Doctors say that there are some obvious pointers to internet addiction such as low levels of real-life engagement with peers and adults. (Illustration: Subrata Dhar) Doctors say that there are some obvious pointers to internet addiction such as low levels of real-life engagement with peers and adults. (Illustration: Subrata Dhar)

Ethan Winters is in search of his wife Mia. He walks through an abandoned house where Mia has been imprisoned in the basement. It’s spooky and unsettling — there’s dried blood on a bathtub and cockroaches scuttle along grimy floors. Even as he tries to evade killers on the prowl, his task is made more difficult by monsters rising from the floor to attack him.

In real life, Ethan is Tushar*, a 17-year-old school boy from New Friends Colony in Delhi, who spends a large part of his day in front of a LCD television, wearing a virtual reality headset — Playstation VR — the latest addition to his collection of gaming consoles. Right now, he is waggling his controller, trying to best onscreen demons in the “survival horror game” — Resident Evil 7. The loss at a gaming competition earlier in the day is haunting him. So, at 4 pm, after an hour of tuition, he is back at his console, practising. “We know people think that we are wasting our time, but you will be surprised at how much dedication it takes to move our hands so fast. That’s why we need to practise for so long,” he says, as he prepares to return to the game.

The lights are dimmed, and soon, there’s pin-drop silence in the room. Halfway through the game, however, he hits pause. “It’s stupid of Ethan to go in search of his wife when it’s so dangerous. After some time, I have to get away from it for a while. I would not recommend this to any one under the age of 12,” he says.

When Tushar was seven, he was gifted his first hand-held gaming console — a Mitashi. “My family used to take several trips to Mussoorie. It was boring for kids, unless you found a gaming parlour around. During these trips, I started playing video games and I loved it. Later, I purchased a Game Boy, a PlayStation and a Nintendo. Once the technology took off, I went along with it,” he recalls. His mother, a housewife, says that her son was a restless child, constantly battling boredom. Video games seemed to give him the stimulation he desired. A decade later, however, she rues the decision. “Honestly, I could not see the warning signs. When he was in Class IV, we received the first complaint from his school that he is always distracted and keeps staring outside. He had problems following multiple instructions. It was then that he was diagnosed with Attention Deficit Disorder. The doctor told us it was borderline, but the real trigger lay elsewhere and was worrisome: It was technology that had made him so restless,” she says.

Is Tushar’s dependence on gaming a distinct disorder that needs clinical intervention? There have been growing concerns worldwide for what has been labelled as “internet addiction.” “People don’t realise the difference between use and abuse. Everyone has access to the internet nowadays. That’s what makes dependence on technology more dangerous than substance abuse. Both affect social and occupational lives. But, what makes technology dependence worse is that, in most cases, the patients come when they have crossed the red line,” says Dr Rajiv Mehta, a consultant psychiatrist at Sir Gangaram Hospital, Delhi, who is treating the youngest case of mobile dependency in the country — a nine-year-old boy from Haryana who slashed his forearms with a kitchen knife when he was denied a smartphone.

Mehta says that in the last one year, about 5 per cent of his patients come to him for treatment related to some form of internet addiction. Most of these patients fall in the age group of 16-18, a time when young adults are going through physiological and psychological changes. Unlike in real life, time on the internet for youngsters often comes without the buffering supervision of adults, many of whom may also not be up to date with the latest technology and social media platforms. It makes children particularly vulnerable to instances of cyber bullying and online phenomenon such as the Blue Whale Challenge, where anonymous instructors instigate players to self-harm over a period of time.

A bewildered mother recently sought help for her teenaged son at Venkateshwar Hospital in Delhi, when she noticed scratch marks on his face.A quiet and withdrawn child, the boy refused to explain how he had got it.

When he eventually came to meet Dr Bhagwat Rajput, a neuro-psychiatrist at the hospital, he said he had scratched himself during a “challenge”. “By then, it was evident that he was addicted to the internet and was suffering from depression. He had relationship issues with his parents and suffered from an inferiority complex because his brother, an extrovert, was more popular. We spoke to the few friends he had, none of whom seemed to have set him any challenge. When I eventually asked him about the Blue Whale Challenge, he seemed very familiar with the game.

