Threat Talk: The Comparative Politics of Internet Addiction 1409433943, 9781409433941

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Threat Talk The Comparative Politics of Internet Addiction

Mary Manjikian

Threat Talk

To my Dad with thanks for the medical knowledge and stories shared over the years

Threat Talk

The Comparative Politics of Internet Addiction

Mary Manjikian Robertson School of Government, Regent University, USA

© Mary Manjikian 2012 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the prior permission of the publisher. Mary Manjikian has asserted her right under the Copyright, Designs and Patents Act, 1988, to be identified as the author of this work. Published by Ashgate Publishing Limited Ashgate Publishing Company Wey Court East Suite 420 Union Road 101 Cherry Street Farnham Burlington Surrey, GU9 7PT VT 05401-4405 England USA www.ashgate.com British Library Cataloguing in Publication Data Manjikian, Mary. Threat talk : the comparative politics of Internet addiction. 1. Internet addiction – China. 2. Internet addiction – United States. 3. Internet – Social aspects – China. 4. Internet – Social aspects – United States. I. Title 303.4’833-dc22 Library of Congress Cataloging-in-Publication Data Manjikian, Mary. Threat talk : the comparative politics of internet addiction / by Mary Manjikian. p. cm. Includes bibliographical references and index. ISBN 978-1-4094-3394-1 (hardback : alk. paper)—ISBN 978-1-4094-3395-8 (ebook) 1. Internet addiction—Social aspects. 2. Internet addiction—United States. 3. Internet addiction—China. I. Title. RC569.5.I54M36 2011 616.85’84—dc23 2011030410 ISBN 9781409433941 (hbk) ISBN 9781409433958 (ebk)

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Printed and bound in Great Britain by the MPG Books Group, UK.

Contents List of Figures   Preface   Acknowledgments  

viii ix xi

1

Risk Assessment, Power and the Politics of Fear  

1

2

Psychiatry, Antipsychiatry and Internet Addiction  

37

3

Critical Psychiatry and the Construction of Internet Addiction  

93

4

Biosecurity and the Securitization of Internet Addiction  

131

5

Internet Addiction and the Assault on Chinese Values  

149

Bibliography   Index  

165 181

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List of Figures 1.1

The matrix of cyberthreat  

29

2.1

Authorship of medical research articles by nation  

46

2.2

Degrees of addiction  

56

2.3

Responses to internet addiction  

58

2.4

Factors Leading to Internet Addiction  

67

2.5

Outcomes from Internet Addiction  

68

2.6

Reported figures of internet addiction by country  

73

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Preface When I began thinking about this book a few years ago, I knew only that I wanted to explore two questions: how analysts and practitioners understand and define the function of the internet and how they understand what threatens – or doesn’t threaten – in cyberspace. As I began thinking about these ideas, I realized that this question was very broad and I began searching for a way to narrow the scope of this inquiry. Traditionally, those who have written and thought about threat in cyberspace have focused merely on national security implications – looking, for example, at how terrorist groups organize in cyberspace or the probability that a hacker or organized group could carry out cyberwarfare tactics to affect a nation’s economic or military operations. However, I wanted to understand threat in cyberspace in a more general sense. In short, I wanted to understand how the average citizen might think about the internet as a threat to their family, their peace of mind and their way of life. Thus, I concluded that an exploration of the way in which researchers and citizens think about internet addiction would be an avenue towards exploring both of my questions – how individuals think about the function of the internet within their societies, and how individuals and groups think about the ways in which the internet both enhances people’s lives and poses new types of threats. It has been challenging to consider a question which is a relatively new one in political science. As you will see throughout this work, at times I have stretched to find a theoretical framework which would allow me a basis to start exploring this topic. However, it has always been my opinion that one can find politics in many types of social interactions if one looks hard enough and that many types of decisions which do not at first seem to be political actually are. I am sitting in a hotel room in Shanghai as I write this preface, and I have been astounded by the degree to which my Chinese colleagues are participating in the internet revolution and the place which technology now plays in all of our lives. Several of these colleagues have asked me whether my intent in writing this volume was to “attack” Chinese’s policies of internet censorship and social filtering. I have replied to them, as I do here, that my goal has actually not been to choose a side at all, nor has it been to argue that either the US or China is “correct” in the way in which they understand internet addiction. Rather, my intent has been to show that the question of why and how the internet might threaten a society looks very different from one nation to another. It is incorrect, I feel, to argue that anyone is engaging in threat exaggeration, or that any one side is incorrectly measuring the threat which they claim to be experiencing. My intent here is instead to illuminate the ways in which two different nations understand what it means to rely on technology, to be enslaved to technology, or to control

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or use technology. I hope that this work might provide the beginning of a fruitful dialogue which addresses this question.

Acknowledgments I have been fortunate that this year has been one of great academic productivity. This is, of course, not due merely to my own efforts. I would like to express my thanks to the staff at the Regent University Library for the wonderful support they offer to all of our faculty, particularly in the area of interlibrary loans. In addition, I am grateful for the support and encouragement of Charles Dunn, and Gary Roberts, two good friends and colleagues. I am thankful to the graduate assistants I had working with me this year, including Diane Hess-Hernandez. They helped keep everything else afloat so I could finish this book. Thanks to Lynne Kohm and Diane Chandler, two good friends who were very encouraging to me in my research projects this year. I would also like to thank Kimberly Young for taking the time to share her thoughts with me about the politics of internet addiction. Thanks of course to my husband who kindly and repeatedly asked why the book wasn’t finished yet and when it would be. And thanks to my three favorite internet addicts – Haig, Lucine and Ruby – who display an ease with and love of technology which continues to astound me. Perhaps their optimism can in some way counter my own doubts about the future of the internet and our place in the brave new digital world.

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Chapter 1

Risk Assessment, Power and the Politics of Fear Broadband serves as a great unifier, an agent of inclusiveness that brings internet users from all corners of the world into a single online community that can widely deliver new opportunities. Dorothy Atwood, 2010 Controversy regarding the positive and negative impacts of Internet and computer use has received considerable attention lately. … Anecdotal evidence shows growing problems of Internet related harassment, stalking and pornography. S.C. Yang and C.J. Tung, 2007

In 1995, a professor at St. Bonaventure University in the United States published a research article and the first of several popular press books which would go on to define an era. Kim Young, a professor of psychology, is said to have alternately “invented” or “discovered” the disease of internet addiction. Young herself maintains that she was merely the first to codify the description of a pattern of activities among a subset of computer users, but that the activities of the users themselves and the syndrome of uncontrolled, unproductive, harmful computer use already existed. That is, she did not “invent” the disease but merely called other’s attention to what was already there. As she recounts the story, a friend of hers mentioned that her husband seemed to be entranced by his computer, and noted that she was worried about the pattern of actions which he was showing. Young was then motivated to create a short survey which she placed online, with a battery of questions drawn from a preexisting survey on pathological gambling. As she tells the story, she notes that “I wondered if there was a pattern and I put the survey on-line to see if there was.”1 The impulse to do so was perhaps a stroke of genius, as it led to the establishment of a successful and rewarding career for Dr. Young. However, the author notes that at the time she was completely unaware of the ways in which the issue of internet addiction would come to be politicized in the years to come. She admits that she never conceptualized of the possibility that her research would lead to the passage of legislation in Japan, China, Singapore and elsewhere, to the establishment of vast networks of treatment centers and to the administration of punitive treatments, including shock therapy in China, nor did she necessarily anticipate that her books would be translated into at least six languages and go on to sell hundreds of thousands of copies.

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Within the US, controversy still rages regarding whether or not internet addiction is a real disease (Byun et al. 2009). Smaller controversies address the issues of whether internet addiction is one disease or several, whether it is actually possible to develop an addiction to technology at all, and what if anything should be done to “cure” those purported to suffer from this addiction. At present, the issue remains in both medical and political limbo. Attempts to include “internet addiction” as a diagnostic category in the gold standard for psychiatric diagnosis, the Diagnostic and Statistical Manual of Mental Disorders (or DSM-V) have become mired in controversy, and while treatment centers have been established to assist those who suffer from the “disorder,” without a formally accepted medical diagnosis, insurance companies will not always pay for treatment. However, the situation in Asia in general and China in particular is much, much different from the situation in the US. In China, any dialogue regarding the legitimacy of a diagnosis of internet addiction was officially closed in 2008 when the Health Ministry announced that it would publish a new manual on internet addiction which codified procedures for diagnosing and treating internet addicts. In announcing the publication of this manual, China’s leading authority on internet addiction, Dr. Tao Ran of the Military General Hospital in Beijing, explained that China was “in the forefront” of research in the area of internet addiction – due to the large number of subjects available to study and the high standards of scientific analysis which were being brought to bear in studying the problem (Macartney 2008). And while controversy still rages in the US and Western Europe regarding the number of internet addicts and the seriousness of the threat, Chinese officials (and others in Korea, Taiwan and Singapore) have already concluded that what exists is nothing less than an epidemic. Estimates of the number of teen and young adult internet addicts in China range from a low of 11 percent of the population to a high of 20 percent of this population. In the societies named above, there is a consensus that internet addiction is a grave social problem which needs to be tackled on the highest level through the mobilization of large-scale state run initiatives. Here the consensus is also that protecting society from the threat of internet addiction is a higher priority than protecting the individual rights of internet users in society. By 2007, legislative initiatives had been proposed and adopted on both local, regional and state levels – all aimed at regulating citizen internet use, for the purposes of stemming the supposed growing tide of internet addiction in China. At present, legislation in China allows the state to regulate the licensing and location of internet cafes, and legislation also compels the proprietors of internet cafes to keep records of the online activities which café visitors have engaged in. In addition, legislation requires producers and proprietors of online video game sites to monitor and regulate the online gaming activities of China’s youth, including requiring that they impose curfews and time limits on site visits. Finally, individuals who are suspected of being internet addicts in China can be involuntarily confined and treated in residential facilities where until recently they could be subjected to

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electroconvulsive therapy (also known as shock treatment) and various forms of drug therapies. In short, the “disease” of internet addiction is understood quite differently in the two societies – due to both cultural and political factors. What is unusual, as well, about the Chinese discourse about internet addiction, is the amount of information which the government has made available and the cooperativeness which China’s government has shown in responding to popular and media queries about the issue. This is atypical of how China’s government has traditionally dealt with questions regarding health hazards in the country – and for that reason alone, it should cause us to consider what unusual facets of the internet addiction puzzle might be responsible for that change in policy stance. Here, one can compare the ready availability of statistics regarding the scope of the internet addiction problem – in comparison to China’s health officials’ reticence in providing information about other public health hazards, such as the existence of so-called “cancer villages” in rural China, where abnormally large numbers of citizens have become ill most likely as a result of environmental pollution and deposits of industrial waste (Lora-Wainwright 2010). In short, it appears that there are major differences in the way in which US and Chinese health practitioners, public health officials and politicians define internet addiction, measure its scope, and think about the treatment of this condition. But how are we to account for these differences, and what can it tell us about the politics of technology? The Narrative of Threat: Objectivity and Subjectivity I begin this analysis of the politics of internet threat with a story about a lady who wished to ride a bicycle. Although at first it appears that the two narratives – an argument about who can ride a bicycle and a story about the internet – have nothing to do with each other, I hope to make the argument that actually they are closely related. In a highly influential article written in 1984, the European analysts Pinch and Bijker (1984) described how the technology which we now think of as “bicycling” came to be. It is a long and rather involved story since as they note the process of deciding what a bicycle was and who it was for actually took nearly ten years to resolve. Here, their main argument is that the answer to the question “what is a bicycle for and who may use one?” was far from straightforward or simple. One could not simply tell what a bicycle was for by looking at it, and the ideology of “bicycling” was a separate entity from the technology itself. It was neither contained nor defined by the hardware. Instead, the ideology rested in the community of users, their preexisting social values and their relations with one another. Together, the community invented the bicycle, its use patterns and the norms which would come to govern the institution called bicycling. In this way, their story parallels the story I will tell about the internet – later in this manuscript.

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As Pinch and Bijker tell the story, the Safety Bicycle was invented in 1884, and in its original conception it was designed as a product for a rugged, wealthy man of leisure. It had very high wheels and could be used to reach great speeds. It was immediately a success, with factories rushing to develop more of the bicycles as quickly as they could. However, as Bijker and Pinch point out, from the beginning there were other would-be users within American society (who were neither rugged, manly nor members of the leisure class) who also wished to be able to access this technology, in order to utilize it for their own pursuits. For example, from the beginning women pressed for modifications to the technology (such as lower wheels) which would allow them to participate in this new trend as well as to benefit socially, politically and economically from increased mobility in their communities without violating other social norms regarding ladylike behavior and clothing restrictions. Similarly, other individuals raised safety concerns related to the high wheels and fast speeds attainable on the bicycle and pushed for modifications which would domesticate the technology through allowing individuals to use it in a practical manner without training for it or through making it available to children. That is, in the beginning there was no consensus about what the technology was for – whether it was a leisure item for racing and entertainment or a means of transportation. Different groups of individuals attributed a different meaning to the artifact and as a result saw different opportunities as well as risks residing within and arising from the technology. Thus, what occurred was a contest to define the meaning of the technology, to determine which risks were “real” and how and if they would be solved. (It is perhaps at this point that the parallels with the story of internet regulation will begin to become clear.) That is, for Bijker and Pinch, as well as for other analysts of the social constructivist school, technology is viewed as having a “social character” or existing within a social context. As this short story shows, one cannot understand the bicycle (or the telephone or the internet) as merely a collection of material inputs or as a physical structure. Rather, within this paradigm, a particular technology can only be understood by making reference to the social setting within which it is defined and understood (Lawson, 2008). As the analyst John Searle (2010 7) tells us, humans differ from other animals by virtue of the fact that only humans are able to “impose functions on objects and people where the objects and people cannot perform the functions solely in virtue of their physical structure.” In other words, only humans have the ability to make meaning and to attribute meanings or use narratives to objects, and to embed them within larger social institutions. That is, a monkey might pick up a stick and use for a tool, but he would not have the ability to give status to a particular tool, to create rituals around its use, or to come up with a set of complex social rules regarding who might use the tool and under what circumstances. Only humans have the latter capability. Only humans can imbue a technology with an ideology regarding what it is for, who may enjoy it, what it “means” or signifies, and who should and may be excluded from enjoying the technology. Oldenziel

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and Zachmann (2009) illustrate the “ideology of technology” in their study of the “Cold War kitchen.” In this work, they describe how women’s identities, including their economic, political and gender roles, were described through the social institutions and patterns which accompanied the introduction of new food preparation technologies in America. The technology’s ideology (which humans invented and then ascribed to it) thus served to discipline the users and would-be users of the technology. Searle thus introduces us to the notion of social constructivism – or the idea that as humans we cannot ultimately speak of the bicycle (or the internet) without also considering the ways in which it has been socially constructed in terms of whom its users will be and what their use patterns will be. These social elements form a key part of the identity or essence of the technology itself. These unwritten (and sometimes written) rules regarding who may purchase or acquire the technology, how it will be used, and what restrictions will be placed upon its use are thus made to seem as if they are part of the fabric of the technology itself. Any technology is thus at least partially constructed by the community activities which appear which incorporate this technology. (Thus, for example, one can simultaneously speak of the internet as a library or an information weapon or a sort of “toy” for the recreational user since it exists within at least three different social settings. Each definition would be correct, and each would describe, at least in part, what the internet “is.” But to describe the internet merely in terms of its cables and inputs – or in terms of the amount of bandwidth which it occupies – would thus be incorrect, because it neglects the social element.) In accepting the claim that technology’s meaning is constructed, we must simultaneously accept the claim that technology does not implicitly contain a particular ideology regarding how it should be used. Here one might consider an example put forth by Bruno LaTour, who asks us to think of the architect and his relationship to a classroom which he has designed in a university building. (2005, 194-5) The architect may make decisions regarding the size of the room or the types of materials from which the building is to be constructed – but he does not in any way dictate what sorts of activities might occur in the classroom (dancing, watching a film, lecturing or engaging in a debate) nor does his design in any way dictate the content of the activities which might take place there (whether the lectures take place in French or in English, and whether they are lectures about science, literature or poetry). Similarly, the technology of the printing press, the television or the radio does not affect the content which can be carried by these media. However, while technology does not in any way dictate that activities should take on a particular form, the society which utilizes the technology can and does establish norms regarding how the technology is to be understood and utilized. Thus, particular objects and their functions are always exist deeper systems of meanings which Searle refers to as “networks of beliefs.” (2005, 267) Thus, he argues that one cannot decide to go to the movies without also accepting that a movie is a form of entertainment, that they are enjoyed in groups within

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a public setting for which one pays admission and so forth. Objects thus have different meanings within different settings, or can be given different meanings by different users who might embed them within different networks of beliefs.2 Thus, a technology’s meaning may change according to the culture one is in, or the subculture in which one is raised. Furthermore, within the social constructivist school, the relationship between the user and the technology should be understood as reciprocal. That is, it makes no sense to speak of bicycling, automobile driving or the internet without making reference to the users, and one also should acknowledge that users may define themselves in relation to the technology and its ideology as well. Technology’s Hidden Social Characteristics and the Interplay of Politics Using a social constructivist model, one can thus become aware of the ways in which technological decisions and innovations are not simply “clean,” scientific processes – but how they may be influenced by social roles, class differences and the environment in which they are developed. As Pinch and Bijker express the equation, “the sociocultural and political situation of a social group shapes its norms and values, which in turn shape the meaning given to an artifact” (1984 428). In the constructivist model, an object or new technology may thus end up having a variety of different meanings which emerge organically from different environments. That is, the inventors of the bicycle did not invent the technology in isolation. Rather, they acted within a set of Victorian beliefs about class differences, the role of women, and the ways in which technology and access to that technology could be used to convey social status. Thus, as Pinch and Bijker note, both the inventors of the technology and the early adopters were convinced of several factors: that bicycle riding was a leisure activity to be undertaken as a show of athletic prowess and bravery. It was an activity which required practice, and was one which was suitable only for men (who were daring, unlike women) and only for those who were wealthy (since it required large amounts of leisure time to practice.) However, rather than stating directly that the inventors and users wished to deny the technology to others, inventors and early adopters created (or constructed) a discourse about the technology’s inherent meaning. That is, they exercised power, which Searle defines as “the ability of an agent to get subjects to do what the agent wants them to do whether the subjects want to do so or not.” (2010, 147) Others wishing to access the technology were informed that their proposed uses for this technology were incorrect and contrary to the spirit of the technology. Here the enthusiasts claimed that speed and a high degree of risk somehow resided in the technology itself. That is, as they described it, bicycling simply was a dangerous sport, and to alter the usage patterns of the object was to fundamentally deny the technology its “natural use.” Here the notion of a technology’s inherent ideology became a means to discipline users: ideology was used to define the “good user”

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of the technology as well as to exclude others from the pool of would be users (by labeling them “inappropriate users” or “inappropriate candidates” for the technology). Here, as Searle argues, power can be exercised in two ways. First, the subject may be convinced to want what the agent wants – when the subject has no strong preferences. Alternately, the subject may be convinced to abandon his original preference, in order to want what the agent wants instead. Power thus represents a sort of manipulation in which the subject is asked to view the problem from a new perspective so that he may desire a different outcome. Here, it is my contention that those would-be users who accepted the discourse of riskiness and therefore abandoned their quest to acquire the technology of bicycling were manipulated by those in power who told them two things: that bicycling was inappropriate for them and that bicycling was too dangerous for them. Thus, they were convinced to change their preferences and to “choose” instead to keep themselves safe by abstaining from its use. That is, not only was the technology socially constructed, but so was the discourse surrounding the technology, including the discourse of risk. Here, as Pinch and Bijker tell the story, it becomes clear that technology does not inherently possess an ideology, nor does it somehow organically move towards the fulfillment of its potential aside from human agency. Rather, Pinch et al. see use norms and regimes of user discipline as deriving from power politics within a society, including the politics of production. Furthermore, Pinch and Bijker’s story allows us to see how the “ideology” of a technology can change both temporally and culturally, depending on other social norms in place at the time (1984, 410). Thus, today, bicycle riding is a sport open to everyone, and it has a variety of different “meanings” or ideologies attached to it. Those in Africa who wish to possess a bicycle want one for business reasons – so that they can engage in trade over a wider area, for example. In Holland, riding a bicycle is a sign that you are an environmentalist, but this is not so in China or in Africa. The same technology thus has different norms and different meanings in different cultural settings.3 Risk Assessors as Gatekeepers However, the part of the story which Pinch and Bijker allude to only in passing is arguably the most interesting part of all, at least for political scientists. This is the brief statement of the ways in which the bicycle’s inventors engaged in the process of risk assessment – before drawing the conclusion that the activity as described was too dangerous and inappropriate for one group of would-be users, and that these users therefore should not have access to the technology. Here, the discourse of danger and hazard (which I refer to throughout this manuscript as “threat talk”) served two purposes: it helped to construct a norm regarding the appropriate use of technology, and it disciplined users (and would be users) who sought to change that socially constructed usage norm. In short, women were prevented from riding bicycles for almost ten years by virtue of the statement: “this is too dangerous for

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you.” Those in power were able to use this statement to “wall off” the technology from would-be users who wanted to use it to transform society. Instead, “threat talk” was thus used to delimit the scope of usages which were to be accepted as normal and safe. The new technology which might have had a large role in transforming society was instead redescribed as having only a small or limited role, and the social status quo was preserved. Threat talk was a construct which many would-be users believed enough that they were willing to abandon their quest for freedom and mobility within the community in exchange for a guarantee of safety from risk and threat. Here, it is my contention that the discourse of risk is a key component in the social construction of technology, as well as in the formation of norms regarding proper uses for the technology. Arguably, disciplining or convincing the user might be seen as a “second best” type of control strategy. Ideally, those in authority would wish to control the development and the ideology attributed to the technology itself. (That is, users and the wider community would come to a consensus regarding what the technology was for. They might come to understand, for example, that a certain technology had military uses but that it would be inappropriate for civilians to demand access to that technology. Therefore, the community would understand that it was “inappropriate” for individuals to have nuclear weapons – and in some societies where gun control norms are very strong, the community might even come to understand that it was “inappropriate” for users to have conventional arms.) However, if what some might describe as the inevitable logic of technological diffusion comes to pass, and it is impossible for a society that wishes to be modern to make a decision to either abstain from or refuse to adopt new technology, then instead threat talk can construct norms regarding who may access technology and under what conditions. Here one can consider the way in which the Xerox machine was utilized in the former Soviet Union and throughout communist Eastern Europe from the 1960’s until the early 1980’s. While it was impossible for a government office to refuse to utilize a Xerox machine, it was a relatively simple matter to simply implement a number of access regimes and personnel restrictions regarding who might access the Xerox machine, under what conditions and for what purposes (Shane 1997). However, in the Soviet example, would-be users were told merely that they did not have access to the technology. The use of the discourse of risk, however, is a somewhat more sophisticated secondary use of power. This is because it is a covert rather than an overt means of exercising control over would-be users, and it is one which essentially co-opts the would-be users through changing the ways in which they think about the costs and benefits of having access to the technology. The discourse of risk thus explains why the individuals who might benefit most from the widespread dispersion of internet technology and access to that technology may instead collude with authorities to restrict access to this technology, and why they might oppose rather than welcoming international attempts to increase their access to that technology. (It might also explain why many Europeans agree with

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gun control in their own nations, agreeing themselves that arms are too dangerous for individuals to have in their homes.) “Threat talk” and its widespread and unquestioned usage explains how one can find letters to the editor in Chinese newspapers from parents who worry about the deleterious social effects of internet access, as well as how it is possible for users to organize to restrict the growth of internet cafes and to push for stronger curfews and controls on internet sites. In short, it explains the growth of a discourse (about which we seldom hear in America) of a would-be user in China, Russia or India who states “Actually, I don’t want freedom on the internet. It’s clearly too dangerous. I prefer the safe environment with clear rules which the authorities have constructed for me. I do not want this freedom for my children either. I prefer that they be kept safe by my actions and the actions of the state.” Threat talk helps explain how citizens can be brought to engage in self-policing of their actions and the actions of others. In this manuscript, I argue that the notion of internet dependence and internet addiction was used by the state (with the collusion of state scientists, psychologists and psychiatrists) to help create a set of domestic norms regarding the need for control, restriction and policing of the internet in China, beginning in the early 1990’s. Many (though clearly not all) Chinese citizens “bought into” this threat talk and as a result requested and colluded in the production of a different internet regime than has grown up elsewhere in the world. Here, the discourse of risk “fits” the situation – because it meshes with other cultural understandings in that society (including a tendency to safeguard the family and to prize group initiatives over individual autonomy) about what threatens the citizen and his society. Society didn’t therefore impose the narrative, but it helped and participated in the emergence and growth of the narrative. Threat talk explains Fallon’s (2008) findings that Chinese citizens do not feel the same way about government repression of the internet as Westerners do. She notes that Chinese users are significantly less likely to view internet content as reliable in contrast to Western users. In addition, she notes that over time, their judgments of the reliability of internet content have grown steadily worse. (In 2003, 52 percent of users regarded internet content as reliable, but by 2008 only 26 percent felt this way.) That is, Chinese users are more likely to view the internet as threatening, and to wish to be protected from it. And as the discourse of internet addiction has grown stronger and more pronounced in Chinese society, citizens’ fear of the internet and desire to be protected from its deleterious effects has grown stronger as well. Evidence suggests that a similar situation exists in Russia, where many citizens seem to favor strong government controls over media access and content than their Western counterparts do. Catone (2005, 1) notes that a 2005 survey found that 82 percent of Russians were in favor of government censorship of TV – though most were interested in having the government remove “sex and violence.” In this work, I argue that when new technology emerges in a culture, there are actually two separate discourses – a discourse of risk and a discourse of opportunity – that work together to construct the meaning of new technology

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within a particular culture. When new technology is introduced, citizens and government alike grapple with and refine their ideas on a number of issues: First, they may eventually form a consensus regarding what the technology represents (the ideology of technology). They begin formulating rules regarding what it is for (the utility of technology). They also create norms and agreements regarding who may use it and what they may use it for (norms and discipline regarding technology). This results ultimately in what I refer to as “the discourse of the good user” – a socially accepted set of practices and ideologies regarding the technology which will vary from society to society, as well as a set of practices setting out who should not have access to the technology and how society should react and respond to potentially harmful consequences of technology. I contend that during the initial process of social contestation, threat talk plays an equal – though opposing role – to the discourse of opportunity in constructing understandings of any technology, including the internet. Policy-makers, citizens and creators of the technology engage in a process of risk assessment – in which they weigh the types of risks which are likely to be created with emergent technology, as well as the likelihood that individuals within a society will be subjected to these risks. As W.D. Rowe (1992) describes the situation, risk analysis is a policy tool. Policy-makers and decision-makers rely on a knowledge base of information created by scientists and those involved in science policy. Utilizing this information, they go on to make decisions and rules regarding the “proper” use of this technology. Each society or culture thus undertakes a process of risk management, in which decisions are made regarding an “acceptable” level of risk, and which procedures and policies should be implemented to reduce or control risk, bringing it down to this acceptable level. In this work, I show that within the past 15 years, as states have begun to evolve norms and legislation to regulate the internet, each state has created its own discourse of danger – or its own understanding of exactly how the internet threatens their citizens. Indeed, the first US congressional hearings having to do with internet technology were about computer pornography and materials available which were seen to harm children. It is has been difficult to locate this discourse, however, because of its diffuse nature within a particular nation, as well as the ways that it varies from one nation to another. When one looks, for example, at the United States, it is obvious that many separate Senate and House Committees and Subcommittees have held hearings on the subject of danger in cyberspace – with little or no coordination between the various bodies. During the One Hundred and Eleventh Congress in 2009, the most recent year for which full records are available, hearings on cyberspace were held by at least ten different bodies, including the House Subcommittee on Courts and Competition Policy, the House Subcommittee on Technology and Innovation, the House Subcommittee on Commercial and Administrative Law, the Senate Subcommittee on Research and Science Education, the Congressional-Executive Commission on China and the Senate Committee on Commerce, Science and Transportation.

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Furthermore, I feel that our overwhelming academic and policy emphasis on digital rights has left us insufficiently cognizant or informed about the subject of digital “wrongs” – or the dangers to users which states have acknowledged and begun to face in cyberspace. Within the United States, there is presently a relatively high degree of consensus regarding, for example, what sorts of risks and threats the internet presents to children and the proper roles which parents, schools, software manufacturers and internet service providers (ISP’s) should take in either shielding children from or preparing them for this risk. But invariably, American discourse also stresses the ways in which the payoffs from internet use – including the possibility of global connectivity and its attendant political and economic benefits – far outweigh any possible risks associated with introducing internet technology into a society. Reid (2009) refers to this as the “politicization of connectivity.” However, these emphases on user’s rights to universal access to the internet as well as attempts to construct a sort of universal virtual citizen who would enjoy the same rights of internet access and use everywhere in the world have been both hasty and ill-advised. Thus, it is my goal to consider more fully the language of digital wrongs – or digital danger. It is my contention that the discourse of digital danger is rooted not in universal concepts, but is rather highly contextualized – varying from one environment to another. In every state, one can find underneath the language of digital rights a secondary discourse which considers issues as varied as internet addiction, the threat of lost productivity due to improper internet use, and the dangers which arise due to citizen behavior on the internet. That is, there are two separate discourses which one can identify with regard to the rights and responsibilities of citizens in cyberspace. There is a discourse of opportunity which deals with the rights citizens enjoy – to access information, to participate in internet society and to express themselves in cyberspace. And there is also a discourse of risk – which seeks to assess and understand the dangers citizens may face in cyberspace both individually and collectively. This discourse is not one of rights, but one of responsibilities – as individuals, civic leaders and governmental authorities assign responsibilities for the policing of cyberspace and the ways in which citizens must be kept safe from danger. A recent article by three Chinese researchers illustrates the linkage between the two discourses. They write that: The internet provides tremendous educational benefits, including access to information across a wide variety of topics, establishment of educational links and enhancement of communication between teachers and students. However, excessive use of Internet and Internet addiction can lead to negative outcomes such as poor performance at school, social isolation and impediment of the adolescent’s psychosocial development. (Ni et al. 2009, 330)

Here, researchers speak both of opportunity and risk, where risk is defined as assessment of consequences or exposure to the chance of loss. That is, risk is a

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probabilistic assessment of the likelihood that one could be harmed by a particular event, object or environment (Waterstone 1992). In this work, I illustrate how technology’s creators and its early adopters, as well as the policy officials involved in regulating and assessing risk, can serve a gate keeping function. Based on their findings, they find themselves welcoming in some types of users while excluding others as ineligible. Here, the discourse of risk can be used to ascribe blame as well as to make arguments about agency. As A.V. Cohen (1996) notes, the implementation of quantitative risk assessment is never a neutral process. Rather, it is always political – undertaken to satisfy users who have voiced concerns about a threat, imposed from above, and aimed at in some way controlling further conversations about the threat. O’Riordan (1996, 213) has described risk as “a combination of technical appraisal and social tolerance.” Here, states may have very different levels of social tolerance, and very different ideas of what constitutes and “acceptable” or tolerable risk. In addition, states may differ about who should be subject to the risks which accompany the introduction of new technology. It is my contention that in the Western, information society model, the emphasis is on the private citizen as the subject of risk. Here, the citizen is viewed as autonomous and capable of making his own decisions about how he wishes to protect himself in the cyberspace environment. The citizen himself makes the decision about how much risk to undertake and acts accordingly. Does he wish to set limits on the amount of access he and his family have to the internet? Does he wish to purchase filtering software? To impose a curfew on his family? To set up computer programs which will police his own internet usage? At heart, all of these are viewed as personal decisions. The implication is that when the internet is running through his own home, cyberspace is essentially an extension of his or her personal space. Thus, it is appropriate for a parent to police his children’s internet activities at home – just as he should would police his children’s other activities which are being performed in the home. Similarly, student access to cyberspace is predicated upon the assumption that the cyberspace accessed at school is an extension of school property. Thus, school officials may police student access (including asking for log-ons, policing access and implementing curfews and reporting regulations) in the same fashion as they police other student activities occurring in the school. Finally, when one accesses the internet at work, the understanding is that this is “work cyberspace” which is therefore subject to the same sorts of regulation as other activities which individuals perform at work. In contrast, the information state model stresses the role of the state as the decision-maker, rather than the role of the individual. Here, the state determines what sites will be blocked, what filters and firewalls will be used, as well as who will be issued a license and IP address. In essence, the individual or group tasked with studying and quantifying the threat occupies a position of power where he or she now has the right to decide whose concerns about risks and threat will be aired and whose will not. That is, the assessor now has the ability to make decisions regarding whose concerns are legitimate and whose are not, as well

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as to ultimately decide whose rendering of the overall safety or danger of an environment will prevail. Thus, in the internet society model, a private citizen may decide that he or she is not particularly concerned about the threat of identity theft. In contrast, in the information state model, only the state may designate what is or is not a legitimate concern. The two types of risk assessment – individual risk assessment versus state level risk assessment – thus lead to radically different policy descriptions regarding how society should cope with the threat of internet addiction. In the Chinese case, the groups most involved in constructing the narrative or story of internet addiction, as well as measuring the seriousness of the problem, are state-run organizations, including medical hospitals, associations of medical researchers, and members of the military and police forces. In certain situations the technology might be described as so powerful and so dangerous that all would be advised to avoid it (hence, the fact that there are no nuclear weapons for home use), while in other situations, the technology itself might be described as useful for most users except for those who are likely to use it improperly (hence, the decision in America that firearms should only be sold to individual licensed users who do not have a criminal record or psychiatric history). In the first instance (no one can have it), the technology itself is blamed for creating harm, while in the second instance (some people can have it but others cannot), the bad user is lamed for creating harm. And in the first instance, the policy solution is to control the technology, while in the second instance the policy solution is to control the bad user. In this situation, those in authority might set up a system whereby would-be users might have different levels of access to a technology, depending on their social status (for example, children using the internet at school might have less access than adults using it on their free time). Here policy-makers become gatekeepers using risk assessment to shape understandings of the technology and to exercise power in terms of how the technology is handled – and who may be allowed to handle it. Thus, particularly in cases where the new technology is highly desirable and sought after by all, the process of risk assessment and the language of hazard and risk can serve as a means of rationing access to technology or limiting its use. In other words, the ability to label something as dangerous confers power.4 Danger, Gatekeeping and Culture The problem is that frequently when we encounter “threat talk” as a means of defining a technology’s ideology and disciplining users we tend not to see it. It is only when we view technology in a comparative perspective that we can see how the same technology may have a different ideology attached to it, a different “narrative” about what it is for, and a different normative set of use patterns imposed on it. It is only in comparative perspective that we see how the politics of risk assessment works. Here we might consider briefly the debate in Saudi Arabia about whether women should be given access to automotive technology (or “driving”). In official

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government publications, threat talk is used to construct driving as a dangerous activity. Officials note that driving raises the risks of mixing between the genders, temptations, and tarnishing the reputation of devout Muslim women. As one analyst put it, if women were given the right to drive, then drivers will be free to leave home alone, they will unduly expose their eyes while driving and they will perhaps interact with male strangers, such as traffic police and mechanics (Los Angeles Times 1990). Other commentators make reference to the fact that driving is particularly challenging in the Middle East, noting that driving on roads requires fast driving and bravery. That is, the automobile’s ideology in that nation is gendered, and associated with male attributes. The Saudi assessment of the risks attached to driving seems remarkable to us for two reasons: First, in the American context, driving is imbued with a very different ideology. As Campbell (2005) notes, Americans associate “automobility” with concepts such as the freedom of the open road (and perhaps even Manifest Destiny and the drive west), the provision of individual user autonomy to travel and range freely. It also serves as an expression of individuality.5 From the beginning, the dominant narrative about the automobile wove in strands of American folk mythology and democratic ideology. Both commercial discourse as well as that involving government regulation of the auto industry referred to the fact that the automobile would “free” Americans, help us to conquer this big land and allow us to explore it. The nation’s roads (like our internet) stretched from “sea to shining sea” and they allowed Americans to travel the whole country, thereby increasing their sense of exploration and citizenship. The auto thus represented progress, prosperity, travel and freedom (Flink 1988). The risks enumerated in the Saudi calculus thus make no sense to an American analyst. Instead, an American will likely dismiss the risks enumerated by his colleague as “not real” because they do not configure within his own ideological construction of the automobile. Similarly, in the case of the internet, Americans in particular just assume it has a particular ideology and proceed to evaluate the risks and opportunities associated with the technology within that ideological context. To most Americans, the Internet is fixed within the ideology of globalization – and analysts thus tell us that the internet has the ability to undermine state sovereignty and to create new units of social organization. The internet is viewed as “progressive” type of technology which will replace old ways of thinking about territoriality, the role of social government and patterns of social organization. It is hard to imagine that others might view it differently. However, those writing from other perspectives do not accept the American description of internet ideology. As early as 2002, the British analyst Christopher May (31) argued that: “Technologies have no natural character; They do not automatically support or destroy democracy, but rather help reproduce social structures and systems through the manner in which they are used (and misused).” Technology can thus, he argues, just as easily support repressive structures as it can be turned against repressive structures, resulting in their destruction. And

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Marcus Alexander, for example, wrote in the Russian journal Demokratizatsiya in 2004 that governments can also appropriate information technology, using it to create more government control rather than more user autonomy. From his perspective, it is not obvious that internet technology has a particular ideology associated with freedom, nor a particular predetermined trajectory of liberating events which will result from its usage. Rather, as Alexander sees the problem, what are important are use patterns – which users have access to the technology and what they use it for. And increasingly, attempts by Western analysts to equate internet technology with freedom itself have been criticized by those who downplay such “cyberoptimism.” Most recently, Evgeny Morozov (2011) has suggested that internet technology can be used to increase government surveillance, making repressive states more rather than less powerful, while May suggests that optimistic arguments impute a sort of determinism to technology which does not in fact exist. Instead we see attempts to make reference to cyberrealism, cyberpessimism, and cyberterrorism. Thus, we are left with a puzzle: Why do citizens and elites from different states come to such different conclusions about the ideology, the opportunity and the risks of a particular new technology when it is implemented? (Here, the obvious answer is that the “ideology” of the technology is really the ideology of the inventor or controller of the technology, not the ideology of the technology itself – or as May suggests, we have the question backward if we ask merely “what is technology doing to us and our societies?” Rather, we should ask: “what are our societies and cultures doing to and with technology?”) And in the face of two differently, culturally constructed risk assessments, does it make any sense to ask which one is “real”? The problem also becomes one of ethics and even human rights when one culture regards its safety measures as justifiable given the degree of perceived risk associated with the new technology and its improper use – while other, outside observers do not feel that the risk identified is real or serious, and thus question whether the state should be permitted to take extreme measures to protect its citizens from the perceived risk. This is the puzzle that is at the heart of many of our debates today about universal norms in international relations. In particular, those NGO’s which argue that internet access is a human right frequently base their statements on a complete denial and refusal to consider a state’s rhetoric of risk and hazard, as well as a dismissal of the claim that the state is taking proper measures to protect its citizens from perceived risks. Here, the constructivist view of the internet requires accepting that the internet (like the press, guns or nuclear power) has no inherent, predetermined social function which is universally accepted in all societies – nor does the technology somehow automatically contain or create the laws, regulations, norms and regimes regarding its use. Rather, all of these accompanying social institutions are created by individuals and groups (or states) associated with the technology – either consciously through deliberative decision-making processes or incrementally as these practices evolve. The internet may thus look different and fulfill different

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social functions in different societies (just as not all societies will evolve the same system of political parties.) Furthermore, the constructivist view means that there are also few genuine, measurable risks attached to internet use in a society. And even if it were possible to establish risk probabilities (using statements like “for every additional hour your teenager spends on line, the likelihood that they will be the subject of internet predators goes up by a value of five”), it is unlikely that doing so will change how users and societies think about these risks – since the process of risk assessment is also socially determined. This is because our own cognitive preconceptions cause us to shut out the perception of some dangers while highlighting others. This observation helps to explain why, for example, Chinese citizens evince a much higher rate of concern regarding the dangers of the internet even amongst those who spend a great deal of time on-line (Markoff 2009), as well as why exposure to social institutions alone over time does not necessarily alter perceptions of risk and threat inherent in these institutions. They may be socially and culturally preconditioned to think differently about the risks and dangers associated with internet use. That is, the debate about the risk and threat sustained through using the internet is not about whether or not the threats or risks are “real”. And all of these items – norms, interactions with the international community, and the discourse and narratives of internet danger – will vary widely from one culture to another. As Wildavsky and Douglas state the argument, “risk perceptions are derivative of social norms… We choose which risks to attend to in the same package as we choose our social institutions” (quoted in Braman and Kahan 2006, 1292). In other words, while it may appear that citizens are arguing only about the dangers which accompany a particular development in their communities (such as the introduction of a nuclear power plant into the neighborhood), what they are really arguing about are competing norms regarding what the community should look like and how it should be organized, as well as the danger posed to that community by the new technology. They do not perceive the risks and dangers in the same way, because their perceptions are affected by the different norms which they subscribe to regarding how a community “should” look. Bijker makes a similar point in his discussion of “risk cultures.” In comparing the ways in which the United States and the Netherlands have dealt with the threat of catastrophic floods in the wake of Hurricane Katrina, Bijker argues that the two societies think differently about two factors: First, societies differ in their assessments of who should prepare for catastrophe and participate in the calculation or risks – with Dutch society viewing the job of preparing for flooding as a community responsibility while in America it is seen as the preserve of corporations and professional public officials. (Thus, for example, the Dutch may have volunteers within their community who are responsible for monitoring the condition of levees, a function which would be carried out by paid public officials in the US.) Secondly, societies may differ regarding how much monetary and organizational emphasis should go towards preempting an event, and how

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much should go towards mitigating an event once it has occurred. (Here, Bijker suggests that the Dutch devote more effort overall to preventing the possibility of flood and are more likely to undertake costly efforts to head off possible flooding, while Americans might “skimp” on preparation and focus instead on large-scale evacuation efforts and mitigation effects once the event has occurred.) As Douglas and Wildavsky tell us: “The choice of risks and the choice of how to live are taken together. Each form of social life has its own typical risk portfolio. Common values lead to common fears and, by implication, to a common agreement not to fear other things” (1983, 8). As Wildavsky and Douglas pointed out nearly 20 years in their ground-breaking work on environmental risk analysis, the average technology user is rather illequipped to think objectively about the threats and risks which he encounters on either a daily or a long term basis through his exposure to the technology – even if he wanted to. The user is unable to formulate a rational proposition about what constitutes an unacceptable risk from the technology since he either doesn’t have all of the information, doesn’t understand that information, or chooses to ignore it. In the face of these obstacles to a perfect weighing of threat and risk, Wildavsky and Douglas suggest that each society or culture may engage in certain heuristics and shortcuts as a way of “organizing their bias.” They will choose certain aspects of the threat equation to focus on while choosing to ignore others. The weighing of threat and risk thus rests at least partially on culture and history, and the process is far from objective. Particularly when people are thinking about brand-new technological risks which are novel (like the internet and the threat of war in cyberspace), there is very little past evidence that analysts or users can go on in making these conclusions. Rather, in such a situation, each state might undertake a search in which they gather lessons from past experiences with the introduction of new technology. Thus, each state is likely to use and weigh different evidence in evaluating threats and will reach different conclusions as a result. This process becomes evident in examining the cybersecurity doctrines of various nations. Japan’s cyber Security Doctrine, written in 2009, describes how Japan has been successful before in other circumstances where they were both behind industrially and technologically and where they needed to quickly enter into and compete on a world stage. The Japanese Doctrine stresses how the state’s own culture of discipline (both on the individual and societal level) and unity helped them to become an Asian Tiger in the 1970’s and describes a willingness to do this again in relation to Japanese aspirations to dominate cyberspace. While Russia’s cyberspace doctrine does not explicitly reference any past historic events, one may suggest that the heavy emphasis on avoiding the spiritual impoverishment and corruption of the West and its attendant dangers echoes the rhetoric generated by Russia’s political parties – many of which rely on nationalist planks which stress the ways in which Western ideas are to blame for the moral dangers facing Russia today (Papkova 2007). And the most recent US cyberspace doctrine, as well as rhetoric appearing in the 2010 National Security Strategy, references past US successes during the Cold

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War as well as establishing themes of competition between competing blocs in cyberspace. Each state thus uses its own historic and cultural lens to make sense of and explain the puzzle of new technological risks stemming from the internet. Threat Talk and the Internet It is my contention that Western internet analysts (and Western internet architects) have thus far been overly focused on the rhetoric of opportunity and have paid insufficient attention to the rhetoric of threat – or the process of risk management. Much of our American academic theorizing about internet norms in particular rests on a teleogical narrative in which the internet represents progress and the power of democratic ideas. The internet is thus “destined” to be accepted everywhere and to function similarly in every society. (It is seen to possess an ideology, rather than being assigned an ideology within a particular cultural and social setting.) Ultimately, we are told, the spread of the internet will lead to a particular set of outcomes on the world stage. Consider, for example, the following descriptions available on-line for the work of a US government supported organization called Internews. This organization works in many newly democratizing countries to “assist” citizens with becoming connected on the internet. The mission statement for the organization informs visitors to the group’s internet site that: Information is the power that can change the world. We are in the midst of a revolution in human communication that is profoundly reshaping our future. Yet, for nearly half the planet, the promise of this revolution has not been fulfilled. Internews is an international media development organization whose mission is to empower local media worldwide to give people the news and information they need, the ability to connect, and the means to make their voices heard.

