“Internet Gaming Disorder” in China

Abstract

“Internet addiction” in China and elsewhere is considered a serious social problem. In China, some psychiatrists have claimed 10% of all Internet users—60 million—are potentially “addicted” to the Internet. Following on the heels of the publication of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), this qualitative-based research article critically investigates the new concept Internet gaming disorder, a category recently included in the DSM-5 as a condition “warranting more clinical research and experience before it might be considered for inclusion in the main book as a formal disorder.” This article takes up this challenge and responds in the following way: When we investigate the social existence of online gamers labeled Internet addicts in China, and then subject their social existence to the DSM’s own definition of a mental disorder, we discover not a clearly understood mental disorder called Internet gaming disorder but more so an issue of social deviance.

Keywords

Internet gaming disorder Internet addiction China youth deviance

Introduction

With an estimated 618 million Internet users and 338 million Internet game users in China (CNNIC, 2014), “Internet addiction” is both a serious social problem and big business. Within the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) “Internet gaming disorder” is identified in Section III as “a condition warranting more clinical research and experience before it might be considered for inclusion in the main book as a formal disorder” (American Psychiatric Association [APA], 2013, p. 1). By tentatively including Internet gaming disorder and not Internet addiction disorder as some hoped (Block, 2008) the APA seeks to “encourage research to determine whether the condition should be added to the manual as a disorder” (Block, 2008, p. 1).

This article takes up this challenge by analyzing empirical research from online gamers in China labeled “Internet addicts” (wangyin) and responds in the following way: When we investigate their social existence, and then subject it to the DSM’s definition of a mental disorder, we are unable to clearly categorize their behavior as stemming from a mental disorder called internet gaming disorder. What is more clearly revealed, however, is the way those labeled as Internet addicts come from maladaptive home environments containing stress- and distress-producing conditions (parental divorce, neglect, absence, violence, illness, and death), part of which is a result of the “failures” they are having trying to meet both their parents’ and Chinese society’s educational expectations. What we also see is the way in which they then use the Internet and Internet games as a mechanism to deal with these stresses and expectations (and so violate social norms in the process).

This article argues that the danger of framing their socially problematic Internet use as stemming from a mental disorder called Internet gaming disorder is to overly focus attention upon the one-to-one relation between child and Internet. This conceptualization diverts attention away from the socially produced distress that envelopes the family and that resides outside of, yet is connected to, the Internet. To employ medicalized concepts to morally censure adolescents for using the Internet too much to the detriment of their schoolwork runs the risk of overlooking or downplaying the problems the child is having with school, interpersonal relations, family life, and schoolwork (i.e., the normal pattern of living). In essence, the Internet may be mistakenly viewed as the cause of the problem rather than as an effect of other, much more serious, causes.

Moreover, this research sets itself against the work and words of Tao Ran, China’s foremost proponent of the Internet addition disorder concept. In a paper by Tao et al. (2010, p. 557), it is proposed that the following 8-point symptom-based diagnostic criterion is useful for the standardization of a mental disorder called Internet addiction disorder. The author’s explicitly argued their findings could be presented as evidence that there exists a valid and reliable diagnostic criterion for Internet addiction and therefore this model should be included in the DSM-5. The 8-point list used to diagnose Internet addiction, itself based upon the original diagnostic model put forth by Young (1998), is as follows:

Preoccupation: a strong desire for the Internet. Thinking about previous online activity or anticipation of the next online session. Internet use is the dominant activity in daily life.

Withdrawal: manifested by a dysphoric mood, anxiety, irritability, and boredom after several days without Internet activity.

Tolerance: marked increase in Internet use required to achieve satisfaction.

Difficult to control: persistent desire and/or unsuccessful attempts to control, cut back or discontinue Internet use.

Disregard harmful consequences: continued excessive use of Internet despite knowledge having a persistent or recurrent physical or psychological problems likely to have been caused or exacerbated by Internet use.

Social communications and interests are lost: loss of interests, previous hobbies, entertainment, as a direct result of, and with the exception of, Internet use.

Alleviation of negative emotions: uses the Internet to escape or relieve a dysphoric mood (e.g., feelings of helplessness, guilt, and anxiety).

Hiding from friends and relatives: deception of actual costs/time of Internet involvement to family members, therapist, and others (Tao et al., 2010, p. 557).

In layman’s terms, we may say this person is suffering from Internet addiction disorder:

thinks about the Internet too much;

is unsettled in some psychological way when not online;

feels an increasing need to get online;

is unable to reduce this increased time spent online;

disregards the harmful consequences associated with online use—despite knowing them;

loses interest in other activities;

uses the Internet as a remedy to negativity;

is in denial about their problematic Internet use; and so

uses deceit to cover it up.

This article, drawing principally from Horwitz’s (2002) analysis of the DSM, critically analyzes the validity of this diagnostic model by posing the following question: Can Internet gaming disorder clearly distinguish between this person being psychologically sick (i.e., suffering from internet gaming disorder) and not socially bad (i.e., an individual violating social norms and expectations; Conrad & Schneider, 1992)?

For this model to be considered either a valid behavioral addiction or mental disorder, it needs to show, for example, how this person is not a deviant son who wants to do that which he should not do, and so gets agitated in some way when not allowed to do it, and then through defiance and rebelliousness not only continues doing it but actually increases his use which, expectedly, impacts in socially negative ways upon his other activities (in particular his schoolwork) and on his social relationships (in particular with his parents), and thus in order to continue defying societal norms and expectations acts socially inappropriately (i.e., bad).

