There are now over a billion gamers on Earth, and the video game industry which caters for them is soon set to earn over $100 billion annually. But are gamers unknowingly harming themselves – and what effect are games having on children today? The media tends to throw around acronyms such as COD (Call of Duty) and GTA (Grand Theft Auto) whenever a horrific act of public violence has been committed, or whenever average year-to-year school grades fall, but is there any evidence to support such claims? This is a debate which has raged for decades.
Many people have grown up playing console games, myself included. Memories of hopping around Jolly Roger’s Lagoon as Kazooie on my Pikachu-themed Nintendo 64 certainly bring about nostalgic feelings of a simple childhood well spent. But games are not as they once were. With the advent of relatively affordable and readily accessible gaming machines such as the PlayStation 4 and Xbox One, demand for high graphic fidelity and realistic gameplay is greater than ever before. Coupled with this, it takes only a quick visit to an online retailer to observe a very noticeable rise in the proportion of current-gen games published with an M (Mature 17+) rating – often owing to extreme violence, blood and gore within said games. These two phenomena lead to a situation in which a great number of people (generally ordinary and – with the ineffectuality of game ratings – of all ages) not only become accustomed to violence, albeit virtual, but also actively partake in it (again virtually). What effect, if any, does this have on our minds?
Violent games, violent gamers?
The grotesque public acts of violence so often attributed to video game use are frequently perpetrated in the US, and so we must cross the pond to consider the opinions and evidence-base (or lack thereof) of organisations claiming this causal association. The tragic Sandy Hook school shooting in Connecticut in 2012 led to the re-emergence of rhetoric that blames violent video games for such heinous acts. Soon after the incident, the National Rifle Association (NRA) held a press conference wherein spokesperson Wayne LaPierre attempted (unsurprisingly) to shift responsibility from guns to video games**, despite the fact that playing games would not have distinguished the perpetrator from the majority of adolescent males who also game. Upon completion of an extensive investigation, it was revealed that the shooter indeed spent long hours secluded in his basement playing video games, but preferred Super Mario Brothers to any sort of violent game.
So what do medical associations and government bodies make of this? Would they also have you believe that killing wave after wave of zombies on COD might cause a very real form of… brain rot? The American Academy of Pediatrics (AAP) is one of the more vocal proponents supporting the link between in-game and real-world violent tendencies. In 2009 the AAP published a policy statement in which they cited evidence showing that violent games contribute to hostile behaviour and desensitise users to violence. The American Psychological Association (APA) approaches this subject more conservatively, releasing a policy statement earlier this year which confirmed a link between playing violent video games and raised aggression, but found insufficient evidence connecting gaming exposure with criminal violence.
Governments are apparently more sanguine about the matter. Councils and task forces from the US (sources here and here), Australia and Sweden have all stated that there is a distinct lack of studies with sufficient methodological quality to make any bold conclusions in this debate. If the government says so, it must be right! Right?!***
A platform for aggression?
So what of video game-induced aggression then? Often in science, individual studies are inadequate in power to demonstrate a certain effect, trend or association. In biomedical research we address this problem by collecting all research papers investigating a specific topic, for example the effect of an exposure (such as playing violent games) on a certain outcome (such as increased aggressive behaviour). This type of study is termed a systematic review, which provides what is considered the gold standard of evidence in medical research. This is because within a systematic review we are able to meta-analyse the collated data to comprehensively summarise all published evidence for a given question.
A significant 2010 meta-analysis addressed the putative link between violent video game exposure and enhanced aggression by summarising the results of 136 relevant papers (reporting data on 130,296 participants!). Meta-analysing the entirety of the dataset, which included measures of aggression both psychological (such as self/parent/teacher-reported aggressive behavioural changes) and experimental (such as choosing to shock another human with electricity), the authors of the paper concluded that there was indeed a significant correlation between increased violent game use and raised aggression. A co-author of the meta-analysis claims the association is as strong, or stronger, than other risk factors for youth violence, including drug abuse, having a poor IQ, and even being male.
But research never rests on its laurels. A more recent meta-analysis, published only this month (and with a fantastic title), offers alternative answers. It showed instead that the influence of violent games on aggressive traits in children and adolescents is minimal. The author stated that previous meta-analyses (the one above from 2010, one by the author himself in 2007, and another from 2001) were inadequate because of the inapplicability of the included studies to societal populations, and the flawed methodologies with which the studies were conducted. For example, the studies collated in previous analyses focused mostly (but not exclusively!) on college students, and used proxy measures for aggression that ignored other mental health-related outcomes.
The neurobiology of gaming
Let’s flip to the other side of the coin. Is there any brain benefit to playing games? Well, according to neuroscientists, apparently there could be. In late 2013, a group from Germany published a study in which they demonstrated that regularly playing the game Super Mario 64 actually caused parts of the brain to increase in size (!). In the study they assigned 23 adults (mean age 24) to play the game for at least 30 minutes every day for 2 months, and compared this group to an equal-sized control cohort of adults who did not play the game. At the end of the study period the video game training group showed increases of grey matter in regions responsible for spatial navigation (the right hippocampus), future planning and working memory (the dorsolateral prefrontal cortex), and fine motor skills (the cerebellum). It seems the N64 days of my childhood might have been rewarding not only in and of themselves, but to my brain too! Excellent news? ‘But Mummm, playing Mario is good for my fine motor development!’.
The use of video game technology has also been extended to address certain conditions and disease states. A study in 2012 showed that a one-month, 40-hour training regime of playing a first-person shooter game (which I have played and is realistically violent) improved eyesight in adults with defective vision. The study participants were born with cataracts, which are routinely removed in early life, but nonetheless impact upon the hardwiring of the developing brain and cause a lifelong disorder of sight. The adult neural apparatus responsible for the visual deficiency, hitherto considered permanent, is therefore sufficiently plastic to accommodate (video game-induced!) repair – a remarkable discovery. Other diagnoses responsive to cognitive electronic game therapy include Huntington’s disease and even multiple sclerosis.
Research published in the BMJ has shown that mental disorders such as depression are also amenable to gaming technology therapy. The study presented the findings of a trial utilising a computerised behavioural intervention (“SPARX”), which demonstrated effectiveness as a possible alternative treatment for depressive symptoms in adolescents.
For an extensive review on the therapeutic uses of electronic games, see here.
In summary, given the available evidence, it seems likely that violent games can worsen aggressive behaviours, but a supposed link between virtual violence and perpetration of actual violent acts is currently inconclusive. There is also a plethora of data indicating a therapeutic benefit to using gaming technology in healthcare, so perhaps it’s not all Doom and gloom after all. What do you think? Let us know!
Article by Alex B. Munster. Alex (henceforth known as A.) is a graduate medical student at the University of Cambridge with interests in gaming, cardiovascular research, and lifting heavy objects. View his published research here or connect with him on Twitter: @AB_Munster.
*Pun most definitely intended.
**We must be ever-vigilant regarding the interface of science and politics, as political pressure (exerted by such organisations as the NRA) might jeopardise the independence inherent to the scientific method.
***As an ethical aside beyond the scope of this article, even if fake violence doesn’t encourage actual violence, does that make fake violence (or casually entertaining ourselves with it) okay? Some argue we worry too much about this question.
If you are interested to learn more about this topic there was a very informative (albeit – like the violence hypothesis – ultimately inconclusive) documentary exploring this topic on the BBC programme Horizon, which can be found here.