Advances in Psychiatric Treatment (2007) 13: 31-33. doi: 10.1192/apt.bp.106.003004
© 2007 The Royal College of Psychiatrists
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Computer addiction – a sceptical view

INVITED COMMENTARY ON: LOST ONLINE{dagger}

Fionnbar Lenihan

Fionnbar Lenihan is a consultant forensic psychiatrist at the Orchard Clinic Medium Secure Unit (Royal Edinburgh Hospital, Morningside, Edinburgh EH10 5HF, UK. Email: fionnbar{at}cix.co.uk). He has a long-standing interest in health informatics and is a committee member of the Mental Health Informatics Special Interest Group of the Royal College of Psychiatrists.


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Abstract
 
The concept of computer addiction is examined and the importance of conceptual and nosological clarity emphasised. The risk of tautology in the construction of such conditions is raised, as is the issue of whether it would be better to classify many affected individuals in terms of the end behaviour rather than the mediating mechanism. Definitional difficulties and sociocultural contexts are explored.

‘The only reason to make the distinction [between habit and addiction] is to persecute somebody’ (Szasz, 1973)

Defining behaviour as a disorder, the act of carving it out as a distinct entity, is not just a technical convenience. Even the most atheoretical and syndromal of diagnoses can become reified and appropriated by wider social and political forces, eventually carrying a burden of meanings that were not originally envisaged (American Psychiatric Association, 1994; Warden et al, 2004).

Therefore, this commentary will focus on questioning the validity of the concept of internet addiction assumed by Murali & George (2007, this issue) rather than on their emphasis on good history-taking and their very sound suggestions for behavioural treatment.

The authors acknowledge that considerable nosological ambiguity surrounds internet addiction. However, their suggestion that the continuing debate regarding its validity ‘limits our current understanding of the aetiology and treatment of the problem’ could have the unintended consequence of pre-empting a very necessary process.

It could be argued that, at this time when accusations of ‘disease mongering’ (Heath, 2006) are too easily levelled, it would be wise to clarify such ‘nosological ambiguity’ before embarking on a programme of diagnosis and treatment. To do otherwise risks labelling and treating a heterogeneous group of behaviours as a unitary syndrome. The advantages of doing this are not obvious, particularly since an individualised formulation-based approach could probably deliver the same benefits without the need to invoke a new disorder.


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Internet addiction as a concept
 
Circularity
The authors refer to Beard & Wolf’s (2001) concept of internet addiction, which is more inclusive than Young’s (1998) original. Beard & Wolf advance this concept as an ‘explanation’ for uncontrollable damaging use of the internet, seemingly unaware of the circularity of their argument. This is rather like ‘explaining’ crime by invoking antisocial personality disorder.

Murali & George risk a similar epistemological problem when they note that internet addiction can have ‘wide-ranging adverse consequences’. It would be surprising, given the definition they use, were it without adverse consequences.

Addicted to what?
If the concept of internet addiction is to have utility, both for research and clinically, then it must convey some sense of what it is that the addicted person is addicted to. Murali & George acknowledge this issue and go on to suggest that subtypes of internet addiction can be delineated depending on the nature of the preferred online activity (e.g. gambling, pornography, multiplayer games, etc.).

This raises the question as to whether it might be equally valid to regard compulsive internet gamblers or pornography users as primarily gamblers or porography users, rather than classifying them together based only on the mediating mechanism. We do not, for example, regard men who habitually drive too fast, who kerb-crawl in search of prostitutes or who drive to the off-license to buy alcohol as suffering from a unitary car addiction.

Defining addiction
The authors note that early research defined internet addiction as the use of the internet for more than 38 h a week. Given that this approximates to a notional normal working week one would be forced to classify most website designers, online journalists and researchers as addicts.

Although Murali & George do not themselves endorse this very simplistic analysis, their concept of internet addiction is itself problematic as it does not seem to acknowledge the social and economic context of internet activities, for example internet use that is a necessary part of work or the increasing availability of functional services such as internet grocery shopping, internet banking and internet telephony (Voice over Internet Protocol or VOIP), all of which replace corresponding ‘real-world’ activities. There is even a burgeoning literature on the use of the internet to deliver treatments for other addictive behaviours (Squires, 2005).

As an example of a more contextualised approach, consider the work of Kubey (2001), who examined the different types of online activity engaged in by a sample of college students. Kubey found that ‘synchronous’ applications (for example chat and multi-user games which involve a real-time interaction with another person) were more damaging to academic performance than ‘asynchronous’ applications such as email.

This highlights the issue of harm – harm to self, to others, to a more general social fabric – all of which are possible consequences of over-engagement with the virtual at the expense of the physical. Of course, harm in this context is not as unambiguous as needle marks or cirrhosis. Harmful internet use needs to be understood in the context of ‘opportunity cost’, what the person affected might alternatively have chosen to do with that time. This clearly involves a value judgement leading to cultural and subcultural issues, to which I will now turn.

