In 2023, 87.35 million people in Pakistan were Internet users, with an Internet Penetration Rate of 36.7%. This rapid rise in digital life integration has created a gap in understanding digital media use and its influence on youth. This could lead to clashes between indigenous culture and what digital media promotes, such as individualism, self-expression, and instigation. Cultural values influence digital media’s use and effects. In Pakistan, media are avenues for localisation and local value reassertion that centre on collectivism. Such conflicts can also be an opportunity to reshape adolescent development, well-being, and intergenerational relationships. The gaming industry is the soft power of any country as it arises from the appeal of a country’s culture, ideals, and policies.
3% of the world’s 3.4 billion gamers are estimated to suffer from Internet Gaming disorder (IGD). However, its imperative to know that not every gaming behaviour requires clinical attention, as this phenomenon exists on a spectrum. The aetiology and course of development of IGD need to be better understood. There are few clear indicators of who is most at risk for developing more symptoms, such as impulsivity, lower social competence, and higher amounts of gameplay. This is the trajectory; it is not a linear pathway to IGD. However, there are some good, bad and ugly facets of gaming.
The Good, the Bad and the Ugly
Video gaming (VG) involves playing electronic games through consoles and computers. It has been shown to positively affect cognitive and social skills and promote inspiration, validation, and a sense of purpose. Additionally, it boosts mental agility, self-discipline, and executive functions. A link between violence in VG and violent behaviour in real life is a much-debated topic. Internationally, this debate generally intensifies after mass public shootings. In Pakistan, VG has been scrutinised following cases of suicide and homicide by gamers. However, such incidents require an individual psychological evaluation and psychological autopsy; It is important to note that VG-related deaths represent only a small fraction of cases in Pakistan. The media’s failure to discuss the need for formal psychiatric evaluation in these incidents reveals a societal lack of knowledge about mental health.
Gamers’ reality in Pakistan requires that we start recognising their worth and refer to gaming professionals as athletes rather than addiction sufferers. A seasoned gamer is a full-time competitor paid to play video games requiring a nuanced understanding of attitudes, intentions, and online behaviours to make effective team decisions. There are motivational differences between professional and recreational gamers.
Recreational gaming is casual for enjoyment, with no at-risk behaviours associated with it. Frequency of use is not the sole determinant, but how one uses the digital world and its impact on one’s functioning. Less than an hour of video gaming daily can positively impact people by improving resilience, pro-social behaviour, problem-solving skills, life satisfaction, lowering conduct problems, and interpersonal emotional issues. However, a subpopulation of at-risk gamers with red flags indicates that certain behaviours, if continued over time, may cause future problems. For example, students spend more time playing games and less time attending classes and doing homework. Then, we have a sub-cohort of gamers that exhibits problematic gaming behaviour. This means that their gaming conducts are likely to impact their mental and physical health and social well-being negatively but do not meet the diagnostic criteria outlined by the World Health Organization (WHO) International Classification of Diseases (ICD-11). In addition, factors like cyberbullying and cyber-victimisation can lead to problematic gaming behaviours. Then we have a gaming behaviour at the far end of the gaming continuum; Internet Gaming disorder. To diagnose a gamer with IGD, the behavioural pattern must be sufficiently severe, resulting in considerable impairment in personal, family, social, academic, and occupational domains of life evident for at least 12 months.
Gamer’s Mental Health: Prescription to Policy
Gaming continues to be viewed as a pastime in Pakistan; despite the growing economic advantage, Mental health experts can bridge government directives and the gaming industry. However, unfortunately, child and adolescents mental health experts are out of the conversation.
Supporting adolescents toward healthy digital citizenship takes a village. Little is known about who is most at risk and whether the clinical course is continuous or intermittent. Paediatricians can help teach parents and patients about the potential adverse effects of video games and recommend using systems for video games, such as limiting use to age-appropriate games. Adolescents have digital citizenship and perceive the online world in ways that align with cultural values.
Gamers’ reality globally requires formal advanced training to support and manage the growing number of gamers seeking mental health care services. To make informed decisions, stakeholders must stay up-to-date on the latest socio-technological trends and avoid impulsive reactions. Rather than trying to eliminate ambiguity, they should focus on controlling it to foster collaborative discussions on policies, strategic recommendations, resource mapping, priority setting, and defining values and guiding principles for engaging with technology.
Digital Video games and Mental Health discourse must go beyond the tug of war of being or not being a diagnosable psychiatric disorder. The unique context in which VG exists distinguishes what brands VG as a gaming disorder. To address gaming addiction, it is vital to consider personal, interpersonal, and environmental factors. Prioritising the mental well-being of gamers is essential, and treatment should not be delayed until mental health disorders have developed. Parents can prevent gaming addiction by monitoring computer usage and setting time limits. Institutions should support the global gaming community and learn from countries where gamers are celebrated as national heroes for winning international eSports championships. Banning certain games is not a viable solution, and a proactive approach that considers cultural and local contexts is necessary.
About the authors: Aisha Sanober Chachar: Consultant, Child and Adolescent Psychiatrist and Co-Founder, Director Synapse, Pakistan Neuroscience Institute.
Mahnoor Yousif Shaikh: An MBBS Dr passionate about psychiatry and about to start her psychiatry training soon.
Competing interest: None
Handling Editor: Neha Faruqui