Is video game addiction real?
The recent decision by the World Health Organization (WHO) to classify gaming addiction as a mental health disorder for the first time has ignited debate over the point where an innocent hobby turns into harmful dependency. Do we have a modern epidemic on our hands, or have things been blown out of proportion?
Julian Nowak has no specific recollection of when he first started gaming, but he can trace back the thrill to playing alongside his father on the PS1, the first incarnation of the PlayStation.
Little did Nowak know back then that this innocent father-son bonding activity, soon-to-be personal hobby, would cross over into the territory of addiction and almost cost him his job as a young professional.
It was one game, in particular, that Nowak couldn't get out of his head: Football Manager, the football-themed simulation game, in which the player is afforded the opportunity to lead their favourite team to glory in an alternative cyber universe. The game is said to be so addictive that it has been cited in a number of divorce cases in the UK.
For Nowak, the compulsion to play was gradual. At first, it encroached ever so slightly on his sleeping pattern: he would get up an hour or so earlier in the morning for a quick game. Soon, he was playing from the moment he got home from work at 7 pm until around 1 am. Meeting friends took a back seat in order to slake the urge for 'a heavy weekend of gaming'.
Things came to a head last December, when 26-year-old Nowak, a content executive, based in London, was called into a meeting with his boss, who had noticed an inordinate amount of sick days taken by his colleague. Football Manager had, at this point, taken precedence to such an extent that even the notion of a career had become secondary.
Rather than attempt to fudge the issue, Nowak admitted there and then that he had a problem.
"I admitted I was playing Football Manager," he recalls. "Even when at work I found myself playing on my phone, planning my team, or planning my team tactics."
Thankfully for Nowak, his management listened and "worked out a way for me to ease off the game" and resume his role. "I'm very relieved not to have lost my job," he says.
Such stories are no longer unique, or serve merely as curious tabloid fodder. Stories of the effects of gaming addiction circulate across all walks of life, from children to adults, country to country.
Last year, Australian snooker champion Neil Robertson admitted that an addiction to FIFA and World of Warcraft had drastically impacted on both his professional and personal life. The problem of addiction amongst teenagers has become so much of a concern in South Korea that in 2010 the government introduced a law banning access to online games to those aged under 16 years, between midnight and 6 am.
More recently, a nine-year-old girl in the UK was reported to have entered intensive therapy due to an addiction to Fortnite, the online multiplayer shooter, which is believed to be the most popular game in the world right now.
An uptick in reported cases of gaming addiction has notably piqued the interest of the WHO, which earlier this year listed it for the first time as a mental health condition, as part of its 11th International Classification of Diseases (ICD).
The question for many is when does an innocent pursuit of playing one's favourite game becoming something more insidious?
"As long as a gamer still has control over when they choose to play, and, critically, when they choose to stop - for example, for a meal, or to sleep - gaming will not have a negative impact on their lives," explains Dr Richard Graham, lead technology addiction specialist at London's Nightingale Hospital.
"They are able to stop playing when other priorities arise, such as eating, drinking, going to school or to work, meeting up with family and friends. However, as soon as the gaming becomes beyond the control of an individual, one enters into the sphere of addiction.
"As with other addictions, the craving becomes so strong that nothing is able to stop it, even though they may try to, and know it is having a negative impact on their lives and on the lives of those important to them."
When the line into addiction is crossed, the impact on daily life - as in the case of Nowak - can be injurious, adds Graham.
"The impact of addiction on daily life can be total and massively disruptive to ordinary life," he says.
"In the case of gaming, the addiction becomes so invasive that it can even take priority over basic needs, such as sleep, eating and drinking. I have seen patients who have become seriously dehydrated because the gaming has prevented them from finding time even to drink a glass of water. It can be all-consuming, and so powerful that basic needs and drives are suppressed."
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Internet addiction clinics
Serving as a testament to growing societal concerns, June saw the announcement that the NHS is to launch its first ever internet addiction centre. Known as the Centre for Internet Disorders, the centre - run by the Central and North West London NHS foundation trust - will focus initially on gaming disorders.
"The main issue here is the loss of control," says psychiatrist and addiction specialist Henrietta Bowden-Jones, who is heading up the new clinic.
"If harm is being experienced from the long hours of play leading to neglect of one of several life areas - whether it be academic, relationships, or your job - then it is time to cut down or indeed stop.
"Gaming addiction leads people to neglect previous commitments and roles, such as doing their homework or even going to school once the disorder is severe. People have dropped their favourite hobbies and sporting activities to prioritise gaming over everything else.
"They become isolated and tend to get more and more involved in their online virtual existence and support network."
The WHO's declaration, however, has lit the touchpaper of debate within clinical circles over whether gaming addiction should be seen as a mental health disorder or not. Jan Slater, a Harley Street counsellor, sees the WHO's findings as valid.
"As a professional working with clients in various degrees of distress, I recognise there are many activities where people can lose stability. Gaming can be one of them," she says.
"The term addiction - when relating to gaming - might to some, seem far-fetched. However, any cause that means an individual chooses to prioritise the habit - be it drink, gambling or gaming - over normal healthy behaviours, often risking relationships and neglecting self-care, can be recognised as addictive behaviour.
"So, as a therapist, I support the recognition of this behaviour, when taken to the extreme, as an addictive behaviour."
Others aren't convinced. Anthony Bean, a US-based, licensed psychologist and expert on the impact of video games on children and adolescents, believes the addition of 'video game addiction' to the WHO's ICD comes with a lack of sound basis.
"The WHO addition of this diagnosis means that they are saying there is sufficient data to state that there is a gaming disorder," he says.
"However, the largest problem overall is that there is not a good base of understanding video gaming culture and why video gamers play - not many clinicians ask the question 'what makes this interesting for you?'
"Without a base understanding of the culture, how can one make an assumption and diagnose a condition which they do not understand? I don't believe that we need more centres for this as they are going to be treating the incorrect diagnosis."
In what comes as no surprise, the gaming industry is none too happy about the WHO inclusion either.
"Video games across all kinds of genres, devices and platforms are enjoyed safely and sensibly by more than two billion people worldwide, with the educational, therapeutic and recreational value of games being well founded and widely recognised," reads a statement I was sent by a spokesperson from UKIE, the trade body for the country's games and interactive entertainment industry:
"We are therefore concerned to see 'gaming disorder' still contained in the latest version of the WHO's ICD-11 despite significant opposition from the medical and scientific community. The evidence for its inclusion remains highly contested and inconclusive. We hope that the WHO will reconsider the mounting evidence put before them before proposing inclusion of 'gaming disorder' in the final version of ICD-11 to be endorsed next year."
Nowak is in no doubt, however: having been through it himself, the dangers of video game addiction are incontrovertible.
"I'd say it's just the same as alcohol, cigarettes or drugs," he says. "You find yourself thinking about it non-stop and struggle with normal tasks. It's even harder to give up when you have been brought up with it and it has been a big part of your life."
Nowak has vowed never to play Football Manager again. He also refrains from playing games without an end date ("If it can go on indefinitely then there is an addictive appeal to it."), limiting his activity to "the occasional game on my phone".