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20 years ago, video games are entertainment tools which are thought, belong exclusively to children population but now, the majority of video games don't fit in quite well with children. Some are filled with gore, some are decorated with ominous scenes, and some games are just purely violent. If you were born between the 80s and the 90s, you will realise that the pattern of gaming popularity among children and adolescents have been evolving; when I was a child 20 years ago, playing Super Mario gave me the satisfaction that nothing else can provide especially if I'm able to rescue the in-game princess (not the ugly one, the beautiful one at the last stage). I remember my parents used to restrict my gaming time to 6 hours per week (I can only play during the weekend) and I felt it was more than enough. It can be due to the fact that there were few choices of games back then and most of my times were spent with my friends, playing outside. Nowadays, with the advent of online gaming, people were willing to spend most of their times in front of their computers, practising and spending some money on the in-game items, so that they can beat other players to retain a respectable ranking, in the gaming community.

There are a lot of choices and new updates offered by numerous games' companies, making it difficult for us to be completely satisfied with our in-game achievement. For example, in 2015, when I opted for Warframe, a free-to-play cooperative third-person shooter game, I sat for hours in front of the computer, farming for various kind of frames, weapons and mods, levelling up my characters and completing the story mode. There were a few kinds of weapons, frames and mods back then, so maximising all of them were quite easy but now, the number of available warframes have increased to the point that it has gotten out of hand. The game's mechanic has changed and there are a lot of new features which have been introduced to make the game so much fun, which beg the question when it's going to end? The thing is, creating an environment which provides an ideal condition for a game to be played without running out of something to do is the ideal concept of online gaming. If you have finished the main quest, you can play the online multiplayer mode, which would allow you to compete with other players scattered around the world while strengthening your ranking as a gamer.

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It's a different form of social interaction than the conventional meetup, get to know each other and went on separate ways; the online gaming community gives us the opportunity to make a 1000 friends/acquaintances without feeling attached to any one of them (although some might have limits). According to a review done in 2016 by Naskar S. et al, gamers can be divided into a few classes based on their playing style and gaming personality:

• The achievers: This is the king of gaming. They seek pleasure and validation from ranking and levelling experience which motivates a lot of gaming companies to create a ranking and levelling based system even if it is only applied to each individualised gaming account. Higher level/rank usually indicate experience, dedication and superiority over the others which make them the star of the show. These players were usually competitive and easily frustrated if they were to be defeated by someone who owns a low-level/rank account/character. They were driven by goals and objectives to beat a specific game and if they really do, they will be satisfied.

• The explorer: Nowadays, there are many games which adopted an open-world concept. Being an explorer can be fun and entertaining especially if it is an online game which would have their content, frequently updated with events. Discovering something new can be fun and people who seem adventurous in the game were usually ignorant about their position in the gaming community. They would rather have fun, exploring so many features provided in the game rather than to compete in any sort of tournament or gaming system which would result in putting their name in a specific list which could have been elegant and somewhat satisfying for an achiever.

• The socialiser: We have so many social media nowadays which could have simplified communication among people around the world but to the socialiser, nothing can beat what a game (particularly an online one) can provide in terms of communicating with other people, virtually. This kind of player is usually the head of a specific gaming community who is dedicated enough to manage a group of players (in some games they were called guild, for some it's clan) while organising group-related events. They can be found, especially, among popular games which have a lot of players and the only reason they were playing (daily) is so that they can establish themselves in the virtual social ladder and communicate with others.

• The troll: First of all, even though most of the people who were considered "the troll" of a specific gaming community were made up of scammers, spammers and beggars, there are some who can be an achiever, but enjoy bullying others especially people who are weaker than them. Most of the people categorised under this gaming role can be quite annoying. I mean, wouldn't you? If someone constantly harasses you, asking for free gold or any form of in-game currency just because they were lazy enough to farm on their own. They were considered the lowest among all four types of gaming personalities as they don't intend to help people building their characters or communities but to trick people for their own gain. That is kinda wicked, right?