Here, the orthodox (uncontested) view of the internet rests on three basic principles: The internet is described as having a progressive character which resides in the technology itself, rather than being imposed upon the technology by outsiders or those above the project. Next, the internet is described as having a leveling or democratic character. Finally, the internet is seen as transformative and deterministic. In fact, Western writing about the internet, about cybersecurity and about cyberthreat rests on a package of shared intersubjective understandings – which are not spelled out because they are understood implicitly by virtue of one’s situatedness in the culture which produced them. The research institutes in the United States and Western Europe which purport to study the internet rely on this core package of concepts. The homepage for Harvard University’s Berkman Center for the Internet and Society describes the organization’s mission as “to explore cyberspace, share in its study, and help pioneer its development.” Its participants are described as “working to identify

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and engage with the challenges and opportunities of cyberspace.” Note here that cyberspace is described as a progressive sort of boundary or frontier which is to be explored, and that the emphasis is only on challenges and opportunities in cyberspace – without an acknowledgement of either threats or dangers. In addition the internet itself is described as “a social and political space where constraints upon inhabitants are determined not only through the traditional application of law, but, more subtly, through technical architecture (“code”). The notion that code determines the character of cyberspace here suggests that the internet itself has agency in creating its functions and structures – rather than that these things are a function of individuals or social groups. Also, “the inhabitants” are described as inhabiting only cyberspace, and thus may be conceptualized of as universal, rather than national – and one may interpolate that the inhabitants are thus similar, regardless of where they might live in the real world. The Center for the Digital Future, headquartered at the University of Southern California’s Annenberg School, displays a similar orthodoxy regarding the progressive potential of the internet. The mission statement for the school states that “the Center is a research and policy institute committed to work that has a real and beneficial effect on people’s lives, while seeking to maximize the positive potential of the mass media and our rapidly evolving communication technologies.” The Center’s new project, funded by the United States government’s National Science Foundation, has a normative agenda aimed at changing the behavior of current non-users of the internet in the United States. The description of the project presents a decision not to use the internet as deviant, and proposes studying this class of individuals to learn what compels them to behavior in such deviant ways. Here, the orthodox view is that computer use is healthy and normal and that the “failure” to use computers is just that. Those who are not on-line are not regarded as having exercised autonomy in regards to that choice. Instead, they are described as “digital have-nots” who may be regarded as less well-informed, and having less agency. The study’s description reads in part “if penetration of the Internet into homes reaches ninety percent, the study will be able to determine who the ten percent of non-users are, why they remain non-users (that is, what types of economic or psychological issues might account for this condition) and how they do offline what most of the nation is doing on-line . . . the project will trace whether a situation of information haves and have-nots develops and the ways in which our social, political and economic lives are changing.” The ambitious policy program associated with Brandeis University’s Internet Studies Program bears the title, “Tools to Change the World.” Again, the spread of the internet is regarded as progressive and inevitable, as well as being presented as self-fulfilling and neutral, rather than being implemented by any one state. The website tells us: “The program in Internet studies affords opportunities for students and faculty members to study the evolution of this revolutionary technology and its pervasive political, economic, cultural and artistic ramifications in a multidisciplinary framework. It highlights the socioeconomic forces that shape the

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internet and the global response to it and helps students to frame the information revolution in critical perspective.” Frequently, the trope of “the internet as an agent for transformation” finds its way into other parts of a university’s philosophy – beyond that of a program aimed at studying the internet. Thus, a mission statement found on the International Technology (IT) homepage of Georgetown University tells the reader: “Georgetown University recognizes the Internet and Web as powerful tools for advancing teaching, learning, and research in today’s networked, global society. The underlying interactive technology of the Web can promote greater student participation in learning and open up new possibilities for teaching and scholarly communications.” The internet is regarded as transformative and democratizing not just on an international level, but also within specific social structures in the United States. Survey research projects again embrace this orthodoxy with, for example, the World Internet Project’s explicitly stated goal of exploring the “transformative power of the internet.” Finally, the World Values Survey has begun including questions about internet use in its international survey tool, but arguably always predicated upon the assumption that modernization is a good to be sought and that more technology is desirable for a society. Here, Flichy voices the orthodox American view which is that norms governing internet behavior appear to be American but are in reality universal. She states: The internet Imaginaire, like the technology accompanying it, was born in the particular context of the United States but subsequently became universal . . . Wherever one is in the world, logging on the internet is, in a sense, plugging into modernity and the country that best symbolizes it. (2007, 211)

Here, I would argue that these principles – that the internet is progressive, transformative and inevitable – form part of US foreign policy. The problem with this orthodoxy is that it precludes either the expression or the exploration of opposing views. Within this orthodox set of beliefs, the right of individuals and groups to either resist technology or to control it is not recognized. Those who attempt to restrict technology or to resist it are not given the language (discourse), tools or the right to do so. Instead, the dominant paradigm tends to label them both as illegitimate and regressive. Writing by contemporary analysts and policy-makers frequently labels these nations which seek to filter and control the internet, limiting its access within these societies as “internet enemies” – without truly considering the risks which these nations may perceive as inherent in internet technology. The international nongovernmental organization Reporters Without Borders, which has collected statistics regarding imprisonments and punitive measurements against cyber dissidents has referred to China as “the world’s biggest prison for journalists and cyber dissidents” (Radio Free Europe 2006). Instead, these nations are seen as a type of rogue nation which does not accept the norms of internet use and

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which may even seek to disrupt these norms. Thus, for example, attempts by a fundamentalist Islamic government like Saudi Arabia’s to “defend” their national cyberspace as well as their national citizens in cyberspace through filtering out content which includes pornography, feminist themes and pro-homosexual websites are generally regarded by Western-based nongovernmental organizations as a human rights violation committed by the government against its citizens. Here the argument being made by the nongovernmental organization in this instance is not that everyone should be able to access anything they want at any time on the internet. Rather, there is a broad international consensus that governments should have the ability to defend their cyberspace and their citizens through filtering out content which is “harmful” or threatening to a nation and its users. Thus, for example, there was agreement between heads of state, ministers and international organizations regarding the International Telecommunications Union’s actions in 2009 to implement the Child Online Protection Initiative (COP).6 There are clearly sub classes of materials which are considered universally harmful – such as child pornography – and here all players in cyberspace seem to agree that filtering out or otherwise controlling access to such materials is a state’s right as well as its duty. A state which fails to allow its citizens access to child pornography through the use of internet filtering is thus unlikely to be accused of committing a human rights violation. However, the problem is that beyond this limited number of materials which are deemed explicitly harmful to all, there is no broad international consensus regarding which materials and practices on the internet are threatening or harmful to users, to environments and to political regimes. The problem thus becomes slippery in situations where a state claims that it is protecting its citizens and territory through engaging in social and political filtering, but where the international community does not accept the state’s claim that such materials threaten its citizens and its regime. Particularly in cases where states – including Russia, Ukraine and China – claim to be defending citizens from spiritual and moral pollution or contamination which might harm a society through internet exposure, their claims are usually judged invalid by the international community. Furthermore, when the state is engaged in defending its territory and citizens from ideas which it views as prowestern and therefore antithetical to its native culture, this claim is usually labeled as invalid because the threat is dismissed as being either not real (not observable) or manufactured. Nations which refuse to sign on for the information revolution due to a sense that it threatens their culture may find that threats they raise are disregarded for one of two reasons: Either they are informed that there is no empirical evidence of the threat (according to positivist criteria), or their national and cultural sense of threat may be disregarded as being irrational or a product of superstition and fear. (In other words, what seems to individuals within a country to be a genuine risk is actually recoded by the dominant power as a phobia or an irrational fear.) Furthermore, the whole notion that a country might be threatened by the West and Western technology at all may be disregarded as irrational by western analysts. Thus, frequently we see Western discussions of resistance to

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internet democracy which rest on the implied assumption that the recalcitrant regime is perhaps only pretending to be threatened in order to enact repressive measures, but in reality knows that there is no real threat. Transscience and the Measurement of Threat and Hazard But the question remains: did those early Victorians who sought to protect women from the dangers of bicycle riding (or those contemporary Saudis who feel that the daring, male sport of auto driving is too dangerous for women) actually believe that it was dangerous and therefore chose to act benevolently in protecting those who were vulnerable from the probable harm caused by the new technology? Or were they engaged in some form of deception in which they acted as if the technology were dangerous in order to use their power to carry out a process of exclusion? That is, can any supposedly objective outside observer ever definitively draw conclusions and satisfactorily measure the dangerousness of a new technology, or is such an exercise always doomed to failure – because of the inherently subjective nature of risk, and the inherently social nature of technology? This is the question which is at the heart of the debate today about regulating the internet. Here, Western analysts have tended to dismiss statements by Chinese and Russian government officials in which they have expressed reservations about the risks which they see the internet as posing to their citizens. Claims by Russian and Chinese officials that the internet threatens the safety of their citizens and their social and moral systems have been largely ignored or rebuffed by Western and international analysts. Instead, analysts have acted as though these Chinese and Russian individuals were engaged in either deception (because they knew there was no “real” threat and merely acted as if there was) or threat exaggeration – as part of a concerted campaign to deny their citizens access to the internet. Alternately, they might just have been practicing “bad science” – using flawed measures and poor research methods to arrive at faulty conclusions. However, the problem is not quite that simple. Part of our problem here is that until quite recently, analysts have regarded scientists as politically neutral personnel who gather information about scientific threats including disease, climate problems or public health hazards – but who do not advocate (or even have, apparently) a policy position regarding how authorities should respond to the threat. That is, scientists were regarded as acting like reporters, gathering information which was then reported back in a neutral format. However, analysts did not consider that scientists might be involved in framing how policy-makers thought about issues – either accidentally or on purpose. Scientists were viewed as providing raw components which were then used or assembled by policy-makers to assess and measure a risk and formulate a policy response. However, in recent years, analysts like Keller (2009) have claimed that scientists actually construct the issues – since their word choice, the metaphors

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and images which they use, and the data which they choose to present (they could not possibly prevent all of the data on an issue like global warming to a Congressional Committee, for example) ultimately affect how policy-makers think about an issue. Ingram, Milward and Laird (1992, 37) state this position somewhat more stringently, suggesting that scientists – including those engaged in risk analysis – actually have the power to create public issues. Similarly, Eriksson (1999, 2) notes the heavy reliance on technological personnel in the making and interpretation of cyberspace policy. He argues that research on technological issues may be understood as the production of data (which he refers to as the factual knowledge base of policy); the production of ideas or concepts, or the production of arguments (which he notes are sometimes used to legitimize a decision which has already been made.) Here, the implication is that scientists might be guiding conversations about risk – even if they are not consciously doing so, since their own underlying values affect how they edit their data or how they present it. In doing so, they end up leading policy-makers to draw certain conclusions or to support certain policies – whether they planned to or not. The implication of the trans science model is that it is impossible to fully wall off “hard science” data from the social context in which it is produced. While the numbers themselves might be neutral and free of culture, the ways in which they are expressed are not. Thus far, analysts like Keller who analyze trans science have done so only from an American perspective. However, in this work, I argue that if hard science data exists within a social context, then it only makes sense to expect that scientific conversations about technological risk might also look different within different cultures – even if the underlying data looks the same. Different groups of scientists from different nations might form different conclusions about what the data means, what risks are presented by new technology (including the internet), and the measures which policy-makers might choose to implement as a result. That is, all states may use the same processes to carry out risk analysis and they may even have the same or similar data, but they may use different calculuses and they may reach different conclusions. In that sense, one can argue that early Victorians actually believed the bicycle riding was dangerous and that the Saudi analysts actually believe that driving is dangerous for women – since their cultural values cause them to present and interpret the data in a particular way. They are not prevaricating or practicing deception. They genuinely feel threatened. Threat Talk and the Cultural Context of Risk Assessment In that same vein, I contend that each of the states studied in this manuscript has actually had its own ongoing internal conversation about risk identification as it relates to the internet – over a period of approximately ten years. And each state has identified what it regards as proper state and private sector responses for safeguarding citizen internet users. That is, each state has identified the hazard, engaged in risk assessment and characterization and reached a policy decision,

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which is continually being both implemented and evaluated. In each society, the steps taken and the process implemented are the same, but the conclusions reached in the course of the assessment are vastly different – which is understandable since states differ in how they view the costs, benefits and risks associated with unregulated citizen access to the internet. The problem here is that we, as analysts, have failed to recognize the cultural component of this risk assessment. As Hood et al. (2001) ask, “If risk is a thermometer, who determines what the setting will be?” Who determines when a risk is “too dangerous” and decides to shut down the system?” Using a positivist approach, we have tended to assume that the parameters for such a problem as “how do states deal with the risks to citizens and to society from the adoption of internet technology?” are predefined and objective. However, it is also possible that societies arrive at a consensus regarding how dangerous a new technology is, and what levels of risk are acceptable with regard to a new technology, through a process of contention – which again can differ from one society to another. Hood refers to the public management of risk, in describing the tug of war which might take place when a new technology is introduced. Often, he argues, a state might try to regulate a new technology and to introduce thermometer settings which are described as being objective. However, it is also possible for those settings to be contested by other users within a society. (This explains why, for example, states within the United States might have different speed limits, or different laws regarding whether or not it is necessary to wear a helmet while riding a motorcycle.) However, what becomes puzzling is a situation where two groups of scientists in two different societies are using similar methodologies to study a similar problem – and yet one group arrives at the conclusion that an activity is inherently risky and constitutes a significant public health hazard – while the other does not. It appears that similar (and sometimes even the same) data is being used to assemble or construct two different threat narratives – each of which resonates in one society, but not the other. As a result, the citizens of one society have concluded that a technology is dangerous and undesirable while the citizens of another society have reached a very different conclusion. This notion that some risks are more “real” than others is illustrated in the American popular media, where increasingly analysts use the term “scare” to make a sort of ideological statement about the veracity and the legitimacy of some risks in comparison to others. In recent years, American media consumers have been informed that there exists an “autism scare,” a “flu scare” and perhaps even a “terrorism scare.” In each instance, the choice of the term “scare” is an interesting one. First, it is a word which describes an emotion and thus perhaps an irrational, emotional reaction – rather than a carefully thought out analysis of risk. Next, the term “scare” itself implies childishness. Children are “scared” of many things – the dark, witches and dogs, to name a few. To describe society as being in the thralls of a “scare” is to make a sort of paternalistic statement about how people in society may be acting childish, emotional and reacting to a fear which is not “real.” Here the implication is that people may panic (like children) until someone in authority

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steps in to calm them and reassure them that their fears are not real. The adult turns the lights on, checks under the bed and assures the scared child that there are no monsters, for monsters are not real. Thus, the term “scare” frequently refers to a risk which a large number of people may have reacted to, but which ultimately did not come to fruition and was not realized. (Thus, media coverage of the 2009 swine flu season uses the term “scare” to note that many people overreacted, since ultimately there was no epidemic.) Thus, it is a term which is sometimes applied ex post facto to a situation – in order to delegitimize the threat which people may have felt or reacted to at the time. Alternately, one side may use the term “scare” to delegitimize a risk or threat which the other side feels is genuine (as is the case with the phrase “autism scare”. Historically, we have seen the ways in which our discussion of risk was politicized during the so-called “Red scare” in the 1950’s. Initially, anyone who questioned the ways in which American vulnerability to covert Soviet operations within their borders was being measured and assessed was told that they were disloyal or un-American. They might have been investigating as being a Soviet operative themselves. There was little room given in the media or in public hearings to the notion that perhaps American leaders were being paranoid, or mistaken in their assessment of the threat. The debate was effectively closed down. Later, analysts like Schmidt (2000) used the phrase “scare” in their rendering of the role of the state in assessing the Soviet threat. Here, she asserts that US government “whipped up hysteria.” She also suggests that the political administration, including the FBI, profited from exaggerating the prevalence and strength of the Communist threat. Similarly, Potter (2009 683) suggests in the contemporary era that Bush Administration officials went out of their way to exaggerate the risks of environment activist groups, pushing to label them terrorists. (Here the assumption is that there was an actual objective way of measuring the danger posed by environmental activists, and that the Bush administration instead manufactured a perception of danger when none existed in actual point of fact.) Again, Potter asserts that the Bush administration used “rhetoric” to do so. (Again the implication is that language was used by the labellers for political purposes but that they didn’t actually assess the danger as that threatening, nor did they believe their claims that the situation was hazardous). Instead, Potter asserts that the rhetoric of threat was used to demonize activists (2009, 683). Similarly Americans act as though any attempt to query the safety or negative effects of the internet is merely a “scare” – that the threat is not real. The question then becomes: what happens when two groups (or nations) arrive at radically different conclusions regarding the risk and hazard posed by (or contained within) a new technology when conditions require that they cooperate to form regimes to regulate the shared technology? Whose risk calculus will prevail and are there any common grounds for cooperation? Here, I contend that this will become an increasingly important issue in the future as members of the international system consider many types of shared problems –

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including the threat of avian flu, the problem of internet warfare and the problems of uncontrolled immigration and financial regulation. In every instance, there appear to be two sides to the problem: those who are threat minimizers, assuming that states and the international system should interfere as little as possible to manage the risk and who believe that others are “exaggerating” the threat; and threat maximizers who believe that those on the other side are misinformed and naïve not to be concerned about the global threat. They are concerned enough to want to take every measure possible to manage and regulate the threat. What we saw with Bijker and Pinch’s example of bicycling was that over time the miminalist position came to prevail. Over the long run, risks inherent in bicycling were downplayed and minimized (though one may argue that even today the debate continues – with the caricature of the “security mom” who insists that her children wear helmets while bicycling while the more laidback “slacker moms” laugh at her earnestness and what they regard as a hysterical and disproportionate level of fear associated with the activity). Here, a consensus seemed to form that would treat some risks as more “real” than others, and that would allow for technological modification and the domestication of the technology, making it thus available to a wider universe of users.7 A Case Study of Threat Talk: The Comparative Politics of Internet Addiction In this manuscript, I have chosen to focus in particular on the politics of internet addiction as it has evolved from its discovery in 1995 by American psychiatrist Kimberly Young to the present day. In the course of this analysis I consider how internet addiction has been studied, diagnosed, defined and treated in two different societies – China and the United States. By looking at a specific facet of internet threat talk, I go on to draw broader conclusions about how different societies have socially constructed the meaning of the internet, and the ways in which it is viewed as threatening or harmful to citizens within a particular culture. The case of internet threat is of particular interest, I feel, because it has been and still is a subject of international contention – though within some states, like China, a consensus has been reached. Internationally, analysts disagree about what it is, how many “addicts” exist within their societies, whether or not it even exists (or whether or not it is a “real disease”) and how and if it should be treated. In contrast, the debate seems to have stabilized and closed in China, Thailand, Vietnam, Singapore and South Korea – where legislation has been enacted to deal with what is described as a serious public health issue. In addition, societies have evolved very different explanations of who is to blame for internet addiction – with various analysts explaining it as an individual moral character failing, a medical and psychological pathology, a lifestyle choice, and an inevitable effect of the exposure of children to too much technology.

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In this work, I trace the evolution of the discourse of internet threat chronologically, pointing out the different ways in which discourse has evolved in two separate societies – the United States and China. Here, what is striking is the unanimity of opinion shared by, for example, Chinese researchers in contrast to the disunity or raucous disagreement showed by American researchers in particular, and European researchers in general. In essence, there was one epistemic community in China – headquartered in the Ministry of Defense and its related medical facilities, and many communities in the US scattered among a variety of university research centers in medicine and psychology, as well as at US facilities associated with the National Institute of Health. American medical research was both publicly and privately sponsored. Even now, one can state that Chinese researchers uniformly agree that internet addiction exists and that it is a problem. In addition, there is a standardized model for the treatment of such addicts. The measures which government personnel and medical personnel should take both to prevent and treat internet addiction have been codified into the medical field through the development of a handbook on the treatment of internet addiction in 2009, and have been codified into law with the passage in 2007 of the Law on the Youth of China. In contrast, American researchers do not agree about the existence of addiction, about the extent of the problem, or about treatment options. The debate about whether or not internet addiction should be recognized in the American Psychological Association’s Diagnostic and Statistical Manual of Mental Illness, version five (the so-called DSM-V) has been ongoing and is still unresolved, despite the appointment of a 28 member task force to look into the issue and form conclusions prior to the 2012 issuance of the manual. The issue of whether or not internet addiction exists and how it should be treated has also been a subject of contestation at meetings of the American Psychopathological Association (Kaplan 2009). It also appears that while Chinese citizens, researchers and public officials became more concerned about internet addiction over time with the evolution of the issue into a full scale public health crisis, the discourse of internet addiction evolved in an opposite fashion in the United States and Western Europe. Here, it might be said to have “blown over” as researchers and citizens placed internet addiction within a larger risk context where they asked questions about how one should and could “manage” one’s addiction to technology in a safe and health way, achieving “cyberwellness.” That is, the conversation about internet addiction has come to be centered within a larger conversation about technological literacy. This discourse focuses on ways in which the skills of the user can be improved in order to bring him or her to a position where he can enjoy greater agency in relation to the medium. That is, the emphasis is on empowering users so that they exploit the technology – and it does not exploit them (Hargittai 2004, 10). In the American context, specialists have concluded that empowering citizens involves giving all would-be users (including senior citizens and marginalized social groups) more access to the internet, not less. American policy thus focused on increasing the

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numbers of computers available to would-be users, including the provision of computers in public venues like libraries, inner city schools and senior citizen centers. Thus, while Chinese authorities worked to limit user’s access to the medium, it appears that American policy-makers in particular did exactly the opposite! However, Western analysts did allow that there existed a subset of individuals for whom technological literacy and cyberwellness were inappropriate goals. These individuals (who frequently had preexisting addictive conditions) might be unable to manage technology appropriately whatever the circumstances. For these individuals, medical personnel evolved a description of limited use regimes or even prohibition of the technology to these individuals. However, the subset of individuals viewed as incapable of using technology correctly was deemed relatively small in the US, in comparison to the much larger description of an at risk population which evolved in China. In addition, the discourse of blame evolved differently in the two societies – the US and China – in describing why some individuals might become deviant users. Here it appears that US analysts tend, to some degree, to blame so-called deviant users who are unable to manage the technology in a “normal” fashion while Asian analysts are more likely to blame both the user and the technology itself, as well as in some instances the surrounding culture which is seen to enable technological addiction. In this work, I argue that societies differ regarding whose job it is to protect users from threat. Is it the job of the parents, the schools, the community or the government? Other differences thus include the way in which treatment regimes were established – with treatment occurring largely through private facilities and programs in the United States while government-sponsored large scale treatment programs came to be the norm in Asia. In addition, societies (and even organizations within society) may differ regarding what constitute reasonable measures to take to prevent damage to children, property and society as a result of internet threat. Thus, states may differ in how they answer questions like: Is it reasonable for a university to monitor students’ access to internet, including imposing curfews? Is it reasonable for schools to disallow internet access? Cultures may differ regarding how the problem of internet addiction should be addressed, with different states putting forth a wide spectrum of treatment options ‒ from individual empowerment at the user level, to social measures within the family and society, to the need for government intervention including punitive measures and covert measures to restrict access. Thus, risk assessment and measurement can be seen as resting on three factors: the preexisting biases and misconceptions of the perceiver (in this case, the analyst or policy-maker), his or her relationship to the object (in the case of the Western analyst, our inability to look past our American cultural understandings of what the internet means within our own societies) and the object’s relation to society. Here, because of the way in which one’s perception of risk is situated within a particular culture and one’s own bias, it is impossible for an analyst (or a participant in

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society) to ever consider a particular risk “surgically” or in isolation. Rather, one’s understanding of a particular risk always rests within a matrix of related risks. In considering how a state thus considers the risks to its society (both domestically and internationally) from participation in cyberspace, the following schematic illustrates the issues to which cyberthreat is related.

Figure 1.1 The matrix of cyberthreat This diagram illustrates the interrelated nature of the questions one can ask in relation to internet risk. On a state level, we can ask why officials in states like China, South Korea and Russia have come to view the internet as a public health hazard while others have not. On an individual level, we can ask why individual users in different states may feel so differently about the risks seemingly posed by and facing the internet user. Why have users – and states – taken up such different stances in regard to the question of how and to what degree internet user should be regulated and the means which are appropriate to do so? Here, it is my contention that different societies assess the risk of individual internet use in a society – particularly recreational internet use (as opposed to at work or school) very differently. That is, they are not engaging in threat exaggeration, nor are they consciously using threat talk as a pretext for engaging in censorship or internet restriction. Rather, as Nelkin notes (1989 111) one’s understanding of risk is influenced by many other factors, including one’s level of familiarity with the risk, whether it is new or novel, and the information they might already have about dangers which have been associated with a new risk. These factors may cause one community to adopt a “risk maximizer” approach to a new technology, while another community adopts a more minimalist approach. One community might be more inclined to believe government assurances that a new technology is safe, than another, and the communities might also differ in terms of what specifically they see a risk as threatening. Similarly, I argue that a more mobile society like the US is less

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likely to produce citizens who worry about the internet’s ability to destroy social bonds and community cohesion. However, a more traditional society like China will perceive that risk differently. Societies which play a high value on community and family interactions will find individual internet use more risky than societies which are more individualistic. In addition, internet addiction will seem to be a bigger threat in societies which play a high value on social cohesiveness, as well as societies which view individual citizen inputs in a collective sense. Here, the sense is that an individual’s labor belongs to the whole community and that a citizen who whiles away the hours playing video games is not merely wasting his own time; Rather, he is also withdrawing one’s social responsibilities and in a sense “stealing” from that community. (That is, if a teen is risking his future academic prospects and getting failing grades due to too much time spent on the internet, an American family is likely to describe it as the teen wasting his time, while a Chinese family might suggest that the teen is being selfish and jeopardizing his entire family’s future.) A news article appearing in the Chinese press echoes this sentiment when the columnist argues that “Young people are the future pillars of society. If they indulge in the internet and neglect their school work today, what can they do tomorrow?” (Xinhua News Agency 2006). The Chinese analyst Wenlei (2009, 43) makes a similar argument in noting that over months and years, internet abuse becomes “detrimental” because “it excludes variety and choices of activities, provides only escape and diversion and is not job related or productive.” Here, China’s media frames the story as one of threats to productivity, rather than social maladjustment. Thus, stories in the news frequently feature a widowed mother or single parent for whom the addicted child is the sole source of financial support. The woman’s life is “ruined” as the child is not expected to fulfill his educational potential or to contribute productively to society (Demick 2009). Taiwanese researchers similarly stress the ways in which internet addiction upsets community and social relations – arguing that internet addicts are likely to suffer negative influences on: daily routines, school performance and relations with their parents (Lin and Tsai 2001, 411). This notion of academic achievement as a collective good explains why high achievement-oriented cultures like China, Singapore and Japan have all placed particular emphasis on the study and identification of internet addiction patterns among college-aged students. It also explain why behaviors which are not pathologized in Western Europe and the US (including staying up too late on the internet and skipping class as a result) have been pathologized in Asian models. In addition, I suggest in this manuscript that the internet has been socially constructed differently within Asia than in the United States. Here, it is my contention that for citizens in all societies, entering cyberspace may represent an alternate form of “exit,” as described in Hirschman’s groundbreaking work, Exit, Voice and Loyalty (1970). However, that “exit” may be more enticing for youth in highly achievement oriented cultures with strict regimes for social behavior. In his groundbreaking work, Hirschman originally described the ways in which employees behaved in a dysfunctional work environment. Some employees, he

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argues, simply attempt to exit the workplace, through searching for other jobs, engaging in absenteeism, or loafing on the job. Others actively seek to change the environment, through “voicing” their concerns, while others who are highly loyal to the organization, attempt to “wait it out,” hoping that new management or other events will lead to changes in the workplace. Exit has both a physical and psychological component with workers distancing themselves from the organization, its culture and its ideals – in some cases through merely thinking about leaving the organization (Naus 2007, 688). Hirschman’s work was applied in the field of comparative politics in the 1980’s to describe how citizens stood up to oppression in the former Soviet Union. Soviet citizens were said to exit literally by applying for exit visas, for example, to Israel. But they could also exit metaphorically by, for example, refusing to vote in one-party elections. I argue here that internet addiction represents a fundamentally new type of “exit” for citizens in both repressive and nonrepressive regimes. By logging onto the internet and claiming citizenship in an international community governed by new norms (often for many hours at a time), citizens are “opting out” in a new and powerful way. And this opting out has governments worried. Those who spend the most time online in China and other developing countries are usually the country’s youth – those on whom the government depends for future developments in productivity and technology, as well as those on whom their parents depend for support in their old age. These are the citizens China can least afford to lose. And as Naus (2007, 691) indicates, those who are considering exiting a dysfunctional organization also appear to have significantly lower levels of psychological investment in the organization. Thus, the propensity to exit can also be read as a measure of discontent with the organization, as well as a measure of how legitimate the employee regards his relationship with his employer to be. Naus (2007, 294) also points out that the more rigid the organization and the higher the degree of role conflict which the employee feels the more likely he is to entertain the exit option. We see descriptions of this role conflict in interviews with internet enthusiasts and addicts who may state that they somehow feel more “real” or more “themselves” in the internet environment, where they are accepted for who they really are. That is, “exit” is a greater risk in some cultures than others. In China, in particular, risk analysts have developed an awareness of the ways in which citizens can escape into the internet and “exit” society, through refusing to be mobilized in traditional ways. This has implications for military service and citizenship. Part of China’s description of internet addiction as a “public health crisis” is based on perceived social problems which might arise if too many students decide to “exit” from their traditional roles and social expectations. (Here one can make the argument that “exit” has always been a culturally accepted means of resisting power in China. In pre-communist China, women might have committed suicide to “exit” from unhappy arranged marriages, and opium addiction also provided a means of “exit” from imperial society.) All of these types of “exit” implied a rejection of the norms and values of traditional Chinese society. In Chinese writing, an opium

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addict might be referred to as a “ghost” since his body resided in China while his mind and soul resided elsewhere. The “ghost” trope appears in contemporary writing about internet addiction as well. Even the director of contemporary China’s most well-known internet addiction treatment center has acknowledged that some Chinese citizens appear to be happier living “virtual lives” in cyberspace than they are living their “real lives” in China. The director of Beijing’s internet addiction treatment center Tao describes the use of drug therapy to treat internet addicts, noting that “we use these medicines to give them happiness, so they no longer need to go on the internet to be happy” (Golub and Lingley 2008, 63). Similarly, the anti-internet crusader Tian Bingxin has noted that: The allure of internet games for children is like the poison of opium in China so many years ago. It doesn’t discriminate between the poor and the rich, between those of high or low position. It doesn’t matter if you’re an unemployed worker, a wealthy businessman, or a party cadre, the highest hopes of innumerable parents for their children’s future may well be destroyed by Internet games. (Golub and Lingley 63)

Next, I argue that perceptions regarding the risks of internet usage will differ depending on whether the technology is seen as “local” or as “western.” That is, users and would-be users view endogenous and exogenous risk differently. Here, Johnson and Covello (1987, 27-9) argue that sources of risk that are perceived to be internal the community are often less feared than those which are perceived as coming from outside. Particularly when the subject of discussion is the risk of new technology, one can find that “threat talk” may include metaphors of invasion or colonization, as newspaper columnists and experts speak of aliens and invaders who want to kidnap children and socially vulnerable individuals by enslaving them or luring them with technology. One sometimes encounters references to “technological pied pipers” who draw children into dangerous practices associated with the shiny new technologies. (Again, one can see that Chinese students are viewed as “exiting” the regime, and instead attempting to visit Western Europe and the United States through spending time in cyberspace.) Here, I argue that in both Russia and China in particular, much “threat talk” rests on this notion that internet technology is a foreign threat which comes from abroad, which somehow threatens the pristine and innocent land and people, threatening to render them impure as they are filled with Western ideas. Here, the internet itself is seen as both a symbol and a carrier of Western values, threatening to poison the state and its people. (It is often seen as a tool of transnational organized crime in much the same way.) While this risk has been misunderstood by Western analysts, I argue that it is “real” for those in China and Russia. Again the invasion metaphor here suggests a lack of agency, almost as though the individual internet addict comes to be “inhabited” by something else. That is, the individual provides a sort of host for the internet. He has become a cyborg. Thus, as I analyze

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media coverage of the risks of internet addiction, I will consider where the media portrays it as coming from and why.8 My case study of the comparative politics of internet addiction concludes by laying out several policy implications for the international community. First, I argue that it is not logical for any group to make assessments regarding either the validity of one society’s threat assessment in comparison with another society’s threat assessment or the validity of measures taken to address threat. This is, of course, not to state that it is ever morally justifiable to imprison anyone for internet addiction or to imply that this is not a human rights violation. In this work, my aim is not to definitely solve this debate regarding this risks in cyberspace are “real.” Instead it is to start a conversation, to cause people to view the problem of the politics of internet risk from a different viewpoint and to acknowledge that there are two sides to the issue – through placing it within the context of the politics of threat assessment. A Problem Which Crosses Boundaries The question of how practitioners and the state both define and react to the problem of internet addiction is an interesting one because it crosses the boundaries of two different disciplines – the politics of technology and the politics of health. Both sets of academic literature deal with an overlapping set of concerns, particularly in the areas of risk definition and risk management. Risk management itself can be considered a cross-disciplinary field which includes practitioners from fields as diverse as criminology, political science, medicine, architecture and history. In the fields of technology studies and health politics, practitioners in both fields ask questions about how one defines and measures risks ‒ to the patient or to the technology user. Both ask questions about the risks which are real, versus those which are invented, constructed or exaggerated. Next, both fields deal with the question of how best to identify and treat those who are at risk. Both sets of practitioners raise questions regarding who should have the authority to regulate the behavior of those at risk ‒ the state, the doctor or the at risk subject himself? In both the field of medical sociology and technology studies, questions are frequently raised regarding how one can best balance the right of an individual to engage in risky behaviors versus the right of society to be preserved from the effects of these behaviors. (In essence, the question of whether a nuclear power plant should be allowed in a residential neighborhood and the question of whether a noncompliant tuberculosis patient should be allowed to roam freely in the same neighborhood are two sides of the same coin.) Finally, practitioners in both fields raise questions about whether there are practices and technologies which are so dangerous that no one should be permitted to engage in them or have access to them. That is, those in tech studies might ask whether all nuclear power plants should be closed, while those in medical sociology might ask whether all those suffering from schizophrenia should be

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involuntarily incarcerated. That is, both ask questions about security – about the security and safety of the individual patient or technology user, and the security of the larger society and the state in which they reside. For this reason, I feel that it is beneficial to consider the narratives of internet addiction which have arisen both in China and the US through a variety of different lenses, all of which are derived from the literature on the politics of medicine. Here, it is my contention that whoever controls the narrative of an illness has profound power – to marshal notions of blame and causality; to discipline those who are identified as carriers, as well as those who are identified as susceptible to the disease. Whoever gets to “explain” the disease – in terms of controlling the conversation regarding who caused it and what it means for a society politically, morally and culturally – is very powerful, since that narrative can be then used to mobilize resources, to make policies and even to deprive others of their rights. It is my contention that one can actually identify three different types of narratives which have emerged in the academic and popular discussion regarding internet addiction – and each of these narratives rests implicitly on a different view of the role of the state in regards to the practice of medicine. There is little common ground between the three narratives: which I refer to as the antipsychiatry narrative, the critical psychiatry narrative and the biosecurity narrative. Instead, each narrative makes different assumptions about a number of critical issues, including: what it means to be ill, how a concept of illness is created and institutionalized; what the role of the state and the role of the medical establishment is in the practice of medicine, and who ultimately exercises power in navigating the process of illness and curing. As I show throughout this volume, academic and media critics of state’s regulatory practices in regard to the treatment and diagnosis of internet access have implicitly used all of these frameworks. However, no attempt has thus far been made to sort out the different discourses about internet addiction or to examine the assumptions behind him. However, as I show in this volume, each model emphasizes different facets of the story and leads to a different explanation for Chinese actions. Each provides a different lens for making meaning from the Chinese actions. All three models share the assumption that the narrative of internet addiction benefits the state, not the “patient.” And each explains how the RISK of internet addiction is created, and what the narrative means. They do not, however, agree about whether the threat of internet addiction is real, or whether or not it is justified to take actions to prevent the spread of internet addiction. All three stances can be identified within popular writing about internet addiction in both US and Western Europe – though not in China, where thinking on the matter is more monolithic. Finally, in Chapter 5, I give a voice to the Chinese researchers and attempt to present their own risk analysis within a Chinese cultural context. That is, I allow the Chinese researchers to “talk back” through presenting a postmodern analysis which considers the possibility that internet addiction actually is both a different disease in China, and a more harmful one at that.

