Is it Really a Mental Disorder?

Outside, a flock of young boys always cower at the entrance, excitedly waiting their turn. Inside, about 5-6 young boys sit transfixed to the screen, playing, twitching and punching the air as they furiously press buttons on their controllers.

“The only time I am not here playing a video game is when I am in school or if there is a power cut. I like to play actions games which take a lot of time and I don’t leave a mission midway,” said Vishal.

An 18-year-old student, Vishal spends about seven to eight hours every day at the gaming parlour, much to the concern of his father who runs an electrical shop and worries for the boy’s future.

Hundreds of kilometres away in an opulent neighbourhood of Delhi, six young men gape at their laptop screens playing Dota. Occasionally, one of them stretches their back or breaks into profanity as a deluge of cigarette butts and half eaten fast food packets threatens to flood.

For these young men, an average session lasts for seven to eight hours. “We bring our computers and link it to a common network to game. Sometimes we don’t see the daylight for two whole days. It’s all coffee and cigarettes in such times,” revealed one of the gamers.

Gaming is so important for him that he has even lost friends who had a problem with his playing hours. He has also had heated moments over broken game controllers with his parents. “But I have a strong community of online gamers who I identify as my friends, and I love that,” he said.

On June 18, the World Health Organisation (WHO) classified compulsive gaming as a mental health disorder. According to the WHO, gaming disorder is characterised by impaired control over gaming and an increasing priority given to gaming over other activities, to the extent that it takes precedence over other interests and daily activities. The WHO, in the latest update of the International Classification of Diseases, also stated that gaming could be as addictive as substances like cocaine and gambling.

“Gaming can be seen on the same spectrum as other substance-use disorders. The presence of obsessive thoughts about drinking or playing games and a compulsive need to act on them is what identifies substance addiction,” said Dr Rizwana Nulwala, a practicing psychotherapist and faculty at Xavier’s Institute of Counselling Psychology of St. Xavier’s College Mumbai.

“It is not the substance consumed, like alcohol or cocaine that is counted as important. It is the behaviour of not being able to stop once you’ve started a habit. In this sense, gaming tendencies that cost a person his/her productivity, disrupts inter-personal relationships and physical conditions is what makes it an addiction tantamount to drug abuse, ” she added.

Gaming has long had an addictive quality with most games involving multiplayers and other simulative interfaces. But a gaming addiction is not as simple a phenomenon as it appears.

A lot goes into making video games addictive. Designers work hard, making use of predictive algorithms to hook players and a lot of behavorial psychology goes into turning the spectrum of video games so “you can’t put it down”.

Dr Harshal Awasthi, from Sarvam Neuropsychiatric Centre said,“The basic principle behind most forms of addiction is the same- the need to be in a constant state of “high” or be in pursuit of one. Gaming is a form of “instant gratification” where a person can live exhilarating experiences without actually moving an inch. Similarly, in substance abuse, the high they produce gives the person an easy way to feel happy or worthwhile and he gradually disconnects from the real world.”

Yash Ravee, a twelfth-grade student of Sardar Patel Vidyala in New Delhi, who was a loyal audience to his brother’s FIFA gaming sessions until he started himself.

“Once I got introduced to the online gaming scene, the hours I spent playing increased drastically. Playing online provided a platform to play with some of the finest players in the world. Along with FIFA, I played Gears of War and I started playing for 6-7 hours daily. I would completely shut out everything else in the world and play without breaks. I think I was a pro,” said Yash who has packed off his PlayStation console in his final year of school after realising how ‘powerful a distraction’ it was.

Yash said he stopped himself from turning into an addict by replacing it with football and studies. “It wasn’t easy but I had to do it for myself,” he said. Yash said that he knows that games are massively addictive and crossing limits can be dangerous.

Approaching a psychiatrist or specialist for for playing too much video game is not a traditionally practiced response, possibly due to lack of awareness regarding the condition.

But a shift in mobile technology and the arrival of games like Candy Crush, Mini Militia and Pub G that provide network based online multiplayer on users’ phones, have led to wider acceptance and recognition of gaming addiction as a serious condition in recent years.

Sarvam Neuropsychiatric Center reported a case of a young male engineering student who used to play games with batchmates on weekends. With time, he bought one gaming device for his own room, started gaming online and soon that became his entire world.

