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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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Ivy Taylor avatar

Ivy Taylor


Ivy joined GamesIndustry.biz in 2017 having previously worked as a regional journalist, and a political campaigns manager before that. They are also one of the UK's foremost Sonic the Hedgehog apologists.