Methodology

The data from which this work is based stem from two interconnected sources.

Ethnographic Data

Unlike the vast majority of research on Internet addiction, which employs quantitatively driven and questionnaire-based methods, here ethnographic research was carried out with Mr. Tao Hongkai during his decade-long work with thousands of families throughout China, wherein the child is said to have Internet addiction or “pathological internet use” (see, Zhang et al., 2014).¹ The participant observation component of this research stems from the author being invited to join his endeavors as he:

filmed two TV programs;

conducted conferences at universities;

provided consultation and guidance at military-style boot camps and treatment centers; and

conducted his own 4-day course with families dealing with a child who refuses to concentrate on school and, instead, is only interested in concentrating on playing online.²

Tao Hongkai lays the cause of “excessive” Internet use partly at the feet of the child by forcing them to take personal responsibility for their nonconformity and their future but more so at the feet of the parents and the maladaptive interpersonal relations between them brought about by the parents’ problematic educational and socialization methods (Tao, 2005). Because of (a) the one child policy, (b) the excessively competitive education system, and (c) the rise in materialism and consumerism, Tao Hongkai believes parents—who themselves are under immense pressure to get their children to conform—are “spoiling” (McNeal & Chan, 2004) and thus existentially “smothering” or “engulfing” their kids. To “engulf” a child means “loving the child to (existential) death” (Laing, 1965) or “wrapping the child in cotton wool.” The result of which can prevent or stifle the development of ontologically secure autonomy and independence, which, incidentally, is also known to increase the likelihood of becoming a victim of school bullying (Lereya, Muthanna, & Wolke, 2013). Rejection of school and the attraction to online games partly stems from the child’s reaction to their parent’s engulfment and the way they partly chain their affection to academic performance. Feeling existentially suffocated and blocked off from acting autonomously, the growing and individualizing child may rebel by retreating from the family nexus, thereby detaching themselves from the normal functioning of society.

Tao (2006) argues the parents’ central concern is the child’s school grade, and so when the child does well academically the parents reward the child materially. What I call “goods for grades” creates, he believes, dependency and lack of self-control. And so if parents wish to develop “quality education” within the home, they need to be more demanding on their own behavior if they are to produce a socially functional child who has both independence and self-control (Gottfredson & Hirschi, 1990).

His criticism of the parent’s misguided socialization methods toward the child can be summed up in the well-known phrase wangzi cheng long (wishing the child will become successful). Tao Hongkai believes this wishful thinking should be replaced with jiaozi cheng long (educating their child to become successful). An autonomous, independent, self-loving, and self-controlling individual, he believes, will be less likely to become “infatuated” with online games because they are existentially and morally secure enough to “resist” the exciting and stimulating pull factors of the Internet and online games (and materialism and consumerism more generally).

Key to understanding the child’s rebellion is filiarchy (Fromm, 1955). Filiarchy is the traditional patriarchal family structure turned upside down, as parents hand over part of the power, authority, and decision-making process to the child by giving them what they want from an early age as a material reward for getting them to devote their existence to schoolwork. Dictating consumption from such an early age has the unintended consequence of instilling into the child—but especially the son—a sense of empowerment over their leisure world and the family environment (McNeal & Chan, 2004).

One mother’s comment nicely sums up filiarchy: No sacrifice is too great to give my child all the things I didn’t have in order to insure her happiness. What this means in practice is as follows: No sacrifice is too great to give my child everything so that the child will, in turn, sacrifice his or her own autonomy and individuality for school and school grades. Wishing the child can become a “grade-making machine” (successful) may engender fan gan (a rebellious reaction) within the child. “I was reluctant to return home,” one Internet addict told his parents after running away because they had tried to padlock him in his room.“Instead I wanted to play outside where I have lots more freedom.” This retreat from normalcy and advance toward the freedom of the Internet, the Internet bar, and one’s peers is undertaken not to “escape reality” but partly in order to try and establish one’s autonomy.

For many years, Tao Hongkai has been involved in a very public battle with military psychiatrist Tao Ran over the public discourse of problematic Internet use. Although Tao Ran has been advocating a psychiatric-based medicalized discourse for framing, explaining, and solving this widespread problem, Tao Hongkai has been arguing that what China is facing is a set of societal, interpersonal, and moral problems, in particular a malfunctioning education system, maladaptive parenting, and unbridled materialism.

In order to understand the diverging worlds of Tao Ran the doctor and Tao Hongkai the educator, we can use the experience of Keith Bakker to illustrate the differences between these two opposing figures. In 2006, Bakker was the first person in Europe to open up a “detox clinic” for “game addicts,” with his clinic in Amsterdam offering biomedical-based in-house treatment. “Video games may look innocent,” Bakker initially argued, “but they can be as addictive as gambling or drugs and just as hard to kick” (Curely, 2006). By the end of 2008, however, Bakker told the BBC “The more we work with these kids the less I believe we can call this addiction” (Maguire, 2008). And instead of needing biomedical treatment, he believed the young people coming to his clinic needed “their parents and their school teachers—this is a social problem” (Maguire, 2008).

After initially conceiving “game addiction” to be an individual pathology, Bakker came to view problematic online gaming as “a result of the society we live in today” (Maguire, 2008). Bakker noted, for example, that 80% of those in his clinic had been bullied at school and felt isolated. Similar to Tao Hongkai, he believes many of the symptoms they have can be solved by going back to “good old-fashioned communication” (Maguire, 2008). As we will see, Tao Ran has observed the same troubled social existence of his own “patients” but, unlike Bakker, has continued to employ a psychiatric-based biomedical model to frame the problem as centrally one of individual pathology. Yet Bakker argues the root cause of the explosive growth in excessive online gaming lies not with individual pathology but generally with parents who have failed in their duty of care.

