ICD-11 (IDC stands for the International Classification of Diseases) for Mortality and Morbidity Statistics (version 04/2019) now includes section 6C51 Gaming Disorder:
My initial response upon learning this news today was to ask whether this definition could include gymnastics and basketball? What about music? Is a person addicted to music, say, if they prefer playing the guitar over other activities?
I am among those who believe that addiction occurs not in the substance being used, or in this case the activity enjoyed, but in the brain. An addict is a person who finds some thing that stimulates brain circuits chronically under stimulated or insufficient to assuage unpleasant feelings because of trauma or some other biographical or environmental cause. A person seek stimulants, for example, because her norepinephrine levels are poor, and the stimulants provide the level of brain activity that she needs to feel normal.
Leading addiction expert Canadian physician Gabor Maté has found that addiction is, for the most part, the result of trauma and neglect. Consider opiate addition. We’re told that heroin is one of the most addictive substances on earth, yet most people who use heroin (over 90%, in fact) never become addicted to it. They use it recreationally without any lasting negative impacts. Heroin becomes habitual in persons who are addicts, but not in persons who are not addicts. It’s trauma, not heroin, that produces the addict.
One might suspect the same for video games. Most people who play video games never become addicted to them. It’s not video games that are addictive. Rather, persons with addictive disorder risk being consumed by video games.
I am sure that most readers of this blog are familiar with the famous case of the Romanian orphans who were neglected in orphanages. The neglect altered the structure of the brains of these children. Additional research confirmed these findings. When the powerful effects of neglect were recognized, caretakers started picking up the children and holding them. The results, which we now know are biochemical, at the same social, interpersonal, were dramatic.
Human contact produces a hormone in the brain called oxytocin. Oxytocin is the “love chemical.” Without it, the brain does not develop normally. But, like the immune system, the brain circuits that rely on oxytocin to work must be primed by and developed through experience. The experience that triggers the production of oxytocin is social interaction. This is the same mechanism at work in addiction. The heroin addict suffers from low levels of oxytocin, as well as an endogenous opiate endorphin. These deficiencies are caused by insufficient bonding with other persons; it is the result of a failure to sufficiently attach to other human beings. When the addict uses an opiate he feels the warmth and comfort he was denied in earlier experiences. It’s not just the relationship with parents, but the greater social environment that structures the brain. A harsh and individualistic experience alienates a person. The effects of this isolation — or atomization — manifest themselves as addiction and other psychiatric disorders.
Maté is not the only researcher to show this effect. Canadian psychologist Bruce Alexander (a researcher at Simon Fraser) documented this in the 1970s in his Rat Park studies. He found that rats, which are, like many mammal species, highly social animals, placed in cages or Skinner Boxes and addicted to morphine, preferred morphine over anything else (this worked for heroin, methamphetamine, cocaine, and other drugs). These experiments garnered considerable media attention as they played into sensationalist drug war ambitions. However, in his experiment, when rats were allowed to reside in open spaces with other rats, the drugs were not attractive to them even though they were abundant in their free environments. Alexander determined that it was not the morphine that was irresistible to rats. Rather is was the isolation of the Skinner Box that produced conditions conducive to addiction to morphine. He concluded that rats in cages were significantly more like to self-medicate. Combined with considerable historical and anthropological data, he concluded that it was same for people (see his The Globalisation of Addiction: A study in poverty of the spirit, Oxford University Press, 2008.)
What is the mechanism behind this? When wolves, bears, rats, and other animals are caged or constantly stressed their cortisol levels (stress hormones) rise. This makes them unhappy, sick, anxious, and depressed (it is also a cause of obesity, in that excessive cortisol production alters the insulin cycle). Caged, mammals pace and sway, what is called stereotypic behavior. Their coats become dull and patchy. These conditions of unfreedom set them up for addictive behavior. For animals in the wild, running, leaping, and bounding about with their comrades, stereotypic behaviors are absent. The animals are healthy and happy. There is in mammals a drive or need to be free — they are, we can say, determined to be free. If you deprive mammals of stimulation, their brains atrophy and they can lose critical brain functions. They will sit in a cage and feed their brain the stimulation lacking in their lives.
Of course, the brain circuits themselves do not determine the sociocultural systems human produce and live in. Neurotransmitters don’t explain the range of sociocultural variability. The tragedy is that we are not fated to be moral creatures; nature has prepared us to be moral creatures, but segmented systems interfere with the development of our sympathetic (or empathetic) self. And the degree to which the prevailing social order does not allow the organism to accomplish its optimal development — social orders that are authoritarian, disorganized, restrictive, toxic — signals the inadequacy of that social system.
