Prickly denial is the wrong response to WHO's "gaming disorder"

The proposed definition is careful and cautious; more research is needed and the industry should be cooperating, not stonewalling

The World Health Organisation is to adopt a definition of a "gaming disorder" in its new set of diagnostic standards, ICD-11 - prompting a set of reactions from both sides of the aisle that are as predictable as they are unconstructive. Elements of the mass media, having recently been inspired by the success of Fortnite to dust down their decades-old Greatest Hits album of scare stories about video games, have trotted out wildly inaccurate hyperbole about game addiction. Meanwhile, industry bodies around the world have formed an impromptu Greek chorus of denial, straight-up stonewalling the very notion that such a disorder might exist.

Of course, there's no point being annoyed by the lack of nuance industry bodies display in these situations; they basically exist to trot out the 'everything is fine' line in response to any criticism of the business. The one-note chorus of denial over this issue in particular, however, may be doing more harm than good. There are many reasonable criticisms of the disorder's inclusion - and the reaction from the mass media definitely deserves a drubbing - but those aspects are actually undermined by the blunt insistence that gaming has no negative externalities.

Worst of all is the public image damage done by presenting the industry as being stubbornly set on butting heads with the WHO, based on arguments that stem from what feels like a rather wilful ignorance of the clarity and precision of the disorder's definition. Having your industry's negative externalities pointed out by a high profile international health body may sting, but setting yourself up in the public eye as an uncooperative enemy of that body is like responding to the sting by amputating a limb.

"The one-note chorus of denial over this issue in particular, however, may be doing more harm than good"

Let me go back for a moment to brass tacks - the actual definition we're talking about. The WHO's definition of gaming disorder is extremely careful and precise; the science behind it may not be settled (which is one of the very reasonable criticisms of the definition) but the organisation is not swinging at fences here. Several major diagnostic criteria are laid out, describing an individual who has lost control of their own ability to regulate their use of games, has suffered major consequences in their social, professional or personal life as a consequence but has continued or even escalated their usage, and who has continued in this destructive pattern of behaviour for at least 12 months.

In other words, the WHO isn't talking about playing games being a disorder, or even playing games extensively being a disorder. It's not saying that a teenager who slams a door because his mum told him to stop playing Fortnite has a disorder. It's very clearly and carefully talking about playing games to the extent that they impair normal daily life being a disorder. It's not talking about me bailing on someone's house party last week to finish God of War; it's talking about people who lose their jobs, drop out of school, destroy their relationships and even mess with their physical health through playing games.

If you're thinking, "well that's a tiny, tiny fraction of people who play games" - yes, that's rather the point. I'm sympathetic to the argument that we shouldn't pathologise our daily lives, and claiming something is an "addiction" - a word the WHO is careful not to use at any point - is a regular go-to for turning normal bad or anti-social behaviour into a diagnosable condition (plus it's a great way for cheating middle-aged men to claim that they're really the victims of a terrible and formerly undiagnosed sex addiction). However, someone developing an obsession or immersing themselves in a game to the extent that it has massive, sustained and clearly uncontrolled negative consequences for their ability to function as a human being - well, that's not daily life, is it? That's absolutely something we should be pathologizing and trying to find ways to help with.

"Authors and film makers don't have conferences multiple times a year where talks focus on building compulsion loops and snaring 'whales'"

Isn't that kind of obsessive, self-destructive behaviour just a symptom of a deeper problem, though? That's entirely possible. In response to the news of the disorder's inclusion, many people have been sharing stories of different things they became obsessed with at low points in their lives and pointing out that these things were just coping mechanisms, not the root of the issue. I get the point; hand on heart, last time I suffered from a serious bout of depression I binge-watched the entirety of Stargate SG-1 and Stargate Atlantis while barely leaving my apartment. Now, that's a fairly specific and exquisite form of self-harm, but the point is I don't see the WHO adding a Stargate Disorder to ICD-11, or even a (perhaps more sensible) DVD box-set or Netflix Binge Disorder.

