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Time to take responsibility over gaming disorder | Opinion

Disputed classification is about helping people, not scapegoating an industry

The games industry likes to counter criticisms with positives, and this has never been more clear than with the recent debate around gaming disorder.

When the World Health Organisation announced in December 2017 that it would include gaming disorder in its draft of the 11th International Classification of Diseases (ICD-11), the games industry released a collective groan of dismay.

Coming in the wake of the Star Wars Battlefront II loot box debacle, it felt like the industry was beset on all sides by critics from mainstream media, or the more ill-informed corners of public office. It was, some decided, an entirely preposterous proposal brought forward by people too blinded by their own ignorance to see the virtues of gaming.

But here we are nearly 18 months later, and gaming disorder has been officially classified in the ICD-11. Last year, I would have sided wholeheartedly with the detractors, arguing that excessive gaming is symptomatic of deeper problems, rather than a disorder in itself. But after taking some time to reflect on my own extensive catalogue of coping strategies, I'm beginning to see the value in such a classification. Because ultimately, while it can be a symptom of depression, anxiety, PTSD, or childhood emotional neglect (among many others), so can alcoholism, gambling addiction, or compulsive sexual behaviour.

Without formal guidelines or classifications, symptoms range anywhere from an internet porn addiction, to "gamer's thumb"

The clinical utility of gaming disorder is to identify the most appropriate prevention and treatment interventions. Around the world there are already countless people in treatment clinics for some ill-defined variant of gaming disorder, but without a formal classification it's a total free-for-all. Concerns that formalising it as a condition in the ICD-11 will result in rampant misdiagnosis run contrary to what is likely to happen.

Pandora's box was opened long ago, and clinics have been diagnosing and treating gaming disorder for years. The problem is, without formal guidelines or classifications, symptoms range anywhere from an internet porn addiction, to "gamer's thumb." In countries without universal healthcare, it also makes treatment less likely to be covered by health insurance.

Treatment of gaming disorder is not just, "Does this person game excessively?" It's, "Why does this person game excessively?" It's not about locking your Warcraft account and tidying your room; it's about examining the difficult feelings that we compulsively try and escape to the detriment of our personal wellbeing. Excessive gaming is the manifestation of emotional pain, and gaming disorder is the clinical definition for someone who turns to an MMO rather than a bottle of vodka.

The WHO defines gaming disorder as a pattern of behaviour "characterised by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences."

Importantly, this is over a period of at least 12 months. So people who escape into games following a bereavement, or breakup, or to help manage work stress -- even if it's for several months on end -- won't be diagnosed with gaming disorder. Whereas right now, a teenager occasionally getting mouthy because they want to play Fortnite instead of eating a family meal could find themselves in a treatment centre having their thumbs examined and their masturbating habits dissected.

If we're going to espouse the positives, we have to accept the negatives, and take responsibility

I can say that throughout most of my life I've played video games to excess, and there are more than a few extended periods where gaming disorder would have been a perfect diagnosis. And I can tell you now, looking back, it might have been nice if someone had taken notice and said, "Hey, do you maybe want to go to therapy?"

But instead I just continued using video games to distract myself from own personal problems. Yes, it helped, but it's a band-aid not a treatment.

The games industry loves to uphold the benefits of gaming. Whether it's the vibrant communities where outcasts can find a home, or the loose body of evidence suggesting an improvement in hand-eye coordination, we bang the drum loud and proud. But if we're going to espouse the positives, we have to accept the negatives, and take responsibility.

Not since the unhinged ramblings of Jack Thompson dominated headlines has the games industry had so many critical eyes on it. The world, rightly or wrongly, is concerned about the mental and physical health implications of excessive gaming, and yet our only response has been a prolonged campaign of denial.

Newly appointed CEO of the ESA, Stanley Pierre-Louis, even went as far as saying: "We opposed this move by the World Health Organization, but we also recognise that there should be no implication that this exists."

Sorry Stanley, but this classification definitely implies that gaming disorder exists. Implying its existence is the bare minimum such a classification does. Responses like this suggest our industry doesn't care about people so much as profits. We're blowing kisses to ourselves in the mirror while the room behind us burns. All we care about is how the heat makes our hair frizz.

I understand the concerns around what a formal classification of gaming disorder implies about our industry. For the WHO to include it in the ICD-11, along with alcoholism, or gambling and drug addiction, signals that gaming presents a potential threat to a person's health and wellbeing. As an industry we can deny that with every fibre of our being. We can deny that gaming disorder exists, that excessive gaming has ill effects on our lives. We can say there isn't enough evidence, and that more research needs to be done.

