As we gather with friends and family for Thanksgiving, it’s pretty safe to say many of us will indulge in some unhealthy behavior. Maybe it’s eating too much turkey and pie, maybe it’s watching too many football games, or maybe it’s non-stop video game playing. Like eating or watching TV, it’s often hard to say when video game habits have turned into unhealthy behavior. But it’s a question doctors and mental health specialists are thinking about more, particularly as video games become increasingly realistic and as developers find new ways to understand the playing habits of the consumer. Diane and her guests discuss the impact of video game playing on mental health.

Guests

  • Dr. David Greenfield founder, The Center for Internet and Technology Addiction and assistant clinical professor of psychiatry, University of Connecticut School of Medicine.
  • Dr. John Krakauer professor of neurology and neuroscience and director of the Brain, Learning, Animation, and Movement Lab, Johns Hopkins University School of Medicine.
  • Dr. Courtney Conn psychologist, The Wake Kendall Group. Dr. Conn specializes in child, adolescent, and family therapy.
  • Steve Henn technology correspondent, NPR.

Transcript

  • 11:06:54

    MS. DIANE REHMThanks for joining us. I'm Diane Rehm. Today's video games are highly realistic, and easily accessible. Here to discuss advances in video game technology, why they're so popular and whether we can actually become addicted. Dr. John Krakauer, neurologist at the Johns Hopkins University School of Medicine. Dr. Courtney Conn, a child and family psychologist. Joining us from Hartford, Connecticut, Dr. David Greenfield. He's founder of The Center for Internet and Technology Addiction. And joining us from the studios of KQED in San Francisco, Steve Henn, technology correspondent for NPR.

  • 11:07:43

    MS. DIANE REHMI hope you'll join in the conversation. Give us a call. 800-433-8850. Send us your email to drshow@wamu.org. Follow us on Facebook or Twitter. Welcome to all of you.

  • 11:08:02

    DR. COURTNEY CONNThank you for having us.

  • 11:08:03

    DR. JOHN KRAKAUERThank you for having me.

  • 11:08:04

    MR. STEVE HENNGreat to be here.

  • 11:08:05

    DR. DAVID GREENFIELDIt's my pleasure to be here.

  • 11:08:06

    REHMAnd Steve Henn, welcome back, especially to you, having left WAMU several years ago. I know you grew up playing video games. How much has that gaming changed since you were playing those games as a young kid?

  • 11:08:28

    HENNSure. You know, I came of age as video games really invaded lots of Americans' homes with the Atari and the ColecoVision. And when I was playing video games with my friends, we'd go to a store, and save up our allowance, buy a video game and actually snap a cassette into a consul. And at that point, the video game we were playing was fixed. It was programmed and it never changed. What's really gone on in video game development, that's an enormous sea change, is that all of these game systems, whether you're playing on an iPad or an iPod or a computer or a video game consul, are now all connected to the internet.

  • 11:09:09

    HENNAnd so, as we play games, video game designers are watching how we play. And many of them are running a series of tests on the program itself, tweaking little things in the program to see how we respond if the game play changes. That can make a game a lot more fun, it can make it a lot more compelling. But it's also a way to shape the behavior of the people playing the video games. It's a very, very powerful tool.

  • 11:09:38

    REHMGive me an example of how the game producers can shape the game, depending on how you're playing it, Steve.

  • 11:09:51

    HENNWell, right now, in the free to play games, you know, the kinds of games that you might download onto your iPhone or your Android phone, the game designers make money by getting many players to actually buy virtual goods in the game. So, in a game like "Clash of Clans," you can spend money on gems, this artificial currency, and buy more powerful forts, if that's the game you're playing. And one of the things game designers will do is test what is more effective in getting someone to actually click that button and make that purchase.

  • 11:10:36

    HENNAnd the tests can be really small. Are they more likely to click if it's a red button or a green button? But they can also test the game mechanics and try to put game players under stress. So, one thing a game designer told me recently was that it turns out people are much more likely to purchase these virtual goods, in a video game, if they are put in a situation where they've earned something. Say a magical sword in a video game, and then are on the verge of losing it. Game designers call that fun pain or the pinch, and when you're on the verge of losing something you've earned, it causes a great deal of distress.