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Endnotes 1  Personal conversation with the author on May 2, 2011. 2  Here, I am reminded of a story which a friend once told me about how his parents frequently purchased black market food in Soviet Russia from a man who conducted business out of a restroom in Moscow’s leading department store. When my friend’s family eventually relocated to the United States, Alex (who was a small child) was baffled by the institution of the grocery store – since it did not fit within his network of beliefs about where food came from. He assumed that the regular food in the grocery store was of an undesirable variety, and that if he visited the restroom of the grocery store, the food for sale was sure to be better. 3  The social construction of technology paradigm can be viewed as well in Peter Squire’s work on the social meaning of weapons in society. In his 2000 work, Gun Culture or Gun Control, he argues that Great Britain and the United States evolved vastly different definitions regarding the utility and function of firearms in their societies based on different historical and cultural experiences. Specifically, America’s government displays a Libertarian streak in conceptualizing of citizens as independent frontiersmen who also require guns for household protection due to the legacy of British foreign occupation and the development of the second amendment. In contrast, Britain’s government dealt for many years with the problem of domestic IRA terrorism, and tends to display a more paternalistic and collectivist attitude as a result (7). Guns thus have almost completely different functions in the two societies. However, one can nevertheless point to liberal attempts to construct a normative understanding of “what guns are for.” In his work on the 2001 UN Programme of Action to Prevent, Control and Eradicate the Illicit trade in Small Arms and Light Weapons (UnPoA), Podder (2007) shows how the international community has attempted to control the supply side aspect of small arms proliferation. In constructing norms regarding who should be allowed to sell small arms, as well as norms regarding who they should be allowed to sell them to, the international community is not only labeling some individuals or groups as having the right to purchase arms while others do not. It is also implicitly constructing an understanding of what weapons are for – and which nations, nongovernmental actors and individuals are using them correctly. 4  We frequently see this pattern of rationing access to technology through reliance on “threat talk” in medical discourse surrounding the introduction of new medical technologies. For example, in discussing new types of surgical or pharmaceutical interventions, analysts might make reference to classes of patients, describing them as suitable, appropriate or good candidates for a procedure. Here the implication is that a procedure (like a heart transplant) is inherently risky, but that it is more risky for some. For that reason, it is seen as appropriate for the gatekeepers of the technology to exercise power to exclude some individuals from having the chance to undertake that risk. Thus all hospitals have a committee which will assess patients and in some case remove those who are ineligible from the pool of candidates. 5  For more on America’s ideology of the automobile, see David Campbell (2005). Here he suggests that in America, cultural thinking about what the automobile represents has affected how our policy-makers and citizen think about regulating automobile usage, including our reticence about regulating SUV’s despite their gas guzzling tendencies and tendency to roll over.

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6  More information on this program can be accessed at http://www.itu.int/wtisd/2009/ theme.html. 7  That is not to say that there are not risks which are always and everywhere objectively harmful. It is possible to establish a causal link between cigarette smoking and one’s increased risk of cancer, for example, which would hold always and everywhere. 8  In this analysis, I utilize a variety of different methods and sources to examine how various states have understood the internet as a threat in their societies. In looking at internet threat in Russia, China, India and the United States, I have utilized both scholarly articles by technology specialists, as well as discussion and descriptions of internet problems as they have appeared in the popular press. In looking at the individual level threats of internet addiction and the rise of antisocial behavior, I have looked largely at medical and psychological journals which have covered these issues. Although the journals are frequently international, the researchers who have developed an interest in these subjects frequently propose both national explanations and understandings of these phenomena, and there are clear distinctions which one can draw out when considering the nationality of the researcher.

Chapter 2

Psychiatry, Antipsychiatry and Internet Addiction A new disease? I know not, new, or old, But it may well be call’d poore mortals plague: For, like the pestilence, it doth infect The houses of the braine. Ben Johnson Every Man in His Humour 1598

The first model we can use to critique the narrative of internet addiction is the antipsychiatry stance, based on work by the psychiatrist Thomas Szasz. Beginning in the 1970’s, Szasz, a professor of psychiatry at the Upstate Medical Center in Syracuse, New York, began to make the argument that one cannot understand psychiatry or its cousin, psychology, outside of the field of politics (1974). Szasz’s stance is frequently described as being not merely critical of psychiatry, but rather as being one of “anti-psychiatry.” His argument, in its most stark form, is that there is actually no such thing as madness. Psychiatric illness, he argues, unlike medical illness, cannot be located in a particular organ of the body. Thus, he notes that “medical diseases are discovered while psychological diseases are invented” (Szasz 2007, 45). He notes that it is theoretically possible for a medical practitioner to “inform” you as a mental illness sufferer that you are ill, even if you do not currently feel that you are in any way symptomatic. Thus, an individual may take a quiz online and self-diagnosis himself as an internet addict, even if previously he did not know that such a condition existed. This is fundamentally different from the ways in which one “knows” that one has a medical condition – for example if he showed up in the Emergency Room of a hospital shot, bloodied or crushed. Because there is no lesion or wound that one can point to and attempt to treat (as there is with physical illness, like cancer), one should be, he argues, convinced that mental illness or madness is merely a “myth.” In its most extreme form, the critical psychiatric stance suggests that few of the syndromes and behavioral practices which the psychiatric profession has identified as illnesses are “real” in the sense that there is an actual underlying disease that requires treatment. (His work was influential in the deinstitutional movement in the United States, in which many mental patients were released from treatment facilities.) Thus, his major critique of the current psychiatric community and its stance towards disease is ontological in nature. He is concerned with the existence or being of mental illness. Here we can consider Anne Marie Mol’s (2007) work on the ontology of disease. She argues that there is no such thing as an objective, neutral, medical way

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of looking at a problem. Physicians and those in the medical field are definitely not somehow more objective than those in other specialties, including the social sciences. Here, she argues that simply assigning a label – this is arteriosclerosis – is not the same as “knowing” what the disease is. She argues that the patient knows the disease, and various specialists know aspects of the disease. However, as she argues, even if the disease somehow affects the whole body, no practitioner really has this holistic understanding of the disease, but instead tends only to particular parts, aspects and expressions of the disease – depending on his or her affiliation and experience. She writes: The power to mark physical reality, after all, is no longer granted to medical doctors, it is granted to nobody. In a world of meaning, nobody is in touch with the reality of diseases, everybody “merely” interprets them . . . and “the disease” – forever unknown – is nowhere to be found. It “recedes” behind the interpretation. (2007, 11)

Similarly, we can argue that no one can really be said to know definitively or objectively what internet addiction is or is not. Here, we can distinguish Szasz’s work from that of the critical psychiatric school which I will explore in the following chapter, since the critical psychiatry school is primarily concerned with the damage and stigma that can define one who is declared to be mentally ill. They are, therefore, concerned with mental illness as an identity or a label applied to the sufferer, as well as the meaning of mental illness within society – rather than the actual “beingness” of the disease. Here, Szasz’s work shares common ground with the analyst Ivan Illich (2000), who has offered the term “iatrogenesis” or “the induction of harm caused by the health care system” to explain where illness comes from. As Illich states the argument, the main product of the health care system is not the provision of health care, but rather the manufacture of illness. Here, Illich asks how it is possible that one could not know that he or she was ill until he visited the doctor (or took some form of on-line quiz or survey) and “discovered” that in fact he was suffering from low self-esteem, an eating disorder or an anxiety disorder. Here, his argument is that one does not know one is ill because in point of fact one is not. Rather, the medical industry has diagnosed one as being ill. In calling into question the existence of mental illness, analysts suggest that what is actually being problematized is a pattern of behavior or a social formation, rather than an actual medical condition. In Szasz’s anti-psychiatry view, the mentally ill individual is one whose major symptom is a sort of dysfunction or mismatch between the demands of society and the individual’s own ability to respond to those demands. Claudine Herzlich and Janine Pierret make a similar point in their work Illness and Self in Society (1987). In this volume, they make an argument that in the post-industrial revolution time period, western society began to define illness in relation to one’s employment, and one’s identity as one who was employed. They note that prior to the advent of industrialized employment,

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illness was not predominantly associated with not being able to show up at work in the factory. That is, they suggest that particularly in Western industrial capitalist society, an individual is considered well and capable if he is able to work, or to fulfill the most basic demand of that society which is social productivity. Thus, as individuals moved from a subsistence agricultural society to an industrialized, urban society, the basic responsibility of each individual in society began to be conceptualized of as the ability to go to work. They note that: The impairment of the body’s motor and functional capacities is more than a symptom like any other. In a society in which we define ourselves as producers, illness and inactivity have become equivalents. That is why today we have come to perceive the sick body essentially through its incapacity to “perform,” rather than through the alteration of its appearance. For many people this incapacity is the true sign of illness (1987 85)

Dodier (1998) makes a similar point in his analysis of the practice of occupational medicine in France, arguing that the doctor’s job here is not actually to cure the patient but rather to certify his fitness for returning to work. He argues that the physician’s primary occupation is one of labeling individuals as fit or unfit, depending on the particular work requirements they will be asked to meet. Some individuals are thus certified as “ill” because they cannot lift heavy objects, while others are not – because their occupation does not require the application of manual labor. Thus, the anti-psychiatry critique suggests that the individual who is labeled as mentally ill is first and foremost someone who is unproductive according to the demands of society. That is he is someone who is unavailable to be mobilized to serve the state. A Szaszian lens allows us to ask questions about the politics of public health. What does it mean, we can ask, when medicine serves as an agent of the state, to define and organize society’s response to the introduction of new technology like the internet? How does modern medicine serve to exaggerate the dangers inherent in new technology? Can medical agents thus serve to preemptively scare individuals off from demanding access to the technology? Why might the state want to create a “scare” so that citizens were inherently suspicious of this technology, and why and how medicine might be encouraged to go along with these efforts? Finally, we can ask: how can citizens be convinced to regard the internet not as an agent of liberation but rather as something dangerous? Using Szasz’s lens, we can examine the way in which the medical issue of internet addict is really a type of politics, in making an argument that frequently “internet addict” language is used to deny citizens their rights. Szasz’s lens allows us to consider the arguments that there is no such thing as internet addiction, and that there is no danger posed to state by the internet addict. Using Szasz’s lens, we can examine the possibility that the state is illegitimate and does not have the right to oppose practices such as how much time people spend on the internet or how dependent they feel themselves to be upon it. Here, we can consider in particular

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China’s newfound emphasis on productivity, including the acquisition of capitalist wealth, and its discovery of new and novel mental illnesses, most of which have a primary characteristic of being a “slacker.” Arguably, changes in Chinese society have led to a situation where citizens have more autonomy to decide how to spend their time under capitalist rules, yet the centralized Chinese state still tends to view their labor as state property. Therefore, a citizen who exercises his choice to not conform and contribute his labor to the state – choosing to spend it instead playing video games on the internet, for example – risks being labeled as mentally ill. In unpacking the relationship between medical authorities and the state, Szasz makes clear the fact that the medical industry is not always benevolent, and that even highly qualified physicians may have divided loyalties – evincing concern about their particular patients, but never quite forgetting the fact that they also serve a particular state and set of institutions. That is, Szasz implies that for the state and the physician who serves the state, health is not merely a desirable moral goal or a set of altruistic practices, and the state’s role in guaranteeing the health of one’s citizens and thus of one’s community is not simply about benevolence. Szasz in particular argues that psychiatry frequently marries the power of the practitioner with the power of the state in ways which are abusive and illegitimate. The antipsychiatry stance rests on the assumption that the power of the state is coercive and intentional and that the overwhelming goal of public health is the maintenance of social order. He writes that: “Theocracy is the alliance of religion with the state; Pharmacracy is the alliance of medicine with the state” (2007, 52). The anti-psychiatry stance provides the first way in to understanding the development of the “problem” of internet addiction within the medical communities in the US and also in China. Here, the alliance between medicine and the state facilitated internet addiction’s rise to epistemic credibility. That is, an anti-psychiatry stance helps us to make sense of the strong levels of state support for medical research in the areas of diagnosis and treatment of the internet addict. Here, the assumption is the state is not acting merely out of benevolence and a concern for these patients. Instead, the state is utilizing the “myth” of internet addiction (and colluding with the medical establishment in the creation and propagation of that “myth”) in order to control the ways in which new internet technologies are conceptualized and used within that society. As the technology analyst Christopher May (2002, 29) notes, the development of technology can occur in two ways within any society – in a democratic manner or in an authoritarian manner. In the authoritarian model, he describes the ways in which a central authority attempts to dictate how technology is used, as well as to control the outputs of that technology. In this model, the state or central authority can “capture” the new technology, in essence preempting it from becoming a tool of liberation. Here, he offers the example of the way in which slave labor was used to build the pyramids in Ancient Egypt, noting that novel construction technologies might have changed lifestyle and settlement patterns in the region and increased the standard of living of citizens, but instead these same technologies were captured and put into the service of the state. As he described the situation, “the

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powerful had constructed a system in which technology supported their claims for omnipotence . . . Technological deployment and its effects reflect these social relations: No technology is beyond systemic incorporation into authoritarian technics” (2002, 30). Similarly, the anti-psychiatry perspective can serve as a launching point for the argument that in the case of internet addiction, the medical establishment serves the state, artificially constructing a disease called “internet addiction” which serves, at base, to demonize the internet. As a result, would-be users are injected with an irrational fear of contracting internet addiction, and are encouraged to police their use as well as the use of their subordinates, family members and acquaintances. When users are diagnosed with internet addiction based on criteria created by the medical establishment, the state is ready to assist these users, offering services such as psychiatric confinement, internet addiction camps and programs, and curfews and licensing laws which again serve to place a barrier between the user and the technology itself. The possibility that the state is somehow implicated in both the creation of the disease and the application of the label of “internet addict” also helps to explain why figures provided by states about the percentage of their population addicted to the internet vary so widely. How is it possible, for example, that Norway’s government finds that only 2 percent of their society struggles with internet addiction, while China’s government labels up to 20 percent of their population as either a current or probable internet addict? Certainly it is possible for a disease to cluster in one particular geographic area – with, for example, more people suffering from malaria if they live in a swampy, mosquito-ridden area. However, it is also possible that a disease is being overdiagnosed in some regions relative to others, often for social or political reasons that have little to do with the disease itself. This second possibility becomes much more likely when one can also find evidence that diagnosis of the disease is distributed non-randomly within the population, relative to the known etiology of the disease. For example, many current studies of the phenomenon of ADHD diagnosis in the US are concerned with whether the disease is being overdiagnosed among upper-middle class children, or those from certain schools – despite the fact that the diagnosis should be expected to occur evenly throughout the population of school-aged children. (Center for Urban Population Health 2010) The over-diagnosis of the disease within certain communities suggests that there may be political, rather than medical reasons, why some children are more likely to be diagnosed with the disease. Here, over-diagnosis may stem, in part, from the different ways in which a disease may be defined from one society to another. Here, for example, Kimberly Young, an American researcher defines an internet addict as an individual who uses the internet an average of 38 hours per week for nonacademic or nonemployment purposes, while a nonaddict was someone who used the internet for eight hours or less per week (1998, 235). In contrast, the Chinese definition of addiction calls anyone who spends eight hours or more per week on the internet for nonacademic or nonemployment purposes an internet addict! (Ye 2008 213). Here one answer

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to consider – in examining China’s large, non-randomly occurring population of so-called internet addicts ‒ is that China’s government is much more invested in creating the problem of internet addiction, applying the label of internet addiction and treating those who appear to suffer from it. Academic Medicine in Service of the State In his analysis of contemporary relations between the medical community and the state, Szasz argues that there is an orthodoxy in thinking about mental illness which tends to prevail, causing psychiatric practitioners to share not just medical information but also a stance towards the patient, and a set of values and norms regarding what it means to be mentally healthy in a society. In Kuhnian terms, he points to the existence of paradigm which is accepted by the psychiatric medical community. Here, a paradigm is defined as “a set of practices that define a scientific discipline at any period of time.” These practices affect what is to be observed or scrutinized, the kinds of questions which are appropriate to ask about the subject, the ways in which the results of scientific inquiry are to be interpreted, and the way in which questions are to be structured’ (Kuhn 1996). Here, Szasz argues that the existence of a prevailing paradigm – which does not accept the validity of, for example, alternative medicine – leads to unanimity of views and lack of dissent among practitioners. He implicitly references Kuhn in noting the ways in which the political and economic power of the state can be mobilized in support of a particular paradigm, thus serving to shut down dialogue and the free exchange of ideas. Here, Szasz indicts the professional psychiatric community for the way in which the paradigm forces the practitioner to base his theories on a number or ideas with which Szasz disagrees. Within the normal science of psychiatry, the practitioner is forced to assume that mental illness exists, that the practitioner operates from a position of power relative to the patient, and that it is appropriate to deny individuals their liberty if they exhibit symptoms of mental illness (1998). The acceptance of these beliefs thus becomes a requirement for entrance into the scientific community. (In Kuhn’s words, it forms part of the hidden curriculum of psychiatry.) And thus, it is impossible for one to be a psychologist unless he believes that these assumptions are true and treats them as so within his own work. A Szaszian critique of the politics of internet addiction in both China and the US would thus comprise several elements. First, we need to consider the politics of medical research – in asking how the disease of internet addict could be said to have been “invented” by the medical community, in complicity with the state. Here, we need to consider the ways in which the state has acted to fund scientific research and to guide it so that it develops along certain lines. We would also need to examine the institutional ties between big pharma, big science and big government.

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Secondly, we would need to consider the specific ways in which the technology addiction paradigm has been promulgated both in China and in the US. How do physicians in both nations understand the addictive power of technology, and how do they go about defining the parameters of normal internet use? Thirdly, we would need to consider the politics of diagnosis – in asking what sorts and types of individuals are likely to be diagnosed as mentally ill with internet addiction in both societies. Are they the troublemakers and squeaky wheels of the system? Fourthly, we would need to consider specific strategies which states have implemented to treat and monitor internet addiction. Do these practices increase the power of the state? How and why? Finally, using the anti-psychiatry stance, we can begin to ask the question which Szasz asks, in considering the ways in which the addictive or “insane” behavior serves the subject. Here, Szasz suggests that practitioners should listen to the patient, who may not be merely an irrational individual behaving in irrational ways. Rather, he suggests that the patient’s response may actually be a rational way of coping with a particular situation. (Here, for example, we can consider his example of the Victorian woman diagnosed as suffering from hysteria; He suggests that she might actually have found a way to escape from the narrow strictures and norms governing her everyday life in Victorian England. As a hysteric, she might have been granted a respite from these expectations, or might even have been able to travel abroad to seek a cure or treatment. Thus, the existence of a particular class of patients may come to tell us something about the society which created them.) Thus, in understanding why the patient is choosing to behave in a certain way – and the utility which he derives from this behavior, one may in certain circumstances use the patient’s behavior as a way of reading a situation and launching a larger critique of society. Thus, we will ask what, if any, utility the internet addict derives from his addiction. In what ways does developing an internet habit serve the patient? The Politics of Medical Research As noted earlier in this chapter, a field in which there is a dominant paradigm is likely to display a high degree of consensus regarding the kinds of questions which one may ask, the ways in which questions are structured and asked, and the ways in which the results of one’s research are interpreted. As Kuhn notes, in some instances this paradigm may be enforced merely informally – as in, for example, a Call for Papers issued by an organization which implicitly upholds one view or stance towards a problem rather than another. The implication here is that only papers which follow the dominant approach are likely to be considered at the conference. The paradigm might also be enforced formally when, for example, a state-sponsored research project sends out a call for research proposals in which a clear agenda for research and research approaches in included. Here, only those

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adhering to this viewpoint are able to get the funding necessary to carry out their research. In the case of internet addiction research, one must first then consider the ways in which such research has been funded – both in China and in the United States. Although there are no statistics available to the public which give percentages of funding for scientific research in China broken down by their sources, it appears that almost all of the scientific research in China is funded by the state through ministries and scientific institutions. While American scientific researchers may depend on a combination of private capital from businesses such as pharmaceutical corporations, government funds and foundation funds, the Chinese economic environment does not yet include a significant amount of private capital available for research purposes. (However, some Chinese researchers have been successful in securing grants to participate in international research projects such as those sponsored by the 2007 China-Canada Bilateral Science and Technology Agreement.) In particular, Chinese internet research has been largely underwritten by the National Science Council of the Republic of China while Taiwanese research has been underwritten by the National Science Council in Taiwan. The large scale and methodological rigor of internet addiction studies (which may include the administration of surveys and observations at two or three sites in China, with up to 3500 participants per study) has been costly and has necessitated the commitment of large amounts of human and monetary resources. In particular, China’s Ministry of Education has provided research funds for the development of the “Chinese Internet Addiction Scale,” which is a battery of questions to be administered to test subjects, in which they may respond using a five-point Likert Scale (Huang et al. 2007, 805). Here, the major characteristic of the CIAS is that it appears to find a larger percentage of people are either current or probable internet addicts than any existing scale developed by Western researchers. Here it should be noted that in China, in particular, the study of internet addiction has fallen largely under the purview of the Ministry of Defense, which runs the Medical Center for Internet Addiction, located at the General Hospital of the Beijing Military Command. The Chinese Academy of Science has also been instrumental in carrying out research surveys to gauge the extent and seriousness of the problem. The Chinese researchers who publish research in Western publications such as the well-known journal Cyberpsychology and Behavior, for example, routinely include in their articles an acknowledgement note thanking China’s Ministry of Defense or Ministry of Education Statistics for research funding. This appears to have given the state the ability to control discourse about the phenomenon, as well as to set the research agenda in terms of what questions should be asked. Thus it is not surprising to see that Chinese scientists are colluding with the state in the creation of the internet addiction narrative – in truth, they have no other choice. There is no other source of funding available. Furthermore, Thomas Kuhn has suggested that paradigm shifts and the introduction of new paradigms often depend on the actions of a dynamic and

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influential leader who is able to set the agenda and move other scientific researchers in a new direction (1996). In the case of China’s internet addiction research community, there is a clear leader who enjoys sufficient influence to set the agenda both within the research community and within society as a whole, through his use of the popular media. This individual is Tao Ran, a scientific researcher who wears two hats – serving both as a leader in the field of psychiatric medical research and a leader in Communist party politics. China’s best-known internet addiction practitioner, Dr. Tao Ran, is a member of the clinical staff at Beijing’s Military Medical Hospital. He is simultaneously a physician who treats patients, an academic who studies the problem of internet addiction and a trusted advisor to the Chinese government on the matter of strategies for dealing with internet addiction. (He claims that the Chinese “discovered” and began paying attention to internet addiction in 1994, several years before the influential article by Kimberly Young.) Thus, China’s leading figure in the study of internet addiction has not merely “pioneered” new treatments. He also has the unique ability to define the phenomenon – in terms of how it is understood both in the medical community and by the general public through the media. His institute, the Military General Hospital of Beijing, was responsible for creating the official criteria for defining internet addiction, which were accepted by the Chinese Ministry of Health and written into the definitive manual on the subject in 2007 (China Tech News 2008). Tao’s use of language and metaphor – including his use of the term “heroin” to describe the ways in which the internet acts on young brains – have helped to define the framework in which the average Chinese person thinks about the disease, as well as how it is commonly reported in the press. (Indeed, Tao Ran’s previous medical experience was in the treatment of heroin.) Tao Ran appears as the co-author on several academic papers about internet addiction, including Zheng Huang et al.’s study entitled “Chinese internet addiction inventory: developing a measure of problematic internet use for Chinese college students” (2007). The respect with which the Communist Party of China treats Tao’s work is apparent in the fact that on 2007 he was conferred the title of “loving ambassador in network civilization” by the Central Committee of the Chinese Communist Youth League. (This story was reported by more than 200 media outlets in China.) Here, it is obvious both that the Chinese medical community is highly dependent on the research funds and facilities provided by the Chinese government, and that the Chinese government itself is highly invested in the provision of support to researchers who will uphold and support the currently accepted paradigm of internet addiction. Currently, the project of combatting internet addiction is high on the agenda of the Ministry of Health, the Ministry of Culture (which maintains the authority for regulating the content and usage restrictions attached to internet games) and the Ministry of Education. Indeed, since the mid-1990’s, over half of all medical journal articles on the subject of internet addiction appearing in both Asian and international journals have been written by researchers in China, Hong Kong and Taiwan. In a bibliographic essay based on a search of PubMed, the internet database for medical journal

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articles, the researchers Carbonell, Guardiola, Beranuy, and Belles (2009) provide the data in Figure 2.1 regarding the country of origin of the first author of medical journal articles appearing on the subject of internet addiction.

Figure 2.1 Authorship of medical research articles by nation Here, the question which arises is: Why has the Chinese state made research on this topic such a high priority, and why has it managed to find so much money to fund research on this topic when other medical issues receive much less support? Arguably, China’s state officials may feel a greater sense of responsibility towards the consideration of how students and other citizens are affected by the availability of internet services – since it is the Chinese state itself that has furnished these internet services (in comparison to nations like the US, China and those in Western Europe, where internet technology has grown up through a hybrid of state support and commercial initiatives.) That is, in China and in Taiwan (Yang and Tung, 2007), the introduction of internet technology in universities and schools has been state-sponsored and state-financed – in contrast to the situation in US universities, where private funds or a university’s endowment may pay for the introduction of new technologies. Taiwan’s government has, for example, been instrumental in creating networks to link all high school campuses together since 1996. Furthermore, China’s Ministry of Telecommunications has been the driving force behind the creation of the “backbone” which has been necessary to support the creation of broadband access in China. Thus, it may be that China’s state officials feel a certain sense of ownership over China’s internet technology – which leads them to wish to take a leading role both in its introduction and in its evolution in society. Or as May explains the matter, the state which ends up exercising an authoritarian, top-down stance towards technology is perhaps the same state which has introduced the technology in an authoritarian, top-down way (2002, 31).That is, China’s authorities have a vested interest in steering how technology is used and understood in their society – and as a result will utilize all means of doing so, including working with the medical community to engineer a particular understanding of the dangers and hazards inherent in the use of this technology.

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In examining the scholarly literature which has been produced on the subject of internet addiction, one immediately becomes aware of stark contrasts between the way the issue is explored by American and European researchers, and the way the issue is explored within the Asian medical context. Asian researchers frequently start off in their articles with a boilerplate statement of the seriousness of the problem, some statistics about how widespread it is, and a statement about how the addiction is likely to impact society. In Chinese writing as published in the international journal Cyberpsychology and Behavior, the research emphasis is overwhelming not simply on interrogating the concept of internet addiction (in terms of questioning how it is defined or whether or not it exists). In the articles studied, it appears that within the Chinese system, researchers agree about whether or not the phenomenon exists. (It does.) They also agree about how it should be measured, within a consensus focusing on the Chen internet addiction scale as the best measure of whether or not one is an addict. They agree about treatment options, for the most part, and they certainly agree about the scope of the problem, with the consensus being that at least 10 percent of China’s student population suffers from internet addiction. Chinese, Taiwanese and Singaporean researchers are also much more likely to describe internet addiction as not merely a medical, but a social problem as well. Liu, a Taiwanese researcher, notes that internet addiction is the “prevailing problem in the modern wired society” (2007, 699). Finally, researchers in Asia tend to agree that it is a crisis which the government should be allocated strong resources to cope with. That is our traditional view of positivist scientific research rests on the assumption that statistical measurement and profiling doesn’t have a politics. Rather, one ostensibly reports and then measures the number of cases of disease, the patterns of disease and the effectiveness of measures taken to combat disease. However, in reality, states may have competing interests which affect how they report disease, how they understand disease patterns, and the ways in which they choose to portray the consequences of actions taken to combat disease. (This is particularly true when it comes to the reporting of mental health statistics. While there are procedures in place which aim to regularize the reporting of health statistics internationally through the World Health Organization, these generally do not apply to the reporting of mental health statistics. In general, mental health is an area which has thus far low on the agenda of international health bodies – both in terms of seeking data about the parameters of the problem, and in terms of laying out far-reaching programs for the treatment and diagnosis of mental illness (Patel 2011).) Rather, understandings of mental illness, its meaning and consequences for society are largely idiosyncratic throughout the world, as are the reports and compilation of statistics on the phenomena in an international context. Here, what is striking is the unanimity of opinion shared by, for example, Chinese researchers in contrast to the disunity or raucous disagreement showed by American researchers in particular, and European researchers in general. In essence, there was one epistemic community in China – headquartered in the Ministry of Defense and its related medical facilities, and many communities in

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the US scattered among a variety of university research centers in medicine and psychology, as well as at US facilities associated with the National Institute of Health. American medical research was both publically and privately sponsored. Even now, one can state that Chinese researchers uniformly agree that internet addiction exists and that it is a problem. In addition, there is a standardized model for the treatment of such addicts. The measures which government personnel and medical personnel should take both to prevent and treat internet addiction have been codified into the medical field through the development of a handbook on the treatment of internet addiction in 2009, and have been codified into law with the passage in 2007 of the Law on the Youth of China. In contrast, American researchers do not agree about the existence of addiction, about the extent of the problem, or about treatment options. In the United States, mental illness is officially recognized when it is included in the Diagnostic and Statistical Manual for the Diagnosis of Mental Disorders, a process that has not been without controversy. Although the DSM-V (or the current 5th edition) and the organization are American, to a large degree, both the American Psychiatric Association function as an international organization. Thus, the development of consensus about disease in the US may have ramifications in other nations as well. Specifically insurers are bound by the DSM-V in terms of the funds they must pay out for the treatment of a disease. Thus, recognizing a disease as “real” has implications for hospital funding, employment of professionals in offices and care centers, and also for the pharmaceutical industry, which will not develop new drugs if there is no demand for them. Inclusion of a diagnosis in the DSM thus represents the development of a consensus within the scientific community regarding the illness, definition and often the treatment of a disorder. The inclusion of a disorder – or the exclusion of a disorder if one is removed from a treatment manual – is a decision carried out by a 28 member task force known as the APA Committee on Nomenclature, composed of members of the American Psychiatric Association. Members of the task force may convene hearings and hear evidence as they engage in deliberations about how diseases are to be defined and included. Since 1973, the DSM has been rewritten twice, and each time it has been the subject of contention and contestation. For while the DSM listing represents an academic consensus, this is not the same as saying that it has been put to a vote or that there are no detractors among APA members. Indeed, as Bayer (1987) points out, the decision to remove homosexuality from the DSM-IV and remove its classification as a pathology may have been moved along due to efforts aimed at lobbying the issue. In addition, scientific studies such as the Kinsey study on sexuality, conducted in the 1960’s, had provided additional evidence that there was a range of healthy sexual behavior which was wider than had been previously thought (Chiang 2007). As Spitzer (1987) points out, disagreements surrounding the inclusion or removal or a diagnosis may rest on cultural values and understandings, rather than mere medicine. In that sense, every decision regarding the DSM is inherently politicized.

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The debate about whether or not internet addiction should be recognized in the American Psychological Association’s Diagnostic and Statistical Manual of Mental Disorders, version five (the so-called DSM-V) has been ongoing and is still unresolved, despite the appointment of a task force to look into the issue and form conclusions prior to the 2012 issuance of the manual. The issue of whether or not internet addiction exists and how it should be treated has also been a subject of contestation at meetings of the American Psychopathological Association (Kaplan 2008). Though the “disorder” was identified in 1995 and entered into general academic usage in 1997, American researchers still have not reached a consensus regarding the decision to include “internet addiction” or “internet dependence” in the Diagnostic and Statistical Manual of Mental Disorders. (This manual is due to be rewritten in 2012.) Rather, researchers in the United States and in Australia in particular differ regarding a number of issues, including (1) Whether the disorder actually exists (2) How it should be defined (3) What level of internet usage should be classified as problematic and (4) Whether internet addiction is a subset of some other disorder, including either substance abuse or obsessive-compulsive disorder (Dowling and Quirk 2009). Analysts in Austria note that internet addiction is an issue which is in dispute. There is no consensus in the international psychological community (Stieger and Burger 2010 682). However, there are some areas of commonality in the ways in which the disease is understood and portrayed. In particular, one can find evidence for the Szaszian idea that the major “symptoms” of internet addiction are that one is not productive in roles where productivity is required. This notion pervades the literature universally – in the US, China, Taiwan and elsewhere. Thus, for example, a 2009 article in Cyberpsychology and Behavior notes that “approximately nine million Americans could be labeled as pathological computer users addicted to the Internet to the detriment of work, study and social life” (Byun et al. 2009, 203). And the 2008 official Chinese definition of internet addiction, codified in the Internet Addiction Treatment Manual defines an internet addict as “anyone who lingers on the internet for more than six hours a day, not for the purposes of studying or working, having done so for not less than three months” (Jifeng 43). Here Asian researchers in particular have focused in on a loss of social productivity as the main effect of the disease – on both an individual and a group level. Thus, the Chinese analyst Wenlei (2009, 43) argues that over months and years, internet abuse becomes “detrimental” because “it excludes variety and choices of activities, provides only escape and diversion and is not job related or productive.” Taiwanese researchers stress the ways in which internet addiction upsets community and social relations – arguing that internet addicts are likely to suffer negative influences on: daily routines, school performance and relations with their parents (Lin and Tsai 2009, 411). Wu et al. (2007 220) associate internet abuse with a decrease in work efficiency, an unwillingness to undertake contacts with other people, and other “serious and negative effects”. Peng and Liu (2010) note that a majority of online gamers in China reported on its negative impacts on personal life, work or academic performance, while Cho et al. note

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that it is a serious mental health problem in children and adolescents in South Korea, describing 14.9 percent of Korean elementary school students as definite or probable internet addicts (2008, 11.) This notion of academic achievement as a collective good explains why high achievement oriented cultures like China, Singapore and Japan have all placed particular emphasis on the study and identification of internet addiction patterns among college-aged students. It also explain why behaviors which are not pathologized in Western Europe and the US (including staying up too late on the internet and skipping class as a result) have been pathologized in Asian models. The theme of internet addiction as primarily a type of lost productivity appears not only in the scientific literature but in the popular literature as well. Thus, a news article appearing in the Chinese press echoes this sentiment when the columnist argues that “Young people are the future pillars of society. If they indulge in the internet and neglect their school work today, what can they do tomorrow?” (Xinhua 2006). Here, stories in the news frequently feature a widowed mother or single parent for whom the addicted child is the sole source of financial support. The woman’s life is “ruined” as the child is not expected to fulfill his educational potential or to contribute productively to society. Furthermore, only research by the Asian researchers contains an explicit normative agenda, in which researchers note that they believe that internet addiction does exist, and then go on to theorize about its negative effects and how they can be prevented. The normative approach is also apparent in the use of language. Researchers frequently equate a variety of terms – including “the misuse of the internet,” or “problematic internet use” – with internet addiction. The implication here is that there is a right way to use the internet and a wrong way, and that those who bear the label of addicts are those who misuse the internet. Thus, China’s internet expert, Tao Ran has stated that “the misuse of the internet has emerged as a significant social issue with the growing population of the internet” (Stewart 2010). None of the research includes the possibility of “listening” to the patient, in Szasz’s sense, nor is there ever any indication that the development of internet addiction might be a valid response to changes occurring within Chinese society. In all cases, a medical solution (including the use of confinement and medication) is proposed. In contrast to the Chinese approach, research articles by American, as well as European researchers usually begin with a statement of the problem which indicates a lack of consensus in the field regarding the problem. Thus, researchers note that there is a dispute about the existence of the problem, its parameters and where it fits into the typology of existing disorders. They disagree about the extent of the problem in terms of how many are affected, as well as whether it is a separate phenomenon or one which is linked to other diseases, such as alcoholism. They also disagree about how the disease is best measured – that is, what scales and psychological indicators are most useful for measuring and diagnosing internet addiction. That is, one cannot identify the emergency of an academic consensus regarding internet addiction hazard identification in Western nations. In contrast,

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the discourse in China, Taiwan, Singapore and Korea is characterized by a high degree of academic consensus. Researchers here work closely together in funding and carrying out studies, and are in close agreement regarding how the problem is defined and measured, as well as whether or not it can be said to exist. The Asian consensus is that internet addiction is still increasing and that it is a serious problem which necessitates taking policy steps to address. European and American researchers seem equally unable to agree about the best tests to use in measuring the extent of internet addiction and as a result produce wildly varying figures regarding what percentage of the population appears to be addicted. The Dutch researchers Meerkert et al. (2009, 4) note that there is no consensus in the academic and medical worlds regarding which tests are reliable, valid and practical. For this reason, statistics regarding how many internet addicts exist within a society are wildly unpredictable. However, if one looks at trends, it is clear that over time Western researchers have largely revised their estimates regarding the numbers of internet addicts downward,1 while Chinese researchers have revised theirs upwards. Here, we need to consider the possibility that it is in China’s interest to believe that the problem is large and severe, in order to justify large-scale social policies aimed at combatting the problem. In comparing the two ways of describing internet addiction in the scholarly literature, it becomes clear that those researchers in China, Singapore and Taiwan who work at government-run institutes wear two hats: They are scholarly researchers and they are also frequently the authors or proponents of policy legislation which treats the issue of internet addiction from a social or political stance, as well as a purely medical stance. Thus, they have two types of authority – authority as researchers to understand and define the problem, and authority as policy advisors to make suggestions about how governments should respond to the medical issue as a policy problem. This explains why Chinese researchers in particular were able to move so quickly towards consensus in defining internet addiction (Ye, 2008) and towards implementing a policy to address the problem, through designating special hospitals for the treatment of internet addiction. Here, the consensus among Chinese researchers is that internet addiction is real, internet addiction is widespread and that those suffering from it must be treated. Unfortunately, this model also does not allow for true dialogue or an exchange of opinions. “I didn’t even know I was an addict”: Iatrogenesis and Addiction In the US, Western Europe, Australia and the Asian nations of Singapore, Korea, Thailand, Taiwan and China, the most commonly used medium for diagnosing internet addiction is the Young Internet Addiction (or internet overuse) Test, which consists of a battery of 20 questions, which users are asked to fill out themselves using a five-point Likert scale scoring mechanism. (The survey can be accessed at

