A generation of Chinese is growing up with the Internet as just another part of their everyday lives. But, along the path to modernity, obstacles are sure to arise, and China is only just beginning to understand and deal with the myriad side effects technology may have on society. Recently China acknowledged this with the opening in Beijing of its first medical clinic dedicated to the treatment of what it calls “online addiction.”
As China works to reform its healthcare system, it is going to have to determine for itself whether it will approach online addiction as an illness that can be treated with a combination of drugs, therapy and counseling. If China looks outside its borders, it might save some time in formulating a strategy for dealing with this problem.
Online or Internet addiction is typically defined as a proclivity toward compulsiveness in the use of the Internet, which specifically interferes with one’s ability to lead a normal life. Any individual, who forsakes his responsibility to friends, family or employer, and engages in obsessive Internet use at the jeopardy of his own stability, health or social well being, might be suffering from Internet addiction.
In the United States, where widespread Internet began taking a foothold nearly one decade ago, Internet addiction has yet to gain official acceptance as a psychological disorder in the medical community. The gold standard for such acceptance is the inclusion of the disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), published by the American Psychological Association. Currently in its fourth edition, the “DSM-IV” is an attempt at classifying and describing all known psychological disorders according to their symptoms. And while Internet addiction has yet to make it pass the manual’s editorial board, the growing number of case studies outlining patient symptoms and treatment published in various medical journals suggests that the disorder is gaining more widespread acceptance.
“Like the diagnosis for Pathological Gambling, it took decades from the original studies to its inclusion in the DSM as a separate category and I would imagine this same scientific process needs to be completed for Pathological Internet use,” said Dr. Kimberly Young, Director for the Center for Online Addiction in Bradford Pennsylvania.
The concept of Internet addiction was first hypothesized in the 1990s. The ailment, varyingly described as “Internet Addictive Disorder” (lAD), “Cyber Addiction” and “Online Addiction,” has mental health experts and social critics engaged in an ongoing debate over whether such an official classification is even justified. The battle underlying the debate has on its one side the right of patients to be informed about and treated for the problem and to have that treatment covered by medical insurance policies. On the other side is the potential for social stigma that may result from appending the pejorative label of a “mental illness” to what many consider to be no more than a pattern of poor behavior.
The Center for Online Addiction says Internet addiction can be likened to substance based addictions in which the afflicted develop a relationship of dependency of the substance that “takes precedence over any and all other aspects of their lives.” Dr. Young said the most important factor in effectively treating the problem is increasing awareness of the issue and helping people understand the potential harm involved.
In the mid-1990s, when the concept of online addiction was first hypothesized, there was little, if any, scientific data to back up claims that a serious problem was brewing. Initial attempts to call attention to the disorder came under considerable scrutiny and even some degree of professional ridicule.
“At first, people thought I was kind of nuts,” said Dr. Maressa Hecht Orzack, founder and Director of the Computer Addiction Study Center at Harvard University-affiliated McLean Hospital. “I discovered it in myself. .. I saw that my solitaire card game was a problem.”
Orzack says she would play solitaire with no end in sight, often using it as a distraction from other work she had to do. It didn’t take Orzack-a practicing clinical psychologist with years of experience treating substance abuse and other addictive disorders-long before she recognised her problem. She said the message really hit home when her late husband would find she slumped over her computer keyboard, sleeping.
When Orzack mentioned her experience to colleagues, no one paid any attention.
Over time, however, her colleagues started to relay stories of others who they suspected might be suffering from an addiction to the Internet Today, some 10 years later, she gets referrals from all over the world.
Before it was ever considered a treatable disorder, Internet addiction was a nuisance to employers who noticed decreased productivity in their workers who were using the Internet.
“Most Internet usage abuses were occurring at work,” said Dr. Mark Wiedemold, Editor-in-Chief at the journal CyberPsychology & Behavior. ‘That’s when it became a major issue for employers.”
The number of manuscript submissions to CyberPsychology & Behavior on the subject of Internet addiction has increased in both quality and quantity. It’s also become apparent that Internet addiction is not exclusive to the United States.
“Submissions are now coming from all over world,” said Wiederhold. “South America, South Korea, Singapore, Europe.. . Clearly it is an international issue. A growing number of people were experiencing problems in their marriages and other personal relationships, and difficulty engaging in successful ‘real world’ relationships offline.”
The treatment of online addiction is still relatively new. But Dr. Young said the Center for Online Addiction has been successful in treating the disorder with recent studies showing “upward of 70 percent recovery in a six-month follow-up with addicts.”
Still there are some who would argue that there is no scientific basis for treating excessive Internet use as a mental illness.
“When people go on a pub-crawl, they go from one social experience to another,” said Jonathan Bishop, a Britain-based interaction designer and researcher who specialises in the development of virtual communities. ”But we don’t call that behavior an illness. We don’t have a thing called ‘pub addiction.'”
Bishop’s position is that using the Internet is simply an alternative environment for “real world” social interaction. He often uses the “pub” analogy to describe the online experience of chat rooms, instant messaging and message boards. Though he readily acknowledges that compulsive Internet use can become a serious problem if it comes at the expense of one’s job, family or personal health, he is opposed to affixing any official diagnostic label to the phenomenon, especially one that would define it as a mental illness.
“If you treat it as an illness, it could cause depression because (patients) may begin to believe there is something wrong with them,” said Bishop. “Really, there is nothing wrong with them. They just want to be social.”
Bishop says he doesn’t think there is any qualitative difference between socialising online and socialising in-person. These are simply two sides of the same coin, he said. He was surprised to leam that the problem in China had grown to the extent that it would require the establishment of a treatment center.
“I personally don’t see the Internet as what the people are being addicted to,” said Bishop. “I see it as the social experiences that are offered by the Internet that people are addicted to.”
These experiences may include frequent checking of email inboxes, excessive use of instant messaging programmes, chat rooms, games or posting to online newsgroups.
Another characteristic typical of an addictive problem is the feeling of withdrawal that comes when that object or dependency is removed. But do Internet addicts suffer from withdrawal symptoms? Dr. Maressa Hecht Orzack thinks so.
“People will tell me (they) ‘crave being online,”’ said Orzack. ‘They go through withdrawals, they get irritable, they may get depressed, and they need to return to it in order to feel better.”
The documented presence of withdrawal symptoms, as well as the increased tolerance to the dependency, which manifests itself in the urge to be online for longer and longer periods, makes Internet addiction increasingly analogous to more widely understood addictive behaviors, such as pathological gambling.
Yet whatever position they take in this ongoing debate, most experts agree that whether online addiction is recognised as a distinct psychological disorder and given an entry in the DSM is secondary to the promotion of awareness and treatment for the condition. By sheer numbers alone, the existence of a problem with potential for serious consequences is undeniable. Increased social awareness of the condition and a thorough understanding of how to treat it is key to winning the battle.
“What’s at stake for society is a reflection of what’s at stake for the individual,” Mark Wiederhold said. “If this becomes an issue with your ability to perform your job, to have a relationship or otherwise negatively influences your life, then it’s more than just a hobby. We need to educate health care providers that these are potential issues for their patients.”