We're blowing kisses to ourselves in the mirror while the room behind us burns. All we care about is how the heat makes our hair frizz

We can continue making a fuss, and blaming the WHO, or we can take responsibility and show compassion for vulnerable members of our community who might have an unhealthy relationship with gaming, as well as any underlying conditions that might be causing it. If people are playing games to the exclusion of their own personal wellbeing, why is the industry only concerned about its public perception?

And to anyone who says, "What about parental controls?" I politely invite you to climb into this bin so I can roll you into the uncaring ocean. Parental controls are great, but they are not a fix-all solution. They can help effectively manage screen time for young people, but parental controls alone won't help someone with gaming disorder -- especially if that person is an adult -- anymore than locking the booze cabinet helps an alcoholic. The underlying problems are still there, and they still need treating.

The games industry needs to take responsibility for the ways in which it impacts people's lives. A gaming disorder classification is not engineered to demonise the games industry; we've done that ourselves with our tone-deaf and self-interested response that's concerned more with the bottom line than the health and wellbeing of vulnerable people within our communities.

Our denial of the issue only creates more problems. One of the many criticisms levelled against the classification was that it's premature, and the academic evidence is contested. That may well be the case, but that's beside the point now. It's also very rich coming from the games industry, which collects astronomical amounts of data to better understand player behaviour, but won't share it for research purposes.

We could open up this valuable data on how people interact with specific mechanics, the potential dangers, and what can be done to limit them. But the truth is, we're an industry that frequently meets in massive convention centres to talk about compulsion loops, user retention, and "whales"; perhaps it's time to start seriously engaging with the issue.

We could even go as far as funding research. While obviously a contentious issue -- as any study refuting gaming disorder which has been part-funded by the industry would rightly be called into question -- pre-registration can help inoculate research against the dangerous and common habit of repeatedly analysing data until the "right" answer is found.

Countless studies in the past have suggested all manner of confluence between gaming and some awful negatives. There are people out there arguing that gaming is dangerous, that it causes harm, and instead of proving these people wrong, we burrow away in fear that we might prove them right. And the thing is, if we do prove them right, that's something that needed to happen.

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Latest comments (8)

Sean Slavik Chief Executive Officer, Chance6 Studios, LLC2 months ago
I think the industry needs to be very careful about this and how it handles the issue. Quietly and privately supporting (as many Iím sure already do) research and support to help mitigate the long term health problems of their customers will allow actual results without creating problems for the research itself. Iím reminded of the uproar and damage that the tobacco industryís support of nicotine addiction research and smoking cessation programs caused, and how they were viewed as undermining the actual result.

As with all things, No single group is absolutely correct. The WHO has its own political motivations, and the games industry has theirs. Treatment and results will likely be driven not by these groups busy by the people who suffer with the problem reaching out and helping others (as in drug and alcohol rehab, or smoking cessation accountability partners).

Likely it will be best to maintain ďparty linesĒ publicly, while funneling funding and data to the middle in a semi-Machiavellian fashion.
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Tadhg Kelly Senior Partner Manager at Magic Leap, Self-Emplyed2 months ago
The problem with this line of thinking is that the Jack Thompsons of this world still very much exist, and this is exactly the sort of thing that they will seize on. Moreover there's an undertone of prurience in such classifications. People retreat into books or TV just as much as they do into games. for similar "avoid life" reasons. But I don't see anyone classifying a "literary disorder" for someone who spends all their time in the library.
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Eyal Teler Programmer 2 months ago
Well said, Haydn. I've long had a problem with the emphasis on monetisation in recent years, and using psychological research and testing to get people to play more and pay more. When talking about 'taking responsibility', that's the first thing that needs to go.

That also goes for what I think of e-sports. Sports generally have quite a few health and mental benefits. Gaming, fewer. Arguing that they are equivalent, which the game industry is pushing towards, is another case of irresponsibility.

Games are a great art form. They can also be a good form of escapism, just like TV or books can be, and that's fine. But we need to stop cynically trying to addict people to games in order to make more money.
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Show all comments (8)
I 100% agree with WHO, and I have been playing video games for over 20 years now (not a pro gamer in any way though). Gaming or Gamerholic (like Alcohol/Alcoholic, Gambling/Gambler, Smoking/Smoker) is a Disorder!

Edited 2 times. Last edit by AbdulBasit Saliu on 2nd June 2019 1:46pm

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Neil Young Programmer, Rebellion Developments2 months ago
One of the many criticisms levelled against the classification was that it's premature, and the academic evidence is contested. That may well be the case, but that's beside the point now.
Surely this is the real issue though? The main problem with the categorisation is that without an adequate evidence base it's reckless and may do more harm that good. The industry concerns thereby become more relevant, as it may be the diagnosis is being approved for political reasons.

