WHO Announces Inclusion of Gaming Disorder as Mental Health Condition

Albeit a tough read, the bet draft of the 11th International Classification of Diseases by the World Health Organisation will be including something termed as gaming disorder in 2018.

We Recognised This With "EverCrack"

While a lot of the gaming community is up in arms over this, whether it be to call it bullshit out of fear that they might be diagnosed with such or out of fear that gamers may use this new diagnosis as a crutch for their gaming habits, I'm personally really glad that what a lot of us have been calling gaming addiction is finally getting the recognition it's needed. Although it's always been somewhere between a joke and a sad realisation, while I was working at SOE, we would call its first flagship game, EverQuest, by a much more dark nickname of "EverCrack" - something the community even used, to acknowledge the sometimes frightening levels of addictive habit some people had with it.

Even in 2001, when I joined the company, we were seeing people who were doing some pretty horrific things - abusing unemployment, avoiding moving out of their parents' homes, neglecting their children - in order to spend as much time on the game as they possibly could and get in either as much progression as they possibly could or as much time with their online friends as they possibly could. Granted, you see a lot more of the extremes when you're working for a game, particularly an MMO; an online game's frontline, their Game Master/CS staff probably gets to see these sort of things in a higher frequency than anyone else, because of what their job entails and the level of inadvertent trust consumers have with them.

Although I haven't been in the gaming industry on that side of the fence at all since early 2006, due to medical issues, I doubt that things have gotten better in that regard. In fact, I'm willing to be that as video games became less of a "niche" and nerdy past time, and moved into the mainstream as a form of escapism, the above became more and more common, and that's the entire reason that this type of addiction is finally getting attention.

The Good With WHO's Listing

Perhaps the best thing about the fact that this is going into WHO's classifications is that the ICD is used by insurance companies around the world to sort out what they'll cover and what they won't cover. Diseases in the ICD are considered real diseases, and thus insurance companies will consider - and for the more part will often - cover the diseases listed there.

So this means that people who have this addiction can get the help they need.

The Inherent Problem with WHO's Listing

Currently, the listing only has the diagnosis, and no treatment for it - which of course is a huge problem. But part of that problem comes from the fact that it hasn't really been considered a real addiction by a lot of people for all of this time. We technically could go back past the advent of MMORPGs, when it really became noticeable due to how much the genre grabbed more people into video gaming, but the attention really kicked up after online gaming became a thing. But for all the attention that's been kicked up, not enough has been kicked up for any sort of solid treatment that is acceptable enough across the globe yet.

There are a few different programmes that have been developed for kicking online gaming problems and general online habits in China and South Korea that could be looked to as a basis, however they are incredibly strict compared to what Western countries are used to, and this is likely why none of these programmes were included in the draft; I still think these programmes still can be used as a jump point for Western nations to build off of, because in some cases, they will have to get pretty strict to help break the addiction.

In other cases, the addiction can be more like what we see in gambling addiction - or exactly like it, with how a number of games have turned towards gambling like mechanics over the past couple of years with either the Pachinko style "Gatcha" mechanic or with the now amazingly controversial "Lootbox" system. Although the gambling addiction methodology can work for more than just these two styles of games, they're likely going to be key to beating out the addictions to "Gatcha"/"Lootbox" games.

CNN Made a Point - Lining Everything Up

I originally found out about this after waking up from trying to sleep off this damn sinus infection I have in Rhykker's weekly summary video; Rhykker does a fairly good job at covering the issues gamers are going to have with this happening in the video there, and the video itself has a table of contents at the start to direct everyone to his coverage of the issue.

Of course, since this has been a bit of an on again/off again concern of mine for sixteen years, I went poking around the internet right off, but surprisingly entering in "WHO gaming addiction" didn't bring up the draft right off - I got a tonne of news articles on it, and a lot of them weren't exactly too many steps above angry gamers basically already arguing the points Rhykker predicted they were going to be arguing about.

So I ended up deciding that since the Guardian wasn't covering the story (yet), the least click-bait option was CNN's coverage on the matter. It was there that I found the link to WHO's ICD listing directly, and a surprisingly calm coverage about the whole thing. As well as a secondary subject that does merit some food for thought in the US - and possibly other countries in the West as well.

In the US, we already have something called "Internet Gaming Disorder". It's in the DSM currently, but it has been very heavily criticised as it is built around substance abuse disorder...which doesn't really fit what I have seen happening with people at all, "EverCrack" jokes aside; they would have been better off using gambling as a basis for it, because it's more physiological, where most substance abuse runs towards chemical dependence.

CNN points out that the WHO's "gaming disorder" is more along the lines of gambling, insomuch as it looks as to whether or not gaming is disrupting a patient's life - which is exactly what I was seeing happening when I was getting glimpses of different customer's lives while working at SOE and later at SEGA, and occasionally have seen since with random people in the various gaming communities I've been in as a player.

Stand Alone Complex

The rather "naysayer" in the CNN article I believe is wrong about there not being a gaming addiction issue, however he's likely right that it doesn't manifest alone. It's likely very rare that gaming addiction shows up 100% by itself. There's likely always something else that pairs with it - gaming is, after all, an escapism outlet. So there's going to be something like depression or anxiety or PTSD or a host of other things that could be co-morbid with it or have been a trigger for it.

Looking back, almost every instance where someone seemed to be addicted to a game, they had something else going on in their life that could have set them up for it, even if it was something really subtle. In the cases where it seemed like a parent was neglecting their kid(s), these were really young parents - most of them in their young 20s or younger - who probably weren't ready for it and likely just not even aware of what they were doing. One person I talked to who spent all of their time in EverQuest was a shut-in, so they may have had depression issues. The theory that one thing leads to gaming addiction isn't too far fetched.

System Failure

But this brings me to another huge beef I have with mental health - it doesn't adapt all that much with the changing world. It wants to stick hard and fast to the things that have been there for centuries and decades, and that can actually be just as damaging. A lot of the mental health conditions were created before most of our current technology existed, and haven't been adapted to include them, and I think that's a huge failure of the mental health system - I don't think that's anything that the philosophical minds behind mental health ever thought would happen or would ever have wanted to happen with their ideas.

Personally, the fact that it's been twenty eight years since the WHO updated the ICD is appalling to me. The fact that the DSM only gets updated about every nineteen years, with it's supplemental update coming in at six years after its main update then still leaving thirteen years till the next edition, is appalling to me. Major health documentation shouldn't go that long without being updated. A decade is a bit questionable with how much we learn about the world around us and how much technology updates now-a-days.

In relation to mental health, it's also an uphill battle to get anything updated, because as mentioned, they don't adapt well in that arena, even though in the past several decades alone, we've had so many technological breakthroughs and social changes, the world around is is nothing like it was. There's probably a lot in the DSM that is actually so outdated simply because the conditions that create it aren't there anymore, but the mental health industry can't accept that the world isn't the same and it needs to be changed...

Conclusion

Overall, I really hope that the people who are actually affected by gaming disorder can start getting recognised as having such after the WHO's ICD update, that the gaming community can accept that there are people who are truly irresponsible about their gaming habits and that this diagnosis is needed - and that some people will be jerks and try to use it as an excuse but that it doesn't mean that they should be insensitive jerks about its existence, and that maybe the health industry - and particularly the mental health industry - can get better about adapting and updating with the world around them; sure, clinical trials and such need to be done, but that doesn't mean that updates to things like the ICD or DSM need to wait 20 - 30 years for each edition - over-documentation is better than under-documentation, so updating these things once a decade would be far better.