I often jokingly mention that I keep pictures of the proprietors of mobile phone companies in my room and ask them for daily blessings as they look after my financial well-being. The number of young people coming to psychiatrists and other mental health professionals for consultation with excessive use of smartphone is alarming. ‘Addicted to smartphone’ is a term used commonly to describe this behaviour. In psychiatry, to label someone as addicted, means a certain threshold of pathological behaviour has to be crossed. However, in popular press and TV shows, the word addiction is used without the exact scientific rigour.
In my opinion, in current times, the cause which gives rise to most conflict between children and their parent is excessive smartphone use.
It is a new problem in human civilisation. Drug and alcohol addiction is probably as old as mankind. Hence, we know how to address it. But with screen addiction, we struggle because it is a relatively new phenomena. When does use of smartphone becomes problematic use and when do we label it as an addiction? What are the parameters to define it is an addiction? Should time spent on screen be a parameter? Do ‘addicts’ develop craving for smartphones as they would do for say when someone has alcohol addiction? There are many unanswered questions. This leads to the confusion about our approach to address the problem, if at all we acknowledge it can be a problem.
Internet addiction
Earlier, access to the Internet was only possible through computers. With the ubiquitous rise of smartphones and falling prices of both phone and data, it gradually became affordable and has reached virtually most of the population. Therefore, these two market forces also accelerated the pace of the problem. Smartphones are only
20-odd years old. From something which was meant for few, it has now slowly morphed into an essential tool for human existence. Mobile phone and Internet services are listed as essential services with the government.
The conundrum lies in the boundaries. When does the use of an essential item become a vice? The term ‘Internet Addiction’ came into circulation in 1995 with Kimberly Young, a young clinical psychologist writing about it. It did not become a problem for children and young people until the second decade of the 21st century arrived. It was becoming a major concern and enforced smartphone use during the pandemic had a snowball effect. There are a plethora of guidelines on ‘safe’ use of smartphones. Some mention no smartphone exposure under the age of two years. I find it ludicrous. A mother who breast-feeds her baby once asked me whether she should breastfeed while watching television.
Most of us (mental health professionals) are anyway not well equipped to deal with what is now also known to be a part of Behavioral Addiction. These guidelines, framed by experts, without any form of objective, replicable data, to justify those recommendations, makes life complicated for us.
Actually, I have jumped the gun. I have assumed that everyone agrees that there is something called Internet Addiction. There is a very different school of thought, articulated by my trusted friend and my go-to person for all second opinions, Dr Aniruddha Deb, consultant psychiatrist. He, like many others, believes that Internet Addiction is not really Internet Addiction per se but something else. The term is popularised and abused by ‘old’ mental health professionals like me, who were born before the Internet revolution and hence we do not understand the phenomena. He cogently points that all big transitions are viewed with scepticism. Apparently, at one point when human civilisation was migrating from oral to written words, philosophers wondered whether one could get addicted to reading.
Association and not a cause
For the moment, let us put aside whether Internet Addiction truly exists or not, as it is a matter of deeper implication regarding what we mean by the term addiction. The reality is, at an individual level, we do see many young people who are using the Internet in a manner which gravely impacts their well-being. There can be no argument about this reality. An extreme example is one of my 22-year-old patients who used to wear adult diapers and participate in real-time gaming. He would drink pureed juices and smoothies, which he forced his mother to prepare, and drink it with a straw, so that he could continue to play while eating/drinking. He would be on his computers for about 17-18 hours a day. He wore diapers because he did not want to waste time going to the toilet. He compelled his hapless parents to go along with his preferred lifestyle with threats of violence and coercion. This is an extreme example but the list of “supposed” ill-effects of excessive Internet use is long. There is aggression, shorter attention span, viewing unsuitable material and copycat behaviour, loss of social connection, isolation, less family time, decreased motivation for sleep, desensitisation, identity confusion (many parents accuse social media for gender identity confusion in their children), child trafficking, gambling and shopping addiction are some of the problems. The list can be much longer.
Why have I written “supposed” ill-effects? The reason is pretty simple. Human behaviour is influenced by multiple factors. Environment and genetic endowments are the key determinants. To attribute smartphone use, an environmental/social factor as the cause of all difficult behaviour will be unscientific and completely off the track. We can confidently say smoking causes cancer. However, we cannot say excessive smartphone use “causes” attention difficulties or aggression.
