Can't Just Stop

by Sharon Begley

  Indeed. More than any other behavior that people engage in compulsively, the online version—from checking Facebook to texting—shows that just because you’re compulsive about something doesn’t mean you have a broken brain. And just because a behavior is compulsive doesn’t make it pathological. To the contrary: understanding the allure of being online sheds light on some of the mind’s most salient, and utterly normal, workings.

  Despite the lack of evidence for excessive Internet use as a mental pathology, the idea quickly gained traction. Within two years of Goldberg’s proposal, colleges were offering help to students who felt they were using the Internet compulsively (the University of Maryland’s program was called Caught in the Net) and the highly regarded McLean (psychiatric) Hospital outside Boston had created the Computer Addictions Service. At the University of Pittsburgh, psychologist Kimberly Young founded the Center for On-Line Addiction in 1995 and called on psychiatrists to include it in the DSM as an official disorder, which would make insurance companies more likely to cover it. In 2009, the reStart: Internet Addiction Recovery Program in Fall City, Washington (near Microsoft’s Redmond headquarters), became the first in-patient facility for compulsive “chatting, texting and other aspects of Internet Addiction,” which affected “anywhere from 6 to 10 percent of the online population,” reStart said in its launch announcement. Around the same time China and South Korea designated Internet addiction as their top public health threat. In 2013 Young co-founded an in-patient Internet addiction treatment facility at the Bradford Regional Medical Center in Pennsylvania. It described “Internet addiction” as “any online-related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones, and one’s work environment. . . . [I]t is a compulsive behavior that completely dominates the addicts’ life.” A ten-day stay in its “secure and dedicated patient unit,” starting with what its founders call a seventy-two-hour “digital detox,” costs $14,000.

  As for Goldberg, who died in 2013 at the age of seventy-nine, by the end of his life he had come to believe that a small percentage of the population has what he called “pathological Internet use disorder.” It was a canny phrase, camouflaging the fact that no one knew if the behavior was a compulsion, an addiction, or an impulse-control disorder—or none of the above.

  In the years since Goldberg floated the notion of excessive Internet use as a mental disorder, research has not been kind to the idea. Poring over the literature, it is easy to get the impression that the disorder not only exists but is nearly as common as smartphone ownership. In fact, the emerging scientific consensus is quite different: many people go online compulsively, but the behavior falls short of a distinct mental disorder. The coup de grâce came in 2013, when—despite hundreds of papers in psychology and psychiatry journals describing excessive Internet use as an addiction or a compulsion—psychiatrists balked, declining to designate Internet Use Disorder as a distinct mental disorder in the DSM-5. A big reason was that excessive Internet use results from mental processes so common that tarring it as a “disorder” makes as much sense as labeling other nearly universal cognitive quirks such as post-purchase rationalization (“I bought it, so it must be good”) mental disorders. Another concern was that “excessive” is in the eye of the beholder, and as more and more online activities became socially acceptable, the definition of “excessive” evolved. Internet use may be a compulsion for many people, but that does not mean it is pathological. To argue otherwise is to claim that a widespread behavior is a sign of a mental disorder, of a brain not working as it should.

  The studies of researchers who did argue otherwise weren’t persuasive enough to clear even the low bar that the American Psychiatric Association set for designating a behavior as worthy of further study to see if it might merit recognition as a mental disorder. Many of the studies were so flawed they should have embarrassed a student in Psych 101. Or as psychologist John Grohol, who founded the mental health news site Psych Central, put it, “ ‘Internet addiction’ has poor evidence because most of the research done into it has been equally as poor.”