Echoing the data from China, Bakker observed that feelings of frustration, anger, and powerlessness often exist prior to their gaming and that alienated youth bond in the virtual world in order to find a sense of community and belonging. “It’s a choice,” Bakker says. “These kids know exactly what they are doing and they just don’t want to change” (Maguire, 2008). Bakker thus says that calling online gaming an “addiction” strips away the element of choice or agency troubled youth have. “In most cases of compulsive gaming,” he argues “it is not addiction and in that case, the solution lies elsewhere” (Maguire, 2008).

Symbolically put, Bakker started out as Tao Ran and ended up as Tao Hongkai. Or, we could say that instead of overly focusing upon the overt signs and symptoms stemming from excessive Internet use Bakker chose, instead, to focus attention upon the entire social existence of the gamer.

Interpretation of Letters

The second, and more important, set of data, which functions as a “mirror image” to the ethnographic material because the content is virtually identical, stems from the translation and interpretation of 50 of approximately 3,000 randomly chosen letters sent from across China to Tao Hongkai. More than 90% of the letters were written not by this Internet addict himself or herself, but by a parent, usually a mother, literally begging this educator to save their child, usually a son, from the grip wangyin seemingly has over the child and the family.³ Although this collection of letters cannot be considered a random sample in the conventional statistical sense, it is, nevertheless, a random sample of a more “natural” kind (Chan, 2002, p. 164), written by parents from across China who can be taken as representative of a larger population of parents seeking help for their child’s Internet addiction.

The letters reveal that it is the parents who are principally attaching labels such as Internet addiction upon their child’s “antisocial” behavior (some of which only loosely connects to “excessive” Internet use). And so the letters offer us a prism through which we can view the way the parents regard, evaluate, and judge the behavior of their child. At the same time, and inadvertently, we are also able to observe the maladaptive behavior of the parents themselves that significantly contribute to the child’s problematic Internet use, a decisive factor long known to predict juvenile delinquency and crime (Farrington, 2011).

The significance of the letters stems from the way crucial events within the family are discounted or denied, facts that call into question, and may even negate, the Internet addiction disorder concept. Parental absence, neglect, violence, divorce, and death are exemplary examples, as these “acute and chronic stressors” (Horwitz, 2002, p. 18) common to the social existence of the Internet addict are the primary reasons for the emergence of symptoms of distress within the child, which finds expression through deviant behavior (West & Farrington, 1977) but which may be mistakenly categorized as Internet addiction (Cao & Su, 2007).

Although the author has elsewhere analyzed in more detail the parent’s narrative (Bax, 2014), this article principally focuses upon the experience of the child themselves. Although the author draws from the totality of letters in analyzing this phenomenon, in this article four letters written by the son himself are explicitly sampled, which are further complemented by the inclusion of a number of statements made by the child that appeared in letters written by a parent or which were encountered during ethnographic research. Simply put, the letters are methodologically and theoretically valuable because they reveal deeply private, distressing, and intimate thoughts and feelings relating to very serious problems existing within the family.

Tao Ran’s Conceptualization of Internet Addiction

Tao Ran, a psychiatrist, PLA Colonel, Communist Party member, and Director of an Internet Addiction Treatment Centre inside Beijing’s Military General Hospital, has written the following about the perceived physiological effects of Internet addiction:

Internet addiction causes network autonomic dysfunction, gastrointestinal disorders, eye fatigue and other somatic symptoms. This will result in serious physical discomfort for young people. This discomfort will add to their emotional disorder, leading to further internet use, and thus to reduced social or outdoor activities (Tao et al., 2007, p. 165).

It also seems logical, vis-à-vis Tao Ran’s professional history that he would say the following about the behavior of the Internet addict:

Today you go half an hour, and the next day you need 45 minutes. It’s like starting with drinking one glass and then needing half a bottle to feel the same way (Tao et al., 2007).

And due to his background as a military psychiatrist treating “alcoholics” and “drug addicts” then it is unsurprising he would say the following about the “withdrawal symptoms” associated with Internet addiction:

If you let someone go online and then he can’t go online, you may see a physical reaction, just like someone coming off drugs (Cha, 2007).

For Tao Ran, as is common for advocates of the Internet addiction disorder concept, drug addiction, alcoholism, gambling addiction, and Internet addiction share an equivalency because “the effects are the same”:

Some addicts drop out of school, some mug people for money, steal and sell their families’ things to keep playing games. Some end up killing themselves because they feel life has no point (Reuters, 2007).

