Part 2: Mental Health Impact — Japan experts call for drastic measures to fight online addiction
At the National Hospital Organization Kurihama Medical and Addiction Center in Yokosuka, Kanagawa Prefecture, a high school student, front center, is examined by the center’s honorary director Susumu Higuchi in late March. (The Yomiuri Shimbun)
This is the second installment in a series probing the impact of online content on our cognition through interviews with people who have suffered mentally and physically after being affected by unbalanced online content.
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In late March, an 18-year-old high school student from Nagano Prefecture and his parents visited the National Hospital Organization Kurihama Medical and Addiction Center in Yokosuka, Kanagawa Prefecture, where they met with hospital honorary director Susumu Higuchi. The student was planning to go to university from April and live in a dormitory in Tokyo.
“Will you be able to control yourself when you go to university?” Higuchi asked, to which the youth said he would.
Standing on a hill by the sea, the center is known for being a pioneer in Japan to provide treatment for internet and game addicts.
The young person was addicted to online games. In his second year of junior high school, he was chronically truant, playing games from morning till night. Taken by his parents to the center, he was hospitalized for three months and has visited once a month after that.
Online games are frequently updated; his favorite game is updated every three months with new settings, characters and items. It also makes minor changes just as gamers might be getting bored. Notifications of these changes are put on the screen to catch gamers’ attention.
“It never ended, and I couldn’t get out of it,” he recalled.
According to a survey by a Health, Labor, and Welfare Ministry research team in fiscal 2017, an estimated 930,000 junior high and high school students were suspected of being addicted to the internet, including video games. This represented a significant increase from 520,000 in fiscal 2012.
‘Addictive’ gimmicks
On a typical morning in his second year at junior high school, the boy from Nagano sat down in front of the TV after barely eating breakfast. As soon as he switched on the game console, a notification reading “You’ve been invited” popped up on the screen. His online “friends” were waiting for him.
The boy had become absorbed in video games in the fifth grade of elementary school. He couldn’t let go of the game controller even in bed and was frequently absent from school.
In the first year of junior high school, he made online friends. They teamed up to play five-on-five games inside virtual buildings and cities. The boy felt that he had “found a place where I can belong.”
Feeling that his online friends appreciated him, he didn’t want to keep them waiting, and became unable to go to school. He even honed his gaming skills in secret, hoping to be praised by his gaming buddies. In the virtual world, it seemed that everyone did nothing but work on improving skills and winning. He couldn’t take his eyes off the frequent updates.
From 7 a.m. until his parents cut off the internet at 9 p.m., the boy spent 14 hours immersed in gaming, barely eating or drinking. He didn’t even want to waste time going to the bathroom.
He was addicted to games until he was hospitalized at the Kurihama center in the winter of his second year of junior high school.
With the spread of the internet and smartphones, new online games appear every day, and developers are competing for users. An employee at a game maker acknowledged collecting and analyzing data on how much the number of users increased with each update.
“We’re aware that there must be people who get too into it and become addicted,” the employee said. “But, we must increase the number of users by drawing their attention,”
Parents with children addicted to games and the internet gather at the Kurihama center once a month. At such a meeting in early March, a woman in her 50s said that her 20-year-old daughter, a college student, had signed up for a number of credit cards and spent a lot of money.
Her daughter was passionate about a live video streaming app. When viewers pay a tip to a live video streamer — called a “liver” in Japanese — via an app, the liver calls out the tipper’s name and says thank you in front of everyone watching.
The amount of money that people tip is listed on the screen, a system that easily encourages competition among viewers. Using credit cards, the woman’s daughter tipped about ¥6 million (around P2.4 million) in five months.
The mother said: “I had to tap into my retirement fund to repay it. My family is on the verge of falling apart.”
In 2021, there were a total of 2,600 patient visits to the Kurihama center’s outpatient department for addiction. Of them, 60% involved people 19 or younger, even including 27 visits by children under the age of 10.
“Younger children are less likely to be aware of their problems, making it more difficult to treat them,” Higuchi said. “There are gimmicks everywhere in the internet and video games to get players hooked, and anyone can become addicted.”
One person who experienced this phenomenon is a 21-year-old college junior who was mesmerized by in-game commentary that keeps going for as long as the liver is streaming.
After first watching online videos in his spare time, the student eventually began going to sleep at dawn and waking up in the evening. He missed his 9 a.m. classes because he was asleep, and he dozed off in classes that he did attend. Finishing one video, he would move on to the next one recommended by the platform.
The student recently learned that the internet, games and social media operate on the principle of an “attention economy,” in which operators deliberately attract viewers’ attention.
“I’d thought I kept on watching videos because I’m lazy,” he said. “There’s a mechanism that makes it easy to become dependent, so I should be aware of that from now on.”
New lifestyle-related disease
The World Health Organization has identified game addiction that seriously affects daily life as a mental disorder, the equivalent of a gambling disorder and other forms of addiction.
The more a person plays online games, the more skilled they become, which brings the pleasant sensation of achieving high scores and getting items through in-game purchases. A player can build personal relationships through chat functions, and meeting fellow players who praise them in a game boosts their self-esteem.
Although the effects of game addiction on the brain are not yet well understood, there are reports of deterioration in the activity of the prefrontal cortex, which is related to advanced judgment.
Smartphones and tablet terminals are becoming ubiquitous tools for both children and adults. Dokkyo Medical University Associate Prof. George Imataka said, “The government must tackle this issue as a new lifestyle-related disease and launch serious measures through such means as studying treatment methods.”
Toshihiko Matsumoto, director of the Drug Dependence Research Department of the National Center of Neurology and Psychiatry, said, “The risk of becoming addicted varies greatly from person to person.”
Matsumoto said it depended on the individual’s circumstances — for example, whether they had a strong need for approval or had experienced something that severely damaged their self-confidence.