That was when we realised we could not rule out the possibility that he was taking part in it,” says Dr Rajput, who has advised supervised digital access for the teenager. “It’s not just about the Blue Whale game. Tomorrow, it could be a new, more dangerous game. Adolescents are at high risk because they are undergoing hormonal changes and the transformation is often turbulent.

Parental guidance is necessary to help them make sense of this period,” he says.

While very little is known about the rate of incidence of internet dependence among adolescents in India, a study conducted in Mumbai in 2009, by the department of psychiatry, Topiwala National Medical College and by L. Nair Hospital, Mumbai, with a sample comprising 987 adolescents across various faculties, had revealed that 74.5 per cent were found to be “moderate users”, 0.7 per cent were found to be addicts and the remaining 24.8 per cent were “possible addicts”. Those registering excessive use of internet also had a higher incidence of anxiety and depression.

Doctors say that there are some obvious pointers to internet addiction such as low levels of real-life engagement with peers and adults, and, sometimes, parental neglect. “When you give your child access to technology, it should not be because you cannot spend time with him, because when there is a problem, forms of communication tend to become negative. In the meantime, with information at his fingertips, the child begins to think he knows everything. There can only be a balance with positive parenting,” says Mehta.

In a sense, what enhanced internet connectivity has done is to increase a sense of isolation among users. While earlier parents often resorted to books and television to keep children engaged, it still entailed some amount of scrutiny and involvement in matters of selection. Personal devices such as laptops and mobile phones have now nearly done away with that. Restricting access to the device is also not an option because it builds up frustration in the patient, prompting him to seek other methods of gratification. Instead, discussions on internet etiquette are essential at home and in schools to make children aware of the perils of using a medium that comes with few checks.

For youngsters, time on the internet often comes without adult supervision. It makes children vulnerable to instances of cyber bullying. (Source: Thinkstock Images) For youngsters, time on the internet often comes without adult supervision. It makes children vulnerable to instances of cyber bullying. (Source: Thinkstock Images)

A doctor couple in Ghaziabad found out the hard way how youngsters get drawn into a world of make-believe and instant gratification when their son started throwing tantrums when devices were withdrawn. “As doctors, we both have busy schedules. When my son was two years old, we started showing him videos on the mobile phone to stop him from crying. By the time he was four, he started playing games on the iPad. He would only eat his meals if he had the gadget in front of him. Soon, he started using social media,” says the father, who works as a physician in NCR.

Things came to a head when the boy reached Class III. “We didn’t worry till his scores dropped remarkably. He had also become irritable and started blackmailing us. He would lock himself in and not relent till he got the device back. This escalated over time. Even when we went out for dinner, he would refuse to go to a place that had no WiFi connectivity. Finally, when I saw him surfing pornography, we took him to a psychiatrist,” says the father. The boy, now 13, is undergoing counselling at a government hospital.

While researchers are divided in their opinion over whether internet addiction is a distinct disorder in itself or a behavioral manifestation of some other disorder, the term “internet addiction disorder” was proposed by the American psychiatrist Ivan Goldberg in 1995 for pathological compulsive internet use. In a study, his Dr Mark Griffiths of Nottingham Trent University identified six “core components” of addiction: salience, mood modification, tolerance, withdrawal, conflict and relapse. Internet addiction is still not officially recognised as a disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the definitive guide on psychiatry. “China has just recognised internet addiction as a discrete disorder. If that happens elsewhere, too, epidemiological surveys can follow and treatment guidelines can be devised. So far, only severe cases are reported in India, mild to moderate cases go untreated, or, at best, are referred to psychologists,” says Mehta.

According to a report published by the Internet and Mobile Association of India and market research firm IMRB International earlier this year, the overall internet penetration in India is currently pegged at 31 per cent. While India is still to conduct a national study on internet addiction, an extensive study funded by the Indian Council of Medical Research and conducted by the country’s premier mental health facility, National Institute of Mental Health and Neurosciences and titled ‘Behavioral addiction in the community: an exploration’, gives a glimpse into the problem. Conducted in 2012 over 15 months, with a sample size of 2,755 respondents in Bengaluru, it revealed that 4.1 per cent of the respondents were addicted to their cellphones and that mood disturbance and anxiety showed a “positive correlation” with smartphone and internet addiction.

