Smoove_B wrote:Interesting. Well it sounds to me (in my uneducated medical opinion) that making internet or internet gaming addiction a separate defined illness isn't really the issue -- it's recognizing that it might be the particular "trigger" for someone with Impulse-Control problems.
But I guess that's not "sexy" enough for media outlets.
And of course, today's news about how a teen in China
killed one parent and wounded the other when he was denied money to go to a cyber cafe.
I really do think that your word "sexy" is a good one here. As I indicated above, I think that the AMA's announcement is at least partially political--we've discussed many examples of the "video games are the debil" mindset in larger society on both OO and GG. Now that a broader subset of the population is at least briefly having exposure to interactive digital entertainment, those with political agendas against it are foaming at the lips. Whether this foam is due to anticipation of scientific accolades, media attention, federal dollars, or righteous indignation, I couldn't say. It's probably all of the above.
If I could be permitted a personal and professional rant, the issue we're discussing and others like it arise because of all of the above phenomena, plus a genuine (if misguided and ill informed) desire to help people. Let me explain myself here, starting with a little bit of history.
The American Psychiatric Association, in conjunction with the American Medical Association and in the last few decades the World Health Organization, has a large committee that sits down every 5-10 years and starts to decide what conditions are going to be included in the next issue of the mental-health diagnostic manual, the
DSM. TThe first version of the DSM (published in 1952) was just over 100 pages long and had just over 100 conditions listed in it. Diagnosis was a rather esoteric process based on Freudian, Jungian, and Adlerian psychodynamics (various combinations of the old ideas of id, ego, superego, the unconscious, dream interpretation, psychosexual stages of development, etc.) The current version is a text revision of the 4th edition published in 2000, and weighs in at just under 300 conditions and over 800 pages. In addition to the increase in weightiness of this tome, a major conceptual shift occurred between the first and current editions: instead of the diagnostic conditions consisting of esoteric conjectures about quasi metaphysical substructures and processes in the psyche, they now are conceptualized as biomedical conditions and diagnosed based-at least in part--on observable behavior.
These differences beg
at least two questions: 1) Why the increase in the number of diagnoses?; and 2) Are these conditions really biomedical conditions, in the same sense as pneumonia , for example? In my opinion, it is the answers to these questions that are the source of controversy in issues like the one in this thread. So lets look at a non-exhaustive list of the
potential answers to both of these questions. I'm not saying these answers are correct, I'm just saying that they're hypotheses that fit the observable data. An additional caveat: these are not ideas that I'm making up as I go along. These were discussed extensively during my training and have also been hinted at by other OO members (I get the impression that Captain Caveman, Miss Taken, and Freezer may be able to chime in on this topic). Numerous references to these ideas can be found online, in reputable texts, and legitimate peer-reviewed journals. Citing these references would take me forever, so I'm going to forgo linking citations. If that means you want to lump me in with the tin-foil hat brigade, do what you've got to do. But I encourage everyone interested in this topic to look around for themselves--you'll find that these are
not fringe ideas.
1) Why the increase in the number of diagnoses?
-Maybe as a species, humanity is becoming more mentally disordered in a wider variety of ways.
-Maybe we're refining our understanding of the ways that human beings are capable of becoming mentally disordered.
-Maybe mental disorders are not any more common. Instead, maybe more individuals who struggle with them are willing to come forward and discuss their experiences
Thus endeth, in my opinion, the most obvious "nice" answers to this question. Cometh the "cynical" answers:
-Maybe psychiatrists and psychologists need publications for their professional development, and nothing's sexier for publication than the "discovery" of a brand new disorder--especially when you can attach your name to it.
-Maybe pharamceutical companies can profit from the "discovery" of new disorders by marketing brand new substances to treat them. Maybe many of the professionals who sit on the above committee have, in the past, been found to have financial links to these same pharmaceutical companies. To paraphrase the eminent scholar Chris Rock, "the money's not in the cure, the money's in the medicine."
-Maybe a diagnosis serves to further the disenfranchisement of a minority group to serve a political agenda. The most notorious example of this was the inclusion of homosexuality as a mental disorder in the DSM between 1968 and 1973.
-Maybe high-profile news stories about shocking human behavior are so profoundly disturbing to most of the population that there is a motivation to pathologize the behavior. After all, it's more comforting to state with some certainty that there is something qualitatively different about humans who engage in shocking or upseting behavior than to acknowledge that many of us might be capable of similar behaviors under certain circumstances.
2) Are these conditions really biomedical conditions, in the same sense as pneumonia, for example?
