Semantic Nonsense: Gaming Disorder isn’t what you think it is

Okay Internet, it’s time to put down the pitchforks (which is your ACTUAL addiction, but we’re not here to talk about that today).

It’s time for Damage Control’s first part in an unplanned series on Media Literacy. For those of you unfamiliar with what is, I admit, a buzzword (despite being two words), here’s the quick and dirty from a source that ought to know, the Center for Media Literacy:

”Media Literacy is the ability to access, analyze, evaluate and create media in a variety of forms.”

And just to make sure nobody is confused over a keyword within that, here are the ground rules for “media.” As in, this is the plural form of “medium,” in all the cases provided by the second definition in the Merriam-Webster dictionary.

But to summarize, “media” are:

• The methods by which ideas are spread (television, radio, the World Wide Web);
• The substances an idea can be recorded on (paper, canvas, film);
• The styles in which one does the recording (rap music, mystery novel, romantic comedy movie); and
• Finished, “permanent” products (books, mp4 files, sculptures, newspapers)

If you know other definitions for these terms, forget them while reading this post, or you will not be able to accurately understand it. And understanding a message is the point of putting that message out there, right?

All these links and definitions aren’t just me being a condescending asshole. It’s about making sure we’re all on the same page. While a lot of you will know a lot of these, the missing piece of knowledge is probably going to be a different piece for each person. So I want to be thorough.

We understand through context (can you think of many misunderstandings that occurred through anything other than a lack of context?). What is the idea, how is it being recorded and/or transmitted, under what circumstances was it all done?

So, to truly understand the hubbub over Gaming Disorder and pull the signal out of the noise, it is crucial to have literacy in two things: Journalism and Medicine. (And if the former had the literacy of the latter, this whole kerfuffle might have been avoided.)

Journalism Literacy

The reporting on Gaming Disorder was considerably less than top-notch. It was the result of two issues quite common in professional criticism of journalism but less well-known among outsiders: “Stenography as Reporting.” and “All Science News is Trash”

“Stenography as Reporting” has become increasingly prevalent in recent years as news agencies the world over have eliminated positions and required more stories out of fewer reporters.

In this case, the word stenography doesn’t refer to the practice of writing in shorthand (which many reporters do for notetaking when gathering news on scene or recording interviews), but rather it refers to the job of a Court Reporter (or stenographer), a non-journalist whose job it is to record each word of the court’s proceedings for recordkeeping.

You’ve no doubt seen these sorts of stories before, especially in political news: The news reports “person said [insert quote here],” and more-or-less leaves it at that. The story doesn’t evaluate the quote. It doesn’t include any information from before or after the quote that might provide more context. It makes no attempt to verify any matters of fact relating to the quote. They’re just playing back the record.

You’ve doubtless seen that play out in clickbait. But in many cases for professional or traditional news, the money grab happened long before the headline hit the Internet. Stenography as Reporting is an all too common crutch the modern journalist relies upon to meet deadlines and fill quotas. The work cycle goes a little like this:

“Person A said this. Person B said that. We will do no analysis whatsoever, it’s time to write the next story. Also, we laid off all our copy editors, so even if a fact does find its way in, it will not be double-checked. Or spelled correctly.”

It doesn’t do much to shore up the public’s waning faith in the Fourth Estate, does it?

Context-free reporting by virtue of manpower or simple disinterest is enough to get a bad or inflammatory story on its own. But journalism also has a long history of not getting science reporting right even when they did have resources and research desks.

When I worked for a newspaper, I saw a comic tacked to a bulletin board. It depicted reporters lined up to toss a dart at their own board. That board had a banner at the top that read “Today I am an expert in..” with all sorts of different topics scrawled on the rest of the board, like “economics,” “foreign policy,” “rocket science,” and so forth.

The average reporter will have some sort of life experience in areas that aren’t journalism, just like any person does. But they are unlikely to have a deep understanding of subjects that require highly specialized training and education. At heart, it involves a layman trying to understand complex ideas that are often theoretical, and producing something another layperson would find relevant to their everyday life. It’s no small or simple task, but it might involve an hour’s work at most. Such things are ripe for false equivalence. A study in mice, for example, does not often translate to the same fining in humans, but you’d never know if all you had to go by were the headlines.

Overstatements in the confidence and accuracy of an otherwise scientific observation lead to endless back and forth about new findings one week that are seemingly invalidated by another week’s study. It doesn’t help that bad studies also get published in science journals for the purpose of being refined into something more rigorous and accurate by other scientists conducting a peer review. A reporter jumping on a study in its earliest iterations won’t later come back to the 50th iteration of the study. Even though the findings are far more likely to be meaningful in aggregate, the story has already been written and it’s now “old news.”

And other times, being in a hurry and not really knowing any better leads to the press just getting taken for a ride.

But before you, dear reader point and laugh at such seemingly obvious blunders, remember that art is merely a mirror of reality. Follow those links for two more tragedies of context’s want for a nail.

Bearing all this in mind, what do YOU think happened when something as esoteric as medical coding ended up in the news cycle? (How many people do you suppose even knew this story was about medical coding to begin with?) And when the professional press was done with it, what chance do you think the click-for-bucks online-only enthusiast press that is the modern face of video game reporting had of salvaging the story?