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a variety of locations, including internetoveruse.com). The questions include the following: 1. How often do you find that you stay on-line longer than you intended? 2. How often do you neglect household chores to spend more time on-line? 3. How often do you prefer the excitement of the internet to intimacy with your partner? 4. How often do you form new relationships with fellow on-line users? 5. How often do others in your life complain to you about the time you spend on-line? 6. How often do your grades or school work suffer because of the amount of time you spend on-line? 7. How often do you check your e-mail before something else that you need to do? 8. How often does your job performance or productivity suffer because of the internet? 9. How often do you become defensive or secretive when anyone asks you what you do on-line? 10. How often do you block out disturbing thoughts about your life with soothing thoughts of the internet? In the words of Sylvia Tesh (1998) these diagnostic questions include a “hidden curriculum.” That is, they are based on an underlying set of values or assumptions about the role of the individual in the family, in society and in regard to the state. Here, one can identify the following three assumptions which are implied by the survey: First, the internet user is expected to be disciplined, to set limits on his behavior, and not to be carried away by the experience or to spend longer on-line than intended. Next, the internet user is expected to be capable of setting priorities, and of assigning his or her recreational internet user the “proper priority.” (It is expected to come after spending time with spouse or family after school work, and after work performance expectations.) Finally, the “healthy” internet user is not one who prefers virtual life to real life. It is easy to see that Szasz’s statement that those who are unproductive are most likely to be described as mentally ill is borne out by the most commonly used survey of internet addiction. Here, because the survey allows for the measurement of the intensity of one’s addiction – using a score between zero and one hundred – and because it rests on commonly accepted social science rules regarding how questions are to be crafted, one might view the internet addiction test (or IAT) as a neutral, value-free tool used by medical practitioners. But as is clear from the questions above, the diagnosis of internet addiction is thus one which relies on self-diagnosis. The diagnosis also rests on the user’s reports of his behaviors alone ‒ without regard to any underlying attitudes or feelings which the patient may attach to his or her behavior. And it appears from the survey that it is entirely possible for one to not know that he or she is ill until one receives one’s score on the diagnostic medium. The question then

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becomes one of whether the survey has in fact assisted in the identification of a disease which the user already had – or whether the survey has, in fact, helped to create a disease where none existed previously. Here, it is possible that the medical establishment – and the state – have helped to create a new disease, the major symptom of which is lost productivity. Here, it should be noted that Szasz has actually critiqued all of the addiction literature, or the development of the addiction paradigm on the basis of its overemphasis on social productivity. As I show in the following section, Szasz actually suggests that not only is there no such thing as mental illness; There is also, apparently, no such thing as “addiction.” Rather, addiction appears to be a shorthand term applied by the state when an individual is engaged in spending his time in ways other than those desired by the state. Here, one can briefly consider the ways in which “addiction” or “substance abuse” is described in the American Psychological Associations’ Diagnostic and Statistical manual of Mental Disorders – since this definition of addiction provides the framework upon which the Young internet addiction survey is based. (The so-called DSM-IV, the “gold standard” for diagnosis and treatment of mental illness in the US, and many other countries of the world.) The DSM-IV allows for the application of a diagnosis of substance abuse when a patient exhibits one or more of the following four “symptoms”: failure to fulfill major obligations; use when physically hazardous; recurrent legal problems and recurrent social and interpersonal problems. A subject may be diagnosed with substance dependence (or “addiction”) if he exhibits three or more of the following symptoms: tolerance, withdrawal, large amounts of use over a long period; unsuccessful efforts to cut down; time spent in obtaining the substance replaced social, occupational or recreational activities or continued use despite adverse consequences. The DSM-IV also notes that: “the relationship with the drug becomes primary – it is like a consuming love affair – it becomes the most important relationship for the individual and all decisions made are based on the maintenance of this relationship.” The American Society of Addiction Medicine provides the following definition of addiction: Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. … Addiction is characterized by impairment in behavioral control, craving, inability to consistently abstain, and diminished recognition of significant problems with one’s behaviors and interpersonal relationships … Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

However, in his work, Szasz queries whether there is, in point of fact, such a thing as addiction at all. Here, Szasz suggests that addiction, like insanity, is a “myth” in the sense that it is a concept which has been created by the medical community as a strategy of control (Szasz 1996). Again here, he argues that there is a “politics” implicit in the ways in which a condition which was accepted as normal for centuries (like smoking) might later achieve a label such as “nicotine

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addiction.” Here, he suggests that what has changed is not the behavior itself, but rather the social acceptability of the behavior. Those behaviors which tend to receive the label of “addiction” are frequently those which society feels are somehow distasteful or which violate social norms. Addiction thus differs from other types of illness (physical or mental) since the disease exists only in reference to a specific outside object. That is, one has to be addicted to something – to television, the internet, food or pornography. Thus, it becomes apparent that the definition of addiction is in essence a rendering of an expert’s judgment on the appropriateness of the individual user’s relationship with that object. Here, the expert is asked to give a judgment regarding the closeness with which the user regards the object, or the priority which one gives to the object. That is, normal science pretends that there is some objectively created set of criteria which allow the expert to decide the appropriateness of the user’s preference or prioritization of two activities – in for example, preferring to spend time playing Solitaire on-line over visiting one’s grandmother. The second judgment the expert is required to make has to do with the amount of interaction with an outside object which would be considered appropriate or desirable rather than appropriate or undesirable. If one accepts the rules of normal science as they have been described here, then implicitly one accepts the following notions in regard to how the state might act in regulating access to the internet, and preventing the growth of internet addiction. One would accept that: 1. The government, along with the medical establishment, is perfectly capable and ideally suited to make a judgment regarding how much internet use is too much for a citizen, based on a judgment regarding the harm likely to occur if that threshold is exceeded. 2. The government, along with the medical establishment, is perfectly capable and ideally suited to make a judgment regarding the priority which internet use should play in individual’s lives, or the values which users should ascribe to their relationship with the internet. 3. The government, along with the medical establishment, is perfectly capable and ideally suited to make a judgment regarding the hazards associated with internet use, as well as the risks which an individual runs in beginning a relationship with the technology. 4. The government, along with the medical establishment, is advised to take steps to guard citizens against developing an unhealthy or harmful relationship with internet technology – through implementing preemptive precautions, warning citizens away from using the internet, monitoring citizen internet use, and coming to stand between citizens in the internet in the event that the relationship being developed is too harmful. 5. Finally, if the experts within a certain society decide that overall, any relationship between any citizen and the internet is too harmful, and then the

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state should have the ability to shut down the internet or implement internet prohibition – excluding any type of relationship or use of the substance. The anti-psychiatric critique of the internet addiction paradigm in particular, thus rests on an interrogation of these ideas: that an outside expert would somehow know how much interaction with an object (like the internet) is “normal,” and that that same outside expert would somehow know how close a relationship with an object is desirable, normal or appropriate. Here, Szasz’s critique of the addiction paradigm argues that there are no objective criteria regarding the appropriate amount of time one should spend in a specific pursuit, nor are there objective criteria regarding how close a relationship with the object is “normal.” The antipsychiatry critique thus interrogates the addiction paradigm through calling into question the assumptions that experts are able to render objective judgments (free from political or social concerns or prejudices) regarding how much of a substance is harmful; how close a relationship with a substance is harmful, and ultimately how harmful the substance itself is. Thus, the critique goes to the heart of current discussions regarding the politics of internet addiction – as I shall show later in this chapter. The dominant addiction paradigm also rests on the assumption that scientific and medical practitioners are the individuals who are best suited to rule on the harmfulness of a particular substance, or the appropriate role which a substance or practice should play in the life of a community. Here, one can make a distinction between those who advocate for “abstinence approaches” towards a particular object versus those who advocate for “moderation.” The abstinence approach (which has been popularized through the so-called Twelve Step movement in the United States) rests on an assumption that a particular object (alcohol, tobacco or heroin, for example) is so dangerous and so beguiling that it is impossible for individuals to ever resist the substance, to enjoy it in small quantities or to have a “normal” or healthy relationship with the substance. Thus, due to the extreme risks associated with citizen use of the substance, the only possible solution – advocated by both medical practitioners and the state – is to create a strict state policy which renders creating, trafficking or using the substance illegal, and implements penalties for those who do so. In the words of Stanton Peele, the medical community has worked in complicity with the state throughout the twentieth century to “demonize” certain substances. Such substances are said to “enslave” people (1999, 43). Here, Peele points out that the best example of this abstinence-based policy is the American government’s decision to implement prohibition in the 1920’s, outlawing the manufacture and consumption of alcohol in any form or in any situation. He suggests that the final decision regarding implementing prohibition has less to do with any objective rendering regarding the hazard associated with alcohol consumption than it does with the lobbying by temperance groups which occurred in American society in this time period. Here, he points to the fact that prior to that time period, individuals within the original 13 colonies frequently drank beer, and that working men may even have had their wages paid in beer – and that the epidemic of alcoholism

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described by temperance activists never materialized. Similarly, Jellinek argues that the American organization Alcoholic Anonymous “invented” the alcoholic – both the word and the idea. He suggests that the ideology of Alcoholics Anonymous provides the basis for the statement that one is “powerless” against the problem (1960, 45). The notion of powerlessness is thus not an objective measure but rather an ideological stance that one can either choose to accept or to reject.

Figure 2.2 Degrees of addiction Here, one can conceptualize of addiction paradigms as existing on a continuum illustrated by the graphic illustrated in Figure 2.2. In considering this diagram, one can see that the position at the left assumes that individuals have no agency or capacity for autonomous action with regard to the substance, while the position on the right assumes that individuals have a high capacity for autonomous action with regard the substance. Thus, those who accept the “universal abstinence” position in regarding to a substance also accept a high degree of state intervention and regulation in regard to the substance. In Szasz’s words, the position taken by the state and the medical profession here creates a paternalistic relationship in which the medical patient is infantilized, though to be incapable of deciding independently how he chooses to interact with a substance, and incapable of regulating his own actions in regard to the substance. The assumption of universal risk or universal harm appears, instead, to pave the way for a state to take all possible preemptive precautions to limit individuals’ exposure to the new substance or technology – without even giving them a possibility of attempting to have a normal or moderate relationship to the substance. Such precautions might include warning individuals about the substance before they ever encounter it, or attempting to predict the sorts of ill effects one might experience through exposure to the substance, even if one has never before been exposed to the substance. In this way, it becomes similar to an autocratic state’s policy of ideologically inoculating or vaccinating its citizens against the ill-effects of possibly coming into contact with a foreign citizen, even if in reality the chances that one might do so are actually slight to nonexistent. The universal harm stance thus provides the justification for the medical establishment and the state to undertake a policy of “surveillance” – in which those who are seen to be at risk of developing a disease also become the objects of medical practice, since

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the state and the medical practitioner now has license to monitor their patterns of substance use so that they may intervene, prior to the flowering of full blown illness or addition. In contrast, those who accept the “moderation” position can still advocate for a lower degree of state intervention with regard to the substance. Finally, the position on the right represents a policy of moderated access. Here, the assumption is that there is something potentially quite harmful about the substance and for this reason; all users should be warned to approach the substance with caution. The state might implement public information campaigns (for example, warning people about the dangers of smoking) or institute fines so that all citizens are aware of the dangers of overusing a substance. However, the substance is likely to remain legal with people having access to it. This is not to say, however, that the position of moderation is merely one of benevolence on the part of the medical institutions nor on the part of the state. Rather, as Hanson (2008) suggests, the institution of public information campaigns by the state aimed at moderating people’s health practices still relies on strategies of manipulation and often the introduction of fear tactics. Here, she suggests that the overwhelming goal of such campaigns is to change the calculus which citizens may engage in before deciding to engage in risky practices (such as unsafe sex) through increasing the sense of risk or danger they may attach to a practice. Thus, one can trace a philosophical line between the regime which uses tactics of covertly threatening citizens with the possibility of developing an illness and the regime which moves on to overtly diagnosing and treating them for that same illness. The diagram below in Figure 2.3 illustrates the varying rates of caution with which the state and the medical establishment might approach the internet. When one considers this chart, however, it is important to note that no country adopts only one of the strategies, nor can one neatly match up the levels of access to particular countries. Notice as well here that the emphasis is on strategies which states use to protect their users, based on their understandings of how the internet may harm the user. This is not a chart of “internet enemies” nor is there any emphasis on filtering internet content. Rather, one can find evidence of US use of all of the strategies, and one can also see how states have moved within the levels over time. Politics of Universal Abstinence If we return to the chart in Figure 2.2, we can again consider the position of universal abstinence. The position on the left represents a policy of “universal abstinence” in which practitioners might conclude that a substance (like heroin) is so universally harmful, that it should, in essence, be kept from everyone at every time. From this viewpoint, there is no possibly of any human being ever developing a healthy relationship with heroin, or becoming a moderate heroin user.

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Figure 2.3 Responses to internet addiction From a risk perspective, one can view the assumption of universal, irreparable harm as an application of the so-called precautionary principle to the medical field. The development of the precautionary principle is an outgrowth of the work of the German theorist Ulrich Beck (1992) in developing what he refers to as the notion of “risk society.” Beck noted that in the present modern age, there are many risks which can be described as “pervasive risks” – because citizens are subject to these risks as an inevitable part of the human condition. One does not, therefore, have the ability to “opt out” of being subject to risks like nuclear radiation or environmental contamination since one does not have the option to stop eating food, drinking water or breathing air. Thus, Beck suggested that when considering technology policies which might have the potential to create a pervasive risk, the only sensible strategy from a risk management perspective was to act with extreme caution. The precautionary principle exists to give governments the authority to act to prevent

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environmental contamination – even before a risk assessment has been done, pointing definitely to the fact that such a technology is indeed harmful. Rather, policy-makers are instructed to behave “as if” the technology is harmful and to act with all due caution, until the technology is proven otherwise. In addition, the precautionary principle rests on the assumption that not all hazards resulting from new technology are either immediately measurable or quantifiable using currently available models. Thus, for example, a precautionary-based perspective would allow for consideration that “the risks at present might be unknown, and perhaps even beyond our conception – but they might become apparent at some time in the future.” Such currently unknown risks might include, for example, genetic damage to future generations. In the case of internet addiction, a precautionary-based perspective would make room for arguments regarding hazard resulting from internet use (or overuse) that might include such vague and nonmeasurable risks as “spiritual harm” or “a loss of our nation’s unique cultural environment.” Here, for example, it would suggest that the Russian state (and its psychiatric community) would need to take seriously the allegations of Russia’s Prime Minister Vladimir Putin, who has spoken out in opposition to the introduction of computer technology in Russian kindergartens, suggesting that early exposure to computers might lead to mental illness, including schizophrenia. Here Putin has allied himself with spokespeople for Russia’s Orthodox Church community, who have described the internet as a site of defilement and sin, which targets the purity of Russia’s citizens. Frequently, those who use the language of spirituality, morality, and purity in their risk assessments assert the idea that a nation was clean and holy until it was invaded by the internet.2 That is, the internet itself is seen as an agent of Western modernization. Thus, for example, the Chinese internet expert Zhang Chunliang stated in 2004 that “just as power plants take responsibility for discharging pollutants, game companies should take responsibility for the consequences of spiritual pollution caused by their products” (Xinhua 2006). And in Russia, Archpriest Artemy Vladimirov, the rector of a church in Krasnoye Selo, Moscow described cyber addiction using the following language: “I see that the devil sneaks up unnoticed and then enters audaciously and boldly, like a commander, into the homes of affluent people who have managed to get their heads above water” (Pravoslavie Ru 2008). The same trope appears in Japan, as well (which is perhaps not surprising, given a long history of xenophobia and distrust of foreigners). The analysts Shukla and Rogers (2001) notes the ways in which children are regarded as pristine and innocent, until they are “polluted” by technology. Similarly, analysts suggest that Chinese view China today as “just like the Qing Empire” – full of the promise of a growing cosmopolitanism that will strengthen China and integrate it into a global political system but also exposed to foreign influences that may lead to its downfall (Golub and Lingley 2008, 60). Here, the internet is often compared to opium, another foreign substance imported into China which helped lead to its downfall. A precautionary perspective would also necessitate taking seriously even the most vague, unproven allegations regarding the ways in which internet addiction

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is destroying competitiveness, social life and health in China. Currently, Chinese officials have blamed internet addiction for a variety of effects, including juvenile obesity, a rise in juvenile crime, 80 percent of high school and college dropouts and the September 2010 loss which China’s national women’s volleyball team sustained (Stewart 7). And China’s more sensationalist newspapers have reported a variety of stories including the story of a Chengdu child who died after a two day marathon of game playing, a homicide in Qingyuan by a boy whose father disagreed with him regarding his attachment to the internet and the suicide of a Tianjin teen who had just spent a day playing World of Warcraft (Stewart 4). In each case, these claims would need to be investigated and disproven before officials could contemplate removing any restrictions on internet access. China’s leading internet addiction researcher and clinician, Tao Ran, has referred to the internet as “heroin” and to the addict as an ‘internet junkie.” Similarly, the antiinternet crusader Tian Bingxin has noted that: The allure of internet games for children is like the poison of opium in China so many years ago. It doesn’t discriminate between the poor and the rich, between those of high or low position. It doesn’t matter if you’re an unemployed worker, a wealthy businessman, or a party cadre, the highest hopes of innumerable parents for their children’s future may well be destroyed by Internet games. (Golub and Lingley 2008, 63)

Arguably, the precautionary perspective may lead researchers to begin seeing patterns and connecting the dots on what are actually only isolated incidents. When one considers a population as large as one billion people, and one then finds 12 suicides by gamers, does this in actuality constitute the discovery of a pattern, or simply the fact that one has an incredibly large population of data from which to select cases? Furthermore, in a society which may have been hypersensitized to the existence of a problem, this perception bias could then lead researchers to find examples of the phenomenon at an increased rate – or to see patterns when in actuality one is simply observing random events. However, the problem with the raising of the precautionary principle as a support for implementing tighter controls over internet access is that it raises a problem of inconsistency. Currently, the Russian government finds itself advocating two contradictory positions: On the one hand, Prime Minister Putin argues that the internet as a technology is so dangerous that all reasonable (and perhaps even unreasonable) precautions should be taken in relation to it so that those most at risk should not be exposed. However, simultaneously, Russia’s President, D. Medvedev, is attempting to push government employees to become computer savvy in order to increase their work productivity (Berry 2008). Here, it seems quite inconsistent to argue that the technology is extremely dangerous and that the government is aware of it – yet at the same time, the government is mandating that individuals expose themselves to the technology on a regular basis. One way out of this dilemma – which one can find increasingly in Russia

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and in several Asian nations – is for those in charge of regulating the internet to begin to redefine the notion of “internet addiction.” Here, for example, we can see the birth of several new diseases, which basically define a subset of internetrelated behaviors which are likely to lead to addiction. Thus, for example, there is ostensibly such a disease as “video game addiction,” “internet surfing addiction” or “instant messaging addiction,” while there is no disease called “addiction to learning valuable workplace technologies.” In applying the precautionary principle, the responsibility thus falls upon the technology’s creator to provide “proof of safety,” rather than on the regulatory authority to provide “proof of harm.” Here, Hathcock criticizes the over-application of the precautionary principle, noting that “excessive precaution leads to paralysis of actions resulting from unjustified fear” (Hathcock 2000, 1). Furthermore, a situation in which a society adopts an assumption of universal, irreparable harm and addiction towards a new technology decreases the likelihood that the state can ever find a compromise position or a rapprochement with that technology. Furthermore, it creates a balance on power in which the state is much stronger than the provider or creator of technology. In considering the argument regarding internet addiction, one can consider, for example, a situation where the state is considering implementing regulations regarding strict procedures to regulate the growth of internet cafes. In adopting a precautionary perspective, or implicitly accepting the claim that “the internet is harmful to young people unless proven otherwise,” the onus now falls on the owner of a cybercafé to “prove” that the environment he has created is not harmful to youth, rather than on legislators to prove that the environment is harmful to youth. That is, using this perspective, proprietors of cybercafés are assumed to be guilty of inflicting harm, while the state is assumed to be innocent – or as Murray puts it, a precautionary stance tends towards a depiction of new technologies as providing “all risk, no benefit” (Throne-Holst and Sto 2008, 106). Here, it is reasonable to ask why there is so little Chinese writing on the benefits of internet technology – in contrast to the burgeoning literature in the US on topics such as “why the internet makes you smarter,” or recognition that the internet provides valuable skills. In contrast, the US government has provided funds to set up sites for teachers about how to harness the productivity of internet technology and has even sponsored research based on the notion that virtual reality, gaming and even social networking may have an upside. Or we may consider the thought of two Singaporean analysts, Alfred Siew and Oo Gin Lee (2007) who describe cybergaming as being like fire; it can be either useful or dangerous. The secret is in how you manage it. In the most extreme policy position derived from this argument, one may even argue that internet use is socially beneficial, in that it can help individuals who suffer from a variety of maladies having to do with adaption to the environment. Thus, the Australian researchers Campbell, Cumming, and Hughes suggest that internet use can actually help those who are socially fearful, shy, those who have Asperger’s syndrome, those who are seeking support for a disease diagnosis, or those seeking support for postpartum depression. In their work, they fault the medical community

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for its focus on over-users, suggesting that certain groups can benefit from online interactions. (2006, 69) In summary, the universal, irreparable harm stance assumes that the hazard associated with the substance is so great that all should be considered at risk in reference to the hazard, and that all should be warned to approach it with caution if not to stay away altogether. Here, if this stance comes from a practitioner it serves the purpose of defining the technology in such a way that most individuals will think carefully before beginning a relationship with the technology. That is, the internet is portrayed as an equal opportunity threat to which all are vulnerable. This threat is said to exist because of certain facets of the technology itself which serve to “lure” users. American researchers (Greenfield, Griffiths, Widyanto, and Griffiths) pointed to qualities of the internet which caused it be uniquely addictive – including its speed, accessibility, the intensive of the information available and the stimulation provided. (Griffiths added that the anonymity of the internet might cause people to be more likely to use it in socially harmful ways.) Meanwhile, the Chinese researchers Chen et al. (2007) fault the internet for its ease of use, as well as the availability and breadth of information which it offers. Here, it appears that researchers agreed that the internet was addictive, but were not in complete agreement regarding exactly why it was so addictive (Chou, Condron, and Belland 2005). In Szasz’s antipsychiatry model, the political purpose of psychiatry is described as the ability to establish order, while the political purpose of the addiction model is seen as the stigmatization or demonization of certain substances or practices. Criticisms of the addiction model thus focus on the ways in which it denies agency to the patient, instead making the claim that there is a substance or practice existing in society which is so compelling and attractive that some individuals (or sometimes all individuals) are powerless to resist it. Here, we can consider a number of metaphors which emerged to describe the internet. The internet was a “trap” which could snare people in the net (in the words of researcher Kimberly Young whose first book was titled Caught in the Net). China’s best-known internet researcher, military Colonel and psychiatrist Tao Ran descried it as “heroin” and those who overutilized the internet as “internet junkies.” (Here one might wish to pause and consider the related term “crackberry” which was a slang term for the Blackberry communications device. This term blended the names of the drug “crack” with the name Blackberry to convey the sense that the device was addictive and perhaps malevolent. This term first emerged in print in 2001.) These terms were then repeated in both the American and Chinese press. In both sets of terminology, the discourse is one in which users have no agency, and are nearly powerless to resist the overwhelmingly strong and dangerous internet. Specifically, the term netaholics is used to convey the sense that one can be victimized by the disease of addiction to the internet in the same way that one can be victimized by the disease of addiction to alcohol. Here, again, Chinese and American practitioners largely agreed upon the sorts of treatments which were appropriate for those who suffered from internet addiction. Kimberly Young advocated abstinence for the addiction, since the user was clearly

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incapable of maintaining any sort of controlled use of the medium. In many cases, practitioners adopted the language of a 12-step program for “netaholics” similar to that used in the recovery support group Alcoholics Anonymous, in which sufferers were first asked to confront their addiction and the notion that they were powerless against it, before surrendering to a higher power. Here, the discourse had an effect on how people thought about their relationship with the internet and the world of computing but also on how readers, practitioners and policy-makers thought about the internet itself, about its power to affect human relations and about the controls on the technology itself which might be necessary in order to fix its place in society – so that humans were in control of the technology and not vice-versa. The addiction model thus becomes another way of extending government’s reach – since it becomes the job of government to come between the individual and the harmful substance against which he is incapable of exercising agency. In short, the only way to prevent a situation in which some (or all) of society’s members become useless, dysfunctional addicts who are incapable of fulfilling their roles in society is to ban access to the substance in question or institute very tight controls on its use. The universal harm stance thus serves the state since it shifts the blame for denying access away from the state and to the substance itself instead. Thus, the universal harm stance supports the state’s claim that is not the state’s fault that citizens cannot access the internet – because the state is being autocratic, antidemocratic or unfair. Rather, it is the fault of the internet itself. The state is thus not acting autocratically, but rather benevolently in protecting citizens from something which is dangerous. And the solution is thus not to change the state’s policies – but perhaps instead to act on the content of the internet itself or the activities of the users (through implementing technologies such as filtering, surveillance or restrictions on who may access the technology). The universal harm stance thus allows for the state to take on a role of protecting users from a substance or practice which is labeled as dangerous (Szasz 1996, 4). The state thus comes between the substance and the user in a variety of ways – both through treating those who have already become addicts, and also through regulating access to the substance for those who are at risk. Finally, the state may institute public awareness campaigns aimed at warning individuals, including young children, away from the substance. However, the literature suggests that in the case of most new technologies, the stance of universal, irreparable harm is one which is usually abandoned after a short period of adjustment, as states find that in reality, only a limited subgroup of individuals have some sort of underlying predisposition which makes it likely that they will not be able to exercise normal restrain with regard to the technology. That is, as Fitchen et al. note (1987), risk perception is seldom a fixed or static process. Rather, it is dynamic. Frequently individuals and groups are extremely worried about new technologies, and the ability of new technology to rob individuals of agency. We can see this historically with the emergence of Mary Shelley’s Victorian novel Frankenstein, which has been understood as a discourse about society’s underlying fear of the new technology of electricity. Historically, individuals and

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groups have created “threat talk” regarding the side effects of “new” technologies such as television and the radio, as well as the telephone. As Fischer (1994) tells us, individuals worried that the creation of telephone technology would destroy patterns of social interactions as people preferred to chat on the phone rather than going into town to visit with people. (They also apparently worried that the lack of physical activity created with the addition of telephone technology would make people “lazy” – if not fat.) Other analysts raised arguments that television and the radio rendered people “stupid” since they now depended on others to entertain them, rather than entertaining themselves, were also not new. The risk that children would be exposed to inappropriate material (as on the internet) also has a long pedigree – activists raised the concern with the introduction of the radio and later with television. Over time, however, it appears that societies have made their peace with such technologies as the telephone, television, the radio and electricity. In the words of the noted media analyst Marshall McLuhan, individual users learn how to “see” differently – so that they have the skills they need to consume media in the ways in which it was intended. McLuhan argued that TV was indeed a “drug,” but that over time, media users would develop the skills needed to evaluate and work within a new medium (1964). Thus, the pattern suggests that as individuals become more familiar with a technology, “threat talk” is likely to wane as claims regarding the danger associated with a new technology are properly evaluated and found to be either false or overstated. That is, over time, the state and the medical profession may change how they view a risk, its seriousness and the proper public health measures which should be taken in regard to risk. Who is the Internet Addict? Politics of Differential Access In the American case, the paradigm of “internet addiction” was already being seriously reexamined by the medical community in 1999. At this point, American researchers began questioning the assumption that there was anything uniquely addictive about the internet itself, as well as the notion that all were equally vulnerable to the threat of internet addiction. Instead, scientists began to suggest that it might be a disorder which was comorbid with other diseases, including other types of addictions or impulse control disorders. Here, the analysts Widyanto and Griffiths (2006) were the most critical, stating that some “allege” that there is a disorder called internet addiction. However, they argue, that if such a disease exists, it likely affects only a very small percentage of the online population. In other words, Americans moved quickly to stop blaming the internet itself for causing or creating the disease, instead beginning to focus on the behaviors of the user. More recently, Jiang Qiping, from China’s Information Technology Research Centre of the China Academy of Social Sciences, has concurred that sensationalist writing about internet addiction disorder may be more likely to stigmatize the internet and its use than the internet users (Szablewicz 2010, 457).

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By the year 2000, Kimberly Young, who had originally discovered the disorder began advocating for the use of the term “online addiction,” which she felt better expressed the notion that sufferers had a behavioral disorder as a result of their behaviors, but that the internet itself was not to blame for the disorder (Young and de Abreu 2010, 250-251) Indeed, the US psychiatric community, by 1998, had already begun in some instances to use quotation marks around the phrase “internet addiction” (DeAngelis 2002; 2001; Mitchell 2000). In later years, American scientists would begin to speak of a so-called novelty effect, in which users might initially be infatuated with new technology and might tend to overindulge with the technology when they are first introduced to it. The notion is that as users become more familiar with the technology, it loses its luster, and users are better able to incorporate the technology into their lives through the establishment of normal use patterns. Here, the norm is that most users will eventually adapt to having the new technology and will swear off the addictive behaviors which might have characterized their initial “honeymoon” with the technology. In addition, American scientists began to critique some of the earlier methodological work which had been done with an aim of measuring, determining and mapping the extent of the problem. They faulted Chinese research in particular, which they feel had been too quick to apply the label internet addict, and as a result had overstated the extent of the problem in China in specific and Asia in general. In her 1998 paper, Young laid out the thesis that all were not equally vulnerable to internet addiction. (As early as 1997, she occasionally used the term “habit,” rather than addiction to refer to individuals’ internet problems.) Rather, she argued that particular types of individuals were more likely to misuse the internet to the extent that it interfered with healthy psychological and social functioning. Later, the term Problematic Internet Use (or PIU – sometimes also rendered as Pathological Internet Use) was coined, to describe the “multidimensional syndrome that consists of cognitive, emotional and behavioral symptoms that result in difficulties with managing one’s off-line life” (Caplan, Williams, and Yee 2009). Symptoms are noted to include using the internet as a “maladaptive mood regulation, compulsive internet use, and a preference for online social interaction” (Caplan, Williams, and Yee 2009, 1313). Since then, analysts have introduced a much wider term, that of “improper use” which provides a wide umbrella under which to group a variety of other medical terms, including internet addiction, internet dependence, technology addiction, problematic internet use, pathological computer use and internet addiction disorder (Yang et al. 2009). By 1998, Young and others already saw the need to include (Young, Bradford 1998) language justifying the stance that PIU is a legitimate concern. By 1999, in the US, the term “controversy” was frequently linked to the term “internet addiction” as in discussions of the “internet addiction controversy.” In addition, beginning in 1999, empirical research was carried out which included case studies of self-confessed, “internet addicts,” survey research and the use of experimental methodologies. In addition, the field saw the formation of specific groups within the American Psychological Association concerned with personal behavior in cyberspace, and the formation of journals like

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Cyberpsychology and Behavior. This new journal embraced the normative goal of studying the ways in which the computer could be used in providing psychological services, through online counseling or psychiatric evaluation – as well as studying psychological effects of computers on humans (Wiederhold 1998, 1-2). This hard scientific research gradually dispelled the myth that all were mutually vulnerable to “internet addiction” – or internet dependence. That is, in Szasz’s terms, the state together with the medical establishment began to rewrite the risk calculus associated with this behavior and to redefine the parameters of the disease. Instead of diagnosing all as potentially sick with the disease, the state and the medical establishment moved to narrow the definition of the disease, so that now only some would be viewed as potentially harboring the disease or the potential for developing the disease. That is, the internet was still viewed as a site of possible risk and harm, but gradually the definition of who was most at risk of harm was being narrowed. However, at the same time, research by Chinese academics in particular, began to focus on identifying new sub-types of the disease which, arguably, simply moved the locus of blame away from indicting “the internet” as a whole from creating the disease, to instead indicting certain specific sites within the internet. Thus, citizens were no longer being diagnosed as being addicted to the internet – but were instead diagnosed as being addicted to instant messaging, online gaming or visiting cybercafés. That is, each new diagnosis was in essence simply a shorthand for a more specific type of anti-social behavior. And as a result, new modes of cure focused less on demonizing the internet as a whole, but instead on regulating specific sites within cyberspace or specific online practices. Thus, for example, one can see a tendency by China’s government beginning in 2005 to place increasingly strict regulations on the institutions known as internet cafes. McMahon cites the advent of legislation which requires users to present their ID’s at cafes, as well as to have their photos taken in Beijing. Café owners were also required to keep records of user’s online behaviors which could then be surrendered to the government upon request (McMahon 2011). In narrowing the definition of who was an internet addict, medical personnel utilized the term “comorbidity” – defined by Mosby’s medical dictionary as: Two or more coexisting medical conditions or disease processes that are additional to an initial diagnosis. In identifying comorbidity factors, or psychiatric or physical conditions which might run concurrently to internet addiction, researchers in both the United States and the Asian nations have used a strategy of working backward. Here, they begin with the outcome and then drill down to examine the pool of those who carry the diagnosis. Here, a number of factors have been identified including the existence of compulsive behaviors as conditions which appear to magnify or even trigger the flowering of internet addiction symptoms. Indeed, some researchers have gone on to suggest that there is, in point of fact, no such disease as internet addiction. It is rather merely a subset of obsessive compulsive disorder or a particular manifestation of the syndrome. Others have suggested that among those who have an addictive personality, they may be exercising some agency in choosing to substitute one

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addiction for another. Thus, for example, it may be that having internet addiction is arguably a more socially acceptable form of addiction than others (Young, personal conversation). Finally, some researchers have suggested that those who are depressed or who have poor social skills are more likely to become internet addicts. Others have suggested that internet addiction may be comorbid with attention deficit disorder (Lin and Tsai 2004). Taiwanese researchers compared students who exhibit internet addiction with those who exhibit other substance abuse problems, including problems with alcohol use. Here they showed that the two groups had similar scores on the Behavioral Approach System and Behavior Inhibition System questionnaires (Yen et al. 2007, 221). By the late 1990’s, Western researchers were speaking of an “addictive personality” who might be addicted to the internet, or who might use the internet to facilitate other underlying addictions – like gambling. Dr. Catriona Morrison, who directed a study on the linkages between internet addiction and depression notes “while many of us use the internet to pay bills, shop and send emails, there is a small subset of the population who find it hard to control how much time they spend online” (Morrison and Gore 2010, 124). Internet addiction has thus become a subset of addictive behaviors and while American experts still dispute whether it is a “real” medical condition, it is no longer portrayed as a danger which afflicts every citizen nor it is seen as having the potential to do so. Rather, the academic consensus – in both the US and China – is that internet abuse is more likely among those who have a penchant for addiction – with gamblers likely to become addicted to internet gambling. Compulsive shoppers are likely to discover compulsive internet shopping, while those who are already lonely or socially isolated (such as stay at home mothers or the elderly) are more likely to become addicted to internet communication. The chart in Figure 2.4 illustrates the variety of risk factors seen as indicative of or leading to internet addiction. Factor

Source

Biogenetic temperament and character

Chou, 2000 Cho et al., 2008

Problematic social relationships

Kandell, 1998

Neurological Differences

Lu et al., 2010

Academic or work difficulties

Kandell, 1998

Depression

Young and Rogers, 1998

Socioeconomic status

Young and Rogers, 1998

Figure 2.4

Education status

Ni et al., 2009

Gender

Yen et al., 2009

Family structure

Chen et al., 2009.

Factors Leading to Internet Addiction

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Internet addiction was treated as both a dependent and independent variable in studies carried out by researchers in the 1990’s. Here, researchers were interested both in what was causing internet addiction, and what the effects of this addiction were. Here, internet addiction was said to lead to a variety of outcomes, as illustrated by Figure 2.5. Outcome

Source

Increased drop-out rates for students

Kandell. 1998.

