Case Study Pathological Preoccupation with Video Games GEORGE A. KEEPERS , M.D.
Abstract. Controversy continues concerning the harmfulness of video game use by children. The author encountered clearly pathological preoccupation with video games in a preadolescent. The child had stolen , forged checks, and skipped school to continue using video games. He and his mother were physically abused by his father. Placement of the child in a residential treatment center with marital and family therapy resulted in resolution of the patient's pathological use of video games. J. Am. Acad. Child Adolesc. Psychiatry, 1990, 29 , 1:49-50. Key Words: video games, pathological gambling, child abuse. unable to prevent his activities. He would, by their report, either miss his school bus or leave school without permission in order to play video games. As a result, his grades in school had dropped from As and Bs to Ds and Fs. M.E. had discontinued former friendships in order to associate with a group of boys whose primary activities centered on video-gaming . The patient had limited his own gaming activities to "Ms. Pac-man.' In this game, the player controls a small, yellow video protagonist. Successful strategy requires the player to avoid being eaten by pursuing ghouls while devouring energy dots. These feats must be accomplished while maneuvering in a maze. M.E. described attaining an intensely pleasurable, concentrated state while playing this game in which he became unaware of his surroundings or the passage of time. The home situation was disturbed by the parents ' marital difficulties . M.E. ' s father was a large, obsessive, careful Caucasian man who believed that children should behave perfectly at all times. He had physically punished M.E . on numerous occasions for minor rule transgressions. M.E .' s mother, an American Indian woman , was much more relaxed in her child-rearing practices. The parents frequently clashed over the children and other issues; at times they had physically attacked one another. When interviewed , the patient was silent and withdrawn. He volunteered little information except when he was talking about his favorite video game, " Ms. Pac-man," which he spoke about with great enthusiasm. He was very reluctant to answer any questions about his parents or home. He was not psychotic or cognitively impaired. Initial behavioral interventions suggested to the parents failed to alter M.E. 's habits. As a result, he was placed in a residential treatment program for adolescents. He was restricted to the treatment facility grounds and tutored there to prevent further runaway behavior and to limit his access to playing video games . During his first 3 weeks in the group home, he remained silent and noncomrnunicative. During study periods, he was noted to be distracted and daydreaming. When asked what he was thinking about , he replied that he was imagining playing video games . Group home staff were instructed to tap M.E. gently on the shoulder whenever they noticed him daydreaming. In the ensuing
Sales of video games and coin-operated arcade games are now a billion dollar/year industry. There has been considerable controversy concerning the appropriateness of allowing children to play these games . Some communities have gone as far as to ban them entirely from public places. The popular press is replete with stories concerning video game players who become " obsessed" with these electronic diversions. Experimental studies indicate video games increase aggressiveness in children similarly to violent television (Silvern and Williamson, 1987; Anderson and Ford, 1987). However, surprisingly little can be found in the medical literature concerning any physical or psychological hazards associated with these devices (Green and Asher, 1982; Ross et al., 1982; Harry, 1983; Kestenbaum and Weinstein, 1985; Loftus and Loftus, 1985). The author encountered a preadolescent whose video game playing was quite pathological. The case is presented in order to alert clinicians that preoccupation with video games is not always a benign condition and may indicate serious marital and family problems.
Case Report M.E., a 12-year-old boy, was brought to the clinic by his mother . The patient's father had forbidden his return to the home after discovering that M.E. had taken $150 in cash from his wallet. During the 6 months preceding his clinic visit he had been playing video games for 4 to 5 hours each day . A single day's video game activities cost him between $30 and $50. This amount of money was far beyond the child's means; he had been stealing in order to play. At the time he was seen, he had stolen money from both parents, a sister, a brother , and several other adults. He had, in addition, stolen checks from his father and succeeded in cashing forged checks of up to $100. The boy's parents had attempted to stop him but were
Accepted April 13, 1989. George A. Keepers, M .D.• is Unit Chief, Inpatient Psychiatry at the Portland Division (lI6A -P) ofthe Veterans Administration Medical Center, P .O. Box 1034, Portland , OR 97207. where reprints may be requested. 0890-8567/90/2901-O049$2 .00/0 © 1990 by the American Academy of Child and Adolescent Psychiatry.