  • 11:11:18

    HENNIt's just sort of how we're wired. And so we're much more likely to purchase.

  • 11:11:22

    REHMSteven Henn is technology correspondent for NPR. Turning to you Dr. Greenfield, as founder of The Center for Internet and Technology Addiction. I gather you're concerned about how realistic these games have become. Tell us about what you're seeing.

  • 11:11:47

    HENNWell, I also came of age during the development of the gaming systems, but I started, probably, a little earlier with one of the earlier games called Pong, where you just watched a ball go back and forth. And believe it or not, that was entertaining enough in those days. But, obviously, with advances in digital technology, the games have become much more realistic, to a point where we're just probably one click away from not being able to discern a game based image, at least on some of these games, from a real image.

  • 11:12:26

    GREENFIELDBut the game designers, the games are inherently addictive because they all operate on a variable ratio reinforcement schedule. In other words, the rewards vary, and the game designers know this, in terms of when the rewards are going to come and what the rewards are going to be. And they vary them enough so that there's a compelling neurological desire to keep playing. And, not unlike a slot machine. And because of this changeability and variability in the game structure, it forms a strong neurological connection, which is a way of saying addiction.

  • 11:13:05

    GREENFIELDNow, not everybody that plays video games becomes addicted. I would say the percentage is probably somewhere in the five to six percent range. And you have to have some pretty deleterious consequences in your life, but I see those patients. I see the more extreme cases where people are playing six, eight, 10, 12, 15 hours a day.

  • 11:13:27

    REHMWow.

  • 11:13:27

    GREENFIELDAnd that alone isn't really enough to qualify a medical diagnosis of addiction. It would have to be that there's some real negative impact on their life, in terms of their legal status, health, financial, family relationships, academic performance, work performance. Some major sphere of their life, and that they're using the game almost compulsively, and that they experience a sense of withdrawal when they discontinue the use.

  • 11:13:58

    REHMDr. David Greenfield is Assistant Clinical Professor of Psychiatry at the University of Connecticut School of Medicine. Turning to you, Dr. John Krakauer. As a neurologist, when it comes to what's happening in the brain, do we understand the impact of video games and why they become so compelling?

  • 11:14:32

    KRAKAUERWell, before I answer that question, the answer to that is no, in so much that there have not been definitive studies of video games themselves. There's a lot of work in humans and in animals about the reward systems we just heard about it. And arguments can be made that there's generalizability from those other forms of reward to video games. But, it's not been definitively proven, as of yet. It's also a little bit of a problem to claim that because you can see reward areas activated, that that implies that this is also going to be an addictive task.

  • 11:15:14

    KRAKAUERSo, I would just say one has to be cautious from too quickly extrapolating from one kind of rewarding task to another, I.e. video games. And also, just because something is rewarding and subject to reinforcement doesn't mean that it can be, it immediately will be addictive. Even those are thought, in current models, to lie along a spectrum.

  • 11:15:38

    REHMHas anyone in your laboratory done studies watching the brain at work as it's involved, as that individual is involved in playing a game, a video game in which he or she is very involved?

  • 11:15:59

    CONNWe haven't done that yet. We're going to study structural changes, we hope, in the brain over time, but we have not done functional imaging yet. We're interested in gaming as a platform to study learning, cognition, for therapy, but we haven't imaged while people play.

  • 11:16:17

    REHMDr. John Krakauer is Professor of Neurology and Neuroscience at the Johns Hopkins University School of Medicine. Dr. Courtney Conn, as a psychologist, you specialize in child adolescent family therapy. What are you seeing with, especially the kids and the adolescents, as far as their focus and the possibility of addiction to these video games?

  • 11:16:55

    CONNSure. Well, it is a common concern that families come in with. And, obviously, as kids, they have to be in school during the day, so the possibility for what Dr. Greenfield was speaking of, in terms of 10 to 15 hours a day, you're not seeing as much with kids. But, you know, what I am seeing is some of these compulsive behaviors of needing to play when they get home to the detriment of completing their homework, doing more pro-social activities, sports, playing with friends and really effecting their time management skills to the detriment of their academic success.

