What was once a parody may soon be diagnosis
By Greg Beato
IN 1995, in an effort to parody the way the American Psychiatric Association's hugely influential Diagnostic and Statistical Manual of Mental Disorders medicalizes every excessive behavior, psychiatrist Ivan Goldberg introduced on his website the concept of "Internet Addiction Disorder." Last summer Ben Alexander, a 19-year-old college student obsessed with the online multiplayer game World of Warcraft, was profiled by CBS News, NPR, the Associated Press and countless other media outlets because of his status as client No. 1 at reSTART, the first residential treatment center in America for individuals trying to get themselves clean from Azeroth, iPhones, and all the other digital narcotics of our age.
At reSTART's 5-acre haven in the woods near Seattle, clients pay big bucks to detox from pathological computer use by building chicken coops, cooking hamburgers and engaging in daily therapy sessions with the program's two founders, psychologist Hilarie Cash and clinical social worker and life coach Cosette Rae. With room for just six addicts at a time and a $14,500 program fee, reSTART isn't designed for the masses, and so far it seems to have attracted more reporters than paying clients. When I spoke with Rae in May, she said "10 to 15" people had participated in the 45-day program to date.
Still, the fact that reSTART exists at all shows how far we've progressed in taking Dr. Goldberg's spoof seriously. You may have been too busy monitoring Kim Kardashian's every passing thoughtlike thing on Twitter to notice, but Digital Detox Week took place in April, and Video Game Addiction Awareness Week followed on its heels in June. Internet addiction disorder has yet to claim a Tiger Woods of its own, but the sad, silly evidence of our worldwide cyber-bingeing mounts on a daily basis. A councilman in the Bulgarian city of Plovdiv is ousted from his position for playing Farmville during budget meetings. There are now at least three apps that use the iPhone's camera to show the world right in front of you so you can keep texting while walking down the street, confident in your ability to avoid sinkholes, telephone poles and traffic. Earlier this year, 200 students taking a class in media literacy at the University of Maryland went on a 24-hour media fast for a group study, then described how "jittery," "anxious," "miserable" and "crazy" they felt without Twitter, Facebook, iPods and laptops. "I clearly am addicted," one student concluded, "and the dependency is sickening."
In the early days of the web, dirty talk was exchanged at the excruciatingly slow rate of 14.4 bits per second, connectivity charges accrued by the hour instead of the month, and the only stuff for sale online was some overpriced hot sauce from a tiny store in Pasadena. It took the patience of a Buddhist monk, thousands of dollars and really bad TV reception to overuse the web in a self-destructive manner. Yet even then, many people felt Ivan Goldberg's notes on Internet addiction worked better as psychiatry than comedy. A year before Goldberg posted his spoof, Kimberly Young, a psychologist at the University of Pittsburgh, had already begun conducting formal research into online addiction. By 1996 the Harvard-affiliated McLean Hospital had established a computer addiction clinic, a professor at the University of Maryland had created an Internet addiction support group and The New York Times was running op-eds about the divorce epidemic that Internet addiction was about to unleash.
HOOKED ON ELECTRONICS: Studies reportedly show that 3 to 6 percent of Internet users are addicted.
In 1998 Young told the Riverside Press-Enterprise that "5 to 10 percent of the 52 million Internet users [were] addicted or 'potentially addicted.'" Doctors today use similar numbers when estimating the number of online junkies. In 2009 David Greenfield, a psychiatrist at the University of Connecticut, told the San Francisco Chronicle that studies have shown 3 percent to 6 percent of Internet users "have a problem." Is it possible that the ability to keep extremely close tabs on Ashton Kutcher actually has reduced the Internet's addictive power?
Three percent is an awful lot of people. Argue all you like that a real addiction should require needles, or spending time in seedy bars with people who drink vodka through their eyeballs, or at least the overwhelming and nihilistic urge to invest thousands of dollars in a broken public school system through the purchase of lottery tickets. Those working on the front lines of technology overuse have plenty of casualties to point to. In our brief conversation, Cosette Rae tells me about a Harvard student who lost a scholarship because he spent too much time playing games, a guy who spent so many sedentary hours at his computer that he developed blood clots in his leg and had to have it amputated, and an 18-year-old who chose homelessness over gamelessness when his parents told him he either had to quit playing computer games or move out.