Concerns over business models and marketing tactics are somewhat tangential - it is possible and indeed reasonable to oppose the creation of the diagnosis and to support more responsibility in overall practices.
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Klaus Preisinger Freelance Writing 2 months ago
I may inject the idea of people first.

Allow for the classification, allow for people to get treated, allow the people offering treatment to sort it out. If you must regulate on thing, then the fact that people offering the treatment be no charlatans. For people to get help for something, that something must be a thing in a book. If that book does not list the common cold and I go to the Doctor with the common cold, he will tell me 'that is not a thing, go away.' Even if 100 people seek help and it turns out 99 need treatment, but not because they play too much games and the reasons are to be found elsewhere, then that is still 100 people seeking help who should have sought help and gaming addiction being a thing in a classification book helped them to get the help they needed.

Roadblocking the idea of people getting help in an effort to protect business models is sending the type of signal that the social media virtue vultures will pick you to pieces for.

It takes one hell of an epidemic for regulation to act upon something (cmp. prescription opiates and what is done there) and I do not see that large of a problem. That does not mean there aren't people with problems, there are. The industry should get behind the WHO on this one. Let the professional psychologists figure this one out over time and do not hit them over the head with denial before they even had the chance to get to work.
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Jo„o Namorado Project Manager, Portugal Telecom2 months ago
@Klaus
Funny that you mention opiates. The WHO has cited studies fabricated by Purdue Pharma that immensely downplayed the potential for addiction from Oxycontin consumption. https://arstechnica.com/science/2019/05/world-health-organization-parroted-purdues-deceptive-opioid-claims-report-says/

We need to make sure a thing is actually a thing before we start treating it. Good intentions mean nothing if you are actually making things worse or simply not making it better. It's like Neil said in the previous comment.
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Ian Griffiths Product Owner, Hutch2 months ago
The evidence that we have so far suggests that gaming disorder doesn't exist. The risk of misdiagnosis is real, the risk of mistreatment is real.. One thing this 'acknowledgement' does is validate these dangerous 'gaming addiction' camps that they force people into.

Who are we to tell someone that they should stop? When they should stop? Why they should stop? At what point did a player invite us into their lives to make value judgements about them? To parent them? How would we justify such interference in someone's privacy? For their own good!? Well, the road to hell is paved with good intentions, as we see with each pernicious step of the nanny state.

And I can tell you now, looking back, it might have been nice if someone had taken notice and said, "Hey, do you maybe want to go to therapy?"
Most people aren't fans of actual authoritarianism when it hits them in the face. Asking a player if they want some therapy would be seen as an insult. The cost to the vast majority of people would be negative in the long run. Players would have the feeling of being surveilled, even in their down-time, and that there is always someone there ready to solve their problems. Learning that someone is always watching, isn't actually healthy in the long run. As Jonathon Haidt points out, this attitude has been hurting the most recent generation, not helping them build an 'anti-fragile' mindset seems to be causing mental health problems.

We could open up this valuable data on how people interact with specific mechanics, the potential dangers
How on earth we would do that? In order to know potential dangers we would need to violate individual's privacy, contact them directly and understand the problems in their life. Violating someone's privacy would be an actual harm.

as any study refuting gaming disorder which has been part-funded by the industry would rightly be called into question -- pre-registration can help inoculate research against the dangerous and common habit of repeatedly analysing data until the "right" answer is found.
The irony here is shocking. There are billions of gamers and yet no smoking gun. If gaming order is such an obvious illness then why aren't the streets riddled with gaming addicts? We seem to keep doing studies and finding next to nothing. The prevalence of issues, if they indeed exist, seem to have so little prevalence. And yet we're expected to prove that there's no problem? As if the lack of evidence doesn't speak for itself. And as I touched on above, we're even meant to impact the vast, vast majority of people with no problem in ways we suspect cause long-term societal issues for the benefit of an undetermined tiny minority with techniques that go as far as bluntly telling people 'maybe you need therapy', a technique that frankly wouldn't work.

Well, I reject this unproven condition, this nanny state surveillance, this unasked for interjection into people's lives, this damaging coddling of average citizens and this shoulder shrugging 'tell people they need to get help' non-treatment approach if they indeed do have an issue. It's all just absurd.

Edited 2 times. Last edit by Ian Griffiths on 4th June 2019 11:33am

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