But what about computers, smartphones, or the internet more broadly? Proposals for internet addiction have been advanced for possible inclusion in the DSM-V. In those cases, a similar reliance on the substance-abuse model persists, along with suspicions regarding the legitimacy of withdrawal and tolerance as diagnostic criteria. The WHO told me that it began evaluating the public-health implications of excessive use of computers, smartphones, and the internet in 2014, in response to concerns from its community. But despite those concerns, gaming disorder made it into the ICD-11 draft as the only “clinically recognizable and clinically significant syndrome” related to the broader category of computing and the internet.
Some researchers wonder if the WHO might be under pressure to codify gaming disorder. In 2017, an article in the journal Professional Psychology: Research and Practice argued that two members of the WHO advisory group, Geoffrey Reed and Vladimir Poznyak felt political pressure to identify gaming disorder, particularly from member states where the consequences of excessive online gaming have been particularly extreme.
Christopher J. Ferguson, a clinical psychologist at Stetson University and one of the coauthors of the article, showed me emails from Reed and Poznyak. “Not everything is up to me,” Reed wrote to Ferguson in August 2016, “and we have been under enormous pressure, especially from Asian countries, to include this.”
The WHO denies any political coercion. “There was no pressure or any communication to the WHO secretariat from any government with a suggestion to consider inclusion of gaming disorder in ICD-11,” a spokesperson told me — while also acknowledging that members of the organization’s constituency have repeatedly brought attention to their “concerns about the health consequences of gaming behavior.”
But it makes sense that the WHO would respond to lobbying by its affiliates. If the overuse of games or smartphones are a matter of behavior, then of course that behavior is bound to vary by region, nation, culture, and other social conditions. To some extent, all diseases require a social construction—they have to be acknowledged by a body like the WHO in a bureaucratic artifact like the ICD in order to be diagnosed, treated, managed, and paid for. But unlike a viral infection or an autoimmune condition, a behavioral disorder is particularly susceptible to the varied social contexts in which the behavior takes place.
This is one of the counterpoints that gaming-disorder detractors often raise. What about people who dance to excess, or become obsessed with tanning parlors, or while away hours tapping and swiping on Instagram, or even those who read novels—the source of a moral panic in the 18th century—or watch football to the detriment of their social and work lives? If the purpose of the DSM or ICD is to help people, and if only a very small percentage of gamers (or dancers, or tanners, or Instagrammers, or novel-readers, or football fans) are compelled to the point of pathological overuse, and if what is pathological in the first place is subjective, then why not create a broader Behavioral Overuse Disorder that could apply to anything, without prejudice?