  How poor? In thirty-nine studies of pathological Internet use, beginning in the 1990s, different researchers came up with wildly different estimates of its prevalence, found a 2009 analysis by Marina Blanton of the University of Notre Dame and colleagues in CyberPsychology & Behavior. For starters, there was essentially no agreement on how to define the supposed disorder. Some studies used a single criterion: how much time people spent online. That, Blanton and her team wrote with commendable understatement, “has severe limitations.” For instance, it snares millions of people who feel no great desire to be online but must do so for their work and are therefore no more addicted to the Internet than they are to, say, typing. Other diagnostic questionnaires used thirty-two true-or-false questions, or thirteen yes-or-no questions, or something else entirely, and there was no evidence that if someone “passed” (or failed) on one of the questionnaires they would pass (or fail) on the others, a troubling absence of validation. Virtually none of the studies examined whether the questionnaires capture behavior accurately, and they often recruited participants in a way that caused serious sampling bias. By seeking volunteers who were interested in the Internet, the studies wildly inflated estimates of the prevalence of Internet addiction. It was akin to measuring the prevalence of alcoholism by canvassing barflies.

  The main trouble, of course, is that the criteria in most Internet disorder questionnaires can be used to label anything a pathological compulsion. Staying online “longer than you intended,” neglecting chores “to spend more time online,” forming relationships with fellow netizens, checking email “before something else that you need to do,” getting complaints from family or co-workers about how much time you spend online . . . well, substitute any activity that society deems more socially virtuous and you can see how ridiculous this is.

  Studies of compulsive Internet use have also failed to separate content from form. Users who go online to watch porn or gamble or shop feel compelled to watch porn or gamble or shop. It’s not Internet use per se that they find compelling. Instead, the Internet is how more and more people watch porn and gamble and shop. Similarly, if text messaging is how your friends communicate, then your choices are to become adept at typing with your thumbs or become a social recluse. Again, using digital technology this way is not evidence of compulsive behavior.

  I asked psychologist Nancy Petry of the University of Connecticut, who led the expert APA group studying behavioral addictions for possible inclusion in the DSM-5, to sum up the case against problematic Internet use as a mental disorder. She didn’t come up for breath for eleven minutes. You can’t reliably assess it, she pointed out, “and when different diagnostic tests come up with prevalence estimates varying from less than 1 percent of the population to more than 50 percent, there’s clearly a problem.” The criteria in many of the questionnaires are ridiculous, asking whether you have lost sleep due to going online late at night and whether you have “neglected chores” because of it. “Ninety percent of adolescents would say yes to this”—as would most people who love to read, listen to music, or socialize—“but that’s not indicative of a psychiatric disorder,” Petry said. “The questions have a very low threshold, asking you to agree to only a few symptoms, with no indication that they’re clinically significant. You have to distinguish between psychiatric disorders and mere problems budgeting your time, setting priorities, or generally dealing with life’s demands.”

  * * *

  It’s important to debunk the notion of Internet Use Disorder or Internet Addiction Disorder because the wild claims for its prevalence, and even its existence, have pernicious consequences. One is that they elevate the ordinary to the pathological and thus deny the truly pathological. A tiny percentage of people do have a problematic compulsion to live life online, to the detriment of the rest of their life. Lumping them together with the teenager who sends 300 texts a day—no mor
e than the number of conversational exchanges many people had in person, voice-to-voice, in the old days of the 1990s—trivializes their predicament. Another problem is that, as with video games, there is good reason to suspect that excessive Internet use is not primarily about the Internet but is instead a marker or symptom of something else, such as social anxiety or depression. “If you’re spending a lot of time on Facebook, is that really its own psychiatric condition or is it a manifestation of something else, like wanting to keep up with your friends, feeling bored or lonely or shy, or in need of mindless distraction?” Petry asked. To call Internet use the primary pathology is like saying that using hundreds of tissues a day to dry your tears is pathological: it conflates the symptoms with the illness and thus obscures the actual reasons for the behavior. Tagging someone as having an Internet compulsion can therefore be like diagnosing someone as having Kleenex Use Disorder . . . and charging $14,000 to treat it, rather than the depression that is the true illness. “The field has to come to a greater consensus before problematic Internet use can be recognized as a true mental disorder,” Petry said.

