American Psychiatric Association Joins the Fray

A week or two ago (okay, confession: I am delinquent on blogging this), Kurt Squire & I participated in an 'issues workshop' at the annual conference of the American Psychiatric Association entitled 'OnlineVideogames: Psychopathological or Psychotherapeutic?' I was surprised to find that this was the first time the topic has been formally broached by APA clinical psychiatrists, especially given the amount of air time (and anxiety) given it by the industry (e.g., Damon Watson's session at GDC this year entitled 'Massively Excessive: Addiction or Irresponsibility?'). Either way, these folks may very well be the new face of the movement to 'medicalize' the issue of mmoging.

Here's a barebones (mildly editorialized) overview...

Introduction
by Jeffrey Wilkins, M.D. @ Cedars-Sinai Medical Center [Co-Chairperson]
Dr. Wilkins, one of the main forces behind the symposium, .... uh, well, introduced everyone. And made the point that the claim that 'online videogames matter' is obvious...

Ultra-Brief History of Online Videogames
by William Huang, M.D., Cedars-Sinai Medical Center
Dr. Huang gave a hyper-condensed summary of historical and economic significance of the internet, videogames, and online videogames - the 20 minute version. Way too much for me to blog and mostly known by this fair community.

Internet Addiction and Gaming
by Dr. Maressa Orzack, Harvard University
Dr. Orzack's first main claim was that MMOG addiction & internet addiction & computer addiction are all same thing. Then it got ugly - a few highlights follow...

Symptoms
* The need to use the computer to experience pleasure, excitement or relief.
* Loss of control when not on the computer resulting in anxiety, anger, depression (She then told a horror story about some teenager playing EQ who, after dying online thanks to an interruption from his younger brother, became so furious that he threw the little tyke down the stairs, ending with "Thought that would give you an example on how strong urges can be...")
* Craving the newest hardware or software (OMG I'm 3 outta 3)
* The need to spend increasing amounts of time or money on computer activities in order to get the same effect.
* Lying about the type of activity
* Lying about the amount of time spent
* Risking the loss of relationships with family and friends (Then she told another horror story about an unemployed dad at home forgot to take care of his two kids, ending with "need i say more.")
* Jeopardizing financial, career, or academic goals (thank god I get paid to game)
* Failure at efforts to stop compulsive use
* Physical health suffers (She then told about a patient she had who used depends in order to stay at the game screen. And for the first time ever, I thought 'yes, there is such a thing as mmog addiction.)

Do you suffer from five or more of these symptoms? Then you suffer from addiction. *cough gasp ahem*

Characteristics of users at risk
* social phobias
* shyness or low self esteem
* other addictions
* unemployment
* Aserger's syndrome

Associated behaviors
* Instant messenging
* blogging... (with vivid 'depends' example in mind, I stopped taking blog notes on this talk here)

Videogames and Violence
by Stephanie Steward, MD & Henrik Zakari, MD, Cedars-Sinai Medical Center
Dr. Steward asked the $64k question that seems to come up, at least in my experience, every time I talk about games to those who don't play: Do videogames with violent themes influence behavior? Unlike the media, however, she gave a fairly fair and balanced discussion to both sides of the debate. The only problem, in my small opinion, was how she defined the sides. In the one corner, she place the "violent videogames teach violence" camp, largely consisting of the military and police academies (and hysterical mothers and news-starving media and Anderson et al. and...); in the other corner, however, she put a lesser known, stranger opponent: a kind of "aggressive play is natural and inevitable... an outlet to deal with violence..." sort of thing (a 'Killing Monsters' kind of take? no reference but seems to be hailing back to Jones & Ponton stuff). Given her subsequent (viewer shocking) display of a screenshot from Postal2, it seemed the notion of what constituted 'violent videogames' in the first place was taken as obvious. What all this had to do with online gaming, I wasn't sure. But, Steward & Zakari's summary of the debate, even if the terms aren't exactly those I recognize (after all, I can come up with several opposing-purported-link-btwn-videogame-and-violence arguments), is certainly worth addressing.

Educational Use of Videogames
by Dr. Kurt Squire & Constance Steinkuehler, Constance, University of Wisconsin
Kurt and I were basically there to talk about the educational possiblities of games. Of course, I shamelessly used it as a platform to criticize the metaphors often used to frame the 'MMOG addiction' issue and argue that we need to consider virtual spaces as a critique on society rather than a critique on gamers [slides 18.5MB]. Kurt then illustrated the range of learning possibilities made available through games and drew a parallel between games and Harry Potter 'addiction,' asking the question, 'how can the formal school system respond in ways that won't render them completely irrelevant?' He then discussed contemporary innovations and issues in game design and illustrated his point with Revolution, a multiplayer game he has been working on with the Education Arcade people at MIT.

Online Videogames in Mental Health
by Jack Kuo, M.D. @ Cedars-Sinai Medical Center [Co-Chairperson]
After this long series of presentations focused on risks & possible benefits, Dr Kuo followed with a discussion of applications: specifically, the use of virtual reality in clinical treatment of various disorders such as phobias, ADHD training, etc. There are some obvious advantages to using VR in such work: consistency of stimuli, hierarchical challenges, greater ecological validity, etc. He ended his discussion with suggestions for how MMOGs might be used for treatments that require features such as group scenarios (such as teamwork training) and not just individual ones. Pretty cool stuff. Quite honestly, if this APA workshop represents the new move toward 'medicalizing' the issue of excessive gameplay, then I want Jack to be the one in front with the flag.