Internet Gaming Disorder, Illegal Electroshock Therapy, and Gaming Culture in China

I would like to preface this by saying this blog post will touch on sensitive topics like suicide and self-harm. Please click off of this post if it is uncomfortable for you.

What is Internet Gaming Disorder?

The American Psychological Association (APA) considers Internet Gaming Disorder (IGD) to be a disorder warranting more research and attention - but did not include it in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), citing insufficient evidence. The World Health Organization, however, considers it a disorder, including it in the International Classification of Diseases (ICD-11). The ICD-11 defines IGD as lack of self-control over gaming.

Symptoms of IGD include the irresistible urge to game, gaming affecting sleep, school and memory,

Since the APA does not consider IGD to be official enough of a disorder, the diagnosis has not taken off in the United States and most of the Western world. But up to 10% of Chinese adolescents have IGD, according to a recent meta-analysis. Higher prevalence of IGD is reported in Asia, but is it really because Asians are predisposed to IGD, or because the disorder is a common diagnosis in Asia?

Why is internet gaming a problem?

Past research has found that internet gaming disorder might contribute to the following bad mental health consequences for youth: academic decline, sleep deprivation [12], interpersonal relationship problems, family conflict [13], physical health problems, loneliness, suicidal ideation [14], aggression, depression [15], social withdrawal, dissociative experiences [16], cybercrimes [17], and future decline in workplace competitiveness [18]. Therefore, as of 2018, the World Health Organization formally enrolled internet gaming disorder as a mental disorder. Accordingly, there is a strong need for diagnosing IGD earlier and providing effective early treatment strategies for gaming-addicted youth.

Gaming Cafes

Gaming/Internet Cafes are incredibly common in China, especially for young people. They are places for young people to eat and have a safe space to sleep at if they are kicked out of their home. Unfortunately, breaks are not enforced, and there have been instances of people dying at the computer.

Although youth under 18 are not allowed, these rules are not strictly enforced, and owners desperate for more money are seeking customers wherever and whenever. When I visited China last summer as part of my internship, I was able to enter one of these dingy cafes, situated in the top of an otherwise futuristic mall, even with the large signage in the front saying "NO MINORS ALLOWED" in messy handwriting.

These spaces are not necessarily harmful - in fact, "third spaces" are often important to young adults and older ones alike. However, the lack of government regulation on these cafes is abhorrent, and more should be done regarding illegal activity.

Yang Yongxin

Yang Yongxin’s story is a cautionary tale for neuroscience, one that shows in stark detail why ethicists need to be more than fringe consultants in this field. Yang, a Chinese psychiatrist, became known for treating adolescents reportedly addicted to the Internet using electroconvulsive therapy (ECT) without anesthesia or muscle relaxants. He claimed tremendous success rates and had official recognition, yet investigations revealed deeply troubling practices: patients (many minors) allegedly subjected to ECT as punishment, involuntarily committed, deprived of informed consent, living in quasi-military conditions, and in some cases harmed physically or psychologically. Despite a ban by the Chinese Ministry of Health on his methods (insofar as using ECT for “Internet addiction”) due to lack of scientific evidence and ethical violation concerns, Yang later introduced a variant called “low-frequency pulse therapy” said by former patients to be even more painful.

What Yang’s case underscores is that neuroscience isn’t just about what we can do (or think we can do)—it’s about what we should do, under what conditions, with what oversight, and for whose welfare. Scientific ambition, especially in dealing with mental health, brain stimulation, addiction, or emerging therapies, must be held in careful balance with respect for human dignity, patient consent, justice, and safety. And that is precisely where ethicists must be woven into neuroscience projects: in the design of interventions, in consenting protocols, in regulatory oversight, and in public accountability. Yang Yongxin reminds us that unchecked neurological intervention—especially with vulnerable populations—can slide into practices that violate basic human rights. More ethicists embedded early in neuroscience research and clinical translation would help guard against such harm.