Various news sources
this week, including Fox News and The Guardian, are reporting on an editorial published in this month’s American Journal of Psychiatry. In it, the author, Jerald J. Block, argues
that internet addiction is a real psychological disorder, and that it ought to
be recognised as such in DSM-V, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, which is
currently being compiled by the American Psychiatric
Association.
Block
writes that ‘the diagnosis is a compulsive-impulsive spectrum disorder that
involves online and/or offline computer usage and consists of at least three
subtypes: excessive gaming, sexual preoccupations, and email/text messaging’
(1). He goes on to list four components
of the disorder:
1) excessive use, often associated with a loss of
sense of time or a neglect of basic drives,
2) withdrawal, including feelings of anger,
tension, and/or depression when the computer is inaccessible,
3) tolerance, including the need for better
computer equipment, more software, or more hours of use, and
4) negative repercussions, including arguments, lying, poor
achievement, social isolation, and fatigue.
Put in
these terms, it is not difficult to see why there is at least a case for
internet addiction being recognised as a psychological disorder. The behaviour described is likely to be
disruptive to one’s life, work, health, and relationships, and few of us would
view such symptoms in a close friend or relative without concern.
However, if
we use Block’s four components as a guide to what can count as a type of addiction,
it is interesting to consider what other sorts of behaviour might turn out to
be pathological. Many of those whom we
conventionally admire—including many artists, writers, sportsmen and women,
academics, scientists, politicians, and businessmen and women—behave in a way that conforms
to Block’s four-point guide. In the case of such admirable people, their problematic behaviour is often romanticised: a
difficult personality, neglect of personal relationships, mood swings, and an
inability to perform simple practical tasks are often ascribed to an artistic
temperament, a brilliant intellect, or an unusual amount of focus on developing
a talent. Whilst many may shy from becoming personally involved with such people, the prevailing attitude
is that their behaviour should be indulged and their ‘addiction’—to art,
science, sport, or whatever—supported. Contrast this with our attitude towards commonly accepted cases of addiction, where we tend to believe that addicts
should be weaned off the object of their addiction in order that they may focus
on those aspects of their life that their addiction has led them to neglect.
It seems,
then, that the problem with internet addiction as Block views it is not the
resulting behaviour, since this is tolerated in other contexts. Instead, the
problem must stem primarily from a judgment about the value of activities like
‘excessive gaming, sexual preoccupations, and email/text messaging’. Pursuing such activities, the reasoning might
run, is not worth the sacrifices it requires in other areas of life, as
outlined in Block’s four components. On
the other hand, activities like creating a great work of art, making a
scientific breakthrough, and honing an exceptional talent for football are worth the sacrifice.
But, is
this right? A common complaint about the
use of drugs like Prozac to treat depression and enhance mood runs as
follows. Van Gogh was a great artist,
and also suffered great mental torment. Had Prozac been available during his lifetime, he may have been happier,
but as a result he may not have produced great art (2). Therefore, prescribing Prozac is not always a
good thing: it is sometimes good to be depressed. This line of thought has always struck me as
glib: is the production of even a large amount of great art really worth significant personal
misery? Since, I assume, nobody would
seriously advocate inducing van Gogh-style misery in children in an attempt to turn them
into great artists, or sacrificing the well-being of one person for the sake of
another person’s art, I take it that this line of argument is not really
persuasive. But it does raise the
interesting question of the extent to which the value of one’s
projects—including one’s art and one’s addictions—outweighs the value of one’s health, relationships,
and so on. Block is probably right that
the value of ‘excessive gaming, sexual preoccupations, and email/text messaging’
does not outweigh the value of the aspects of life one loses as an internet
addict. But the really interesting
philosophical question is why, and on
what what basis?
References
(1) Jerald
J. Block, ‘Issues for DSM-V: Internet Addiction’, American Journal of Psychiatry 165/3,
March 2008: 306-307.
(2) This complaint relies heavily on the (rarely
articulated) assumption that Van Gogh’s ability as an artist was dependent upon
his being depressed. This assumption
probably owes more to romantic ideas about what artists are like than to facts
about the basis of artistic ability—but for the sake of the argument, let’s
ignore this point.
Rebecca,
you seem to be arguing that some forms of addictive behaviour are socially condoned – for example obsessional devotion to sports or the arts, whereas others are frowned upon. You argue that this is a reflection of the value that we place on certain activities. On this basis addictive behaviour in some spheres is labelled as pathological, whereas addictive behaviour in other spheres of life is condoned or encouraged.