A few minutes on Google yields even more lurid anecdotes. In 2007 an Ohio teenager shot his parents, killing his mother and wounding his father, after they took away his Xbox. This year a South Korean couple let their real baby starve to death because they were spending so much time caring for their virtual baby in a role-playing game called Prius Online.
On a pound-for-pound basis, the average World of Warcraft junkie undoubtedly represents a much less destructive social force than the average meth head. But it's not extreme anecdotes that make the specter of Internet addiction so threatening; it's the fact that Internet overuse has the potential to scale in a way that few other addictions do. Even if Steve Jobs designed a really cool-looking syringe and started distributing free heroin on street corners, not everyone would try it. But who among us doesn't already check his email more often than necessary? As the Internet weaves itself more and more tightly into our lives, only the Amish are completely safe.
As early as 1996, Kimberly Young was promoting the idea that the American Psychiatric Association (APA) should add Internet addiction disorder to the Diagnostic and Statistical Manual of Mental Disorders (DSM). In February, the APA announced that its coming edition of the DSM, the first major revision since 1994, will for the first time classify a behavior-related condition—pathological gambling—as an "addiction" rather than an "impulse control disorder." Internet addiction disorder is not being included in this new category of "behavioral addictions," but the APA said it will consider it as a "potential addition ... as research data accumulate."
If the APA does add excessive Internet use to the DSM, the consequences will be wide-ranging. Health insurance companies will start offering at least partial coverage for treatment programs such as reSTART. People who suffer from Internet addiction disorder will receive protection under the Americans With Disabilities Act if their impairment "substantially limits one or more major life activities." Criminal lawyers will use their clients' online habits to fashion diminished capacity defenses.
Which means that what started as a parody in 1995 could eventually turn more darkly comic than ever imagined. Picture a world where the health-care system goes bankrupt because insurers have to pay for millions of people determined to kick their Twitter addictions once and for all. Where employees who view porn at work are legally protected from termination. Where killing elves in cyberspace could help absolve you for killing people in real life. Is it too late to revert to our older, healthier, more balanced ways of living and just spend all our leisure hours watching Love Boat reruns?
DUAL DIAGNOSIS: Internet porn addiction usually coincides with an unhealthy attachment to the web.
ASK Stephen L. Braveman what most of the patients he treats for pornography and sex addiction have in common and he'll tell you that, in about 85 percent of the cases, they're also addicted to the Internet.
"It's very common for people who come in my door to say they're addicted to their Blackberry or addicted to their computer," says Braveman, a Monterey-based marriage and family therapist specializing in sex therapy. "It's not a big deal for a computer programmer who's making a million dollars a year working on their computer. But for someone like a commute train operator who's checking email when they should be watching the tracks, it's a big problem."
Although Braveman's practice is focused on patients' sexual problems rather than their online habits, he says the Internet has brought a slew of new challenges for the modern sex therapist. Instant, and often free, access to online pornography makes avoiding temptation exponentially more difficult for sex addicts who are looking to tamp down their obsessions. Child pornography, also widely available online, is fueling an increase in pathology and criminality among those who produce and consume it.
Braveman says he recently treated a soldier who had been downloading child pornography onto his government-issued laptop. Instead of having him discharged or court-martialed "and wasting the $100,000 they spent trying to make him a killer," Braveman says the young man's commander came to him looking to get the soldier treatment.
In many cases, Braveman says his patients have to find a replacement for the computer altogether, because even if a patient gives up online porn, he or she can quite easily switch to online games, shopping or gambling.
"With porn addicts we have to be very careful," he says. "If we don't find a proper outlet, they can switch to something else. If we get them away from adult content but they spend hours on computer games, we haven't helped them much."
Send letters to the editor here.