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Marathon video game sessions: Is that sick?
Dave Taylor always knew his lust for playing "Fallout" and "Total Annihilation" bordered on the pathological. The video games would hold the West Hollywood software programmer in such a vise-like grip that he'd often play for 24-hour stretches, forestalling sleep, skipping meals and twisting himself in knots to delay bathroom breaks.
"It's super unhealthy," he said. "But man, I'm just so swept away in another world and so focused on my goals that I don't care. It hurts to be away from the game."
Now some doctors are lobbying to give his condition a formal medical diagnosis — video game addiction.
The American Medical Assn. is scheduled to debate such a proposal in Chicago on Sunday, then vote on it early next week. Backed by the Maryland State Medical Society, the proposal advocates that the Diagnostic and Statistical Manual of Mental Disorders, considered by many psychiatrists to be the final word for assessing mental illness, include video game addiction. The proposal also would have doctors exhort parents to curb their children's use of the Internet, television and video games to two hours a day. In addition, it would have the AMA, the influential physician organization with 250,000 members, lobby the Federal Trade Commission to improve the current system for rating video game content.
Getting the AMA to deem video game addiction a psychiatric disorder is the first step in a long process required to create a new mental health diagnosis. The ultimate arbiter is the American Psychiatric Assn., which publishes the authoritative DSM guide on mental disorders, currently in its fourth version. Getting APA approval could take years.
Executives in the $30-billion game industry are already on the defensive. They say the measures are not supported by scientific evidence. "The American Medical Assn. is making premature conclusions without the benefit of complete and thorough data," said Michael Gallagher, president of the Entertainment Software Assn., a trade group that represents video game publishers. But doctors in favor of the proposal say the condition exists and needs to be recognized by the medical establishment so it can be properly treated.
It's already happening in South Korea. In 2005, government officials there sent psychologists into Internet gaming cafes to warn players of addiction dangers after a man died of heart failure brought on by exhaustion and dehydration after a 50-hour binge playing "World of Warcraft." A spokesman for Blizzard Entertainment, the game's Irvine-based creator, declined to comment on the case.
Physicians in the U.S. are concerned about the exposure children have to media violence, particularly in a medium as engaging as games. They're also alarmed by the growing popularity of risque fare such as "Grand Theft Auto: Vice City" and "Manhunt 2." The latter, which features a mentally ill patient on a killing spree, was recently banned for sale in Britain and Ireland, with officials citing "unremitting bleakness and callousness of tone." In the U.S., the game received an "Adults Only" rating from the Entertainment Software Rating Board, a designation that would make the title unavailable at major retailers including Wal-Mart Stores Inc., which refuses to carry adult titles.
Take-Two Interactive Software Inc., the game's New York-based publisher, said Thursday that it was temporarily suspending the game's release, which had been planned for July 10.
But addiction also can be triggered by casual games that don't involve anything more frightening than a "game over" message, said Maressa Hecht Orzack, director of the Addiction Studies Center at McLean Hospital in Belmont, Mass., and an assistant clinical professor at Harvard Medical School. Orzack diagnosed herself as being addicted to solitaire in 1995. Her late husband would find Orzack draped over her keyboard, fast asleep in the middle of a game. Lacking sleep, she sometimes turned up late for her appointments or missed them altogether.
Now Orzack, a clinical psychologist, treats half a dozen patients for video game addiction and fields a dozen requests each day from other people seeking treatment. "They're desperate for help," Orzack said. "They drop out of school. They lose their jobs. They don't get to meals. Often, they lose sleep because they're up late playing games. They also jeopardize their relationships with their family and friends. It can get so out of control."
Liz Woolley started to see some of these symptoms in her son, Shawn, when he started playing an online multiplayer game called "EverQuest," which players jokingly call "EverCrack." As her son became increasingly involved with the game, he started withdrawing from his friends and family.
Shocked by the transformation, Woolley, of Harrisburg, Pa., tried to get help for her son. She was disappointed when the psychiatrists he saw treated him for depression, not addiction. "It's like trying to treat someone for depression when he's a full-blown alcoholic and you're not trying to get him to stop drinking," Woolley said.
Her son killed himself with a rifle in 2002, two days before Thanksgiving. His mother found him in front of his computer with the game running. He was 20.
A spokeswoman for Sony Online Entertainment, which publishes "EverQuest," said it was not the company's role to monitor how its customers spend their time. "The majority of the hundreds of thousands of subscribers play the game in moderation, enjoying the game play as well as the community interaction the game provides," spokeswoman Courtney Simmons said.
Woolley traced part of her son's distress to a broken relationship he had developed with someone who was playing the game. Soon after, she started an online support group called Online Gamers Anonymous. It now counts 3,000 members. "We're flourishing because these people have no place else to go," Woolley said. "Having [the AMA] proposal pass would go a long way toward helping people get the treatment they need."
Game industry representatives say that the games themselves may not be to blame, that the addiction may have other root causes such as an addictive personality or major life stressors. "The causation question is not particularly well-supported," said Jamil Moledina, executive director of the Game Developers Conference, an annual event for professional game creators. The proposal before the AMA also points out the inadequacies of current studies, citing "insufficient research to definitively conclude that video game overuse is an addiction."
Dr. Jeffrey Wilkins, the director of addiction medicine at Cedars-Sinai Medical Center in Los Angeles, disagrees. He believes patients with video game addiction have symptoms that straddle two disorders: behavioral dependence and impaired impulse control. "If you have something that takes on the characteristics of two disorders, you probably have a new disorder," he said.
If the AMA approves the measure, it will present its case to the psychiatric association, which plans to begin discussing revisions to its mental disorder manual next month. The current edition, which took 14 years to publish, hasn't been substantially updated since it came out in 1994. In the past, the organization has been lobbied to add Internet addiction and road rage as conditions but hasn't yet made a decision.
"We want to be careful not to harm the process by rushing things," said Dr. Carolyn Robinowitz, president of the Arlington, Va.-based association. "If you have a diagnosis, it should be reliable, clear and accurate. Otherwise, people may get over-treated, under-treated or badly treated."
It's also high stakes for health insurers. Although inclusion in the Diagnostic and Statistical Manual of Mental Disorders is not a guarantee that insurers will pick up the tab, Robinowitz said, it does give patients a stronger position from which to argue for coverage.
Taylor, however, doesn't want treatment. "I am sure it should be treated like pathological gambling," Taylor said. "But I don't want to be cured."
Although there is no current medical diagnosis called video game addiction, some mental health professionals administer a variety of questionnaires to assess dependency. These are some of the questions Maressa Hecht Orzack, director of the computer addiction studies center at McLean Hospital in Belmont, Mass., asks her patients:
• When you're not playing a game, do you find it difficult not to think about it?
• Are you uninterested in anything else besides games?
• Do you feel unable to control how much you play?
• Are you often late for appointments because of your game play?
• Are you having difficulty managing daily life?
• Do you skip meals to play?
• When you feel alone, do you use games to communicate with others?
• Do you spend more than three hours at a stretch playing?
• Is game play preventing you from getting enough sleep?
• Do you have headaches, dizziness or seizures?
I'm still quite young, but back then I fit what society defined as hot.