However I think that the cases that you cite of approved addiction probably do not (in most instances) represent genuine pathological addictions. I think that the characteristic features of pathological addiction are the loss of autonomy and often insight, as well as the negative consequences on how well my life is going overall. This latter factor means that there is a need to weigh up the good that comes from the ‘addiction’ against the harms that ensue
So I may be addicted to coffee if I am unable to reduce my coffee intake, but only pathologically addicted if it leads me to run up enormous debts in pursuit of the perfect imported coffee machine. But this latter factor may depend upon how much coffee-drinking contributes to my overall well-being. Imagine if I were employed as a coffee taster, had written multiple books on coffee, spoke at international conferences on coffee-tasting (if there are such things). It might be that the benefits of my coffee addiction outweigh the negative consequences on the rest of my life.
Similarly an elite runner who neglects his family in order to train for the Olympics, and whose sporting career gives him enormous personal fulfillment – would not count as pathologically addicted. But a similar runner who continued to run long distance despite recurrent injury, at the cost of other aspects of his life, and despite a failure to meet the goals that he set out to achieve – would and should be classified as having a pathological addiction.
The features that Block cites are observable behaviours that frequently occur in association with pathological addiction – though they do not seem to be sufficient for a pathological addiction to be present. We could imagine someone using the internet frequently and obsessively – at the cost of other parts of their life, but who nevertheless obtained enormous personal value from their internet use.
In summary I wonder whether it is not the value that society places upon an activity that leads to a definition of pathological addiction – rather it is the value that that activity contributes to the wellbeing of that person.
cheers
Dom
Dom, thanks very much for the comment. I think you are right that the contribution that the activity makes towards the person’s well-being is (or should be) relevant, although it’s also true that this is filtered through generalised, often social, expectations about what sorts of things do or do not contribute to well-being. So, when seeing that someone’s heroin habit has resulted in their losing their family leads us to reflect on what a terrible thing heroin addiction is, this is at least partly because we think that keeping one’s family is – generally speaking – more valuable than any positive aspects of using heroin. It strikes me that such generalised judgments are necessary in deciding what counts as an addiction, for at least two reasons. First, there has to be a social aspect to the concept of addiction (at least, in the way we use it), since we generally take addiction to involve warped values (e.g. continuing to take heroin even when it is jeopardising one’s marriage) and – as you say – a loss of autonomy; and someone can be judged to have warped values or less autonomy only by comparison to some generalised standard, usually the standard of other humans, or other humans in a particular culture, social group, or some other subset. Consider that, if we discovered a new type of being whose intelligence compared with that of humans but whose behaviour was very different to that of humans, and we discovered only one member of this new type, I don’t think it would make sense to ask whether any of that being’s behaviour was pathologically addictive: at the very least, we would need to compare the behaviour to that of similar beings in order to decide what sort of behaviour was normal (not that defining normal behaviour is unproblematic!). Second, classing a certain level of involvement in a certain activity as a pathological addiction merely on the basis of the effect that activity has on an individual’s well-being, without reference to generalised judgments about well-being and the value of certain goods, looks unpromising. In fact, I’m not sure we could even decide what counts as contributing to or detracting from an individual’s well-being in a helpful way without making generalised, often social, judgments: consider that addicts may genuinely prefer to indulge their addiction than to have it cured. I’m reminded here of the words of Vivian Stanshall’s Sir Henry: ‘If I had all the money I’ve spent on drink, I’d spend it on drink’ (see http://www.imdb.com/title/tt0081520 ). We usually take this to mean that their addiction warps their values and preferences. However, without making generalisations about the relative values of certain goods, on what basis can indulging the addiction be said to be contrary to their well-being? Answering along the lines of, ‘If they stopped behaving in this way, they would be much happier/healthier/etc’ will not suffice: there are many ways in which I could become happier/healthier/etc by making certain behavioural changes, but this does not entail that my failure to do so makes me an addict. It seems to me that, given the way we use the concept ‘addiction’, the social dimension is necessary for deciding what sorts of behaviour count as pathological.
Finally, I wasn’t arguing that ‘some forms of addictive behaviour are socially condoned’. I’m largely ignorant of exactly how addictions are defined. Rather, I argued that if we use Block’s four components as a guide to what counts as an addiction, then all sorts of behaviour that are not usually regarded as pathological turn out to be addictive. Incidentally, Block, in his editorial, does not suggest that the four components should be used as a general guide to what counts as an addiction. However, many of the news sources that cover this topic report the four components in a way that seems to imply that they demonstrate why excessive internet use is being regarded as an addiction. It was the assumptions involved in this demonstration that I found interesting.
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