Dr Richard Graham, Clinical Director, Tavistock Clinic presents on Clinical Observations On Computer Games as part of the Game Based Learning Conference. Video of presentation may be found at: http://newlearning.blip.tv/file/1906537/

1. Dr Richard Graham
Tavistock & Portman NHS Trust

2. Mental Health and Emotional Well-Being Service

for Children and Adolescents, and their
Parents, in the Tavistock Clinic, from 0 – 25 years.
Can offer complex, open-ended assessments and

interventions, based on Child Development
Research, Psychoanalytic Theory, Systems
Theory and Psychiatric Research.

3. Recognition that many children, adolescents

and young adults feel ‘healthy’ and do not
believe that their problems require a health
service response.
Project to deliver services in user-preferred

form.
Development of web-based information and

interventions, to promote well-being.

4. In development by Sally Hodges, Emilios

Lemoniatis and colleagues.
Age-appropriate, highly interactive health site to

promote well-being.
Commissioned by Primary Care Trust.

Concurrent developments of a site for

adolescents and young adults.

5. Over the past 5 years, increasing referrals in

which computer games were a factor, but also
other aspects of new technologies e.g. social
network sites.
Subsequent awareness of how a particular game

– ‘World of Warcraft’ - impacted on the
development of some adolescents.
Series of single case studies; many in difficulty do

not reach the service.

6. Is it, and why is it ‘addictive’?

Why are other games less ‘addictive’?

Combination of factors?

 ‘Levelling’ – compulsive progression through the
multiple levels, with new ones introduced in upgrades.
 Ability to acquire high social status or prestige within
the game.

7. Combination of factors?

 Group dynamics and team aspects of Guilds.
 Excitement of violent raids, venting frustration.
 Ability to gain varied and elusive rewards.
 Social networking, across the world, allowing
particular intimacy.
 Fishbowl effect; frequent returns to game to observe
what is happening.

8. Is it addictive?
 ‘Craving’ time in the game and preoccupation with
it difficult to resist. Day is structured around
game, and obtaining access to it.
 Cunning arguments secure time in the game, and
suggest how staying in the game is compatible
with health and development.
 Fear of being excluded from the game –
(?)withdrawal syndrome and violence.
 Excessive time in the game; 14+ hours per day.

9. Consequences:
 Physical health suffers
 Poor sleep, eating, drinking, personal hygiene.
 Dehydration and stasis increase risk of various
illnesses and disorders.

10. Consequences:
 Gradual dropping out from education or
work, often slowly over months or years, as
ordinary life is eroded.
 Social relations restricted to those in the game.
 Avatar may be so successful, that switching off
may be experienced as being ‘downgraded’.
 Wider development is arrested.

11. Nightmare:
‘a cat lay on the floor of a hospital, paralysed.
When observed more closely, it was seen to have no
muscles, existing just as skeleton and skin.’

12. Little suggestion so far of a single

neuro-developmental factor, such as Asperger’s
Syndrome.
Multiple individual, family, social and educational

factors contribute.

13. It's a god-awful small affair,
To the girl with the mousy hair,
But her mummy is yelling “No”,
And her daddy has told her to go.
But her friend is nowhere to be seen,
Now she walks through her sunken dream,
To the seat with the clearest view,
And she's hooked to the silver screen…
‘Life on Mars’
David Bowie (1971)

14. Individual and Social Aspects
 Body dissatisfaction.
 Failure in tests or trials a precipitant.
 Mood disturbance.
 Past experiences of being bullied or of social
exclusion/awkwardness.
 Imaginative capacities and hopes for something
better.
 High IQ – (?)intellectual snobbery.

15. Family Aspects
 Parental conflict or marital breakdown.
 Parents uncertain as to how they should act, as
playing game is not overtly antisocial.

16. Other aspects:
 The nature of, and relationships within a Guild
colour the relationship to the game.
 Demanding, and ruthlessly rejecting: exclusion
from Guild can be devastating.
 Tolerant Guild can be more supportive of time
spent out of the game.

17. Habit, compulsion or addiction?

Is there a ‘Disorder of Disconnection’ for those

that cannot switch-off from games, social
network sites, emails etc. that amounts to a
terror of exclusion, of missing something?
Are we now intolerant of those who do not keep

up with the deluge of daily information and
communications?

18. Promotes compulsive behaviour
 Visual stimulation (eg in autism)
 Violent acts
 Competition and rivalry
 Triumph and superiority
Ordinary life is diminished or dull in contrast.

19. TV was introduced in 1995 to a remote part of Fiji

(Nadroga).
Ethnic Fijian traditional aesthetic ideals reflect a

preference for a robust body habitus, and they
did not pursue thinness.
Individual efforts to reshape the body by dieting

or exercise traditionally have been discouraged.

20. By 1998
 Key indicators of disordered eating were
significantly more prevalent following exposure.
 Narrative data revealed subjects' interest in
weight loss as a means of modelling themselves
after television characters.

21. Eyes appear to function like taste-buds; a

pleasing visual experience stimulates desire.
Rapid effect on the self.

Culture of high visibility.

Dissatisfaction with body image.

Link to avatar, which may be more appealing.


22. Healthy development requires bodily

involvement.
Risks of hypertrophy of certain brain (visual and

motor) centres.
Developing capacities to wait and bear

frustration versus over-valuing of speed.

23. Parent Forums and clinical services for parents.

Tech & Web clinical service.

Assertive Outreach.

Working together to enhance

development, creativity and well-being.