Fiddling Around with "Game Night"

I provide a monthly didactic at Rutgers Robert Wood Johnson Medical School centered around a feature-length film that we flip as a fictional case study of mental illness. The objective is not to render diagnoses per se, as that would run the risk of stigmatizing individuals with mental illness (films universally provide inaccurate portrayals of mental disorders). Instead, the selected film serves to stimulate discussion over social media to educate learners as well as to inform the general public about mental illness. The following blog is a pre-posting of this month’s discussion.

Synopsis

Game Night (2018) is a comedy that depicts a competitive gamer couple who host a game night that seemingly turns into a real-life mystery after one of them is apparently kidnapped. The whodunit is complicated by the dynamic created when Max’s brother, Brooks, shows up uninvited. As of this posting, the film holds an 84% rating on Rotten Tomatoes and a score of 7.0 out of 10 on IMDb.

How it relates to psychiatry

The film depicts behavior in its main characters that may be indicative of Gaming Disorder, a twist on Internet Gaming Disorder, a condition described in the section recommending conditions for further research (Section III) in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The Addictive Disorders chapter of the DSM-5 includes substance-related disorders and non-substance-related disorders. Gambling Disorder is the only current non-substance-related disorder identified in DSM-5. The inclusion of this second disorder is supported by studies that suggest individuals who are preoccupied with internet games have dopaminergic reward pathways in the CNS triggered in the same way that a drug addict’s brain is affected by a substance of abuse (1). As such, individuals may experience a) tolerance (the need to spend more time gaming to gain the same effect) and b) withdrawal symptoms (sadness, anxiety, irritability) when gaming is taken away or not possible. Since the film is a parody of Internet Gaming Disorder given that the main characters play board games, readers are reminded that this condition is primarily an addiction to the internet/video games by the acronym used to recall the remaining DSM-5 criteria (sorry I went old school):

• Preoccupation with gaming.
• Activities given up, loss of interest in previously enjoyed activities due to gaming.
• Cut down (unsuccessful efforts).
• Continuing to game despite problems.
• Misleading family members or others about the amount of time spent on gaming.
• At risk or having jeopardized or lost a job or relationship due to gaming.
• Negative mood states “self-medicated” by gaming.

The DSM-5 notes that gaming must cause clinically significant distress or impairment in several aspects of a person's life. In a dark, comical way, this criterion is fulfilled by the plot of the film as the hijinks are a direct consequence of the couple’s obsession with gaming.

An alternative perspective of this film is that upon Brooks showing up, the events that unfold are a product of Max’s mind. The stress of his brother’s intrusion results in the main character engaging in (autistic) fantasy as a defense against shame and doubt (alluded to in the film).