So now that we are more literate in the methods, conditions and limits of journalism, I hope that you can use that literacy to identify a few potential issues in the reporting and the reaction to the reporting on the World Health Organization’s recognition of Game Disorder. But getting down to the facts of the matter is going to be much harder that taking a deep breath, counting to 10 and engaging critical thinking. It requires that expertise the reporters were missing, which is a much bigger gap that being aware of journalism’s limitations.

Medical Literacy

I know I’m going to have to answer my own question here. I am by no means a doctor, but I do claim to have a narrow amount of medical literacy that is just wide enough to understand this situation. I claim this expertise in part from a different job I had: Providing reporting for Electronic Health Records Meaningful Use. Not for a newspaper, but for a Federally Qualified Health Center. The other part was my study of psychology in college as a possible minor and the requisite use of the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders. Say that three times fast.

Remember a few short paragraphs ago when I referred to “medical coding” as that esoteric thing that entered the news cycle? That illustrates the difference between these two particular sorts of literacy. While Media Literacy does need a foundation of knowledge to build upon, it’s mostly a skill; a way of thinking. Medical Literacy (or anything else as specialized), on the other hand, is pretty much all knowledge.

I, too, was ready to dismiss a so-called Gaming Disorder as yet another boorish attack on the pastime. Honestly, I’m pretty sick of being the object of “kids these days” rhetoric when I’m old enough to run for President of the United States (Not just President. Let’s not make assumptions that you telepathically know the presidency to which I refer when I could just tell you instead).

But the knowledge I had from my work of medical coding and from my studies of psychological diagnostic criteria allowed me to notice a pattern in the excerpt quoted in the report I read:

Gaming disorder is characterized by a pattern of persistent or recurrent gaming behaviour (‘digital gaming’ or ‘video-gaming’), which may be online (i.e., over the internet) or offline, manifested by:
impaired control over gaming (e.g., onset, frequency, intensity, duration, termination, context);
increasing priority given to gaming to the extent that gaming takes precedence over other life interests and daily activities; and
continuation or escalation of gaming despite the occurrence of negative consequences. The behaviour pattern is of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning.

I recognized the language and the formatting… and the intent that comes with it. The World Health Organization was not defaming video gaming as a dangerous vice; they were codifying the conditions under which something that was otherwise harmless would become harmful.

And in reality, it was a lighter touch than that. I know from my experience that medical coding is made like a hierarchy. Like any other taxonomy, you can get more specific information about any disorder by seeing where in the tree are listed.

I turned to the International Classification of Diseases new 11th edition guide — the adoption of which is apparently the source of all these new WHO medical stories — professionally known as the ICD-11 for Mortality and Morbidity Statistics.

(And here’s our next bit of Medical Literacy: “Morbidity” in medical parlance is a statistical word referring to how often a condition occurs in a given group of people.)

So where was Gaming Disorder filed? Follow this path:

Mental, behavioural or neurodevelopmental disorders >

    Disorders due to substance use or addictive behaviours >

        Disorders due to addictive behaviours >

Where Gaming Disorder shares space with Gambling Disorder. Another clue?

If you were to go up one level to “Disorders due to addictive behaviours,” as the reporting on this disorder did NOT do, you would find the following guidance (emphasis in bold added by me):

Disorders due to addictive behaviours are recognizable and clinically significant syndromes associated with distress or interference with personal functions that develop as a result of repetitive rewarding behaviours other than the use of dependence-producing substances. Disorders due to addictive behaviors include gambling disorder and gaming disorder, which may involve both online and offline behaviour.

In other words, Gaming Disorder isn’t gaming to the point of it disrupting your everyday life in the particular was described above, it’s doing so ONLY when it’s chasing that rush of hitting a jackpot. Put more simply: Gaming Disorder only applies to people who spend their entire day being victimized by Gaming’s Public Enemy No. 1: loot boxes. Which is why it’s clumped with Gambling Disorder. Literally all other possible forms of being addicted to gaming are NOT included.

A person who plays 8 hours a day, has no interest in supporting themselves and never showers but does not chase repetitive rewarding behaviors might still have a problem (Depression doesn’t care if you pass your time by playing video games or by painting a boat), but they unquestionably DON’T have Gaming Disorder.

A much better clickbait headline for the gamer blogs would have been “Medical Science Agrees that Loot Boxes are Gambling,” or even “Gatcha Whales Have Mental Illness.”

How medical coding works is not very common knowledge, and that’s a big part of the issue here. Think of the ICD not as an encyclopedia of diseases, but rather a way to describe what lead to a person’s current state of being. It’s not a list of whats, it’s a list of hows. Medical coding serves two purposes: To provide a hyper-precise record of a patient’s medical history, and to provide exactly the sort of asinine details that will determine whether your health care gets covered or not.

I implore you to check this list: Nextech’s Top 10 most hilarious codes in ICD-10 before taking Gaming Disorder as a personal attack.

Please note that the ICD-10 has are separate codes for “Burn due to water skis on fire” depending on if it is your first instance (V91.07XA) or a repeat occurrence (V91.07XD).

So relax, everybody. Contrary to public outcry or awful reporting, the WHO is not out to defame your hobby. They just want insurance to pay up if your hobby breaks you in a single, specific case.