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How has 'gaming' become constructed as a contemporary mental health issue and addiction
Over history, however, the construction and explanations put forwarded for the cause and spread of disease and ill-health, have changed, in line with social, political, cultural and economic changes (Naidoo and Wills, 2016). This has led to ill-health no longer being represented as just being free from disease, but influenced by the social conditions in which people, live and grow (Burr, 2015; World Health Organisation, [WHO], 2014). However, a most recently recognised mental health ‘condition’, included in the Diagnostic Statistical Manual of Mental Disorders [DSM 5] (American Psychiatic Association, [APA], 2013) is termed as ‘Internet gaming disorder’; a mental health condition, where individuals’ forgo their basic needs (Maslow, 2013), such as sleeping, eating and social contact, to instead play games for numerous hours. As Grossman (2008; 52) claims, “The Internet, was conceived as a research and productivity tool, [but] has become a weapon of mass distraction”, which supports WHO’s (2014) assertions that mental ill-health is not simply individually and biologically determined, but can be influenced by the actual social conditions in which people live in. This essay therefore aims to examine how 'gaming' has become medically and socially constructed as a contemporary mental health issue and addiction, drawing on psychological theory and the empirical evidence base, to understand the impacts of this on the individual, and society.
Traditionally, scientific, biomedical models of health have informed biological and cognitive psychological theories around the causation of mental health conditions, representing addiction, as due to an individual’s inherent psychological or physiological vulnerabilities and thus, beyond an individuals’ control (Griffiths, 2012; McCarthy and McDonald, 2009). Such deterministic models are useful in understanding addictions such as alcoholism or drug misuse, in terms of explaining the bio-chemical effects that substances can elicit upon an individual (McCarthy and McDonald, 2009). These addictive behaviours then trigger a range of physical, neurological and psychological changes in the brain and body, fostering and sustaining the addiction (Monti, Rohsenow, and Hutchison, 2000).
The potential risk posed by time spent gaming online, is not a new issue, as in the 1990s, a number of research papers originating from social scientists from Europe and Asia, suggested that people could become addicted to the internet in general (Boyd, 2017). The reasons asserted were due to the swift access that it offered to social media, and gaming, which could activate a state of physical and mental arousal and gratification, in the brain’s reward system, which can be equated to the dose-response experienced from chemical drugs (Boyd, 2017; Griffiths, et al. 2016). However, whilst all forms of addiction can be understood though a bio-medical lens, as Griffiths et al. (2016) explains, such accounts fail to acknowledge the changing social times and cultural factors. For example, Buckingham and Wilet (2013) and Clements (2004) discuss the effects on individual behaviour that cultural, technological and social changes have elicited on children’s play, with indoors and technological play, superceding outdoors play, due to what has been termed a culture based on preventing potential risk to children (Clements, 2004). Buckingham and Willet, (2013) state that this has led to childhood itself and concepts of play changing, being redefined and reconstructed, with indoor ‘gaming’ becoming a more socially acceptable and ‘safer’ form of play. However, decades later now the 90s and millennial children have become adolescents and adults, the effects of such social changes and gaming have been drawn upon to explain individual’s ‘abnormal’ behaviours and mental health, such as in the case of the mass shootings and murders of school children in the Sandyhooks case (Pow, 2012).
Debates however, are evidenced, as to the dangers of labelling gaming as dangerous, with Grifiths, Kuss and King (2012) stating that this pathologises ‘gaming’ itself as risky, assuming from a behaviourist viewpoint, that playing games will automatically elicit a stimulus-response behaviour within an individual, where ‘high involvement’ could trigger an ‘addiction’, or imitation of gaming ‘shooting’ behaviour, as indicated in the Sandyhooks massacre (Pow, 2012; Skinner, 2011).
The DSM criteria (APA, 2013) recently, has offered specific diagnostic criteria in identifying ‘gaming’ addiction, being based on individuals having played video games online or offline, for a period of at least 12 months; although to what extent timewise in this 12-month period is unclear. Consequently, diagnosis also based on a range of behavioural symptoms, which, if shown to be severe, despite some individuals playing only a short time, can indicate addiction to gaming (APA, 2013). Supporting the DSM (APA, 2013) in legitimising and constructing gaming addiction as a clinical disorder and contemporary mental health condition, the International Classification for Diseases ([ICD]: WHO, 1990), utilised by many countries globally, also included ‘gaming disorder’ as a new official diagnosis category.
