REPOSTED (orig. June 1, 2008) —
A short while ago, Mark Bittman wrote a smart, amusing column in the New York Times about the need to take an occasional break from technology (“I Need a Virtual Break. No, Really”). A self-described “techno-addict,” Bittman was haunted by the thought of not responding to voice messages within minutes of receiving them. Too much unanswered email makes him twitchy, even panicky. “What if something important was happening,” he despairs, “something that couldn’t wait 24 hours?”
Like many of us, I’m sure, I smiled sympathetically, amazed by the lure of Web-news (my particular weakness, especially during election season). But I have always attributed that to simple interest in current affairs. I’ll gladly concede the pull and pressure of email, and follow any reasonable advice on how to reduce that stress. Anyone who works in a university—or a busy office, for that matter—knows how much information today is conveyed electronically, and how rapidly one often must respond to it. So when Bittman worried that he might be suffering from “the latest in American problems, Internet addiction disorder,” I assumed he was being largely tongue-in-cheek and laughed accordingly.
The March issue of the American Journal of Psychiatry seems to have missed Bittman’s irony and to have taken him quite literally. “Internet addiction appears to be a common disorder,” Jerald J. Block opines in an editorial urging the American Psychiatric Association to adopt it as a formal disorder in its next edition of the Diagnostic and Statistical Manual of Mental Disorders. His recommendation has led to a crop of almost surreal newspaper articles, with titles such as “Net Addicts Mentally Ill, Top Psychiatrist Says.” Given my penchant for Web-news, apparently I’m one of the crowd. Worse, I’m in denial, insisting I don’t have a problem.
Block says that three “subtypes” of extreme Internet use concern him: “excessive gaming, sexual preoccupations, and e-mail text messaging.” I’m going to take a wild guess and say that last one applies to quite a few teenagers—and the middle one to a sizable number of former senators, governors, and mayors.
If the editorial had appeared a month later, on April 1st, I would have shrugged it off as a brilliant hoax designed to poke fun at the well-known and seemingly incurable addiction that has beset the APA since the early 1980s. That addiction comes in several subtypes, but all are variants of “Diagnostic Creation and Exaggeration Disorder,” which I’m hoping will find its way into DSM-5. That would be a disorder I finally could get behind. Peter Kramer once dubbed the problem “diagnostic bracket creep.” In lay terms, it refers to the organization’s sometimes-overwhelming urge to sneak a few hundred more pages and disorders into its diagnostic bible.
The addiction appears to have intensified in recent years. When the APA found it irresistible to christen commuter stress and road rage “Intermittent Explosive Disorder,” a few eyebrows were raised but the media largely turned a blind eye. Nowadays we’re a bit more skeptical, with “Internet addiction disorder” sparking bemusement, even disbelief, amid all the hand wringing.
One reason is that the line between compulsive behavior and sheer hard work is so difficult to determine, much less reliably diagnose. It would be hard enough to pinpoint in a society not already boasting a fierce work ethic, but it’s virtually impossible to isolate in one with a faltering economy, where conditions are so precarious that many work online far into the night and weekend just to hang on.
In his editorial Block voices understandable concern about the large number of schoolchildren in South Korea who fritter away hours each week texting, gaming, and surfing. Clearly, many lose perspective and let technology overwhelm their lives. Still, is that really a mental disorder in the strict psychiatric sense of the term? Is it not instead a sign that technology can be all-consuming and that along with its advantages it has serious drawbacks that need careful attention?
In the U.S., many parents and teachers also despair over the amount of time their children and students waste in cyberspace and on electronic gadgets—time that’s clearly not being spent devouring books. Yet Block is completely off-base when he argues that the remedy for this problem is medication. As he puts it, referencing a single conference paper, “About 80% of those needing treatment [for overuse of the Internet] may need psychotropic medications, and perhaps 20% to 24% require hospitalization.” Hospitalization? For gaming and text messaging? In a New York Times article in November 2007, by contrast, Martin Fackler described one of 140 government-sponsored Internet Addiction Counseling Centers in South Korea and never once mentioned medication. Their treatment programs “follow a rigorous regimen of physical exercise and group activities, like horseback riding, aimed at building emotional connections to the real world and weakening those with the virtual one.”
Block further undercuts his call for medication by concluding, “Internet addiction is resistant to treatment, entails significant risks, and has high relapse rates.” Since it’s now widely known that S.S.R.I. medication itself entails significant risks (a litany of mild-to-serious side effects) and that placebo accounts for 80% of the drugs’ effectiveness, one has to wonder why psychotropics play such a major role in Block’s bid to make “Internet addiction” a formal disorder. Robert Spitzer, chair of two earlier DSM task forces, offers one clue. He told me recently, “If you have a treatment, you’re more interested in getting the [new] category in” the manual (qtd. in Shyness 75). In this way, the APA occasionally puts the cart before the horse, using the apparent promise of medication to legitimate new diagnoses and make them appear to be bona fide illnesses.
Michael Miller, editor in chief of the Harvard Mental Health Letter, deplores this practice and is skeptical of the rush to call cyber-addicts mentally disordered. That the Internet facilitates easy connection to pornography and gambling sites doesn’t in itself mean the medium is the key problem, he usefully observes. For that and a myriad of other reasons, “it is difficult to call ‘Internet addiction’ a unified disorder,” and “probably not helpful to invent new terms to describe problems as old as human nature.”
Before we medicate yet more teenagers and adults, let’s pause and ask whether overuse of the Internet really belongs with schizophrenia and paranoia in a manual of mental disorders. Certainly we must recognize and respond to how technology is shaping—sometimes blighting—many lives. If South Korea’s treatment programs are anything to go by, the solution lies in stronger ties with other human beings, not more overblown connection with the pharmaceutical industry.
Christopher Lane, the Pearce Miller Research Professor at Northwestern, is the author most recently of Shyness: How Normal Behavior Became a Sickness.