|
A young mother logs 12 hours a day on her laptop, perusing chat rooms and dating sites while neglecting her children until she loses custody of them. Teenagers turn down invitations to real social events in order to pull Red Bull-fueled all-nighters playing fantasy warcraft games online. An IBM employee -- reportedly fired for spending work hours visiting a sexually explicit chat room -- sues the company for failing to provide counseling for his "Internet addiction."
But is the Internet really addictive? Do some people come to regard the frenetic clicking as seductive hits on the cyberspace crack pipe?
Or is this mere psychobabble, evidence of our tendency to label any outside-the-norm behaviors as a pathology, and our willingness to proclaim addiction to almost anything: chocolate, or foreign oil, or shoe shopping.
The very term "Internet Addiction Disorder" was coined as a parody -- a hoax created 11 years ago by New York City psychiatrist Ivan Goldberg, who posted it on a Web bulletin board to amuse fellow psychiatrists. Replicating the lingo of the American Psychiatric Association's diagnostic manual, he concocted symptoms including "fantasies or dreams about the Internet," and "involuntary typing movements of the fingers."
When several colleagues e-mailed in all seriousness seeking help, he obliged by creating an online support group, which, it was quickly noted, was akin to convening an AA meeting in a bar. Soon, hundreds of selfdiagnosed addicts responded, including one who claimed to have worn out his computer keyboard in less than a year. Not long afterward, a bemused Goldberg admitted to reporters that there was no such thing as Internet addiction.
"It makes it sound as if one were dealing with heroin, a truly addicting substance that can alter almost every cell in the body. To medicalize every behavior by putting it into psychiatric nomenclature is ridiculous," Goldberg told the New Yorker in 1997.
To this day, Internet addiction has no official recognition in the psychiatric world, although there are practitioners lobbying for that status, and thriving centers have been established to treat it. Internet addiction has yet to earn disorder status in the American Psychiatric Association's diagnostic manual.
"I would not at this point rule it out, but I would say it's just way too early to conclude there is such a thing as Internet addiction. The media has gotten way ahead of the science here," said psychiatry Professor Elias Aboujaoude, who led a Stanford survey to analyze Internet use in the general population. His cautions didn't stop dozens of newspapers covering the study this autumn from reporting that it had documented "Internet addiction."
What the researchers did find from their random survey of 2,500 adults was that 14 percent of computer users found it hard to stay away from the Internet for several days at a time, 9 percent tried to conceal their Internet habit from family, friends and employers, and 6 percent acknowledged their use was causing their relationships to suffer.
So, some Internet users exhibited some symptoms similar to those seen in recognized addictions. Many questions remain, including whether Internet abusers have another undiagnosed condition, such as chronic depression or social phobia, that is manifesting itself in unhealthy screen time. The Stanford researchers are designing as their next experiment face-to-face follow-up interviews -- an attempt to tease out the causes and effects of Internet use.
"What is normal and what isn't normal? As psychiatrists we can make terrible mistakes trying to determine that," Aboujaoude said. "If someone is spending five hours a day online but is happy and successful and responsible, with (a) loving relationship, who am I to say they have a problem? The danger isn't how many hours a day somebody spends on the computer -- it's whether we can see signs of distress in their lives because of it."
Certain substances, like cocaine, methamphetamines and alcohol, work on neurotransmitter pathways in the brain and can produce true physiological addiction, including cravings, dependency and withdrawal. But psychiatry classifies other problems as symptoms of impulse-control disorder, including kleptomania and compulsive hair pulling.
Some experts predict that if Internet abuse does make it into the psychiatric association's diagnostic manual, it will be not as an addiction but as an impulse-control disorder. Even Goldberg has proposed, seriously this time, to name it "Pathological Computer Use Disorder" and apply it to cases where computer overuse causes people distress and/or hurts their "physical, psychological, interpersonal, marital, economic or social functioning." He likens it to workaholism or to a disorder that actually has cracked the psychiatric associations' diagnostic manual: pathological gambling.
As defined by the psychiatric manual, pathological gambling is an impulse control disorder that is a chronic and progressive mental illness, characterized by preoccupation, more intensity required for the same "rush," withdrawal, escape, lying about gambling to others and so forth, as well as the fact that the patient may have a lack of norepinephrine, a hormone in the brain that controls impulsive behavior.
Some of those pushing for official recognition for Internet addiction used that description as a model for their own criteria, which failed to impress critics such as John Grohol, founder of PsychCentral -- a Web site on mental health.
"Do these two dissimilar areas have much in common beyond their face value? I don't see it," Grohol observed. "I don't know of any other disorder currently being researched where the researchers, showing all the originality of a trash romance novel writer, simply "borrowed" the diagnostic symptom criteria for an unrelated disorder, made a few changes, and declared the existence of a new disorder. If this sounds absurd, it's because it is."
But others argue the parallels are too real to ignore.
One of the true believers is Maressa Hecht Orzack, a Harvard-affiliated psychologist who began playing on the Net to relieve stress. "Initially I noticed that I was spending too much time on computer games such as solitaire and cruel," she wrote. "I became so absorbed in games that I neglected or delayed meeting various personal obligations. I stayed up too late. This led me to realize that behavior of this kind could be an addiction."
Given her years of using cognitive behavior therapy to treat addictive behaviors and impulse control disorders, she made the connection to her own computer use and helped establish the Computer Addiction Service at McLean Hospital.
"Unlike gambling, people must be able to use their computers in work or school," she noted. "Therefore, they must learn how to normalize their computer use just as those individuals with eating disorders need to learn to eat in order to survive."
Indeed, advocates say it took years for the world of psychiatry to recognize compulsive gambling as a disorder, and to stop regarding homosexuality as one. In other words, the definition of diagnosis can change with the times.
"Academics for the next couple of decades may still be debating 'Is it an addiction or not?' but the reality is many of us have moved beyond the controversy and we're treating it," said Kimberly Young, who first discussed Internet addiction at an American Psychiatric Association convention in 1996, founded the Center for Online Addiction in Pennsylvania, and wrote the fist book on online addiction, "Caught in the Net." "Whatever label we put on it, I don't know anybody who would argue that the problem doesn't exist," she said.
Nor is the debate mere semantics. Some health insurance plans refuse to cover the costs of treatment unless a diagnosis merits listing in the manual. And there are criminal defense and civil liability ramifications as well, as IBM is discovering in the lawsuit filed by fired "Internet addict" James Pacenza.
More research is under way to determine patterns of Internet abuse -- data that could lead to classifying it as a compulsive disorder and ultimately as an addiction. Whatever the terminology, nobody disputes that the Internet is wreaking havoc on some lives.
With that in mind, the world headquarters of Netaholics Anonymous offers a tongue-in-cheek test to determine whether you might be "caught in the Web." If you name your children Eudora and Mozilla; if you spend plane trips with your laptop on your lap and your child in the overhead compartment; if the last mate you picked as a JPEG? Well, the experts aren't sure what to call it, but let's just say it might be time to get some fresh air.
Signs of obsession
Indicators that your Internet use may spin out of control, according to Stanford researchers:
-- Do you find it hard to stay away from the Internet for several days at a time?
-- Do you often stay online longer than you intended?
-- Have you felt a need to cut back on Internet use?
-- Do you try to conceal your Internet time from family, friends, employers?
-- Do you go online as a way of escaping problems or soothing a bad mood?
-- Have your relationships suffered because of excessive Internet use?
| 
