Internet addiction.
Galton Shen (沈德修) vividly remembers the first time he treated a patient whose suffering was linked to an addiction to the Internet. “He was a young man, just 22, complaining of severe constipation,” says Shen, a physician who shares a clinic with another doctor in Changhua County’s Beidou Township in central Taiwan. “I’ve treated every member of his family over the years, so I knew something about their lifestyles. I asked him some questions about his diet and habits, and it was soon obvious that his problem was a result of not eating regularly and not eating healthy foods,” recalls Shen. “This surprised me because his parents grow their own vegetables.”
The next day, the young man’s mother visited Shen—to discuss her son’s health rather than her own, it turned out. “Pretty soon, I got a clearer picture of what was happening. He wasn’t working or studying, and he was spending at least 100 hours each week in an Internet cafe. Whenever he felt hungry, he’d eat instant noodles or some junk food. He wasn’t drinking enough water, and he wasn’t exercising,” the doctor says.
Shen called the young man in for another consultation. “I told him he needed to reduce his computer use, improve his diet and so on. But I knew my advice probably wouldn’t be effective. I could see it was an addiction, a compulsion that had taken over his life.”
Over the course of his career, Shen has on numerous occasions advised alcoholics to reduce their drinking and smokers to quit. “With smokers and alcoholics, I could refer them to programs that might help. But with this young man, I had nothing to offer.” Within a few months, however, the 22-year-old had drastically reduced the amount of time he spent playing online games. Shen does not take any credit for this. “He began to suffer severe eyestrain. According to his mother, the physical discomfort and warnings from his ophthalmologist pushed him to change his lifestyle,” the doctor notes.
Shen’s diagnosis of the young man took place in 2003, when the study of Web addiction in Taiwan and elsewhere was in its infancy. Among the pioneering researchers in this field locally were Wang Chih-hung (王智弘), now an associate professor of Guidance and Counseling at National Changhua University of Education, and Ko Huei-chen (柯慧貞), currently dean of the College of Humanities and Social Science at Asia University in central Taiwan’s Taichung City and head of the Center for Prevention and Treatment of Internet Addiction, also in Taichung. Since its establishment in 2012, the center has been developing diagnostic criteria for Internet disorders, researching and providing treatment for addicts, and working with various nongovernmental organizations to promote healthy computer use.
When trying to gauge the extent of Internet addiction among a group or in an individual, one of the most commonly used diagnostic tools is the Revised Chen Internet Addiction Scale (CIAS-R). The original CIAS was devised more than a decade ago by Chen Sue-huei (陳淑惠), a professor in the Department of Psychology’s Division of Clinical Psychology at National Taiwan University in Taipei.
The CIAS-R comprises 26 questions that are answered on a scale of 1—“Does not match my experience at all”—to 4—“Definitely matches my experience.” The minimum possible score is 26, and the maximum is 104. The CIAS-R is also often used in mainland China and Hong Kong. Cross-border comparisons suggest problematic Internet use in Taiwan is comparable to other societies where inexpensive Web access is almost universal.
For a 2011 study, Ko and her co-authors considered a score of 64 or higher to indicate Web dependency, and concluded that the level of Internet addiction among local college students was 15.3 percent. They found Web addicts not only spent more time using the Internet than non-addicts, but were also more likely to display symptoms of depression, feel unsatisfied with their academic performance, and exhibit lower refusal self-efficacy, which is the ability to ignore the Internet when it is available. The study further suggested that Internet addicts were more likely to be male than female.
Researchers using other methods have come up with similar results. Between 1999 and 2003, Tsai Chin-chung (蔡今中) and Sunny S.J. Lin (林珊如) of National Chiao Tung University’s Center of Teacher Education published survey results indicating that around 12 percent of Taiwanese high-school students were addicted to the Internet, spending at least 20 hours online per week.
According to the results of an Asia University-National Cheng Kung University survey of more than 9,000 individuals published in September 2015, young Taiwanese spend a great deal of time on the Web. Excluding school-related online activity, those in the fourth to sixth grades are on the Internet for 57.8 minutes per day. Junior high school students are online for 115.8 minutes daily, while for senior high schoolers the figure is 147.2 minutes. These are weekday averages; on weekends, the daily totals approximately double.
There are five generally accepted categories of Internet addiction. The first is a cyber-sexual addiction to online pornography and adult chat rooms. The second is compulsive shopping, gambling or stock trading. The third is compulsive searching for and consumption of information. The fourth is the obsessive playing of computer games. The fifth is an unhealthy preference for relationships with people online rather than real-world friends and relatives.
Constantly checking for social network updates has become recognized as a form of addiction amid the proliferation of smartphones. (Photo by Chang Su-ching)
The proliferation of smartphones in recent years appears to have altered the nature of Internet dependency. According to experts, the typical addict is less likely than before to be a teenager who engages in overnight binge sessions of gaming at Internet cafes, and more likely to be someone in their 20s who checks their phone for social network updates several times each hour. Recently, Chen and her collaborators have been working to adapt the CIAS-R to investigate smartphone addiction, taking into account symptoms some users have reported, such as phantom vibration and ringing.