Social, occupational and psychological impairment

Young and Rogers, 1998

Problematic Family Relationships

Chen et al., 2007

Suicide

Kim et al., 2006

Figure 2.5

Outcomes from Internet Addiction

The consensus as a result of these new findings was largely that the “average citizen” is seen as having sufficient agency to govern his actions regarding the internet. And in the case of Young’s claim that addicts are capable of substituting one addiction for another, it gives significantly more agency to the patient than the “universal harm model” does. It suggests that most individuals are capable of resisting the lure of the internet, and that of those who do not, they still may be exercising agency in, for example, choosing to become an internet addict rather than a heroin addict. Furthermore, the differential access model suggests that – despite the Chinese propensity to refer to internet addiction as an epidemic – internet addiction is not contagious. That is, if one accepts the claim that only those who have underlying conditions are likely to become internet addicts, then one must also accept the argument that individuals cannot “contract” internet addiction from visiting a cybercafé, spending time with others who are addicted or purchasing a shinier new computer which runs faster. Acceptance of the differential access stance also means accepting the finding that the “average” person has a fair amount of ability to self-regulate computer user, notice his or her patterns, and is unlikely to succumb to the disease. From this set of research findings developed the doctrine of differential access, or support for a medical and state policing which would lead to the profiling and policing and surveillance of those labeled as least able to govern their online use patterns appropriately. (Thus, for example, there was wide social support for the notion that children – who do not have a sense of appropriate time limits on internet use or a sense of appropriate personal information to share and not share in cyberspace – should not be allowed to have free agency for decision-making in regard to their internet use.) In short, the differential access stance suggests that some individuals are more vulnerable than others to the hazards associated with the object in question. That is, there are some people who are less able to resist the siren call of alcohol, or heroin, or the internet than others. The overall outcome

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of these new scientific findings has been, at least in the US and in Europe, to significantly narrow the pool of those who are actually measured as suffering from internet addiction, as well as the pool of those who might be seen as potentially likely to contract the disorder. However, as I shall show in the following section, the question of how many currently suffer from internet addiction and how many have the potential to do so is still the subject of great disputes among practitioners from different nations. In introducing the notion of differential access, however, the blame for the problem of internet addiction is shifted once again. The differential access stance suggests that rather than blaming the substance (alcohol, heroin or the internet) for the problem of addiction, at least some of the blame should be placed on the user himself. Again, none of the blame falls upon the state itself. Rather, the state is seen as acting benevolently in shielding some users (those identified as being at greatest risk of sustaining harm) from the substance. The differential access argument suggests that for these individuals, a particular stance of caution in relation to the substance is advised, and that it may be appropriate for the state and the medical establishment to implement procedures to limit the access which these particular individuals have to the substance. The problem with the “differential access” position, however, is that historically, the decision to restrict access to new technologies, social opportunities or other substances to some population subgroups while denying it from others has not been free from politics. That is, it may be impossible for any outside expert (whether a physician, a sociologist or a criminologist) to make an objective rendering regarding who should be allowed access to books, the internet, the automobile or other substance –free from any extant prejudices which they may harbor about the fitness of various groups within society, based on race, class or gender distinctions. (Here, we may think back to the conversation about the bicycle in the introduction to this work.) The question then arises: Is it possible to make a statement that “this substance is somehow in all probability more harmful to you than to others?” In such a way that one is merely rendering an objective opinion – or is that simply not possible? Historically, there is a great deal of evidence that differential access positions in regard to illness have had more to do with politics and prejudice than they have had to do with science. Cultural assumptions about fitness and health, as well as about proper social roles, played into any discussion regarding who was at risk of developing a health problem. For example, one can consider the politics of the “rest cure,” a regime of treatment for women implemented in the late 1800’s and early 1900’s and popularized by the American doctor Silas Weir Mitchell. As Poirier explains, the profile of women at the turn of the century was that they were “sickly and emotional creatures” (1983, 16), fragile and largely incapable. In America and Europe, women were seen as prone to illness, both of the physical and emotional variety (Martin 2007). The well-known Dr. Weir – whose name appears in Charlotte Perkins Gilman’s feminist classic novel The Yellow Wallpaper – specialized in providing his women patients with warnings

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and counsel regarding the need to safeguard their strength, eschew challenging situations and occupations (including the pursuit of higher education) in order to lessen their chances of contracting a nervous disease. He can thus be said to have invented the “disease” of neurasthenia or “nervous exhaustion,” which served as a pretext for confining women in sanatoriums and excluding them from the workplace. The disease thus caused women to view themselves differently, and to alter their behavior as a result. The profile which he constructed of women caused them to preemptively alter their behaviors and their preferences as the result of how they viewed themselves and their capabilities. The question thus becomes: Does making a blanket ruling of the sort that would say “internet access is too dangerous for this group – and they must be kept from having free access to it” more like a sensible, sane policy of restricting children’s access to matches or firearms, or more like a misguided, damaging policy of restricting women’s access to higher education? Furthermore, one can argue that the creation of risk groups within the population tends to infantilize those who are described as requiring protection. Here, not coincidentally, it is largely those who occupy a weaker position within society – by virtue of age, gender or minority status – who are most often identified as requiring specific protection. The identification of risk groups is thus, arguably, not an exercise in science, but an exercise in politics. In the Chinese case, it is perhaps telling that they are significantly more likely to identify young people, including students, as a risk group. This action may actually be more reflective of social prejudices and cultural ways of thinking about age than it may be an exercise in epidemiology. Asian academics are more likely to refer to high school and college students as “boys and girls” in scientific publications than are their Western counterparts, who usually use the terms “men and woman,” and Asian academics are also more likely to suggest that it is appropriate for parents to strictly monitor students’ online activities, even when they are of college age (Yen et al. 218). Thus, in a recent article in Beijing Review, the author quotes Gao Wenbin, a researcher at the Chinese Academy of Sciences, who indicts the families of teen “addicts,” noting that they have failed to socialize their children into values like self-esteem, recognition and confidence (Wenlei 43). In the same article, the author notes that children are less able than adults to understand the limits of the internet, thinking of it as “the world,” rather than merely “a tool.” As a result, many of China’s laws aimed at regulating access to the internet have fallen to a large degree upon China’s young people. For example, 2005 legislation standardizes requirements set by the General Administration of Press and Publications of the Ministry of Culture regarding the setting of time limits for online gaming. This legislation has an undue impact on the practices of young people. The regulations require Chinese online gaming sites, which require government approval to operate, to establish controls to deter people from playing for longer than three consecutive hours. After three hours, gamer’s “characters” begin to lose their powers, and after five hours, users are locked out of the system (BBC News 2007). And legislation in 2010 called for stricter enforcement of age

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limits in internet cafes (where patrons are required to be 18 to have access to the internet). New rules established by the Ministry of Culture call for cafes that admit more than three underage people at a time to lose their licenses (China Digital Times 2010). Furthermore, some states have a tendency to infantilize all of their citizens, based on a historic tendency to adopt a paternalistic governmental stance. Thus, officials may identify particular risks which their citizens are more vulnerable to – as the result of the introduction of new technology. For example, Russian officials have focused on a national proclivity towards both addictive behavior and a love of gambling, arguing that risk management strategies for this hazard need to be stricter in Russia (Alexander, 2009). In Japan, policy-makers have noted that privacy norms are different – and some analysts argue that different internet norms regarding privacy have evolved within “Japanese cyberspace” (Mizutani, Dorsey, and Moor 2004). Furthermore, Japanese officials have evolved their own legislation regulating so-called “suicide sites” where those contemplating suicide can meet to encourage one another and to exchange suicide techniques and tips. Again, since Japanese culture has traditionally had a problem with suicide, this risk has been reflected differently and magnified in “Japanese cyberspace.” Chinese discourse overwhelming speaks of a lack of agency involving those who are socially vulnerable. In other words, over time we have seen the establishment of protected classes of individuals, based on the understanding that these people are less well-equipped than others to monitor their own usage and safety (by virtue of their extremely old or young age or other types of infirmities). Here, the understanding is that these individuals may be granted less than full internet citizenship, and that in circumstances where they are likely to experience danger, these individuals can have their sovereignty violated. Thus, for example, family members are encouraged to spy on users if necessary to find out if they are using the internet safely or compulsively. In recent years, we have seen the development of software which can log the keystrokes of other family members. (That is, family members are encouraged to practice “surveillance” against one another.) We have also seen the development of discourse regarding steps families can carry out to keep their children safe on the internet – including monitoring children and the use of software which locks children out of dangerous parts of the internet. Treating those at Risk: Two Approaches From the beginning, social studies of the phenomenon of internet addiction have been characterized by a high degree of methodological rigor. However, from the beginning of this burgeoning field of study, analysts differed greatly in how the problem was defined and measured – and most of these divisions have been along national, rather than ideological lines. Thus, beginning with a shift from the universal harm to a differential risk assessment of the hazards inherent in internet

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use, the stances of the two major groups of analysts – Americans and Chinese – began to diverge sharply. The fact that the views diverged does not invalidate Szasz’s claim that psychology and psychiatry are largely activities led by the state for the aims of the state. It merely suggests that not all states have the same aims when implementing medical and public health policies. Here American analysts have allowed that there exists a subset of individuals for whom the development of technological literacy and cyberwellness were inappropriate goals. These were individuals who had preexisting addictive conditions, and young children. These individuals clearly might be unable to manage technology appropriately whatever the circumstances. For these individuals, medical personnel evolved a description of limited use regimes or even prohibition of the technology to these individuals. However, the subset of individuals viewed as incapable of using technology correctly was deemed relatively small in the US, in comparison to the much larger description of an at risk population which evolved in China. As the chart below indicates, the estimates of how many individuals are either currently addicted to the internet or who have the potential to become an internet addict varies widely and systematically between cultures. Self-reported internet addiction rates range from a reported low of 3 percent to a reported high of 20 percent in Singapore. Here it is important to note that the statistic may not have been calculated the same way in all societies. (In some, states report the number of computer users within the population – which might be less than half the population – who are reported to be “addicted” to the internet, while others report the percentage of the total population.) In addition, many analysts have critiqued the survey frequently administered for determining who is an internet addict on the grounds that it is too vague, does not control for competing explanations and may capture only an individual’s feelings at a specific point in time, rather than overall. (For example, one question asks “True or False: I would rather spend time on the computer than with my wife or family.” Critics have noted that responses might vary depending on the quality of one’s marriage or family life, or on events which may have transpired prior to taking the survey.) Asian researchers, have, however, persisted in seeing the problem as much more widespread among their societies, and are less likely to conclude that it was either an isolated phenomenon or one which occurred in distinct patterns. While the Western perception of the danger posed by internet addiction lessened, the perception of threat grew stronger in many Asian countries (see Figure 2.6).

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Country

Statistics

Source

Norway

2.42 percent of males 1.51 percent of females

Bakken, 2007

Korea

3.5 percent of population 18.4 percent ‘possible’ or ‘potential’ addicts

Techaddiction.ca

Taiwan

13.8 percent of population

Wu and Cheng, 2007

Greece

8.2 percent of population

Konstantinos et al, 2008

China

13 percent of population

Jifeng, 2008

Figure 2.6 Reported figures of internet addiction by country Here, one needs to pause to consider the following question: If the scientific community has concluded that only some subset of the population is in fact at risk of contracting the disease, and if that same community has furthermore concluded that the disease is not contagious, then is still correct to describe the situation as an “epidemic” as Chinese researchers as well as China’s popular press have tended to do? Here, the popular understanding of an epidemic is a situation of panic in which a disease is spreading rapidly and uncontrolled, in a situation of high contagion (Green et al. 2002). Clearly, in regards to the situation of internet addiction, it might be preferable to use the term “localized outbreak” – since the hazard is, in point of fact, only dangerous to some within the population. In addition, one needs to ask whether it is actually possible to have an epidemic of what some have described as a chronic disease (Van Grove 2009). Scientific definitions of epidemic usually focus on a disease whose transmission and path of infection are swift, brutal and deadly. The disease is said to eventually burn itself out because all of those who might pass the disease on quickly succumb themselves. In contrast, internet addiction is arguably not deadly, not easily transmittable and furthermore, is something which individuals may battle their whole lives – rather than a pathogen which quickly infects and kills them. – as indeed all addictions are described as. Research by Taiwanese researchers describes certain populations as more vulnerable to developing a chronic problem with internet use and thus as requiring tighter supervision of their internet use from an early age. Furthermore, the term epidemic conveys a meaning of an outbreak which is somehow beyond expectations or predictions for the spread of a particular disease. Here, Green et al define an epidemic as: the occurrence in a community or region of cases of an illness, specified health behavior or other health-related events clearly in excess of normal expectancy; the community or region, and the time period in which cases occur are specified precisely (2002, 3). In contrast, the Chinese usage of the term – both by members of the research community and the general population, is not actually accurate, given the facts of the situation. In the following chapters, I consider why exactly the trope of the “epidemic” might have been so well-received in China and so widely used by

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the Chinese government. However, here it is sufficient to note that while Chinese citizens, researchers and public officials became more concerned about internet addiction over time with the evolution of the issue into a full scale public health crisis, the discourse of internet addiction evolved in an opposite fashion in the United States and Western Europe. Here, it might be said to have “blown over” as researchers and citizens placed internet addiction within a larger risk context where they asked questions about how one should and could “manage” one’s addiction to technology in a safe and healthy way, achieving “cyberwellness.” That is, there were two possible policy responses to the notion that some individuals were more at risk of developing internet addiction than others. The first was for the state to implement a broad policy aimed at increasing the sense of agency which users felt in relation to their internet activities, while the second was for the state to erect a system of barriers and monitoring devices, in order to survey those deemed as being most at risk either in the present or in the future. Here, it appears that for many Western states – including the US, Canada and Europe – the conversation about internet addiction has come to be centered within a larger conversation about technological literacy. This discourse focuses on ways in which the skills of the user can be improved in order to bring him or her to a position where he can enjoy greater agency in relation to the medium. That is, the emphasis is on empowering users so that they exploit the technology – and it does not exploit them (Hargittai 2004, 10). In the American context, specialists have concluded that empowering citizens involves giving all would-be users (including senior citizens and marginalized social groups) more access to the internet, not less. American policy thus focused on increasing the numbers of computers available to would-be users, including the provision of computers in public venues like libraries, inner city schools and senior citizen centers. Thus, while Chinese authorities worked to limit user’s access to the medium, it appears that American policy-makers in particular did exactly the opposite! Cyberwellness policy rests on the provision of training and regimes which would teach individuals to use the internet wisely and responsibly, and to be responsible for monitoring their own use and overuse of the medium. Users are encouraged to think of themselves as “netizens” or “internet citizens” and to both take ownership for and behave responsibly in their cyber environment. Thus, in Singapore, schools have included topics on internet gaming and cyberbullying in the school’s Civics and Moral Education module. The state has also provided funds for the establishment of “cyberwellness” centers for youth (Siew and Lee 2007). Along the same lines, many states have funded the establishment of internet addiction hotlines or employee wellness centers where users might voluntarily seek training. Here, Western European nations frequently called upon individuals, families and schools to police themselves in regard to deviant internet usage, while states like Russia and Kazakhstan argued for more broad-ranging measures, including the provision of curfews or the need to license computers. Here, the discourse of “wellness” seems to represent an acceptance of the inevitable introduction of the internet to modern life. Here, the implication is that

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people had better figure out how to have a healthy relationship with this technology, since it is not going to go away. It is part of society and it is here to stay. Here, one might also point to a solution proposed by Chinese analyst is to train “addicts” in the ways of e-business, so that rather than simply spending all their time with their internet hobby, they can become productive citizens who use the internet (through buying and selling items on online auctions). The implication here is that average users could be trained to use the internet correctly with the greatest benefit for society and the least harm to themselves. The second strategy would be one of actively monitoring an individual’s internet use by the state, in collusion with business interests (such as game sites and internet providers). Here, the strategy can be read as one of disempowerment, rather than empowerment. In essence, the state tells users: We know best how much internet access you can handle without it undermining your own roles and responsibilities in life, and thus our job is to come between you and the internet, in order to regulate your access. Policy responses include both steps to be taken ex post facto against those who have developed problems with their internet use, as well as steps which may be taken preemptively. Here, there is a broad international consensus that governments can and should take steps to protect children from dangers stemming from internet use. Thus, for example, there was agreement between heads of state, ministers and international organizations regarding the International Telecommunications Union’s actions in 2009 to implement the Child Online Protection Initiative (COP).3 There are clearly subclasses of materials which are considered universally harmful – such as child pornography – and here all players in cyberspace seem to agree that filtering out or otherwise controlling access to such materials is a state’s right as well as its duty. The first US Congressional Hearings regarding the internet were similarly concerned with regimes aimed at regulating children’s internet access – focusing both on the amounts of time children were spending online and the sorts of materials they were encountering when online. Similarly, in 2007, Australia’s Labor Government vowed to provide internet filtering for all Australian homes, schools and public computers. A 2007 initiative in China required all on-line game companies to install so-called anti-addiction time-limiting software. The software works by enacting certain penalties on gamers who are deemed to have been on the internet for an unhealthy amount of time. In some instances, penalties are imposed on the number of points the gamer can score, while in other instances, he is simply booted off the site. The legislation describes an unhealthy amount of time as more than three hours of on-line gaming, and an excessive amount of time as more than five hours. In 2007, Chinese authorities also enacted bans on the opening of additional cybercafés. China’s government thus includes an entire department tasked with monitoring and controlling the content of computer games (MATP 2007). In addition, the state has taken measures to establish curfews on-line as well as in dormitories and cybercafés in many Asian nations, including Korea, Taiwan, Singapore and India. These same nations have worked for the installation

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of software in schools designed to block children’s access to sites which offer features like gaming. In considering how differential access strategies are imposed, it becomes clear that the medical establishments of different states have worked to construct different regimes, based on differences in how they see the “typical” user. Thus, American reports have tended to describe the typical internet addict as a housewife or stay-at-home mom or someone who is unemployed (Byun et al. 2008). In contrast, Asian media and academic reports have focused largely on children and young students as the typical internet addict. As a result, the strategies put forward are very different. Thus, in the West, there has been no significant movement to describe social policies aimed at curbing internet addiction. In contrast, in China, the legislative tool box has included the passage of both zoning laws for internet cafes and the use of online curfews in schools. In addition, Western researchers have shown much less of a preoccupation with preempting internet addiction through profiling probable internet addict (Dowling and Quirk 2009, 22). It may be simply that they find the question less interesting, but it may also be that they do not have the same investment in the creation of public policies. Here, one set of Dutch researchers used the term “conceptual chaos” in 2009 to describe the state of research studies on internet addiction by American and European researchers (Meerkerk et al. 2009), arguing that there is no clear consensus regarding who is the typical internet addict, nor about what methods are best implemented to deal with such individuals. Furthermore, American researchers theorize less about the social costs of internet addiction, including the possibility that students might fail in school or drop out. In other words, American researchers might be aware of the fact that internet addiction jeopardizes students’ academic success in college but might not draw the same conclusions from their research. Rather, in the American viewpoint, a physician would seek to treat the internet addict’s immediate symptoms, but would assume that problems with schoolwork are best left to others, including individuals in the fields of student services or even the students themselves. Western researchers are also significantly less likely to describe internet addiction as a social problem, focusing instead only on behavioral aspects of the problem as they affect the individual. This may reflect a difference both in the politics of internet addiction as well as in medical ethics and cultural differences. In contrast, Ni et al., the Chinese researchers, acknowledge that one goal of their research paper is to “provide a preventive and intervention strategy for internet addiction at the beginning of university life” (2009, 329). And governmental bodies or institutions in Asia have devoted many resources to the creation of early screening programs for those likely to develop internet addiction (Yen et al. 2009; Lam et al. 2009). States thus exhibit a concern with identifying those likely to get addicted and preempting it. As stated in Ni et al.: “internet addiction intervention among university students should be taken as early as possible. Therefore, investigation of Internet addiction and associated influential factors in freshmen students should be more helpful for the implementation of

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corresponding measures at the beginning of their university life” (2009, 329). Here, the emphasis is on preemptively identifying those who are likely to become problem internet users. At first glance, the first approach – that of empowerment – sounds as though it is less coercive and that it affords a higher degree of freedom to the individual user. However, increasingly, critical theorists have begun to interrogate the “health citizenship” model (Petersen et al. 2010; Bell 2011). Here, they argue that in imposing a requirement upon citizens that they should monitor and police their own health (by for example wearing a bicycle helmet, getting a health checkup or abstaining from junk food), the state has merely moved the site of policing from the state to the individual or to the larger society which can exercise peer pressure through stigmatizing the citizen judged to be “irresponsible” or “undisciplined” (Thompson 2011). However, policing is still a major required activity in society and it still occurs. Thus, rather than coercing individuals to behave a certain way, the state covertly implements a requirement that citizens coerce themselves. But the requirements regarding what constitutes responsible and irresponsible citizenship, as well as the ways in which policing and discipline should take place are still dictated by the state, rather than the citizens themselves. (This point will be examined more closely in the following chapter, which examines internet addiction policies from a critical theory stance.) The second approach – that of overt monitoring and enforcement – is clearly easier to condemn from an international human rights standpoint. It is easy to make an argument that sentient, competent adults should not be subject to curfews being placed on their online activities, nor should they be “shut out” of video games when the game site, in collusion with the state, has concluded that they have been playing for too long. Yet one can argue that both approaches have the same state-sanctioned aimed: to spell out a list of practices which the so-called “good user” is expected to abide by, and to create some sort of enforcement mechanism to sanction those who do not act like “good users” in society. The meaning of both practices is explored more in the next chapter of this work. The final topic to explore in applying Szasz’s critique to the politics of internet addiction is the ways in which the individual internet addict either profits or loses through his diagnosis and his practices of internet addiction. Listening to and Empowering the Patient: Antipsychiatry as Libertarian Critique Szasz’s writing has often been described as libertarian, since it rests on the assumption that the human mind or the human psyche is not a proper or necessary object of regulation by the state. In short, he believes that individuals should be allowed to think or believe anything they like – particularly if they are not harming others. Here, he raises the question: What does it matter if someone believes that they can talk to dead people, that they have been abducted by aliens or even that

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they are Jesus Christ, as long as they are not a threat to others or themselves? The anti-psychiatry stance thus suggests that there is no real risk associated with use of the internet – whether the internet user is a child, an adult or someone who is in some way impaired. There is only the risk of being labeled as diseased by a state which works in concert with the medical community. The anti-psychiatry stance thus implies that there is no actual danger of developing a harmful internet use pattern, and assumes that any threat that one feels as the result of the introduction of internet technology into a society is not real or valid. Thus, Szasz, as a libertarian and a critic of state involvement in the field of psychiatry, would likely conclude that internet addiction is not an illness but a lifestyle choice and one that individuals should have the right to choose. His writing thus supports the position that it should be up to the individual user to define for himself what he regards as a healthy relationship with the substance, as well as to decide what, if any precautions he wishes to take against developing an unhealthy relationship with the substance (just as he could make a decision about whether or not he wanted to wear a seatbelt, buy life insurance or vaccinate his children.) Szasz’s position thus is one of opposition to all types of regulations being placed on internet use – from the punitive centers for treatment which exist in China to the more benign camps which exist in Germany, where children are encouraged to play in the fresh air and to realize that they are more than the sum of their internet use patterns. He would be more likely to draw a parallel, then, from the practices of Nazi doctors (Proctor) to the practices of Soviet psychiatrists who “invented” diseases like sluggish schizophrenia in order to punish and incarcerate those who disagreed with the regime (Reddaway) to the practices of the contemporary Chinese psychologist Tao Ran, who works closely with the Chinese state to describe, treat and legislate policies dealing with young internet addicts today. It should be noted here that this particular libertarian critique – that the state does not have the right to regulate or control the human body – exists outside of psychological writing, in the other fields of medicine as well. For example, in the early twentieth century, American antivacccine activists argued that the question of how much risk was acceptable and how much risk an individual should expose his physical body (or the bodies of his children) to was essentially an individual query which Americans in particular should have the freedom to answer as they saw fit. Deciding whether or not to be vaccinated was thus a narrative about bodily integrity and the “right to choose” as it were. Anti-vaccionationists resented and opposed the use of government force (which they referred to as medical policing) to impose a regime of preventive care upon US citizens absent an actual present threat at that time (and in some cases, even in the face of that threat) (Willrich 2011). The argument that an individual should enjoy the right to use the internet in any way he chooses, as long as he is not harming another, thus falls into the libertarian critique about both mental and bodily integrity (as well as the critical theory stance about the ways in which the state constructs “the body,” as we shall see in the

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next chapter). Here, an individual making an argument from a libertarian antipsychiatry stance would thus argue that the state had “invented” internet addiction as a way of enhancing the scope of its power – into newfound regulatory powers over the internet and over those who would seek to use it. As Szasz states the argument: In sum, I have tried to show that therapeutic interventions have two faces: one is to heal the sick, the other is to control the wicked. Since sickness is often considered a form of wickedness and wickedness is a form of sickness, contemporary medical practices – in all countries regardless of their political makeup – often consist of complicated combinations of treatment and social control. (1974, 69)

Echoes of Szasz’s work can be found in the political writings of the Soviet analyst Peter Reddaway and Sydney Bloch (1977). Writing in the late 1970’s, they launched a far-reaching critique of Soviet psychiatry, which they described as being a perversion of western academic psychiatry, since the Soviet psychiatrist served not the patient, but the state. Their work falls within the anti-psychiatry framework, in that they propose that the disease and syndromes created by Soviet psychiatrists were invented and not real. Instead, they describe a situation in which psychiatrists worked in cooperation with the state to invent panoply of diseases (and cures) – including the diagnosis of “sluggish schizophrenia” which was applied to many of Russia’s most well-known political dissidents. These diagnoses were then being applied to society’s most uncooperative members. Theirs is a more nuanced critique than Szasz’s in the sense that they do not say that no psychological syndrome or disease is real. Instead, they merely raise the possibility that some psychological syndromes and diseases are invented by psychiatrists working with the state, for the purposes of upholding social order and social norms. They also subscribe to the anti-psychiatry model in the sense that they view Soviet psychiatric treatment as fundamentally punitive rather than curative. In this framework, patients are described as coerced and the psychiatrist is described as not fundamentally concerned with helping the patient – who in any case doesn’t need help since he isn’t actually sick – but is rather interested in securing his complicity with the goals and norms of the state. Here, it is important to note that the Chinese psychiatric establishment in general (not just those concerned with the diagnosis and treatment of internet addiction) has been accused of practicing political psychiatry in the past few years. Western journalists reporting in sources such as the New York Times (“assertive Chinese face the risk of being locked up as insane”) and Psychology Today (Lane 2010) have noted that citizens who attempt to use new liberalized legislation regarding their legal rights to, for example, a court hearing have been diagnosed as mentally ill and involuntarily treated with a variety of medical interventions including electroshock treatment. Here, the journalist Christopher Lane quotes Sun Dongdong, chief of forensic psychiatry at Peking University, who notes

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that “I have no doubt that at least 99 percent of China’s pigheaded, persistent “professional petitioners” are mentally ill” (Lane 2). Such a history of practicing political psychiatry thus provides a context and a justification for applying Szasz’s framework to understanding how internet use practices can become politicized in China. The model explains how Chinese authorities have conflated the normative agenda of teaching people to use the internet “properly” with the medical agenda of diagnosing and curing those who do not do so. Indeed, China’s leading internet addiction researcher and clinician, Dr. Tao Ran, has noted that he expects society (and presumably the medical establishment) to devote its efforts towards guiding children in the proper use of the internet, noting that “we should teach our children that computers are tools … Not toys.” That is, Ran appears to be advocating a position in which all recreational use of the internet should be banned (Sheridan 2009). Thus, one sees that Szasz’s work is clearly political – since it is fundamentally anti-state. Szasz’s argument rests on a fundamental distrust of the ability of the state to serve citizen interests, and fundamental opposition to any increase in state scope or power. Szasz, in his work, does not indict merely the medical practitioner, whom he views as autocratic, but rather the whole medical establishment. He thus uses the term “monopoly” to explain the ways in which the free market for health care has been perverted by the actions of the practitioner-state alliance which enforces an orthodoxy through creating only one paradigm through which to view and practice mental health. The analyst Ivan Illich makes a related argument, noting that medical science enjoys a monopoly, and that the medical system colludes with the state to “appropriate” individuals’ personal characteristics in service to the state (2002, 42). In Szasz’s view, any time a medical authority states that he is acting to preserve the mental health of an individual, he is automatically acting as an agent of the state – and he has invented the notion of “poor mental health” as a ruse for the imposition of state power.4 That is, Szasz does not argue merely that medical personnel act as agents of the state in the creation of health practices (Greenberg 1977). He also argues that medical personnel may act as agents of the state in the creation of health knowledge. In simplest terms, medical personnel can be said to “invent” diseases which are not real – in order to control and punish those who present a threat to state power or to state values. Here, one can argue that psychiatry and the practice of normal academic medicine becomes a way of creating authority which then resides in the psychiatrist, who has the power to label, treat and cure the afflicted individual. Arguably, Chinese authorities have borrowed the authority and the authoritative stance of the psychiatrist to make pronouncements on the politics of the internet, to pronounce about its harm to society and the normal stance towards technology which should be embraced in society. The state thus has a vested interest in buying into the existence of this disease, because it opens a door for the state to begin to regulate unproductive practices on the internet, and the practices of unproductive citizens in cyberspace. Here, one can draw a parallel between the two sides in the “internet addiction” debate. As

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Borsook notes, American technological culture is libertarian, with an emphasis on individual autonomy, and an individual’s right to define himself in cyberspace and his right to decide whether or not his use of the internet is healthy or unhealthy – hacker culture. The largely libertarian activists associated with groups like Wired Magazine in silicon valley believe that the internet, like the human body, is not a proper object of state regulation. Similarly, civil libertarians in the internet sphere today question whether the state has the right to regulate the internet and whether the state has the right to regulate individual behaviors on the internet – particularly when the justification to do so is a type of medical policing. Instead, these “hacktivists” believe that “information wants to be free,” that government should not be heavily involved in regulating the internet – or in regulating those who use the internet. Thus, they argue that government does not have the right to determine what dysfunctional behavior by internet users is. This is the stance found in writing by experts in Silicon Valley in the US, including those writing in Wired Magazine, as well as leaders of organizations like the Electronic Frontier Foundation. The Libertarian stance thus rests on the assumption that psychiatry serves the state because it gives the state an excuse for interfering in spheres where it has no business interfering – including in the area of what people do in cyberspace. Here, for example, one can consider Paul Barstow’s Declaration of Independence in Cyberspace (Barstow 1996) in which he proclaims: “Governments of the Industrial World, you weary giants of flesh and steel, I come from Cyberspace, the new home of Mind. On behalf of the future, I ask you of the past to leave us alone. You are not welcome among us. You have no sovereignty where we gather.” One might also consider the so-called Hacker Code of Ethics, popularized by Steven Levy (1984) which includes the “commandments” that: 1. All information should be free. 2. Access to computers – and anything which might teach you something about the way the world words – should be unlimited and total. Always yield to the Hands-on imperative! 3. You can create art and beauty on the computer, and 4. Computers can change your life for the better. Discussions of the emerging norms of “digital citizenship,” or “digital citizen rights” in addition focus largely on the rights of citizens to access material, as well as the responsibility of the state to provide access to material.5 For example, the European Union’s unit on Information Society and the Media finds support for the notion of a human “digital right” in a number of documents including the Universal Declaration of Human Rights, the European Convention on Human Rights, the International Covenant on Economic, Social and Cultural Rights and the Charter of Fundamental Rights of the European Union. (European Commission 2007 80) Utilizing these documents, European Union officials find support for the notion that “internet citizenship” includes rights to user privacy, access to

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information, and a new concept referred to as the right of access to knowledge. In addition, citizens who participate in the internet are said to be invoking their right to assemble and their right to freedom of expression (European Commission 2007, 85). Here, the implication is that “digital citizenship” is a universal human right and that the norms governing how citizens should access the internet are universal – regardless of which nation they inhabit or hold citizenship in. In recent years, European Union representatives have begun referring to a “global information society’ which is seen to include every nation, and where there appear to be no provisions made for a state which might choose to opt out of the “global information society’. Here, they make reference as well to the “global ethics of the information society,” in essence making a claim that such ethics are universal – rather than being based on the cultural norms, belief systems or history of a particular state or region (European Commission 2007, 82-83). “Rights talk” focuses on paradigms of e-governance and the ways in which the internet can improve citizens’ lives through increasing government responsiveness and citizen participation. It rests on the drawing of a theoretical line from the establishment of human rights with the formation of the state system following the Treaty of Westphalia to the present day formation of cyberspace, with the implication that just as the establishment of the state system conferred certain rights on citizens, the establishment of cyberspace likewise conferred “digital Rights” on “cybercitizens.”6 If there are rights in relation to content carried on the internet, the overwhelming emphasis is on the rights of users to resist any type of censorship or restrictions on content – rather than the right to restrict content. Thus, the American Library Association Bill of Rights notes that “libraries and librarians should not deny or limit access to information available via electronic resources because of allegedly controversial content or because of the librarian’s personal beliefs or fear of confrontation” (Shade 1996). In the “rights talk” paradigm, the internet itself is constructed as containing a particular ideology. Here, the assumption is that the internet is best understood as territory, rather than technology. Thus, the emphasis has been on how territory should be “governed,” rather than on how technology should be assessed and regulated. The problem, however, is that (in my opinion), territory is a metaphor to be used in understanding the internet, rather than a legal concept which should be used in regulating the internet. Legal claims to the effect that “cyberspace is international space, subject only to international, rather than national regulation” as well the notion that “there is no such thing as national sovereignty in cyberspace” all come out of this understanding of cyberspace as territory, rather than technology.7 In this metaphor, the internet is understood as being similar to Antarctica, outer space and the high seas, rather than similar to an automobile, a telephone or an airplane. In this paradigm, internet access is constructed as a free good which “involves and empowers” citizens (European Commission 2007, 84). The EU document in particular notes that other analysts have put forth even more wide-ranging bills of “internet rights” which might include the right of

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citizens to engage in governance, through participating in referendums and public opinion polls which a state might make available through electronic media. Here, citizens incur these rights naturally as a result of their international “citizenship in cyberspace” rather than as the result of any type of social contract between national citizens and their national government. Within the rights talk paradigm, the implication is that any state, institution or individual who attempts to limit or restrict internet access is a so-called “internet enemy.” In its most extreme statement, the implication is that there would never be any legitimate reason for restricting either internet access or content (Wikileaks). (Furthermore, a nation which attempted to do so would be seen as having no legal grounds for doing so – since it exercised no particular sovereignty over its citizens when they were in cyberspace – which is regarded as international.) Here, as elsewhere, connectivity is presented as a goal which is universally desirable by all nations. Atwood goes on to note that while countries may make different decisions about how and when this technology will come to their nations, “they are all seeking to strengthen their citizens’ national and international sense of community by delivering next generation Internet connectivity to all.” Here again, the implication is that internet citizenship, as well as the role which the state will play in establishing and mediating internet citizenship, looks the same in all states. Internet citizenship, apparently, only comes in one flavor. Within the rights talk paradigm, Szasz’s model – as it relates to internet addiction – resonates strongly within the tech community of Silicon Valley. It provides the frame, for example, for Wired Magazine’s coverage of the internet addiction story in China. Wired Magazine’s editorial staff and contributing editors do not recognize the existence of internet addiction and frequently use the words “myth” and “invention” in their reporting on the story. Often, the phrase “so-called internet addiction” figures prominently in the text. Statistics from the Chinese government on the prevalence of internet addiction are reported as “claims” (Stewart 2010). The existence of an epidemic of internet addiction is similarly refuted. In this same article, Stewart explains that the authoritarian government of China is opposed to the internet because it is a “nonstop disruption machine – overturning every business model, cultural institution and societal norm it touches … its destabilizing impact on Chinese society has been immense.” In this article, China’s establishment of internet addiction treatment facilities – or camps – is recounted in the same breath as statistics on the imprisonment of cybercriminals. Here, the implication is that China’s “treatment” is punitive, oriented not towards curing addicts (who don’t need to be cured anyway, since according to Wired Magazine they have been diagnosed with a nonexistent disease) but towards teaching them a lesson and altering their orientation towards the liberating potential of internet technology, which is described as “an uncontrollable force.” Stewart suggests that China’s authorities are disciplining their youth since they cannot control the internet itself. Controlling the students who would access the internet thus becomes a halfway measure towards imposing social control.

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The Wired Magazine article clearly does not accept the claim that the internet is so beguiling that individuals are powerless against it, incapable of exercising the agency which would enable them to turn off the computer, log off of the video game or close the window to the chat room. Instead, it suggests that somehow addicts are deriving some utility from their internet addiction. Thus, it is logical to ask what that utility might be. The Utility of Internet Addiction: Listening to the Addict Earlier in this work, I suggested that Szasz’s model critiques the medical-state “monopoly” on curing disease, as well as the normative stance that dictates that both the state and the medical establishment should be primarily interested in “fixing” the patient, with the goal of restoring him to productive social function within the existing society as it is in the present. Szasz instead raises the provocative question: What if the patient is not, in actuality, “broken” or in need of fixing? Here Szasz claims that the practices currently invoked in diagnosing mental illness rest on a fundamental denial of the patient/subject’s claim to rationality. This means that the medical subject therefore cannot justify his actions (such as using tobacco or using the computer too much) as stemming from any type of logical reason. However, Szasz asks us to consider the following possibility: Perhaps the patient does not accept his diagnosis, not because he is deluded, but because he is right. In Szasz’s work, he argues that the insane person is in essence someone who refuses to play the game, or to follow the unwritten set of rules which are set by the state, in complicity with the medical establishment, about how one is meant to live in society. As Porter describes Szasz’s work, “Properly speaking, contends Szasz, insanity is not a disease with origins to be excavated, but a behavior with meanings to be decoded. Social existence is a rule-governed game-playing ritual in which the mad person bends the rules and exploits the loopholes” (2003, 2). That is, Szasz asks the reader to consider a situation in which, for example, developing alcoholism may actually be a rational reaction to life on a Native American reservation with its limited job opportunities, low likelihood of social and academic advancement and loss of meaning. As he makes the argument, he states that “Mental illnesses do not exist. Only problems in living (quoted in Illich 2000, 221). Similarly, Sylvia Tesh suggests that in some instances, social structures can be implicated in causing disease (1988, 77). She notes that people may develop eating disorders as the result of a society which does not value differences in body types, or individuals may develop obesity as the result of living in an unhealthy environment where there are few outdoor spaces for recreation. And clearly the problem with alcoholism in the former Soviet Union may have had a basis in the stultifying political and social institutions of a repressive regime, the grinding poverty, and the need for an escape – even if only temporarily, through alcohol. Indeed, Campbell et al. (2006) have has noted that many individuals who develop an “internet habit” are actually lonely, and that the actual stimulus behind

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the development of an addiction is an environment in which there are few avenues open for the development of genuine friendships – particularly for individuals who are elderly, trapped at home with small children or differently abled. And German social scientists have suggested that children may develop internet habits because they do not know how to have fun playing outside or because they are alienated from their physical bodies (Deutsche Welle, 2003). Thus, German internet treatment programs are unique specifically because they address this problem, which they see as the root cause of technology addiction. Similarly, the American sociologist Talcott Parsons raised questions beginning in the 1960’s regarding what he referred to as the “sick role” (Lupton 2003, 8). Here he argued that the act of describing oneself as unwell can be seen as a sort of social protest, since one who is unwell cannot be expected to fully participate in society or undertake one’s social roles in society. Instead, the sick individual is given a sort of reprieve from participating in the pressures of daily life – including being economic productive – for a period of time. Parsons describes this as an unwritten contract, in which Western social welfare systems tacitly agree to provide care to the individual, so that he can concentrate on his “job” which is restoring his health and his true role as a productive member of society. (Writing on the sick role does not assume that the individuals are not in point of fact, ill. Whether one has a cold or is recovering from a heart attack, one may genuinely need to opt out of social activities or work, and to stay home and recuperate. Rather, as Parsons indicated, the embracing of the “sick role” represents a sort of contract between society and the ill person – in which the person agrees to participate in certain public health measures (such as staying home while infectious) and in return is granted a reprieve from some of the demands of daily life. Thus, our final exercise in this essay is to consider the possibility of what it might mean to listen to the internet addict and what he might say. Is it possible that today’s Chinese internet addict, in particular, actually derives some utility from his practices of denying reality, preferring the virtual world to the real world, and disappearing into his online environment for hours at a time – even if it means neglecting his real-world commitments and alienating those in his family and his society? Perhaps developing internet addiction is actually a rational reaction to life under Communist repression. This stance allows us to consider the possibility that the medical subject has actually performed a cost-benefit analysis and concluding that he does not so much run the risk of contracting the disease of internet addiction as much as he willingly undertakes the risk of developing an unhealthy relations or dependence on technology – because he decides rationally that the possible/probable payoffs – developing an exit strategy or a series of meaningful relationships elsewhere – outweighs the risk. Thus, it is possible to make an argument that taking on the role of the internet addict may be a quasi-legitimate form of social protest. The addict temporarily embraces the “sick role” and is given a reprieve from participating in a newly competitive China, where the emphasis for the wage-earner is on competing at work, while the emphasis for the student is on competing at school. The addict is

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thus described as economically unproductive in his present sick role, but the state and the instruments of curing are applied so that he can be restored to his more productive state. The declaring of oneself to be ill can thus serve as a sort of safety valve within a society – as it allows for a means of nonpolitical social protest. It is in this regard that China’s “epidemic” of internet addiction becomes particularly compelling. As noted earlier in this work, it appears that adopting the “sick role” of the internet addict is thus a way for individuals who are unable or unwilling to cope with the pressures and demands of contemporary Chinese society to “opt out” of the system. In this regard, Turner (1995) speaks of a “deviant sort of sick role” in which the sufferer adopts the sick role as his permanent identity. Here, he describes Merton’s theory, put forth in the 1950’s, that American society perhaps overemphasized achievement and worldly success. Merton argued that for the individuals who were perhaps incapable of achieving that success, there might be those who simply chose not to compete at all. Thus, the inability to be productive led them to define themselves as sick. Cole and LeJeune suggest that it may in some instances be less embarrassing for an individual to develop an illness, than to admit that he has either failed in his assigned professional role, or that psychologically he is unable to cope with the stress which his role places upon him. They argue that in many instances, individuals prefer to blame their inability to work or be productive citizens on their poor health. Thus, they describe how “people who come to view themselves as unable to fulfill their normal social roles will come to define themselves as sick to legitimatize their self-defined failure” (1972, 352). Here, Merton suggested that retreatism or escapism might become a permanent orientation to the social structure, where the deviant rejected both the ends of the society and the means for achieving those ends. (This philosophy was perhaps best expressed by the flower children and hippies of the 1960’s in the US who embraced the slogan, “Tune in, drop out.) Here it is my contention that for citizens in all societies, entering cyberspace may represent an alternate form of “exit,” as described in Hirschman’s groundbreaking work, Exit, Voice and Loyalty. That is, those who decide to embrace virtual reality over actual reality because it is more exciting or more in line with their values and orientation are engaging in the escapism which Merton describes. And, that “exit” may be particularly enticing for youth in highly achievement-oriented cultures with strict regimes for social behavior, as well as for those segments of China’s economic sector who have been able to adjust to a new capitalist “winner take all” society. One Chinese newspaper thus profiles a woman named Zhou Lan, stating that: “Zhou Lan became addicted to the internet after she was turned down time and time again for a factory job as a lathe operator” (Shanghai Daily, 2007). In a profile of the achievement-oriented children of China’s one-child families, the psychologist Taylor Clark (2008) gives the following statistics: Every year four million Chinese graduate with university degrees, but the economy is currently only producing 1.6 million white collar jobs. Thus, many graduates of Chinese universities may view themselves as failures when they do not obtain a