  • 11:17:32

    REHMAnd what you’re saying is that they're not complaining, but their parents are complaining.

  • 11:17:37

    CONNExactly. And the parents are coming in with concerns, in terms of time management, or how their academics may be effected. Or even just being concerned about kids isolating themselves socially. And to that, the kids will say, well, I'm playing with friends, and I'm speaking with friends over the internet, and things like that, but that is a very different thing than actual face to face practice, socially.

  • 11:18:01

    REHMWhat is your thinking about the use of the word addiction in that situation?

  • 11:18:09

    CONNI'm hesitant to use the word addiction with children, and Dr. Greenfield spoke to a number of factors that sort of qualify you for an addiction. And because kids do have to be in school, I think that the amount of time that's often needed may not be there yet, but some of the compulsive actions are there.

  • 11:18:32

    REHMDr. Courtney Conn, psychologist with The Wake Kendall Group. She specializes in child, adolescent and family therapy. I look forward to hearing your calls, your questions. Stay with us.

  • 11:20:01

    REHMAnd welcome back. Here in the studio with me, Dr. Courtney Conn. She's a psychologist who specializes in child adolescent and family therapy. Dr. John Krakauer is a professor of neurology and neuroscience at Johns Hopkins University. He's also director of the Brain Learning Animation and Movement Lab at Johns Hopkins. On the line, Dr. David Greenfield, founder of the Center for Internet and Technology Addiction. He's assistant clinical professor of psychiatry at the University of Connecticut School of Medicine.

  • 11:20:48

    REHMAnd from the studios of KQED in San Francisco, Steve Henn. He's technology correspondent for NPR. Steve Henn, you may have seen the op-ed piece this morning in the New York Times written by a young Korean man, Young-ha Kim who talked about his own literal addiction to video gaming. Do I understand correctly that Korea has far more addiction to not only video games but to alcohol, to drug addiction than even we here in the United States?

  • 11:21:42

    HENNI can't speak to that however, I do know that Korea has a very vibrant video game culture. There was recently a gaming tournament that was televised online for a game called "Legal Legends." It attracted 32 million people. Eight million people were watching it live at one time. And just as a point of comparison, the first game of the World Series had an audience of 14 million people. A huge number of the folks in the audience and one of the teams in the finals for that video game tournament came from Korea. So there is a vibrant video game culture in Korea. And this issue of video game addiction, I think, is one that is often talked about there.

  • 11:22:27

    REHMDr. Conn, can you comment?

  • 11:22:31

    CONNYeah, I mean, it's interesting to me the level of video game usage in South Korea. I believe it's also interesting that the level of violence there versus the U.S. is much lower. And so I think that should make people pause.

  • 11:22:48

    REHMDr. Greenfield, you want to comment.

  • 11:22:51

    GREENFIELDYeah, my -- I've lectured in a lot of the Asian countries where video gaming seems to be a bigger issue, China included, Hong Kong, Korea. And a lot of the conferences that I've spoken at have had representatives from these countries. And a lot of the research that's being done on internet and video game addiction is coming from these countries.

  • 11:23:17

    GREENFIELDWhen I went to Hong Kong, there's some cultural differences. A lot of the gaming that's done in some of these Asian countries is done -- are done in cyber cafes. They're done in public situations or sort of semi-public, whereas in the U.S. a lot of the gaming is done in individual homes in these Asian countries. There are these facilities with cubicles with dozens and dozens and dozens of computers that people sort of sit at hour upon hour upon hour a day. And a lot of them are school age. Some are post-school age. Some of them are missing school and some of them are coming right after school and staying until all hours of the night.

  • 11:24:03

    GREENFIELDBut because I think there are some cultural differences, it seems that the advances in the technology within the culture, as well as the way they use gaming increases the propensity for the addictive use in the game.

  • 11:24:19

    REHMDr. Greenfield, is there any connection -- you talked earlier about the inability -- the growing inability to separate the real from the created. I wonder if there is any concern about violence and the connection to video usage, whether you can draw conclusions from what you'd seen in the far east or in this country.

