How has gaming become constructed as a contemporary mental health issue and addiction?

Over history, the construction and explanations put forwarded for the cause and spread of disease and ill-health, have changed, in line with social, political, cultural and economic changes (Naidoo and Wills, 2016). This has led to ill-health no longer being represented as just being free from disease, but influenced by the social conditions in which people, live and grow (Burr, 2015; World Health Organisation, [WHO], 2014). However, a most recently recognised mental health ‘condition’, included in the Diagnostic Statistical Manual of Mental Disorders [DSM 5] (American Psychiatric Association, [APA], 2013) is termed as ‘Internet gaming disorder’; a mental health condition, where individuals’ forgo their basic needs (Maslow, 2013), such as sleeping, eating and social contact, to instead play games for numerous hours. This essay aims to examine how 'gaming' has become medically and socially constructed as a contemporary mental health issue and addiction, drawing on psychological theory and the empirical evidence base, to understand the impacts of this on the individual, and society.

Traditionally, scientific, biomedical models of health have informed biological and cognitive psychological theories around the causation of mental health conditions, such as addiction, as due to an individual’s inherent psychological or physiological vulnerabilities and thus, beyond an individuals’ control (Griffiths et al. 2016; McCarthy and McDonald, 2009). Such deterministic models are useful in understanding addictions such as alcoholism or drug misuse, in terms of explaining the bio-chemical effects that substances can elicit upon an individual (McCarthy and McDonald, 2009). These addictive behaviours then trigger a range of physical, neurological and psychological changes in the brain and body, fostering and sustaining the addiction (Monti, Rohsenow, and Hutchison, 2000).

The potential risk posed by time spent gaming online, is not a new issue, as in the 1990s, a number of research papers originating from social scientists from Europe and Asia, suggested that people could become addicted to the internet in general (Boyd, 2017). The reasons asserted were due to the swift access that it offered to social media and gaming, which could activate a state of physical and mental arousal and gratification, in the brain’s reward system, which can be equated to the dose-response experienced from chemical drugs (Boyd, 2017; Griffiths, et al. 2016), therefore supporting the argument that gaming addiction is not socially constructed. By socially constructed, as Burr (2015) asserts, this refers to how concepts and understandings of illness and health, can be influenced by policy, social norms and dominant representations in social systems, of disease and illness. However, bio-medical accounts of addiction, as Griffiths et al. (2016) explains, fail to acknowledge the changing social times and cultural factors.

For example, Buckingham and Wilet (2013) discuss the effects on individual behaviour that cultural, technological and social changes have elicited on children’s play, with indoors and technological play, superseding outdoors play, due to what has been termed a culture based on preventing potential risk to children (Clements, 2004). Buckingham and Willet, (2013) state that this has led to childhood itself and concepts of play changing, being redefined and reconstructed, with indoor ‘gaming’ becoming a more socially acceptable and ‘safer’ form of play. However, social changes to indoor play and in particular, violent gaming, have been drawn upon to explain new forms of mental health issues, which deviate from social norms (Hammersley, 2017). Such social constructions of the effects of excessive gaming in youth, has been used to explain abnormal violent behaviours, such as in the case of the mass shootings and murders of school children in the Sandyhooks case (Burr, 2015; Pow, 2012). However, there is no actual evidence to support this claim.

Labelling gaming as dangerous, however, as Griffiths, Kuss and King (2012) note, pathologises ‘gaming’ itself as risky, assuming from a behaviourist viewpoint, that playing games will automatically elicit a stimulus-response behaviour, where ‘high involvement’ could trigger an ‘addiction’, or imitation of gaming ‘shooting’ behaviour, as claimed in the Sandyhooks massacre (Pow, 2012; Skinner, 2011).

Despite empirical evidence to support the impact of violent gaming in the Sandyhooks case (Pow, 2012), the DSM criteria (APA, 2013) recently, has offered specific diagnostic criteria in identifying ‘gaming’ addiction. This being based on individuals having played video games online or offline, for a period of at least 12 months; although to what extent timewise in this 12-month period is unclear. Consequently, diagnosis also is based on behavioural symptoms, which, if shown to be severe, can indicate addiction to gaming (APA, 2013). Supporting the DSM (APA, 2013) in legitimising and constructing gaming addiction as a clinical disorder and contemporary mental health condition, the International Classification for Diseases ([ICD]: WHO, 1990), also include ‘gaming disorder’ as a new official diagnosis category.

However, Ferguson, Coulson, and Barnett, (2011) in a meta-analysis examining pathological gaming prevalence, challenges the social construction of gaming as a recognised mental disorder, suggesting its construction may be economically and politically motivated. This may indicate that the construction of gaming addiction may be politically and economically mediated, as developing treatments could be financially lucrative to health care providers, in attaining increased funding from budget holders. 