Early in 2015, Taiwan became one of the first nations in the world to create a law to help address the problem of Internet addiction when it introduced an addition to the Protection of Children and Youths Welfare and Rights Act that bans digital devices such as smartphones and tablet computers for children under 2. The new legislation also introduced fines for parents who allow children above this age to use the Internet excessively.
To better safeguard the mental health of students, in 2011 the Ministry of Education expanded the school counseling system so that all elementary schools as well as junior, senior and vocational high schools with 55 or more classes can hire a full-time, on-campus counselor. These guidance teachers are the first responders whenever students show severe emotional or behavioral problems.
In the southern municipality of Kaohsiung, guidance counselors pass the most serious cases on to the Kaohsiung Student Counseling Center. Web addiction is an issue staff members have been tackling since the facility’s establishment in October 2005. The center, based in Minzu Junior High School in the city’s Sanmin District, oversees seven branches around the municipality, which has a combined elementary and high school student population of approximately 313,000.
The center does not compile statistics relating to Internet dependency because the problem seldom exists in isolation. “Most of the troubled young people we encounter come to our attention because of multiple problems, one of which may be Internet addiction,” says Lo Hsun-che (羅訓哲), a psychologist working at the center. “Usually, we notice their Internet addiction after they’ve been sent to us for counseling on other issues, such as dropping out of school, poor discipline or involvement in criminal activities.”
In some cases, pathological Web use is both a consequence and a cause. Some teenagers may spend hours online because they do not get along with their peers or parents. Their online obsessions then lead to a further deterioration in their real-world relationships.
According to the center’s staff, there is no evidence that the growth of Internet addiction has led to a decline in smoking or other harmful forms of behavior often associated with teenagers. They also point out that sometimes more than academic grades, eyesight and family harmony are at stake. Several of the young people interviewed by Tsai and Lin more than a decade ago adored the Internet because it “enlarged their social life by introducing them to more people.” This is just what many parents and educators fear—excessive Internet use, combined with a poor home environment, makes a young person more likely to fall victim to Web-related deviant or criminal behavior, such as promiscuity, compensated dating and abuse.
Whenever a student is referred to the center, a case conference is convened. This is preceded by a social worker’s visit to the student’s home to gather information about the family’s circumstances. Typically, the conference is attended by the young person’s homeroom teacher, his or her school’s counselor and director of student affairs, as well as center staff. If possible, his or her parents join the meeting. Social workers, psychiatrists, special education teachers and police attend if it is thought necessary.
Lo explains that each case conference has two major goals. “Firstly, we want to quickly grasp the student’s circumstances and understand the reasons for his or her behavior. We try to determine the causes,” he says. “Secondly, we decide how the adults involved will work together. The professionals assigned to the case must hammer out a consistent approach.”
Students being counseled by the center usually receive 12 one-hour sessions. “If it seems we need to continue counseling, we’ll report that to our supervisors, and perhaps provide an additional four or eight hours of counseling,” says Lo. The psychologist describes a recent case in which he achieved some success. “The boy was in sixth grade. He often lingered outside the classroom, and his teacher found it very difficult to persuade him to come in for lessons. He frequently argued with his mom, an immigrant and single parent, and he spent a lot of time in Internet cafes.”
On one occasion when the boy’s mother tried to limit his Internet use, he ran home, went to the top floor of his apartment building, locked the door and threatened to commit suicide. “Because of the boy’s suicidal behavior, this case was immediately brought to the attention of our center. We were greatly concerned. Also, anytime there’s police involvement, we intervene rapidly,” Lo explains.
The psychologist says when he realizes Internet addiction is a factor, he broaches the subject with the student. He does not denigrate the young person’s Web habits, but rather tries in plain language and a positive manner to discover what the Internet means to him or her. It is important to establish a good relationship with the person you are trying to help, he stresses. In the case he cites, Lo says he soon discovered the boy lacked self-esteem because of his poor grades, but that his success in the realm of online games made him feel much better. Classmates who looked down on him because of his performance in tests admired his online gaming skills. In this respect, Internet dependency is different than other addictions. Lo says that one of Tsai and Lin’s most striking findings was that, “all of the adolescents they interviewed self-reported that their parents were negative toward their Internet addiction, but their peers held positive or at least neutral attitudes.”
According to Lo, there was also an economic factor in the case of the sixth grader. “The boy came from a low-income household. By playing and winning games, he was able to earn points and prizes that he then sold to others. This also helped his real-world relationships,” he explains. “With such people, we have to find what they’re good at. In this case, the boy was able to ride his bicycle long distances and always find his way back home.” Accordingly, Lo encouraged him to do more cycling as a healthy alternative to online activities.
Lo did not try to convince the boy to stay away from the Internet altogether. Realizing poor self-esteem was a key factor, he suggested to the boy’s homeroom teacher that, during their pre-graduation class party, he be allowed to show off his excellent computer game skills to his classmates. The aim of counseling is behavior modification, Lo points out. “We want them to gradually reduce their Internet use. But it’s very difficult, and of course relapses occur, just as with other forms of addiction.”
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Steven Crook is the author of Taiwan: The Bradt Travel Guide.
Copyright © 2016 by Steven Crook