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Chris Ferguson (professor of psychology at Stetson University in Florida, Psychologist and media researcher) has condemned the World Health Organization’s (WHO) classification of “Gaming Disorder” as a form of gaming addiction.

Contributing to The Hill, Ferguson tackles ICD-11 (as the International Classification of Diseases classifies gaming disorder).

In the article, Ferguson cites the American Psychological Association’s Media Psychology and Technology’s policy statement opposing the WHO. In addition, he also cites an open paper by twenty-eight scholars opposed to the decision titled “Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal” (cited as “Scholar’s Open Paper” from here on out). The article also includes Ferguson’s own email discussion with the WHO, his own research, and myriad of academic papers to back up his claims.

Together their proposals are summarized as the following:

Research of nearly 30 years has not clearly defined what constitutes video game addiction, and what is a healthy level of consumption. Nor has it offered clear guidelines for symptoms, prevalence or whether it truly exists as an independent disorder.

Research has also not indicated that the disorder is not just symptom of other mental health issues, which studies with more scrutiny have suggested. “it has not been convincingly demonstrated that problematic gaming is not better viewed as a coping mechanism associated with underlying problems of a different nature” (Scholar’s Open Paper). This is also supported by research from the paper “Attention Problems and Pathological Gaming: Resolving the ‘Chicken and Egg’ in Prospective Analysis” by Ferguson and T. Atilla Ceranoglu. Ferguson also quips in The Hill article “For instance, many depressed people oversleep but we don’t diagnose “bed addiction.” ” This leads other concerns that this diagnosis can cause “significant harm by distracting clinicians from real problems and encourage treatments that remove coping mechanisms for stress without replacing them.”

The research has had poor transparency. “We would prefer to see a body of research developed using open science, preregistration and standardized measures prior to the reification of a diagnosis.” This is further compounded by reports’ and Ferguson’s own email saying that the WHO is under pressure to push this diagnosis from stakeholders and “primarily Asian countries” respectively.

Treating the behavior as though it is similar to substance abuse is a poor place to start that can offer bias to the results. For example; thoughts, feelings, and actions that would be a sign of substance abuse, but not in someone who is addicted to gaming. Such as lying to friends or loved ones how long you play games for, using them to improve your mood, or “thinking a lot about games”. Ferguson states “The same arguments for “gaming disorder” could be made to make anything an “addiction.” Why not “cat addiction?” Given that dopamine release is normal for pleasant activities one could claim that stroking a cat release dopamine “just like cocaine does.” Many of the symptoms used for gaming addiction such as using the thing to feel better after a bad day can certainly be applied to cats. And we can find anecdotes of people who clearly overdo cats, living in houses full of diseased cats, and persisting in the behavior despite legal consequences. If “gaming disorder” is real, then so is “cat addiction.” ”

Research suggests the addiction is “unstable”. Most of those with high symptoms at one point in time being resolved several months later with no treatment.

Propose that individuals that “overdo gaming” are no different than individuals who overdo “sex, food, work, exercise, shopping and even [dancing]”. As such, video games cannot be singled out for a disorder no more than general behavioral addictions.

The WHO’s “obsessive focus” is in response to moral panic. This in turn will only fuel more moral panic, and even “miscommunications that game playing can be compared to substance abuse”. Ferguson proposes that this could extent to parents taking their children to “predatory clinics”. The clinics will then use untested and unproven treatments in an attempt to scam parents or insurance companies for “thousands” as the parents desperately seek a cure for a non-existent condition they hear about. These treatments may even cause psychological or physical harm to the child.

Concern that little to no further research will be done, and instead conformation bias will take over. “This type of research will thus provide us with more screening instruments (confirmatory thinking), instead of stimulating the fundamental validation and theoretical work (exploratory thinking) that is needed to understand the phenomenology of problematic gaming.” (Scholar’s Open Paper)

Those who are enjoying the habit healthily will receive scrutiny for their hobby, and cause an adverse effect on their mental health. This includes increased media and parent ignorance on what is and is not a healthy amount of gaming. It could even raise tensions between parents and children and “can perpetuate violence against children.”

Diagnosis may even be used to control and restrict children under the guise of helping them. “[…] which has already happened in parts of the world where children are forced into “gaming-addiction camps” with military regimens designed to “treat” them for their gaming problems, without any evidence of the efficacy of such treatment and followed by reports of physical and psychological abuse.” (Scholar’s Open Paper) Such consequences would violate the UN Convention on the Rights of The Children. As a UN agency, the WHO must uphold it. Ferguson mentions that (as mentioned earlier) there is pressure from “Asian countries” for the WHO to push gaming disorder, that it “raises the specter that the diagnosis could be used by authoritarian countries like China to further suppress free speech.” He then cites an example of Chinese “boot camps” where treatment for Internet and gaming addiction has resulted in fatalities.

The trio finalized their statements with condemnation of the WHO’s proposal.

“We also express concern that a problematic diagnosis can cause significant harm by distracting clinicians from real problems and encourage treatments that remove coping mechanisms for stress without replacing them. Further, a problematic diagnosis may promulgate policy efforts that restrict free speech and minors’ rights, without appreciable positive impacts (Lee, Kim &Hong, in press). Thus, we call on the WHO to consider not implementing diagnoses related to gaming at this time.”

(American Psychological Association’s Media Psychology and Technology’s policy statement)

“In brief, including this diagnosis in ICD-11 will cause significantly more harm than good. Given the immaturity of the existing evidence base, it will negatively impact the lives of millions of healthy video gamers while being unlikely to provide valid identification of true problem cases. Therefore, as stated previously, we suggest to remove the proposed category for Gaming Disorder.” (Scholars’ open debate paper on the World Health Organization ICD-11 Gaming Disorder proposal)

“Unfortunately, with “gaming disorder” the WHO have made a serious mistake, pathologizing normal behavior despite a weak scientific basic for their decision. This opens the door for predatory clinics, free speech curtailment and the disparagement of gamers, while reducing technology in education. It also reduces confidence in how mental illness, in general, are classified. Ultimately, it will be people with real mental illnesses who will pay the costs.” (Chris Ferguson, The Hill)

Many of the concerns laid out here also mirror those of our own Carl Batchelor. In case you missed it, you can find his editorial on gaming addiction here.