Dr Bhavna Barmi, clinical psychologist at Fortis Escorts Heart Institute, Delhi, has just finished a session with a 16-year-old who is addicted to a 2D shooter game, Mini Militia, that is available on android devices. What is scary, she says, is that her patient is no longer unique. A lifestyle disease, internet addiction is more likely to affect the upwardly mobile and most of her patients come from that section of the society. “We get at least one case each day related to technology and internet addiction. This number is rising in the last one year. Gaming, in particular, has become a social addiction, fuelling a false sense of self-esteem,” she says.

Among Barmi’s patients is another young boy, one of the youngest patients being treated for porn addiction in India — a nine-year-old boy from Delhi. “When he came to me, he had unkempt hair, long nails and very poor hygiene. He had lost 12 kg in under two months. While the parents thought he was burning the midnight oil to study and felt happy at his efforts, he was actually watching pornography,” says Barmi.

Digital addiction among juveniles can broadly be divided into addiction to online games, to pornography and to social media. Other off-shoots include excessive chatting and gambling. Mehta recalls an instance when an 18-year-old boy studying in Delhi University was referred to him for treatment. “The boy had started missing university and making mistakes at the family business. When pulled up for it, he tended to turn aggressive,” he says. Over sessions, the boy revealed that he was addicted to pornography that he watched on his mobile phone. “He used to masturbate seven times a day while watching internet porn. The criteria for dependence is not the act alone. The person keeps thinking about it so often that it becomes all-consuming and distracts him from his ordinary course of life. Similarly, in this case, the teenager used to be consumed by the thought of when and how to watch porn,” says Mehta.

For Tushar, the turning point came when doing well at video games gave him a sense of achievement. “I tried playing outdoor games, but nothing worked. But, when I played video games, I performed better than my friends. I started loving the competition and I thought, ‘Let me continue’,” he says. Soon, the pastime grew into a “coping mechanism” and by secondary school, his life came to be dominated by it. “I did not have to make time for gaming. It started making time for itself. I would play for over seven hours at a stretch. I made friends through gaming. We discuss life beyond games, but it’s also easier because we all have similar interests,” he says.

In the real world, though, his problems were only just beginning. His grades started falling and he found it difficult to make friends. Soon, he dropped a year at school. “In the gaming community, there is something we call ‘one last game’. If you lose a game, you play one more. This goes on from 12 am to 4 am. We look at the time and then we realise that we have school in three hours. But we are still up for that one last game. That’s how I came to fall behind in school,” says the teenager, who will appear for his Class XII board exams next year. “He would return from school, put his bag down and rush back to the game. Soon, he stopped having meals with us and missing school,” says his mother. Eventually, he underwent counselling sessions with both a psychologist and a psychiatrist. “The harm has been done. We are focussing on his exams now. After he completes it, we will undergo further therapy,” she says.

At the monthly session of “Technology Anonymous” at Psycare Hospital in Delhi, a bunch of people, mostly in the age group of 15-21, once addicted to technology in some form and now rehabilitated, comes together to share their stories. A 15-year-old reveals how he took to the internet to get over feelings of low self-esteem. “His teachers had pulled him up for poor academic performance and he felt humiliated. He started spending more time online to avoid his friends. When people talk about their issues openly, they realise that they are not alone and that it is possible to overcome their addiction,” says Barmi.

Half the battle, doctors say, is to make the patient realise that there is a problem that needs to be addressed. Dr Sandeep Vohra, senior consultant (Psychiatry), at Indraprastha Apollo Hospital, Delhi, speaks of a 15-year-old girl who had come to him in desperation because she could not control her urge to “repeatedly check the number of likes on her photos on social media — on Facebook, Instagram and other forum”. It led to erratic sleep and eating patterns, her grades dropped, she gained weight and became aggressive and irritable. “We started off by counselling her to correct her sleep pattern. Then, the family was counselled on ways to wean her off the smartphone gradually. It took time but the family was supportive and the girl herself wanted to get better. She completed her therapy successfully and has moved to the US for higher studies,” says Dr Vohra.

Tushar, for instance, admits to being addicted to gaming but is loathe to give it up altogether. “My parents are well aware that I can be focussed. I do not get distracted when it comes to gaming. It’s not all bad,” he says. He scrolls down on his phone before stopping at a message on a gamers’ WhatsApp group. It reads: ‘Teach a kid how to build a gaming PC so that they do not have any money left for drugs’. “I think that’s very true,” he says.

* Name changed to conceal identity

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