49
KEEPERS
3 weeks, he became less distracted and his schoolwork improved. He began to relate more freely with the other adolescents in the group home . The patient remained reluctant to discuss his parents .or his home situation. In an effort to uncover some of his feelings, M.E. was asked to design his own video game. He carried out this assignment by inventing a video game called "Salmon Chase. " In this game the player adopts the role of a salmon trying to swim up waterfalls without being speared by an Indian fisherman. Using video games as a vehicle for communication, M.E. gradually was able to talk about his fear of his father and feelings of helplessne ss. Marital and family therapy were undertaken with the eventual outcome of parental separation and return of the child to the mother. At the 6-month follow-up, no recurrence of the patient's difficulty was noted. Discussion Video game designers take great pains to ensure that their creations are attractive to players. Game programmers communicate experiences concerning the effectiveness of various techniques through conferences and industry publications such as Softline, Personal Computing, and BYTE. Several game authors have written of the need for a successful video game to induce an altered level of concentration and focus of attention in the gamester. Anecdotal descriptions of this state strongly resemble the description given by the patient in this study. Recentl y, the factors which induce players to continue to play have been scientifically studied, and the results have been incorporated into commercial games (Kibbey, 1975; Maloney , 1980, 1981; Favaro , 1984). Thus, these recreational programs are constructed using algorithms which deliberately promote habituation. It is not, therefore, surprising that some children
should become deeply engrossed in playing these games . In M.E. 's case the continuation of repetitive play and his stealing in order to continue to play far exceeded the degree of habituation observed in other children. The thievery and forgery perpetrated in this case are reminiscent of cases of pathological gambling in which the patient is unable to resist the impulse to gamble despite the harmful consequences of his or her activity. It is likely that this occurred because the patient's video game playing was a partially successful adaptive response to the marital and family problems that were evident. The
50
playing of video games contributed to M .E. 's avoidance of the family problems in two ways. By spending as much time at the games as he did , the patient was able to physically avoid his parents and the home situation. Additionally, the mental state that he attained while playing assisted his avoidance of the family problems and repres sion of aggressive and violent feelings toward his father. The author speculates that M.E.'s choice of video games ("Ms. Pac-man") represented a vehicle for defense against his feelings of helplessness, fear , and rage. Ms. Pac-man's dilemma, wandering through a difficult maze pursued by dangerous ghouls , accurately reflected the patient's perception of his home life. Since successful playing of the game involves avoiding the ghouls and occasionally turning the tables on them, " Ms. Pac-man" may have been an ideal fantasy solution to M .E. ' s problems . Indeed, the themes of danger, pursuit, and escape are repeated in the patient's own video design, "Salmon Chase," in which the player is a potential victim rather than an aggressor ; The absence of any aggressive action by the player may indicate the extent to which M.E ~'shostility was repressed. These interpretations are supported by his abstinence from video games since resolution of the marital conflict. References Anderson, C. A. & Ford, C. M. (1987), Affect of the game player: short-term effects of highly and mildly aggressive video games. Perspectives in Social Psychology Bulletin, 12:390-:-402. . Favaro, P. J. (1984), How videogames affect players. Softside, 7:1617. . . Green, J. S. & Asher,!. (1982), Electronic Games (letter). JAMA, 248:1308. Harry, B. (1983), Obsessive videogame users. JAMA, 249:273. Kestenbaum, G. 1. & Weinstein, L. (1985), Personality, psychopathology and developmental issues in male adolescent video game use. J . Am. Acad. Child Psychiatry. 24:329-333 . Kibbey, D. N. S. (1975), Fractions curriculum of the PLATO elementary school mathematics project. Computer-based education research laboratory technical report, University of Illinois. Loftus, G. R. & Loftus, E. P. (1985), Mind at play-the psychology of video games. J. Am. Acad. Child Psychiatry, 24:245. Maloney, T. W. (1980), What makes things fun to learn? A study of intrinsically motivating computer games. Technical report number CIS-7 (SSL-80-11). Xerox Palo Alto Research Center. - - (1981), What makes computer games fun? BYTE, 6 :25~277. Ross, D. R. , Finestore, D. H. & Lavin, G. K. (1982), Space Invaders Obsession. JAMA, 248:1177. Silvern, S. B. & WiIlamson,P. A. (1987), The effects of video game play on young children's aggression, fantasy, and prosocial behaviour. Journal of Applied Developmental Psychology, 8:453-462.
