Lost in the virtual world

"Please help, our son games all day and we don’t know what to do anymore!" "Our daughter is constantly on her phone and we are unable to get through to her!" 
These are just a few of the painful cries for help we receive from parents on a daily basis. Although computer games and social media have been around for decades, only in 2018 Compulsive gaming has officially been added to the Diagnostic and Statistical Manual of Mental Disorders (DSM), a charter used worldwide to classify mental health issues. Piet Jansen, Director of International Relations at Yes We Can Youth Clinics, delves into the modern phenomenon of teenagers and young adults getting lost into the virtual world.

You don’t have to be a wizard to understand internet and social media have completely changed our way of living in the 21^st century. Although the term social implies platforms connect people as originally intended, nowadays many of these digital hangouts are abused by trolls to disorganise, misinform and groom (advertisers know more about you than you about yourself). It is also clear that many lifestyle pictures are too good to be true and like my mother always said, if something is too good to be true, it certainly is. Kids are constantly presented with a world that cannot exist in reality.  

A few facts before I give you the story of Jimmy and Sarah. Did you know that on the entire planet, almost one in two humans older than 13 have a Facebook account (2.7bln users)? Did you know gaming revenues ($137.9bln in 2018) are almost triple to the film industry ($50bln in 2018)? In 2020, about 62% (4.8bln) of the entire world population have internet access, with the US (90,3%) and Europe (87.2%) having the highest percentages of connection. If you realise that 1 in 6 people (1.3bln) is aged between 10 and 19 and that 1 in 3 suffers from a mental health issue, you roughly have more than 400mln youngsters at risk. You do the math and decide for yourself if compulsive social media and console use are at a pandemic level, destroying the lives of families all over the world.

Let’s introduce Jimmy, a 15-year old boy, gamer, suspected autist but never diagnosed, highly intelligent, extremely sensitive, bullied for years and never told a soul. His school curriculum is dreadfully dull to him and does not cater for his intellectual needs. So Jimmy becomes lazy and his grades drop rapidly. The kids at school, his teachers and even his parents think he is dumb witted. So he starts to act like one. But in fact, he is smarter than all of the kids’ thinking caps added together. His social skills were never well developed, an unfortunate consequence of him being autistic. So the only way out is to isolate and the virtual world offers salvation. His intelligence and ability to focus on one specific activity for lengthy periods of time crown him king of the game. He gets high doses of dopamine every time he wins and opponents applaud him. In his view, he finally became someone. According to Jim, his virtual friends understand and respect him. So he needs more, every day. More dopamine, more adrenaline, more wins. He hardly leaves his room, underperforms in school, sees none of his real life friends (as if he had any in the first place), neglects his hygiene, isolates even more, eats his food in his room and no longer engages in any family activities, let alone speaks to anyone. Aggression and sneers have become his daily routine to keep everyone out of his room. Ask a gamer why he games and he will respond it is not the game that pleases him, but the social contact…

So Jimmy is sent to see a therapist. He finds this very strange and uncomfortable, as it limits him from doing what he likes best. You hear him think: I never asked for any of this and now I am the problem? No way! So not the bullies need to go to therapy, but me? No one understands me, this is all so unfair! Then he sees a therapist who treats 15 patients a day and he is number 15. The therapist is tired, silently thinking about the marvellous pasta to prepare later that evening and he sits there posing the obvious first question: what is your problem and how can I help? Can you understand his fury? Why me? Why do I have to go through these antagonising interviews and not these bullies, why? Why do I have to share my deepest darkest thoughts with someone who is not really interested in me? I hate my parents, my school, I hate the world. I just want to die.

His sister Sarah is 18-years old, never diagnosed with anything, smart, hyper sensitive and super creative. Skippy balled through her younger years with no worry in the world. Now at university, she is no longer part of the cool crowd, but just one of the many in a landscape with too many challenges. So Sarah tries to belong and decided her appearance is the key to success. Her phone is her most treasured possession. She posts like crazy and adores a bunch of influencers who she deems to live the life she always envisaged for herself. Slowly she loses weight and after her high school sweetheart ends the relationship badly, she starts to self-harm. Sarah no longer likes the person she is and starts to hate the body she is in. Other students see her smile all the time, but what they do not see is that Sarah has mastered the art of keeping up appearances like there is no tomorrow.