To summarize, this Internet addict is conceptualized and visualized as pivoting on a funicular-like axis of differing forms of mental disorder as he or she moves further away from the perceived normal functioning of society—the unproblematized and taken-for-granted “real world”—and more and more toward the (problematic and morally criticized) “unreal” virtual world. And with increased Internet usage, the more new physiological and mental disorders they are said to create for themselves (including, Tao Ran states, autism, self-contempt, conduct impediment, and personality impediment; Adams, 2009). At the base of this conceptualization, however, resides a value judgment: A subjective binary exists between the good real world and the bad virtual world. Or with reference to the opium addict of the 19th century, excessive online gamers are morally judged to be “hooked” on what is called “electronic opium” (Golub & Lingley, 2007; Tian, 2005).⁴

Real World Versus Virtual World

According to Tao Ran, “under heavy pressure in life or work, some internet users hope to escape reality or release their emotions in cyberspace” (Zan, 2008). This is because they are said to “lack self-confidence and often don’t have the courage to continue their lives” (Zan, 2008). And so in the real world they become “depressed, upset and restless,” while at the same time, “believe the virtual world is beautiful and fair” (Zan, 2008). This “escape from reality” thesis has been described elsewhere as an “inadequate stress coping strategy,” which is premised upon the gamer “playing the hurt away” (Grüsser, Thalemann, & Griffiths, 2007, p. 291). But the social existence of youth labeled Internet addicts reveals an alternative understanding of the aims and motivations underpinning what we could call socially problematic Internet use. Far from the real and virtual world being part of a value- and judgment-based binary opposition, they are, on the contrary, inextricably interconnected and so one cannot be understood without the other. They are two sides of the same coin, as socially problematic Internet use is premised not upon category (addict/not addict) but rather upon dimension (levels of intensity and engagement/degrees of effect upon one’s entire life world).

“Xiao Wang,” for example, wrote the following about his “infatuation” with the Internet:

I am infatuated with the internet because in the virtual world I can find a sense of satisfaction and freedom. Inside the internet I simply don’t know what is pressure or worry. I am able to say and do whatever I like, and no one is going to discriminate against me as everyone online seems equal, and so in cyberspace you can feel like an emperor. I don’t receive any restriction there. The friends in cyberspace really stick together through thick and thin, and so I feel that my friends online are the only ones I can consider to be real friends. But in reality? It is really difficult to accept! Like this I have broken away from reality.

The “reality” he says he has broken away from is one where he is regarded as a “big fatty” because he weights 115 kg. “Fat people,” says Xiao Wang,

are a group where it is easy to be discriminated against by other people, so where can you go? You can feel people’s abnormal looks towards fat people! But inside games this situation does not emerge. In the real world I absolutely don’t love to show my face where there are lots of people, for fear that people will make fun of me. I feel that there is this nameless pressure that is too great, which also makes it hard to breathe, and sometimes I think that I am on the road to ruin!

The price he paid for breaking away from reality, in particular being absent from school, was being severely beaten by his father, a policeman, and eventually locked in his room for 2 weeks until he wrote a guarantee that he would not go to the Internet bar again.

“Xiao Chuan” attempted to explain in a letter to his parents his relation to the Internet after he failed to meet their expectations in school exams and after they accused him of being addicted to the Internet:

Even though you did not let me get online, you still don’t understand where I am coming from. All I wanted was a little distraction from study so as to walk into time’s gap, for doing so allows me to have a small taste of extreme happiness. But as soon as I return back to reality from being online, I begin to suffer again. My best friends are on the internet, and I am able to reveal to them my true intentions and am able to laugh with them. They are extremely important to me, even to the extent that they are more important to me than you are. My family is inside the game, and we never argue, rather we always mutually help each other. I have already lost too much for you, and have paid out too much, so don’t force me again.

“Xiao Ming,” like many “internet addicts,” bemoaned the fact that he is always failing in the real world, and so told his father,

Only through playing on the computer am I able to find a sense of achievement. I want to dominate the world, and I want to let people in the world listen to me.

Contrary to popular belief, we see that they are not using the Internet simply to “escape reality” but are seeking out feelings of satisfaction, freedom, peace, equality, and even superiority there. Thus, we see the interconnectedness of their real world and their virtual world, wherein the real world is one where they perceive and experience discrimination, discontent, and dissatisfaction—it is cold and dangerous—while cyberspace is perceived and experienced as a space of equality—warm and safe. We see that a discriminatory society partly “pushed” them away, while, at the same time, the facelessness of the Internet “pulled” them in by allowing them not simply to escape reality but to try and deal with it; and to even try to overcome it (albeit unsuccessfully).

This helps us learn why youth, who are relatively powerless in an authoritarian society, are so attracted to the Internet, as it is a kind of “safe monastery” in a society deeply out of balance (Frazier, 2010). By feeling like an “emperor” the powerless Xiao Wang, along with millions of adolescents like him, is also able to feel in control of his actions and the center of his universe. That is, they are able to express their individuality and to feel like an authoritative figure themselves.

In contrast to the majority of parents who write in their letters that they see their child’s online friends as “unreal” and “bad,” we see them referring to online friends as even more real than any friends in the real world. Yet their sense of failure at not having succeeded academically, within a society where academic success has obtained a “meta value,” has left them facing serious existential crises, wherein, expectedly, they feel deep regret at not having adhered to social norms and expectations. Unsurprising that they desire to go online for it is here, and nowhere else, where they are able to experience a sense of happiness, freedom, and satisfaction.

Thus, we must note that they are not merely having trouble controlling their Internet use but, much more problematically, are having trouble dealing with the normal pattern of living. Xiao Chuan, for example, is having serious trouble relating on any level to his parents, who he feels do not understand him and the function the Internet plays in his life. Moreover, he feels his parents have forced him to “pay out too much” and as a result he feels he has “lost too much” to them (in particular, his “happiness”).

Moreover, their desire to be someone through feeling like a winner by dominating others (Fromm, 1942) signals not simply that they are escaping from the real world, but, on the contrary are struggling, in a devalued social space, to adhere to the dominant ethics such as competition, ambition, self-assertiveness, and individualism so central to both the “normal” functioning of contemporary adult Chinese society and online gaming.