Perhaps games are being unfairly picked on compared to other media, then. Or perhaps games have developed into a massive medium with some branches that are particularly enticing and potentially damaging for people in those vulnerable situations. Again, the research isn't terribly conclusive in this field, which is precisely why the WHO is being cautious; it wants to highlight a potential problem for practitioners to be aware of, while hopefully encouraging more and better research around the issue. But stonewalling about the existence of this kind of disorder is a losing strategy in the public sphere regardless of the status of the research, simply because rather a lot of people have a sense that they've actually seen it in action.

Of course it's a tiny minority of gamers who are subject to this sort of disorder, and tens of millions of people play games very extensively without the slightest issue. But how many people of our generation can really say they don't know anyone who's managed to lose a job, fail a year of school, or mess up an important human relationship because they couldn't get their obsession with a game under control? How much worse is this in the next generation down the line, I wonder, now that so many games are deliberately designed not just to be fun for 50 or 100 hours, but to engage players for years on end - and often to keep them financially engaged for the long term, too?

"This isn't the tobacco industry and we shouldn't act like it; the games industry is not and should not be in the business of harming its players"

That's rather the point with regard to the question of whether games are being singled out unfairly. This is an issue on which the industry wants to have its cake and eat it. Comparisons with other kinds of media and talking about the value of escapism is a rather slippery attempt to avoid the core point; book authors and film makers don't have conferences multiple times a year where talks focus on building compulsion loops, snaring "whales" and using psychological tactics to encourage consumers to stay engaged for years. Some of those tactics are fine (some of them aren't, mind you), but you can't openly and proudly discuss that stuff for years on end and then scream blue murder when a health body points out that, for a small minority of vulnerable people, those strategies may be working far too well altogether.

Moreover, for all the hand-wringing about how defining a gaming disorder might obscure diagnosis of underlying issues, that's simply not how diagnosis works. Talk to professionals who actually work with addicts and similar cases, and you'll find that an accurate diagnosis of a non-physical addiction (e.g. gambling addiction) is often a very helpful step in identifying deeper problems. Sure, the mass media is going to have a field day and some unscrupulous authors are undoubtedly going to write some books squarely targeted at parents convinced their teenager would be a sweet angel if it weren't for the demon PlayStation, but for those people (a tiny minority but still likely a large number in itself) whose obsessive and self-destructive engagement with games is a signpost to a deeper issue, the ability to have that effectively diagnosed could be an important step on the path to recovery.

I keep emphasising that we're talking about a tiny minority, because that's an important point. Nobody is trying to pathologise an ordinary gaming habit, even a pretty hardcore one. Saying this is a small minority, however, doesn't actually detract from the WHO's decision in any way.

Most people who drink alcohol don't get addicted or mess up their lives, red wine is good for you in moderation, whiskey's great for a cold, and hardly anyone would ever start a new relationship without a bit of Dutch courage, but none of that changes the fact that alcoholism exists and can be utterly devastating. The whole point of the WHO's definition is that playing a game to the extent that you lose your job and your friends, forget to feed yourself right and collect bottles of piss under your desk is not actually daily life, and needs to be treated as abnormal - researched, understood and, hopefully, cured.

That's precisely why the industry's response is all wrong. It should be presenting itself as cooperative and willing to assist, not as stubborn and prickly. If the research is unsatisfactory (which it is), then get involved; open up data and access to medical and social researchers (not just your hand-picked tame ones, either) and let them really get to the bottom of this. If there's no harm being done and games truly are just incidental to a set of other issues some people face, great; games are off the hook and that's important information for the professionals working with those cases. If there is harm being done to a minority of players, however, that's also an important finding for the industry, and one it should welcome knowing about.

This isn't the tobacco industry and we shouldn't act like it; the games industry is not and should not be in the business of harming its players, inadvertently or otherwise, and presented with evidence that this may be happening, it should welcome the chance to help right that situation. Pointing out that games can have strong positive social impacts and even therapeutic value is right and true, but that's all meaningless if valid suggestions of harm are met with stonewalling and stubbornness. Engagement and openness, not denial and derailing, would be the responses of a properly mature and responsible industry.