So Sarah is encouraged by her brother to see a therapist. She finds this very strange and uncomfortable, as she really does not want to talk about her feelings. You hear her think: I am so ugly, no one will ever be able to help. I rather die than share my real story online. My life has become a total disaster. No one understands me, this is all so unfair! Then she sees this therapist who really understands her, but can only meet with her once a week. As soon as she is back in her dorm, she stops eating and continues to self-harm, up to the moment she needs to be hospitalised.

Just two simplified stories from young people we see in our clinic every day. Compulsive gaming and screen addiction almost always stem from untreated mental health issues. It just creeps into the lives of young people and in the end it can destroy them. It is not the time online that counts, but the reason why they game or compulsively need to check their phone. Their actions are either driven by a strong desire to belong or by a self-inflicted conviction they never will. Young people misbehave, rebel and throw in the occasional tantrum. It’s all part of naturally transitioning into adulthood, as challenging parental control is the most normal thing to do. But what if temperament turns into aggression or destruction? It starts to become a real problem when this kind of behaviour lasts for several months. When being cheeky, aggressive, disobedient and rule breaking behaviour becomes the norm. When rebellion turns into manipulation, lying, steeling, cheating or violence. When upholding structure and discipline no longer works. When school/work/social activities suffer and risk-taking behaviour gets out of control. Or depressive lethargy sets in, totally cutting oneself off from the outside world. Seeing a psychiatrist or psychologist is probably the most sensible thing to do. But what if that ship has sailed and a more intensive approach is needed? And how to motivate a revolting child?

When you relate to this article, perhaps the time has come to accept you have become powerless over your problems and professional help is needed. Asking for help is difficult, for some even impossible, the ultimate form of humiliation. Feelings of failure. As a parent and in life. Feelings of fear. To lose your child, but also for your other children to be affected if you don’t act. To see your marriage disintegrate, if it didn’t already. Feelings of shame. To yourself, your friends, family, neighbours, colleagues or whomever living on the greener grass. Feelings of despair. This was not the life you envisaged. You feel exhausted, drained, at the end of your wits.

When joyful gaming has turned into compulsive behaviour, a typical symptom of addiction, Jimmy needs his shot and he needs it now. He develops traits of anti-social behaviour, aggression, insomnia and so on. Communication with the family deteriorates until it fully breaks down. The constant fights fuel self-pity and warrant his anti-social behaviour, spiralling him and the entire system into the abyss. Why accept help if nobody really loves you, everyone hates you, no one understands? Why don’t they just leave you alone? Deep down Jimmy resents his family. Why weren’t they there for him when he needed them? The blaming game has started. All of it is their fault, not his. Jimmy is definitely stuck now. And so is his family.

The rollercoaster of emotions is quite understandable, logical even. Whichever way you put it, you are in this as a family. Perhaps you are a single parent or part of a blended family where bonus mothers or fathers and a string of other children from previous relationships might be involved. Perhaps your child is 18+, no longer living at home and legally free to do whatever he/she wants. Perhaps you are close to a mental breakdown yourself, if you did not collapse already. Point is the entire system needs to align. It makes no sense for one parent to exaggerate and the other to downplay the situation. The tiniest of cracks can cause the dyke to break and the flood to destroy your life. Specialist family counsellors can help to manage this much needed alignment. They will hear you out with patience and explain what co-dependency and enabling means. They will uncover all sorts of unhealthy mechanisms which you believe are right but in actual fact only make things worse. Align the system to allow help to happen!