This is a tougher question to answer than you might think. Many of my medical and psychiatric colleagues would unabashedly answer this question in the affirmative. So would much of the general population, largely due to the educative efforts of the above professions over the past several decades.
Many psychologists, however, argue against this point. Sure, it's better to call mental disorders "diseases" than some of the other labels society has used in the past ("demon possession", "examples of racial/sexual inferiority", "the result of imbalanced humors", and "the result of an unresolved desire to kill your father and have sex with your mother" are some of the more charming ones). Many of the psychologists I trained with prefer the term "disorder" to describe these diagnoses, in an attempt to avoid a process they refer to as "reifying the diagnosis". This process occurs when one mistakenly attributes the presence of signs or symptoms to the presence in the patient of a discrete pathogenic condition.
Reification, I would argue, is
not a mistake for many purely physical and infectious diseases. Take pneumonia for example. One of the numerous vectors for infection gets in your body, overwhelms your immune system, and starts to grow. As a result the following signs/symptoms begin to present themselves:
-fluid fills your lungs
-you cough a lot, and this is exacerbated by long periods of lying down
-your chest hurts
-fever develops
-you feel fatigued
-others can develop similar symptoms if exposed to you in ways that put them in contact with the pathogenic vector
etc.
It is absolutely conceptually correct to make the statement, "These symptoms are showing up because the patient has pneumonia." A pathogen or a mechanism malfunction has shown up in the body, and is producing the effects. This kind of observation of signs and symptoms and inference of the contributing factor is at the heart of diagnosis within the biomedical model. Further, unless the pneumonia kills the patient or other complications such as comorbidity or age related factors are present, removal of the pathogenic vector alleviates pneumonia (at least until reinfection) in virtually all patients.
Let's look at a common mental disorder, major depression, to see why reification is a mistake for many mental disorders. The following are "signs/symptoms" of major depression. Five or more of these must occur, more days than not, most of the day, for at least two weeks:
-you feel sad and maybe cry
-you lose interest in pleasurable activities
-you feel worthless, hopeless, and/or guilty
-your sleep patterns change
-your appetite changes
-you feel fatigued
-you have difficulty concentrating or focusing your attention
-you feel restless and "sped up" or, conversely, "slowed down"
-you think about, plan, or execute suicide
The difference, here, is that the best science we have on depression (and indeed, most mental disorders--exceptions include mental retardation due to Down's Syndrome, and many of the dementias) suggests that the "cause" of them is not purely an outside pathogen or mechanism malfunction in the body, but rather a combination of factors. Psychiatrists and neuroscientists have been looking for one or more physiological markers for depression that would indicate a pathogen or mechanism malfunction for years, and been unable to find one that can be given causal status in the way that the microorganisms that produce pnuemonia can be said to cause that disease.
Yet.
It's at about this point in the discussion that someone usually chimes in with something to the effect of, "You're wrong, Doc. Depression is caused by low serotonin levels in the brain. Period." Twenty-five years ago, the same statement was made about another neurotransmitter, norepinephrine. The problem is, we've have not demonstrated this assertion causally, to the exclusion of other factors. What we have observed is that
some patients with depression, when they take an agent that is thought to maintain the presence of serotonin (or norepinehrine) in the synaptic cleft for longer periods of time, report feeling better. This is a correlational observation at best.
Am I saying the biological processes play no role in mental disorders? Not at all; I'm merely asserting that they are not the primary, exclusive cause of these disorders. Am I intimating that people who are depressed aren't really suffering? Not in the least. My point is that it is conceptually
incorrect to make the statement, "These symptoms are showing up because the patient is depressed." Because of the lack of a discrete pathogenic vector or mechanism malfunction that can be assigned causal status, it is more accurate to state, "this collection of observations can be termed, for the sake of understanding and convenience, major depression." The minute we find such a marker conclusively, I'm willing to change my opinion.
PHEW! I need a life. I've spent two hours of my Saturday morning typing this rant. I'll wrap up now by making my final point:
I believe that controversies about the inclusion of collections of behaviors (like compulsive gaming) as a new "disease" stem from more than the process in which we learn more about "The Truth" of the world around us and active resistance to the acknowledgment of this "Truth". These issues are controversial because of disagreement as to what a "disease" is and the effect of various political motivations on the development of diagnostic categories. Hence, my statement that the AMA's proposal "at least partially political". Thanks for reading my rant.
"The ever-increasing disconnect between objective reality and popular belief is one of the more frightening things about modernity." -Ironrod
