- 게임이용장애(Gaming Disorder) 질병코드 반대입장 표명

게임문화재단(이사장 김경일)은 세계보건기구(WHO) 사무총장에게 서한을 보내 국제질병분류 제11차 개정판(ICD-11)에 게임이용장애(Gaming Disorder)가 등재될 예정인데 대해 항의하고 이를 철회해줄 것을 요청했다고 9일 밝혔다.

게임문화재단은 WHO의 이번 조치는 명백한 과잉의료화(over-medicalizaion)의 사례에 해당하는 것으로, 그동안 많은 질병들이 WHO의 노력에 의해 퇴치되었음을 높이 평가하나, 질병의 범위를 무리하게 확장시킴으로써 결과적으로 WHO가 인류의 복지가 아니라 의료산업에 봉사하게 되는 것을 경계하여야 할 것이라고 지적했다.

또한 학생·청소년에 대한 과잉진료는 물론 그에 따른 약물처방 남용 우려를 제기하며, 우리나라와 같이 의약품 단가에 대한 통제 시스템이 존재하는 특정 국가에서는 약물 처방에 대해 보험 수가 적용을 받지 않을 뿐만 아니라 다른 정신질환에 비해 거부감이 훨씬 덜한 게임이용장애 진단이 남용될 우려가 더욱 크다고 지적했다.

아울러 게임의 과용은 고립감, 학업 스트레스, 과도한 경쟁, 가정 폭력 등 여러 요인과 연관되어 있다는 연구결과가 보고되고 있는 점과, 미국정신의학회(APA) 또한 더욱 많은 연구가 필요하다는 입장을 취하고 있는 점을 들어 게임이용장애의 질병 분류에 더욱 신중한 판단이 필요하다고 촉구했다.

게임문화재단 김경일 이사장(아주대학교 심리학과 교수)은 “WHO 홈페이지의 의견 수렴 창구와 국제우편을 통해 항의 서한을 전달했으며, 향후 국제공동 연구결과 발표 및 심포지엄 개최를 통해 게임이용장애 질병 분류의 부당성을 과학적 근거에 의해 밝혀 나가겠다”고 말했다.

원문

May 8, 2019

Dear Dr. Tedros Adhanom Ghebreyesus

Director General

World Health Organization

On behalf of the Game Culture Foundation, I highly recommend the World Health Organization to withdraw its plan to enlist gaming disorder code in its eleventh revision of the international classification of diseases(ICD-11) based on the following reasons.

First of all, gaming disorder code is a sign of overmedicalization. WHO is now going overboard on a societal issue that should not be approached in a medical perspective. Game is a technological product, and it can either be used in a good way or in a bad way. What leads to such different manner of use cannot be understood by medicine but in a multi-level perspective. Distinguishing whether a behavior is either normal or abnormal is not that simple and easy, thus cannot be defined in a number of sentences in a code book. We might have taken a huge number of drugs if there were TV disorder or movie disorder or anything of that sort that deals with excessive use of media in the code book. WHO has worked so hard to tackle all sorts of medical problems worldwide and thereby contributed for the welfare of all humanity. Nevertheless, excessive expansion of the scope of diseases is not a way to contribute to the welfare of humanity but to the interest of the medical industry, and this is what I believe the WHO should refrain from. 

Secondly, there is the possibility of overdiagnosis. The code needs to achieve cross-cultural comparability and utility in its overall diagnostic criteria. For this sake, culture-bound syndromes should not be included in the code book. If the latter, despite my worries, happens and becomes a reality, there is the possibility for the doctors of a specific culture to succumb to the demands of parents or teachers and diagnose children or students with a gaming disorder although there may be no sufficient basis in them. The reason for this is because such diagnosis provides a quick and easy way for those guardians to do away with a more serious and caring process which is engaging in a deep conversation with those children. This lessens the burden for the adults as they can simply dismiss the problems of those children saying that those were due to their gaming. Further, it will not be easy for doctors to overcome the temptation to further their financial benefits by demanding those patients to resort to expensive medical services. It is easier to diagnose with a gaming disorder code as it sounds better than other codes for mental diseases such as anxiety, depression and ADHD. So that makes it easy for doctors to persuade parents. Plus, the price of drugs with regard to those symptoms are not constrained by the government’s regulation on drug pricing, and thus the doctors who prescribe those medicines can gain more financial benefits in return. This is especially true for the countries that are leading the enlisting of the gaming disorder code in the ICD-11. 

Lastly, it goes against the recent worldwide trend in medical science which now tries to categorize diseases not based on the outwardly shown behavior of a person but based on the neurologic causes that induce a certain behavior. Many studies have shown that the factors that are associated with the overuse of game are negative moods due to isolation, stress, excessive competition in academics, conflict or violence inside a family. As stated above, neurologic link between the various causes, i.e. anxiety, depression, ADHD, and etcetera, and the overuse of game should be investigated if doctors and medical professionals including those in WHO really want to dissuade the excessive use of game. We need to be reminded of the fact that the American Psychiatrists’ Association(APA) is taking a cautious approach on internet gaming disorder by categorizing it under the items for further study in its fifth revision in Diagnostic and Statistical Manual of Mental Disorders (DSM-5). 

In sum, gaming disorder should not be included in the ICD-11 as it contains the problem of overmedicalization, overdiagnosis, and anachronistic regression. Any code in ICD should not be a measure to cover up the true problems across societies. There are complex reasons that lead to excessive gaming. But if there is a code that deals with the superficial outcome derived from inherent sociocultural problems, people will be led to think they are treating the problem in medical way and there is no further task that belongs to them. In addition to that, the code gives an impression that all the faults are attributable to one single individual with no respect to the innate problems that permeate throughout the society. We need to take into consideration that the environment that surrounds an individual formulates the identity and thoughts of a person to engage in a certain problematic action.

Based on the arguments above, I hereby submit a dissenting opinion to WHO's plan to enlist gaming disorder in ICD-11.

Yours faithfully,

Kyoung Il Kim

Chairman of the board

Game Culture Foundation