Jerald Block

TRANSCRIPT

RUSHKOFF: Thanks so much for talking to us today. We've got a lot of questions for you. To start out, maybe you can just give us an overview. Explain to us what, exactly, is Internet addiction?

BLOCK: Well, Internet addiction... let's start with the term. Some people have called this disorder "Internet addiction." I much prefer the tem pathological computer use. The reason why is we're talking about computer use which may not involve Internet. It may be single-person games or Instant Messaging through phones. So that's one issue, it may not involve the Internet. The second issue is, addiction is a very loaded word in our vocabulary. And it's probably better to disentangle that a bit and remove the word from the actual clinical disorder. Now, what is pathological computer use? Really consist of four things. The first is it has to be excessive use of the computer, and that, or electronic media, and that probably consists of around 30-40 hours a week, more generally. But it can vary. I mean, if you're in the North Pole, or in Antarctica, and you don't have a lot to do, it may be very reasonable to be playing games for that period of time. However, if you're carrying a job or going to school, that may be difficult. So excessive use is the first criteria.

The second criteria is, it has to be producing real, serious problems in one's life. Someone has to be claiming, very, very loud. So we're not talking about causal use where you're just concerned, it has to be producing real problems. Someone has to be complaining. The third issue is mood symptoms when you try to stop playing, or after prolonged use. So often people describe a sense of anger, frustration, depression, that results when they're playing for a long period of time or when they try to stop playing. And the fourth criteria is a sense of tolerance, or a need for more over time. So you need either more equipment, so people spend thousands of dollars on better equipment, more software. They might be buying 2 or 3 computer games each week. Or in general, a more involved experience.

RUSHKOFF: In a sense, doesn't this describe any of us?

BLOCK: No, it doesn't. Because how many of us are having real problems that result from the computer use? How many of us are really having to deal with people complaining that you're not getting up and going to work, instead you're playing computer games. I think it actually probably describes, in the U.S., maybe 3%, 5% of individuals.

RUSHKOFF: So how do you distinguish between that and someone's wife complaining, you come home from work, and you still do email, you're using your Blackberry while you're driving the car, you're not paying attention to the kids because of this thing... and meanwhile you're taking the money to buy a better Fios connection so you can get more work and stock quotes, you know, in the morning. Isn't that, how do you draw the line between when we just feel overwhelmed by the computer, or the computer use affecting our lives.

BLOCK: I think that scenario that we're looking at, in terms of trying to produce the best research criteria, possible, where we can distinguish who has it, who doesn't. But this is not an unusual problem with any disorder. With any disorder, there's a cutoff. There's normalcy, and what's not normal. And it's generally, it's often around a matter of degree. How intensely one is participating in something. So with alcohol, for example, as a society we think, maybe 1 or 2 drinks, generally, might be OK, but over that might be excessive. So you know, likewise, with the computer use, if someone is complaining. If you're getting in trouble with work. If you're failing out of school. If, uh, you're not making money and falling behind on your rent. Well, then there's a serious problem.

RUSHKOFF: So right, it becomes kind of circumstantial. I don't mean circumstantial, but it's affecting the course of their real life. There's something...

BLOCK: Yes, and remember, I'm a psychiatrist, so if there's an added element, that if someone is coming to me for help, they've thought about it long enough, they're convincend that there's an issue that there's actually seeking outside help. And that's another step that indicates there's something serious going on.

RUSHKOFF: : And that's how they classify homosexuality in the DSM-IV. It's not a disorder unless the person is going to a psychiatrist saying, I have a problem with my homosexuality. So it's kind of like, most controversial

BLOCK: Most homosexuality isn't a disorder...

RUSHKOFF: You know when they argued how to get it in at the time, they decided it would only go... With any controversial, or at the time controversial human behavior, you know, it's only defined as a disorder if the person sees it as a problem themselves.

BLOCK: Yes. Let me clarify what I'm saying. One of the lead criteria for any of the diagnostic, um, all the diagnoses in the DSM, is it has to be a problem. It has to result in real pain or suffering. And so, yes, if, uh, you have to be in a substantial amount of distress in order to have anything diagnosed.

RUSHKOFF: So maybe you could share with us, what does a typical patient, with an Internet, with a pathological computer use problem, I mean, how do they present themselves to you?

BLOCK: Usually the computer use is what we call egosyntonic. It makes people feel better. And it's often what they're using to avoid some other issue in their life. So, for example, somebody may have major depression. Be very, very depressed. And be isolated in their home. And the only way they're getting out is through virtual reality. Through the gaming or the computer use. Or somebody might have an anxiety disorder, panic attacks. And be afraid to get out to the stores. And the only way they're getting out is through the computer use. So what people often present for is not the computer use. Because they like that. That's the one aspect that they feel frees them up. But instead they present for the other disorder. Which we call co-morbidity. There's some other issue going on that they're presenting about. So the co-morbidity for compulsive computer use or pathological computer use is about 100%. Almost every patient I've seen has something else going on that's diagnosable. Major depression, anxiety disorder - the list is huge. And it's not a 1:1 mapping. So it's not as if every, you know, every case that I see is, uh, also has, um, major depression.