Xiao Kang’s experience, as articulated in his letter, offers a window into which we can view this dilemma they face between failing to meet (often unrealistic) expectations in the real world and then seeking then out in the virtual world:

Upon entering Jiaotong University I was full hope in the future, and had life planned out. A famous school and a famous major made my friends praise me endlessly. More so, my family thought I had already entered into a magnificent future. I did not have the slightest anxiety. However, at university I encountered students from poor areas whose gaokao grade was 50–60 points higher than mine. Their diligence gave me a very big shock. Their assiduous studying was something I did not even want to think about, for compared to them I was simply like the pampered son of the wealthy family. Listening to them made me feel unprecedented pressure. From this day on my competition was going to be with those who could put all their energy into studying.

What we see is Beijing-raised Xiao Kang experiencing “unprecedented pressure” after learning firsthand the nature of his “competitors” at university, whom through hardship and industriousness had managed to locate the route out of an economically deprived village and into a prestigious university. The fact that, from the outset, he conceptualizes his classmates as competitors reveals much about Xiao Kang’s preuniversity socialization. As “Wang Gang” said while undergoing treatment at Tao Ran’s military hospital:

Perhaps the problem is that the whole society gives us too much pressure. Pressure at home and school is too much. All our parents say is ‘achieve, achieve.’ My classmates and I don’t have any brothers and sisters, and so I hope that we are able to become friends, but instead it is like we are rivals. Like this, there is only one place where you can escape these problems and make friends, and that place is the internet.

For Xiao Kang what was worse than not being able to compete with these rivals was not being able to bond with them. From the outset of his migration to Shanghai, he was estranged from those closest to him; an estrangement made all the deeper by his initial positive sense of his place in the world and the bright future he perceived lay in front of him. Fortunately, and unfortunately, for Xiao Kang he came into possession of a computer:

As for encouragement, I had my computer. Everyone marvelled at this cherished thing, because this was the first time many had used a computer. This computer completely belonged to me, and because I didn’t have other people’s restrictions I could do on it anything I wanted. I proudly taught others how to use the computer, and from the expression in their eyes I could see envy, even to the point of jealousy, and I felt an unparalleled satisfaction. Through the games I was best at it was as if I had found the easiest kind of method for gaining respect. This, compared to study, was much easier and more relaxing. Every time I broke my own record I was able to experience the joy of achieving. I became the whole dorm’s focus, and it seemed that every person was looking forward to hearing about my affairs, and I had to continuously challenge a new record, for only then could I continue to obtain their recognition. My reputation as a good gamer got bigger and bigger, to the extent that students from other departments would come to my dorm and watch me play. Within the games every person can become a leading character, and the focus, and so they can also enjoy the victor’s joy and happiness.

Through his ownership over and competence on the computer, Xiao Kang’s sense of aloneness evaporated as he became a somebody in the eyes of others. He felt “unparalleled satisfaction” from perceiving what he thought was envy and jealously toward his computer skills. He lapped up being the focus of other’s attention (i.e., like being at home), which in turn drove him toward continuously challenging himself. In order to continue to be someone he felt like he needed to continue to perform for his “fans.” Xiao Kang also found, in contrast to his difficulties in the real world (home and school), that obtaining a sense of respect through online gaming was much easier and more relaxing. This is partly why online gaming threatens formal study and the education system because it is premised upon continuous feelings of instant gratification in the here and now. Thus, Xiao Kang was able to easily and repeatedly experience the “joy of achieving.”

Tao Ran’s psychologist, Xu Leiting, has said Internet addicts “escape to the virtual world to seek achievements, importance, and satisfaction, or a sense of belonging” (Reuters, 2007). Such a discourse partly functions to morally censure this Internet addict, for they are essentially being chastised for playing the wrong game: the game of use-value (leisure) and not exchange-value (work). That is, the Internet addict is condemned because they cut themselves off from the society of study and, instead, escape into what is believed to be a world of fantasy and simulacrum (Derrida, 2003). While “attached” there they are thought to produce nothing real, and since they are being nonproductive, and more importantly are harming their future prospects, then they are said to be “wasting” their time.

Yet the notion of “compulsivity” that underpins behavioral addiction, wherein addicts “cannot help” but act compulsively because their use is caused by forces largely beyond their control, carries within it the danger of removing the motivation and will of the user and, instead, locating it in their body or mind (Conrad & Schneider, 1992). This particular conception of human behavior overlooks the fact that Xiao Wang, Xiao Chuan, Xiao Ming, and Xiao Kang were so attracted to the Internet not simply because it allowed them to escape or retreat from reality but more so because it allowed them to advance toward a new and different kind of social reality. It was not simply that they had failed at life and so drowned themselves in games as a way to escape their difficulties and avoid their problems but partly that life had failed them and so they migrated to cyberspace in search of biopsychosocial solutions as a way to prevent themselves from drowning existentially.

But this view—wherein Internet use is a socially active process—requires moving away from value-loaded real/virtual and work/leisure binaries, wherein Young considers the online world to be “make believe” (Cover, 2006). Criterion-6 of the diagnostic model cited previously, for example, assumes that the real is equivalent to the social and the virtual to the nonsocial and so the Internet addict’s life is said to become both less real and less social the more time spent online. But making a subjective distinction between the real and the virtual world overlooks how the gamer is obtaining alternative forms and feelings of success through Internet use. According to the diagnostic model, such achievements are not considered successes because they possess little or no social value. But if “real” Chinese society is not fulfilling their existential and social needs, then is it not rational and logical (i.e., expectable) for a young person to seek solutions to such needs elsewhere if readily available?