Sociocultural context
So far I have discussed (and to some extent discounted) internet activities that are work-related, merely a medium for more familiar vices such as pornography or which directly replace mundane real-world activities such as grocery shopping. What then about people who use the internet for other purposes? Are they necessarily addicts?

Labelling an unfamiliar activity as an addiction or a ‘craze’ has, at times in the past, been a response when large numbers of people (usually young) are engaged in activities with which the labeller is unfamiliar. In the 20th century, jazz, rock and roll, and role-playing games were all the subject of such moral panics (Waldron, 2005; Boyd, 2006). I am old enough to remember earnest editorials about ‘television addiction’. More recently, video games and mobile phones have also been described as ‘addictive’.

Murali & George quote research that describes typical ‘pathological internet users’ as ‘introverted, educated, technologically sophisticated males’ (Shotton, 1991). Although that may have described the early adopters of internet technology in 1991, this (rather stereotyped) picture hardly fits the heterogeneous world of the internet today, where ‘social networking’ sites such as MySpace (http://www.myspace.com) are frequented by the most fashion-conscious teenagers rather than socially excluded ‘nerds’.

Murali & George describe a fairly restricted range of internet activity. At the risk of perhaps losing some readers at this point (Wikipedia at http://www.wikipedia.org is a useful resource for the baffled) I feel compelled to add to their list activities such as blogging, web development, wiki-editing, podcasting, internet telephony, videoconferencing, file sharing and photoblogging. In addition there are activities that are conducted partly online and partly in physical space, such as geocaching or live-action mobile role-playing games such as Assassin.

Even the prototypical obsessive computer user that Shotton described, the solitary, usually male, programmer who develops repetitive strain injury from excessive typing, need not necessarily be considered an addict. Although this may seem an impoverished existence to some, programming (or coding) is an intensely intellectual activity, which has been described by leading experts in the field as an art form (Knuth, 1974). It may be the case that great art always appears somewhat compulsive to those who do not share the artist’s vision, but is this a reason for society to invoke the concept of addiction, with its historical legacy of prohibition and control?


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Conclusions
 
It seems likely that, with the increase in diversity in both those using the internet and the range of activities available online, the idea of a homogeneous ‘internet addiction’ will seem increasingly anachronistic and one-dimensional. Murali & George partly acknowledge this when they say that the internet is an integral part of modern life, going on to suggest that a total-abstinence model would be impracticable.

It might be better instead to incorporate compulsive behaviours which are mediated by a computer or a computer network into a comprehensive formulation that takes into account the person’s desires and preferences, their social and economic background, the nature of the online activity and the cost it imposes on themselves and others.


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Declaration of interest
 
F. L. is a committee member of the Mental Health Informatics Special Interest Group of the Royal College of Psychiatrists and the author of Computers in Psychiatry (published by Gaskell, 2006).


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Footnotes
 
{dagger} See pp. 24–30, this issue. Back


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References
 
  1. American Psychiatric Association (1994) Desk Reference to the Diagnostic Criteria from DSM–IV. American Psychiatric Association.
  2. Beard, K. W., & Wolf, E. M. (2001) Modification in the proposed diagnostic criteria for internet addiction. CyberPsychology and Behavior, 4, 377–383.
  3. Boyd, D. B. (2006) ‘Identity Production in a Networked Culture. Why youth heart MySpace’. Talk presented to American Association for the Advancement of Science, St Louis, MO, 18 February. http://www.danah.org/papers/AAAS2006.html
  4. Heath, I. (2006) Combating disease mongering: daunting but nonetheless essential. PLoS Medicine, 3(4), e146.
  5. Knuth, D. E. (1974) Computer programming as an art. Communications of the ACM, 17, 667–673.[CrossRef]
  6. Kubey, R. (2001) Internet use and collegiate academic performance decrements: early findings. Journal of Communication, 51, 366–382.[CrossRef]
  7. Murali, V. & George, S. (2007) Lost online: an overview of internet addiction. Advances in Psychiatric Treatment, 13, 24–30.[Abstract/Free Full Text]
  8. Shotton, M. A. (1991) The costs and benefits of ‘computer addiction’. Behaviour and Information Technology, 10, 219–230.
  9. Squires, D. D. (2005) Diffusing a PC-based intervention for problem drinkers. Dissertation Abstracts International: Section B: The Sciences and Engineering, 65(9-b).
  10. Szasz, T. S. (1973) ‘Drugs and Freedom’ (radio interview). http://www.szasz.com/drugsandfreedom1973.html
  11. Waldron, D. W. (2005) Role-playing games and the Christian right: community formation in response to a moral panic. Journal of Religion and Popular Culture, IX (Spring).
  12. Warden, N. L., Phillips, J. G. & Ogloff, J. R. P. (2004) Internet addiction. Psychiatry, Psychology and Law, 11, 280–295.
  13. Young, K. S. (1998) Caught in the Net: How to Recognise the Signs of Internet Addiction and a Winning Strategy for Recovery. John Wiley & Sons.

Related articles in APT:

Lost online: an overview of internet addiction
Vijaya Murali and Sanju George
APT 2007 13: 24-30. [Abstract] [Full Text]  




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