Compulsive Acts: A Psychiatrist's Tales of Ritual and Obsession

One Eternity Drive

In retrospect, it should not have taken a comprehensive psychiatric interview or the battery of tests I put my patients through to understand Alex’s problem. Dawn could have accurately diagnosed him from three e-mails she received from him—and forwarded to me—in quick succession one morning. The first one read: Dawn, You must have reviewed with the doctor by now the phone screen you did with me yesterday. Please e-mail me at your earliest convenience to set up an appointment with him. It’s 8 a.m. now. Alex At 8:15, he wrote: Dawn, Still no sign of life from your clinic . . . I’m really eager to see the doctor and get evaluated. Anxiously waiting, Alex One Eternity Drive 137 By 8:30, Alex was clearly desperate: Dawn, If it’s difficult to set up an appointment with the doctor for a face-to-face evaluation, can he perhaps e-mail me his questions? I can e-mail my answers back, and he can give me his recommendations . Better yet, can you please check whether he would meet me in a chat room? Don’t worry! I can set it up so we have total privacy. Alex Dawn attached her commentary to the last forwarded e-mail: Dr. A., Would you ask this guy to log off already? “Can you please check whether he would meet me in a chat room?” Yeah, right! And maybe I can start telecommuting to clinic and checking people into chat rooms from the comfort of the kids’ playroom. Unbelievable! Dawn ⡥⡺⡥ Despite its relatively young age, the Internet has radically and irreversibly changed many aspects of how we work, play, learn, and express ourselves. According to estimates by the Nielsen/Net Ratings Web site, U.S. Internet household penetration reached 75 percent in early 2006, with the number of active users still growing and the speed of Internet connections continuing to rise. Many advantages lure users to the Internet. These include the 138 / One Eternity Drive convenience it adds to a wide spectrum of basic tasks, from paying utility bills to buying movie tickets; the sheer breadth of the information it makes accessible, overshadowing all other resources; the chance to build communities, including the ability to connect with people who share our interests, no matter how rare or narrow these interests might be; and, finally, the anonymity it gives and the attendant freedom to express views or play out (usually) harmless fantasies in front of a large audience in a way that is normally repressed by societal norms and constraints. However, a dark side to this vast new world of opportunities has emerged. Accumulating data point to individuals for whom the Internet becomes a consuming habit that takes over their lives, exacting a significant toll along the way. Some of these individuals are approaching psychiatric clinics across the country for help in controlling the compulsion to use the Internet or dealing with the aftermath of a destructive Internet habit. For lack of an established diagnosis or an agreed-upon phrase to describe this phenomenon, I will refer to these individuals as problematic Internet users and will call the clinical condition problematic Internet use. ⡥⡺⡥ A week later, Alex and I met for our intake appointment—held, as all my sessions had been up to that point, face-to-face—in my cramped office in our clinic building, an edifice made all too real by overheating problems in the summer and occasional water leaks in the winter. “I don’t consider myself to have an addictive personality,” Alex began. “I don’t drink or do drugs. I don’t get addicted to the kind of habits that bring people to this clinic, either: I don’t check or clean excessively; I’ve never gambled; and I don’t pick my skin or One Eternity Drive / 139 pull my hair or bite my nails compulsively. But I’m an addict nonetheless. A modern-day addict. “For as far back as I can remember,” Alex continued, “I’ve been extremely shy. Whenever I could, I minimized my interactions with people. I built my few friendships by carefully socializing in small groups and even made career choices that limited random, spontaneous run-ins with people—that is how I became a research physicist working with radioactive isotopes under strict isolation. But one area where I could not accommodate my anxiety was...