  • 11:24:57

    GREENFIELDWell, there are -- the research is mixed on whether exposure to and playing violent video games increases likelihood of being violent. Obviously this is an area of grave concern in the United States because we've looked at a lot of these mass shootings. And there have been some ties to the act of use of violent video games by a lot of these shooters.

  • 11:25:31

    GREENFIELDI personally have significant concern of specifically around these first-person shooter games. These are games that are designed for the user to be the shooter. And they are so realistic that you actually feel like you are committing these violent acts. And they do two things that I have concern about. One is, they do reward you in the form of points and raising -- elevating you in your status within the game as you become a more efficient effective killer. And they also -- so one could argue that there is a dopaminergic reward experience because of that.

  • 11:26:20

    GREENFIELDThe other thing they do, which I'm even more concerned about, is that they desensitize people from not only viewing violence like on television movies, those we've been concerned about exposure to violence, but by committing violent acts and actually training you to be a more effective killer. The early first-person shooter games were created by the army as a training and recruiting tool. And so in a sense they're designed to train you to kill more effectively.

  • 11:26:54

    GREENFIELDDo we really want our youth culture learning how to kill more effectively and is that a good thing for our culture? And I think the video game community now is just beginning to start to admit that they have some responsibility for the content that they're putting out there and they're creating.

  • 11:27:16

    REHMDr. Krakauer, you're shaking your head.

  • 11:27:19

    KRAKAUERWell, I just wanted to take a step back. I mean, I think all sorts of conceptual errors can be made here. I mean, one is anything pleasurable in the world can conceivably, by talking about reward circuitry, become addictive. So we have sex addictions, shopping addiction. We have now binge-watching of HBO TV series. So, you know, we need to separate out discussions about every time the world comes up with something -- a new pleasure, along with it comes the potential for a small percentage of people to become addicted to it.

  • 11:27:58

    KRAKAUERThe DSM, the Diagnostic Statistics Manual number five does not have video gaming as an addiction in it. It says it's something needed for future study and it's still, as Courtney said, up for grabs. So we use addiction in a very colloquial way. We confuse it with word compulsion. And suddenly, like mushrooms in a forest, everyone's concerned and everyone's talking about it. I should add that in 1978 when Space Invaders came out, an MP in England in '81 was already saying that Space Invaders was going to be terrible and there should be legislation against it.

  • 11:28:33

    KRAKAUERSo I'm saying, let's distinguish between our concern about addiction to anything pleasurable to the potential of video games in their particularity to be particularly worrying, because they have something about them that makes them more dangerous than anything else.

  • 11:28:48

    REHMSteve Henn, you're smiling.

  • 11:28:52

    HENNI am. I think that Dr. Krakauer made some excellent points. I think that sort of throwing around the term addiction when you talk about video games is an easy mistake...

  • 11:29:05

    REHM...may be premature.

  • 11:29:08

    HENNRight. It's premature yet it's something that when I've talked to parents about their own children's perhaps compulsion to play or love of video games, it's a word that comes up a lot colloquially. But I also think that video games and their ability to adjust as they are designed, and sort of create this circumstance for sort of mass behavioral testing are particularly interesting for both brain research and as a business model.

  • 11:29:42

    HENNAnd I do think there's intriguing research being done on video games' effect on the brain. There was recently a paper by Adam Gazzaley that was the cover article in Nature in September, which actually looked at a positive effect of video games. He designed a video game that allowed older people to race a car and do it while responding to road signs that they passed. And basically he had -- there's a long body of research that documents older people's struggle with multitasking. And this game was designed to help them learn to multitask.

  • 11:30:22

    HENNAnd the results were fairly powerful. And as a layperson I found them quite intriguing. But I do think that these games -- the way they're designed and built and the way we interact with them have a certain amount of power, which I, as a reporter, just find fascinating.

  • 11:30:38

    REHMHelp me to understand, Steve, exactly how these companies figure out ways to get not only kids but people in general, not only to stay longer but to spend more money?

