Peace Through Progress
Refocusing the Debate Surrounding Video Game Addiction
In 2018 the World Health Organization included gaming disorder in the 11th revision of the International Classification of Diseases, a decision that resulted in some strong push back from the video game industry as well as some medical professionals. This debate did almost nothing to progress the conversation and the results were negative for all concerned parties. As a result of the debate that grew surrounding the nature of video game addiction, the issue rose to an unprecedented level of prominence in news media unseen at any point in the history of video games. This factor can be attributed mainly to the unnecessarily reactive response the ESA and other key players in the video game industry had to the WHO decision coupled with the lack of proactive solutions in response to the decision. Now that video game addiction is seen as such a contentious issue there is an almost definite chance that the WHO definitions will result in a crackdown on the video game industry. There are now more people playing video games than ever before, and although the first decades of research focused primarily on adolescent males, the reality of video game consumption has grown far from that notion. Video games are quickly becoming one of the dominant leisure activities and sources of entertainment for people of all ages around the world, and in America, the industry creating these video games has grown significantly.
The lack of good research combined with the ESA’s poor handling of WHO, has created a problem that Przybylski believes will plague the industry for at least another half decade.
The US Video Game Software industry generated $20.2 billion in 2018, a massive sum that is projected to grow to $24.4 billion in 2023 (Diehl). This already large, and steadily growing industry represents a substantial source of employment for Americans, with 265,858 individuals employed across 82,311 businesses in 2018 (Diehl). Enhanced regulations and restrictions on the video game could lead to some of these businesses to leave the industry, a response seen in South Korea – a country that began enforcing strict regulations on video games to try and mitigate the negative impact of video game addiction. In January 2019, South Korea’s largest game company went up for sale, and if there is an increase in game companies selling as a result of the growingly complex social status of video games, the projected growth of the industry may be affected negatively. South Korea and China have also demonstrated some of the most aggressive responses to video game addiction with their for-profit treatment camps. In the US, the insufficient body of research and unknown nature of video game addiction meant that there were no medical treatments universally agreed upon and treatment instead has been done informally via support groups based upon the 12 step program like GameQuitters and OLGA. These groups are headed by passionate individuals who have shown through the past two decades that they are committed to helping the group of individuals afflicted by gaming addiction. With the elevated perceived threat level of video game addiction in the US, there will be more individuals than ever who believe they are addicted to video games and will seek help, but instead of finding solace in a compassionate community they may soon end up in for-profit addiction treatment centers. South Korea has already begun to reverse the course on the country’s historically problematic relationship with gaming addiction, declaring their opposition to the WHO’s push to further classify the disease (The Korea Bizwire).
If the US continues this escalation of the argument surrounding video game addiction it is possible that we will follow a similar trajectory to that of South Korea. US legislators and the WHO can use the experiences of South Korea as an example and avoid replicating their mistakes on a much larger scale. Key players in the video game industry must be proactive in providing solutions to reduce the addictivity of their games and make a concerted effort to utilize and promote ethical game design principles industrywide. If the video game industry stops acting so defensively and instead takes steps to address the legitimate concerns of video game addiction advocacy groups there is a much better chance of reaching a mutually beneficial solution. Almost everybody participating in this debate at least agrees that some percentage of gamers struggle with video game addiction and are suffering because of this phenomena, but disagreement arises around the definition of the phenomenon and the focus of everyone’s concern is misguided. These concerns are even more clear when considering the diverse group of individuals now consuming video games. One of the concerns expressed by the ESA and others regarding the classification of video game addiction as a mental disorder was that they were worried about the implications the decision would have for future research. It is clear that these concerns were not unfounded since the WHO classification the public stigma of gaming has increased substantially in a way that is negatively influencing the progress of the positive side of video games, despite the fact that even in 2017 over 130 million Americans played commercial video games (Brown). Figure 1 shows the Pew Research Center’s findings regarding the distribution of American gamers, and these statistics tell a different story than that of most research. The history of video game addiction research, as well as many of the other, argued harmful effects of video games like a contribution to aggressive behavior has always had samples disproportionately representing teenage boys. As a result of this, much of the current research that has led medical organizations like the WHO to their classification of video game addiction as a brain disorder is built off a wholly inaccurate understanding of the way video games affect the majority of individuals consuming them. In order to reverse the course, organizations need to retract their decisions on the nature of video games and heed the numerous calls for research into the positive benefits of video games and encourage the development of the medium in a way that contributes to the quality of people’s lives and the development of the art form.
