It’s a brilliant day in suburbia. In one backyard, winter sun sparkles on a well-tended vegetable patch, bordered by lavender. Nearby orange trees, still full of fruit, have generated a surplus of marmalade this season. A young dog chases itself around the lawn.
It’s an idyllic setting, and home to average people who could be neighbours, relatives, a family from school: two parents, two teenagers. Big doors open up from their living room onto the garden, their dog coming and going as she pleases.
Daniel*, the father, is looking around the room and remembering a night three years ago. “I came home about 9:30 at night, and everyone in the house was cowering in the corner. I came into this back room and chairs were thrown around, everything was smashed,” he says.
“And it was because we had stopped [our son] from being on the device.”
It was the start of a period of immense difficulty for this family, in which their young son reacted violently over many months to their attempts to limit his time playing video games. He was in the midst of what they, and his psychiatrist, consider to be a gaming addiction.
When *Emma and *Daniel's son started high school things started to unravel. Photo: Insight Source: Insight
Daniel and his partner Emma* are speaking with Insight about their experience, as the show explores the highs and lows of video gaming, and debates the recent inclusion of ‘gaming disorder’ in the World Health Organisation’s (WHO) most recent edition of the International Classification of Diseases (ICD-11).
Their identity has been anonymised to protect the privacy of their young son, who has given his permission for them to speak to Insight.
In early 2015, their son started Year 7 at the local public high school. He was a “relatively normal kid”, they remember, with average NAPLAN results and who liked to play soccer. Previous teachers had suggested he be checked for autism spectrum disorder, and other behavioural disorders, but he didn’t quite meet the diagnostic criteria. Throughout primary school he hadn’t been allowed a phone, or his own device.
“He didn’t really cope with the transition to high school,” says Emma. “The high school had a policy of ‘bring your own device’, so he was immediately exposed to a device that was very difficult to manage on our part and on his part.”
For the boy who sometimes found social situations difficult and avoided large groups, new worlds began to unfurl in games he’d never been exposed to before: limitless lands to explore and build upon in Minecraft; heroes to control and battles to be won in Overwatch.
Emma suspects the games were filling a void for him. “They are a place where he feels comfortable,” says Daniel. “Whatever was causing him to want to get into them in the first place, there’s so much in that world that’s keeping him there.”
Within a couple of weeks of starting school, he was consumed by these games, Daniel and Emma say. If he wasn’t playing them, he was constantly thinking about them, pulled deeper by the adrenaline, competition and camaraderie.
‘Gaming disorder’ has been included in the World Health Organisation’s most recent edition of the International Classification of Diseases. Photo: AAP Source: AAP
When they tried to put restrictions in place, he would react with anger, and physical violence. When his device was taken away from him, he would rage for hours into the early morning. Exhausted from so much emotion, he couldn’t get up for school the next day. Eventually, he refused to go altogether. Each morning, Emma or Daniel would pack the modem into their car and take it to work, trying to limit his play during the day.
“There was a point where none of us really wanted to come home, we were all so anxious about what was going to happen, and we knew it was going to be a long night,” says Emma.
At crisis points, in shock and with shame, says Emma, they called the police - five times in total, during that period. He would respond well to their authority, and the local police were sympathetic to their situation.
“There was probably about a year we were just terrified of the physical violence he would play out on us.”
Gaming disorder
The WHO’s decision to include ‘gaming disorder’ in the ICD-11, which was released in late June 2018, has been much debated. It defines the condition as “a pattern of gaming behaviour characterised by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.” It will normally have been present for at least 12 months.
Proponents say it will bring about a clear diagnosis - and with it, discrete services - for those struggling to manage their gaming habits. The ICD-11 will be used in hospitals and by GPs around the world, including in Australia, from 2022.
But some argue there isn’t sufficient research to justify including the disorder, particularly as a stand-alone condition, and have expressed concern it may be “more moral panic than good science”. Further criticism has been raised around whether or not gaming disorder is, rather, a symptom of other underlying mental health conditions. Others say there isn’t consensus around diagnostic criteria for the disorder, and that its inclusion may stigmatise healthy gaming.
In response to this, a spokesperson for the WHO told Insight that there was sufficient available evidence for the inclusion of gaming disorder in the ICD-11, and that it “reflects a consensus of experts from different disciplines and geographical regions.”
The WHO also pointed to the development of treatment programs for people with health conditions “identical to those characteristic of gaming disorder” around the world, as laying the groundwork for inclusion of the condition.
The organisation acknowledged that in many cases of the disorder, there would be comorbid, or co-occurring, conditions, and that “significant changes in the pattern of gaming behaviour can be a manifestation of another underlying mental or behaviour disorder.”
Philip Tam, a psychiatrist who treats young patients struggling to manage their gaming, acknowledges the WHO decision has been contentious, but is convinced it’s a legitimate disorder.
“It can cause clinically significant impacts for some people,” he tells Insight host Jenny Brockie. “[It] is an endpoint result of a whole range of underlying conflicts, and it does take a lot of time to tease that all out, but I think on balance, I think it’s a good step that it’s recognised as a disorder because a lot of parents and families are, frankly quite desperate for help.”
“It boils down to: are you in control of your internet or gaming use, or is your internet or gaming use in control of you?”
Jocelyn Brewer, a psychologist who specialises in technology, is concerned gaming disorder is pathologising a hobby that, for the majority of people, has a positive effect on their lives.
“My concern would be around, specifically, diagnosing young people with addiction and where that fits into their health history especially when we’re talking about data and MyHealth,” she adds, during the Insight discussion.
Turning a corner
By the end of 2015, Emma and Daniel’s son had been referred to a psychiatrist, after a particularly violent episode. They made headway in addressing some now-identified underlying conditions - attention deficit disorder, and intermittent explosive disorder - but a path away from his obsession with gaming remained elusive.
“I took a long time, finding the right help,” says Emma. “I think maybe the problem was, there was no diagnosis … there was no other thing that anyone could explain [his gaming] behaviour with.”
“Now that we’ve moved to another psychiatrist who really does see gaming addiction as a condition,” says Daniel, “it looks like our son’s engaged with that person better, and actually does seem to recognise there’s something there.”
“We talk about it as an addiction, and our son doesn’t really disagree with that - he thinks he probably is addicted.”
They think their son, who’s now 15, has turned a corner in the last few months. With the psychiatrist’s help, and a family friend acting as mentor, he’s returned to school and is starting to self-regulate his gaming time.
“He is actually starting, for want of a better word, to grow up,” says Daniel. “I think he’s actually starting to see that he doesn’t really want this to continue forever.”
The WHO points to research that gaming disorder is likely to only affect a small portion of gamers, and Emma agrees that many people will have no problem managing their gaming habits. She wouldn’t want the diagnosis to be overused, or misused.
But the impact of their son’s condition on their family has been profound, particularly on their other child, just a few years older. They stress their love for their son hasn’t changed, but it’s been a difficult three years.
“We talk about it as an addiction, and our son doesn’t really disagree with that - he thinks he probably is addicted,” says Daniel. “And having a psychiatrist who recognises that, and possibly has the support of the WHO guidelines, will probably make treatment more acceptable and available to people.”