  • 11:30:58

    HENNSo not just in games but in software development generally on the internet, there's something called AB Testing. So if 100,000 people visit a website or a video game, the company that designs that site might show 50,000 people one version of the site or the game, and the other 50,000 a slightly different version. And then they test the behavior of those large groups and see which response -- which design generates the response that they're looking for.

  • 11:31:27

    HENNSo if I am designing, you know, say Obama's fund raising website for the 2008 campaign, they did this and they would test a red button versus a blue button. And slowly and incrementally they adjust the design of the site that they show to the most people to maximize their yields. So if I'm designing a video game like Candy Crush Saga, I change the dynamics of the game play slightly and test it again and again to drive the behavioral response I'm aiming for.

  • 11:31:59

    HENNAnd so I think that that's a very powerful tool. And I'm very curious about what those game designers were almost accidentally tapping into in people's brains that drives behavior that frankly is baffling. I mean, why people spend real money on virtual cows in Farmville is a great mystery of the technological age. And I think there might be some clues in our brain's circuitry that could help explain it.

  • 11:32:27

    REHMSteve Henn. He's technology correspondent for NPR. And you're listening to "The Diane Rehm Show." I'm interested to follow up on that, Steve. Are there neurologists among those game designers?

  • 11:32:49

    HENNYeah, there are. And I've spoken to some of them. There are also behavioral economists. Every large gaming company has built or is building a digital analytics unit within their game design system. So they are hiring very bright people to design these AB Tests, interpret the results that they get and try to design game mechanics that are effective in driving the type of behavior that they want to encourage.

  • 11:33:19

    REHMGive me an example.

  • 11:33:22

    HENNWell, I think one of the most common examples is the one I was starting to explain before. So there is a term that was thrown around in Zingo when Zingo was doing better than it is now called fun pain. And it's this idea that you slowly change the dynamics of a game so that you introduce a certain level of discomfort for the player. And then at some point you offer them relief if they're willing to pay money. And it's an ingenious and sort of insidious idea but it was very effective.

  • 11:33:58

    HENNThe other thing that happens is that these free-to-play games begin really as games that are skill games. So if you play longer or you have more skill at the task, you're able to succeed. But over the course of the game play, the game becomes more challenging and your ability to succeed just through game play is reduced or diminished or ultimately eliminated. And slowly they become more like slots where your ability to win depends on your willingness to spent money.

  • 11:34:29

    REHMAnd Dr. Greenfield, Dr. Krakauer earlier mentioned the Diagnostic Manual. Do you believe, based on what you know thus far, that internet addiction is a mental health disorder that should be recognized?

  • 11:34:58

    GREENFIELDWell, you know, there has been a lot of research over the last 15, 16 years around internet addiction, and all the variants which would include video game addiction. And the two areas that I see the most in terms of clinical practice are issues around video games and all the variants -- platforms that they're played on and pornography. Those are really the two problematic areas. Both of those content areas existed prior to the internet but there seems to be a synergistic amplification of the pleasurable experience when you combine them with the internet. And that may be due in part to the ease of access, the perception of anonymity and there's a variety of other factors.

  • 11:35:49

    GREENFIELDAs far as the DSM 5, yes, it is included in the appendix as an area that does not yet qualify for a full diagnosis -- diagnostic recognition but requires further study. I expect at some point in one of the coming revisions that there will be a notification or a diagnostic category that includes abuse or compulsive use of digital media technology, whether you -- it may not be called internet addiction or video game addiction.

  • 11:36:27

    GREENFIELDAnd until recently the word addiction didn't even appear in the DSM. The words dependence and abuse were used with regard to substance and alcohol. So I agree that the word addiction may not be the best word. It may be we may see something about compulsive or impulsive use. But the people that I do see in clinical practice are having negative consequences in their lives. And in some sense it doesn't matter what we label it, we have to still deal with it and fix it. And on an actual life level there's no way to avoid that.

  • 11:37:07

    REHMDr. David Greenfield. He's founder of the Center for Internet and Technology Addiction. We're going to take a short break here. And when we come back, we'll open the phones, your calls, your comments. I look forward to speaking with you.

