Inclusion Of Gaming Disorder In The International Classification of Disease
Author: Sharyu Rumde, School of Law, Mumbai University
Abstract
The World Health Organization classified Gaming Disorder as a mental illness caused due to excessive gaming. This inclusion has divided the opinions of people as the decision is both praised as well as condemned. In this article, we will study about this condition and determine the validity of the decision. The World Health Organization in their 11th Revision of the International Classification of Diseases added Gaming Disorder in the group of ‘Disorders due to addictive behaviours’. This inclusion ended up creating quite a controversy as many people criticized the decision. There was a clash of opinions all over the world. Digital and video games are immensely popular amongst the masses. In fact, to such an extent that it is estimated to be more profitable than the movie making business. Gone are the days when video games were a form of entertainment for just kids, with the amount of popularity it has garnered over the years, teens and adults equally divulge in it. However, it has been observed that people end up spending too much time playing these games. To say that people are not addicted to it would be an understatement, as some people have come forward to seek help in order to stop their gaming addiction, but naming it as a disorder and classifying it with the likes of gambling addiction is where the questions start arising.
What is Gaming Disorder?
Gaming Disorder is a relatively new term which is used to signify an addiction caused due to an uncontrollable urge of continuously playing video games which can result in social withdrawal and can even deteriorate a person’s mental as well as physical health.
In the year 2013, the American Psychiatric Association in their fifth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), first coined the term Internet Gaming Disorder. The organization didn’t recognize it as a disorder but instead classified it as a condition which required further study. One of the leading reasons behind this decision was a study conducted amongst a group of individuals from different countries. The study determined that fewer than one in hundred individuals were distressed due to video games.[1] Since then, the organization has been collecting data and researching on this topic, but to this date no concrete data has been found to support the claim that gaming addiction is a disorder.
The World Health Organization, however, has a different perspective. In the 72nd Worth Health Assembly held on 25 May, 2019, the WHO board decided to add Gaming Disorder in their revised version of the International Classification of Diseases (ICD- 11). The description provided is as follows:
Gaming disorder is characterized by a pattern of persistent or recurrent gaming behaviour (‘digital gaming’ or ‘video-gaming’), which may be online (i.e., over the internet) or offline, manifested by:
- impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context);
- increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities; and
- continuation or escalation of gaming despite the occurrence of negative consequences. The behaviour pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.
The pattern of gaming behaviour may be continuous or episodic and recurrent. The gaming behaviour and other features are normally evident over a period of at least 12 months in order for a diagnosis to be assigned, although the required duration may be shortened if all diagnostic requirements are met and symptoms are severe.[2]
While many people are familiar with the cause and effects of gaming addiction, gaming disorder is a fairly new concept. The term itself has been derived in the recent years. The intent of coining this term was to gather more data and arrive at the necessary conclusions to determine the existence of a disorder, but the researchers are far from completing the analysis. The WHO has included this disorder to help people with conditions related to excessive gaming, but many experts argue that the condition itself doesn’t exist. On the other hand, the description issued by the WHO is vague in nature, there are no proper provisions to help determine how they will differentiate between a healthy and an unhealthy gaming style, how they will determine as to who is suffering from this disorder and who is not, how they will provide a proper medical aid to a diagnosed person. Due to this ambiguity, many questions remain unanswered.
Gaming Addiction Laws
Whether or not gaming disorder exists is something which can be debated upon, however the denial of gaming addiction would be a foolish claim. This addiction has affected people from all corners of the world. In the last two decades, there has been an alarming rise of gaming addiction in the continent of Asia. The addiction became prevalent to such an extent that the governments had to formulate new policies and law to control the issue.
- Thailand is said to be the first state where government had implemented measures to help tackle the issue. In the year 2003, the government issued an order which required all game servers (domestic and international) to be blocked between 10 p.m. and 6 a.m.[3] Though the order was issued in good faith, the ban was not implemented as a formal law and ended up lasting for only 2 years until it was replaced with a juvenile non-access policy in Thai Internet cafés.
- China soon became the second country to implement measures as in the year 2007, the government implemented a regulation where online game providers were obliged to monitor their users’ playtime and discourage underage users from playing for prolonged periods. The registration was to be done with a person’s real name and identification card number. After 3 hours of gameplay, minors only got half of the experience points, whereas after 5 hours of gameplay, experience points were reduced to zero. In addition, after 5 hours of gameplay a message appeared in every 15 min, warning players that they had entered unhealthy game time and should stop immediately.[4]
- A similar regulation was implemented in Vietnam in the year 2011, when the government asked Internet service providers to block access to all online games between 10 p.m. and 8 a.m.[5]
- The South Korean government soon followed the lead as they didn’t just implement a shutdown policy but rather a Shutdown Law. Under Article 26 of the Juvenile Protection Act, the South Korean government imposed regulation on the online game venue providers to reduce gaming access by teenagers under the age of 16 years of age from midnight to 6 a.m. Any person found contravening this law may be held liable for a punishment up to 2 years of imprisonment or a fine of approximately $9,000 (US). Since 2005, five attempts were made to pass the “shutdown” bill before it was introduced in April 2011. However, the shutdown laws faced strong opposition, particularly from the gaming industry. Prior its enactment in November 2011, the constitutionality of this new law was questioned in regard to the constitutional rights of freedom and equality for youth. After two and half years, the constitutional court of South Korea finally judged that the shutdown law was constitutional.[6]
The implementation of these policies and laws give us an idea about the dangers of gaming addiction. It is a serious issue which needs to be addressed. The ill effects of gaming addiction need to be discussed and people should be made aware about healthy gaming styles. However, all these things can be achieved by spreading awareness. This brings us back to the bigger questions, Are these people mentally ill? Do they really have a disorder? If they do, is it because of the excessive gaming?
