In my clinical experience as a child and adolescent psychiatrist, I have observed that discussing gaming behaviours is almost taboo. Parents loathe it in their children, experts avoid broaching the topic, and decision-makers do not fully understand it. Yet the youth loves video gaming, and the gaming industry continues to flourish. According to a recent article published in Express Tribune, experts project Pakistan’s gaming revenue to exceed 200 million dollars in 2023. More than 87 million people use the Internet in the country. However, since Pakistan has a value insistence that centres on collectivism, this rapid rise in digital vitality could lead to a clash between indigenous culture and what the digital media values (perceived or actual), such as individualism and self-expression. Culture extends through every human activity; the aspect of play is not an exception. So if our sociocultural context includes the practice of play compellingly, why is our attitude different toward video gaming when it serves the same purpose? Video gaming signifies playing electronic games through consoles and computers. It enhances cognitive skills, fosters social skills and a sense of purpose, and improves mental agility, self-discipline, and executive functions by altering neurochemical changes in a player’s brain. However, the most discussed aspect of video gaming has been the link between video gaming and violent behaviour in real life. Internationally, this debate deepened after the rising phenomenon of mass public shootings. In Pakistan, this came to light after the cases of suicide and homicide in the context of gaming behaviours. While such incidents warrant an individual psychological autopsy, video gaming-related deaths represent only a tiny fraction of cases in Pakistan. The media’s depiction of these incidents does not include a wider discussion and the need for formal psychiatric evaluation, demonstrating inadequate mental health literacy at a societal level. The discourse around digital video games and mental health must go beyond defining it as a diagnosable psychiatric disorder. The unique context in which video games exist distinguishes what brands gaming as a gaming disorder. Simply put, the frustration at being unable to play becomes a symptom of withdrawal rather than an understandable reaction. Three percent the world's 3.4 billion gamers are estimated to suffer from Internet Gaming disorder (IGD). However, not every gaming behaviour requires clinical attention, as this phenomenon exists on a spectrum. Furthermore, the cause and effect of the development of IGD have few clear indicators of who is at risk for developing more symptoms with various facets of gaming. In Pakistan, we must start recognising gamers’ worth and refer to gaming professionals as athletes rather than addiction sufferers. With no formal advanced training to support and manage the growing number of gamers seeking mental health care services, using any diagnostic labelling loosely raises a moral and ethical concern; clinicians must stay updated with the latest knowledge. While working with a dynamic demographic cohort, we must try to understand what is happening in their community while being acutely aware of their status as an outsider. We now know that the teenage brain is a work under construction. However, because of the number and scope of the biochemical changes and the cognitive maturation that only sometimes keeps up with other drives, as compensation, teens are more vulnerable to adopting alarming behaviours, especially if they struggle with self-identity, fears and anxieties. Drug experimentation is common among teenagers, but addiction is a severe mental health disorder. Adolescence is not recent, as the narrative's expression has changed. Still, the fundamental human psyche remains the same. For example, research shows that teenagers lie or withhold information on 12 of 36 topics, ranging from how they spend their allowance to deception. We worry about children's physical safety, stranger danger, and child locks in cars, doors, and child-proof homes. So why don't we do the same for their psychological safety? If we want to protect our children from the harms of the digital world, why do we not even try to learn what is out there? Our attempts to protect them are understandable, but what do we protect them from? We are not protecting our kids by avoiding drug talk or by not talking about death. So by not recognising video gaming as a behaviour, we are raising a generation who will doubt themselves at the fundamental level believing that their strength is disgraceful, a waste of time, and a severe form of addiction. Video games are not without adverse effects, but at the same time, evidence shows that playing video games requires problem-solving strategies — some games are considered digital therapeutics. In addition, neuroscience and cognitive science have shown that gaming can help people's social behaviour, self-esteem, and coordination skills. We need to move beyond the disease model by examining the influences at various levels. Such as, Individual impact includes their sense of responsibility for other tasks and roles, ability to plan/schedule, meet self-care needs, gaming habits, reasons for playing and preferred game genre. Interpersonal influences include co-habitants, friends, social apps/websites, co-workers, and teammates. Videogaming affects people's actions, but the gamer's perspective varies. Some factors come up more than others, such as online trolling, academic decline, and mental health. On the other hand, gamers find gaming helpful for stress management. Environmental impacts include the design of the games, where they live, and measures that support/constraint on activity engagement. Gamers need adults to talk to about cross-cultural communication, fundamental rules to avoid in online and offline relationships, protecting one's reputation, and how to respond if they give personal information. "Mind games such as bridge or chess could have a positive effect," says one gamer. Playing video games helps eye and hand coordination, especially "how it requires a keen hearing," said a young gamer. Though most gamers feel calmer and less stressed, there are also downsides: "I feel stressed when I am losing or happy when I am winning," says one young gamer, "So it is the adrenaline rush either way." Let us examine a common critique of a decline in the academic performance of gamers. Schoolwork and video games Cognitive science says that schoolwork is always overly challenging for a student; it should be no surprise that they dislike school. The principle guiding this argument is that people are naturally curious but not inherently good thinkers; people will only think if the learning conditions are right. This aspect implies that teachers should reconsider how they encourage their students to consider maximising the likelihood that students will get the pleasurable rush from successful thought, something the gaming industry understands and delivers well. The gamer's perspective on improving school or work performance while balancing gaming behaviour is fascinating. The dilemmas of the modern gaming industry are being discussed in the popular media, the community, and academic literature. However, unfortunately, the education sector has yet to incorporate gaming principles. One young gamer, however, has an interesting suggestion. "Teachers could tie school and work performance to video game rewards like gaming points," he said, referring to gamification. In addition, some gamers said they would not mind playing video games with teachers. "Teachers could play video games with me, tie school performance, and monitor my gameplay," said another gamer I interviewed. But some gamers do not want teachers to interfere with their gaming. "It would be an excellent idea for video game companies if they gave out free items to high-performing students," said a gamer. “If we can be offered academic lessons as part of the video gaming package and gave out free things that limited the amount a video game could be played." There is a more significant responsibility for the video game industry here; offering academic lessons and monitoring young children's time online by integrating a mechanism they could not play for more than a specific time. Parental supervision If we worry about our children's digital safety, why are we not supervising them? Gamers often feel that parents or guardians do not supervise their gameplay, nor do they use gameplay to help them do well in school. Most gamers play with friends they met online or do not know personally but play for one to five hours daily, mainly with friends they know. We must consider replacing it with validation if we want them to play less. For example, what would they feel if they didn't play video games? Most said they would be bored, watch TV, interact with friends, or read books. Moreover, it varies from one to 10 hours. Evolutionarily, humans seek methods to ease misery, stress, and the harsh realities of life through board games, card games, and sports. Despite this, video gaming continues to carry the perception of undesirable activity. Gaming community members are given a countercultural movement identity like hippie culture during the 1960s and 1970s; we can open a civil discourse to reduce the widening generation gaps. New interventions mean increasing awareness, knowledge, and enlightenment almost always pushes the needle in the right direction. This also opens the door to a collaborative discourse on policy, strategic recommendations, resource mapping, priority setting and defining the values and guiding principles for interacting with technology. Technological trends take on a life of their own, like the broom in The Sorcerer's Apprentice. To bring them under control, stakeholders must learn to tolerate ambiguity, resist the lure of the immediate, cease fearing uncertainty, and rechannel their response to wonder. Aisha Sanober Chachar is a psychiatrist and co-founder of Synapse, Pakistan Neuroscience Institute. All facts and information are the sole responsibility of the write
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