Figure 1: Demographics of American Video Game Players (Pew Research Center)
Professional research into the efficacy of video games as a positive force in the lives of individuals comes in two main forms, with one group researching custom made video games for health-care while the other investigates commercial off the shelf games. Researchers in the field of video games for health argue that specially designed video games may represent “exciting, innovative, potentially highly effective methods for increasing knowledge, delivering persuasive messages, changing behaviors, and influencing health outcomes.” (Baranowski, Tom et al.) There has been a developing body of research supporting the numerous benefits of video games for health, but the stigma surrounding video games has caused these voices to be effectively silenced. In a 2012 review of the “Role of Video Games in Improving Health-Related Outcomes” the authors analyzed the nature and state of research in the field. Although it is clear that the research is limited, the authors clearly identify the significance of the findings and potential of the suggestions. This review makes an important observation, identifying that “almost all of the studies with higher-quality design features reported positive results; this provides reassurance that the current findings of potential health benefits of video games are not simply a consequence of low-quality studies.” (Primack, Brian A et al.). This suggests that, if investigated further, the positive benefits of video games will only continue to become more apparent. The same can not be said for video game addiction research and the majority of investigations into the negative aspects of video game usage. These studies can be criticized for the same methodological shortcomings of positive investigations, however, these studies seldom suggest that further investigation with proper samples would yield similar conclusions. Investigations into the efficacy of games for health showed that they have the potential to increase knowledge and aid learning in classroom environments, however, the lack of perceived legitimacy of these tools makes it so that few classrooms have the chance to use them (Baranowski, Tom et al.). It is a similar situation for the usage of video games in therapeutic and medical contexts due to the negative attitudes towards the medium. Some other issues surrounding games for health come from the stakeholders concerned with the state of games for health, as with any video game . In the article the stakeholders are identified as “those who (a) are interested in using G4H to advance their or their organization’s agenda, (b) may benefit from playing the games, (c) create G4H for profit, and (d) conduct research on G4H.” (Baranowski, Tom et al.) While it is obvious that there are some people looking to advance this research for monetary games as video game developers, the public good of games for health is much greater than that to those with commercial interests.
At the beginning of 2018, a mini review titled “Commercial Video Games As Therapy: A New Research Agenda to Unlock the Potential of a Global Pastime” was published in the peer reviewed journal Frontiers in Psychiatry. This review was written by a group of prominent researchers advocating for the shift in the narrative surrounding video games. In this review, they consider the potential therapeutic benefits of commercial, off-the-shelf (COTS) video games. The authors advocate for the adaptation of games that people already play in a way that helps improve mental health instead of the creation of games with intentional therapeutic/educational (Carras et al., 1). The researchers provide a framework to guide future research into this concept which can be seen in figure 2 on the following page. This is an idea that represents great potential and utilizes improved research techniques to truly enhance the understanding of this issue in an exploratory manner, contrary to the biased confirmatory approach that stigma and prevailing narratives have grown to promote. Although this call for research professes the immense potential benefits of COTS games in the lives of those consuming them, they also identify a host of problems limiting progress. These are identified as “a lack of standard terminology, rapidly changing technology, societal attitudes toward video games, and understanding and accounting for complex interactions between individual, social, and cultural health determinants.” (Carras et al.) Overcoming the limitations like a lack of standard terminology are simple, and with renewed legitimacy in the field and communication amongst researchers they would correct themselves, but things like the societal attitudes toward video games cannot change until the debate is taken in a more constructive and meaningful direction that considers the interests of all parties concerned with the issue.
Figure 2: COTS Video Game Research Framework
This research into the positive benefits of video games is one part of how industry professionals can attempt to ease the tensions regarding video game addiction, however, there is more that will be needed to be done to solve this problem. Celia Hodent is the former UX designer for the hotly debated free to play video game Fortnite, which has been the target of criticism for its addictive design and use of loot boxes. In an interview with Gamasutra Hodent discusses the conversation surrounding video game addiction and urges companies to take proper steps to create ethical games and shape the conversation to reflect the interests of the industry while always keeping the players health and well being in mind (Francis, Gamasutra). Hodent believes that :
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“If we [the game industry] self-regulate, at least we can control the discussion around it, and we can make it more rational before waiting to have regulation made by people that don’t understand game development or how it works. It’s getting more intense, it might be unfair for some people, so if we do it ourselves we can at least have a better conversation about it. A less rushed, less emotional conversation than one imposed from outside.” (Hodent)
Oxford researcher Andrew Przybylski was the first to suggest that the ESA statement and rebuttal letter to the WHO created the present climate. Przybylski identified that there are is a massive issue with the research supporting the measurement of video game addiction, however, he firmly believes that way the ESA responded created the net effect observable today with the expected future of video game addiction classification and regulation (Crecente). Przybylski worries that the result of this relationship between the video game industry and the WHO is that:
“We’re going to stigmatize the hobby of more than a billion people on the planet…There is going to be a lot of really dumb regulations coming down the pipe. Depending on the patchwork of markets and regulations, in some places more aggressive regulators are going to fragment the market. There are going to be some kind of labeling rules, there’s going to be sin taxes. And there are going to be fines…So in a lot of ways, there have been short term victories that are going to lead to long term defeats on this.” (Przybylski)
These are the kinds of negative impacts that could lead to the crash of the US video game industry and prevent the positive influence of video games identified in the research earlier from reaching society.