RUSHKOFF: Does this mean they would have had this thing had no computer existed? Would they still have had this?

BLOCK: If no computer had existed... it's not clear which came... Well, there's two issues. One is, which came first? Did the computer use come first, and therefore they became isolated and depressed. Or did they become depressed, and then the computer use kicked in as a response to that? And it varies from person to person. That's not always clear, and you have to take a history and talk to the person pretty intensely to figure that out. What is certain is that the two issues complicate one another. So if you're trying to treat depression, one of your goals is to get the person out f and functioning back in society. And if you're treating it but not aware that they're using the computer, and that's how they're getting all their relationships at present, that's going to be a resistance and a difficulty in terms of the treatment of the depression. So one of the reasons why I think this is a very important point of start to clarify or really codify in our research criteria is it complicates the treatment of these other disorders. It's not simply a variant of the disorder, it's a whole other entity that complicates the treatment of the disorder.

RUSHKOFF: Or in some cases even serves, temporarily, as the treatment for those disorders. In other words, someone who's a shut-in with some, you know, disorder, or some stress, or some phobia of going out. They can start to converse with people online as maybe a baby step towards socializing in the real world?

BLOCK: That's correct. It act as a support. And the question is, when you see that occurring, how aggressively do you want to take that away? If you take it away, the person can really dissolve, because currently, that's their entire social life. That may not be optimal. Maybe shooting for someone with anxiety disorder to get back out their and have relationships in the real world, be able to go back to work, but if you suddenly remove their one conduit to that, which is the computer, then you might destabilize them.

RUSHKOFF: And what's the sort of normal course of treatment? I guess it's different with every person depending on what they have. But, um, I guess, what have you learned in treating as many people with computer-related disorders as you have... I mean, what, what sort of specific treatments have you developed or have you found useful, unique to this?

BLOCK: I think it's very challenging to treat. And it's challenging for several reason. The first is, as I said before, it's egosyntonic. People like doing it. The games, the computer interaction, the social networking site, all those are designed to be entertaining. So we're talking about something that's designed to pull people in, and so it's hard to get people to stop doing it. The second thing is that, uh, again, much of their social life or much of their, well, much of their social life is swept up in the computer. So you're asking somebody to completely change the way they've structured their life. And that's time-consuming and difficult. And the third thing is, that computers are present everywhere. So it's not like you're telling somebody, you have to avoid going to a certain place. For example, people with alcoholism, we tell people to avoid alcohol , avoid bars. With technology, that's very difficult to do. How do you avoid your cell phone, how do you avoid computers, especially if they're required at work or at school. So it requires building up a certain degrees of self-restraint.

My experience, first thing you need to do is, get everybody on the same page, that this is a problem. We have to both agree it's a problem. And sometimes I'm wrong. Sometimes I think it is a problem, and the patient convinces me, no, this is more of a support and useful, and I want to continue it. Well, OK, but, in those cases where we both agree it's a problem, then at least we can figure out methods and way in which they can reduce use.

RUSHKOFF: What's the difference between treating an adult who comes in with a problem with Internet porn, and a kid who comes in with a problem with Internet gaming? Is it the same basic treatment approach?

BLOCK: It's interesting because, kids will often very readily talk about their gaming. There's not much stigma with gaming. So they'll talk about that with the therapist. They won't talk about the porn. Adults, on the other hand, will very readily talk about porn use. Because they know that it's something that is, society's viewpoint is that it's a problem, and so they're seeing a psychiatrist to talk about that problem. They will not talk about the gaming. The gaming is almost, uh, even more shameful in their viewpoint, from their viewpoint, than the porn is. So I think the first step for the adult is even get them talking about the gaming, which is very tricky. Or the kid, it's to get them to talk about their porn use. Um, sorry, though, I think I lost track here of your question.

RUSHKOFF: Is it the same basic treatment approach with the adult who comes in, "I can't stop my Internet porn," and the kid who comes in and his parents say, "We can't get him off, out of Doom." Is it the same basic, is it the same treatment that you do?

BLOCK: It is the same basic treatment, which is essentially recognizing that there's a problem, and trying to figure out then how to best deal with the problem with that particular person. How to cut back. What is the purpose of the gaming? What are they avoiding with the gaming? They understand this, but the computer gaming, or porn, for that matter... aggressive impulses...

RUSHKOFF: Hold on a sec... The latency on this connection... we should call you back.

[DIALING SOUND. No answer.]

[DIALING SOUND]

RUSHKOFF: Call refused.