However, Ferguson, Coulson, and Barnett, (2011) in a meta-analysis examining pathological gaming prevalence, challenges the social construction of gaming as a recognised mental disorder, suggesting its construction may be economically and politically motivated, as developing treatments can be financially lucrative to health care providers, in order to attain increased funding from budget holders. However, there are fears that individuals accessing services may receive unequal treatments, due to gaming addiction being represented and diagnosed differently depending on whether the ICD (WHO, 1090) or DSM (APA, 2013) is used (Grifiths, Kuss and King, 2012). For example, the DSM criteria assumes a biomedical view, that biological and psychological mechanisms underpin gaming addiction, drawing on similar biochemical dose-response effects in the brain, as substance misuse; triggering dependency and thereby addiction (Cleary and Thomas, 2017; Grifiths, Kuss and King, 2012). In contrast the ICD, focuses on the impacts of gaming on the individual’s life, examining social and environmental factors, which reveal contradictions in how each conceptualise gaming addiction as occurring, based on either individual physiological or environmental effects and vulnerabilities (APA, 2013; WHO, 1990). This as a result, indicates quite a large discrepancy between the models, in how gaming as a mental health illness and its impacts on the individual is constructed and thus, seen as best managed (Grifiths, Kuss and King, 2012).
However, whilst diagnostic criteria attempt to categorise individuals’ observable symptoms and experiences of gaming addiction, research does not support that gaming can be so categorically defined, as ‘gaming disorder’ as a condition, is shown to be an unstable criteria (APA, 2013; Grifiths, Kuss and King, 2012). Research reveals that testing at different points of time, can show initially a gaming disorder, which then disappears, revealing symptoms that can shift daily according to how much time gaming that day has been spent (Grifiths, Kuss and King, 2012).
Since the year 2000, there have been many empirical studies undertaken studying the effects of video game addiction (Kuss and Griffiths, 2011). Much of this literature suggests that there is a gender bias to the negative effects of playing video games, with adolescent males and young male adults, being most at risk of experiencing mental health issues, although this may be due to the form of video game that boys may play, such as violent, shooter games, which have been shown to trigger more aggressive behaviours in players (Grifiths, Kuss and King, 2012). Many studies that have been undertaken however, share key methodological issues, such as sampling bias, in selecting known children that play video games more frequently than other groups, therefore unable to attain a true effect, as some participants may have fostered a growing resilience to the effects of the gaming, which impedes the reliability of the findings (Grifiths, Kuss and King, 2012; King Delfabbro and Griffiths, 2011).
There is however, despite known methodological limitations, a large body of empirical evidence that does corroborate that gaming for long periods of time does pose negative consequences for the individual (Grifiths, Kuss and King, 2012; Kuss and Griffiths, 2011). Studies reveal that individuals will stop engaging in interests they once enjoyed, skip school, work and socialising, to continue playing (Yee, 2006); experience loneliness (Lemmens Valkenburg and Peter, 2011), and perform poorer academically (Jeong and Kim, 2011). Individuals can also experience aggressive behaviour (Chan and Rabinowitz, 2006), as well as suicidal ideation (Rehbein Kleimann and Mossle, 2010). Additionally, physical effects include risk of epileptic seizures (Millett, Fish and Thompson, 1997) and obesity (Shimai et al. 1993). Hence, there is sufficient evidence to indicate that playing games excessively can greatly impede the holistic health of an individual, whether or not this is identified as an actual addiction.
Research has however offered strong evidence of gaming addiction being associated with existing comorbid disorders, such as attention deficit hyperactivity disorder (Han et al. 2007; Batthyány et al. 2009), generalized anxiety disorder, depression, social phobia and school phobia (Batthyány et al. 2009), which offers support that ‘gaming addiction’ may be a behavioural manifestation of an already diagnosed or undiagnosed condition (Grifiths, Kuss and King, 2012). Thus, some individuals may possess a comorbid vulnerability to be more likely to experience the negative effects associated with gaming. This does raise questions as a result as to whether gaming addiction actually exists as an actual addiction and condition, or whether it is merely a symptom of behavioural effect associated with other comorbid conditions and as such, whether it should have its own classification in diagnostic frameworks (Grifiths, Kuss and King, 2012; Yellowlees and Marks, 2007). A health prevention and promotion approach as oppose to a diagnostic and deficit approach to addressing the potential negative effects of gaming on individuals, may be a better approach, in aiding individuals to understand that they may have an increased susceptibility to the effects of gaming, so that individuals can be active in minimising their game playing time (Naidoo and Wills, 2016).
In conclusion, the essay has demonstrated that gaming addiction is a contemporary socially constructed mental health condition, which reflects how modern socio-cultural and political influences shape individual health and medical knowledge. However, the ways in which the DSM and the ICD has conceptualised gaming addiction is quite different, with the DSM emphasising the effects upon individual psychological and biochemical neural changes, which perpetuate and reinforce the addictive behaviours. In contrast, the ICD conceptualises gaming addiction, in terms of its impact on social and individual functioning, to support people to make changes in their lives, to change their social conditions and behaviours. As research however reveals, the negative effects associated with gaming, may be linked to vulnerabilities associated with pre-existing mental health conditions, such as depression and anxiety, and this raises the issue therefore, of whether gaming should be treated as a sperate condition, or whether it can be a manifestation and symptom of an already existing and categorised mental health . Ultimately, this area is still in development and as such it is difficult to fully determine how this are will progress, although further research is needed.
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