  • 11:40:01

    REHMAnd before we open the phones, here's an email from Travis in Oklahoma City. He says, "I'd like to hear from one of the panel about the positives of using video games for cognitive development. Specifically we see games geared toward education, other games that may be fictional stories, but also encourage hand eye coordination and decision making abilities." Dr. Krakauer.

  • 11:40:36

    KRAKAUERYes. So there's a lot of evidence now that people who are video game players perform much better on a whole host of psychological tests which were not inherent in the game itself. So decision making, selective special attention, working memory tasks and other tests of attention. And these are -- actually the games that seem to be causing these enhancements are the first person shooter games.

  • 11:41:07

    KRAKAUERAnd there are recent studies, in fact, just in the American Psychologist this week they were showing that playing these games leads to better performance in school, better performance on certain mathematical tasks. So in other words, what we're going to find, and I think it speaks to what Steve was saying, is that it's so fascinating what can be done with these games in terms of psychological sophistication and the number of cognitive challenges that you can build into these games, is that you're going to find like any other interesting, complex technology that it can be abused or it can be highly beneficial.

  • 11:41:41

    REHMDr. Greenfield, do you want to comment?

  • 11:41:46

    GREENFIELDYeah, I mean, I think there is data that shows that there's enhancement in certain cognitive and attentional skills. And I also agree with our previous speaker that there probably are positives, and really the argument that I make is that the technology is very powerful, and that people need to be conscious of that power, and because it's powerful, there is a potential for it to be abused or overused. But that doesn't mean that everybody that uses it is going to become addicted or have negative consequences.

  • 11:42:23

    REHMAnd yet here's a totally different comment from Adam, who says, "I've been playing an MMORPG Final Fantasy 11 for the past 12 years. I find it hard to stop playing. I used to play in stretches of 12 to 14 hours a day for weeks. I'm trying to stop playing now. I still find it hard to resist playing sometimes. Is there anything I can do?" Steve, before I go to Dr. Greenfield, did you come across people who would describe themselves that way?

  • 11:43:11

    HENNYou know, most of my reporting was about how games affected dynamics within families. So I think because I was talking to younger players who still, you know, had to go to school, had to respond to their parents demands, who had parents who were concerned enough to take video games away, I wasn't really dealing with people in that situation. Although my colleagues at NPR have recently done a series on video game addiction halfway house where, you know, there were generally young men who had dropped out of college or had been unable to hold down jobs because of situations like that one. So it's not a story I'm unfamiliar with.

  • 11:43:53

    REHMDr. Conn.

  • 11:43:54

    CONNYeah, I think the take home message for, you know, families is, you know, the big variable here is parental involvement. And, you know, we live in a culture of excess, and anything really in excess for kids and teenagers is not necessarily a good thing. So there are positive effects that can be had with video games. So long as parents are keeping tabs on how long the kids are playing and what they are playing, I think that, you know, you're not going to run into a big problem.

  • 11:44:22

    REHMSo, Dr. Greenfield, if Adam had come to you and said, I'm playing for 12 to 14 hours a day, I'm trying to stop, what would you or how would you have treated him?

  • 11:44:39

    GREENFIELDWell, treatment of -- I mean, he would probably by my standards qualify as having a compulsive or addictive pattern of use, and we would treat it very much like we treat other addictions. We would create a complex set of skills to reduce his use pattern. We change the behavioral rituals. We also use an IT specialist to block -- to put in block on computers and routers and portable devices when people really want to stop and are unable to, or we put in timers so it limits the amount of time they can play.

  • 11:45:21

    GREENFIELDOne of the things that we found in -- what I found in some of my early research is the experience of disassociation when people play, or actually when people are on the internet in general, we lose track of time and space. We cannot accurately judge the amount of time that we're online. Many of us have experienced that. And playing video games is the same experience. Then we -- for this particular fellow, we would then construct a new set of skills around beefing up his real-time living, because nature (unintelligible) a vacuum.

  • 11:45:57

    GREENFIELDWhat happens is the other real-time aspects of the person's life atrophy, so we work on reintroducing those, including enhancing real-time social skills. We develop a relapse prevention plan, which is not unlike what we would do with someone with an alcohol or drug addiction.