[DIALING SOUND]

RUSHKOFF: This is part of our show. This is perfect. Call refused. Oh, now he's calling us. I'm gonna answer. Monkey Man, is it you? Monkey Man! Monkey Man? Monkey Man?! Connection lost? See, there was a thing. That's that. This is why I hate the Internet! This is why I hate the Internet! For every connection that I make, wonderful, heartfelt, loving, warm, human beings connection, there are 8 or 10 disconnection experiences that more than compensate for the love. Monkey Man! Monkey Man? Monkey Man! Monkey Man! This is Douglas Rushkoff! Connection lost! Monkey Man!

[MORE ATTEMPTS TO CONNECT, DISCUSSION OF OTHER WAYS TO VIDEO CHAT].

RUSHKOFF: That's almost the way to go if you have a problem with this stuff. If I imagine that my iChat was going to be down for 24 hours, how would that affect my life. You know, is the way I answer that question sort of significant in whether or not I have a problem?

BLOCK: Yeah, I have a little tale about that, but you're not showing up on my screen. You have video of me?

[ADJUSTMENT MADE]

BLOCK: You know, one of the things I ask people to imagine... let me back up. There are three things that the computer, for somebody who obsessively or compulsively uses the computer, there are three things that they get from that. First off, it becomes a time sink. It's something that they spend a tremendous amount of time in, maybe 30 or 40 hours a week or more. Which is time they don't have to spend occupying themselves doing something else. Anything else. The second thing it does is it provides a relationship, and this is as real a relationship as one you might have with a girlfriend or a boyfriend or whatever. In the best example I have of that is something that you were suggesting a moment ago, that, imagine if your hard drive fails. And I don't know if that's ever happened to you, but how that feels. And now imagine if your entire life is spent in front of that computer, using it, how that might feel. So it's, it is a very real relationship that is formed with the computer. People that are heavily into it know what the tics and the little sounds are, the hard drive, they know when something's wrong before the computer tells them something's wrong. They know it intimately.

The third thing the computer provides is a way to deal with emotions. So emotions like anger, sexual frustration, that are difficult, at best, to deal with in real life, and often lead to turmoil if you try to talk to someone about them. So instead of talking, or instead of dealing with it in real life, they go to the computer, and they exhaust themselves and deal with those emotions there. Now the problem is, if you abruptly cut the cord, or cut someone off the technology off computer, all of a sudden, they've lost one of their most important relationships. They have no way to deal with the emotions they've been sequestering into the computer. And lastly, they now have 30-40 more hours to fill, doing something. And so often what you see is a real, uh, a person really dissolves and they become very enraged outside themselves or at themselves. Sometimes suicidal or dangerous to others.

RUSHKOFF: So what do you do, you taper?

BLOCK: It's tricky. Um... one solution is you slowly tape over time. Another solution is you take people and put them into a camp, or someplace where they don't' have any technology available, but you fill their time, you fill their day as intensely as possible, and as exhaustingly as possible, so they don't have the opportunity to sit back and think about how angry and frustrated they are at that point. And that, I think that's been the experience that's been tried in China and in Korea. Where they have camps where they send kids off to, and their experience has been that one week being sent... sending a kid off for one week isn't long enough. That what you tend to do is engender some of that rage that we were just talking about, and maybe it needs to be longer than that.

But the problem is, even if you do send them off to camp, you haven't really changed the behavior. When they come back, what's to stop them from going back to the computer and using?

RUSHKOFF: We're talking about that the camp's not long enough. And more importantly, when you bring the person back to their life, I mean, you look at our story in South Korea, and I look at that little boy's life, and, um, the Internet's a character in his life. But, you can tell even in the short time we spent with him, there's a lot else going on in that kid's life that would really need to be addressed in a therapeutic setting besides a relationship to the keyboard. S in an extended therapy, or in real therapy, as it were, do you, I mean you have to, right, get involved in the entirely of a person's life rather than just this one aspect.

BLOCK: My training is as an analyst, a psychoanalyst. So I tend to get pretty deeply involved in what is going on in that person's life. And the computer's just one aspect of that. I think, you know, my emphasis on the technology, on the computer is that we've neglected that, or not dealt with that as a profession, and it's increasingly becoming a thing of concern. It impedes treatments when people are excessively involved in the technology, and it prevents them from getting out in the real world. An d that I think is an important education point for other therapists. And an important thing to start to factor into our treatment plans for people.