Violence—Virtual or Real?

In order to highlight the harm Internet addiction is causing to Chinese society, Tao Ran made the following statement: “Why in our prisons now do 76% of juvenile criminals have internet addiction or some kind of relation with the internet?”⁵ The underlying message conveyed is that the content and structure of “violent” video games “teach” the gamer to fight, steal, and kill. As a result, the gamer’s moral nexus and moral judgments are said to dissolve under the constant exposure to, and proficiency toward, virtual violence (Wu & Zhang, 2008).

Yet, (a) the content of the letters, (b) the ethnographic data, and (c) Tao Ran’s own data (highlighted subsequently) show that this person does not encounter real-world violence in the virtual world but rather encounters real-world violence firsthand in the family. Xiao Wang, as is common (Bax, 2014), tells how he was beaten severely a number of times and then, like one of his father’s criminal suspects, locked in the house. What we see is parental violence and maltreatment contributes to increased Internet use.

Yet while this person is presented as a potential criminal with a physiologically diseased and psychologically disordered mind, Tao Ran has also said they are “very special and intelligent.” And thus, “It’s only normal for people to make detours when they’re young. Our mission is to help them get back on track before it is too late” (Jiang, 2009). But conflating (biopsycho) sickness and (moral) badness creates confusion, and not clarity, when attempting to present a valid explanation of the causes underlying the socially problematic Internet use (Conrad & Schneider, 1992).

On one hand, this person is conceptualized as an abnormal individual who needs to be cured by medical and psychiatric means. Yet this person is also presented as a normal individual who has simply made a detour off the normal functioning of society and needs merely to be guided in the right moral direction (principally through military discipline). But to be suffering from a mental disorder and to be socially and morally misguided are two different conditions. The former requires that there is something malfunctioning within the individual whose ordered psychological system has somehow been made disordered (see subsequently), while the later indicates a disjunction between individual conduct and societal norms and expectations. In short, the former is seen as “sick” while the latter is seen as “bad” (Conrad & Schneider, 1992).

Xiao Wang, for example, said his mind was unable to be calm while sitting in school as he was always thinking about going to play. Is this an expression of “withdrawal symptoms,” and so his online usage had disordered his mind by filling it with unwanted urges to game? Alternatively, we could say that while doing what he should be doing he thinks deeply about that which he should not be doing. In reality, Xiao Wang’s thoughts only make empirical sense in relation to the social context his thoughts arise from, which in this case involves him sitting in a classroom. In relation to this environment, which “Internet addicts” commonly say they dislike, detest, or even hate, we should not at all be surprised—or even expect—that he is thinking about the stimulating and exciting Internet bar and online games that the Party-State has allowed to become a ubiquitous feature of contemporary social and electronic life. But this visualization only becomes valid if we suspend our value judgment toward the classroom as something inherently positive and the Internet bar and “violent” online games as something inherently negative (and vice versa).

DSM’s Definition of a Mental Disorder

In light of the social context highlighted previously, let us examine the Internet gaming disorder concept through the prism of the DSM’s own definition of a mental disorder.

In order for “Internet gaming disorder” to be classified as a valid mental disorder in the DSM it must meet three broad criteria. First, the behavior pattern or syndrome under consideration:

Must not be merely an expectable and culturally sanctioned response to a particular event, for example, the death of a loved one (APA, 2013, p. 20).

In addition to this behavior not simply being an expectable response to a stress condition, the following criteria must also be met:

A mental disorder is a syndrome characterized by clinically significant disturbance in an individual’s cognition, emotion regulation, or behaviour that reflects a dysfunction in the psychological, biological, or developmental process underlying mental functioning (APA, 2013).

Finally, the DSM is clear on the third part of the definition:

Socially deviant behaviour (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual (APA, 2013).

In summary, mental disorders must be distinguished from inappropriateness as defined by social norms (i.e., deviant behavior/“badness”) as well as from expectable responses to stressful environments while, at the same time, shown to be the result of an internal dysfunction. This is because the inappropriateness of behavior is not sufficient to indicate the existence of a mental disorder. Instead, this merely indicates that the person is “bad” (i.e., a social deviant going against social norms)—and not sick (i.e., a mentally ill person whose behavior stems from an unexpectable response to a stress condition originating from a dysfunction in the individual).

Contextualizing Internet Use

If we take the common features of the social existence of youth in China labeled Internet addicts, then we need to contextualize increased Internet use after one or more of the following situations occurs:

a child subjected to acts of violence, absence, and neglect by one or both parents;

parental divorce;

the death of a parent;

feelings of intense pressure due to examinations and schoolwork; and

feelings of “engulfment” due to parental pressure and emotional overinvestment in the child’s education (e.g., turning the child into a “grade making machine”);

Under such conditions, we must ask whether it is more valid to conceptualize their reactions as an expectable—and not unexpectable—response to their stress producing and maladaptive environments.

Horwitz notes an essential distinction to be made when persons in positions of authority are labeling the actions of people in a relatively powerless position as stemming from a psychological addiction is the distinction between mental disorders and social deviance. Deviations from social norms, such as refusing to do schoolwork and desiring and/or demanding to play online, may arise not because of internal mental pathologies but because of a range of other “moderating” factors, including:

conflicting cultural norms (i.e., desiring play & consumption over work & production);

conformity to the standards of subcultures (i.e., peer pressure to play games resulting from their ubiquity among youth, wherein widespread usage may mean to not play games becomes “abnormal”; Kutner & Olsen, 2008); and

a lack of adequate social control (i.e., because of engulfment and filiarchy parents may have not instilled appropriate ways of acting in the child, and have also lost control over the child by, e.g., allowing the child to play online all through the night and letting him sleep during the day; Horwitz, 2002, p. 20).

