The internet: Mental-health specialists disagree over whether to classify compulsive online behaviour as addiction—and how to treat it.
Mar 10th 2011.
CRAIG SMALLWOOD, a disabled American war veteran, spent more than 20,000 hours over five years playing an online role-playing game called “Lineage II”. When NCsoft, the South Korean firm behind the game, accused him of breaking the game’s rules and banned him, he was plunged into depression, severe paranoia and hallucinations. He spent three weeks in hospital. He sued NCsoft for fraud and negligence, demanding over $9m in damages and claiming that the company acted negligently by failing to warn him of the danger that he would become “addicted” to the game.
But does it make sense to talk of addiction to online activity? Mental-health specialists say three online behaviours can become problematic for many people: video games, pornography and messaging via e-mail and social networks. But there is far less agreement about whether any of this should be called “internet addiction”—or how to treat it.
Some mental-health specialists wanted “internet addiction” to be included in the fifth version of psychiatry’s bible, the “Diagnostic and Statistical Manual of Mental Disorders”, known as DSM-V, which is currently being updated. The American Medical Association endorsed the idea in 2007, only to backtrack days later. The American Journal of Psychiatry called internet addiction a “common disorder” and supported its recognition. Last year the DSM-V drafting group made its decision: internet addiction would not be included as a “behavioural addiction”—only gambling made the cut—but it said further study was needed.
Skeptics say there is nothing uniquely addictive about the internet. Back in 2000 Joseph Walther, a communications professor at Michigan State University, argued that other factors, such as depression, are the real problem. He stands by that view today. “No scientific evidence has emerged to suggest that internet use is a cause rather than a consequence of some other sort of issue,” he says. “Focusing on and treating people for internet addiction, rather than looking for deeper clinical issues, is unwise.”
Others disagree. “That would be wrong,” says Kimberly Young, a researcher and therapist who has worked on internet addiction since 1994. She insists that the internet, with its powerfully immersive environments, creates new problems that people must learn to navigate.
No one disputes that online habits can turn toxic. Take South Korea, where ubiquitous broadband means that the average high-school student plays video games for 23 hours each week. In 2007 the government estimated that around 210,000 children needed treatment for internet addiction. Last year newspapers around the globe carried the story of a South Korean couple who fed their infant daughter so little that she starved to death. Instead of caring for the child, the couple spent most nights at an internet café, sinking hours into a role-playing game in which they raised, fed and cared for a virtual daughter. And several South Korean men have died from exhaustion after marathon, multi-day gaming sessions.
But compulsive behaviour is not limited to gamers. E-mail or web-use behaviours can also show signs of addiction. Getting through a business lunch in which no one pulls out a phone to check their messages now counts as a minor miracle in many quarters. Pornography is hardly new, either, but the internet makes accessing it much easier than ever before. When something can be summoned in an instant via broadband, whether it is a game world, an e-mail inbox or pornographic material, it is harder to resist. New services lead to new complaints. When online auction sites first became popular, talk of “eBay addiction” soon followed. Dr Young says women complain to her now about addiction to Facebook—or even to “FarmVille”, a game playable only within Facebook.
Treatment centres have popped up around the world. In 2006 Amsterdam’s Smith & Jones facility billed itself as “the first and, currently, the only residential video-game treatment program in the world”. In America the reSTART Internet Addiction Recovery Program claims to treat internet addiction, gaming addiction, and even “texting addiction”. In China, meanwhile, military-style “boot camps” are the preferred way to treat internet problems.
Yet many people like feeling permanently connected. It’s as if it is not a pleasure but a necessity.
Bob LaRose, an internet specialist at Michigan State University wrote in his research on college students that he found that less than 1% has a pathological problem, he adds. For most people, internet use “is just a habit—and one that brings us pleasure.”