There are also fears that individuals accessing services, due to gaming addiction being represented and diagnosed differently across the ICD (WHO, 1090) or DSM (APA, 2013), may receive unequal treatments (Griffiths, Kuss and King, 2012). For example, the DSM criteria assumes a biomedical view, that biological and psychological mechanisms underpin gaming addiction, drawing on similar biochemical dose-response effects in the brain, as substance misuse; triggering dependency and thereby addiction (Cleary and Thomas, 2017; Griffiths, Kuss and King, 2012). In contrast the ICD, focuses on the impacts of gaming on the individual’s life, examining social and environmental factors, which reveal contradictions in how each conceptualise gaming addiction, based on either individual physiological or environmental effects (APA, 2013; WHO, 1990). Thus as a result, this indicates quite a large discrepancy between the models, in how gaming as a mental health illness and its impacts on the individual is constructed and thus, seen as best managed, suggesting gaming addiction is socially constructed.

Whilst diagnostic criteria attempt to categorise individuals’ observable symptoms and experiences of gaming addiction, research does not support that gaming can be so categorically defined, as ‘gaming disorder’ is shown to have unstable criteria (APA, 2013; Griffiths, Kuss and King, 2012). Research reveals that testing at different points of time, can show initially a gaming disorder (Griffiths, Kuss and King, 2012), which then disappears; revealing symptoms that can shift daily according to how much time gaming that day has been spent.

Many empirical studies been undertaken studying the effects of video game addiction (Kuss and Griffiths, 2011). Much literature suggests a gender bias to the negative effects of playing video games, with young males, being most at risk of experiencing mental health issues, although this may be due to the form of video game that males may play, such as violent, shooter games, which can trigger more aggressive and addictive behaviours in players (Thornhill, 2013; Griffiths, Kuss and King, 2012). Many studies that have been undertaken however, share key methodological issues, such as sampling bias, in selecting known children that play video games more frequently than other groups, therefore unable to attain a true effect, as some participants may have fostered a growing resilience to the effects of the gaming, which impedes the reliability of the findings (Griffiths, Kuss and King, 2012; King Delfabbro and Griffiths, 2011).

There is however, despite known methodological limitations, a large body of empirical evidence corroborating that gaming for long periods does pose negative consequences for the individual (Griffiths, Kuss and King, 2012; Kuss and Griffiths, 2011). Studies reveal that individuals will stop engaging in interests they once enjoyed, skip school, work and socialising, to continue playing (Yee, 2006); experiencing loneliness (Lemmens Valkenburg and Peter, 2011), and performing poorer academically (Jeong and Kim, 2011). Individuals can also experience aggressive behaviour (Chan and Rabinowitz, 2006), as well as suicidal ideation (Rehbein Kleimann and Mossle, 2010). Additionally, physical effects include risk of epileptic seizures (Millett, Fish and Thompson, 1997) and obesity (Shimai et al. 1993). Hence, there is sufficient evidence to indicate that playing games excessively can greatly impede the holistic health of an individual, whether or not this is identified as an actual addiction.

Research has however offered strong evidence of gaming addiction being associated with existing comorbid disorders, such as attention deficit hyperactivity disorder (Han et al. 2007; Batthyány et al. 2009), generalised anxiety disorder, depression, social phobia and school phobia (Batthyány et al. 2009), which offers support that ‘gaming addiction’ may be a behavioural manifestation of an already diagnosed or undiagnosed condition (Griffiths, Kuss and King, 2012). Thus, some individuals may possess a comorbid vulnerability to be more likely to experience the negative effects associated with gaming.  This does raise questions as a result as to whether gaming addiction exists as an actual addiction and condition, or whether it is merely a symptom of behavioural effect associated with other comorbid conditions and as such, whether it should have its own classification in diagnostic frameworks (Griffiths, Kuss and King, 2012; Yellowlees and Marks, 2007). A health prevention and promotion approach as oppose to a diagnostic and deficit approach to addressing the potential negative effects of gaming on individuals, may be a better approach, in aiding individuals to understand that they may have an increased susceptibility to the effects of gaming, so that individuals can be active in minimising their game playing time.

In conclusion, the essay has demonstrated that gaming addiction is a contemporary socially constructed mental health condition, which reflects technological changes and changing social conditions (WHO, 2014). However, the DSM in emphasising individual psychological and biochemical neural changes, perpetuates and reinforces a biological view of gaming addiction in contrast to the ICD that conceptualises gaming addiction, as determined by environmental factors, which impact on social and individual functioning. This supports an assertion that gaming addiction is a socially constructed, contemporary condition to make sense of a wide range of physical, psychological symptoms and social behaviours, which do not conform with dominant social norms of expected behaviour.

REFERENCES

American Psychiatric Association (2013) Diagnostic Statistical Manual of Mental Disorders. New York: American Psychiatric Association.

Batthyány, D., Müller, K. W., Benker, F., & Wölfling, K. (2009). Computer game playing: clinical characteristics of dependence and abuse among adolescents. Wiener Klinsche Wochenschrift, 121(15- 16), 502-509

Boyd, M. A. (2017). Addiction and substance-related disorders. In M. A. Boyd (Ed.), Essentials of Psychiatric Nursing (pp. 448–476). Philadelphia, PA: Wolters Kluwer.