While the industry as a whole needs to listen to the advice offered by Przybylski and Hodent, there are some game studios that are already taking the necessary steps to solve this problem. In May of 2019, the developers of the popular mobile version of Player Unknown’s Battlegrounds (PUBG Mobile) took steps to address the criticisms they have received regarding the addictive and negatively influential nature of their game by implementing a “gameplay management” system and “game for peace” variant (Brown). Brown argues that the addition of the gameplay management system is a direct response to the attempts by governments in India and Nepal to ban the game completely, although the company has not admitted this. The gameplay management system designed for PUBG Mobile consists of notifications to remind the player to stop playing or take a break along with information regarding how long they have been playing (Brown). The characteristics of the Gameplay Management system are very similar to those in Google’s digital well being, Apple’s screen time, and other Smart Phone usage tracking programs that attempt to reduce unhealthy and excessive engagement. These programs may be effective in reducing general smartphone engagement, but it is unclear whether these passive suggestions are substantial enough to actually alter the gaming behavior of players – particularly those who consider themselves addicted to the game. The accusations regarding the addictive nature and harmful potential of PUBG Mobile and other games often are primarily concerned with their danger to younger players and because of this factor, PUBG mobile will also now contain a warning message requiring acknowledgement for players under 18 to continue on and play (Brown). While these steps taken by the PUBG Mobile developers represent movement in the right direction on the developer/industry side of the issue, this is still a far-cry from the advice of Przybylski and Hodent, and likely far from what many critics will see as a concerted effort to mitigate the risks of problematic gaming behavior. In order to truly show regulators and organizations like the WHO that they wish to solve this problem without creating new ones within their industry, game studios must have an open and honest dialogue regarding each other’s concerns like Hodent said.
- “65% Of American Adults Enjoy Playing Video Games.” The Entertainment Software Association, www.theesa.com/article/65-american-adults-enjoy-playing-video-games/.
- Baranowski, Tom et al. “Games for Health for Children-Current Status and Needed Research.” Games for health journal vol. 5,1 (2016): 1-12. doi:10.1089/g4h.2015.0026
- Brown, Anna. “Who Plays Video Games? Younger Men, but Many Others Too.” Pew Research Center, Pew Research Center, 11 Sept. 2017, www.pewresearch.org/fact-tank/2017/09/11/younger-men-play-video-games-but-so-do-a-diverse-group-of-other-americans/.
- Brown, C. Scott. “PUBG Mobile’s New ‘Gameplay Management’ Will Combat Addiction Accusations.” Android Authority, 15 May 2019, www.androidauthority.com/pubg-mobile-gameplay-management-986708/.
- Colder Carras M, Van Rooij AJ, Spruijt-Metz D, Kvedar J, Griffiths MD, Carabas Y and Labrique A (2018) Commercial Video Games As Therapy: A New Research Agenda to Unlock the Potential of a Global Pastime. Front. Psychiatry 8:300. doi: 10.3389/fpsyt.2017.00300
- Crecente, Brian. “Oxford Researcher Blames ESA Reaction for Prolonged Gaming Addiction Crisis.” Variety, 26 Mar. 2019, variety.com/2019/gaming/news/oxford-researcher-gaming-addiction-esa-1203172623/.
- Diehl, Heidi. “51121e, Video Game Software Publishing in the US”. IBISWorld. December. 2018. https://clients1.ibisworld.com/reports/us/industry/default.aspx?entid=1993
- Francis, Bryant. “Former Fortnite UX Lead Digs into Ethical Game Design.” Gamasutra Article, www.gamasutra.com/view/news/342130/Former_Fortnite_UX_lead_digs_into_ethical_game_design.php.
- “Gaming Disorder.” World Health Organization, World Health Organization, 14 Sept. 2018, www.who.int/features/qa/gaming-disorder/en/.
- Herald. “[Feature] ‘Game Addiction Is Real, but …’.” The Korea Herald, 4 Mar. 2019, www.koreaherald.com/view.php?ud=20190304000497.
- “S. Korea Tells WHO It’s Opposed to Classifying Gaming Addiction as Disease.” Be Korea-Savvy, koreabizwire.com/s-korea-tells-who-its-opposed-to-classifying-gaming-addiction-as-disease/136766.
 Gamasutra is a website that publishes articles about The Art and Business of Making Games
 PUBG pioneered the modern battle royale which includes the previously mentioned Fortnite, which has been similarly attacked. This genre has increasingly become the scapegoat of the video game addiction debate in recent years.
 This version contains less blood and does not show players die, but rather kneeling in defeat. This is to address accusations of excessive violence and not addiction, however, they are in many ways parts of a whole.
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