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Latest comments (5)

Neil Young Programmer, Rebellion Developments3 years ago
Moreover, for all the hand-wringing about how defining a gaming disorder might obscure diagnosis of underlying issues, that's simply not how diagnosis works.
Given I first heard this argument from healthcare professionals and suffers of recognised illnesses, I wouldn't dismiss this argument so readily.
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Sergio Rosa3 years ago
Thank you!!!
It's like the gaming industry was too busy being offended to actually take a look at what the WHO's definition said. When the industry is more focused on disagreeing and bashing a definition, than trying to cooperate to find a solution to someone not eating, not sleeping, or not even going to the bathroom, because that person's too busy playing Overwatch or whatever, the industry clearly has its priorities all wrong.

Personally at first I found the industry's reactions funny, but then they began to make me go like "dude, seriously???"
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Klaus Preisinger Freelance Writing 3 years ago
Cause, effect and underlying reason.

Cause is the bonding of neurotransmitters to the pleasure centers of your brain. Effect is the continued consumption of a substance with severe side effects. Hence opioids are a problem, it is all about the side effects from failing health to illegal trade. If chocolate makes you happy, chew away and die from diabetes, the world does not care. Heroin you ask? Overall worse side effect on the whole of society so no deal. We have no rules against having fun and we have no rule that says you have to be a productive member of society. There are negative effects, if you do not have money, but if you do, there is no law against spending it without adding more wealth to your pocket. But is the underlying reason for all drug consumption pure hedonistic thrill seeking that begins at an emotionally neutral stage? I dare say that quite the opposite is closer to the truth. A person with 100 pairs of socks is less likely to require more socks, just as a happy person is less likely to require more drug fueled happiness. Drug stories begin at a place of misery more often than in a place of happiness.

Reading through the ICS-11, it becomes very obvious that disorder is just a word for "stuff people do for reasons not given and that the WHO does not agree with without giving reasons". All the WHO does is identify regularly occurring behavior it frowns upon and lists it as a negative. Read the news paper every day at the expense of other daily activities: well done, you are healthy. Read online websites every day at the expense of other daily activities: sorry, you are an online addict. Instead of asking why something is done, the ICS-11 just asks what is being done.

That is no way to help anybody who is addicted to anything for any reason. It is but a tool to single them out and probably pile on them further. Rather than to asks them what prompted such behavior and get to the underlying reason. Then again, the ICD-11 is just a list of symptoms, nothing more, nothing less. It is not the internationally agreed upon list of root causes.
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Show all comments (5)
Neil Young Programmer, Rebellion Developments3 years ago

some of the criticism from the healthcare/scientific side.
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Bonnie Patterson Narrative Designer, Writer 3 years ago
If you want a similar term to compare "gaming disorder" to, consider "eating disorder."

The existence of illnesses defined as "eating disorders" does not suggest that we should ban food, it's simply an umbrella category for a collection of conditions with different causes and effects, but which are all centred on behaviours that involve eating.

Even once you have a more specific diagnosis, such as "anorexia nervosa", it's still a group of more general conditions manifesting with a specific effect on behaviours around eating - it could come from a form of obsessive compulsive disorder, anxieties over being seen eating and negatively judged for it, anxieties caused by past traumas either associated with or displaced onto eating, addiction to the feeling of triumph upon successfully losing weight or even a post-traumatic response wherein the individual tries to reassert control over their life by controlling whether or not they eat.

It's the same with gaming disorder. Underneath the label may lie an addiction that leads someone to play so much, they haven't seen another human in weeks - queuing the person up for depression and social anxieties. Or there may be extreme temper tantrums that lead to self-harm - we've probably all run into wall-punchers at some point. And none of us thought poop-socking is conducive to a healthy, disease-free lifestyle, did we?

As a diagnosis, it's really just a way of telling medical personnel where to focus their early questions, and it's not something the vast majority of gamers need ever even worry about.
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