Query to a Psychotic DSM-5: Is Gaming Addictive?

Adam Lanza lived in a shrouded room playing video games: Could he be addicted?

Posted Nov 26, 2013

News Item

Adam Lanza, the Newtown mass murderer who killed 26 people at Sandy Hook Elementary School (20 of them first graders):

spent the final months of his life mostly alone in his bedroom. His windows were covered with black trash bags. He was preoccupied with violent video games . . . .  Mr. Lanza refused to speak even to his mother, communicating with her only by email, even though their bedrooms shared the same floor of their house. . . .

Is it possible that Lanza was addicted to gaming? It might seem so. I pose this question rhetorically to DSM-5 for reasons I will make clear. As is typical with addiction, Lanza felt incapable of finding real-life rewards and instead relied on video games for succurance:

Mr. Lanza, 20, could not connect with people but obsessed over “Dance Dance Revolution,” an interactive video game he played in the lobby of a nearby movie theater, spending as long as 10 hours at a time trying to follow dance routines as they flashed on the screen.

Is this some indication of a wave of the future?

Background—The Disastrous DSM-5:

America's psychiatric bible, DSM-5, abounds in critics, including prominent PT bloggers.  This document faced the unique situation of being rejected on publication—after years, nay decades, of development—by the head of the National Institute of Mental Health. Thomas Insel declared his goal and psychiatry's is "to reshape the direction of psychiatric research to focus on biology, genetics and neuroscience."

Unfortunately, there IS no such genetic, neuroscientific, and biological basis for mental illness. To take one key example, the World Federation of Societies of Biological Psychiatry, a consortium committed to finding biological sources for depression, declared in a consensus document in anticipation of DSM-5: "no biological markers for major depression are currently available for inclusion in the diagnostic criteria."

Meanwhile, one PT blogger, Allen Frances, indicates that we should bank our diagnoses and treatment of mental illnesses on their biological sources, and is puzzled why "there is a big disconnect between our remarkable recent advances in basic neuroscience and the deep rut in clinical diagnosis and treatment." Yet another blogger, Edward Shorter, who also believes in "real" biological roots for mental illness, fantasizes that one such marker was already discovered for depression, but the discovery was suppressed

Frances, in what I find a confusing non sequitur, simultaneously feels we are becoming an overdiagnosed, pill-popping society. He counts as one of its saving graces that DSM-5 "eventually dropped under great external pressure. . .mixed anxiety/depression." Shorter, who also feels there are too many unsubstantiated diagnoses, on the other hand feels that psychiatry's not recognizing this same conglomerate anxiety/depression disorder, and to prescribe sedative/stimulant concoctions for it, is a great failure!

The weary "require stimulation; those who are agitated and preoccupied require sedation," he writes. "Half a century ago the pharmaceutical industry marketed a highly successful combination of barbiturates and amphetamines," which has now, in his view, unfortunately fallen into disuse.

The insight of Frances and of Shorter in questioning specious and unnecessary diagnoses is a valuable critical contribution that, for me, focuses on people's strengths and independence.  I hope that people experience the positive thrust that these writers' critiques imply, rather than believing that what ails people is some irreversible biological sickness.

The Psychotic DSM-5 Addiction Section:

Nowhere is the insanity of the DSM-5 more evident than in its addiction section. Oh, there is no addiction section? Let me clarify, please.

1. There is no drug addiction in DSM-5. There are mild, moderate, and severe substance use disorders (SUDs).

2. There is a “Substance Use and Addictive Disorders” section, but the ONE thing it calls "addictive"—in a subsection called “Behavioral Addictions”—is “Gambling Disorder.” 

3. The DSM-5 is in a vast muddle about which activities (virtually every psychoactive drug may produce an SUD) are addictive and which not. For instance, at the last moment, DSM-5 excluded hypersexuality (read: sex addiction), after it seemed to be a fundamental diagnosis to many (including PT's Marnia Robinson).  

The head of the SUD subcommittee, psychiatrist Charles O'Brien, justified including gambling, and only gambling, as a behavioral addiction on the grounds that “substantive research” indicates that “pathological gambling and substance-use disorders are very similar in the way they affect the brain and neurological reward system.” If this is so, then as I wrote for PT, "why is it a 'behavioral' addiction and not simply an addiction?" In fact, as I also say, "If there is some such higher level 'neurological reward system,' then it can’t be said to exclude anything, from sex to food to gambling to video games."

Psychiatry won't stop at labeling a single nondrug activity as addictive. Already DSM-5 lists “Internet gaming disorder” as another possible behavioral addiction in Section III, which outlines disorders under consideration for future inclusion in the manual. What are they waiting for? To see whether “persistent and recurrent use of Internet games, and a preoccupation with them, can result in clinically significant impairment or distress.”

Did Lanza's preoccupation with video games cause significant impairment and distress? We could ask him or his mother to see if this is the case if they weren't both dead, along with 26 other people.  But it seems clear that gaming was part of Lanza's complete inability to function normally.  As I expressed:

The problem with the DSM-5 approach is in viewing the nature of addiction as a characteristic of specific substances (now with the addition of a single activity). But think about obsessive-compulsive disorder (OCD): People are not diagnosed based on the specific habit they repeat—be it hand-washing or checking locked doors. They are diagnosed with OCD because of how life-disruptive and compulsive the habit is. Similarly, addictive disorders are about how badly a habit harms a person’s life. 

As I concluded in PT in 2011: "In the future, DSM-5 will be looked on as a document of the moment, not as a successful delineation of addictive disorders. Indeed, DSM-5’s current proposals on addiction will not stand the test of even the short time it takes until its scheduled publication."

Stanton's next book (with Ilse Thompson), due out in February, deals with these and related clinical and self-help issues.  You can preorder here Recover! Stop Thinking Like an Addict and Reclaim Your Life with The PERFECT Program.

P.S. (November 27):

A Korean novelist wrote in the Times about subletting an apartment in Brooklyn from a game developer, and spending all of his time playing an interactive war game:

But among teenagers, Internet games are perceived as a serious addiction [in Korea]. Given the extreme competition surrounding university admissions, parents regard enjoyment of video games with great displeasure. The conflict between parents and their kids, who see the games as a form of escape, has even been known to lead to violence.

Recently, the governing Saenuri Party introduced an addiction law that would treat online video games like drugs, alcohol and gambling and also online video games. . . .

Would a law providing for treatment of Internet gaming addiction actually help players to recover?

I didn’t put the controller down in my Brooklyn apartment because of a law. One day my wife approached me as I sat back exhausted from shooting the toy gun.

“You still having fun?” she asked.

I thought about it, and shook my head: “No.”

“Then let’s go out.”. . .

I feel ashamed thinking back on my time in Brooklyn, when I was addicted to games and isolated from the world. But like a physical scar that is part of one’s body, that time is part of my history.

What would have happened if my wife had sent me to a treatment center? Without access to the Internet, I probably would have recovered — but I would have lost confidence in my ability to overcome the addiction on my own.

Young-ha Kim is a novelist and short-story writer. This article was translated by Krys Lee from the Korean.