RUSHKOFF: So you think of it in a sense as almost as a sign of our times, of our era. That, you know, there was a time when they didn't even take diet into account is psychotherapy. Or, uh, the body, or nutrition, or anything. That this is another players. Obviously, for our purposes, the role, the influence, the sort of cause-and-effect influence of the computer, which is almost impossible to parse out from the entire ecology of a person's experience, but we're trying to figure out, what, you know, what is the computer doing? Or what is the Internet doing? What is this technology doing that the various software or worlds it's introducing don't do by themselves. So someone might be an Internet gambler, or an Internet prom, or a computer gamer, who before was just a gambler. Or a magazine/video porn addict. Or a fantasy role-player with other kids, playing Dungeons & Dragons. In other words, what, what does the computer do? What is the computer's flavor from your experience? Does it just magnify these kinds of things that people would normally or already be, have compulsive relationships to? Or is there, is the medium itself something different? Does the medium have its own sot of agenda or bias with us?

BLOCK: Conceptually, there's a lot of way to think about what needs the computer is meeting that makes it such an attractive medium for people. When we're talking about, for example, I'm going to walk you through a few of these different theories as to what makes the computer, the technology, so attractive. So one idea is, and this is primarily around the sexual use of the computer, the Three A's. The computer gives the appearance, and the Internet use of the computer gives the appearance that what you're doing, excuse me, what you're doing is Anonymous, it's readily Available, and it's Accessible and cheap. So the Three A's. Um, uh, and that, uh, makes, if you have a porn, a tendency to porn, that makes porn, uh, uh, seem attractive. Because you can get it anywhere you want, you can get it at very little cost, and it seems like you're doing it anonymously. And that may not be the case; any of those may not be the case. But, unless that's the appearance. So that's the model around the sexual addictions that occur on the computer. Um, a different model, a developmental model, that an analyst might look at, is if we're looking at adolescence, where, and that's where we see a big kick up in the computer, in the amount of time spent on the computer, adolescents are struggling with issues, we're talking generalities here, but male adolescents are often struggling with aggressive impulses, and they're sexually [unintelligible] who they are as a person, who they like, they're experimenting with relationships, and tremendous amount of aggression, tremendous amount of hormones. And tremendous amount of sexual impulses.

And so you look at what boys are attracted to. They're attracted to games where there's a lot of competition, a lot of aggression. And if you look at what they're talking about as they're playing, they're using Voice Over IP, or they're typing, it's often sexually charged comments. So you can see why the games fit, the activity they're doing fits what they're struggling with. Likewise with girls, they're often struggling with body image issues. Girls' bodies are developing, adolescent age, they're starting to develop breasts, their menstrual cycle for the first time. Struggling with their appearance, the changes in their appearance, what is appealing, what is not appealing. And so they tend to gravitate more to the social networking sites, where you can get a quick bead on how popular you are, or how your image is perceived by other people. So we see, um, developmentally, you can see an attractiveness of these two medium, and why people differentiate to one or the other.

There's other models, but [laughs] those are two good ones to chew on.

RUSHKOFF: Is there, is there something sort of intrinsically wrong or dangerous about spending time in virtual worlds?

BLOCK: It's not an issue of being wrong or dangerous. It's an issue of, um, how intensely one is getting involved. Uh, one of the things that... I, uh... I, this is a new... this new technology has repercussions. And the repercussions are both positive and negative. And there's been a recent study looking at, uh, surgeons. And the more skilled surgeons, uh, are one that, uh, in this particular study, the more skilled surgeons were the ones that were computer gamers, because their hand/eye skills were particularly good at using the fiber-optic methods that were being sued during the surgery. So that would be an example in which the video gaming, in this case, uh, was helpful. Um, likewise, uh, those people that are heavily involved in computer use are probably more familiar with computers more generally, and have more comfort with using them in the workplace. So, you know, in the 21st Century, that's important. Um, on the negative side, what concerns me are those people that compulsively use, and that becomes their life, where they prefer the virtual over the real. And there's confusion that can occur in some cases, between the virtual and the real. Which is more important to you? Which is more valid?

RUSHKOFF: I'm starting to feel that the Internet is asking a lot of me. In other words, if I've got a phone, and it's beeping with people's messages, and my boss's message and my wife's message and this, unlike lining my socks up in the drawer, my socks don't ask me to line them up in that special obsessive-compulsive way, so I don't do it. But the computer, it's as if the Internet is driving compulsion. It's not just there as a neutral platform on which I express my OCD. It's almost OCD, an OCD instigator or catalyst, isn't it?

BLOCK: Um, well, there's for example, a recent story in the Washington Post about a young girl who was IMing on her phone, every 10 minutes, roughly, every waking hour of the day, of each day of the year. So...

RUSHKOFF: I hear that, and it doesn't sound like a lot.

BLOCK: One IM every 10 minutes. For every waking hour?

RUSHKOFF: Well, one every 10 minutes. What if you do 6 in a minute, and then you can let the rest of the hour go, right? It would average out. Most... and most kids I see walking around the street, when they're not in class, and even when they are, they're IMing. I mean, isn't that what they do?