The current state of knowledge allows us to assert that it is an “association” (in scientific terms), and not a cause. Stating that it is an association, is actually not saying much. One regularly comes across hundreds of research papers citing a “link” between smartphone use and mental illnesses. But one cannot extrapolate a “link” as a cause. That will be over-reaching of the inference. Let me give an example. I can produce a research paper which shows that in Calcutta, sale of chicken momos has increased over a period of last 10 years and the diagnosis of autism has also increased during the same period. So, can I go on to say that increase in consumption of chicken momos is “linked” to rise in autism and conclude that chicken momos can cause autism?
Right amount of screen time
The point I am trying to arrive at is, when a young person comes to us with excessive smartphone use, we look for vulnerabilities which can explain his behaviour. The vulnerabilities lie in his genes or in his environment and most commonly, in both. Our search starts with the impact of screen time and why the young person is resorting to excessive screen time. Passing diktats, purely based on time spent on screen, is useless in my opinion. A young person could be watching KBC with family members, then doing his homework on laptop, then helping his grandparent find the right kind of phone on a shopping app and then read a book on Kindle. That is not harmful by any measure.
But if we find that his sleep is getting affected as he is reading books on Kindle till early hours in the morning, is groggy while attending school, and is becoming irritable when teachers question his behaviour, then it is a problem. Consider the other extreme. A young person does not at all watch TV and does not use smartphones. He will be unaware of (maybe) many things. There is a “right amount” of screen time, which improves social connectivity and knowledge. The right amount varies from person to person and on the unique situation the person is during that phase in his life. I personally think we oversimplify the use of screen time and its link with adverse mental health. All of us avoid searching for complex explanations for behaviours, when an easy scapegoat can be found.
However, there are definitely many situations, where mental health professionals are convinced that the young person’s excessive screen time is detrimental. In those situations, we dig deeper to try and understand the reality of the lived experience of the person. My colleague, Parmeet Soni, consultant clinical psychologist, believes that burying their head in a mobile phone for long hours is actually an escape for many young people. There is very often an excessive amount of family conflict, domestic violence and lack of peace at home. The young person feels lost, sad and his only refuge is a phone. The adults around him are fighting their own demons and disengaged from nurturing the well-being of that young person. Some others may have social anxiety. Anonymity of cyberspace plus the option of virtual interaction and relationships with others, provide them a refuge. In real world they find it difficult to establish and navigate relationships and social interactions.
Many battles at home
Many others, who present with excessive smartphone/Internet use, have undiagnosed ADHD or other undiagnosed learning problems. They find it easier to focus on fast-moving images on the screen and mobile games, rather than on textbooks and classroom lectures. Many others have lack of other viable options to engage with them meaningfully. Lack of recreational activities in the neighbourhood, lack of a culture of family conversations and shared family activities contribute to the young person drifting towards smartphones to look for entertainment. Then gradually they get sucked in and parents notice it only by the time the problem impacts educational activities. Attempts to wean them away from phones result in violence, threats of self-harm or actual self-harm. After many battles at home, some of them reach mental health professionals.
Treatment of such problematic behaviour is like unpeeling an onion. There can be many underlying vulnerabilities as I have mentioned above, leading to the culmination of “screen addiction” and associated disruptive behaviour and mental health problems. To simply assert that mental health problems and illnesses are just linked to the single factor of excessive screen time, is a gross error and scientific untruth.
So what advise I have for parents:
- Accept that screen time is a reality in our world now. We must live with it.
- Educate children / young people about safe use of Internet/social media. This is mandatory. For this to happen, adults also need to be cognisant about the world of social media, to its fullest extent. Ignorance is not really an option.
- Do things together, both online and offline on a regular basis.
- Have fixed no-screen time periods, for example Sunday evenings. This is applicable for all members of the family
- Young people learn through observation. If they see adults around them doing other positive recreational activities besides using the screen, they too will follow. Reading together is the best thing one can do.
- Prevention is much better than cure. Don’t try to lock the stable door after the horse has bolted. Be mindful and observant about behaviour changes which indicate possible mental illnesses. Does it correlate in any way with excessive smartphone use?
- If you are concerned about excessive screen time, express concern, not anger. Do not humiliate. There is a difference between voicing criticism and resorting to humiliation.
- If all else fails, approach a mental health professional. Remember, we are not gods with magical powers who can remove all ills with few magical words. The journey back to healthy smartphone use and restoration of amicable home environment will require behaviour change for all members of the family and not just the young person.
Dr Jai Ranjan Ram is a senior consultant psychiatrist and co-founder of Mental Health Foundation (www.mhfkolkata.com). Find him on Facebook @Jai R Ram