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I'm sure, each and every one of you can classify yourself according to any of the 4 mentioned gaming roles but do we really want to admit, we were trolls if we really are? It's a little bit difficult to judge and quite frankly, at some points, we do enjoy bullying other people. Nowadays, there are a lot of people who make a lot of money, playing video games. There are a few streaming sites like Twitch, dlive etc. which enable players to showcase their talents while providing the opportunity for fellow gamers to follow their feeds, filled with entertaining (for some, competitive) gameplay of several genres. Me, myself, enjoy watching Shroud plays Player Unknown Battle Ground (PUBG) on Twitch, Muselk plays Fortnite and Tactical Potato plays Warframe; there are various games' streams provided by different streamers to choose from, and all of them make quite a sum of money. 10 years ago, I would have never expected the gaming industry to make such a stride but since the 1st Dota Tournament provided players with a 1 million dollars prize pool (now the prize pool is even crazier), I guess I was wrong, huh?

Video Games As Educational Tools

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Let's face it, when we are talking about the possibility of video games to be used for educational purposes, I don't mean Dota being played by students for curricular or extracurricular activities. Yes, they can be adopted and modified to accommodate a specific subject but the final results, details and the protocol designed might have seemed distasteful if we want to compare them with the current version of Dota or any other popular games. I think by now, there were a lot of games which have been released via the Play Store or Apple Store on mobile phones that might have some educational qualities with them. The objective is to spark curiosity and interest among people regarding specific subjects that the game was based on but the validity of scenes and events being held as part of the chapter in the game might have been questionable. Nevertheless, it was practically known that a game which is designed for a specific purpose (which is not for entertainment) can give many benefits to the player in terms of emotion, knowledge, social and sometimes physical benefits (if the games require some movement to play like VR and such).

An educational game is defined as an instructional method that requires the learner to participate in a competitive activity with preset rules.

Source

Theoretically, any games which have been marked as educational are not only fun to be played with, but also would be able to encourage communication and discussion among players regarding a specific subject. There are a few situations which can't really be simulated according to what close to the real situation without involving some aspect of games in it, for example, disaster management. I mean, even with games, we can't really duplicate exactly the same situation to the point that people can learn and actually know what to do just in case of disaster struck; experiences are still important but we can spark interest among people to know and learn more about various kind of disaster management in a safe virtual environment. If you consider some of the popular first-person shooter games, you will think that people benefit nothing apart from violence but there are some subjects which you can learn from it such as history (some facts might have been changed to accommodate the protagonist in the game), physics (I assume most people wouldn't even care about why snipers have to aim higher when shooting people who were far, but some might be curious) and learn about guns etc. Being a sniper might have been fun in the game, but in real life, they were raking their brain off with numbers and equations in order to hit the right target (one shot, one kill), try to estimate the position of the other snipers by using sound etc. all of which can be incorporated into a game that can be educational as much it is fun.

There are a lot of games which have been developed for people who were in the medical field and some of them can be quite entertaining. For example, I remember when I was in the anaesthesiology posting in my medical school, we have a computer session in which we have to try being a virtual anaesthesiologist by giving anaesthesia and other kinds of drugs while the patient is being operated by the surgeon. Of course, the game is quite difficult and among 6 patients (different conditions) that I have to manage, only 1 survive (the other 5 end up with brain deaths). Even though real life experiences are necessary as there were no other aspect of video games that would be able to give you much exposure to an infinite possibility of things that could happen during a surgery but still, video games can make us confident, less anxious, curious to learn about something and you can practice over and over again without hurting anyone. It can cover pretty much every basic knowledge and skill that would have made someone feel prepared to face a real-life situation.

ESA - Wikipedia (CC BY-SA 3.0)

In 2012, Bedwell has listed some of the features which are usually incorporated into a game to make it a suitable educational tool:

• Communication methods between the player and the game (action language)
• A system which would be able to track progress by accumulating score for correct answers (assessment)
• Different level of conflicts and challenges based on the subject of the games
• Some options being provided to the player to alter the game (control)
• An appropriate and specific kind of environment according to the subject being emphasized by the game
• Appropriate platform for social interaction between players
• Appropriate storyline
• Objectives/rules that will be informed to the players regarding the game

Incorporating video games into the educational system would provide some opportunities for a higher level of education by encouraging students to engage with problems at hand and be more creative with solutions along with some feedback based on different results. Have you ever felt frustrated if you fail to solve a problem (be it mathematical or understanding specific kind of theories) and want to try it again? Of course, you have, that's the cornerstone of education, try and error, and with video games, those things can be applied without fatal consequences. In a study conducted by Graafland M et al in 2012, they found that surgical-related games which are being developed for surgical training purposes can encourage fellow surgeons to develop technical and non-technical skills through blended and interactive learning opportunities (Source). It is important for an educational game to be carefully inspected of their potential to provide facts and any form of learning so that their benefits could be optimised.

