Should overuse of the Internet become a mental disorder?

When exactly does overuse of the Internet become pathological?

Posted Mar 25, 2009

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The next time your son begs to continue playing Nintendo Wii over dinner, your daughter texts her friends for the umpteenth time that day, or you find yourself lost online, madly pursuing links to new websites, consider this: American psychiatrists are busy debating whether such activities should soon be known as "Internet addiction."

One year ago, the American Journal of Psychiatry published an editorial calling for recognition of internet addiction as a "common disorder." A crop of almost surreal newspaper articles followed, with titles such as "Net Addicts Mentally Ill, Top Psychiatrist Says."

But the response from our medical and mental-health communities was closer to a collective yawn. True, a skeptical reply came from the Harvard Mental Health Letter, whose editor, Michael Craig Miller, warned that it's "probably not helpful to invent new terms to describe problems as old as human nature." Other than him, few experts seemed to notice—much less mind—that the flagship journal of American psychiatry was arguing quite seriously that overuse of the internet might be a psychiatric illness, on a par with, say, schizophrenia.

The anniversary of the editorial seems like a good moment to revisit its controversial claims and see whether they have any merit.

Jerald J. Block, the Portland-based author of the piece, argued that the disorder presents three subtypes: "excessive gaming, sexual preoccupations, and email-text messaging." Given the opening scenario I described of mayhem at dinnertime, it's not a wild guess to say that the last one applies to quite a few teenagers. Nor is it a surprise to news junkies like me that the middle one turns out to apply to a sizable number of former senators, governors, and mayors.

In all seriousness, one reason Block's proposal is so dicey is that so many professions, organizations, and services rely on email, the Internet, and of course computers. The line between compulsive behavior and sheer hard work is also difficult to gauge, 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 voiced 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 this country, many parents and teachers 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 strikes me as completely off-base when he claims that the remedy for that problem is medication. As he put 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." Antidepressants and hospitalization? For gaming and text messaging? Have we lost all perspective here?

In a New York Times article published in November 2007, 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."

Before we medicate yet more teenagers and adults, let's pause and ask whether overuse of the internet really belongs with schizophrenia 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 University, is the author most recently of Shyness: How Normal Behavior Became a Sickness. Follow him on Twitter: @christophlane