The therapist diagnosed Jimmy with Asperger and his sister with an Obsessive Compulsive Disorder (OCD). Both are classified as depressed, with low levels of self-esteem and high levels of anxiety. Classic ingredients to crash anyone at any point in time. Although a proper diagnose may provide some form of clarity for treatment, a label in itself is never the answer to what is needed. And every disadvantage also harbours an advantage. People diagnosed with autism often outperform others in auditory and visual tasks. They also do better on non-verbal tests of intelligence. But at the same time they suffer to a higher degree than average with mental health problems like anxiety, depression and obsessive compulsions. People diagnosed with ADHD are generally very creative, innovative, hyper focused, highly energetic and productive. But they also have a mind never at rest, always thinking and creating. Being multi-talented is wonderful, but it might imply the inability to do one thing well, which may lead to frustration and low self-esteem. ADHD kids have too many thoughts and ideas, making them bad conversationalist and bad listeners. Obviously the environment doesn’t respond well to either behaviour. The diagnose in itself might clarify certain behaviour and indicate therapeutic approaches on how to best live a full-filling life, but putting a label on someone is not always the solution. If you can trust the diagnose in the first place. And the list of labels seems endless: anxiety (fear, panic, post-traumatic stress, phobia, obsessive-compulsiveness), mood (depression, bipolar, mania), psychotic (schizophrenia, delusion), personality (borderline, narcissism, antisocial, etc.), eating, sleeping, sexuality, impulse, gambling, gaming, substance abuse, autism, ADHD, conduct, oppositional defiance, body dysmorphia and so on. It is more important all key players start to accept changes are needed.

Some diagnoses are very straightforward and obvious. If you have a broken leg, an X-ray will help as an extra set of eyes to look inside and assess the severity of it all. When it comes to the mind and soul, we are often thrown back in time with relatively ancient questionnaires and circumstantial evidence gathered in scientific research. But say two people are dyslectic, one grows up in an environment of support and warmth (try your best, you are good as you are). The other in an environment of hostility and bullying (you are stupid and no good). Both born with the same condition, but raised in totally two different environments. Who you think will have a higher chance of overcoming the disadvantages of dyslexia, gain self-confidence and a healthy self-esteem?

So the environment is very important to our core belief system and thus the development of our personality. Sure, certain traits are engrained in our system since the day we were conceived. Compelling stacks of research show the imminent influence on the development of our brain during pregnancy. Even our sexual identity is decided for us in the womb. So the way our mothers carried us during pregnancy, already influences our future to a great extent. There is conclusive evidence that stress, anxiety and mal-nourishment have adverse effect on our life long health, schizophrenia being one of them.

The construction of our body and brain is truly a miracle. Every chromosome counts, the interplay between oestrogen and testosterone needs to be just right and preferably the host (your mother) is having the time of her life. One little construction error and we could not even see the day of light. And when we do, then our environment has a huge influence on the way we develop. First as a baby, helpless and in need. We are the only species brought into this world unfinished. The fontanelle needs to close (open at birth, otherwise we could not get through the birth channel) and we need to be fed. We can’t walk, talk, see, nothing. So after nine months of production, we need to be taken care of with warmth, love and safety. Ingredients we will long for the rest of our lives. Then you go to school (we all remember waving at our mothers with tears in our eyes – why is she leaving me here with all these strangers), you make friends, you change school, you make friends again, a place where social acceptance and social belonging becomes even more important, you fight the powers that be, particularly your parents and finally you either find a job or go to university. By the time you are 25, your brain is fully developed and you are now supposed to live a life of fun. But work, financial commitments, emotional relationships, pressure to be accepted and admired by your peers and a lot more issues determine the level of happiness, a term so difficult to define I will not even attempt to. And were you born in a deprived area in Africa or an affluent part of the Western world? Were you raised under strict religious laws or anthroposophical? Were you blessed with good looks, a higher than average intelligence, superb social skills or an outstanding talent in the arts or sports? Some have it all, but 99,99% do not. Not to mention, trans-generational trauma, where one problem is passed on from one generation to the other. In short, so many things influence our path that anything happening to us is always layered in a multitude of events.

So yes, some people are more lucky than others. And yes, some cards were dealt to us at birth and some were given to us thereafter. But in general, you have to realise you and most people in this world struggle. All of us need love, warmth, safety, just as much as clean air, water and food. And yes, screen and gaming disorders reach pandemic levels, as big tech giants have masterminded ways to keep us online for eternity. One cannot undo the past, but once you accept your problems and look the beast in the eye, you will see you not only have the strength to deal with your issues, but also to overcome them and find purpose in your life, in which you and your talents can flourish.

The author of this blog Piet Jansen is, as the Director of International Relations, a valued member of the Yes We Can Youth Clinics team.

At Yes We Can Youth Clinics we treat over 800 youngsters a year suffering from mental health issues, addictions and behavioural problems. The second most common addiction amongst these youngsters is a game- and screen addiction. As shown in the below figures, these numbers continue to grow.

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