  • 11:46:14

    REHMAll right. Let's go to Jay in Concord, N.H. You're on the air.

  • 11:46:21

    JAYHi, Diane, thank you for taking my call.

  • 11:46:23

    REHMSure.

  • 11:46:24

    JAYSo my question was related to sort of the new wave of technology with video games that are coming out now. There's early technologies right now that actually read the electrical impulses through a headset of the gamer. And they can control, you know, video game interfaces and computer interfaces in that way. And so I feel like that is kind of merging the neurological even more so with the psychological and in the media. And I was curious as to what the panel thought about that, the future of that technology and how that would relate to addiction.

  • 11:47:01

    REHMSteve Henn.

  • 11:47:03

    HENNWell, my understanding of those types of technologies is that they're pretty rough around the edges at this point. I don't think that game designers have embraced those devices because your ability to control a character would be relatively crude. I'm going to defer to John Krakauer or others on the panel about, you know, the ability to actually image a brain and connect it to a game. I think we're pretty far away from that, but they obviously know more than I do.

  • 11:47:35

    REHMDr. Krakauer.

  • 11:47:36

    KRAKAUERYeah, so, I mean, Steve's right, I mean, we're nowhere near ready for this. But there are two distinct things. One is can you control the game with your brain versus can your brain be decoded so that people could have a better idea how to addict you. So decoding and being able to control are somewhat different. Neither are ready for primetime in any way that makes you -- you shouldn't fear that we're in a big brother stage where they're going to be able to tap into you to get you addicted. We're not there yet.

  • 11:48:13

    REHMAll right. And yet here's a comment from the website. "My daughter has become very involved with a game called Our World. Slowly it has become her whole social world. The fixation was partially responsible for her losing a good friend because she would stay on the computer when the friend was over. She often does not want to do anything else but play on this website. Makes it hard for her to get schoolwork done since she's so easily drawn away from her work and back to the game. What can I do to draw her away from this very rewarding and satisfying pastime?" Dr. Conn.

  • 11:49:05

    CONNYeah, I think this is an example of when mom can step in a little bit and set some more limits.

  • 11:49:11

    REHMIt sounds as though he's trying.

  • 11:49:15

    CONNNeed to be a little bit more firm and, you know, come up with a schedule on, you know, how much time does she need to be spending getting all of her academic work done, set some goals for more face to face social activities, and, you know, treat this game as more of a reward. And if she is able to complete all of these other things, then she does get to get some time on the game. But it's important to be able to include other life activities.

  • 11:49:40

    REHMDr. Greenfield, do you have anything else to offer?

  • 11:49:45

    GREENFIELDI would agree with all that. In order to do that, and we run into this all the time, the parent has to be incredibly vigilant because the child really doesn't have an adequate ability to judge the amount of time they're spending. So if you say to the child, you have one hour a day or an hour and a half a day, and the kid will tell you in earnest, yes, I will spend an hour or only an hour and a half. If the parent isn't right there to turn it off, or you don't have automatic systems in place to do that, that kid is going to play longer. So it requires a lot of vigilance on the parent's part, or some systems in place to assist in that process.

  • 11:50:29

    REHMSteve Henn, are we being unfair to the video game industry? Aren't they simply providing what their consumers want? Aren't they developing more and more products that people really enjoy playing?

  • 11:50:52

    HENNWell, I think that's true. You know, the industry is enormous. This year it's expected to gross $20 billion. And to put that in perspective, that's roughly twice the Hollywood box office. And there are thousands and thousands of artists, developers, really creative people who pour their heart and soul into developing, in some cases, immersive, beautifully rendered worlds, complete with music that will actually adjust and change with your game play dynamically. I mean, the technology and the art and the thought that goes into these games is really fairly incredible. And I think it's a huge part of our culture now that many people who don't play are cut off from. So I think writing off video games entirely would be a big mistake.

  • 11:51:44

    HENNAnd I think that there is -- it's such a big industry that there's a lot of variance in how people design games, how they -- what their goals are as designers, and the business models that they adopt to support and pay for those games.

