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Are you a txt addict?

March 28th, 2008

Dr Petra

According to today’s papers it seems many of us are. There’s been plenty of coverage warning us that if we text a lot, or are technophiles, or spend hours in front of a computer or online then we not only have an addiction, we may be crazy

Texting, email and internet use are all being described as indicators of possible mental illness.

Perhaps as you read this you’re worrying that you’ve been online too long, or maybe are regretting sending all those recent texts or emails. Maybe you’re concerned you’ve got a mental health problem.

What’s driving all this concern and media coverage?

It’s from an editorial by a psychiatrist in the latest edition of the Journal of American Psychiatry, which you can read here. I would recommend you do read it in full, as obviously most journalists who’ve covered this story didn’t bother.

If you read the piece the first thing you should notice is it’s an editorial. That means it’s one person giving their view on something. And it’s a great way us academics and practitioners use to get a discussion going.

However, editorials are not necessarily proof of something. They serve to get us thinking about an issue and urge us to share our opinions. In this case the psychiatrist believes that internet addiction is something that is serious enough to warrant inclusion in the forthcoming DSM-V.

In case you were wondering, DSM stands for Diagnostic and Statistical Manual of Mental Disorders and has been used by psychiatrists since the 1950s as a means of classifying and diagnosing psychiatric problems. While many practitioners find it a useful means of identifying disorders, critics of the DSM argue that many of the categories are not reliably measured and object to the concept of setting out what constitutes ‘abnormal’ behaviour. Critical and community psychologists and psychiatrists as well as patient groups also complain the DSM enforces dominant Western values, is influenced by the pharmaceutical industry, and tends to overlook the causes of a person’s problems such as poverty, racism, abuse, or lack of education or safe housing.

In the AJP editorial, it’s stated that Internet addiction is characterised by “excessive gaming, sexual preoccupations, and e-mail/text messaging… All of the variants share the following four components: 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”.

My problem with measuring concepts like this are they are often too vague to give us helpful insights into behaviours. For example someone might use a game or email excessively because they have some spare time, or because they’ve just got a new piece of technology, or because they’re involved in a long distance relationship.

If you’re expecting an email about a new job or to hear about how a sick loved one is doing you may well feel angry or tense if you can’t get near a computer. And anyone who’s got a teenager in the house will be used to rows over texting at the dinner table or spending hours online chatting to mates on MSN.

Rather than looking at (or blaming) new technology and its use we need to assess wider issues. How long is a person using the internet for? What are they using it for? Is our concern over usage valid – for example are they putting themselves at risk by excessive use or are they just pissing us off by not being accessible when we want them to be? Is someone using the internet, email or text for escapism or for a real need (for example as part of their job)? Are our concerns about internet use – particularly around sexual or gaming content – more about our morals and values rather than healthcare concerns?

Before we decide that problematic internet, email and text use is enough of an issue to be classified into a mental illness we need proper parameters to identify what ‘problematic’ or ‘excessive’ use means.

We also need to look at situational factors that may drive behaviour, and ensure we’re not diagnosing people as ‘ill’ simply because we don’t approve of what they’re doing. In most Western society our values are around work, income, family, monogamy, and face to face communication. So adults who want to play games, participate in online relationships, take on different personas, enjoy extra or non marital sex, or not contribute to the workforce are always going to be viewed negatively. That doesn’t mean, however, that such behaviours make them mentally ill.

Clearly as well as measuring frequency, purpose and outcome of usage we also need to look at distress. Someone who feels they cannot control internet access may well need some assistance. However, again we need to be careful about how we measure this, since someone whose relationship is ending may be very anxious about if they’ll get a text or email and very distressed about internet use. But again, that doesn’t make them crazy nor mean the problem is caused by technology.

The issue is if we medicalise the overuse of new technologies we are prey to all kinds of new classifications, disorders and inevitable drug treatments. Presumably if we are addicted to the net we will need to be cured of this – but how? Is this going to be another situation where there’ll be a pill to pop to stop you sending a certain number of texts per day, or a talking therapy to get you out of second life?

And what about people who’re already finding online or text health education or therapy beneficial? Would we remove access to these forms of care and support to those who’re diagnosed as internet addicted?

I’m not against research in this area. In particular I feel the issue around sex and the internet/email and texting does need further investigation. There are practitioners who suggest that simply looking at sexual images online constitutes an addiction or form of mental illness, and there are certainly debates to be had on how such practitioners classify behaviour and treat patients.

Outside of this there are more mundane questions to be asked about how porn on the net informs how we understand sex and our sexual behaviour. Does it offer us more ideas, or restrict our sexual horizons?

We’ve yet to fully explore issues around online dating, using new technologies to begin and end relationships, sexual relationships that only exist in cyberspace, how texting and email are now part of the courtship process for many couples, and how many folk play out all aspects of their relationships through blogs, social networks or messaging friends.

These are all areas worthy of investigation, but the problem is if we label all internet, email and text usage as problematic or indicative of mental disorders it significantly limits the opportunity to research the positive or the everyday.

It can also mean we are quick to reclassify behaviours that are rude or dismissive into full blown mania. So now if your partner texts his mates while you’re out on a romantic date he’s not being an insensitive arse – he’s got a medical condition!

Which directs the media to write about the internet in a pseudo-medical way. Watch out for features on how to test yourself to see if you’re a text/email/internet addict heading your way soon.

Really what this editorial has shown us is there are more questions than answers, and a debate ready to be had. We can now talk about whether we think the internet poses a risk, how it might be a problem (or not) and whether and what ‘treatment’ options might be available.

But the press haven’t addressed this issue. Instead they’ve assumed that using the internet or texting is an indicator of a mental health problem. This is irresponsible reporting. It leads to those folk who disapprove of new technology use to justify banning access, it means parents who don’t like their kids texting can now say their kids are crazy rather than just being teenagers. And it means that people who are using the net a lot may well now feel there’s something clinically wrong with them and to worry unnecessarily.

So the story here is not that we’re all getting addicted to new technology, no matter what you’ll read in the press in the coming months. It’s simply an invitation to discuss whether we think this is a problem. Some of us will believe it is some of us won’t. But we all have the right to share our opinions – and you can do that by responding to the piece in the American Journal of Psychiatry.

Don’t feel you have to bury your blackberry or delete your facebook profile just yet. Instead sit back and enjoy the irony of newspapers, radio and TV shows inviting us to text or email in our thoughts on this story.

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