Monday, March 31, 2008

Is Blogging a Sickness?

Advertising Age points to a recent article that apparently has others in the blogosphere buzzing.

The original article, an editorial in The American Journal of Psychiatry by Dr. Jerald Block, argues that "Internet addiction" should be included as a pathological condition in the next edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). Dr. Block writes:

Internet addiction appears to be a common disorder that merits inclusion in DSM-V. Conceptually, the diagnosis is a compulsive-impulsive spectrum disorder that involves online and/or offline computer usage (1, 2) and consists of at least three subtypes: excessive gaming, sexual preoccupations, and e-mail/text messaging (3). All of the variants share the following four components: 1) excessive use, often associated with a loss of sense of time or a neglect of basic drives, 2) withdrawal, including feelings of anger, tension, and/or depression when the computer is inaccessible, 3) tolerance, including the need for better computer equipment, more software, or more hours of use, and 4) negative repercussions, including arguments, lying, poor achievement, social isolation, and fatigue (3, 4).
Most of Dr. Block's data comes from studies in Asia, with applications to the United States only suggested by those studies. Nonetheless, he concludes:

In the United States, accurate estimates of the prevalence of the disorder are lacking (11, 12). Unlike in Asia, where Internet caf├ęs are frequently used, in the United States games and virtual sex are accessed from the home. Attempts to measure the phenomenon are clouded by shame, denial, and minimization (3). The issue is further complicated by comorbidity. About 86% of Internet addiction cases have some other DSM-IV diagnosis present. In one study, the average patient had 1.5 other diagnoses (7). In the United States, patients generally present only for the comorbid condition(s). Thus, unless the therapist is specifically looking for Internet addiction, it is unlikely to be detected (3). In Asia, however, therapists are taught to screen for it.

Despite the cultural differences, our case descriptions are remarkably similar to those of our Asian colleagues (8, 1315), and we appear to be dealing with the same issue. Unfortunately, Internet addiction is resistant to treatment, entails significant risks (16), and has high relapse rates. Moreover, it also makes comorbid disorders less responsive to therapy (3).

Responding in Advertising Age to Block's article, Simon Dumenco writes:
In other words, endlessly checking Facebook or spending hours mainlining YouTube could be a sign of an actual, specific sort of mental illness. That diagnosis was, of course, perfect fodder for bloggers, who could muse about their own craziness while continuing to engage in precisely the activity that makes them crazy -- while also implicating their readers. It was like watching a bottle of Jack Daniel's getting passed around at an AA meeting.
Dumenco notes, correctly, that the Internet has always been viewed as somewhat pathological:
Internet addiction as a media meme, of course, dates almost to the earliest days of the medium (and obviously interweaves with other media addictions -- to TV, video games, etc.).
He points to another article in The Observer, a British quality ewspaper, that first picked up on Block's argument in the mainstream press. Writing on Easter Sunday, technology correspondent David Smith noted that, even before Block made his plea in the professional press, treatment for Internet addiction had already popped up in various places:

Internet addiction clinics have sprung up around the world in an attempt to wean people off their need for a fix. Many people have turned, apparently without irony, to web discussion boards with names such as Internet Addicts Anonymous. The Centre for Internet Addiction Recovery in Bradford, Pennsylvania, says internet addiction has become a growing legal issue in criminal, divorce and employment cases. It offers a consultation service to lawyers that includes 'assessing the role of electronic anonymity in the development of deviant, deceptive and illegal sexual online activities'.

Robert Freedman, editor of the American Journal of Psychiatry, said expressions of the addiction could be diverse. 'In Korea, it seems to be primarily gaming sites. In America, it seems to be Facebook. It's porn, it's games, it's gambling, it's chatting with friends. All these things existed before, but now they're a lot easier.'

To beat the addiction, he advised: 'A self-help group might be a place to start. Maybe replace an online group with a real one.'

Like any form of entertainment (or employment), the Internet can be enjoyed in small doses, in moderation, or in inordinately large chunks of time. Is sitting at a computer playing video games that much more addictive than sitting in a basement playing Dungeons and Dragons or Monopoly? Is reading Wikipedia inherently more addictive -- or more dangerous -- than reading volumes of Britannica (as I did as a pre-teen)?

There seems to be a modern tendency to label any behavior that is eccentric or out-of-the-normal (not necessarily abnormal) as being pathological. That is a line we should be wary to cross, and we should do so only when the evidence is incontrovertible.

In the meantime, somebody pass me the Jack Daniel's.


Douglas said...

There's a substantial portion of the population in the United States that doesn't access the Internet from home. Instead, they use the public libraries (at one of which I happen to work).

While I'm no psychiatrist, let me tell you, we definitely see all four components (excessive use, withdrawal, tolerance, and negative repercussions) in some of our Internet users.

Mind you, I have some skepticism for the "everything is a disease" school of psychology, but if you accept their criteria, I would say this is not unwarranted.

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