Internet Gaming Disorder

Even though internet gaming disorder was never included in the latest Diagnostic and Statistical Manual of Mental Disorders V (DSM-V), its propensity to cause addiction is quite well known which is why it is placed under review for the future edition of DSM. People often confused the difference between internet addiction and internet gaming addiction (they do sound alike) in which, according to Griffith and Pontes, are two different things presented with two sets of different behaviours. Internet addiction has been illustrated by Király et al as a general term to explain a population which invested a significant amount of time doing any activities related to the internet usage which include social media and networking while internet gaming addiction, explained addictive behaviour geared specifically towards online gaming. Even though internet gaming disorder was never formally recognised as a mental illness, there are some criteria which could have been used to identify whether or not someone is addicted to online gaming.

In general, internet gaming addiction is a behaviour of persistent and recurrent use of the internet to engage in games, often with other players, leading to clinically significant impairment or distress as indicated by five (or more) of the following in a 12 months period. The criteria include preoccupation, withdrawal, tolerance, unsuccessful attempts to control, loss of interests, continued excessive use despite psychosocial problems, deceiving, escape, and functional impairment.

Source

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There are a lot of studies which have been conducted in the past to investigate in what kind of population does online gaming is the most prevalence; most of them pointing towards Asian population. According to Ahn JY., the number of people who were diagnosed with internet gaming disorder in South Korea is quite high which would have imposed a great public health burden. Approximately 24% of the population which have been diagnosed with IGD require restrictions in a form of hospitalisation due either due to consequences of prolonged gaming or per requested by the next of kin. Gaming has been one of the most popular forms of escapism utilised by the male gender to create an ideal world whereby you can do anything within certain limitation provided by specific kinda games. In 2016, Muller et al conducted a study among 12,938 children to find any kind of factor which could have accentuated online gaming addiction, and most of them were associated with poor self-esteem, poor daily life satisfaction and broken home.

Playing online games can be a fun hobby but if you involved in it chronically, it has the potential to affect your judgement and how you deal with a situation, emotionally speaking. People who have been involved with online gaming for a long period of time or they satisfy the criteria to be diagnosed with the internet gaming disorder are emotionally unstable. If you are one of the people, who have been going to cybercafe frequently, you will notice some of the gamers were so emotional when it comes to the outcome of their own games. This can be attributable to a few factors which include sleep deprivation due to prolonged hours of gaming and depressive symptoms which have brought them to online gaming in the first place; when online games are places you can destress, it would be quite frustrating to be stressed by it. Some gamers were afflicted by some physical symptoms and the most common one being Carpal Tunnel syndrome. It would be quite distressing, right?

Currently, there is no appropriate treatment protocol outlined for online gaming addiction and most of the modalities focused on support groups system. People who want to overcome their addiction associated with online gaming can attend either an online or a meetup support group to ventilate their own concern and the reason why they were involved in online gaming. It's pretty much dialled down to what you want to do for yourself in order to overcome your addiction to online gaming. It's pretty difficult to differentiate between people who were addicted to online gaming or people who make careers out of online gaming i.e. streamer and playing professionally for various gaming teams. I guess we have to wait and see whether the disorder would be included in the next edition of DSM.

Sources

• “One level more:” A narrative review on internet gaming disorder
• A systematic review of serious games in medical education: quality of evidence and pedagogical strategy
• Educational Games as a Teaching Tool in Pharmacy Curriculum
• Game-Based E-Learning Is More Effective than a Conventional Instructional Method: A Randomized Controlled Trial with Third-Year Medical Students
• Systematic review of serious games for medical education and surgical skills training
• Internet Gaming Disorder in DSM-5

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