BLOCK: Uh-huh. Um... I don't know, we don't' have standards to know yet what is normal with the number of IMs and what we consider pathological and what we don't. You know, just from this example, to me it sounds like 5,000-something IMs in a month, sounds like a lot. But uh, uh, I think others might argue with that. Uh, uh, but your point is, does this, does the computer kind of fit into compulsive behaviors people have, either further them, or uh, um, um, uh, make them worse, I guess. I mean, I think it is a compulsive... I think it can be a compulsive behavior, in and of its own right. Uh, and it's a new manifestation of compulsion. Um, so, that's the best I can say.

RUSHKOFF: You look at the rise of the computer into our lives. The PC and the hand-held, and - do you look at it as a public health crises? Are we more mentally ill because of this stuff than we are empowered?

BLOCK: I look at it as a large, a 50-year social experiment that we're conducting, without even knowing we're conducting it. I think that we've introduced a very powerful change to the fabric of society, the developmental aspects of adolescents, young adults, and we don't know the repercussions, positive and negative, well enough. So I think that it definitely needs more study. Is it a public health crisis? Um... not - I don't think yet. I think, I think we need to do, we need to substantiate it more as to what the repercussions are before we can say it's a crisis. And I think there's other things clearly that deserve a tremendous amount of attention. And that is something that compete for that issue, that title.

RUSHKOFF: So is there a nightmare scenario for you? Is there, do you have a fear if this relationship to people and society and our computers isn't addressed, Is there, what's sort of the worst-case scenario down the road, that we're all walking around in some autistic haze? In other words, where do you see it going if we don't look at these issues?

BLOCK: Well, I think, if I were to... now this is pure conjecture, OK? But if I were to extrapolate what I think is happening. Personally, what I think we're doing is, we're delaying adulthood for many children. That childr--- that part of adolescence is rebellion from parents. And expressing aggression and sexuality. And instead, um, that aggression and sexuality is being turned into the technology. Or is being covertly expressed. So the kid is in the back seat, text-messaging about their parents and what doofuses they are. But that anger, rejection, is not occurring directly. So what's happening - again, this is conjecture, but what I think is happening, is there's a delay in the normal development of adolescence into adults. Where they need to, uh, in some ways reject the parents' authority and power, and become their own individuals. And instead, they are rejecting it covertly, the rage and sexual impulses are being turned into the computer, and you don't see the division between the parent and child that might otherwise have occurred. Um, I also think that may have repercussions of decreasing externally expressed anger and sex, so you may have actually a decrease in, for example, pregnancies in high school. You may have a decrease in the extent of violence in youth. Um, and uh, however, it may also produce periods of psychotic violence, where people get confused about what is real and what is, uh, not real; what is virtual, what is real. And you may have a resulting increase in psychotic violence, such as the shootings as Virginia Tech and things like that. 00:44:50

RUSHKOFF: It almost sounds like the cure, if you've got an adolescent... if you're got a teenager playing too many video games, is, you know, give him the keys to the car, say, go on, get laid, get drunk! You know, rebel against me! Is that, in some sense, the cure?

BLOCK: Well, I think one of the things you need to pull into treatment with an adolescent, is you need to let them know how they're handling their anger and frustration. And that, uh, there are other ways to express it. And certainly you don't want to encourage them to do something destructive. But nonetheless, part of growing up is getting out there and making some mistakes and taking risks and exposing some of those impulses to the real world.

RUSHKOFF: I know, it's strange to think of parents being in the position of promoting their kids' rebellion. And once we are doing that, then is it, you know, the jig is up also because it's no longer rebellion them. Tricky. You saw the piece that we're putting together on Korea.

BLOCK: I haven't seen that yet.

RUSHKOFF: It was interesting; the main thing they seem to be doing in these camps is physical contact. They have these gorgeous, you know, college-age female counselors, just touching these boys constantly, almost as if to wake up their, their more normal sensory impulses. Get them to have crushes on them. To show them, look what you're missing in the physical world, you know?

BLOCK: Uh-huh. Uh-huh.

RUSHKOFF: It seems consonant with the kid of therapy tat you might prescribe, too, though. Just how them how they can replace things they're getting online with things in the real world that might satisfy these urges more deeply.

BLOCK: Uh, yeah, I try to highlight how they're expressing sexual needs or aggressive needs through the computer, and that there are alternatives to that in the real world. Um, and that how they're also trying to avoid arguments or fights with their parents which may need to occur. I mean, in the same way, this doesn't just occur with adolescents. It occurs with adults, too. You look at couples who are having trouble. Often one of the two of them will turn to the computer and express their frustration or rage through the gaming. And lose contact with their spouse in doing it. And it may, in fact, be functional for a period of time. It avoids the big argument and a blowup between the couple. But if it's used as the primary defense, the primary way to avoid [unintelligible] issues of the marriage, then eventually the marriage loses a great deal of intimacy and it may break up.