J .Am.Acad. ChildAdolesc. Psychiatry, 29:1 . Ja n. 1990
Abstract. Controversy continues concerning the harmfulness of video game use by children. The author encountered clearly pathological preoccupation with video games in a preadolescent. The child had stolen , forged checks, and skipped school to continue using video games. He and his mother were physically abused by his father. Placement of the child in a residential treatment center with marital and family therapy resulted in resolution of the patient's pathological use of video games. J. Am. Acad. Child Adolesc. Psychiatry, 1990, 29 , 1:49-50. Key Words: video games, pathological gambling, child abuse. unable to prevent his activities. He would, by their report, either miss his school bus or leave school without permission in order to play video games. As a result, his grades in school had dropped from As and Bs to Ds and Fs. M.E. had discontinued former friendships in order to associate with a group of boys whose primary activities centered on video-gaming . The patient had limited his own gaming activities to "Ms. Pac-man.' In this game, the player controls a small, yellow video protagonist. Successful strategy requires the player to avoid being eaten by pursuing ghouls while devouring energy dots. These feats must be accomplished while maneuvering in a maze. M.E. described attaining an intensely pleasurable, concentrated state while playing this game in which he became unaware of his surroundings or the passage of time. The home situation was disturbed by the parents ' marital difficulties . M.E. ' s father was a large, obsessive, careful Caucasian man who believed that children should behave perfectly at all times. He had physically punished M.E . on numerous occasions for minor rule transgressions. M.E .' s mother, an American Indian woman , was much more relaxed in her child-rearing practices. The parents frequently clashed over the children and other issues; at times they had physically attacked one another. When interviewed , the patient was silent and withdrawn. He volunteered little information except when he was talking about his favorite video game, " Ms. Pac-man," which he spoke about with great enthusiasm. He was very reluctant to answer any questions about his parents or home. He was not psychotic or cognitively impaired. Initial behavioral interventions suggested to the parents failed to alter M.E. 's habits. As a result, he was placed in a residential treatment program for adolescents. He was restricted to the treatment facility grounds and tutored there to prevent further runaway behavior and to limit his access to playing video games . During his first 3 weeks in the group home, he remained silent and noncomrnunicative. During study periods, he was noted to be distracted and daydreaming. When asked what he was thinking about , he replied that he was imagining playing video games . Group home staff were instructed to tap M.E. gently on the shoulder whenever they noticed him daydreaming. In the ensuing
Sales of video games and coin-operated arcade games are now a billion dollar/year industry. There has been considerable controversy concerning the appropriateness of allowing children to play these games . Some communities have gone as far as to ban them entirely from public places. The popular press is replete with stories concerning video game players who become " obsessed" with these electronic diversions. Experimental studies indicate video games increase aggressiveness in children similarly to violent television (Silvern and Williamson, 1987; Anderson and Ford, 1987). However, surprisingly little can be found in the medical literature concerning any physical or psychological hazards associated with these devices (Green and Asher, 1982; Ross et al., 1982; Harry, 1983; Kestenbaum and Weinstein, 1985; Loftus and Loftus, 1985). The author encountered a preadolescent whose video game playing was quite pathological. The case is presented in order to alert clinicians that preoccupation with video games is not always a benign condition and may indicate serious marital and family problems.
Case Report M.E., a 12-year-old boy, was brought to the clinic by his mother . The patient's father had forbidden his return to the home after discovering that M.E. had taken $150 in cash from his wallet. During the 6 months preceding his clinic visit he had been playing video games for 4 to 5 hours each day . A single day's video game activities cost him between $30 and $50. This amount of money was far beyond the child's means; he had been stealing in order to play. At the time he was seen, he had stolen money from both parents, a sister, a brother , and several other adults. He had, in addition, stolen checks from his father and succeeded in cashing forged checks of up to $100. The boy's parents had attempted to stop him but were
Accepted April 13, 1989. George A. Keepers, M .D.• is Unit Chief, Inpatient Psychiatry at the Portland Division (lI6A -P) ofthe Veterans Administration Medical Center, P .O. Box 1034, Portland , OR 97207. where reprints may be requested. 0890-8567/90/2901-O049$2 .00/0 © 1990 by the American Academy of Child and Adolescent Psychiatry.