DSM—Expectable Response to a Stress Condition

The postulation that the presence of eight manifest symptoms indicates an underlying mental disorder called Internet addiction, regardless of the social conditions these symptoms stem from, is particularly problematic when psychosomatic symptoms are themselves products of a stressful and taxing social environment. This is because such a model may mistakenly equate an expectable response to a stress condition with an addiction/mental disorder. This is because no adequate demarcation is made between those under stress and those who are not. The DSM is clear on this point. This is why bereaved people do not suffer from the mental disorder called “depression,” because people are naturally depressed following the loss of a significant other.

Significantly, Tao Ran himself admits that “Internet addicts” come from maladaptive stress-producing environments and have encountered acute and chronic stressors, for he has said:

Every child in this rehab center has a sad or miserable history, because their parents didn’t treat them justly (Adams, 2009).

Of the kids at our camp, 58% have been cursed and beaten by their parents.⁶

Parents who are violent toward their children and in families where relationships are not good, drive children to seek consolation from the Internet (Zan, 2008).

Ninety-five percent are boys who lack the love of a father (Zan, 2008).

What these data demonstrate are that Internet addiction may stem from an expectable response to a stress condition. So instead of arguing that Internet gaming is a mental disorder he is, on the contrary, arguing that it is not a mental disorder.

If the family nexus, in particular parental violence and counterproductive parenting and socialization measures, is the main cause of Internet addiction disorder (Li, Garland, & Howard, 2014), then why have mental health professionals forced youth to take unspecified types of medication, undertake pseudo-psychoanalytic treatment—including electro-shock treatment (Hu & Qin, 2009), and subjected them to military-style exercises (Cha, 2007)? Shouldn’t the (violent) parents, first and foremost, be the ones forced to change?

This is one of the fundamental oversights of the diagnostic model, as it attributes the self-perceived “symptoms” of this person—anxiety, irritability, pessimism, anger, low self-esteem, inattentiveness, and so on—as being caused by internet addiction. Yet at the same time the taxing and stressful social environments these adolescents are embedded into are acknowledged, thereby in effect erasing the biomedical model itself. But while this “sickness” of the social environment is acknowledged, the focus continues to be placed upon the perceived biomedical sickness of the individual. Why?

In reality, a large part of the symptoms attributed to Internet addiction result from before they entered into an socially problematic relationship with the Internet as well as from the interpersonal relationships connected with their Internet use (which they “inflame” through their defiance and nonconformity), for the Internet partly functions as a remedy or existential weapon they utilize in order to deal with existing stressful social conditions. Thus, when a son stops communicating with his parents after they scold and violently beat him for refusing to do his schoolwork, and chooses instead to play online, then such behavior maybe understood (partly) as an expectable response to a stress condition. Or when the son runs back to the Internet bar after his father beats him or locks him in his room, then such behavior may not signify that he is unable to control his Internet use but may be an expectable response to a stress condition. For example, Xiao Kang’s migration to online games may be validly understood as an expectable response following from him feeling like a social outcast because he had no classmates to socialize with as they were all studying excessively. Likewise, Xiao Wang’s attraction to the Internet may be partly seen as an expectable response to facing discrimination due to his weight, as online he was able to overcome this stressful condition through the “faceless” mechanism of the Internet.

It may be valid to claim one of the main attractions of using the Internet as a remedy is because “they believe the virtual world is beautiful and fair” (Adams, 2009). But it is misguided to then say “In the real world, they become depressed, upset, and restless—they are very unhappy” (Adams, 2009). This is because we are not told of the conditions making them feel depressed, upset, restless, and unhappy; rather, such youth are often presented as immature, weak, and unable to “adjust” to the normal functioning of society (Wu & Zhang, 2008). But the DSM states that “distress that emerges from social conditions is neither a mental disorder nor a distinct disease condition” (Horwitz, 2002, p. 13). Unfortunately, many parents do not detect their child’s distress, for there is a general perception that their children are—despite them being caught in the eye of a monumental and disorientating social transformation—somehow made of existential steel.

In reality, many adolescents are under enormous stress and distress, stemming from schoolwork and/or their dysfunctional family situation (Jepson & Xie, 2012), and so some use the Internet and Internet games as a mechanism to deal with this stress while some take this activity to socially problematic levels. Thus, to call their socially problematic gaming a mental disorder is questionable, for it presumes that the issue principally lies in the relation between child and Internet and consequently attention is diverted away from the socially produced distress that envelopes the family and resides outside of (yet connected to) the Internet. Blaming the child for using the Internet too much to the detriment of their schoolwork overlooks the problems the child is having with school, interpersonal relations, schoolwork, and family life (i.e., their existence). The mistake is to see the Internet as the cause of the problem rather than as an effect of other, much more serious, causes. In short, effect may be mistaken for cause.

DSM—Internal Dysfunction

As noted, in addition to behavior not simply being an expectable response to a stress condition, the behavior must also be shown to have originated from a dysfunction in the individual, and, therefore, it must be proven that there is something wrong with the internal functioning of a person. An internal dysfunction exists only when an internal mechanism—such as cognition, perception, motivation, emotion, memory, or language—is unable to perform its natural function, and not simply when it does not perform this function. These functions, according to Horwitz (2002, p. 11):

Are not social constructions but properties of the human species that have arisen through natural selection. People with internal dysfunctions have some psychological system that is incapable of performing within normal limits.