RUSHKOFF: You know, at the same time, from our experience in Korea, it seems like Internet addiction is a much bigger deal there. Uh, with a much huge percentage of the population there, than here. And I know you wrote a piece on that as well. Why do you think it's happening there in a way that it isn't here?

BLOCK: I don't think that's true. I think it's equally a problem here. I think it's recognized there. It's a public health crisis there. They've, uh, defined it as that, they've seen the number of deaths that have resulted from the computer use. There's over 10 people that have died in the PC things that, places where people play the games there. So it's a highly visible issue in Korea. Likewise in China, it's considered a major crisis there. Their estimates as 12% or more of adolescents, they think are addicted. In the U.S., I don't think it's any different. The use pattern is different. We don't tend to play in PC... in Internet cafes. People have their own computers. So it's more invisible. And if someone were to, and if a 30-year-old man were to die in front of his computer. It may never be linked to the computer use, because he's in his own house, as opposed to an Internet cafe. I would like to see a study of pulmonary embolisms, which are, uh, blood clots that can form in one's legs, for example, and pass to the lungs, and are often the cause of death in these, in South Korea. I'd like to see that study in the U.S., see if there's an increase in pulmonary emboli that have occurred. But we're not there yet.

RUSHKOFF: And on the other hand, we seem, you watch mainstream media, we're more concerned about it than ever. And ready to blame Littleton, CO on violent video game playing. It seems like the media and, the media's pushing Internet addiction hype, you know...

BLOCK: You may be aware, you may or may not be aware, I've written a paper on Columbine. Um, which I believe is what you're referencing there. And I think the proper way to understand what happened there was not that the exposure... wasn't the exposure to the violent content that triggered the rage in those kids, as best as I could make out, but rather, the attempts to limit them from accessing the technology. Remember that, um, uh, theory that I presented to you earlier, where people are stabilized because they're spending 30-40 hours playing the games. The game becomes a significant other. And, lastly, they throw their emotions into the computer. Well, if you cut somebody off who's already somewhat fragmented and is living between the virtual and real, and can't figure out which one they like. You cut them off, suddenly they have a lot more time. They have a lot of emotion and anger to express, and you've just cut off their most important relationship. Well, I think that's in part what happened, a part of what happened at Columbine. Is that the kids were restricted from accessing the computer, and at that point became enraged and decided to strike back.

RUSHKOFF: It's hard to know in that case, did the computer create the problem, and then it exploded because it was taken away, or was the computer kind of a healthy catharsis. I mean, we do know from studies that your typical rampage killer is less likely to play violent video games than an average member of the population. You know, does that mean that they're releasing some healthy violent rage that they can't get out otherwise?

BLOCK: Well, I'm not aware of that study. So I'd be interested in seeing it. Uh, but, uh... sorry.

RUSHKOFF: It was just a New York Times piece where they went through all the rampage killer of the last, you know, 30 years, and found out, you know, so few of them actually played violent video games. Like two out of all of them. Which is less than it would normally be. Um, something else you said in your AJP editorial is that the most interesting research on Internet addiction has been published in South Korea. Why do you think that is? Because they made it a public health crisis? And why, why are we lagging behind in that?

BLOCK: They have funded an enormous effort to explore the issue. First of all, South Korea is one of the most connected countries in the world. I believe it's the most connected country. So that most houses have Internet connection, almost everybody has Internet accounts. Um, and, uh, uh, the Internet is considered critical in that country. So, um, uh, that they're exploring the impact of that, and they've seen dramatic changes in their culture in the past few year. And that they're exploring the impact of that is not surprising. Also, let's remember that South Korea that has the ten documented deaths for people who were playing 40, 50, 60, 70 hours straight. And just keeled over. These are young men that had no other health complaints that shouldn't have died, but they did. Um, that being said, uh, South Korea has funded four different governmental commissions to investigate he issue. There's a commission that looks at how to deal with it from an education standpoint, there's a commission that's been formed to discuss how to deal with it from an epidemiological standpoint, so they've gathered data on it. There's a third that's looking at treatment. And then there's a fourth commission that's an oversight commission that coordinates the other three. So they put a tremendous amount of energy into this. Now, they're not alone. If you look at China, they're also funding a tremendous effort nationwide. They've set up a number of hospitals, there's one hospital that's only treating Internet addiction. Um, and, uh, if you look at Taiwan, you also see someone. So, why Asia? Well, Asia's, the majority, I believe at this point the majority of Internet users are in Asia. So as much as we, uh, we have, um, absorbed high-tech in the West, remember, there are many, many more people in Asia and the actual penetration, the use of the Internet, is greater in Asia. And then, I think, they've seen tremendous cultural change as a result of their adoption of the technology. And therefore are more prone to look at it and investigate its impact.

