On a Wednesday night in early February 2012, a waitress at a Taiwanese-based internet café made a grim discovery. Chen Rong-yu, a binge gamer, was found dead in the chair from which he’d been engaged in a marathon gaming session. The game that Chen was playing prior to his death was League of Legends, an immensely popular MOBA (Multiplayer Online Battle Arena) computer game.

Chen started his game session at 10pm on a Tuesday evening: at midday the next day, a waitress from the café observed Chen talking on his mobile phone while still continuing to play League of Legends on his computer terminal. This was to be the last time anyone noticed Chen alive. Nine hours later he was discovered deceased, slumped in his chair with both arms stiffened in a pose that indicate Chen was still attempting to reach the keyboard and mouse whilst undergoing a suspected cardiac arrest.

This sad event should give any gamer – or anyone in significant social relationships with gamers – pause for thought. Chen’s death is tragic for multiple reasons, including the fact Chen ignored obvious physical cues – and resisted warning signs – to stop the very behaviour that was contributing to his impending death.

Another factor in the tragedy of Chen’s passing is the obliviousness of everyone present at the time of his death. How could the Café staff and customers let a deceased person remain undetected in their midst for such a length of time? What factors could have been so pervasive that the staff (and Chen’s fellow gamers-in-arms) would consider it normal for a man to be sitting stock-still in front of a computer for nine hours without contemplating his welfare?

Was Chen’s compulsive need to play (and those of his fellow internet café gamers) so severe that such behaviours should be classified as a full-blown addiction? Just what is it about these types of games that makes them so compelling?

Defining game addiction

Computer game addiction and Internet dependencies are on the rise, according to Dr. Philip Tam, a psychiatrist and the President and co-founder of the Network for Internet Investigation and Research in Australia:

It is a cliché to state that computing, the Internet and gaming are now ubiquitous elements of daily life for most if not all people, particularly the young. The power and reach of the WWW most probably far exceeds any technology in humanity’s short but eventful history… In many ways, Internet Overuse/ Addiction is the ultimate post-modern affliction for the 21st Century.

Just as with Internet addiction, the concept of game addiction is slippery to define. The current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) – or “psychiatric bible” as it’s known colloquially in psychological circles – does not acknowledge game addiction as a disorder. Internet and video game addiction have not been explicity included in the fifth edition of the DSM (due for release mid-2013) with the category of “Internet Gaming Addiction” instead being considered for future research.

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Game addiction is conceptualised in Western countries as a compulsion or set of aberrant behaviours that occur when a user is focused on playing games via computers, consoles, wearable computers, or mobile devices. The games may vary as much as the hardware, with popular genres including First Person Shooters, App-oriented Social Games (such as those produced by companies like Zynga), MMOGs and MMORPGs (Massive Multiplayer Online Games/Role Playing Games), Strategy Games and Transmedia/Alternate Reality Games.

In an article in The American Journal of Psychiatry, author Jerald Block outlines the following set of criteria to help define game addiction:

excessive use, often associated with a loss of sense of time or a neglect of basic drives withdrawal, including feelings of anger, tension, and/or depression when the computer is inaccessible tolerance, including the need for better computer equipment, more software, or more hours of use negative repercussions, including arguments, lying, poor achievement, social isolation, and fatigue.

In Chen Rong-yu’s case, his excessive use manifested in binge gaming sessions where a gamer plays for an extended (often extreme) amount of time while actively neglecting other concerns, including potentially life-saving absences from the game.

Theorist and Educator McKenzie Wark (and author of “Gamer Theory”) questions whether prolonged use of computer games should even be classified as a discernible addiction:

Is ‘addiction’ even the right term? Or is it just a metaphor? Why do we stigmatize certain engrossments more than others? When my kid reads books all day, my partner and I are happy about it. When he plays games all day, we are not. Who is to say one is better or worse than the other?

Given that even mental health clinicians and game professionals find it hard to establish definitive markers of video game addiction, it’s no wonder that the mainstream majority also struggle with the concept.

Another example that illustrates the dangers associated with prolonged bouts of binge gaming is the July 2012 case of Chuang, an 18 year old Taiwanese gamer who died after playing Diablo III consecutively for 40 hours at an internet café. The circumstances surrounding Chuang’s death were startlingly similar to those of Chen Rong-yu: both had undergone significant physical and mental strain associated with an activity (gaming) that restricted physical movement for long periods of time.

