Marking the World Mental Health Day which fell on October 10, we spoke to Dr. Mahesh Rajasuriya, Consultant Psychiatrist, National Hospital of Sri Lanka and the Senior Lecturer from the Department of Psychiatry, Faculty of Medicine, University of Colombo who warns that “all frills of digital devices including smart phones come at a huge cost,” impacting our overall mental health and well being.

by Randima Attygalle

The smart phone has come to stay with us and there is no escape. From communicating with people to reading your daily newspaper, the smart phone has become indispensable. More than a mobile phone, it is now a movie theatre, a TV, a radio, a camera, an alarm clock, a diary, a notebook, a flashlight, a navigator, a health checker, a banker, grocer and so much more! It has become the first thing we check in the morning and the last thing before we go to sleep. While leaving home without the phone makes one ‘lost’ for the rest of the day, losing it is a nightmare.

While addiction to our smart phone or other digital devices such as tabs or computers (with access to the internet) is yet to be classified as a ‘mental disorder’, the negative impact of their overuse on our overall health and well being cannot be underpinned says, Dr. Mahesh Rajasuriya, Consultant Psychiatrist, National Hospital of Sri Lanka and the Senior Lecturer of the Department of Psychiatry, Faculty of Medicine, University of Colombo.

“Drunk driving could crash your car and kill another pedestrian and leave you disabled for the rest of your life. But one need not necessary be an alcohol addict to be in this predicament. It is the same with device or screen addiction. There need not be an underlying pathological condition for us to understand the seriousness of addiction to these devices. Your family and work life, education, social connections and even sex life would all be at stake,” says Dr. Rajasuriya.

A mental disorder is diagnosed on acceptable diagnostic guidelines. There are two such internationally renowned guidelines: The International Classification of Diseases (ICD 10, ICD 11) by the World Health Organization (WHO) and Diagnostic and Statistical Manual of Mental Disorders (DSM 5) by the American Psychiatric Association. None of these guidelines still recognize a ‘disorder’ for addiction to screens or electronic devices, yet it recognized internet ‘gaming disorder’ in the section recommending conditions for further research, along with caffeine use disorder and other conditions.

In a move that addresses concerns about the public health implications of excessive use of electronic devices, WHO has included gaming disorder in the 11th Revision of the International Classification of Diseases (ICD-11) which is to come into effect on January 1, 2022. Accordingly, Gaming disorder is defined ‘as a pattern of gaming behavior (“digital-gaming” or “video-gaming”) characterized by impaired control over gaming, increasing priority given to gaming over other activities to the extent that gaming takes precedence over other interests and daily activities, and continuation or escalation of gaming despite the occurrence of negative consequences.’ According to the WHO, for gaming disorder to be diagnosed, the behaviour pattern must be of sufficient severity to result in significant impairment in personal, family, social, educational, occupational or other important areas of functioning and would normally have been evident for at least 12 months.

However Dr. Rajasuriya explains that not all people who engage in gaming will develop a gaming disorder. “Studies have shown that gaming disorder only affects a small proportion of people who engage in digital/video-gaming activities.” Evidence-based research findings are yet to emerge on the pathological use of digital devices, yet the obvious harms such excess use can inflict on the user and his family and loved ones which are larger than pathological conditions, cannot be overlooked he says. “It is no rocket science,” reflects the psychiatrist who goes on to say that if the use of digital devices entail any concerns for you, your children and others, certain interventions are necessary. These would include neglect of daily chores, drop in academic performance, strains on family life and cyber/online harassment including sexual harassment.

The physical and mental health cost of device abuse is enormous. An increase in energy intake, sleep disorders, daytime tiredness, the displacement of time available for physical activity and reduction, poor attention and lack of concentration in metabolic rate are among the latest research findings related to physical health impact. Irritability, low mood, impaired cognitive and socio-emotional development and poor educational performance are among the mental health consequences of excessive device dependency. In case of ‘developing minds’, this could be worse, resulting in low IQ levels and poor interpersonal skills in children.

Citing the Screen time Guidelines by the American Association of Paediatrics, Dr. Rajasuriya says that for toddlers under 18 months, no screen time is permitted unless it is to connect with a loved one such as ‘video chatting with grandma.’ While little screen time of ‘high-quality educational content’ is permitted for toddlers between 18 months and two years, according to each age groups up to 13 years, the Guidelines offer advice for parents and care givers.

While letters, post cards and aerogrammes could be ‘ancient communication regalia’ for the present youth, forging a life banishing the latest technological devices would only be unreal. Hence, empowering them to be the master of their smart phone without becoming a slave to it is the way forward, points out Dr. Rajasuriya. “We need to accept that youngsters spend a considerable time on their smart phones, connecting with the world and people. Today WhatsApp groups are popular which could collectively link many people instantly- both students and adults. The instant communication these enable is beneficial, especially in an emergency situation. The COVID pandemic situation further validated the benefits of the digital world.”

In case of social media, while it enables enhanced connectivity, it could also be an intrusion on privacy, calling for ‘smart’ navigation of it. Cyber bullying, online sexual harassment and even digital crimes are rampant today. ‘The projected reality’ created by many digital platforms could lure their users, especially the youngsters, notes Dr. Rajasuriya. “The online social connections foster a false sense of enrichment although in reality the brain is negatively stimulated by them. Such experiences are not deepening or rewarding.”

Identifying early markers of ‘digital device’ addiction could help mitigate its long term cost. “If you or your adolescent child use social media, yet forge real-life social connections with no phobia, socially interact with the extended family, peers and colleagues at the workplace, it does not become a concern, yet if the only social connections are those made on social media, then it becomes a serious concern,” warns the psychiatrist. Inter personal skills, negotiation skills, problem solving, mentoring and even intimacy are all essential elements of human development which could never be replaced by social media, he adds.

Introverts and those with social anxiety find social media and other digital devices as a means of escaping from the reality. “As a result their behaviour doesn’t get corrected but enhanced. In case of depressed people, no real life friend would be there to identify early markers and intervene, the repercussions of which could sometimes be fatal. While some of these introverted people including adolescents may harbour a false sense of achievement and self-esteem in the digital world, in the real world, they would be socially handicapped.” Excessive dependency on these media could even trigger conditions such as depression as a result of an exhausted brain and lack of coping strategies says the Consultant.