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job commensurate with their education. He notes that for such students, it is not surprising that they exhibit high rates of depression, an increased rate of suicide, or a penchant for “escaping” into video games. Internet addiction might thus be a way of saving face in a culture where one is unable to meet the unrealistically high achievement standard which has been set. Thus, as Cole writes: “in achievementoriented societies, one may use illness to justify failure to fulfill socially prescribed role obligations.” In his groundbreaking work, Hirschman (1970) originally described the ways in which employees behaved in a dysfunctional work environment. Some employees, he argues, simply attempt to exit the workplace, through searching for other jobs, engaging in absenteeism, or loafing on the job. Others actively seek to change the environment, through “voicing” their concerns, while others who are highly loyal to the organization, attempt to “wait it out,” hoping that new management or other events will lead to changes in the workplace. Exit has both a physical and psychological component with workers distancing themselves from the organization, its culture and its ideals – in some cases through merely thinking about leaving the organization (Naus 2007, 688). Hirschman’s work was applied in the field of comparative politics in the 1980’s to describe how citizens stood up to oppression in the former Soviet Union. Soviet citizens were said to exit literally by applying for exit visas, for example, to Israel. But they could also exit metaphorically by, for example, refusing to vote in one-party elections. We might also consider the politics of obtaining a so-called “section eight” mental illness discharge from service in the US military during the Vietnam War. Those who were opposed to the war and did not wish to be mobilized to serve sometimes attempted to have themselves declared mentally ill in order to not have to participate. Arguably, internet addiction represents a fundamentally new type of “exit” for citizens in both repressive and nonrepressive regimes. By logging onto the internet and claiming citizenship in an international community governed by new norms (often for many hours at a time), citizens are “opting out” in a new and powerful way. In Szasz’s words, they are refusing to play the game by the rules which society has set for them. Here one can make the argument that “exit” has always been a culturally accepted means of resisting power in China. In pre-communist China, women might have committed suicide to “exit” from unhappy arranged marriages, and opium addiction also provided a means of “exit” from imperial society. All of these types of “exit” implied a rejection of the norms and values of traditional Chinese society. In Chinese writing, an opium addict might be referred to as a “ghost” since his body resided in China while his mind and soul resided elsewhere. The “ghost” trope appears in contemporary writing about internet addiction as well. Even the director of contemporary China’s most well-known internet addiction treatment center has acknowledged that some Chinese citizens appear to be happier living “virtual lives” in cyberspace than they are living their “real lives” in China. The director of Beijing’s internet addiction treatment center Tao describes the use of drug therapy to treat internet addicts, noting that “we

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use these medicines to give them happiness, so they no longer need to go on the internet to be happy” (Golub and Lingley 2008, 63). And this opting out has governments worried. Those who spend the most time online in China and other developing countries are usually the country’s youth – those on whom the government depends for future developments in productivity and technology, as well as those on whom their parents depend for support in their old age. These are the citizens China can least afford to lose. And as Naus (2007, 691) indicates, those who are considering exiting a dysfunctional organization also appear to have significantly lower levels of psychological investment in the organization. Thus, the propensity to exit can also be read as a measure of discontent with the organization, as well as a measure of how legitimate the employee regards his relationship with his employer to be. Naus (2007, 694) also points out that the more rigid the organization and the higher the degree of role conflict which the employee feels the more likely he is to entertain the exit option. We see descriptions of this role conflict in interviews with internet enthusiasts and addicts who may state that they somehow feel more “real” or more “themselves” in the internet environment, where they are accepted for who they really are. That is, “exit” is a greater risk in some cultures than others. In China, in particular, one can make a national security argument (as I do in Chapter 4), which points out the risks for China’s military and social mobilization of population resources in situations where citizens escape into the internet and “exit” society, through refusing to be mobilized in traditional ways. This has implications for military service and citizenship. Part of China’s description of internet addiction as a “public health crisis” is based on perceived social problems which might arise if too many students decide to “exit” from their traditional roles and social expectations. The critical psychiatric field thus gives us two ways of thinking about addiction: Traditional thinking states that one becomes an addict because there is something beguiling about the object of one’s addiction (for example, the discourse of “demon rum”). Here, the object maintains the agency, and the individual is powerless. Our initial understandings of technology addiction fit this model. However, an alternate interpretation says one becomes an addict because of some lack or deficit in oneself, or some mismatch between one’s environment and one’s personality. (Here, we can consider the notion of self-medicating with alcohol, or “escaping” through technology). Here, the agency goes to the individual who is consciously choosing to use (or misuse) technology. Arguably, in both the US and the Chinese case, medical personnel moved from an embrace of the the first position to a position of support for the second. However, the Chinese are less likely to admit that they believe in the second interpretation. Instead, they have modified the internet addiction narrative to preserve the illusion that individuals are essentially powerless against the all-powerful technology. Thus, for example, we have seen a modification of the internet addiction narrative which blames not the net itself, but rather the place where it resides – the internet café. As I show in Chapter 3, the internet café as a site of pestilence trope

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describes the ways in which people can “contract” internet addiction by visiting this dangerous place. Thus, the internet café is seen as robbing people of agency. They thus become criminals or addicts against their will due to peer pressure and spending too much time in an unsuitable and dangerous environment. Conclusions Szasz’s critique of the medical/state nexus thus assists us in understanding the politics of internet addiction in a variety of ways. First, from an institutional standpoint it helps us to understand why there is a consensus among China’s psychiatric community regarding the existence of the phenomenon on internet addiction, the parameters of the problem and the preferred treatment options. As Loren Graham, a Soviet analyst notes, decision-making within the Soviet Union was similarly characterized by a great deal of consensus. As Graham notes, an officially sanction position was decided upon and promulgated (1987, 260). Here, Unschuld, an expert in Chinese medicine, notes that homogeneous societies are more likely to have shared conceptions of disease concepts. He argues that: “any group in society that on the basis of a specific sociopolitical ideology strives for political influence or even dominance, will sooner or later support or create a specific set of therapeutic concepts consistent with its social norms while contradicting the ideology of political opponents” (1985, 13). In addition, as Szasz guides us to see, there is a great deal of overlap between those who make health knowledge and those who make health policy. In China, we see that those who make internet addiction policies and those who investigate the phenomena are frequently the same individuals. This is contrary to what experts in the field of risk analysis recommend. As Rosenbaum (DATE 173) points out, scientific judgment may actually contain only “limited neutrality.” He notes that perhaps 50 opportunities exist in a normal risk assessment procedure for scientists to make discretionary judgments. This manipulation may occur on both sides – with both American and Chinese risk assessors assuming that they are being neutral in their analysis of internet addiction – though in reality neither one is. However, I would argue that to some degree, China’s newfound emphasis on covert political manipulation is actually a step forward – since it at least rests on an understanding that overt coercion is not acceptable to the international community. That is, straight out repression is no longer considered acceptable (such as locking someone up in jail for espousing anti-social ideas). However, “diagnosis” has come to take its place. Now at least the pretext of insanity is required in order to repress those in society who espouse unpopular ideas. This, however, is a step forward, since only insanity is considered an acceptable reason for denying people their “natural rights.” The decision to diagnose and treat someone for insanity is thus implicitly an acknowledgment that they are not merely socially disruptive and can thus be disposed of as the government wishes. Instead, the state is forced to adopt the pretext that they are insane and socially harmful.

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In addition, in his work, Szasz has noted the relationship between economic development and the development of the mental hospital. He argues that in Victorian England the US, the creation of private mental hospitals meant that those with sufficient finances could now pay others to take care of (or take away) their troublesome, disruptive and embarrassing relatives. (Previously, he argues that poor houses and the like could be used to take away the troublesome poor, but it was more difficult to repress those with means.) Thus, there is something quite entrepreneurial about China’s creation of private means for dealing with those who are anti-social and disruptive. Two of the major critiques which have been levied against Szasz’s work are, however, that it is insufficiently nuanced. Rather, it serves as a large-scale indictment of collusion between the medical establishment and the state – not distinguishing between various types of states (such as authoritarian and democratic), nor recognizing that there may be degrees of complicity between medical practitioners and the state. Furthermore, Szasz’s critique rests on an implicit assumption that medical knowledge is static, rather than dynamic. That is, Szasz’s critique is insufficient for an explanation of how the politics of internet addiction medicine may have changed over time. The critique of the addiction paradigm can also be addressed, however, by considering a stance which shares common ground with the anti-psychiatry stance, the critical psychiatry stance. Here, while the anti-psychiatry stance only recognizes a couple of characters in the narrative: the doctor, the patient and the state, it does not specifically address questions such as why certain groups might be more marginalized or more likely to be diagnosed than others – other than to look at criterion on functionality. In the following chapter, I will delve more closely into Foucault’s deviance model, which explains why those who do not fit criteria of “normalcy” are stigmatized and more likely to be treated and disciplined.

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Endnotes 1  For example, Dowling and Quirk describe how the modifications to Young’s internet addiction scale proposed by Beard and Wolf actually lead to a lower number of individuals being diagnosed with internet addiction. While the Young scale diagnoses 4 percent of Australians are being addicted to the internet, the Beard and Wolf revisions lower that number to 0.9 percent (2009, 22). 2  The trope of the internet as a spiritual threat is not, however, found only in the developing world. The notion that the internet is somehow evil can appear in various guises in American and Western European writing as well – though without the underlying notion that these nations were themselves pure and pristine prior to being subjected to internet spiritual pollution. Instead, the focus is on children in particular as innocent prior to encountering internet practices. The Australian magazine “The Age,” features an article entitled “Trouble in Cyberia” in which a policeman describes the ways in which children can be forever changed through “soul-destroying practices” on the internet, including having a former friend or boyfriend circulate naked or embarrassing images of them without their knowledge or consent. 3  More information on this program can be accessed at http://www.itu.int/wtisd/2009/ theme.html. 4  In Szasz’s world, regimes like Nazi Germany, where doctors and the state collaborated to practice and impose medicine on helpless children are a disgrace, but so are regimes like the one which exists in the US, where children may be prescribed Ritalin so that they will sit quietly in their seats and do their schoolwork so that they can one day become good citizens of the state. Those who criticize Szasz (Bracken, Thomas 1997, 222) frequently point to the binary nature of his distinctions, suggesting that he does not allow for shades of grey or even moderate types of state-medicine alliances. Furthermore, the model does not allow for the possibility that the relationship between medical practitioners and the state might look different in different states and seen through a different cultural lens. 5  The components of Digital Citizen Rights are detailed in European Commission, 2007. “Breaking Barriers to Egovernment: Case Study Report.” Brussels, Belgium: European Commission, particularly Section 5: Digital Citizenship. Report may be accessed at http://www.egovbarriers.org/downloads/deliverables/casestudy/-Case_Study.pdf. See also Mark Bovens. 2002. 6  This is implied in Bovens, though not stated outright. 7  This conceptual argument, that cyberspace is territory, is well laid out in Darrel Menthe 1998.

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Chapter 3

Critical Psychiatry and the Construction of Internet Addiction The critical psychiatry model or critical health care model diverges from the antipsychiatry model in two important ways: in the framework it uses to understand and explain the politics of diagnosis and the conceptual basis upon which it explains the politics of treatment. In both of these instances, the critical psychiatry model makes an argument regarding the ways in which disease and illness fit into a larger social construct which can vary from culture to culture; and in the ways in which power is seen as exercised within the medical profession. Each of these differences has implications in the development of a narrative which describes the growth and development of the problem of internet addiction. In contrast to Szasz, the French social theorist Michel Foucault argued in his work (written at roughly the same time period) that madness does indeed exist in the sense that people behave as though it does, as well as in the sense that some people are indeed ill and they do indeed suffer. However, while madness exists, one should also realize that it is nonetheless constructed in a certain way by people in power. The madness construct is thus, according to Foucault, a product of cultural norms and power politics. And “madness” often holds a truth – in the sense that those who appear to be mad may actually be revolutionaries or people who are simply ahead of their times, in the ways in which they think about lifestyles and practices. Foucault was in some ways less interested in limiting the practice of psychiatry than he was in making readers and observers aware of the ways in which it was not the “clean,” neutral, scientific endeavor that they may have thought it was. He thus regarded his work as that of “unearthing” the practices which underlay contemporary psychiatry beliefs today. Here, the anti-psychiatry model suggests that our understanding of addiction rests largely on the ways in which the medical establishment (in complicity with the state) causes us to see the substance to which individuals are addicted. That is, in that model, alcohol – or the internet – is “demonized.” In contrast, the critical psychiatry model focuses on the ways in which the medical establishment (along with the state) views the patient, and the way that the patient is encouraged to see himself. To paraphrase the writing of the critical psychiatric analyst Ivan Illich (2002), the main product produced by the medical industry is not health, but sick people. In contrast, Szasz would suggest that the main product produced by the medical industry is the disease itself. Illich argues that contemporary medical science tends to pacify individuals, robbing them of their sense of agency as autonomous (and healthy) individuals. Instead, they are taught to see themselves

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as largely powerless subjects of the medical establishment, and are often taught by that same medical establishment to view themselves as unwell or on the verge of becoming unwell. The critical psychiatric school rests on many ideas originally put forth by the French social theorist Michel Foucault, whose work deals with the ways in which citizens are disciplined by society and the state, in a system where power is exercised indirectly through language, institutions and unwritten rules or norms. In the field of critical psychiatry, the name for this complex of interactions is “biopolitics.” As Lysaught (2009 390) argues: Within a biopolitical regime, power will not most often be wielded in an overt, coercive manner. Ideally, individuals come to wield it over themselves. Within a regime of disciplinary power, each person – by internalizing the norms and surveillance of the social order – effectively disciplines herself or himself. … The basic goal of disciplinary power is to produce persons who are docile – persons, in other words, who do not have to be externally policed.

The critical psychiatry approach also suggests that disease risk is a construct – dependent on preexisting values, norms and cultural values which may exist within a community. That is, the critical approach is based on the notion that there are perhaps no absolute or objective means of understanding and applying labels like diseased, contagious, carrier or illness. Rather, because communities vary in their cultural practices and values, the meaning attached to being an internet addict, as well as the ways in which individual suffers and the larger community will react to the threat of internet addiction, are likely to vary as well. Here, politics is found in the uneven ways in which treatment may be imposed on people or denied to people, as well as the notion that individuals may be treated against their will. Politics is found both in the actions carried out by medical personnel and the policies which medical personnel may help in formulating. At base, the assumption of critical psychiatry is that medicine frequently violates bodily autonomy through causing individuals to comply with the wills of those in power. Individuals might comply by choosing to be vaccinated, by policing their diet and nutrition, or through agreeing to stay home from work when they are sick. To the individual, it may seem as though he is freely choosing to engage in these activities. However, the way in which the problem is presented to him and the information he is given tends to cause him to choose to control his own behavior in line with the goals of those in power. In this chapter, I make the argument that the discourse of internet addiction is actually a mechanism for inducing individuals to police themselves, to monitor themselves and to restrain themselves in regard to their own internet use. As Lysaught explains, the writing of Foucault helps to explain how power can be used to organize and “produce” or shape a population, inducing people to behave in particular ways (2009, 384). The discourse of internet addiction (and internet abuse) gives an important role to the notion of risk, in working to convince the

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population that the internet is dangerous and to be feared – and to induce them to feel that they themselves have arrived at this conclusion. In addition, the discourse of internet addict creates a new actor, “the internet addict,” as a subject of biomedical surveillance and discipline. Technology users are encouraged to see the internet addict as an Other, as someone quite unlike themselves, and thus to feel that any actions which the state takes against the internet addict are appropriate and necessary. Any critique which the internet addict might make about existing society, as well as his decision to exit, are thus rendered invalid. As Boorse notes, “to call a disease an illness is to view its owner as deserving special treatment and diminished moral accountability” (1974, 56). Technology users also come to understand that they are all inherently at risk of becoming this Other, the internet addict, if they are not careful in regard to their own internet usage. Thus, the discourse of internet addiction creates two new risks – the individual risk of developing an unhealthy relationship to technology and the social risk of acquiring an identity as an internet addict. (A third risk, that of the danger which the large number of internet addicts present to society as a threat to social productivity and social cohesion can also be identified and will be discussed in the next chapter.) Here, I argue that technology users are affected by the discourse of internet addiction, and that it causes them to begin to discipline themselves in their practices and attitudes towards technology. Here I focus in on the emerging language of cyberwellness, which encourages individuals to feel that they must act responsibly to monitor their own internet usage and that of their family members. Here, individuals often feel that they are acting autonomously and responsibly to control their internet use – even though the norms and values which underlie monitoring regimes have been developed not by the users themselves but by the state and the medical establishment. Thus, adults may come to feel that, for example, “Responsible parents monitor their children’s internet usage” without considering where that phrase came from or who it ultimately serves. As Lysaught writes, “these mechanisms of organization and production by larger social forces are nothing other than politics, and the organization and production of bodies for social ends is therefore biopolitics” (2009, 387). Thus, the critical psychiatric analysis of internet addiction discourse and practices would lead to the following propositions: Contemporary medical science teaches people that they cannot cope with their internet on their own. Rather, it makes them aware of and creates their own dependent stance – in relation to the medical profession and in relation to internet technology. Thus, the major problem with the construct called internet addiction is not that it demonizes technology. Rather the problem is that this model teaches people that they are not autonomous, capable computer users. Rather, they learn that they require training, monitoring and treatment of their computer use practices, lest they risk acquiring technology or internet addiction. Lysaught argues that a biopolitical regime requires three things to exist: discourses; practices and institutions. In this chapter, I show how since the

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identification of the construct called internet addiction in 1997, the medical establishment, the state and society have together created a discourse of internet addiction; a set of practices (such as training courses on how to be a good internet user or internet citizen, offered in schools and workplaces, concluding in a formal pledge to be signed by users in which they agree to abide by certain rules in using the internet); and a set of institutions (including centers for training, cyberwellness, incarceration and psychiatric evaluation). In this chapter, I begin by examining the politics of diagnosis through a critical psychiatric lens. Here, I briefly consider what it means to describe someone as ill, and the ways in which power politics play into the invention of illness. Writing in the Journal of Medicine and Philosophy, Jeffrey Bishop paraphrases Michel Foucault to describe the ways in which medicine “does violence to the subject” (2009, 346). In considering what it means to diagnose someone as ill, we are forced to ask “What is the project of medicine and in what ways is it the same as the project of the state? How do the two discourses and sets of institutions work together to discipline the subject?” Here, the critical psychiatric approach suggests that there is a “politics of medicine” which occurs throughout the patient-doctor encounter, as well as in the areas of the creation of medical knowledge. Using the language of Foucault, we can point to medicine as a practice of governmentality, where governmentality is defined as a series of acts carried out by “experts” whose knowledge and practices appear to be neutral and objective (1977, 1979), but which aim at establishing a consensus regarding how a population should behave within institutions and how individuals should related to institutions – and technologies. That is, through the practice of governmentality, the state exercises power over individual citizens and over the population at large in a variety of ways, some of which are not traditionally recognized immediately as “politics.” Thus, in Section 1 I ask: what does it mean to suffer from internet addiction, and how does the construct of internet addiction play into larger questions within society, such as “what does it mean to live a meaningful life?” Here, I argue that there is a politics which describes some activities as healthy, and some activities as unhealthy. I argue that the state can seek to normalize practices and thus exercise power over the ways in which citizens behave (Lupton 2007, 9-10; Turner 1995, 13). Writing in 2009, Charles Scott (351) noted that “power, instead of coming as it were from on high, is structured to reach into the very grain of individuals (to touch) their bodies, and (to insert) itself into their actions and attitudes, their discourses, learning processes and everyday lives.” He notes that “all manner of disciplines, from medical science to criminology, pedagogy, and theology were enlisted to mold the bodies and minds of citizens in the direction of normal, constructive good sense” (360). In the case of internet addiction, we can trace the language of the medical community to understand how it has worked to normalize internet practices – defining what is a normal or expected amount of internet use, and a normal or expected priority for the internet to play in an individual’s life. Here, we begin to understand how the internet addict is constructed as someone who is deviant

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(and possibly criminal) since his stance towards the internet and its role in his life deviates from the norms set by the medical establishment and the media and accepted by society. In particular, I examine the character of the hacker – an individual who clearly does not have a “normal” relationship with computer technology. This individual is considered a sort of folk hero in contemporary American discourse: His unusual dress, work hours, diet and social relations are part of the charm of this anarchic rebel who does not recognize or conform to many of the norms – or laws – regarding internet usage. In contrast, “hacker” is considered a term of derision in China, where hackers are considered part of the criminal element. Here, we become aware of the ways in which patients, their family members and larger society may often be complicit in the creation of a disease identity or disease label. The critical psychiatry approach thus allows us to explore the meaning which individual sufferers and the larger community attach to internet addiction, including how they regard, judge and treat the sufferers and the disease itself. Disease is thus about more than physical suffering. It is also a way of understanding what is empowered and disempowered within society, as well as how the state and society explain the causes and meaning of that suffering. This argument is particular compelling when applied to the problem of internet addiction, since many internet addicts are in fact self-diagnosed. The disease label is thus not something imposed upon them in a top-down manner, but rather one which they are encouraged to adopt. In Section 2, I examine the politics of treatment. Here, I consider how the medical professional (as part of the medical profession) regards the patient, and ultimately how the patient comes to regard himself. Here, I examine treatment as a form of disciplining which is carried out by the medical establishment. The argument here is that in teaching people how to be good or healthy internet users, they are also taught how to properly regard the internet and its place in their lives. Those who give the internet too prominent a role in their lives are described as deviant, with internet addiction a form of deviant behavior. One wonders whether the Chinese Bill Gates or Mark Zuckerberg might have been disciplined and treated as an internet addict rather than lauded for his accomplishments, since neither of these individuals has followed a strict linear career path which includes finishing one’s degree, joining an organization and starting at the bottom. Indeed, both engaged in what is arguably deviant behavior (staying up all night programming, taking monetary risks and skipping class) in pursuit of their projects. They both appear to display symptoms of internet addiction. Instead of encouraging users to become “lost” in the internet and to experiment with technology, users are taught – particularly in China – that the proper stance towards this new technology is one of fear. They should maintain their distance, monitor their interactions with the technology and seek not to be subsumed by it. In this way, the narrative of internet addiction ultimately serves to construct the narrative of the internet itself and its proper role in society.

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As Jeffrey Bishop notes in “Revising Foucault” (2009, 324), Foucault claims not to be making moral judgments about medicine. Nonetheless, his insights can help to think through ethical and normative issues associated with diagnosis and treatment of internet addiction in cross-cultural context. A Foucaultian lens thus allows us to ask questions about how society thinks about health and illness. It sheds light on questions like: What are the beliefs that we have about health and illness in relation to new technology and where do they come from? Why do we believe that this technology poses a special risk to certain users – and why do we seek to deny these individuals access to this new technology? What does this discourse tell us about old patterns in our society – regarding who is powerful, and who is weak, who needs to be protected and from what? Foucault’s analytical framework thus allows us to better understand in which the young and woman in particular are identified as the proper subjects of medical intervention. In this chapter, I focus less on the punitive actions of treatment and more on the practices of prevention medicine, including the ways in which individuals and groups are profiled and caused to think differently about the internet as a danger in their own lives. I begin my analysis by asking, “What does the internet represent?” That is, I seek to understand why the internet addict construct has developed in this way in this context. In answering this question, I also ask “What does the internet addiction construct tell us about our values?” Here, we consider several possibilities, including the ways in which internet addiction discourse is really a conversation about society’s fear of technology and the ways in which technology represents a threat to a culture of paternalism and family and the notion of balance. Politics of Diagnosis: Every Era has its Own Diseases In undertaking this analysis, it is first necessary to stop and ask the question “What kind of disease is internet addiction and what does it represent in society?” That is, a critical psychiatric approach suggests that disease cannot be understood except in relation to the social context in which it is discussed, discovered and developed. Thus, it assumes that every disease is more than simply the sum of the symptoms which are presented. Rather, using this approach, we are forced to ask: What is unusual or significant about this disease? Why has it been discovered at this time and in this place and what does the identification of this disease tell us about the society in which it resides. Herzlich and Pierret, in their work, Illness and Self in Society” (1987, 4-5) suggest that each era has a particular illness which in some ways represents the ethos of that era. They argue that the epidemics of Plague which swept through Europe in the late 1300’s were interpreted by patients, the medical establishment and the authorities of the time (and indeed in the present day) as a symbol of the vulnerability and fatalism which characterized life at that time period. To worry about contracting plague was thus to worry about being at risk from unseen

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forces which one could not control. In contrast, they argue that tuberculosis or consumption which was a major fear for citizens in England and America after the Industrial Revolution was a different sort of illness. Tuberculosis was a “wasting disease” which did not kill the victim at once, but rather allowed him to go on suffering publicly for long periods of time. Here we can consider the romantic figure of the tuberculosis sufferer – such as Beth in Louisa Alcott’s Little Women, who became purged, holy, pure and innocent. Leprosy, finally, was about isolation. Those diagnosed with the disease were the subject of elaborate church rituals in which they were announced as “dead to the world” (with the carrying out a funeral mass) prior to being cast out from their villages and families. As Herzlich and Pierret note: Every era has its own diseases. … at different times one specific disease was seen by everyone as the embodiment of illness itself, not only because of its frequent recurrence and the danger it represented, but also because it various ways it was the material sign of the conditions of life, of the concepts of human existence and of the values of the time. (1987, 3).

Margaret Healy calls our attention here to the fact that several prominent epidemiologists do not believe that the “plague” which plays such a major role in the history of Western Europe was actually one disease. Instead, epidemiologists argue that in some years the “dread disease” might have been pneumonia or flu (influenza) while in others it was pestilence or bubonic plague. She notes, however, a tendency towards the conflating of multiple threats together into a more generalizing illness which becomes the threat of an era (1993, 21). In a sense, what the disease is becomes less important than what the disease represents. Thus, it becomes clear that the meaning of illness is not constructed only by the sufferer. Rather, illness’ meaning is also configured by larger society as well. For example, leprosy derives much of its meaning from the ways in which society reacts to the leper – treating him as a subject of affliction, as a sinner, or as a pariah. Susan Sontag (2001) has written of the ways in which society constructed the meaning of Acquired Immune Deficiency Syndrome (AIDS) resurrecting old explanatory variables like “divine retribution” and using the illness as a sort of shorthand for our own social ambivalence towards the homosexual community and those who are marginalized in society. That is, the ill person may be managed and controlled by others, and others may attempt to speak for him, putting forth descriptions of his illness, or etiologies (or narratives regarding how the illness was created). In her work, Natasha Posner (2001) makes the assertion that illness is not only constructed within society but that in some cases, illness can almost be said to have been “invented” within and by society. That is, particularly in modern society, there are several well-documented cases of illnesses where there is not an academic consensus by practitioners or a popular consensus within society about whether an illness exists, how severe it might be, or how much of a threat it might pose to larger society. Communities experience divisions regarding how seriously

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food allergies should be taken at school, and experts debate whether so-called “autism clusters” do in fact exist within certain localities. Here, Posner (2000) argues that the narrative of an illness often draws upon larger issues or currents within a community and the story of the illness thus becomes a sort of canvas upon which the larger story is drawn. Here, she traces the rise of the narrative of the herpes sufferer within popular women’s magazines and on talk shows, arguing that this common virus which had always existed in the human population was dramatically recast in the mid-1980 as a dread disease. Here, it became the main character in a morality play which featured individuals who engaged in promiscuous behavior being struck with the disease. Similarly, Tesh notes that particularly in the twentieth century, Western medicine frequently implicated industrialization and the rise of the city in its narrative of disease, suggesting that modernity itself was somehow sickening people (Tesh, 55). Thus, we can stop and ask: What is the meaning of internet addiction and why does it play such a prominent role in Chinese society at the moment? What does internet addiction represent and why do we fear it? Here, it is my contention that internet addiction, like herpes, is a sort of modern-day whipping boy. The discourse of herpes was actually a metaphor, or an expression of people’s distaste or discomfort with changing social mores (as AIDS was). Similarly, the internet addiction narrative is a discourse which is as much “about” society’s fear of technology, and the ability of technology to control us (rather than vice-versa), than it is about the disease itself. Internet addiction thus becomes a metaphor for our ambivalence about technology and the sort of bargain which we as a society have made with technology – where we are simultaneously dependent upon technology in our everyday lives and resentful of the ability of technology to create this dependence. In this way, the narrative of internet addiction joins a long line of similar narratives which have existed ever since the Industrial Revolution. The story of internet addiction thus shares common ground with the classic nineteenthcentury novel Frankenstein by Mary Shelley which describes the ways in which a newly emerging technology called electricity was married with a human being to create a sort of cyborg or hybrid creature, who was half-human and halftechnology. One can also find common ground with the novel by E.M. Forster, written in 1905, called The Machine Stops. This novel presciently describes a sort of technology, composed of “tubes” which would transmit messages throughout the world, enabling people to communicate with each other while remaining isolated and alone in their rooms. (It even includes the character of a woman who appears to be a professor of online education – in 1905.) Here, Forster describes the sense of dislocation which the characters feel when the machine which has rendered them helpless and dependent stops and they are forced to exit into the real world and fend for themselves. As Shade notes, individuals and analysts have always raised moral issues when new electronic communications technologies have been introduced. Questions about how such technologies will affect society have accompanied the introduction of the telephone, the radio and the television. Analysts worry about

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whether personal relations will suffer, as well as the ways in which these new technologies may come to violate the sanctity of the home and to weaken the borders between public and private space (Shade 1996). The discourse of internet addiction thus fits within this larger conversation. The Metaphor of Kidnapping In various articles about internet addiction which have appeared in the popular press both in China and the US, it has been suggested that internet addiction is a bit like a kidnapper, coming to steal your children from you. It is also described as being like an invader, as the internet somehow takes over your child, stealing his soul perhaps, and replacing his personality and his values with something else. In at least one instance, the internet has been blamed (by the Beijing Review) for turning children into “zombies” (Wenlei, 43) who are dead as themselves, but somehow reanimated by the technology of the internet. Each of these narratives thus places the story of internet addiction within a larger narrative – which rests on cultural assumptions about the place of technology in society, understandings about where technology comes from and what it represents, and existing cultural narratives about the proper and improper uses of technology. And these beliefs or stories provide the foundation in which understandings of emergent risks will become embedded. Here, for example, one might wish to consider the numerous urban legends and folkloric tales which have arisen in China beginning in the early 1990’s which feature tales of Chinese children being abducted by foreign businesspeople. In some instances these narratives describe children being “carried away” by Western families which adopt them, while in other narratives the children (who are usually rural and poor) are described as being somehow killed and dismembered, and then fed directly into the engines of Western production (Campion-Vincent and Scheper-Hughes 2001). In these narratives, China’s citizens are viewed as providing the raw materials or inputs for Western wealth production – whether the story is of children whose organs are taken to provide transplants for elderly, ill, wealthy foreigners, or of children whose eyes are plucked out to provide inputs for Western photography processes. In each instance, these narratives suggest an overwhelmingly lack of trust in Western rhetoric of industrial progress, as well as an implicit understanding that others will profit from the drive towards industrialization while China’s citizens will pay the price. These cultural understandings thus provide the “soil” in which the internet addiction narrative has grown. The Metaphor of Invasion Along with the abduction or kidnapping metaphor, one can identify an invasion metaphor. Here, the invasion metaphor again suggests a lack of agency, almost as though the individual internet addict comes to be “inhabited” by something else.

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That is, the individual provides a sort of host for the internet. He has become a cyborg. In a related metaphor, internet addiction is described as a sort of moral contagion and contamination from outside – if internet is perceived as a Western technology. Thus, arguably, internet addiction is really “about” a fear of Westernization, or a fear of loss of control by indigenous sources of power. It is thus in some ways a narrative of nationalism. Here, Weinstein speaks of “plague logic” – which he defines as “the suspicion that particular groups are secretly boring their way into our society, jeopardizing our security, posed to strike us in our collective security organs” (2003, 103). Internet addiction can likewise be described as a sort of infection to which particular groups are vulnerable – and it must be defended against by establishing boundaries and barriers. They must be inoculated against it. In both Russia and China in particular, the narrative of internet addiction (and the epidemic of internet addiction) implicitly contains the idea that internet technology is a foreign threat which comes from abroad to threaten the pristine and innocent land and people, rendering them impure as they are filled with Western ideas. Here, the internet itself is seen as both a symbol and a carrier of Western values, threatening to poison the state and its people. (It is often seen as a tool of transnational organized crime in much the same way.) Again, the idea that a disease is foreign in origin and thus is best avoided through sealing off national borders is hardly new. Rather, one can trace such rhetoric back to the public discussion which took place during the French Pox or syphilis epidemic in England from 1530 to 1630. Like today’s internet addiction discourse, the narrative of syphilis in the Middle Ages incorporated the notion that the victim was guilty of having contracted the condition by virtue of his own actions, that he was both irresponsible and morally culpable and that the disease came from abroad, from a place where people were less moral and disciplined than the people who were currently being targeted by the disease. Those who contracted the disease were locked up and shielded from public view in an effort to protect others from contracting the disease. Disease victims were seen as having the power to contaminate others both physically and morally or spiritually (Qualtiere and Slights 2003, 5). Here, Patrice Flichy describes the ways in which the internet was viewed by early American theorists: The internet Imaginaire, like the technology accompanying it, was born in the particular context of the United States but subsequently became universal … Wherever one is in the world, logging on the internet is, in a sense, plugging into modernity and the country that best symbolizes it. (2007, 211)

In the foundational document, “A history of the Internet,” Vincent Cerf, one of its architects tells us:

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The Internet has revolutionized the computer and communications world like nothing before. The invention of the telegraph, telephone, radio, and computer set the stage for this unprecedented integration of capabilities. The Internet is at once a world-wide broadcasting capability, a mechanism for information dissemination, and a medium for collaboration and interaction between individuals and their computers without regard for geographic location. (1993, 1)

In this document, the stance is clear – the internet is not merely a technological object, but one which possesses an ideology. In Cerf’s description, the internet contains a progressive ideology in which man will exercise dominion over nature through the “miracle” of technology, as well as the communitarian ideology in which man will overcome national and cultural differences and draw together around the electronic hearth as one body. For the concepts here are all intertwined – internet, freedom, democracy, control and personal autonomy. In their work on ethics in cyberspace, McMahon and Bennett (2011) quote from Barlow’s “Declaration of Independence in Cyberspace,” in which he lays out a cosmopolitan vision of the internet as a space where governance will emerge organically from cyberspace itself, based on “ethics, enlightened self-interest and the commonweal.” Similarly, in their work on Islamic chat rooms, el-Nawawy and Khamis (2009) describe a vision of the internet as a Habermasian public sphere, characterized by a norm of discourse founded on rational, critical and unmediated debate. They describe the dominant norms of this space as being universality (in which access to debate is guaranteed to all citizens) and equality (where all citizens can convene and participate in discussion with no restrictions). Overwhelmingly, the assumption is that the norms and ideology of cyberspace – whether they emerge organically from the medium itself or whether they are imported into cyberspace from the “real world” are derived from Western culture and the Western cultural experience. In each case, the technology is seen as having an agency while the individual technology user is described instead as a sort of passive vessel which is used (or transformed) by the technology. Western writing by the internet’s own architects frequently describes the internet as an anarchic social force which arrives in a society and “transforms” that society – whether the society wants to be transformed or not. Here again, the internet is described as capable of colonizing or infecting society – like bacteria. American writing about the internet frequently includes a teleogical narrative in which the internet represents progress and the power of democratic ideas. The internet is thus “destined” to be accepted everywhere and to function similarly in every society. It is seen to possess an ideology, rather than being assigned an ideology within a particular cultural and social setting. Ultimately, many Western analysts argue, the spread of the internet will lead to a particular set of outcomes on the world stage. Consider, for example, the following descriptions available on-line for the work of a US government supported organization called Internews. This organization works in many newly democratizing countries to “assist” citizens with becoming

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connected on the internet. The mission statement for the organization informs visitors to the group’s internet site that: Information is the power that can change the world. We are in the midst of a revolution in human communication that is profoundly reshaping our future. Yet, for nearly half the planet, the promise of this revolution has not been fulfilled. Internews is an international media development organization whose mission is to empower local media worldwide to give people the news and information they need, the ability to connect, and the means to make their voices heard.