Is it really a disorder?
If the disorder is real, why are so many people against it? Surely they must have their reasons to refute a claim made by the WHO. To get a better idea we should try to look at both sides of the coin. While many people argue that mental illness is a result of excessive gaming, they fail to realize that many people turn towards gaming to relieve their ongoing stress. While people complain about the amount of hours their child/partner spends on gaming, they fail to realize that despite of it, they are effectively carrying out their other day-to-day activities. While people argue that gaming causes violent behaviour, they fail to realize that other internal as well as external factors are equally applicable for that behaviour. While people complain about the amount of time wasted on playing video games, they fail to see that the same can be said about social media apps. So, do we classify spending too much time on those apps as a disorder? Do we try to understand the main intent behind a person’s behaviour or the main reason behind a person’s mental stress? If the answer to all these questions is in negative, then on what basis are we classifying gaming addiction as an addictive mental disorder?
Andrew Przybylski, a psychologist at the Oxford Internet Institute who has extensively studied video games and mental health says, “You could easily take out the word ‘gaming’ and put in ‘sex’ or ‘food’ or ‘watching the World Cup. We know how opiates and nicotine work and what makes them addictive, but we don’t know the same for games. The gaming disorder definition says nothing about what kinds of games or what features of games might be addicting, and so it’s too broad to be helpful. It’s just stating that sometimes people who play games play them too much. This could be true about any activity and such an attitude could lead to a kind of pathologization of every aspect of life.” “It’s undeniable that there are people who suffer because they play too many video games”, says Michelle Colder Carras, a public health researcher at Johns Hopkins University focused on the problematic use of technology. But she argues that these people usually can get psychiatric treatment under a more general diagnosis like depression or anxiety.[7]
The lack of research on this topic is due to a lack of substantive proofs. The addiction is a result of many factors which can be treated but that doesn’t make it a disorder of its own. The studies conducted have always been inconsistent, no two studies have ended up showing a similar result. Merely studying a group of individuals won’t accomplish anything. The controversy created over this decision is for a reason, the lack of proof clearly shows that the experts know very little about this topic. They are still studying, they are still analyzing, and they are nowhere near to draw a final conclusion.
Conclusion
Gaming Disorder is a new concept, a concept which needs to be studied for years to come. By claiming video gaming addiction as a mental disorder and comparing it with the likes of drugs, alcohol, gambling, etc. seems a bit far stretched. There is no proof that this disorder exists. The studies have only just begun and there is no breakthrough to make a claim of this nature.
The WHO aims to treat this disorder but as there is no diagnostic criteria, how they are focusing to achieve it is something worth pondering upon. Similarly, there are many such uncertain aspects in their recent inclusion. Another important aspect that the organization has failed to address is that many people are professional gamers, they earn their living by playing games for hours at stretch. Under what category would this people fall as gaming is their profession and by playing games they are simply doing their job?
The inclusion of gaming disorder in the International Classification of Diseases is not a wise move by the WHO. The lack of proper evidence, the proofs to rebut their decision, the lack of diagnosis and treatment are few of the many reasons which shows the haste of the organization while arriving at this decision. Maybe in the near future gaming addiction will be recognized as a disorder, but today’s not the appropriate time for making that claim. The experts have a long way to go with their research, we will have to wait to find an answer to this question but till then claiming gaming disorder as an illness is not the right answer to this question.
[1]Gaming Disorder: Is It a Real Illness?, The Clay Center for Young and Healthy Minds, https://www.mghclaycenter.org/parenting-concerns/gaming-disorder-is-it-a-real-illness/
[2]6C51 Gaming disorder, ICD-11 for Mortality and Morbidity Statistics (Version : 04 / 2019), https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1448597234
[3]Thailand restricts online gamers, BBC News, http://news.bbc.co.uk/2/hi/asia-pacific/3054590.stm
[4]The more they play, the more they lose, People’s Daily Online, http://en.people.cn/200704/10/eng20070410_364977.html
[5]Vietnamese Gov’t Puts Curfew On Online Gaming, Gamasutra, https://www.gamasutra.com/view/news/33143/Vietnamese_Govt_Puts_Curfew_On_Online_Gaming.php
[6]Policy responses to problematic video game use: A systematic review of current measures and future possibilities, NCBI, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6426392/#:~:text=Fatigue%20system%20(anti%2Donline%20game,from%20playing%20for%20prolonged%20periods
[7]Here’s why experts are skeptical of the ‘gaming disorder’ diagnosis, The Verge, https://www.theverge.com/2018/6/19/17479318/gaming-disorder-who-psychology-video-games-science
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