RUSHKOFF: I feel like in the U.S., we don't know whether to ring the alarm bells if something's wrong, if something bad is happening, to sign more petitions to get more funding for wi-fi, public wi-fi. It feels like, in America, we're in some sense, lagging in both areas. I mean, your work, your work I think it's seen as particularly controversial. Because you're trying to get, or trying to keep, or at least, because the whole notion of introducing the Internet to DSM, to standard categorization of the psychiatric or psychological illness is, I don't know, it seems like the rest of the profession is afraid to go in that direction, as if it represents a threat on some level. Do you understand what that's about, where the resistance is?

BLOCK: I think that there's a valid debate about whether we should include this in the diagnostic manual. And the debate centers on several things. One is, um, we don't want to dilute the diagnoses we have by adding ones that seems trivial or, uh, um, controversial. We want to make sure the diagnoses we have have merit, and are based on science and fact. And I think that we're, with regard to the compulsive computer use diagnosis, I think we're there. We look at the data that's coming out of Asia, and we look at the data that's coming out of some of the studies that have occurred in the United States, there's clearly a problem. The question is whether to create a whole another diagnosis to deal with it our to characterize it, or do we produce a sub-set or a qualifier that's attached to, say, major depression or panic disorder. Panic disorder with compulsive computer use. That, that, that'd be an interesting option. I don't advocate for that. Because I think it's enough of a treatment problem in my experience it's very difficult to get people off of it. It's enough of a treatment problem that it would justify its own diagnosis. Um, however, remember, we're talking about 100% co-morbidity. So there's always some other, almost always some other diagnosis that occurs along with computer use.

So, uh, uh, uh, well, I guess it gets to the second issue which is that people are concerned that by creating these other diagnoses, we're just looking for funding streams. We're looking for money for treatment. And that doesn't really have any validity, because there's always this other diagnosis that you can bill insurance for. There's o problem billing insurance for the treatment of major depression. Or anxiety. Again, there's almost always some other diagnosis. It's really an issue of the resistance to treatment that we're trying to get at. Now, um, the other concern with the diagnostic manual is that it is used by other entities such as insurance companies. But really, the primary purpose of the diagnostic manual has always been research. It's always been there as sort of the psychiatric playbook, here is what we acknowledge are diagnoses. Here's what we define major depression as. So if you're going to do a study on major depression, you have the criteria right in front of you, and everybody's talking about the same thing.

RUSHKOFF: But that goes back to funding, though. But that goes back to funding, though. And revenue. Because once you have it in there, it's like, well now, can't we get Rockefeller to give us some research money to look at this official diagnostic code of Internet addiction.

BLOCK: Well, yes and no. It, it, it's easier to research something if everybody agrees what it is. And so you don't have to debate, are you using the right criteria? Um, uh, you still, though have to go to some funding source and convince them that your study's worthwhile. And that it's worth spending money studying the compulsive computer use as opposed to another study on, schizophrenia, you know? You have to show somebody that this is a legitimate use of money, and a reasonable thing to study. But, you know, a lot of our debate right now, and a lot of the reason our... well, frankly, a lot of the reason the research in the West is stunted right now, is that we don't have one set of criteria that we say, yeah, this is compulsive computer use. You asked me earlier, what does Korea have that's really fostered their study of this. One thing they have is a research instrument called the K (sp?) scale which is a testing instrument that detects compulsive computer use. And it's, um, tested pretty thoroughly, and is probably the most legitimate scale we have of the study of the issue. The problem is the K scale is culturally specific to Korea. So it can't be applied to the United States or elsewhere. But that's, you know, essentially if we had a DSM criteria, we would have our equivalent of the K scale.

RUSHKOFF: Isn't it, then, a little bit too early to be talking about the DSM?

BLOCK: We have several proposals for criteria that have been tested. But people are debating which one is better, what their efficacy is, how useful they are. We need a more of a, I would say, within the national debate, we need to have more of an authoritative, this is the criteria we're going to use for right now, until we can refine them, this is the definition.

RUSHKOFF: On the face of it, isn't it a little bit horrifying to most Americans? We've been told for a decade, get our kids in front of computers, and they're going to get better jobs if we get them in our homes, and it's this great educational tool. And all of a sudden, the Internet is something that's in the DSM, the computer is in the DSM as this addiction, sort of along with gambling or porn or something else, mightn't that just be a little too horrific for us to wrap our heads around at this point, after letting the Internet spread like this, and come into our homes uncontested?

BLOCK: Um, I don't, I don't, I can't read the minds of the American public. But I don't think the DSM as a PR instrument, as something that psychiatrists should be debating whether American public's ready to hear something could be a problem. I don't think that's what its use is.

RUSHKOFF: What I'm trying to do is figure out, why is this taking so long? I mean, we've, the Internet's been around for 20 years. It's been studied, in America even, for a good 10 years. Why can't we agree on, on criteria at this point?

