Marat Kuzaev
On January 1, the 11th revision of the International Statistical Classification of Diseases and Related Health Problems comes into force. He developed a video game addiction disorder. On what grounds do they propose to identify “gambling addicts” and why many doctors and scientists criticize the WHO decision – in the TASS material.
All known health problems, be it the common cold, fracture, cancer or schizophrenia, are collected in a huge catalog – the International Statistical Classification of Diseases and Related Health Problems (ICD), which is compiled by the World Health Organization (WHO). When making diagnoses and prescribing treatment, doctors around the world are guided by the ICD. From time to time, WHO experts revise the list, but the last time this happened in the early 1990s. Video games were much less common back then and were not seen as a cause of addiction.
However, a quarter of a century ago, video games were already considered a public issue. The brutality and naturalism of the fighting game Mortal Kombat, the shooter Lethal Enforcers, the adventure games Night Trap caused a real moral panic in the United States, it came to parliamentary hearings. As a result, a non-profit organization ESRB was established, which determines the age limits for a particular game: without its certificate, the new product simply will not go on sale. In Europe, the PEGI organization does the same, and a similar system operates in Russia.
At the same time, the harm of violent video games for children – and for adults too – has not been reliably confirmed. Now, if the critics of the WHO decision are right, history repeats itself with video game addiction.
How WHO understands video game addiction
The WHO Member States adopted the ICD-11 back in May 2019, but it is only coming into force today. Now doctors will be able to diagnose gambling disorder (this is how the name Gaming Disorder was translated into Russian).
To make a diagnosis, three conditions must be met.
First, with gambling disorder, the person has no control over when and how much he plays.
Secondly, because of video games, he sacrifices other activities and hobbies.
Third, even if a person is aware of the consequences, he cannot stop. This habit causes bad thoughts, distress, harms relationships with family, loved ones and other people, interferes with work, study – in a word, it poisons life.
According to the WHO, addiction to video games is evident when such deviations are repeated or persist throughout the year, but in severe cases, a shorter period is enough for a diagnosis.
Before approving the diagnosis, the WHO listened to the arguments of supporters and opponents for several years. But the final decision does not mean that the scientific community has come to an agreement.
Critics, including nearly 30 academics from Oxford University, Münster University and others, do not dispute that some players get in trouble due to being overly passionate. But, in their opinion , the new diagnosis is unlikely to help solve these problems.
What are the criticisms’ objections?
The main argument of opponents is that there is simply not enough data to include addiction to video games in the ICD. Clinical studies were conducted rarely and on small samples, their results are difficult to generalize, but the problem is probably exaggerated: only 0.3–1% of people meet the diagnostic criteria . However, this is not so little.
Another thing is that these criteria are too vague and similar to those that doctors use in cases of substance abuse and gambling. Simply put, game addiction is portrayed as a kind of addiction, only without drugs. The idea that you can get hooked on certain behaviors is relatively new. It has established itself through brain imaging technologies such as magnetic resonance imaging. Research has shown that certain actions can activate the same reward system as drugs. That is, ultimately, both drugs and addictive behavior rewire the brain, and changes in the brain are associated with the fact that the person himself is changing, sometimes beyond recognition.
The difference is that drug dependence often leads to painful sensations when the drug is discontinued and tolerance to the substance when the previous dose is no longer enough. For video games, this is a stretch. Of course, players, like drug addicts, can think about games too often, turn them on to cheer up, and lie about their habit to family and friends. But if we start only from these signs, then the diagnosis will be received by many people who actually do not have problems.
Moreover, obsessive thoughts can relate to any activity, anything can be used to unwind, and if you do it “too” often, then the feeling of shame will force a person to lie to curious well-wishers. The great Russian physicist Alexander Fridman, who developed the first model of the expanding Universe, wrote in his diary: “No, I’m an ignoramus, I don’t know anything, I need to sleep even less, do nothing for strangers, because all this so-called life is a complete waste of time.” If you want, you can put a medical label on anything, but then there will be almost no normal people.
Discussing video game addiction in an article on the PNAS website , psychologist Chris Ferguson of Stetson University commented: “When depressed, many people spend all day in bed, but we are not saying that they are addicted to bed.”
Ferguson’s words also work as an argument against the unnecessary medicalization of life, but he meant that it’s too early to see addiction to video games as a separate issue. Perhaps gambling is just a defense mechanism.
Those who often play video games often experience depression, anxiety, and attention deficit.
But what is the cause and what is the effect is unclear. Psychologist Anthony Bean told CNN that inveterate gamblers, having got rid of depression and anxiety, play less often than before. Other critics of the WHO decision have also written that the root cause of video game addiction should be sought in other disorders .
What can lead to the inclusion of a diagnosis in the ICD-11
The controversy over gambling addiction began a long time ago. A similar diagnosis – addiction to online video games – appeared in the American Psychiatric Association’s DSM-5 in 2013. True, it is located not in the main part, but in an appendix with a list for further study. Patients are not yet diagnosed with DSM-5. But, as skeptics believe, even in this form, there is a lot of harm from him, and this lesson had to be taken into account when drawing up the ICD-11.
The aforementioned group of almost 30 scientists believes that in the conditions of moral panic around video games, doctors will make a diagnosis unjustifiably, the more vague the criteria for this have. This will hit millions of children and adolescents, lead to family quarrels, and in the worst case, the “sick” will be treated in correctional camps with an army routine, which is already practiced in some countries.
The framework given in ICD-11 will guide further research. Scientists will look for evidence that video game addiction exists, although first it is necessary to understand how behavior can in principle turn into addiction.
With this approach, it will be possible to find pathology in any occupation, but this will only harm completely normal people and prevent real problems from being recognized.
