Tuesday, September 17, 2013

Head Games: Mental health and gaming

In a recent post I covered some of the Facts and Figures of the gaming world in an effort to debunk the image of the stereotypical gamer. My post was obviously pro-gaming but one comment I received asked about the link between addiction and gaming. While I provided a brief response at the time, I feel that the topic warrants a more in depth exploration. Today I discuss the relationship between mental health and gaming with a focus on the issues of addiction and depression.

Before jumping in, I would like to address the topic of mental health in general. Mental health issues run the gamut from paranoid schizophrenia to mild depression and cover varying levels of debility. In the past few years, especially in North America, recognition of mental health issues as treatable illnesses has been steadily increasing. The recognition of depression in particular as a bonafide ailment as opposed to a characteristic of a “weak” individual is a positive sign that the population at large is capable of understanding that not all ailments need to be overtly physically manifested for it to impact one's ability to function. Coupled with this is a growing body of medical and therapeutic specialists who are capable of expertly aiding people suffering from poor mental health. If you feel something may be wrong, consult a professional.


Addiction is broadly classified into two types: physiological and behavioral. Physiological addiction generally results in the body entering into withdrawal when the addictive substance is removed and is characterized by a user building up tolerance and thus requiring more and more of the substance to achieve similar results. It is commonly associated with drug abuse. Behavioral addiction is used to describe addiction in those cases without a physical substance and is characterized by a compulsion to continually engage in an activity even if it is to the detriment of the individual. Obviously, when discussing addiction to video games, we are dealing with behavioral addiction. Where the grey line with behavioral addictions comes into play is determining when a compulsion has crossed to the point where a person's life is negatively impacted. Thus, a gamer who plays a lot on weekends and evenings but is able to maintain a job, social life, and otherwise seems well adjusted is typically not considered to be an addict. On the other hand, a gamer who is missing work, failing to create or maintain friendships, and otherwise seems maladjusted may be an addict. Of course, most cases are not black and white and determining if an addiction is present is an inexact science.

The literature on gaming addiction is somewhat sparse. Few articles exist which outright dismiss the possibility of addiction in gaming, but, on the other hand, few studies seem poised to endorse a strong likelihood of gaming addiction. I personally feel that gaming addiction is a very real phenomenon and that the imprecision in the literature is attributable to the difficult in making a diagnosis of behavioral addiction and the relatively new nature of video games; in terms of scientific research, the possibility of fruitful long term studies (i.e. 20+ years) relating to video games has only recently become a reality. I think, on an intuitive level, games tickle the same pleasure points as gambling. Gambling addicts frequently describe their compulsion as no longer about money but feeding an urge; just one more bet. I think that, even though gaming doesn't intrinsically involve a tangible aspect like money, the Skinner-box mentality of the pleasure reward experienced in gambling can apply; just one more level. Where gaming and gambling diverge, however, is that gaming addiction may affect one's life in more subtle ways than gambling. Gambling addiction manifests in the loss of money which provides a tangible metric to observe; if you are gambling your rent money, or worse yet, gambling borrowed money, you likely have an addiction. On the other hand, spotting the gaming addict is much more difficult to do. Questions like 'how much gaming is too much?' and 'when is social maladjustment the result of gaming as opposed to a different disorder?' are extremely difficult to answer. However, just because something is difficult to identify doesn't mean that it is not there and I suspect that in the next few years, as games become even more popular, the literature will begin to reflect a recognition of gaming addiction.

While I understand reticence in the gaming community to acknowledge addiction, I feel that blindly refusing to recognize a mental health disorder is unethical. No industry wants the bad press and stigma that comes with the notion of addiction but it would be outright tragic if someone in need of assistance coping with an addiction wasn't able to get it. Fortunately, the story of mental health and gaming doesn't end at addiction. Games journalist, Danny O'Dwyer recently released a short documentary covering a few people coping with depression and how they used games to help them; it is very well done and I highly recommend watching it (Games vs. Depression). 


Depression can manifest in a few different ways. Some people are saddled with persistent depression that makes every day a grind. Minor setbacks may seem insurmountable and successes are often left uncelebrated. Others suffer from temporary depression usually as the result of a major negative life event such as a divorce or bankruptcy. In both cases, ones ability to function normally is mitigated and can lead to poor work performance, an inability to maintain social relationships, and a general feeling of malaise. Diagnosing depression can be difficult, especially in temporary cases but a host of pharmaceutical and therapeutic remedies are on offer to aid in coping with the disorder.

I think the stories that O'Dwyer hits on in his documentary are far from unique and that games can be extremely helpful to those dealing with depression. Games offer a source of pleasure and escapism that can help alleviate feelings of despair and low self-worth. Further, games are by and large safe with practically no side effects. Barring addiction, games can be turned on and off at a whim and confer no lingering effect after playing. While some people use drugs or alcohol to cope with depression, the potential for self-harm with these activities is off the scale when compared to games. While I am not condoning the use of games as a sole treatment for depression (again, consult a medical professional if you think something may be wrong), I see them as a low risk option with a high potential to help if even just a bit. Unfortunately, literature on treating depression through games is even less sparse than gaming addiction and I suspect it will be a long time, if ever, that the medical community legitimately recognizes games specifically as a tool for dealing with depression.

In the end, I think it is important that we, as a society, continue to recognize mental health issues and provide a means to aid those who are suffering from them. While the thought of games causing harm through addiction is saddening, I feel this is somewhat mitigated by knowing that those suffering with depression may find alleviation through games. I am sure that the story of the relationship between mental health and games doesn't end here but, hopefully, I have shed some light on a topic that seems rarely covered.