treatment for gaming disorder. And it will be longer still before we can determine if treatment will actually be able to help others like Hsieh and Lee avoid a similar fate.
If you or a loved one seem to be spending an unhealthy amount of time on gaming, consider speaking to a therapist, joining a support group or even just getting on Reddit and seeking the advice of other people who are trying to quit or at least moderate their gaming time.
Maybe I’ll see you there.
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The programme entails bringing on board a professional mental health expert who will conduct regular sessions with the first team and staff, along with sessions for the academy teams.
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