The German idealist philosopher Georg Hegel points out that the standard liberal conception of freedom is superficial — it does not ask why individuals make the choices they make. He theorizes that our choices are conditioned by external and internal forces, so the source of freedom is to be found there, not in the metaphysics of occult forces. The view of the individual agent, authoring its own actions, independent of social, cultural, and historical forces that surround it, mystifies the origins of thought and actions. For Hegel, this condition means that freedom is not judged by degree of separation from society, but rather by degrees of participation and inclusion in society — in collective efforts to shape history for the well being of all the individuals involved. Freedom is not an essential characteristic of unhampered individual activity, but rather results from rational control of individual activity in social contexts. Freedom is present when people able to exert meaningful control over their lives as political and social beings.
The conclusion Marx derived from Hegel’s line of thinking is that democratic control over society’s productive forces and the direction of history lays the basis for human freedom. Or, as C. Wright Mills puts it in The Sociological Imagination: “Democracy means the power and the freedom of those controlled by the law to change the law, according to agreed-upon rules — and even to change those rules; but more than that, it means some kind of collective self-control over the structural mechanics of history itself.” In other words, there is a materialist foundation to freedom, one that touches fundamentally on morality.
There is a real problem in popular science. We hear it in the arguments of Sam Harris and, most polemically in Noam Chomsky, that the remarkable human being — cognitive behavior, moral behavior — is either a miracle or the result of natural selection, i.e. evolved characteristics. But they are not evolved. They are learned. To be sure, the capacity to learn is evolved, but the content is learned. And it is in this process that our brain circuitry is prime and developed. The sociocultural system is variable — it varies over time and across space. Yet humans have eternal needs: creativity, leisure, happiness. Indeed, our neurotransmitters make these possible. The needs are innate. The same needs exist in other animal species. The need for free creative activity and play. The organism depends on a stimulating environment to fully develop. But segmented social systems fail these needs. And, as a result, they damage the person. These deeply alienating conditions create social cages. Addiction is the result.
Let me take one more example, namely attention deficit disorder (ADD). Everybody can be distracted. Most everybody daydreams. Here we are talking about distraction to the point of dysfunction. Moreover, there are other symptoms associated with this disorder: hyper-vigilance, impulsivity. There is variability in ADD. What explains that? We know it runs in families. Children with ADD are more likely to have parents with ADD. But this is not evidence of a genetic component. Things other than genes run in families. A recent study conducted at Cardiff University in England, published in The Lancet, found no genetic differences in 85% of ADD cases compared with individuals without ADD. What ADD children do have in common is a stressed environment.
What is the character of environmental systems where ADD becomes a problem? It occurs in families with high levels of stress and the associated release of stress hormones. When an animal is stressed, it produces cortisol, epinephrine, and norepinephrine. These hormones activate the fight or flight response. This is a good thing if the animal is trying to get away from a predator. As long as the sympathetic nervous system is activated for a short period of time, then is allowed to return to normal, it is not a particular problem. But when an animal is trapped, caged, then the constant production of stress hormones makes the animal sick. The body cannot tell the difference between different types of stress. ADD is one of the effects. Constant cortisol releases lead to adrenal fatigue, which interferes with the brain’s ability to focus (medications, such as amphetamines, work because they wake up the brain). We can say that cortisol production is, in a very real sense, contagious; a stressed parent stresses other members of the family. When physicians prescribe amphetamines to children to help them focus in school, the physicians are feeding an addiction.
The good news is that the brain is plastic and improving social conditions can reverse cognitive and emotional problems. The bad news is that it is hard to change the social conditions when so many people refuse to believe that these problems are caused by social conditions in the first place — and when others in a position of wealth and power benefit from the status quo.
Society has a choice: it can treat the psychiatric symptoms, for example, using SSRIs for depression, or it can change the social conditions that cause depression. It can treat the addict (what Maté does at his Vancouver clinics is provide pharmaceutical grade heroin, clean needles, and a safe injection site) or it can change the circumstances that give rise to addiction. Crucially, then, understanding the effect of social relations on psychological health can help us understand psychological maladies — as well as understand the situations of people. This is why empathy is such a big deal.
So the way to deal with the problem of video game obsession is to change the structure of society such that people experience a variety of circumstances that produce the chemicals that put them in a good state mentally. This way they will not seek them in virtual experiences that become habitual, stereotypic. At the same time, one may argue that video games are a reasonable intervention to promote to these ends. What does it hurt? It’s certainly not the cause. And it comes with a positive side benefit: kids are not out in the world finding optimum hormonal levels by getting their kicks with vandalism and violence; rather they are in their rooms getting their kicks virtually. And they’re having less sex, which is manifest in a falling fertility rate. This is good news for the planet. Of course, none of this obviates the root source of the phenomenon: the alienating conditions of corporate capitalism.
 Two major science journals, Science and Nature, rejected Alexander’s first paper. It finally appeared in Psychopharmacology in 1978, a major journal in the field. However, the paper attracted no attention. Simon Fraser University soon withdrew Rat Park’s funding. Several later studies confirm Alexander’s findings — see, for example, Bozarth, Murray, and Wise 1989 work, published in Pharmacology, Biochemistry and Behavior. Alexander’s The Globalization of Addiction argues that cultural dislocation of human beings instigates addictions of all sorts, including addictions that do not involve drugs.