49
KEEPERS
3 weeks, he became less distracted and his schoolwork improved. He began to relate more freely with the other adolescents in the group home . The patient remained reluctant to discuss his parents .or his home situation. In an effort to uncover some of his feelings, M.E. was asked to design his own video game. He carried out this assignment by inventing a video game called "Salmon Chase. " In this game the player adopts the role of a salmon trying to swim up waterfalls without being speared by an Indian fisherman. Using video games as a vehicle for communication, M.E. gradually was able to talk about his fear of his father and feelings of helplessne ss. Marital and family therapy were undertaken with the eventual outcome of parental separation and return of the child to the mother. At the 6-month follow-up, no recurrence of the patient's difficulty was noted. Discussion Video game designers take great pains to ensure that their creations are attractive to players. Game programmers communicate experiences concerning the effectiveness of various techniques through conferences and industry publications such as Softline, Personal Computing, and BYTE. Several game authors have written of the need for a successful video game to induce an altered level of concentration and focus of attention in the gamester. Anecdotal descriptions of this state strongly resemble the description given by the patient in this study. Recentl y, the factors which induce players to continue to play have been scientifically studied, and the results have been incorporated into commercial games (Kibbey, 1975; Maloney , 1980, 1981; Favaro , 1984). Thus, these recreational programs are constructed using algorithms which deliberately promote habituation. It is not, therefore, surprising that some children
should become deeply engrossed in playing these games . In M.E. 's case the continuation of repetitive play and his stealing in order to continue to play far exceeded the degree of habituation observed in other children. The thievery and forgery perpetrated in this case are reminiscent of cases of pathological gambling in which the patient is unable to resist the impulse to gamble despite the harmful consequences of his or her activity. It is likely that this occurred because the patient's video game playing was a partially successful adaptive response to the marital and family problems that were evident. The
50
playing of video games contributed to M .E. 's avoidance of the family problems in two ways. By spending as much time at the games as he did , the patient was able to physically avoid his parents and the home situation. Additionally, the mental state that he attained while playing assisted his avoidance of the family problems and repres sion of aggressive and violent feelings toward his father. The author speculates that M.E.'s choice of video games ("Ms. Pac-man") represented a vehicle for defense against his feelings of helplessness, fear , and rage. Ms. Pac-man's dilemma, wandering through a difficult maze pursued by dangerous ghouls , accurately reflected the patient's perception of his home life. Since successful playing of the game involves avoiding the ghouls and occasionally turning the tables on them, " Ms. Pac-man" may have been an ideal fantasy solution to M .E. ' s problems . Indeed, the themes of danger, pursuit, and escape are repeated in the patient's own video design, "Salmon Chase," in which the player is a potential victim rather than an aggressor ; The absence of any aggressive action by the player may indicate the extent to which M.E ~'shostility was repressed. These interpretations are supported by his abstinence from video games since resolution of the marital conflict. References Anderson, C. A. & Ford, C. M. (1987), Affect of the game player: short-term effects of highly and mildly aggressive video games. Perspectives in Social Psychology Bulletin, 12:390-:-402. . Favaro, P. J. (1984), How videogames affect players. Softside, 7:1617. . . Green, J. S. & Asher,!. (1982), Electronic Games (letter). JAMA, 248:1308. Harry, B. (1983), Obsessive videogame users. JAMA, 249:273. Kestenbaum, G. 1. & Weinstein, L. (1985), Personality, psychopathology and developmental issues in male adolescent video game use. J . Am. Acad. Child Psychiatry. 24:329-333 . Kibbey, D. N. S. (1975), Fractions curriculum of the PLATO elementary school mathematics project. Computer-based education research laboratory technical report, University of Illinois. Loftus, G. R. & Loftus, E. P. (1985), Mind at play-the psychology of video games. J. Am. Acad. Child Psychiatry, 24:245. Maloney, T. W. (1980), What makes things fun to learn? A study of intrinsically motivating computer games. Technical report number CIS-7 (SSL-80-11). Xerox Palo Alto Research Center. - - (1981), What makes computer games fun? BYTE, 6 :25~277. Ross, D. R. , Finestore, D. H. & Lavin, G. K. (1982), Space Invaders Obsession. JAMA, 248:1177. Silvern, S. B. & WiIlamson,P. A. (1987), The effects of video game play on young children's aggression, fantasy, and prosocial behaviour. Journal of Applied Developmental Psychology, 8:453-462.
J .Am.Acad. ChildAdolesc. Psychiatry, 29:1 . Ja n. 1990