Here, the internet is described as having a progressive character which resides in the technology itself, rather than being imposed upon the technology by outsiders or those above the project. Next, the internet is described as having a leveling or democratic character. Finally, the internet is seen as transformative and deterministic. In fact, Western writing about the internet, about cybersecurity and about cyberthreat rests on a package of shared intersubjective understandings – which are not spelled out because they are understood implicitly by virtue of one’s situatedness in the culture which produced them. Here, I would argue that these principles – that the internet is progressive, transformative and inevitable -- form part of US foreign policy. For Americans (including those in the medical community), internet technology is seen as an indigenous technology which developed and grew organically within the United States. However, in the Chinese context, it is seen to some degree as a foreign technology which was imposed, in some cases unwillingly, on China. MacGregor (2005) notes that China’s internet was created by young Chinese entrepreneurs who were funded by Intell, IDG, Rupert Murdoch, Dow Jones and Silicon Valley venture capitalists. Foreign investment was halted, however, by a 1999 decree by Wu Jichuan, China’s Minister of the Information Industry, which forbids foreign investment in Chinese internet companies. Thus, the internet can be seen as one of many potentially harmful foreign substances imported into China over the years which have threatened China’s citizens and its state power. Here, other substances might include opium, Christianity and a drive for democracy. All of these substances thus are seen to threaten Chinese national pride and are understood within a long tradition of xenophobia and suspicion of outsiders. In China, the internet is thus seen as a threat to family closeness and academic achievement, as a threat to the community through its associations with danger and delinquency, and as a threat to the state through its associations with western ideas. Thus, the Chinese government and society’s fear about the detrimental effects of this technology has been disregarded by those in the international system, and instead the Chinese government has been accused of being recalcitrant and abusive towards citizens wishing to participate in internet activities. Arguably, the discourse of internet addict is thus a way for Chinese scholars, government officials and members of society to openly describe their fear of new technology,

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their resentment of this technology, and their emotions regarding the ways in which this technology has been an agent of suffering rather than transformation in their societies. Here, Johnson and Covello argue that sources of risk that are perceived to be internal to the community are often less feared than those which are perceived as coming from outside (Johnson and Covello 2007, 27-9). Thus, for example, Gjelten quotes James Lewis, an official who has advised the UN Institute for Disarmament Research, on the Russian view of information warfare. Lewis notes that a Russian official told him that Twitter was an American plot to destabilize foreign governments (quoted in Gjelten 2010, 2). Here, the risk potential of Twitter as a threat to social order is viewed as more significant, largely due to its foreign origin. He notes as well an accord signed between the members of the Shanghai Cooperation Organization in 2009. Here, the signatories of the accord (which include China and four other Central Asian nations), described information war as a type of “mass psychological brainwashing” which was “harmful to the spiritual, moral and cultural spheres of other states.” Particularly when the subject of discussion is the risk of new technology, one can find that “threat talk” may include metaphors of invasion or colonization, as newspaper columnists and experts speak of aliens and invaders who want to kidnap children and socially vulnerable individuals by enslaving them or luring them with technology. One sometimes encounters references to “technological pied pipers” who draw children into dangerous practices associated with the shiny new technologies. Here, the societal conversation about internet addiction may really be a way for states to assert the claim that they have the right to halt at least some of the internet’s implied social transformational character, and that states should have the right to determine how far these processes of social transformation should be allowed to go within their own societies. It is thus a defense of the rights of states to determine the trajectory of new technology – and a refutation of the notion that technology somehow has a trajectory of its own which is inevitable. The question becomes, however: At what point does the conversation about protecting oneself against internet addiction actually become a conversation about protecting oneself against the internet itself? And do patients and their families distinguish between the ways they have been threatened and harmed by internet addiction and the ways in which they have been threatened and harmed by the internet itself? Are regimes to promote healthy internet use aimed at teaching individuals to guard against internet addiction or to guard against the internet itself? The Metaphor of a Journey to a Dark Place Finally, one can identify language within Chinese narratives in particular which label the internet addict as similar to an opium addict, and descriptions of the present-day struggle against internet addiction as a continuation of the long-ago

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opium wars. Here, the implication is that “improper use” of the internet is not simply a medical problem, but that it is also a crime. This metaphor affects how citizens come to view the places where one might conceivably acquire internet addiction – such as a library, a school or an internet café. These places are now viewed through the lens of contamination as places of contagion. Here, arguably, the internet access site is regarded as a sort of “portal” through which the virus found on the internet itself pours forth into society and into the user. In this way, the internet itself is regarded as a site of criminality and immorality and by extension so are the places where it is accessed, as well as the individuals who access it. (The view that the internet itself is somehow suspect can be seen in the language of a 2008 initiative under President Vladimir Putin, where Russia’s prosecutors introduced legislation to control cyberspace and “keep the web free of immoral and unethical materials” (Lawmakers in Russia, 2008). That same year, Pavel Gusev, head of the media commission of the Public Chamber, which reviews government activities, proposed that amendments be drawn up to regulate activities of bloggers, noting “It is high time to put an end to the abundant use of swearing, insults and obscene vocabulary on the internet” (Stolyarova, 1). Here Asian risk analysts have presented the internet as a sort of gateway drug for addicts, paving their way to further types of socially deviant behaviors including drug abuse and infidelity. Malaysia’s New Straits Times uses the term “internet junkie children” when referring to the problem of internet addiction. And just like people start with marijuana and then progress to heroin, Chinese analysts suggest that internet addicts may develop other pathologies along the way (including autistic-like behavior and Attention Deficit Disorder, as well as pathological drinking, smoking and drug abuse). China’s top health portal released the “White Book on Chinese Netizen’s Health Status,” in 2007. In this work, analysts blamed internet addiction for the creation of a host of related health problems including worsening eyesight, injured necks, sore waists, insomnia, anxiety, high blood pressure, cardiovascular disease and stomach aches (China Digital Times 2007). The public health crisis constructed in China around the subject of internet abuse has likewise been widened to also include an epidemic of crime. Here, analysts like Ji Fang present Beijing Public Security Bureau statistics illustrating how 76 percent of juvenile crimes were committed by internet addicts (2008, 43). Media reports include statistics like the following: “A report by the Beijing Reformatory for Juvenile Delinquents showed that 33.5 percent of the delinquents there were goaded into committing crimes, mostly robbery and rape, by violent online games or erotic Web sites” (Xinhua News Agency 2007). Here, the internet café is described as a place where criminal behavior takes place, frequently by both internet addicts and criminals. Internet addiction is described as a “gateway” to other types of anti-social behavior. In campaigning for the passage of federal legislation in China to regulate internet cafes, Deputy to the National People’s Congress Wen Yu noted in 2007 that internet cafes (or internet bars) provide internet users with cigarettes and liquor, in violation

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of legal age restrictions. (“A report by the Beijing Reformatory for Juvenile Delinquents,” 2007). Elsewhere, internet cafes have been implicated as the sites of illegal gambling; identity theft, phishing and other computer crimes (Longe and Chiemeke, 2008); or places where organized crime rings meet. In 2006, the Communist Youth League released a statement describing internet cafes as “hotbeds of juvenile crime and depravity” (“obsessed with the internet,” p. 7). And Shukla (2007) notes that at India’s prestigious Indian Institute of Technology, the decision was made to restrict internet use in hostels – saying it made students reclusive and suicidal. Arguably, these measures may have as much to do with punishing and labeling the afflicted using a moral lens as they do with prevention – from the lepers who were not permitted to reside in urban areas during the Middle Ages (Porter 2009 31) to the internet activists who are not permitted to meet together in internet cafes today. In each case, the places where those labeled as diseased gathered were labeled as sites of both medical danger and moral danger, and frequently the threats of disease and criminality were linked together. The gathering place of the diseased thus is seen as a gateway to other types of negative or dangerous behavior. Thus, internet addiction discourse is a narrative about several things: about the ways in which we feel powerless in relation to the seemingly inexorable forces of technology which threaten to shape us and our societies in ways which may leave them unrecognizable. In some cases, internet addiction discourse is about resisting Westernization and its accompanying social, political and economic transformations. It is about feeling invaded and colonized. It is perhaps in some ways a narrative of resistance. But it is also a narrative about behavioral expectations and the ways in which people are constrained in their behavior, and about the ways in which the state and the medical establishment exercise power to affect people’s behavior. Medicalization and the Politics of Behavior Now that we have paused to consider what internet addiction represents, we need to ask, why have we identified or “discovered” internet addiction at this time? For just as new diseases or syndromes appeared to have been suddenly “discovered at a particular time, it is also true that in certain instances diseases appear to have vanished – as norms have changed. In order to understand more fully how and why this is the case, it is important to consider the concept which Ivan Illich calls “medicalization.” Here, he argues that in the modern era – the scope of medicine (and the role of the state) has expanded because of the ways in which disease is now defined and recognized. Here, he does not accuse the state of inventing the disease – but instead suggests that the medical establishment, in collusion with the state, has redefined illness – so that issues which were previously viewed largely as social problems are now viewed through a disease model instead. Medicalization is thus a process whereby life activities

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are deemed to have medical significance (Clarke et al. 2003, 163). In other words, many things which people do in their daily lives (such as participating in sports, smoking, drinking, and disciplining their children, struggling with homework, or fighting with their spouse) at some point come under the purview of medical science and medical technology, and as a result become subject to regulation and cure. (In other words, you don’t merely fight with your spouse. Instead, you are diagnosed with anger management issues. You don’t merely struggle with homework, but are instead diagnosed with ADHD.) In some cases, medicalization appears to happen “all of a sudden,” in that a new disease seems to appear almost overnight. Within the twentieth century, a number of new diseases were seemingly invented and discovered in this way. That is, your “disease” is your failure to obey behavioral norms, and the cure is to bring you back in line with these norms. As Herzlich and Pierret (2009, 113) state the problem, in the post-Enlightenment period the physician became a representative of science, modernity and progress. As a result, he acquired the power to establish norms. Then, as they argue, “confident in the values it incarnated, medicine henceforth claimed the right to state the rules by which society should abide.” The internet addiction construct thus presents a contradiction in terms: The argument suggests that for most individuals, having access to technology is both personally and professional rewarding, that it is life-enhancing and that it can confer a range of social, economic, cultural and political benefits. Technology thus enhances individual and group autonomy. However, the medicalization lens argument suggests that for some individuals or in some instances, the user’s relationship with technology is not beneficial but rather harmful. While others might achieve autonomy through using technology, there exists, arguably, another class of individuals who are likely to lose their autonomy vis à vis the object of their addiction. In this case, these individuals should not be encouraged to use technology, but should rather be protected against it. Their actions vis à vis technology should be regulated or perhaps prevented altogether. Herzlich and Pierret refer to this process as the “policing of health.” However, in this case, one has to wonder if the state is more interested in policing the health of the user or merely in policing the user – and the internet. If we view the role of public health as one of instilling order in society and of disciplining those who present a threat to social health (Lupton 1995, 2; 2007, 9-10; Turner 1995, 13), then the creation of the medical problem of internet addiction allows the state a “way in” – to organizing and defining the correct role of technology in an individual’s and a society’s life. That is, under the guise of keeping a population healthy, medical practitioners may find themselves establishing guidelines which in point of fact set up norms regarding how often individuals should use technology and the conditions under which it should be used. In this way, “healthy” becomes a term which describes both a set of physical practices and a set of ideological practices as well. For example, a set of government issued guidelines which ask parents to monitor their children’s internet use so that

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their children can establish “healthy” use regimes or statements which encourage parents to maintain a “healthy” environment for their young internet users through providing plenty of supervision implicitly contain a number of normative statements. Such statements include the fact that “good” parents supervise their children closely, and that “good” parents do not leave their adolescent children unsupervised in the home while they go to work, for example. Arguably, this curriculum is also predicated on the notion of an “ideal user” and an “ideal family” which might include the presence of a stay at home parent (probably a mother) who is available to supervise children after school. Support for this stance can be found in considering the titles of two pamphlets written by Chinese leader Tao Ran’s Beijing-based internet addiction treatment facility – which goes by the unwieldy name of the Chinese Teenager Mental Growth Base of the General Hospital of Beijing Military Area Command of the Chinese PLA. Written in 2009, the pamphlets lay out guidelines for healthy internet use. The first is titled “Guidelines on preventing network addiction at home,” while the other is titled, “Basic principles for a harmonious family” (China Tech News 2009). And in a 2007 interview, then President Hu Jintao noted that Chinese internet regulators need to promote a “healthy online culture” in order to protect social stability. An example of this equating of “healthy” physical practices and “healthy” ideological practices can also be found, for example, in a recent statement from the mobile phone provider China Mobile that stated that beginning in January 2010, the company would begin screening text messages for “unhealthy” content – in an attempt to prevent both the possibility of children acquiring “text messaging addiction” and the creation of an “unhealthy online atmosphere.” Here, the criteria for what constitutes an unhealthy online atmosphere are not spelled out, but the implication is that these criteria are perhaps ideological rather than physical. Here, it should be noted that the conflating of physical and ideological notions of “internet health” or “healthy internet practices” is not a phenomenon which occurs only in China. Rather, one can point to internet safety programs in the United States which attempt to socialize young people into acceptance and enforcement of the following norms: not sharing personal information or talking with strangers online, particularly about sexual topics; not engaging in interpersonal victimization (including engaging in or responding to unwanted sexual solicitation or harassment); not engaging in aggressive behavior in the form of making “rude or nasty comments” or frequently embarrassing others; and not downloading images or programs using file-sharing programs (Ybarra et al. 2007). While ostensibly even the final norm is aimed at protecting children’s health through shielding them from exposure to harmful materials such as pornography, the emphasis on not using file-sharing programs suggests that this part of the program may also be aimed at teaching children not to violate laws regarding theft of intellectual property and piracy of copyrighted materials. It is jarring to consider a physician being placed in the position of protecting US copyright restrictions through speaking to parents about their children’s internet practices.

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Such norms might be spread through a community through informal mechanisms such as public service announcements asking parents to monitor their children’s internet usage, or through more formal mechanisms such as internet pledges that individuals are required to sign before they can use computers in school, in a workplace or in the library. Because medical practitioners are regarded as experts, these guidelines may appear to be neutral and objective. However, one might also argue that they represent a nonconsensual and monolithic set of rules which all would-be users are nonetheless subjected to. They also represent an extension of the social regulation of what was previously an individual decision (how much to use the computer and under what conditions). Thus, even in a society which prides itself on scoring high on various measures of internet freedom, there may still be several disciplinary mechanisms at work which affect the technology use practices of individuals and groups within that society. The anti-psychiatry analyst Szasz was also interested in medicalization, mostly because of the ways in which it led to an increased role for government in more sphere of daily life. As critics of the process of medicalization note, by the end of the twentieth century, most Americans accepted that all of the following social practices also had a disease component which thus removed them from the realm of private problems, and instead moved them into the realm of government intervention and medical cure: child abuse, domestic violence, bullying, homophobia and post-traumatic stress disorder (Stein et al, 139-144). That is, the scope, role and strength of medicine (and the state) has just been increased since it has now co-opted another sphere of life activity to within its portfolio of regulatory activities (Clarke 2003 161). The critical psychiatric stance emphasizes the ways in which the “medicalization” of a problem is influenced by cultural and temporal norms with some cultural and social practices being considered a medical problem or disease in some cultures but not in others. As Glackin notes, “a judgment of illness is therefore a mixed fact-value attribution; It reflects a judgment both that some physiological or psychological condition exists in consequence of which an individual’s capacities are reduced, and that those capacities are one on which the social or communal order places a significant premium” (456). Here, we might consider the oft-cited example of a man in the Middle Ages who suffered from an inability to read quickly or well. Today, this individual might be considered dyslexic, but he would not have been either diagnosed or treated in the middle Ages. The inability to read only became medicalized in the twentieth century with the advent of more universal literacy standards (Glackin 2010, 452). In regard to internet addiction, one can argue that what has become medicalized is the way in which individuals spend their leisure time, with medical professionals offering their expert judgments regarding the proper or normative use of leisure time. In her work, Lori Reed (2002) asks why it is that spending time on the internet is regarded as more dysfunctional (or pathological) than time spent reading or playing basketball. Here she suggests that there is an implicit judgment contained in the diagnosis of internet addiction based on the idea that internet use is

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a “waste of time” in a way that other leisure time activities are not. Support for her argument can be found in analyzing a recent article which appeared in the journal Cyberpsychology and Behavior. The article “Internet Addiction: Metasynthesis of 1996-2006 Quantitative Research” contains the phrase “the capacity of the Internet for socialization is a primary reason for the excessive amount of time people spend having real-time interactions using e-mail, discussion forums, chat rooms and online games” (Byun et al., 203). Here the use of the term “excessive” creeps in almost without anyone noticing it. Yet, to anyone interested in decoding the language behind the language, the obvious question becomes: Excessive? In what way? And according to whose definition? Here again, the term “excessive” implies that there is some ideal amount of time which a disciplined person should spend on the internet, and another amount of time which would be considered somehow dysfunctional or deviant. As Mol writes, “to enact a disease is also to enact norms and standards. This is because the entity afflicted by the disease deviates – from some normality (121).” Here, arguably, “deviant internet use” has been similarly constructed as harmful and outside the bounds of normal behavior. In recent years, the matter of whether or not internet addiction exists, what it is and how it should be understood has been a subject of discussion of meetings at both the annual American Psychopathological Association and the American Psychiatric Association. As early as 1997, American analysts pointed to the “politics” involved in defining who was or was not an internet addict. Writing in the online forum Psych Central, the editor noted that the designation of what does and does not constitute “normal” internet use is a highly charged political question, as is the designation of who is or is not a normal internet user. In an editorial titled, “What’s Normal? How much is too much when spending time online?” The editor noted that spirited debates and controversies had broken out at the 1997 meeting of the American Psychological Association as medical specialists began discussing whether or not internet addiction was a “real” syndrome, and what the parameters of the syndrome might be (Editors 1997). Johnson (2009 27) argues that the notion of addiction or unhealthy dependence on technology actually stems from a public suspicion of new technologies, and is an artefact of their introduction -- which tends to wither away as individuals become used to and accepting of the role of this technology within their society. She notes as well an implicit hierarchy regarding the value of different types of interactions, in evaluating the claim first publicized in Wired Magazine that excessive internet use could cause individuals to develop autistic-like behavior patterns. Here, she asks: Why is it that in-person interaction is necessarily considered better than online interaction? (2009, 52). In other words, she argues that it is indeed possible that exposure to new technologies changes individuals – but those who fear that too much technology exposure will irrevocably harm individuals and society are implicitly making a judgment about the value of social changes brought about by technological exposure,

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Is Internet Addiction a Disability? Shane Glackin’s (2010) work raises the philosophical question of what it truly means to be “disabled.” Can someone who shows signs of internet addiction be classified as disabled? Here, there are two schools of thought. There are those, like Boorse who argue that illness is in fact an ontologically stable category and that illness and disability are labels which can be applied objectively by medical experts to the population. Here Boorse somewhat controversially makes the Darwinian argument that disability is any condition which does not serve the cause of the perpetuation of the human species. Thus, in his calculation, homosexuality is both an illness and a disability since it inhibits sexual reproduction. Furthermore, Boorse argues that the individual sufferer does not need to feel disabled, or to agree that he is disabled in order for the label to be applied. Rather, disability is a matter of expert judgment. (1974) Thus, using Boorse’s logic, it would be possible for a medical expert to make a case that an internet addict is “significantly impaired” in terms of social functioning in his day to day activities, and to both identify him as disabled and prepare to treat him without his consent. In contrast, we have seen that Szasz argues that functionality within society is largely a matter of values, culture and politics. He would argue that one can only be disabled within a particular society, depending on how functionality has been defined within that society. Finally, the critical psychiatry model argues that medicine is most likely to label those who are deviant (rather than dysfunctional) as ill. This model thus posits that mental illness is actually a label applied to those who violate social norms (as in, for example, spending “excessive time” on the internet). It is not a myth or an invention but a construct – whereby disease language is often applied to those who display aberrant social practices. It is not a diagnosis, but rather an identity. Thus, medicalization gives medical experts the power to construct and label both the problem and the individual who purportedly suffers from it. Here, analysts point out that whether or not one is identified as diseased or disabled thus comes to depend more on prevailing social and cultural norms, then on any objective measurement of health. Here Lynch (2002, 532) points to the construction of the “pervert” in American medical discourse, noting that the label was applied to “anyone who engages in sexual intercourse for reasons other than procreation.” And Proctor notes the ways in which anti-Semitism in Nazi Germany led to the construction of a “Jewish problem” which would culminate in initiatives to solve this “problem” with both a medical and a political solution (1988, 7). Here the politics of diagnosis become clear since a diagnosis thus becomes a label which is imposed on someone who does not follow social mores – often without his consent. Thus, it is possible to identify many current cases where state policy may aim at the illegitimate and unwanted cure for a condition which the sufferers themselves do not recognize as disabling. Here, we can point to sex-selective abortion as an attempt to “cure” the condition of “not being male,” along with historical attempts

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to cure homosexuality, deafness (Glackin 2010, 455) or Asperger’s syndrome – all conditions where the afflicted community does not necessarily view themselves as ill or in need of cure. Rather, instead there may be individuals who view the condition both as part of their individual identity and part of their group identity. In the case of internet addiction, social norms may prevail regarding whether it is appropriate to prefer a virtual environment to a real one; whether it is appropriate to prioritize one’s virtual acquaintances over one’s actual family members; and what the proper balance is between time spent on-line and time spent in other activities. That is, each state “constructs” the internet addict. The measure appears to be an objective measure since it is dependent on a computerized questionnaire featuring questions which meet accepted standards for scientific research. However, the questions still incorporate cultural assumptions, and the questionnaire retains the power to designate what is and is not “normal internet behavior.”) Because social norms may vary from one culture to another, it is easy to see why those in China, for example, who place a high premium on familial traditions and relationships, might be more likely to view the internet addict as disabled, due to the low priority with which he seems to hold family relationships, and the seemingly “inordinate” amounts of time he spends alone engaged in online interactions. In contrast, Reed (2002) notes that Western users are more likely to diagnose someone who refuses to use computers as suffering from a disability (through applying the label of technophobe or computerphobe). Normalizing Internet Use From a critical psychiatry viewpoint, the significance of medicalization is that once a life condition becomes medicalized, the way has now been opened for individuals who are labeled as having the condition to become the objects of medical practice and frequently of state regulation as well. The autonomy of the individual to cope with this problem has just been lessened since the problem has now become not an individual problem but a problem of society and of the state. Someone who previously was just an individual participating in life activities (such as using the internet) has now become a patient – subject to the stigmas which having a disease may impose on one, and subject to the lessening of power which one endures in becoming an object of medical regulation. He is now the subject of disciplining from within a framework whereby experts have the power to determine whether he is conducting his life activities in a proper manner. Here, Foucault describes the ways in which the medical establishment has the power to “normalize” social activities, once they become the object of expert regulation and surveillance. Here, “normalization” refers to the construction of a way of life or a way of being that is “formed and led by institutions and disciplines with the authoritative power to mold the ways individuals relate to themselves and to each other” (Scott 2009, 361). That is, once social behaviors become part of the established medical community’s portfolio, the medical and psychiatric communities now have the authority to help establish the “proper” way for people

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to carry out these activities – whether the activities are the act of being elderly, being an athlete, working through marital conflict, being pregnant, or using the internet. The anti-psychiatry advocate Thomas Szasz once noted that that “all psychiatry is political” (Greenberg, 1977) when it is used to harm those who oppose the system. Here, the medical profession may not always act in overtly political forms – as in the rounding up and treatment of dissidents against their will – but arguably it is political nonetheless, when medical power is used to discipline people in regard to their social behaviors. When it is overt, it is usually termed “psychiatric abuse” and is roundly condemned by the international psychiatric community. However, practices of governmentality in the practice of psychiatry are not always overt. Instead, they may include more vague power politics which Greenberg terms “social manipulation.” Similarly, Lupton calls our attention to the “coercive” practices of public health and public health experts, who seek to normalize the ways in which citizens think about health and act to safeguard both individual and collective health – from urging citizens to get a flu shot to launching a campaign to Stomp Out Obesity (2003, 3). Here, we can point to China’s normalization of internet use through the creation of a notion of cyberhealth. Arguably, the medicalization of the internet addict allows the state to graft together two different identities – that of the good patient (Herzlich and Pierrot, 191), who takes his medicine, looks after his health and cooperates with medical authorities whose power he recognizes and respects, and that of the good internet citizen. Thus, China has used the language of public health, ostensibly to safeguard its citizens. However, the language of public health can, according to Lupton, be both authoritarian and patronizing. In describing the ways in which certain social practices are normalized and medicalized, Foucault has also called our attention to the fact that power is distributed and acts unevenly in society. Here, the approach relies on the assumption that health behavior is part of a larger concept of social behavior, and that how people behave when dealing with issues of sickness and health is in a large part related to how people behave in dealing with other social issues and practices. That is, individuals who might be marginalized, stigmatized or disempowered in other types of social interactions are likely to receive the same type of treatment when they attempt to seek or participate in processes of health care. And prejudices or stereotypes which individuals carry into other social interactions are likely to leak into the health care encounter as well. Thus, the model helps us to understand who is most likely to be identified and treated as an internet addict, and the ways in which power relations in society may play into treatment decisions for the internet addict, including decisions related to practices like involuntary confinement which have been labeled as punitive. Here, the critical psychiatric perspective argues that it is impossible for a practitioner to treat a patient suffering from AIDS, for example, without simultaneously bringing a number of preexisting notions about gender, sexuality, blame and even sin to that interaction. The treatment interaction is thus colored covertly by the “politics” which exists beneath the surface.

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Finally, from a Foucaultian perspective, the problem with disease is the way in which it tends to lump all of the sufferers of a particular disease into that “disease category” (1973, 105). He describes the ways in which the clinic renders an individual into a “case,” so that one cancer sufferer is thought of as the same as all others who belong to the category of “cancer sufferers” rather than as an individual with her own identity. The critical psychiatry model assumes that the practices of psychiatry and psychology are not automatically malevolent – though they can be – nor are they actively aimed at harming their subjects – though in fact they do. Rather, it stresses the ways in which the medical establishment can discipline a patient through less overt means such as stigmatizing those who are mentally ill. The critical psychiatry approach also helps to explain why the state so often appears to be blaming the internet addict who may be described in moral terms. Constructing the Internet Addict Thus, a Foucaultian analysis allows us to ask how society, the state and the medical establishment have constructed the category known as “the internet addict,” as well as the ways in which the application of that label does violence to the individual who has been diagnosed as suffering from that malady. As Herzlich and Pierret (1987) note, “every era has its own diseases” and every era can also be seen as having its particular victims. The question “Who is sick?” thus allows us to see how society in general views those citizens who are frequently identified with illness. In the 1300’s, Jews were frequently accused of carrying plague. In the US around the turn of the nineteenth century, immigrants and the poor were frequently identified with disease. Traditionally, those who occupy a marginal or subordinate position in society (such as homosexuals with AIDS or homeless people with tuberculosis) are singled out as carriers and as the unwell. Here, the line between deviant behavior and illness may become blurred – as the population of those who are marginalized in society (such as the homeless) may overlap with the population of those who are considered unwell and potentially dangerously mentally ill or infectious Thus, what does it mean that internet addiction is particularly associated with students in China and Asia, but not in the West? Here, it may be that students are more often identified as carriers of the “virus” of internet addiction, since students have previously been seen in Chinese politics as agents of social unrest (with its underlying relationship to criminality being implied). In addition, as I show in Chapter 4, students may be viewed a human capital, or as an important national resource which is being systematically plundered by outside, foreign forces through the virus of internet addiction. Finally, Jonathan Kandell (1998, 14) suggests that children and students may be seen as uniquely vulnerable to internet addiction because their identity is more fluid and plastic, or because they themselves are less well-formed as people. Thus, children and young people

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might be seen as occupying a marginal position in society because they are not yet sufficiently socialized into its norms. Thus, they are more likely to acquire a disease which would cause them to behave in deviant ways. Here, one can see the ways in which the individual who displays a pattern of norm violation in relation to his internet use has been constructed by the medical establishment and the media as one who is dependent, rather than autonomous; deviant, rather than “normal”; different or “other” in comparison to other “normal” citizens in society; in need of discipline and possibly disabled. The Chinese media, in particular, has been accused of sensationalizing the story of internet addiction. Media coverage here often focuses only on the most extreme cases. Such as showing, for example, a story about how a group of internet addicts allowed their real, live child to starve to death from neglect because they were too busy caring for a virtual baby online. Here, the portrayal of the patient as dangerous leads to a claim of criminality. The patient is seen as likely to harm others and society (Chodoff 1984, Crawford 1994). The sick, criminal and crazy internet addict is implicitly contrasted with the responsible, normal internet user who exercises discipline and restraint. And as Crawford (1994 1348) points out, without the unhealthy other to point to, it might be difficult to construct the healthy user at all. Here, she argues that in a Foucaultian perspective, the “project” of health was about creating an identity – in this case people who functioned well and appropriately within the existing structures of power in society. (The reasons why it might be important for a society to produce such “useful bodies” (Crawford 1994, 1351) will be examined in greater detail in Chapter 4.) Here Crawford suggests that today’s discourse of health also calls upon individuals in particular to discipline themselves, making the production of health both a collective and an individual project. Crawford calls our attention to the connection frequently made in discourse today between being disciplined and being healthy. Today, she argues, social understandings of many diseases rest on an association between ill health and practices and behaviors that are defined as undisciplined. Today in popular culture we might encounter the idea that the addict refuses to discipline himself and thus succumbs to his addiction; the sexually promiscuous do not discipline their bodies and thus succumb to sexually transmitted diseases. The AIDS sufferer, the obese person and the drinker are all described in terms of discipline – if they would only discipline themselves, create a more useful identity and lose their out of control habits, then they could be healthy instead of sick. The healthy person is thus portrayed as dutiful – to society and to himself. The unhealthy person, in contrast, is a shirker. He neglects both his own health and his larger duty to society. Here, she suggests that the need to draw a binary distinction between the healthy person and the ill person is based on a fear of contagion. The healthy person “others” the sick person in order to reassure himself that his own identity is secure. He would never succumb to bad habits or a lack of discipline – as this other person does, for they are nothing alike. Here, arguably, the Othering of the addict is really about blaming the addict. As long as he can find the seed of the addict’s problem within the addict’s own

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bad behavior, the healthy person does not need to worry that the substance itself is addictive, or that he himself could lose control and become sickened in this way. Public health discourse can create a sort of victim-blaming mentality, in which individuals are seen as both responsible for caring for their own health and contribution to the public good of a healthy society – as well as being seen as responsible for creating the conditions of their own ill health (for example, through obesity or smoking, or unbridled internet use.) The “othering” of the internet addict thus serves a number of purposes. First, it suggests that the problem of internet addiction is best understood by focusing on the characteristics of the sufferer, rather than looking at some aspect of the technology itself which might render it addictive. It also lets society or the environment off the hook. One does not have to wonder if those who become internet addicts are somehow being disserved by their present environment. Critics like Lupton (2003) suggest that current public health practices and discourse leave no room for a more radical set of inquiries into the ways in which a society or state itself may contribute to the erosion of public health and the creation of public health problems. (Thus, for example, it might be more expedient to label children as having attention deficit disorder rather than inquiring into how or why they are acting out in their present learning environment. Creating a new school or curriculum is a much more daunting and expensive enterprise than simply writing a prescription for Ritalin or another similar drug.) The othering of the internet addiction does not however occur the same way in every environment. In Germany, officials have actually begun to undertake a more radical environmental inquiry into the sources of internet addiction. As a result, the major avenue for treating internet addiction in Germany includes sending children to “play camps” where they learn to become more comfortable with their physical bodies and to enjoy healthy outdoor recreation (Deutsche Welle 2003). Such an approach relies on an acknowledgment that children become addicts because of a lack of safe outdoor play, not because they themselves possess some sort of inner moral failing. Similarly, in the United States, medical reports indicate that many internet addicts are bored, isolated, lonely stay at home mothers. Thus, an environmental critique might include figuring out how to offer more services to stay at home parents so that they are not socially isolated but are rather supported and included in the community. In addition to being “othered” by their diagnosis, an internet addict may also be rendered dependent – upon his doctors, caretakers and family. As Bleakley and Bligh explain (2008, 370), the physician’s expert medical perception or “gaze” serves to objectify the subject. Then the doctor is able to exercise active authority over a now objectified and passive patient. As Perkins notes (35), physicians wield great social authority and are seen as having the power to make patients obey medical recommendations. Here, many patients consider a physician’s recommendations to be commands. Some patients even use the term “doctor’s orders.” (As I argue in Chapter 5, this is particularly true in the case of the Chinese internet addict, since the notions of patient autonomy and patient rights in the

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context of medical care are much less developed. The ill patient is thus much more likely to be taken care of by his family who assume a leadership role over him, particularly if he is not yet of legal age.) The construction of the disease of “internet addiction” thus serves the state through transforming an autonomous internet user into a weakened subject – through applying a diagnosis of mental illness to him. Next, the internet addict is described as deviant. The internet addict and his family members are stigmatized, as they are labeled with terms such as “onlineaholism” (Wenlei, 43). To some degree, having any illness in China carries a stigma, and whether the individual suffers from cancer or internet addiction, his own discourse as well as the discourse of the larger community may center on finding out what he did to bring on such an affliction. Thus, Lora-Wainwright (2010, 85) describes the ways in which cancer victims in a rural village discuss the fact that they themselves brought on the disease by, for example, having an angry or anxious attitude towards their lives. Similarly, the focus by Asian medical professionals on identifying personality traits of children with internet addiction serves to make a connection between character flaws such as a lack of discipline, and the development of the disease. In a recent research article by Huang and Leung (2009) the article implicitly indicts the subjects as responsible for their acquisition of the disease through its argument that who have internet addiction show abnormal brain activity, including an impairment of inhibition and a shortage of self-control. In the same article, the researchers note that “teenage addicts were less self-disciplined. They could not control the time spent in instant messaging and neglected their own duties, resulting in academic performance decrements.” Medical experts also seek to profile familial traits which might be seen as leading to the creation of the disease. Here, China’s Tao Ran, Director of the Addiction Studies Center at the Military General Hospital of Beijing PLA, notes that most internet addicts are boys and that overwhelmingly they “lacked the love of a father” (Jifang 2008, 43). The Chinese researchers Yen et al. (2007) describe children who show signs of internet addiction as the product of parents who are overly intrusive, punitive and lacking in responsiveness (perhaps similar to Bettelheim’s “refrigerator mothers” who were accused in the 1970’s of having created autistic children). In both the cases of children and their parents, the underlying implication is that those who acquire internet addiction are somehow irresponsible. They have not been sufficiently vigilant in monitoring their health practices and as a result they have acquired an embarrassing, destructive and socially damaging disease. Here the internet addict is described as the opposite of the “healthy internet user” or netizen. Here, Porter (2009 57) describes the notion of health as a form of citizenship, or the assumption that part of being a good citizen is being responsible for one’s health and welfare. Tracing the idea back to the French Revolution, he argues that particularly within the welfare state model, citizens were socialized to believe that population health was a collective good which all should participate in defending through exercising temperance ”in both the consumption of pleasure

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and the exercise of passions, and through cleanliness. In addition, in modern society, increasingly, maintaining one’s health is seen as a duty of the citizen (Herzlich and Pierret 1987). Thus, he argues that within the West, citizens have come to accept the notion that to be sick is in some sense also to be to unpatriotic or not fully committed to one’s country. Herzlich (1987, 194) quotes the sociologist Rose Coser who notes that the good patient, as defined by society, is one who not only obeys the doctors and the nurses, but also recovers quickly and is able to resume his activities. Someone who is viewed as not engaged in safeguarding his health can thus be viewed as someone who wastes state resources – or perhaps even steals them. Unschuld (1985 11) notes that the process of safeguarding one’s health thus becomes a sort of normative prescription for how one should live one’s life. The norms may vary from one society to another depending on culture, but nonetheless each society contains a prescription regarding who constitutes a socially acceptable healthy lifestyle. In regarding to internet addiction, the Chinese medical establishment and the state have combined to create a discourse about the citizen as a “netizen” while in cyberspace. The term “netizen” has largely faded from discourse in the European nations and in the US, but the term is still frequently used in sources such as the Communist Party sponsored newspaper China Youth Daily. This discourse serves to remind subjects that they are still Chinese, even while they are on-line, and that they should conform to political and social norms regarding behavior and interactions. Programs designed to encourage cyberwellness similarly seek to discipline users and create subjects through educating them in acceptable and unacceptable social and behavioral patterns online. The scholarly literature describes “cyberwellness” as: The positive well-being of internet users, which involves an understanding of the risks of harmful online behaviors, as well as an awareness of how to protect oneself and other internet users from such behaviors (Hu 2007, 13). Here, the Inter-Ministry Cyberwellness Steering Committee of Singapore conflates the notions of cyberwellness, positive use of the internet, and attempts to create a so-called “healthy internet environment” through discouraging practices such as cyberbullying and net rudeness. Thus, “cyberwellness” becomes not merely a medical condition which one attains, but simultaneously a set of proper cultural and ideological behavior practices on the net which one adheres to and subscribes to. In the discourse of internet addiction, states may thus encourage citizens to have a “healthy relationship with technology.” However, the specific parameters of what constitutes a healthy or unhealthy relationship with (or dependence) on technology vary greatly from one culture to another – depending on the way in which the state regarding the technology and its dangers, as well as the way in which the state regards its citizens. In his work on alcoholism, Jellinek points out that it is possible to conceptualize of an individual who might be considered an alcoholic in Texas but not in France. Here, the Southern Baptist orientation of many Texans might affect how they view inebriation, practices of social drinking,

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enjoyment of drinking and the establishment of an alcohol culture. And the winemaking industry of France, the role which wine plays in the culture of the country would affect how social drinking was viewed in this society as well. Here, Jellinek argues that since Texans and Frenchmen differ in terms of how they view the construct of “the alcoholic,” they may also differ in terms of how they view the risk of developing alcoholism. The French are, he argues, less frightened of alcohol, more skeptical about the existence of the alcoholism paradigm and less likely to want to put people into categories. Thus, they may also have a different concept of what it means to have a healthy relationship with the substance. Similarly, American researchers have begun to use a more reflexivist mode of evaluating the “health” of the user’s relationship to technology. Here, Suler (1999) in particular argues that “one’s passion for the internet can be healthy, pathologically addictive, or somewhere in between.” He proposes a new metric for measuring the quality of one’s internet use, which rests on asking what needs are being met by one’s internet use. Here, if one is, for example, deriving a feeling of enhanced agency and competency through learning a new set of skills online, then regardless of the time spent online in pursuit of these activities, the relationship might nonetheless be considered healthy. Suler also argues that the internet user must be self-aware, and able to describe the ways in which he is using the internet and his motivations for doing so. If the user displays these capabilities, he can be regarded as using the internet in psychologically healthy ways, regardless of the actual pattern of hours spent online. However, Crawford (1994) notes that in the modern era, the healthy self is frequently described as one who is disciplined. Today in popular culture we might encounter the idea that the addict refuses to discipline himself and thus succumbs to his addiction; the sexually promiscuous do not discipline their bodies and thus succumb to sexually transmitted diseases. The AIDS sufferer, the obese person and the drinker are all described in terms of discipline – if they would only discipline themselves, create a more useful identity and lose their out of control habits, then they could be healthy instead of sick. The healthy person is thus portrayed as dutiful – to society and to himself. The unhealthy person, in contrast, is a shirker. He neglects both his own health and his larger duty to society. He also, arguably, takes unnecessary risks with his health which have the potential to endanger everyone in a society as a result. Thus, the imperative to avoid risky behaviors becomes both a normative statement and a duty within society. And the individual who fails to discipline himself and who engages in risky behaviors thus becomes someone who can be othered and blamed. Here, we can consider the character of the “hacker,” the internet user who sleeps in his office, has little regard for his public appearance or his nutrition (or his hygiene). This individual might be revered in the United States while he might be diagnosed as mentally ill in a different society because these traits are considered maladaptive and the production which the person makes is not valued. What is intriguing about hacker culture, here, is the fact that most hackers would not diagnose themselves as being mentally ill or indeed ill at all. In China, the

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hacker is described as mentally ill and possibility even criminal. The assumption is that there is inherently something deviant about spending too much time on the internet – therefore, those who do so are likely engaged in deviant or criminal behavior. Longe and Chiemeke (2008) describe a similar phenomenon in Nigeria, where “hacker” is used a synonym for those who engage in behaviors like stealing credit card numbers, phishing and sending spam e-mail, all while at the cybercafé. Thus, in China the hacker is regarded as similar to the internet addict, as someone who “steals” from the state through his refusal to be a productive citizen. A narrative which “others” the internet addict thus serves several purposes: First, it raises the risks which the average reader or observer might feel and thus encourages the average user to regulate his or her usage so as to not run the risk of becoming an Other, an internet addict. Othering the addict also make it possible to implement and lobby for support for punitive regimes, since the internet addict is regarded as not fully human, nor unique and distinct. When one others the subject, one essentially renders him not as an individual but rather as a member of a class of individuals. That is, the construct of internet addiction assumes that all internet addicts are in some way similar enough that they can be discussed in interchangeable ways. Net Hygiene and Internet Health Surveillance As noted in the previous section, the new politics of health thus takes into account the ways in which an individual’s decisions about health practices may affect society as a whole. Arguably, a citizen does not have the right to engage in risky behaviors (or those defined by state as risky) if in doing so, he or she raises the costs and risks to society as a whole. That is, the normalization of health practices means that it is no longer an individual’s own decision whether or not to undertake a risk, but one which needs to be calculated in relation to society as a whole. This new way of thinking about health risks combines with new technologies (such as DNA analysis, computer imaging of the human brain, and the analysis of genetic dispositions) to allow for the identification of individuals as having a particularly high risk of developing a disease. That is, society and the state now have the ability to discipline not only an individual’s current health practices but their future health practices as well. That is, citizens are disciplined to exercise temperance and moderation (for example, eating a low-fat diet) so that they will not sicken in the long term as well as the short term. In the case of internet addiction discourse, the state has increasingly resorted to the use of profiling, in order to identify individuals who are at risk of becoming internet addicts. These individuals are then exhorted to change their behaviors immediately in order to preempt the likelihood that they will develop the disease. The medical term for such preventive practices is “health hygiene,” where hygiene is defined as: “The science that deals with the promotion and preservation of health. Also called hygienics. 2. Conditions and practices that serve to promote

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or preserve health: hygiene in the workplace; personal hygiene.” The practices of so-called “net hygiene” rest implicitly on assumptions about the environment which requires the application of hygiene practices, as well as assumptions about the users themselves. In addition, in institution of net hygiene practices affect those who become the subject of those practices. Here it is important to consider the ways in which practices for the spread of public health hygiene are frequently implicated in ideological practices. Hygiene or the prevention of disease was a key practice, for example, of British missionaries, which culminated in an extension of British cultural practices, some of which were inappropriate for the target audience. (For example, British practices aimed at curbing nakedness, thought to be unhealthy both morally and physically, in tropical climates often resulted in native individuals being forced to wear dress which was inappropriate for the climate (Lupton 2003, 11).) Laite describes the ways in which hygiene practices of “cleansing” (through encouraging the use of soap and water, the boiling of water or hand washing) were predicated as much on cultural and religious notions of “purity” (208) as they were on germ prevention. However, Ring (2003) argues that the overwhelming ethos which engendered the drive for hygiene was the notion that the developing world threatened. (That is, it was a place of risk and hazard.) The lands visited by British colonizers were thus viewed as vast, dark places, overripe, undisciplined and teeming with germs which threatened to spill over their boundaries and overtake the human figures that had come there. “Cleansing” was necessary for the prevention of disease which was clearly present (since the developing world was viewed as dirty and diseased) and which the developing world was guilty of creating. Similarly, net hygiene practices are predicated upon the assumptions that the internet is a dirty, threatening, undisciplined and possibly primitive place; that the internet is guilty of causing disease, and that the internet needs to be disciplined (or organized or perhaps colonized) by the actions of outside state forces. Net hygiene practices are promulgated in a number of ways – through the influence of nongovernmental organizations which lobby for stricter government regulations of the internet environment; through programs in schools which purport to teach healthy internet practices and in the use of government-sponsored public information campaigns. In this way, the authority of the physician in China is combined with the power of the state in a “health campaign,” which might include the use of wall posters, various commercials broadcast on television or on the radio, or exercises carried out in the workplace – in a manner similar to other political propaganda campaigns which have been used in China to secure social support for a particular political end. Here, one can point to the “love teeth day” campaign carried out nationwide in China every year since 1989. Nine government agencies have combined to encourage China’s citizens to engage in preventive oral care (tooth brushing), as well as to have cavities filled. Here again, China was said to be suffering from an “epidemic” of cavities, for which the solution was government-mandated tooth brushing in every household in China (World Health Organization 2011). China implemented a public health campaign in 2003,