  But as with other compulsions that fall well short of pathology, intense Internet use nevertheless reveals something about how the brain works when it is working normally. One way we know Internet use can be compulsive is by the millions of dollars companies have spent to make it so—and you can be sure they’re not targeting a tiny fraction of the online audience that has a psychiatric disorder. No; they believe that with the right hooks, many of them akin to what video game designers have programmed into their creations, anyone can be sucked into compulsive use of a website. The travel website Expedia has a “senior product manager of compulsion,” Technology Review recounted in 2015, and has hired consultants to “develop compulsive experiences.” The intermittent and variable reward structure that permeates video games is only the beginning.

  Enter FoMO

  To identify what it is about online experiences that makes them compelling to people whose cerebral hemispheres are firmly planted in the land of the sane, researchers are taking a page from video-game cyberpsychology. For just as video games have psychological hooks that make people feel compelled to play, so do online experiences.

  Start with the fact that the cost in time and effort of a single online “transaction”—a click, a view, checking Instagram or your Facebook news feed—is so minuscule as to be unmeasurable. It is often so low, in fact (I’m just waiting to give the barista my order), as to be negative. That is, not texting or checking for texts or reading your smartphone screen feels like a greater burden than doing so. “The timescale on which you work with online technology is central to making it compelling,” Sheffield’s Tom Stafford told me. “It’s always on, and time is sliced into small bits. What else can you do in five seconds that’s interesting? So why not check your phone?” This is a large part of why “using the Internet can be compulsive.”

  That suggests that the drive behind use of the Internet, especially via smartphones, is the result of feelings and thoughts more akin to those in obsessive-compulsive disorder—in particular, compulsive checking—than to addiction. “The underlying motivation to use a mobile phone is not pleasure,” as the addiction model says, “but rather a response to heightened stress and anxiety,” said Moez Limayem of the University of Arkansas, who led a study on this presented to the 2012 Americas Conference on Information Systems. We feel anxious if we’re not making use of every tiny slice of time.

  Just how hard—even unpleasant and anxiety-producing—it is to be alone with our thoughts was shown dramatically in a 2014 study. Researchers led by social psychologist Timothy Wilson of the University of Virginia gave volunteers (students) two options: do “nothing” for fifteen minutes or give themselves a small electric shock (which three-quarters had previously told the researchers they’d pay money not to experience). Two-thirds of the men and one-quarter of the women chose the latter, so anxious were they for “something to do.” Don’t blame millennials: adults whom the scientists recruited from a church and a farmer’s market reacted the same way, feeling antsy and anxious when left alone with only the contents of their mind. Milton, as usual, got there first: “The mind is its own place, and in it self/Can make a Heav’n of Hell, a Hell of Heav’n,” he wrote in Paradise Lost. These days, apparently, the mind regards its own company as more like the second option: “The untutored mind does not like to be alone with itself,” Wilson and his colleagues concluded.

  Especially when the mind, tutored or otherwise, sees dangled before it a payoff structure common to many forms of social media, texts, and email: the intermittent/variable reward system that we met in video games. Most of what fills your Twitter feed or Facebook updates is digital dross. (“Barbara changed her Facebook picture!”) Payoff: zero. But every so often, you find a rare gem—a friend offering two free Bruce Springsteen tickets she can’t use, or an acquaintance posting that he’ll be in your neighborhood tomorrow and is looking for someone to share a beer. Hopping from one site to another and landing on one that tells you the secret to fixing squeaky wooden floors, or that a Kardashian just blew up the Internet again, makes the many duds and time sucks worthwhile. The Internet’s cognitive-reward structure compels many people to jump from site to site (This one might have the fact that will change my life), to use social media, to see what YouTube video is trending, lest they miss a life-changing, merely important, or just entertaining bit of information. Our brains want more, and our thumbs oblige. Anxiety that we might miss such treasures in the sea of dross drives compulsive Internet use.