Both Chuang and Chen had neglected basic needs – like eating and sleeping – in order to attain unbroken immersion in their respective game environments. A key difference in their cases involves the fact that Chuang, although playing Diablo III from an internet café, had rented a private room in order to play for an extended length of time. This isolation may have unfortunately acted to prevent any intrusion from other gamers or café staff.

The feeling of ‘fun failure’ and compulsion loops

What drives gamers like Cheng and Chuang to repeatedly engage in excessive game play? Transmedia Game Designer and lifelong gamer Andrea Phillips believes specific types of games produce different compulsive symptoms:

FPSes and MMORPGs tend to maximize length of play session; whereas Zynga-style social and casual games maximize number of sessions [via encouraging] a return to the game as often as possible. I do find the Zynga-style social, mobile games more evil, if you will, just because many of these games are very close to compulsion loops and nothing else. Not a meaningful sense of community or competition, not a narrative, not a sense of exploration. I’m playing a game right now called Jetpack Joyride (not a Zynga game!). In this game, you do the exact same thing every time: You ride a flying jetpack down a hall and avoid traps like lasers and missiles. The game keeps you playing by offering minor variations in the mechanic. After you play enough times, you can upgrade to gadgets that will make it easier to avoid some of the traps, or collect more coins along the way…the game is constantly giving you missions to fulfil to “level up”…But really, every single time you play it’s the same exact thing: One or two minutes of the same randomly-generated hallways. There’s nothing there but the loop.

Phillips also explains that this compulsion loop is similar to ones produced by excessive gambling, with the concept of positive reinforcement being instrumental to both addictive patterns:

There’s also rampant and intentional use of the compulsion loop, which is a term ultimately derived from Skinnerian psychology…The core appeal of gambling is the compulsion loop, too…It’s that tension of knowing you might get the treat, but not knowing exactly when, that keeps you playing. The player develops an unshakeable faith, after a while, that THIS will be the time I hit it big. THIS is the time it will all pay off, no matter how many times it hasn’t so far. Just one more turn. One more minute. But it’s really never just one more… For the most part, I steer clear of multiplayer situations, MMOs, and so on because I just can’t trust myself. With narrative games with an ending, I know I’ll binge-play them, so to avoid the fallout of missed sleep and deadlines, I don’t even start a game like that unless I have a good solid week with no serious commitments.

This impulse to “hit it big” through sporadic rewards should be familiar to most hardcore gamers: MMORPGs invoke this type of intermittent reinforcement to keep players engagement levels exceptionally high. An example of such a MMORPG is World of Warcraft (WoW), where players participate in an immersive game environment that entices players to stay in-game for extreme lengths of time.

Each WoW game character or avatar ­(also known as a toon) interacts with others via a game environment built upon tiered incentive systems. Players perform quests and group with other players to obtain advanced in-game items and achieve high end “prizes” otherwise unobtainable via solo play. Certain kinds of these rewards aren’t immediately assured, however: items such as armour and weapons may have a variable drop rate from specific WoW NPCs (Non-Player Characters).

This method of only rewarding players occasionally (and seemingly randomly) results in what Dr Tam describes as “fun failure”:

What one can observe is, according to freely-available news reports, many of the ‘deaths by internet gaming’ (usually in Taiwan, Japan and South Korea) have involved MMORGs and their equivalents – possibly as there is more ‘pressure’ to play for extended periods alongside your ‘guild companions’ who are often playing overseas… It is generally accepted that a successful game contains the key elements of a sense of fiero (intense satisfaction in achieving an aim) [and] a feeling of ‘fun failure’ when one nearly achieves that key aim (leading to one trying again and again), and clear feedback in how one is progressing.

This idea of “fun failure” links directly to the psychological concept of attentional bias. Attentional bias is where an individual constantly prioritises their attention towards “emotionally dominant stimuli in one’s environment and to neglect relevant data”. Sound familiar? For gamers like Cheng and Chuang, this explains their inability – or reluctance – to stay attuned to their everyday needs and instead focus exclusively on their gaming priorities.

Are game companies inciting addictive behaviour?

Attentional bias may partially explain why gamers willingly spend enormous amounts of time pursuing in-game goals that may seem juvenile or escapist to non-gamers. But do the companies that design the games also need to shoulder their fair share of responsibility for providing vehicles for such addictive, or compulsive, behaviours?