BLOCK: Well, first off, the DSM is going to be issued in 2012. So it's currently being debated very adequately whether or not to include this, and whether the studies warrant it. So I don't, I'm not sure it's taking too long, it's part of the publishing thing schedule. This thing comes out in 2012. The second issue is, understand that most psychiatrists who...

BLOCK: So as part of that company that we formed, there was a patent we applied for that's still pending. And that's software that would allow one to control access to gaming system. Now, the company is no longer, the product is no longer, the patent is still pending. But I can say what still needs to be done, in my opinion, is a tool needs to be produced that people can put on their own computer, that they can self-select that they want this tool installed, that will allow them to set limits on their technology. That will allow them to set limits on the amount of Internet gaming they do, the amount of Facebook time they do. And will cut them off. It should be reversible, so they can change the set limit, but that should be a time-consuming process or somewhat difficult process, to back out of the parameters. And I think that would be a world of a difference, that would allow people a tool. Because generally people who have compulsive computer use know it. And they are looking for something to help them put restrictions on themselves. If they could download a tool and install it, that would be a big boon.

RUSHKOFF: So, does it, does it represent a conflict of interest to you in terms of researching this on the one hand, and having a potential revenue source on the other?

BLOCK: Uh, uh, I suppose that because it is a potential conflict, if only it were a conflict [laughs]. I could tell you, I'm waiting on the Patent Office for several years, and even if the patent comes through, God knows what it's worth. You know, currently I'm not holding onto a lot of hope for anything on that front. But, you know, I think some people might think of it as a conflict, and that's why I exposed it.

RUSHKOFF: But you feel like you'd still promote the use of this kind of tool, whether or not you retain the patent on it.

BLOCK: Well, I'm not as lawyer, and frankly, the patent was applied for by the company, and I'm kind of distanced from that. But uh, I don't even know if what I'm suggested is needed would fall under the purview of the patent. If it's awarded one.

RUSHKOFF: It's the question I feel I have to deal with in every documentary I've worked on or book I've written. It's sort of the so-what question. Well, what's different? You know, from Cervantes writing about Don Quixote using the novel, and going off into fantasy to parents I the 50d or 60s worried that her kids were going to have these reactions rock and roll, and there were credentialed psychiatrists at the time worried about the ecstatic experience and what it's going to unleash in children, to now the Internet. Is this just our generation's technology, or is this something more significant?

BLOCK: It's a good question. We've had our panics around comic books. And with the first movie being shown, that was a big panic. And radio, even, produced real crisis of, oh, my goodness, what's this doing to our youth? Is the same thing happening around technology? Um, or around computer use... Uh, you know, I think we've now started to see real significant health effects in our patients that are hard to ignore. Um, so I would argue that it's a different beast. It's a different thing.

RUSHKOFF: And can you, because this is what I was working on, for 20 years, can you qualify from your experience, what's the difference... because the computer not alive. Right, it's not a living thing. But at the same time, there's something about these technologies. The feedback, their ability to change... [FEEDBACK NOISE FROM THE SOFTWARE] to alter themselves based on what we do, that makes them more pernicious. That makes them more... [FEEDBACK NOISE].

BLOCK: See, the technology right now is trying to cut off your question.

RUSHKOFF: Yeah, it knows!

BLOCK: It knows. [laughs].

RUSHKOFF: It's easy to anthropomorphize it on that level, but there's something about it that's drawing, that feels that, unlike a television or a radio or a comic book, that this technology reaches out and sort of grabs you by the lapels, and is categorically, fundamentally different than what went before it. I mean, have you had that sense of it?

BLOCK: Um, it's not passive in the way that, like TV, or watching a movie is. It is in part under your control. I mean, there's a real sense of control when you're using technology. And a sense that you're dealing with, perhaps, a partner, that if you do everything right, they're going to do everything right. And so it's a matter of getting, figuring out the puzzle, and making sure everything works. So it's a back and forth. Much more so than many other forms of media.

RUSHKOFF: Do you think that the implicit covenant between us and the technology is just one-way, though? That we expect, if we do everything right, that it's all going to work out in our favor, but the technology isn't not making that agreement at all, is it?

BLOCK: Well I think people feel betrayed when the technology bites them. Um, I, uh, I mean, I think that's part of the confusion about that happens about virtual reality. People get very enmeshed and immersed in that, in those worlds. And then, um, something unjust occurs. Or the technology lets them down. Or the world behaves in a way that's not fair. They get very enraged and angry. And it's, you know, in some sense, you expect, um, uh, problems and uh, issues to come up in real people's interaction with you. But when you're dealing with the virtual, it's, um, it's supposed to be fair, and uh, it's supposed to be, um, logical. And when that fails you, people can get very upset. I don't know if that's kind of muddled, but, uh...

RUSHKOFF: I understand what you're saying.

RUSHKOFF: I'm sure we'll be back in touch. This was great. Thanks so much for doing it this way.

BLOCK: All right. Take care.

RUSHKOFF: Bye.