A Digital Disorder for a Digital Generation

“Distracted from distraction by distraction”, T. S. Eliot published these lines in 1941. Although written in a different era, the lines resonate with us today more than ever before. The electronic torrents in which we live have turned us into twittering nerve nodes, a direct result of which is the emerging problem of internet addiction. The term 'Internet Addiction Disorder' (IAD) was first coined by Dr. Ivan Goldberg satirically in 1995. However unintentionally, he introduced an interesting discussion ahead of its time. Some 24 years in, and we are still heatedly debating on the inclusion of internet addiction as a disorder in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Even though addiction to our devices is a relatively new condition and is not yet listed in the DSM-5, the American Psychiatric Association recognises the need to treat the misuse of digital devices under its top ten trends to watch out for in 2019. Conceptually, the diagnosis comes under compulsive-impulsive spectrum disorders that involves online and/or offline computer usage. It is commonly understood as a disorder that causes people to spend an excessive amount of time on the internet irrespective of its detrimental effects on their health, hygiene, work, or relationships. It may also involve developing an emotional attachment to one's online connections and the activities one participates in with them via their screen. Psychologists are looking at FOMO (the fear of missing out) as one of the primary reasons behind increasing minutes of our day spent online. We are all too familiar with having spent more time on Instagram and Facebook than we first intended, lest we miss any gossip. The beautiful wedding photographs of celebrities and new season premiers on Netflix only leave our twitching fingers wanting more.

How seriously must we take the idea of addiction to something as seemingly harmless as a digital screen? The internet provides for precisely the type of sensory and cognitive stimuli - repetitive, intensive, reciprocal, addictive - that have been shown to result in strong and rapid alterations in brain circuits and functions. Researchers at Korea University in Seoul used magnetic resonance spectroscopy (MRS) to gain insight into the brain’s chemical composition of people believed to be addicted to their smartphones. The study found that excessive time spent online can result in an imbalance in the brain’s chemistry and can potentially lead to anxiety problems, depression, impulsivity, and insomnia. Another study conducted at Ben-Gurion University, Israel has found such behaviour linked to changes in social cognition, impaired attention, and reduced right prefrontal cortex excitability. However, we still are a long way short of literature necessary to comprehensively understand the clinical applications of a behavioural addiction such as internet addiction. One of the primary reasons behind this is the lack of consistency in the screening tools used to determine the scale of internet addiction. The most commonly used tools include the Internet Addiction Test (IAT), Revised Chen’s Internet Addiction Scale (CIAS-R), and the Internet Addiction Scale (IAS). Although there is an abundance of screening and diagnostic tools available, they provide highly varied estimates of Internet Addiction, ranging from less than 1% to 27%t. In addition to the heterogeneity of instruments used, these varied figures prove to undermine the confidence in the diagnosability of the IAD.

An alternate perspective on the issue comes from researchers who argue that addiction is probably not the best label for the compulsion to check one’s digital device every few seconds. Chris Ferguson and Patrick Markey, the co-authors of ‘Moral Combat’, believe that it is the moral panic behind the rush to label internet use as an addiction. They argue that some researchers might be casting an age bias on the younger generation. Calling it an addiction implies that all activities on the internet are detrimental or unproductive for the individual. However, we know that is not the case. Individuals today use online resources for productive activities like research and education as well. A lot of jobs have also been created and sustained through the medium of the internet. Youtubers, social media managers, web developers, and bloggers are some of the many who are entirely dependent on the internet as their source of income. Calling the internet an addictive agent solely on the basis of time spent on it would be jumping to a conclusion with little understanding of the breadth of the issue. After all, the internet is a vehicle and not the driver in and by itself. Hence, it is essential to examine the motivations for engaging in excessive internet use and the proportion of time spent online on productive versus unproductive activities before clinically diagnosing one with an addiction.

Whether we agree on the term ‘Internet Addiction Disorder’ or prefer calling it an ‘Internet Use Disorder’ so as to avoid the underlying negative connotations of the word ‘addiction,’ there is no denying the adverse consequences and the reality of it. Just last October, India saw its first case of Netflix addiction in Bengaluru. It is now getting treated under SHUT clinic in the city, set up four years ago to treat internet and social media addiction. The clinic reports enrolling more patients every year than the last. In a country which holds the record to have the second largest internet-user base, documented cases like this play an important part in educating the masses of the potential dangers of unregulated internet use. On another extreme, a young couple in Korea lost their daughter to starvation due to neglect while they were engaged in raising a virtual daughter online. It, however, might not be just to entirely blame internet addiction for these incidents, as forms of behavioural addiction are often connected with comorbid conditions such as depression, substance abuse, obsessive-compulsive disorder or other forms of personality disorders.

We must also consider and address the social factors that might be leading the individuals to rely on the internet to this extent before we deem the behaviour pathological. Danah Boyd, the founder and president of Data & Society, reasons that contrary to popular belief, research now shows that people (young and the old alike) are not so much addicted to the internet as they are to the need to connect with their friends. She argues that we have enslaved ourselves to a style of life which is burdened with work and expectations that allows very little time to actually go out and live our experiences. In such a scenario, the internet barely provides for a relief valve. If not eliminated, the dependence arising out of our need to connect can be minimised early on. Parents could take an initiative to engage their child in stimulating activities that also involve interaction with others. By trapping a child under a safety net, we might be making them more susceptible to developing a dependence on the virtual world for interaction and hence, turning them into lab rats pressing buttons to get pellets of social nourishment. Nonetheless, for existing cases of acute internet-dependence, we have come a long way and already have several interventions in place. Across various studies, cognitive behaviour therapy (CBT) is reported to work well, where one focuses on changing patterns of thinking and beliefs that could be associated with the triggered anxiety and discomfort. It is via thoughts that one addresses the feelings that produce behaviour. With time, we are also seeing a rise in treatment clinics that specialise in treating internet addiction across major big cities. There are also internet addiction support groups available that can be substituted with counselling or therapy for better results.

There is still a great deal of ambiguity surrounding our understanding of and approach to internet addiction by virtue of it being a fairly new phenomenon. The internet is no longer an activity that we log in to for a particular period of time; it is more like a ceaseless cloud watching over. For the same reason, it is imperative to understand and know the lines between using it as a resource for recreational use, regular use, and when it progresses to consequential use. Awareness and self-regulation is the key. And of course, we can always Google for more information if we need to.

Garima Bisoi