Popular mobile game PUBG (PlayerUnknown’s Battlegrounds) once again faces calls to be banned after a 14-year-old gaming addict shot dead his family in Lahore last month. Police officials claim the teenager had turned aggressive after failing to achieve the given targets in the game. Under the influence of the game, they claim, he opened fire on his mother and three siblings, who died on the spot.

PUBG has been previously temporarily banned in Pakistan and police had asked that internet service providers temporarily block it after three teenage suicides were traced to the game.

The relationship between videogames and violence is, however, not that linear. It is a classic chicken-and-egg problem. Is it video games that are making adolescents violent? Or is it that maladjusted individuals are seeking solace in the alternate reality of video games?

In 2019, the World Health Organisation (WHO) officially recognised “gaming disorder” as a mental health condition which occurs when gaming interferes with people’s daily lives, or takes priority over other interests and activities, causing impairments in their familial relationships, social lives and other areas.

Often excessive use of social media apps, such as Tiktok, or video games are linked to higher rates of suicides and mental health issues among the youth. Banning them temporarily seems to be the convenient option for local authorities, but this only serves as a band-aid solution since it will not cure the pathology that led a user to turn to these avenues. Someone looking to escape their home’s hostile environment might find solace in drugs, vandalism or other thrill-seeking activity, if one avenue is blocked.

A recent incidence of homicide by a gamer has sparked debate on whether video games are inciting violence in the youth or whether they are being scapegoated

Clinical psychologist Shahzor Hashim argues: “People who have violent tendencies might channel them through video games. From what I understand about the recent case, it might not have been the game per se, but the lack of patience and impulse control which caused the teen to snap.”

He adds that there are other questions to be asked as well. If there was no gun at home, would he have still killed his family? Was the environment at his home tense and was the video game his only means to escape reality?

“I am not justifying the murder,” Hashim says, “but merely highlighting that other factors are at play here. Games don’t make people aggressive, except if they are extremely violent. I do not think PUBG promotes violence.”

Blurred lines

Reportedly, the teenager involved in the Lahore homicide thought his family members would come back to life after he shot them like characters in the game resurrect or spawn back after being eliminated. This might be the Game Transfer Phenomena (GTP) at play, which is described as the transfer of experiences from the virtual to the physical world that can manifest as altered sensorial perceptions, sensations, automatic mental processes, behaviours and actions with video game content. Immersive gaming experience featuring augmented/ virtual reality makes this phenomenon more likely.

During the pandemic, regular video gamers started spending more time on games and GTP was observed in many of them. At the psychiatric facility where I work, a mother brought her 25-year-old son because he had started throwing temper tantrums and being physically aggressive with the family after he began to play Fortnite all night long for a couple of months.

The mother believed that her son had internalised the role of the hero in the game and was unable to break free of it in his real life. Gamers have reported seeing health bars or ‘answer-choice’ menus while talking to other people. Another common experience is getting “earworms”, when the music or sounds from the game get stuck in your head.

Hooked on games

What causes the brain to get hooked on video games? The “reward centre” in the brain releases dopamine, a neurotransmitter, in response to a pleasurable experience or hyperarousal. If a person experiences hyperarousal while playing video games, the brain establishes the relationship between that activity with dopamine. The person will then get a dopaminergic surge the next time they repeat that activity.

Dopamine is implicated in reward-seeking, which is why it can be hard for people to tear themselves away from a situation or behaviour if it gives them a dopamine rush. It is also self-reinforcing. The more times people experience the behaviour, the more dopamine is released, and the more driven they are to return to the behaviour.

Research has found common brain activities between video game disorders (belonging to the cluster of behavioural addictions) and substance use disorders. It has been observed that the level of dopamine released in the ventral striatum when playing a competition-like video game is comparable to that provoked by psycho-stimulant drugs.

The Pandemic Effect

Due to Covid-related social restrictions in the last two years, many teenagers have only “hung out” with their classmates in the digital sphere, either via social media or through video games. The pandemic has compelled us to drift away from the regular educational system featuring spacious school campuses, playgrounds and sports.

Psychiatrist Dr Shoaib Ahmed says, “Our world has shrunk to our screens. We do not let our children go out and play with peers due to health concerns, but rather encourage them to entertain themselves indoors by playing games on their gadgets. We should put a brake on these games or give some sort of alternative to children.

“If parents see any warning signs, they must consult a mental health professional for early intervention,” says Ahmed, who is executive director at the Institute of Behavioural Sciences in Karachi.

However, it cannot be denied that our pandemic lives today are irrevocably tethered to the digital world. Severing this tie might lead to a worsening of mental health and increased isolation.

Hiba Khalid is another clinical psychologist and also an avid gamer. She says, “In my experience, one’s frustration and aggressive tendencies sublimate through video games. While playing online games, you get a sense of achievement if you are on a winning streak, or playing with your squad.”

Khalid shares her personal experience: “During Covid, since everyone was isolated, video games gave me a sense of connection, since many games now have voice chat options. Otherwise, I would have only stayed in touch with my friends through texting, which is pretty one-dimensional.”

However, the experience is not all positive. Khalid explains that, in online games, once you start losing rounds consecutively, negative feelings start building up, resulting in irritability and rage. “I have seen guys lose their cool and throw temper tantrums in this state,” she says. “Online games give your mood a boost until you are losing the rounds.”

Comorbid factors

Certain individuals are more likely than others to turn to video games or use them excessively. Such behavioural addiction is a maladaptive coping mechanism that arises when an individual is trying to avoid or escape an external stressor.

Children who depict violent behaviour usually also exhibit a cluster of other symptoms at home: domestic violence, dysfunctional parenting style, substance abuse. Oppositional defiant disorder and conduct disorder are common disruptive behaviour disorders seen in children and adolescents. They share similar symptoms, such as irritable mood, temper tantrums, aggression and defiance.

Such disorders often go undiagnosed and untreated, since parents believe that banning video games or not letting them meet their friends might fix their children’s problems.

The Associate Director of Counselling Services and Wellness Office at the Aga Khan University Hospital Dr Hadia Pasha urges us to look at the bigger picture. “In many cases of gaming addiction, there are other co-existing psychological conditions, such as depression, anxiety, obsessive-compulsive disorder, social anxiety, etc.” she says.

While gaming addiction by itself can lead to intensely adverse consequences, Dr Pasha emphasises that an extreme incident like that of the recent homicide warrants a deeper look into possible comorbidities —such as conduct disorder — that significantly increase the risk of harm or aggression.

It also brings to light the unfortunate failure to identify or treat mental health issues at the right time which, when overlooked, lead to such dire consequences.

The writer is a clinical associate psychologist and freelance journalist. She can be reached at rabeea.saleem21@gmail.com

Published in Dawn, EOS, February 13th, 2022