Therefore, what are the internal dysfunctions that are universal qualities of the human species that sets the individual suffering from Internet gaming disorder apart from the “Internet gamer”?

One of the strongest threads running through the letters written by the parents is the parents’ insistence on highlighting how internally functional the child was prior to their Internet addiction. Like the “special and intelligent” youth Tao Ran highlights, the child is described as:

normal, intelligent, good natured, lively, obedient, kind-hearted, outstanding, enterprising, progressive.

Even taking into account the parent’s own attributions (Booth Davies, 1997)—that is, framing the discourse in order to emphasize that the child, and by implication their parenting, was generally “good” until an external factor called the Internet descended upon the family—the data do not indicate that their socially inappropriate Internet use stems from an internal dysfunction. And as Horwitz (2002, p. 22) states “if nothing is wrong with people’s internal functioning, they are not mentally disordered.”

However, another thread running through the parent’s letters is the way a number of parents referred to the child having an “introverted personality.” But a “personality trait” such as being introverted may not stem from an internal dysfunction. An internal dysfunction indicates something is wrong with the capacity of an internal mechanism to function, as it is designed to function, thereby rendering a person incapable of being able to conform to social norms, and not, for example, that an individual has made bad choices in how to behave, or is criticized by others for not behaving how they would like them to behave. By choosing to play online over study, the child, from the perspective of social norms and future prospects, could be said to have made poor choices in how to behave. For it is this “poor” (read: deviant) behavior that parents principally want modified.

Parents are not asking people like Tao Hongkai to transform internal dysfunctions into internal functions because they already believe their child has a “good nature.” They hope, rather, that a professional can restore “order,” “control,” or “stability” to the wayward child so that, above all else, the child will return back to school. As one 14-year-old girl told the author while undergoing disciplinary treatment at a military-style boot camp in Jinan: One of the major effects of the camp is that it does not allow them to think about the Internet as all the talk is centered upon getting to a good university.

In sum, the parents are not as concerned about the effect Internet use is having upon the existential, interpersonal, or spiritual well-being of the child, as they are about the effect this Internet use is having upon the child’s schoolwork (i.e., their future).

Conclusion

In the 1960s, Scheff (1966) argued that “mental disorder” is often a category observers use to explain norm-violating behavior they cannot explain by another culturally accepted or understood category. While Scheff argued psychiatric symptoms are violations of social norms rather than intrapsychic disturbances, Horwitz shows that despite a number of the mental disorders within the DSM not conforming to its own definition, there are still a number of valid mental disorders (e.g., schizophrenia) that demonstrate internal dysfunction.

If we turn to the category Internet gaming disorder, then the data presented here make the following conclusion: When the Internet user’s social existence (i.e., their existential, interpersonal and social relations) is taken into account then their Internet use does not adhere to the three critical requirements set out by the DSM, namely:

mental disorders are internal dysfunctions;

mental disorders are not expectable responses to particular events; and

mental disorders must be distinguished from deviant behavior (Horwitz, 2002, p. 21).

Rather, Internet gaming disorder and Internet addiction disorder are labels that function not to indicate an intrapsychic disturbance or some underlying mental disorder, for the child was evaluated as being “good” prior to contact with “violent” online games and “bad” friends. And as Tao Hongkai tells parents, there are a percentage of the so-called Internet addicts from good homes who are considered to be “excellent” and “healthy” students. Moreover, the parents identify a problem not when the child exhibits an intrapsychic disturbance but rather when their Internet use begins to negatively affect his or her school grades. On this point, we could say the benchmark is not the mind and its breakdown, but rather school-grades and their decline.

Thus, what is thought to be Internet gaming disorder appears to be socially deviant behavior. Or the biomedical model must clearly show in what ways their Internet usage is not a product of social deviance (and an expectable response to stress conditions).

Horwitz reminds us that the classifications of distinct disorders that underpin the DSM’s diagnostic psychiatry are useful when two broad criteria are met:

that each constellation of symptoms is actually a valid mental disorder and

that using manifest symptoms to distinguish diseases aids in establishing distinct causes, prognoses, and treatments for each condition (Horwitz, 2002, p. 11).

It is concluded here that Internet gaming disorder does not meet the two following broad criteria: the constellation of symptoms identified to “diagnose” a certain form of Internet use does not clearly signify a valid mental disorder called Internet gaming disorder, and so using these symptoms to distinguish Internet gaming disorder from “internet gaming”—and mental disorder from social deviance—does not seem to aid us in establishing distinct causes, prognoses, and treatments for this condition.

On the contrary, such a conceptualization may lead us further away from understanding the psychological, interpersonal, and social factors underpinning socially problematic internet use, and, in turn, the most appropriate methods required to seek real-world solutions to this widespread social problem.

As we look forward, we will be required to take into account the rapid migration from personal computers and laptops fixed in homes and Internet bars to mobile phones placed in roaming pockets. By the end of 2013, the number of mobile online game users in China had reached 215 million, representing a growth of 75.94 million, or 54.5%, over the end of 2012 (CNNIC, 2014, pp. 7–8). How are adolescents, their parents, school authorities, and health professionals going to properly deal with young people attracted to online games as the industry shifts from computers to mobile phones?

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research was supported by funding from the National Research Foundation of Korea, 2012-2013. Grant number: 2013S1A5A8023561.

Notes

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