“Within a period of 1 year the student was gaming 20 hrs a day, had dropped out of college, was in a miserable personal health and nutritional status, lost the drive for all things in life, was spending excessively on gaming accessories, and reportedly would regularly fall asleep with the gaming remote in hand and would start upon waking up,” said Dr. Awasthy of the Neuropsychiatric Center.

Suspecting some psychatiric disorder, the engineering student’s parents got alarmed and brought him for rehabilitation.

In this regard, the W.H.O. designation is an important step towards legitimizing concerns about gamers who neglect other parts of their lives. It could also make addicts more willing to seek treatment, encourage more therapists to delve deeper into the subject and increase the viability for insurance companies to cover gaming disorders.

Although there is no standard treatment for addicts, doctors say that cognitive behavioural therapy is effective.

Doctor M.L Kalra, General Physician at Max Healthcare Hospital in Panchseel Park said, “There have been several cases where parents seek guidance over their children’s obsessive gaming patterns because they don’t understand it at all. Apart from the psychological damage, there is also physical wear and tear. Children addicted to gaming become prone to several muscle and joint ailments and Repetitive Strain Injury (RSI) which is extremely harmful in the long-run.”

The gaming industry world over has vehemently pushed back against the W.H.O. classification, calling it “deeply flawed” while pointing to the “educational, therapeutic and recreational value of games.”

Mrinal Dutt, a 23-year old professional gamer with Bluestacks India, believes that the gaming industry even today, is a niche within a niche: a micro niche.

“To say you want to make it in the gaming industry is probably more ridiculous than trying to make it in the dancing industry, or any creative industry,” he explained.

Back in school, Mrinal’s gaming hours were restricted to just one but he was allowed to watch six hours of TV every day. “If I watch TV, I just watch things. If I’m playing games, different genres allow me to do different things. I am constantly engaging my brain to solve problems at lightning fast speeds, and even then, there might be someone solving it quicker than I am, to win,” he said.

While some mental health professionals insist that gaming disorder is not a stand-alone medical condition but a symptom or side effect of more familiar conditions such as depression or anxiety, people like Mrinal who have been gaming for years, profusely disagree.

“Video games are evolving into fully fledged forms of media dedicated to giving you an experience that lets you be the hero,” he said. The 23-year-old said that being the ‘hero’ lets you deal with things better.

Many from the gaming community are deeming the tentative move of WHO to pathologize digital gaming as premature.

The diagnosis verges on mere tautology as treating disproportionate gaming habits as an addiction runs the risk of patholologizing normal behaviour and codifying dangerous stigmatization towards gamers.

This becomes even more problematic when approached from the lens of viewing gaming as a profession.

“I believe gaming is such a social stigma, it’s quite narrow minded at this point. You tell people about e-sports, and they just say: Why would you want to watch other people play video games? Won’t you just play it yourselves? Oh, but you say the same about a cricket match and god have mercy on your soul,” said Mrinal.

While the gaming scene in India is fairly nascent, it is proliferating quickly and gaining momentum. India’s online gaming market stands at $360 million, and is expected to grow to $1 billion by 2021, according to a 2017 Google-KPMG report titled ‘Online Gaming in India: 2021’.

In Asia and the rest of the world, professional gamers are treated like celebrities and gaming competitions are fairly mainstream.

In this regard, India has had a late start with a few small scale gaming tournaments emerging in the scene. MTV organised a major tournament two months ago called “UCYPHER”, featuring an appreciable prize pool for games like Dota. ESL India is another gaming tournament with elaborate formats of seasons and leagues in which teams of different calibers can participate.

At 20, Durgesh Konde had decided to make a career in gaming and started devoting ten hours a day to the same.

“I started earning easy money by winning a lot of local tournaments and getting better at video games became my entire life. Just like any other Indian parent, my parents were against my decision of wanting a career in gaming but that did not stop me,” Konde said, claiming his decision was inspired by the international gaming scene.

Today Konde works with Ubisoft as a game tester.

“I work for 8 hours and practice Dota for another 6 hours. But these 14 hours of screen time is what makes me better at my job. People really need to understand that gaming is a serious profession,” said Konde.

However, he agreed that a career in something like E sports is still a taboo in Indian society.

Konde feels that the biggest problem with WHO’s classification is that it puts professional gamers under a shadow of doubt by being unable to “differentiate between dedication and addiction”.

“Even when i was playing 10+ hrs a day, I did a lot of other things like reading, swimming and even organized gigs. I am in love with my work, give my best and well, it does pay my bills,” Konde said.