  • 11:52:00

    REHMAll right. To...

  • 11:52:01

    HENNAnd that makes a big difference.

  • 11:52:02

    REHMTo Bill in Pendleton, Ind. Hi there, you're on the air.

  • 11:52:07

    BILLThanks for taking my call.

  • 11:52:07

    REHMSure.

  • 11:52:10

    BILLMy question is about the -- well, the debate seems to center on free to play games and first person shooters largely. And I'm a gamer and a young parent, and most of the older folks I talk to who have older kids who have problems with video games don't really know a whole lot about what their kids are doing or what they're playing. And my sense of it is, is if they understood why their kids were playing the games that they had chosen to play, that there might be better activities that those games could dovetail into, or that the parents could become involved in that child experience. And depending on the game, it could be a really helpful, positive thing.

  • 11:52:44

    BILLGames like Minecraft or Kerbal Space Program, which is really popular at the jet propulsion laboratory, could be really educational or dovetail into other activities. Or players of role playing games could be encouraged to write their own fiction or to read compelling fiction that they hadn't been introduced to. And it seems like most parents simply just want to stop the gaming.

  • 11:53:07

    REHMDo you...

  • 11:53:07

    HENNI think playing along with your children is really wonderful advice. I mean, games can be really rich, immersive environments, and if you find that your child is playing a game that you don't like, either because of its content or because of the kinds of behaviors it seems to be encouraging, you know, there are resources out there that could help you perhaps find another game that they'd enjoy as much or more that would be a more positive experience.

  • 11:53:36

    REHMWell, Steve, you recently did a story on video gamers trying to develop games that teach empathy.

  • 11:53:47

    HENNRight. This is a new company. It's called If You Can, and it was founded -- one of the cofounders is Trip Hawkins who is the founder of Entertainment Arts, which is one of the biggest console video game developers in the world. And he and a team of counselors really are trying to produce a video game that teaches children basic social skills. Things like empathy and listening. And it's a really unique challenge, and it's sort of a counter intuitive one, because fundamentally you're giving kids a gadget and then hoping that gadget will help them relate better to people.

  • 11:54:24

    REHMAnd you're listening to "The Diane Rehm Show." One of the areas we haven't talked about is violence and whether these video games, especially the ones where you have the gun and you're murdering people left and right do in fact teach kids to be violent. Dr. Krakauer.

  • 11:54:51

    KRAKAUERI'm not in any way an expert on that. As I said before, first person shooter games do seem to have all sorts of positive effects. Some people have even argued that they can diffuse a propensity for violence by people being violent virtually rather than bullying their friends. The data, which I'm not an expert on, are very mixed. I agree that there seems to be -- that they are very violent, but we have a very violent culture. I mean, we love violent movies. We could have the same conversation about the movies. The only difference is in one case you're actively doing it and the other case you're passively watching it. And we also heard the data on Korea, that everyone's playing these games and it's nowhere near as violent as the U.S.

  • 11:55:35

    REHMDr. Greenfield.

  • 11:55:39

    GREENFIELDWell, I agree that the data is mixed on whether violence -- participatory violence in video games is problematic. I think when it all comes down to the end, we're going to find that for a small percentage of people, the exposure and experience and playing of those violent video games is not going to be a good thing for them. But they're probably co-morbid risk factors that we have not yet identified that produce that combination where it's expressed in a negative way.

  • 11:56:20

    REHMAll right. And final email from Don. He says, "When I was in high school, the only word for my relationship to video games was addiction. I would begin playing immediately after school. I wouldn't quit until late into the night. In order to finish my homework, I would wake up at 3:00 or 4:00 a.m. and finish it before school. The resulting lack of sleep left me depressed. My academic performance suffered. I think video game addiction is remarkably under-recognized today. I am concerned for children who are starting video game playing at younger and younger ages." I think the message from this program is very clearly be aware of what your children are watching.

  • 11:57:24

    REHMThank you all. Dr. Courtney Conn, Dr. John Krakauer, Dr. David Greenfield and Steve Henn. Thank you all. And thanks for listening everybody. Have a great Thanksgiving. I'm Diane Rehm.

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