Andrea Phillips agrees that some game developers do deliberately create games that encourage excessive behaviours, where “it’s common for a game design spec to talk about making a game ‘more addictive’ in positive terms, as shorthand for ‘highly engaging and fun to play’.”

When queried if game production companies might be knowingly producing computer games that are geared towards disproportionate or unhealthy game play, Alternate Reality Game designer Jan Libby donned both her designer and player hat while responding:

In a word – yes, but I don’t believe these designers sit down and say ‘Hey I’m going to make an unhealthy game!’ I would guess they’re searching for ways to get people fired up about the game and to keep them returning to the gameworld. I know there are mechanics that keep us coming back. I play and have played many social [games] and MMORPG’s that have me at their mercy… I’m not certain my projects are designed to trigger “addiction”, but I do look for ways to hook people with a story and characters that’ll keep them returning to the world I’ve created.

McKenzie Wark is of the opinion that media creators in general – including game companies – continually grapple with the problem of capturing and sustaining attention: “Like any other media, games attach themselves to both our appetites and our desires…It is as true of journalism or fiction or cinema as it is of games. It’s the maker’s job to catch and hold you”.

From a purely business point of view, it makes complete sense to develop games that provide deeply engaging experiences, complete with “fun failures” and hooks to keep commitment levels high. However, if a company specifically embarks on game development with the intention of emphasising addictive game elements at the expense of others, this may alter a game’s trajectory to such a degree that these variables eventually reduce overall enjoyment of the game, resulting in the dreaded “grind”.

Grinding – or bland and often boring gameplay – is often symptomatic of games that require repetitious levelling in order to progress. Many steadfast gamers approach this type of play with resignation, accepting it as part of their “fix” in order to obtain rewards derived from intermittent reinforcement. There are a select few who instead accept the grind as part of the overall game experience, and who enjoy the reality of such monotonous actions as focused – as opposed to compulsive – play: not all gamers who spend substantial time in-game are addicted and will ultimately end up in destructive (or in the case of Cheng and Chuang, life-ending) routines. As Dr Tam says:

Whether one states that the game designers encourage ‘unhealthy’ gameplay will depend on whether you view heavy gaming as a positive ‘passion’ (as hardcore gamers do), or an unhealthy obsession.

Dealing with compulsive gaming

China and South Korea deal with the issue of Internet and game addiction by sending those worst affected to Addiction Boot Camps. These Boot Camps vary in terms of treatment regimes, and are the preferred method of dealing with gaming – or Internet overuse – that verges on the pathological, especially for adolescents.

Many of these Boot Camps seek to address compulsive gaming behaviour through military style programs employed by schools like the Jump Up Internet Rescue School. At these camps Internet and phones usage are restricted, with a strong emphasis instead placed on outdoor activities and physical exercise. Unfortunately, controversies surround several of these camps with accusations of participant mistreatment (even torture) being levelled against some of their operators.

Countries like the USA also have their own treatment centres that proactively seek to deal with users who want to quit and resume their lives without having gaming as a core defining aspect. Organisations such as the Australian Network for Internet Investigation and Research take a different approach to game over-immersion by providing education resources and targeted information, as well as operating as a forum for professionals to “to share and discuss research and clinical developments in the field”.

Other groups seek to utilise the constructive power of intensive gaming through gamification of everyday activities in order to create positive feedback loops, or the development of games specifically designed to create beneficial consequences (such as Jane McGonigal’s Superbetter). Even Massive Open Online Courses (MOOCs) like Udacity – though not strictly games as we have come to know them – harness mechanics similar to certain gaming formats in an effort to offer new educational-based platforms.

Perhaps such alternative harnessing of game-like elements is instead where we should be focusing significant attention regarding gaming in general, rather than constantly emphasising negative aspects such as addiction. Maybe then we can seek to develop a rigorous scale of gamer behaviour, one that includes both the detriments and benefits of focused game play: even ultimately questioning whether the game addiction paradigm is necessary in terms of clinical definition and treatment. As Dr Tam states:

There is no simple, single way of ‘controlling’ or ‘treating’ 21st century problems such as internet addiction or video game addiction. Only a full, open and informed discussion by all stakeholders (parents, schools, opinion leaders, games & tech companies, teenagers) will have a lasting impact on this challenging problem. A purely ‘mental health’ perspective is insufficient; also taking account of social, evolutionary, technological, educational and increasingly political and philosophical factors will be imperative.

Image Credit: Kiyoshi Ota/Getty Images

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