Outside, a flock of young boys always cower at the entrance, excitedly waiting their turn. Inside, about 5-6 young boys sit transfixed to the screen, playing, twitching and punching the air as they furiously press buttons on their controllers.

“The only time I am not here playing a video game is when I am in school or if there is a power cut. I like to play actions games which take a lot of time and I don’t leave a mission midway,” said Vishal.

An 18-year-old student, Vishal spends about seven to eight hours every day at the gaming parlour, much to the concern of his father who runs an electrical shop and worries for the boy’s future.

Hundreds of kilometres away in an opulent neighbourhood of Delhi, six young men gape at their laptop screens playing Dota. Occasionally, one of them stretches their back or breaks into profanity as a deluge of cigarette butts and half eaten fast food packets threatens to flood.

For these young men, an average session lasts for seven to eight hours. “We bring our computers and link it to a common network to game. Sometimes we don’t see the daylight for two whole days. It’s all coffee and cigarettes in such times,” revealed one of the gamers.

Gaming is so important for him that he has even lost friends who had a problem with his playing hours. He has also had heated moments over broken game controllers with his parents. “But I have a strong community of online gamers who I identify as my friends, and I love that,” he said.

On June 18, the World Health Organisation (WHO) classified compulsive gaming as a mental health disorder. According to the WHO, gaming disorder is characterised by impaired control over gaming and an increasing priority given to gaming over other activities, to the extent that it takes precedence over other interests and daily activities. The WHO, in the latest update of the International Classification of Diseases, also stated that gaming could be as addictive as substances like cocaine and gambling.

“Gaming can be seen on the same spectrum as other substance-use disorders. The presence of obsessive thoughts about drinking or playing games and a compulsive need to act on them is what identifies substance addiction,” said Dr Rizwana Nulwala, a practicing psychotherapist and faculty at Xavier’s Institute of Counselling Psychology of St. Xavier’s College Mumbai.

“It is not the substance consumed, like alcohol or cocaine that is counted as important. It is the behaviour of not being able to stop once you’ve started a habit. In this sense, gaming tendencies that cost a person his/her productivity, disrupts inter-personal relationships and physical conditions is what makes it an addiction tantamount to drug abuse, ” she added.

Gaming has long had an addictive quality with most games involving multiplayers and other simulative interfaces. But a gaming addiction is not as simple a phenomenon as it appears.

A lot goes into making video games addictive. Designers work hard, making use of predictive algorithms to hook players and a lot of behavorial psychology goes into turning the spectrum of video games so “you can’t put it down”.

Dr Harshal Awasthi, from Sarvam Neuropsychiatric Centre said,“The basic principle behind most forms of addiction is the same- the need to be in a constant state of “high” or be in pursuit of one. Gaming is a form of “instant gratification” where a person can live exhilarating experiences without actually moving an inch. Similarly, in substance abuse, the high they produce gives the person an easy way to feel happy or worthwhile and he gradually disconnects from the real world.”

Yash Ravee, a twelfth-grade student of Sardar Patel Vidyala in New Delhi, who was a loyal audience to his brother’s FIFA gaming sessions until he started himself.

“Once I got introduced to the online gaming scene, the hours I spent playing increased drastically. Playing online provided a platform to play with some of the finest players in the world. Along with FIFA, I played Gears of War and I started playing for 6-7 hours daily. I would completely shut out everything else in the world and play without breaks. I think I was a pro,” said Yash who has packed off his PlayStation console in his final year of school after realising how ‘powerful a distraction’ it was.

Yash said he stopped himself from turning into an addict by replacing it with football and studies. “It wasn’t easy but I had to do it for myself,” he said. Yash said that he knows that games are massively addictive and crossing limits can be dangerous.

Approaching a psychiatrist or specialist for for playing too much video game is not a traditionally practiced response, possibly due to lack of awareness regarding the condition.

But a shift in mobile technology and the arrival of games like Candy Crush, Mini Militia and Pub G that provide network based online multiplayer on users’ phones, have led to wider acceptance and recognition of gaming addiction as a serious condition in recent years.

Sarvam Neuropsychiatric Center reported a case of a young male engineering student who used to play games with batchmates on weekends. With time, he bought one gaming device for his own room, started gaming online and soon that became his entire world.