Buckingham, D., & Willett, R. (Eds.). (2013). Digital generations: Children, young people, and the new media. London: Routledge.

Burr, V. (2015). An introduction to social constructionism. London: Routledge.

Chan, P. A., & Rabinowitz, T. (2006). A cross-sectional analysis of video games and attention deficit hyperactivity disorder symptoms in adolescents. Annals of General Psychiatry, 5(1), 16.

Clements, R. (2004). An investigation of the status of outdoor play. Contemporary Issues in Early Childhood, 5(1), 68-80.

Ferguson, C. J., Coulson, M., & Barnett, J. (2011). A meta-analysis of pathological gaming prevalence and comorbidity with mental health, academic and social problems. Journal of Psychiatric Research, 45(12), 1573-1578.

Griffiths, M. D., Kuss, D., & L King, D. (2012). Video game addiction: Past, present and future. Current Psychiatry Reviews, 8(4), 308-318.

Grossman, L. (2008, August 25). The off-line American. Time, 172(8), 52

Griffiths, M. D., Kuss, D. J., Billieux, J., & Pontes, H. M. (2016). The evolution of Internet addiction: A global perspective. Addictive Behaviors, 53, 193–195.

Hammersley. R. (2017) How and Why Addiction is socially constructed. Hull: University of Hull.

King, D. L., Delfabbro, P. H., & Griffiths, M. D. (2012). Clinical interventions for technology-based problems: Excessive Internet and video game use. Journal of Cognitive Psychotherapy, 26(1), 43-56.

Kuss D.J. & Griffiths, M.D. (2011). Online gaming addiction: A systematic review. International Journal of Mental Health Addiction, 2(4), 12-66.

Han, D. H., Lee, Y. S., Yang, K. C., Kim, E. Y., Lyoo, I. K., & Renshaw, P. F. (2007). Dopamine genes and reward dependence in adolescents with excessive internet video game play. Journal of Addiction Medicine, 1(3), 133-138.

Jeong, E. J., & Kim, D. H. (2011). Social activities, self-efficacy, game attitudes, and game addiction. Cyberpsychology, Behavior, and Social Networking, 14(4), 213-221.

Lemmens, J. S., Valkenburg, P. M., & Peter, J. (2011). Psychosocial causes and consequences of pathological gaming. Computers in Human Behavior, 27(1), 144-152.

Maslow, A. H. (2013). Toward a psychology of being. London: Simon and Schuster.

McCarthy, B. W., & McDonald, D. O. (2009). Psychobiosocial versus biomedical models of treatment: Semantics or substance. Sexual and Relationship Therapy, 24(1), 30-37.

Millett, C. J., Fish, D. R., Thompson, P. J. (1997) A survey of epilepsy-patient perceptions of video-game material/electronic screens and other factors as seizure precipitants. Seizure. 6, 457-459

Monti, P. M., Rohsenow, D. J., & Hutchison, K. E. (2000). Toward bridging the gap between biological, psychobiological and psychosocial models of alcohol craving. Addiction, 95, S229, 19.

Naidoo, J., & Wills, J. (2000). Health promotion: foundations for practice. Bristol: Elsevier Health Sciences

Pow, H. (2012). Should Call of Duty be Banned? Sandy Hooks Massacre Reignites Debate Over Violent Video Games that Arm Players with Automatic Weapons. Daily Mail, 19.

Rehbein, F., Psych, G., Kleimann, M., Mediasci, G., & Mößle, T. (2010). Prevalence and risk factors of video game dependency in adolescence: results of a German nationwide survey. Cyberpsychology, Behavior, and Social Networking, 13(3), 269-277.

Shimai, S., Yamada, F., Masuda, K., and Tada, M. (1993) TV game play and obesity in Japanese school children. Percept Motor Skill. 76, 1121-1122.

Skinner, B. F. (2011). About behaviorism. New York: Vintage.

Thornhill, T. (2013) Why first-person violent video games are so addictive: Psychologists reveal shoot-em-ups make us feel like we're 'playing God' . Retrieved from: http://www.dailymail.co.uk/sciencetech/article-2515101/Why-person-violent-video-games-addictive-Psychologists-reveal-shoot-em-ups-make-feel-like-playing-God.html (Accessed 2/6/2018).

Yee N. (2006) The psychology of MMORPGs: emotional investment, motivations, relationship formation, and problematic usage. In Schroeder R, Axelsson A (Eds.), Avatars at work and play: Collaboration and interaction in shared virtual environments. London: Springer. (pp.187-207).

World Health Organisation (2014) Social determinants of mental health. Geneva: WHO.

Yellowlees, P.M., and Marks, S. (2007) Problematic Internet use or Internet addiction? Computer Human Behaviour. 23, 1447-1453.