  “If I give you a treat sometimes, you have to keep checking all the time: you don’t know when it will come,” Tom Stafford said. “No matter how frequently you check, even if you checked only a second ago, a brilliant email might have just come in,” or a friend might have posted on Foursquare only a second after you last checked that she’s in the bar you just passed. “You feel anxiety about possibly missing something.” Such low-cost, occasionally high-reward activities are catnip to the brain: they produce the experiences most likely to reel you in and impale you on the hook of intermittent/variable rewards.

  If we’re prevented from engaging in a compulsion like staring at our smartphones for texts, the anxiety that the compulsive behavior alleviates comes roaring back. Psychologists have reported that people who are separated from their smartphone often experience an elevated heart rate and other signs of anxiety. In one 2016 study, volunteers who filled out a standard questionnaire about their smartphone use and emotions told researchers that they turn to their phones “to avoid negative experiences or feelings” and “to cope [with] or escape from feelings related to an anxiety-inducing situation.” Psychologist Alejandro Lleras of the University of Illinois at Urbana-Champaign described it as a security-blanket effect, absorbing our bubbling-over anxiety. That fits with the growing number of studies finding that people text as a way to escape anxiety; in questionnaire-based studies, something like 70 percent of participants say smartphones and texting help them overcome anxiety and other negative moods. It’s become a stereotype that people in awkward (read: anxiety-provoking) situations “turn to their mobile phones as a way to disengage,” the Illinois researchers said, and do the same “during times of more intense distress.”

  To get beyond mere observation, Lleras and a colleague attempted something more rigorous. They gave volunteers a short writing assignment that, they explained (falsely), would be evaluated by two experts. To ratchet up the stress further, the researchers said the experts would also conduct an on-camera interview about the essay with the volunteers. While waiting for that, half the volunteers had access to their mobile phones and half didn’t. While 11 of 24 volunteers who were able to text and surf to their anxiety-ridden-heart’s content felt intense anxiety, 18 of the 25 deprived of their phones did, Lleras reported in the journal Computers in Human Behavior. And 82 percent of those who kept their phones used it for every moment of the ten-minute wait. By givi
ng in to a compulsion to use their phone, they were able to defuse much of their anxiety. “People seem to be less vulnerable to becoming stressed in anxiety-provoking situations when they have access” to their mobile phone, the researchers wrote.

  Smartphones “function as comfort objects, antidotes to the hostile terrain of wider society,” as British social theorist James Harkin wrote way back in 2003. By making us feel we are always connected to the world, they alleviate the anxiety that otherwise floods into us from feeling alone and untethered. Anxiety-driven use of mobile phones is pervasive enough to have inspired the neologism nomophobia (for “no mobile phone”) to describe the pathological anxiety, bleeding into fear, that comes from being unable to access our Galaxy, iPhone, or other preferred silicon security blanket. No wonder 40 percent of smartphone owners use their device before getting out of bed, according to a 2013 survey by Ericsson ConsumerLab, an arm of the Swedish technology giant, or that Americans checked their smartphones forty-six times a day in 2015 (up from thirty-three in 2014), according to a survey by the consulting firm Deloitte—and seventy-four times a day if they’re college-age.

  Kevin Holesh’s day always started with a cell phone, usually twenty minutes of swiping through “missed” tweets and emails. He slept with it next to his bed, used it no matter who he was with, constantly checked email, and would no more think of turning it off than a heart patient would consider turning off his pacemaker. “I was afraid of missing out on some big email,” said Holesh, a technology designer and developer in Pittsburgh. “Some CEO wanted to talk, and I wanted to be there instantly. It was me imagining this golden ticket appearing in my inbox.” In 2013, he developed Moment, an app to track how much time users are on their phone each day. Knowing his own numbers—looking at his phone every twenty-three minutes, on average—didn’t quell the anxiety he felt when he tried to resist it, but removing temptation did. He began placing his phone outside his bedroom at night and removed his email from it. That slowly helped him realize he didn’t need to reply to every email instantly; it was fine to wait until morning, or even the next day.