“Within a period of 1 year the student was gaming 20 hrs a day, had dropped out of college, was in a miserable personal health and nutritional status, lost the drive for all things in life, was spending excessively on gaming accessories, and reportedly would regularly fall asleep with the gaming remote in hand and would start upon waking up,” said Dr. Awasthy of the Neuropsychiatric Center.

Suspecting some psychatiric disorder, the engineering student’s parents got alarmed and brought him for rehabilitation.

In this regard, the W.H.O. designation is an important step towards legitimizing concerns about gamers who neglect other parts of their lives. It could also make addicts more willing to seek treatment, encourage more therapists to delve deeper into the subject and increase the viability for insurance companies to cover gaming disorders.

Although there is no standard treatment for addicts, doctors say that cognitive behavioural therapy is effective.

Doctor M.L Kalra, General Physician at Max Healthcare Hospital in Panchseel Park said, “There have been several cases where parents seek guidance over their children’s obsessive gaming patterns because they don’t understand it at all. Apart from the psychological damage, there is also physical wear and tear. Children addicted to gaming become prone to several muscle and joint ailments and Repetitive Strain Injury (RSI) which is extremely harmful in the long-run.”

The gaming industry world over has vehemently pushed back against the W.H.O. classification, calling it “deeply flawed” while pointing to the “educational, therapeutic and recreational value of games.”

Mrinal Dutt, a 23-year old professional gamer with Bluestacks India, believes that the gaming industry even today, is a niche within a niche: a micro niche.

“To say you want to make it in the gaming industry is probably more ridiculous than trying to make it in the dancing industry, or any creative industry,” he explained.

Back in school, Mrinal’s gaming hours were restricted to just one but he was allowed to watch six hours of TV every day. “If I watch TV, I just watch things. If I’m playing games, different genres allow me to do different things. I am constantly engaging my brain to solve problems at lightning fast speeds, and even then, there might be someone solving it quicker than I am, to win,” he said.

While some mental health professionals insist that gaming disorder is not a stand-alone medical condition but a symptom or side effect of more familiar conditions such as depression or anxiety, people like Mrinal who have been gaming for years, profusely disagree.

“Video games are evolving into fully fledged forms of media dedicated to giving you an experience that lets you be the hero,” he said. The 23-year-old said that being the ‘hero’ lets you deal with things better.

Many from the gaming community are deeming the tentative move of WHO to pathologize digital gaming as premature.

The diagnosis verges on mere tautology as treating disproportionate gaming habits as an addiction runs the risk of patholologizing normal behaviour and codifying dangerous stigmatization towards gamers.

This becomes even more problematic when approached from the lens of viewing gaming as a profession.

“I believe gaming is such a social stigma, it’s quite narrow minded at this point. You tell people about e-sports, and they just say: Why would you want to watch other people play video games? Won’t you just play it yourselves? Oh, but you say the same about a cricket match and god have mercy on your soul,” said Mrinal.

While the gaming scene in India is fairly nascent, it is proliferating quickly and gaining momentum. India’s online gaming market stands at $360 million, and is expected to grow to $1 billion by 2021, according to a 2017 Google-KPMG report titled ‘Online Gaming in India: 2021’.

In Asia and the rest of the world, professional gamers are treated like celebrities and gaming competitions are fairly mainstream.

In this regard, India has had a late start with a few small scale gaming tournaments emerging in the scene. MTV organised a major tournament two months ago called “UCYPHER”, featuring an appreciable prize pool for games like Dota. ESL India is another gaming tournament with elaborate formats of seasons and leagues in which teams of different calibers can participate.

At 20, Durgesh Konde had decided to make a career in gaming and started devoting ten hours a day to the same.

“I started earning easy money by winning a lot of local tournaments and getting better at video games became my entire life. Just like any other Indian parent, my parents were against my decision of wanting a career in gaming but that did not stop me,” Konde said, claiming his decision was inspired by the international gaming scene.

Today Konde works with Ubisoft as a game tester.

“I work for 8 hours and practice Dota for another 6 hours. But these 14 hours of screen time is what makes me better at my job. People really need to understand that gaming is a serious profession,” said Konde.

However, he agreed that a career in something like E sports is still a taboo in Indian society.

Konde feels that the biggest problem with WHO’s classification is that it puts professional gamers under a shadow of doubt by being unable to “differentiate between dedication and addiction”.

“Even when i was playing 10+ hrs a day, I did a lot of other things like reading, swimming and even organized gigs. I am in love with my work, give my best and well, it does pay my bills,” Konde said.