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as well, this time using the slogan “Declare War on SARS!” Here, the proletarian masses were encouraged to unite behind the government to conquer SARS (Hanson 2008). Here one can trace a line between more traditional governmentsponsored health propaganda campaigns carried out in China and current efforts to educate China’s population about best practices for preventing internet addiction. One of the standout efforts of China’s campaign is the creation of a 38-episode situation comedy which premiered in 2005. The series, called “The Story of Shan Dian Mao” was sponsored by the China Youth League’s Online Movie and TV Center, the China Youth internet association and a civic organization called “care for the next generation.” The analyst Lupton refers to preventive politics as a politics of “health surveillance.” The individual, along with the medical community and the state, is asked to pay attention to the way in which his health status is developing at present and into the future. That is, once health is defined as a collective good, society acquires an additional right to survey citizens in order to engage in preventive medicine – so that society will not be hurt by an individual’s illness, and so that illness does not become a burden or debt to society. When one combines the health surveillance model with the medicalization paradigm, it then leads to a situation where an individual’s social activities are no longer separate from his political activities and where every area of his life now comes under the control of politics and is policed, because it is all seen as part of the collective whole. In addition, his identity is affected not only by whether he currently has a disease, but whether he is likely to acquire a disease in the future. Under this new set of conditions, one is no longer required to share one’s personal medical information or other information about their individual practices and behaviors only when one becomes sick. Rather, the institution of profiling means that everyone is now always the subject of medical intervention, either because they are currently sick – or because they are potentially pre-sick. In the case of internet addiction politics, the acceptance of the “pre-sickness paradigm” (my term) means that it now becomes acceptable for the state and its institutions to monitor the personal internet practices of all citizens all the time. In this way, individuals can be identified as at risk, so that they can preemptively be “vaccinated” against internet addiction – perhaps through receiving additional education or socialization against the dangers of increased contact with this Western medium. Vaccination might also include limiting internet access or engaging in filtering and monitoring for an entire population deemed to be at risk, even if not all of them end up addicted to the internet. Here, the question becomes where the line lies – in what situation is it acceptable to limit the access of all individuals because of the risk that some will develop a problem? If 10 percent of the population ends up addicted? Twenty percent? This is ultimately not a medical decision but a political decision. Other new medical treatments aim not to limit access but rather to change the “payoff” which the addict feels when he uses the substance. As Hall and Gartner (2011) point out, vaccines are a new approach in treating addiction. Traditional

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vaccine treatment is aimed at inducing immunity in many patients, so that they are no longer susceptible to the addiction. In contrast, pharmaceutical “vaccines” which aim to treat addiction in essence work to decrease the pleasure the addict feels from his addiction (for example, causing extreme nausea if one attempts to drink alcohol) so that the would-be addict becomes abstinent, since there is no “payoff” attached to the use of the substance. (It thus decreases the individual utility of the addictive substance.) Thus, one can be vaccinated against internet addiction through the denial of access to pleasurable internet sites. (Once the internet becomes only a place to read Communist party documents, watch video broadcasts of edifying films or study grammar and math, the would-be addict no longer finds the medium pleasurable in the same way. In addition, the internet no longer provides a means of “escape” if it becomes an exact virtual replica of one’s own real society.) But how else can the state be sufficiently prepared to intervene the moment that the patient’s status moves from being merely pre-sick to being actually sick? And how else can the state preempt the situation in which one becomes an internet addict unless it monitors everyone’s behavior all of the time? In this way, every single internet user in China has now become a potential internet addict – at some point in the near or distant future – and every single individual now requires careful and diligent monitoring, in order to preempt the eventuality that they may someday succumb to the illness – which perhaps lays dormant in all. (In this way, one can only be viewed as guilty of harboring internet addiction, until one proves by one’s exemplary behavior that one is not, actually an internet addict – but one can never be viewed as innocent, regardless of one’s behavior at the present time or in the future, since one is always viewed, to some degree, as a pre-addict, whose addiction has perhaps not yet bloomed. In this way, the internet user is viewed as tainted and corrupted by his association with the “territory” of the internet, in the same way as the tropical or subtropical native is viewed as a source of disease and sickness, by virtue of his connection with the tropical clime which is seen to cause or harbor disease (Livinstone 1999). As Milne points out, individuals are affected by risk discourse even before they experience the adverse effects of a particular activity. Today, both Western medicine and Chinese medicine increasingly make reference to the notion of “susceptibility” – or attempts to identify and treat persons in the present in relation to ills that they are predicted to suffer in the future (Rose 1999 18). Those who are profiled as being “at risk” may alter their behaviors in relation to an activity and may also find that their own sense of self is altered as a result of having been identified as at risk. They regard themselves as weakened and vulnerable. Risk is thus not an objective judgment regarding the probability of harm but is rather a reflexive construct, in which citizens think differently about their identities once they are identified as being “at risk.” Those who are told that they are “at risk” may think differently about their bodies (Rees et al. 2004), their life choices and their futures. Robertson suggests that being diagnosed as being at risk may create a climate of anxiety for sufferers, even in cases where they may have interpreted

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the data incorrectly. That is, even those who do not fit the risk profile may think that they do and may alter their behaviors and sense of self as a result (Robertson 2000, 221). Here, Greaves refers to individuals who have been identified as being vulnerable to contracting a disease but who have not yet done so as “partial patients” (2000). He notes the ways in which being diagnosed as likely to contract a disease at some point in the future nonetheless changes the way in which an individual constructs his identity. He notes that that: “patients may adapt so completely to the labels assigned to them that the whole of their behavior and demeanor is visibly altered in a stereotyped way … once labeled, people are viewed differently by others and they come to perceives themselves as different” (28-9). And it may be that those who occupy a minority position within a society or a position of lesser power may be both more likely to be labeled as at risk and most likely to experience an altering of their self-images as a result. Here, we can think of the phrase “women, because of their delicate constitutions, should not seek higher education.” We can also consider Nazi medicine and the ways in which profiling of ethnic groups, like Jews, shared an overlap with programs of eugenics. Briggs and Briggs (2002, 256) note, one tends to assume that statistical renderings of disease patterns are somehow objective. However, profiling of minorities has also been implicated in a politics of blame, when profiling is combined with stereotypes about particular ethnics groups in studies which seek to explain why certain populations are more likely to fall ill with a particular disease. Such studies often end up considering lifestyle questions and making associations between poverty and poor hygiene, for example, or between race or sexual preference and sexually transmitted disease.) Profiling often may involve a majority culture indicting the culture of a minority through, for example, misinterpreting minority cultural practices. Furthermore, profiling may change the way that the subject culture thinks about itself and itself in relation to the disease. Literature on women who are at risk of developing breast cancer indicates that they think differently about their bodies, and may conduct themselves differently as a result. The labeling of them as “at risk” affects them psychologically and physically (frightening them and causing them to be distressed). It may also alter their relationships to their bodies and to their environments. Robertson suggests that women who fear developing breast cancer may “think of their bodies as the enemy.” Perhaps those who fear developing internet addiction might also think of the internet or technology as their enemy. Here it is easy to see how individuals might begin to engage in their own efforts at self-policing their internet use, or might err on the side of caution in using the internet – if they are worried that they might become an internet addict. The stigma which mental illness carries in China also provides an incentive to Chinese internet users not to exceed the bounds of normal internet use, since being labeled mentally ill (or even at risk of becoming mentally ill) has the potential to affect one’s education status, employment prospects and marital prospects. Here, the state has attempted to head off this possibility through preemptively launching strategies aimed at controlling the behavior of the hypothetical would-be internet

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addict. Here, Greaves suggests that the notion of the “partial patient” muddies the waters, since there is no longer such a clear and pronounced distinction between one who is sick and one who is well. Rather, instead, there exists a sort of continuum, in which one might be described as being “currently well, but also pre-sick.” There are also ethics issues associated with labeling individuals as being at risk. The philosopher Philip Kitcher (1996) asks how people’s lives will be affected if they know in advance that they are the carriers of a disease or likely to develop a particular disease due to genetic susceptibilities. He makes a libertarian argument, noting that an individual should have the ultimate decision-making authority regarding risks which he or she willingly undertakes. He warns against a system in which individuals might be preemptively turned away from certain jobs or activities because they are regarded as being more likely than most to suffer harm as a result of these activities. Here the example of screening for internet addiction susceptibility can be understood using Kitcher’s logic. The danger presented by the profiling of wouldbe internet addicts is two-fold. First the addiction model posits that the wouldbe addict is powerless against the stimulus. (In contrast, Kitcher argues that “increased likelihood” does not mean that one will inevitably develop a condition. The individual should have the right to decide if they want to run the risk of developing the condition, as well as deciding for themselves what measures they are willing to undertake to lessen their risks of developing the condition. A solution in which an employer or the government decides for the citizen that they should not be “allowed” to undertake the risk is essentially paternalistic and denies any sense of agency to the would-be computer user.) Secondly, it risks creating two classes of individuals – those who are able to partake fully in the economic and intellectual benefits of the knowledge economy and those who are unable to do so by virtue of their underlying susceptibilities. In the Chinese case, the situation seems particularly inequitable and unjust since the medical model posits that women students in particular are likely to become addicts (Yen et al. 2009). Thus, utilizing preemptive screening for would-be addicts and steering such individuals away from profitable knowledge careers means that women students in particular might be routinely shut out of this route towards economic advancement. It also raises the possibility that the argument “this is too dangerous for you as a women student and I can’t allow it” can become a ready-made justification for the practice of discriminatory education and employment practices. Thus, one can make the argument that profiling of would-be internet addicts ultimately serves the state rather than the individual. By identifying who is vulnerable to becoming an addict, policy-makers can reassure themselves that everyone is not vulnerable to becoming an addict. In addition, as Greaves notes, the use of probability models to identify those most at risk of becoming diseases also serves the function of transferring the “blame” for the problem to the individual alone. That is, it is far easier for the state to look at the obesity epidemic and to conclude that individuals who know they may be heading towards obesity

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should do more to help themselves, than for the state itself to take on a largescale program aimed at identifying the ways in which society and its institutions may be contributing to the problem of obesity (through, for example, subsidizing only the prices of unhealthy foods and paving green spaces to put up commercial real estate) (30). In the same way, identifying those at risk of developing internet addiction can be seen as a way of “letting the state and society off the hook,” through making it possible not to have a conversation about whether children in society are bored, overworked and lonely – thus causing them to seek solace in online games and chatting. Instead, students are blamed for not being sufficiently engaged or sufficiently disciplined. Politics of Treatment Particularly in China, those who undergo treatment for internet addiction may be treated harshly. Legislation regarding patient’s rights in China – and elsewhere in China – does not recognize institutions of individual patient autonomy as they are commonly understood in Western Europe and the United States (Fan 2010). Rather, a Confucian perspective offers the rationale for both medical ethics and medical legislation regarding patient rights. Within that perspective, the patient is seen as occupying several roles – that of an individual sufferer, and that of a member of a family, both nuclear and extended. For this reason, the physician is able to meet with a designated family member who may “represent” the patient and medical decisions can be made within the consent of the individual patient. In some circumstances, the family representative may decide that the patient does not need full information about his condition (or even his diagnosis) or his treatment options and the decision may be made by his family to withhold information from the patient about his own condition. As Zhang writes: “Traditional Chinese culture, Confucianism, in particular has a non-individualist conception of what it is to be human. It conceives of people fundamentally as members of social groups – specifically, the family, the clan, the political community and the state – not as atomic individuals as perceived in modern society” (2010, 259). In addition, as Yang shows, China’s medical institutions are also guided by Communist principles which emphasize the notion that the medical profession serves both the individual good of each patient, and the common good of society. Health work is thus seen as serving “the people” both individually and as a collective. Here, as well the physician’s orientation towards the patient may be affected, as each individual internet addict may be seen as himself and also as a member of the group of “all internet addicts” and in relation to society as a whole. Here, the physician is interested both in curing the patient and restoring social order within the community. Although legislation was passed in 2009 supported by the Ministry of Health which outlawed both the use of electroshock treatment and the use of physical

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punishment in treating internet addiction (after a rash of investigative journalism pieces which implicated internet treatment facilities in the deaths of several youths), those being treated as patients in China still appear to have very few rights in comparison to those in Western Europe and the United States. Human rights groups have suggested that the lack of patient autonomy is a human rights abuse issue, while others (including Chinese sociologists) argue that patient autonomy is not a universal norm but a Western one. However, international human rights groups have not tended to see the cultural or ideological perspective as it affects medical practices, instead seeing only the fact that many Chinese internet addicts are seemingly treated without their consent. This particular issue is explored at greater length in Chapter 5 of this manuscript – in which I attempt to present the Chinese perspective. Here we can identify one other institutional difference in the treatment of internet addiction in the US versus that in China. Here, the overwhelming impression is that there are many players who cooperate closely together to treat internet addicts both after they have developed a problem, and preemptively to see that they do not develop one. The Chinese health care authorities work with game developers, internet café proprietors and parents to implement a system which includes depriving addicts of access to computers, websites and specific games. Here, one can trace a pattern of increasing cooperation in the treatment of internet addicts, particularly in situations where those addicts are young people. Here, analysts have begun to question whether the overall aim of these treatment regimes is to prevent or cure internet addiction, or simply to have an excuse for depriving individuals, particularly teens, of access to the internet (Human Rights international report). In addition, we can identify attempts to treat the problem through legislation, in this way increasing the ways in which the patient is also the subject of government regulation. For example, in July 2007, the Chinese government formally banned the opening of new internet cafes (Jonathan Watts 2007). In July 2010, China passed its first law on online games, with content drawn up by the Ministry of culture. New regulations for playing online games include requirements that players have to register their real names before games online, and that on-line games targeting minors must be free of content that leads to the imitations of behavior that violates social and moral understandings and the law. Ministry spokesmen note that the law “is expected to protect Children from unwholesome content and internet addiction” (China Digital Times 2010) And beginning in February 2010, the Chinese Ministry of Culture announced that it had reached an agreement with the six major online game operators in China (wanmei.com; Tencent; Shanda; Netease; Changyou and Giant interactive) to implement a socalled “self-discipline program.” Each game now has a page which includes a phone number which parents can call. Parents can register their children’s game account with operators – if they find out that their children are addicted – and operators will implement control to limit children’s access or stop providing services (China Tech News 2010).

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Finally, there have been new treatment protocols in which internet addicts are given pharmaceuticals such as Prozac. Here, of course, the question becomes one of whether the addict is simply treating one type of drug for another. In his work on the politics of methadone and heroin addiction, Philippe Bourgois argues that state-run treatment programs for addicts frequently substitute one addiction which is state-sanctioned for another addiction which is not. He argues that methadone programs, for example, merely create a “good addict,” defined as one who receives methadone, rather than heroin from the state through a program, rather than freely on the street; and who does not derive pleasure from his addiction, in contrast to the heroin addict who may derive pleasurable feelings. Thus, the methadone addict undergoing treatment is a good subject, while the heroin addict is a figure who is undisciplined (Bourgois, 2000). Here, Keane describes methadone programs as “regulatory technologies aimed at creating productive and obedient subjects.” Methadone addicts, thus become socially controlled drug users (Keane, 2008). Similarly, China’s own Tao Ran has spoken out in favor of giving controlled doses of pharmaceuticals to Chinese internet addicts undergoing treatment, arguing that they require a “substitute” for the happiness which internet access once provided to them. In this chapter, we have looked predominantly at the ways in which the state can construct, describe and discipline the internet addict. In the next chapter, we consider the politics of health security in looking at the ways in which the concept of an “epidemic” of internet addiction in particular, provides a pretext for expanding the power of the state relative to the population.

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Chapter 4

Biosecurity and the Securitization of Internet Addiction In the previous chapter, we spoke of the “medicalization” of internet addiction. I showed how what might have been described as merely problematic social behavior instead became the province of the institutions of curing, and hence of the state. In this chapter, we go further into the medicalization problem, in considering whether as a “medical disease” internet addiction now also can be fit within a securitization paradigm. As Maclean (2008, 475) argues, global changes have led to an altering of the ways in which security threats are traditionally defined, expressed and understood. Here, I argue in China in particular, internet addiction has been conceptualized as a threat to the population, and therefore to the security of the state. Arguably, in shielding its population from contracting internet addiction, China is merely engaged in the production and furnishing of human security to its citizens through carrying out measures to inform, alert and protect its population. In this chapter, I ask: What are the perceived costs of internet addiction – in terms of state security and how are decisions regarding the regulation of internet addiction be justified in terms of state security? Here, I make the argument that there is nothing new about a state taking steps to guard its population against a perceived health threat. While internet addiction is clearly a new type of health threat, the steps taken by states to confront that threat are far from new. Rather, throughout history, analysts have pointed to the ways in which states have undertaken public health measures in times of epidemic – including the application of practices of surveillance, quarantine and citizen registration. Indeed, discussions regarding the isolation of lepers can be found in the Old Testament, and practices of quarantine associated with plague can be traced back to the 1300’s. That is, fear of contagion is certainly not new – nor is the idea that those who might be contagious have, at that moment, fewer rights than others. The needs of the many are considered more important than the needs of the few. Internet addiction is thus constructed as a disease, with the internet itself acting as a disease vector, “infecting” the population with a disability which renders them unfit for service, defense, or the taking on of a productive role in the state. By framing internet addiction as a disease, a large-scale social problem and an epidemic, China’s government has now effectively created a rationale to justify initiating large-scale public health measures aimed at protecting citizens from the dangerous internet. Thus, the decision to construct internet addiction as an epidemic requiring a national security solution explains why China, which is not

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always forthcoming with information about its population or its health, has been so quick to publicize information about internet addiction rates. And as with all mobilizations against large-scale contagions which have occurred historically, the question of human rights and autonomy is clearly expected to take a back seat to the more serious and compelling national security issues. In this way, China has cleared the way for taking harsh measures aimed at seizing control of territories associated with the spread of large-scale pathogens – both in claiming actual territory (like an internet café) and in claiming virtual territory (through seizing control of cyberspace itself). That is, if one accepts the claim that there is an “epidemic of internet addiction,” then it perhaps also becomes understandable and acceptable that China’s government should want to shut down any police sites and individuals which might be associated with the spread of contagion, just as public health personnel have historically done during pandemics. However, while the usual public health measures might include shutting down schools, churches and shopping malls where people might gather to exchange germs, in the case of the “scourge” of internet addiction, the state has chosen to shut down and monitor internet cafes and to install filters and firewalls which would protect citizens from the internet itself as well. Here, one can notice that societies which report epidemics of internet addiction also appear to have very strict regulations in place for controlling other aspects of internet use. For example, China also has extremely strict laws regarding what constitutes harassment online – making such practices as forwarding a “dirty joke” or making a risqué remark subject to criminal prosecution (Chuangjiao 2008). And Russia has very strict laws regarding libel and slander. Thus, it appears that authoritarian governments which do not recognize the internet as private social space – not surprisingly – seek to more tightly control what their citizens do there, including medicalizing practices of internet use. As Maclean (2008, 476) points out, once a health problem becomes securitized, in this case through applying the designation of an epidemic or pandemic, the results are frequently more international awareness as well as the targeting of greater resources to the problem. In this way, securitization allows health experts to move beyond the role in which they are merely health personnel, to instead become political players as they frame a disease control strategy. Here, Feldbaum et al. (2006) argue that the securitization of AIDS was responsible for the allocation of global foreign aid, for example, as well as for the carrying out of changes in social policies both domestically within afflicted nations and internationally. In recent years, analysts have increasingly come to frame health as a security issue, highlighting the ways in which health crises can destabilize both a state and the international system. Epidemics and mass contagion can threaten regime stability, and healthy, active citizens are a vital resource which states need to be able to count on for reasons of industrial productivity as well as defense. Thus, the maintenance of a healthy population has implications for a nation’s financial viability, its industrial productivity, and its ability to maintain a military and protect its borders. Conversely, health threats – from forces as targeted as biological

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warfare to those as mundane as obesity – threaten productivity, social order and long-term political and financial stability in a society. For these reasons, every state wishes to maintain its citizen’s health, protect them from disease and combat emerging health threats (Feldbaum 2009). As Jennifer Holdaway states the problem: Not only is health a good in itself, but without it, people cannot enjoy the opportunities for education, employment and personal fulfillment that economic growth may bring. Meanwhile, ill-health undermines human capital, lowers productivity and drains private and public resources. (2010, 15)

Illness or disease thus threatens the state in two ways. In realist terms, illness can be described as an external threat – since it decreases the relative power of a nation vis à vis other competitors in the international system. Here, we can consider, for example, the US National Intelligence Council’s report which describes the ability of the global disease AIDS/HIV to impact strategically important populations including the armed forces (in Russia, Africa and elsewhere). Here, analysts describe the ways in which having HIV affects the ability of a soldier to do his job. In addition, they point out the fact that significant population losses or disabilities due to AIDS could destabilize a region. Here, the report quotes Peter Piot of UNAIDS who asks, “How can government function, public services operate, agriculture and industry thrive, and law enforcement and militaries enforce security, when they are being stripped of able-bodied and skilled women and men?” Thus, as Porter (2009, 49) argues, there has always been a connection between the emergent modern state and the health of its subjects. Population is thus a factor in the economic and political health of the nation. Arguably, a situation in which 20 percent of China’s most dynamic and able-bodied young people are no longer participating in the military or academic communities because they are disabled by internet addiction presents a similar threat to China’s security, both regionally and internationally. And as Maclean points out, the spread of infectious disease has been conceptualized as particularly threatening during periods of rapid economic transition and globalization. Here, she points to the Industrial Revolution, noting the ways in which the transport of industrial outputs combined with increased population mobility to create outbreaks of new diseases (2008, 478). In this situation, the governments of the industrialized nations responded quickly and decisively to the 1918 Spanish Influenza outbreak, for example. However, as Porter (2009) notes, until quite recently state administrations rarely admitted overtly that the undertaking of public health and hygiene practices is about guaranteeing of state security. She terms this understanding the “new public health” and describes the relatively new notion that the provision of health care is not primarily about charity or the display of Christian virtue – but that it might actually be a part of state-building (Risse, 1999). However, physicians and healthcare workers have always been part of the apparatus of government –

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serving as physicians to particular leaders, or more generally being assigned to a city or region since as far back as Ancient Greece and through the Middle Ages (Porter 2009, 12). The new narrative – which sees the state’s provision of public health to citizens not as a matter of charity, but as a matter of pragmatic utility, is thus a type of realpolitik. Here, the emphasis is on the payoffs which a state can accrue through providing and overseeing its citizens’ health. Here, we can regard good health as a form of hard power which a state can deploy in the international system. That is, the maintenance of a healthy population has implications for a nation’s financial viability, its industrial productivity, and its ability to maintain a military and protect its borders. Conversely, health threats – from forces as targeted as biological warfare to those as mundane as obesity – threaten productivity, social order and long-term political and financial stability in a society. For these reasons, every state wishes to maintain its citizens’ health, protect them from disease and combat emerging health threats (Feldbaum, 2009). Finally, the biosecurity model assumes that the state’s foremost interest is in the growth of the state, both in terms of power and territory. Thus, state policy is predisposed to look at the patient as part of the state’s population, which serves as a resource for the defense and growth of the state. The model rests on the assumption that there is a relationship between health and security and health and ideology. In this model, health is a collective good which serves the state, acting as a force multiplier. It is vital to a nation to have a health population in order to project power abroad. A health threat can also present an internal threat to a society – since it can lead to social unrest – through the outbreaks of epidemics, the marginalization of groups of people, and the growth of “slackers” who refuse to participate in society (Lupton 2003). Here, health is seen as both a private good – in which the physician’s duty is to the patient – and a public good, where the physician may experience divided loyalties, with a duty both to the patient who is ill and the larger society, which might suffer if exposed to this illness. The ethical issue arises when the best interests of the two are at odds – when what is best for society contradicts what is best for the patient. Here, the dilemma may be expressed as a contest between the physical comfort and care of the patient – and the security of larger society. And in many types of states – not just those which are totalitarian – the emphasis on security may win out over the emphasis on the individual.1 The decision by China’s authorities to treat internet addiction as a security issue explains why the combatting of internet addiction has been the target of increased government cooperation, and why such a large amount of resources have been devoted to the study, measurement, control and preemption of internet addiction – in contrast to other medical conditions found in China. China can justify allocating serious resources to the development of internet citizen registration and tracking regimes, as well as the development of internet filtering software, and development of internet curfew schemes if the issue is seen as one of national security importance. As Maclean notes (2008, 484) “Health has habitually been regarded as a ‘high politics’ national security issue when an issues such as the international spread of disease has threatened a country’s economic

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or military strength.” Thus, attaching the language of international security to an issue is thought to bolster international initiatives. The world is forced to take the issue more seriously, to put it at the top of the agenda, to devote manpower and economic resources to its resolution, and perhaps as importantly, to cooperate in solving it. But there are downsides as well. Plague Logic and the Development of Coercive Public Health So-called “plague logic” thus provides a justification for the implementation of public health measures and increases in state power vis à vis the individual. Once a condition is recognized as a medical condition rather than merely a social problem, the state has a new authority to undertake a variety of coercive measures aimed at defending the health of society as a whole through disciplining the individual or group which has been labeled as a possible source of contagion (Porter 2009, 31). Lupton describes how an epidemic logic takes over, as the state seeks to take immediate action to contain or eliminate the threat. She notes that “under the logic incited by epidemics, forms of regulatory intervention into the lives of bodies and populations which might, in other circumstances, appear excessive can now appear as justified forms of damage control and prophylactic protectionism” (1993, 30). The construction of an epidemic thus allows agents of the state (or experts acting on their behalf) to take extraordinary measures against individual rights in the name of public good. Lupton (1993, 29) notes that individuals can be quarantined or evicted without their consent. In Brazil, entire villages of slums have been burned and families made homeless, all in the name of stemming contagion. Furthermore, parental wishes can be overridden in an epidemic. The government may vaccinate children in schools or clinics. And surveillance can increase. The government can keep records of who is infected, follow up with patients, and even inspect living conditions in homes. Individuals can lose their right to mobility, be turned back at borders, or refused entrance on airplanes. And using the argument that it is also important to prevent epidemics before they blossom, the state can undertake coercive practices preemptively (Lupton, 65). Here we can point to historic examples of state practices of public health, considering for example, the way in which during the plague of 1347, officials in Venice turned away ships from infected areas in the belief that they were carrying diseased or potentially diseased individuals (Porter 2009, 34). From this first institution of quarantine, we can see how the control of borders, of egress and access has always been a part of the practices of public health. In this way, arguably, internet filtering can be seen as a sort of modern-day type of disease control – which is concerned with the patrolling not of physical borders, but of virtual borders. Here, places like internet cafes represent a “frontier” or “interstitial space” between cyberspace where viruses grow and the real world which is not yet infected. We might pause to consider here how much of this “plague language”

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has already been applied to our thinking about cyberspace, which contains viruses which need to be quarantined, filters and notions of safe computing. Territoriality Epidemics have always led to the growth of new state powers and practices, particularly in the areas of territoriality. The geographer Robert David Sack defines territoriality as “a spatial strategy to affect, influence or control resources and people, by controlling area” (1986, 1). He notes that territoriality can be turned on and off, and that frequently citizens are not aware of the ways in which territoriality is being deployed. More recently, those in the field of tropical medicine have suggested that the rhetoric of “tropicality” essentially presents the entire region of the Third World as a dangerous pestilential place that requires strict state supervision and control. In this way, the rhetoric of pestilence and danger presents an apologetic for imperialist practices throughout the third world (Bankoff 2001, 21). That is, in each instance, the threat posed by a particular location allows the state to engage in a new type of territorial control. In constructing a site of danger in which government intervention is required to quell the threat, rhetoric may often present the site in moral terms – along with public health terms. Again, this practice is hardly new. Watts (1997, 11) describes the way in which the Doge of Venice in 1497 blamed outbreaks of pestilence on sins committed by individuals and groups who gathered in brothels and gambling houses. And as Willrich (2011) points out, US public health authorities in the Deep South described the huts of sharecroppers as dirty and pestilential in campaigning to carry out smallpox vaccinations in the regions. Frequently, public health officials indicted the sharecroppers themselves, suggesting that laziness or a lack of sexual restraint was in some way responsible for the creation of unhealthy conditions. He notes that the inner city slums of recent immigrants to New York City were again described as both dangerous and somehow morally suspect. One can also point to the ways in which the US government implemented prohibition and closed bars and taverns in its fight against a “plague” of alcoholism in the 1930’s as well as the ways in which in more recent years, governments have closed gay bathhouses and venues in its fight against AIDS in the 1980’s. Similarly, one can point to policies implemented in the 1990’s when the governments of many nations including India, Russia, China, Korea and Singapore undertook measures to protect society against the threat of internet addiction through closing down internet cafes or passing harsh legislation to restrict their hours of operation or their location. Clearly, the construction of an “epidemic of internet addiction” also has ramifications for how citizens and would-be internet users conceptualize of the hazards of cyberspace and internet use both for themselves and for the state. Here, the government’s adoption of securitization discourse also serves to alter citizen perceptions, increasing their fear of the internet as a disease vector and the sites associated with contracting the “internet addiction” virus.

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Here again in Chinese, Korean and Indian lore (and sometimes in American lore), the internet is constructed as a site of danger – and perhaps also a place of pestilence. Disease and the fear of disease (and its medicalization) thus works to construct a barrier or border, walling off the population from something which is dangerous, threatening and contagious. Lynch (2002, 547) argues that because the internet can be used to access sexual materials, there has been a tendency to paint the entire internet as a place of perversion. And here, the argument can be extended to therefore suggest that anyone who wishes to obtain access to such a dirty, evil and malignant place must somehow be dirty, evil or malignant oneself. One can therefore speak of the internet itself with disgust, and of those who wish to access it as equally disgusting. Here we might also consider the ways in which the “plague logic” of internet addiction epidemics relies on an extension of tropicality rhetoric. In painting cyberspace as malignant, overripe and dangerous, the argument is now made that people who wish to access it must first be inoculated in some way, through training and warning. They must be careful in how they interact with the environment, and they must be careful about the amount of time they spend interacting with the environment. That environment is viewed as needing to be sealed off from the rest of society. Again we encounter the notion that those who travel to such a dangerous place somehow come back tainted themselves. In many popular media articles, we see a depiction of those who spend a great of time in cyberspace as tainted. In addition, legislation on protecting children in cyberspace frequently relies on this notion that children are pure but that they are somehow corrupted by the internet. The ways in which public health has been supported by legislation are also not new – as is the idea of “criminalizing” disease and the diseased themselves. Rather, as far back as 1604, the Plague Act in England made it a crime to attempt to flee from a diseased region which had been quarantined (Porter 2009, 38). Thus, the fact that in the modern era in both China and the US, public health officials concerned with internet addict work together with legislators and police is not barbaric, a human rights violation, nor new. Rather, it has always been so. In China in particular, the state’s control over territory has been codified in legislation – both on a local and regional level as well as a state level. In an article published in “Zonaeuropa,” China Daily describes the “big earthquake” which shook Guanxian Province in China in September 2009, where reorganization led to the shutting of 21 internet cafes. Here, police inspections took place in all internet cafes which were described as places frequented by “social idlers” who congregate to “cause trouble and bring about social instability.” (These same cybercafés were shut down in 2003, ostensibly to prevent them from serving as sites for the spread of SARS.) State power may thus use either zoning or fines to carry out practices of territorialization, ostensibly under the guise of promoting public health and sanitation. Here, China Daily (2009) notes that in Guanxian province, a fine of

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10,000 yuan by police may be the same as shutting the café, since most café owners do not make enough money to pay the fines. Social Control Epidemics thus serve to increase state power as the state carries out coercive powers of territorialization and social control. Porter (2009, 37) notes that from the fourteenth century, then, measures taken to prevent the spread of plague were aimed at containing the panic, civil disorder and social breakdown which the epidemic threatened to create. Understanding the way in which the disease was spread was only relevant inasmuch as it affected the means of containing social disorder. Protecting health was only considered in relation to the economic and political survival of the status quo. During times of illness, public order was always a concern. Thus, officials were concerned with controlling the movements both of those thought to be ill, and those thought to be capable of spreading illness. Porter notes that economic policy was often entwined with health policy. Plague deaths created labor shortages throughout Europe and lords of the manor feared that their laborers would leave for cities where wages were higher, leaving no one to till the fields (Shrewsbury 2005). Thus, restrictions were placed on worker mobility and the ability to exit a region. Similarly, if internet use is seen as a type of “exit” from the system, the state is perhaps justified in implementing regulations that would keep people in places where their employment, industry and skills were needed. And in making an historic argument, one can consider the ways in which pandemics have traditionally generated major economic and social repercussions. Here, Bolton (1996) argues that the plague in the Middle Ages created serious and widespread labor shortages for several generations following the outbreak. As a result, workers left the manor to seek high wages in urban areas, agricultural productivity declined and inflation soared. In addition, gender roles changed due to differential mortality rates from the plague and fertility rates declined (Bolton 1996, 54). A government which showed an awareness of the serious social unrest and disorder engendered by an epidemic might thus be justified in implementing strict measures to prevent the outbreak of such an event. Here, one can consider as well the profile of the typical internet addict – a young male with the ability to acquire higher education and contribute decisively to China’s economy. A decline in the size and strength of these labor inputs could have a major impact on China’s economy, including the withdrawal of social support for China’s aging population. For this reason, it is important to acknowledge that public health measures are invariably aimed at preserving existing social structures and institutions through stemming the growth of epidemic disease and the resulting social unrest. That is, the state uses various means – including quarantines and disease registration – to prevent the development of social unrest and disorder. Rather than viewing an event which destabilizes society as an opportunity, then, for the development of new, more equitable social institutions or the rewriting of social norms, public health in essence seeks to return things to the status quo. Thus, public health is generally

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regarded as reactionary rather than liberating. Therefore, there is a fundamental disconnect between those who seek to preserve the status quo through containing internet addiction, and what internet libertarians see as “fundamentally anarchic character” of the internet itself. Public Health and State Defense In reconceptualizing the role of the state in providing health care to citizens, we must also reconceptualize of the role of the physician or public health worker. Here, medical personnel play a seamless role from the initial discovery of the disease through to the implementation and enforcement of public health measures aimed at controlling or curing the disease. That is, one can make the argument that in China in particular, physicians have worked with the state to “make knowledge” about what disease is, who is diseased, and who can be treated. Then, once physicians have “created” the disease through defining it or “discovered” the disease, they may then go on to create an epidemic or a state of emergency – in which large individuals are found to have the disease, and the coercive measures noted above can now be implemented. Within the context of the new public health, physicians serve the state in diagnosing patients, but also in carrying out coercive policies or providing support for coercive policies like slum clearing of diseased districts; the creation of pesthouses; the involuntary incarceration of the sick; and the invoking of quarantine measures or vaccinating people against their will. Here as well, the claim that state’s steps to confront these steps encroaches on the sovereignty of citizens, borders and raises issues within the international system is not new. Neither are claims that such practices violate citizen rights and are applied unfairly. A critical approach to the study of public health thus focuses on the ways in which historically public health practices favored state interests and the pursuit of group safety (or health security) over the rights of the individual. In Biblical times, lepers were sent away from the community in order to avoid infecting others. In the Middle Ages, individuals responsible for public health and safety frequently acted to quell an epidemic through instituting a quarantine policy. In such a situation, the ramifications upon a particular individual may have been devastating in forcing family members to stay confined with an ill member of their household rather than fleeing the area of contagion. In the contemporary era, there are numerous cases of individuals and households being involuntarily vaccinated against small pox, so that group safety could be maintained (Willich 2011). In each of these situations, medicine is seen as having served state interests over the interests of the individual, leading to the growth and strengthening of the state. (Indeed, some argue that with the plague, the current system of nation-states in Europe might never have come into being. As nascent political institutions struggled to cope with social disruptions, including refugee streams, as a result of the plague, they evolved a system of controls which tied individuals to the land and regulated labor practices.)

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As Fidler argues (in Feldbaum et al. 2010, 83) global health is “merely a tool, an instrument of statecraft the value of which extends no farther than its utility in serving the material interests and capabilities of the state.” Here, Feldbaum (2010) points to major developments in the field of health policy, noting that state drives to improve citizen health have traditional been associated with state-building. Here, we can reference the drive by the US to find a vaccine for yellow fever – which coincided with the building of the Panama Canal, and the establishment of London’s School of Hygiene and Tropical Medicine which coincided with the British drive to colonize tropical and subtropical areas. Similarly, arguably, the Chinese state fixation on problem of internet addiction may be seen as part of a larger strategy to increase state power in order to “colonize” and organize the internet through internet hygiene practices. Disease control can thus be seen as a form of state-building. In times of epidemic or perceived epidemic, the state may identify certain groups as carriers or disease transmitters, and then particular strategies may be implemented against targeted groups – in the process, increasing state power against the group and also altering the balance within groups in a society. As Watts writes: Though epidemiological contexts differed, very often the elite would claim that the disease targeted one particular set of people while leaving others alone. Arrived at through a complex of cultural filters, this perception was part of what I term the “disease construct” – in establishing official responses, this construct determined what, if anything, should be done in an attempt to limit disease transmission. (2007, xv)

And as Porter points out (2009, 7) health practices have long been implicated and entwined with practices of imperialism and state-building. Here, health is seen as a collective action problem – whereby state acts to regulate citizen health practices in order to guarantee security for all citizens. It is, at base, a type of power politics. Furthermore, widespread illness is often associated with disruptive, even revolutionary social change (Porter 2009, 87). Thus, a state wishes to guard against illness not only to shore up its power through having a health population, but also to guard against the types of social disruptions (famine, refugees, labor shortages, inflation) which frequently accompany an epidemic. Here, Elbe suggests that securitization of an issue takes the issue away from civil society, and instead puts it into the portfolio of intelligence and the military. Thus, a private sector solution is less likely. In addition, he argues that securitization gives the actors tasked with resolving the issue more leeway in terms of overriding civil liberties. In particular, when coping with a pandemic or epidemic disease (such as HIV), the state risks implementing measures to track those thought to be hosts or carriers, as well as to limit their movements or autonomy. That is, once the language of emergency has been introduced (Calhoun 2008), the state is now able to take on a larger role and in point of fact to implement a sort of martial law to cope with the threat. As Elbe (2006) notes, “securitization means that the issue has

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become an existential threat requiring emergency measures and justifying actions outside the normal bounds of political procedures.” Indeed, we can consider the tendency in the United States in particular to use the phrase “War on . . ,” to identify a social issue which has been securitized. In the past decades, we have seen a war on terror, on drugs, on obesity and on poverty. In each instance, this has led in the United States to the appointment of a so-called “policy czar” (such as the Drug Czar, Unemployment Czar, Energy Czar and so forth) who usually reports directly to the president, and whose appointment is not subject to the usual government appointment and vetting process. The policy czar may have access to a large budget which may or may not be subject to the same types of oversight and accountability regulations as other government agency budgets are. Here, the British analyst Kushlick (2009) argues that in declaring a “war on drugs,” many nation states have effectively set up a situation where efforts to combat the drug problem domestically and internationally are no longer subject to the same levels of public scrutiny as other efforts in other areas. Here, one can make the argument that Dr. Tao Ran is actually the “cyber addiction czar” of China. He holds an unofficial position of great influence in Chinese society, has vast amounts of monetary resources at his disposal and appears to be largely unaccountable to any legislative oversight or accountability regulations. He is clearly the spokesperson for the issue of internet addiction, and appears, as a Colonel in the Chinese army, to be the person in charge of marshaling resources for a war on internet addiction. In addition, Elbe argues that often when an issue becomes securitized; it is difficult for many players to satisfactorily resolve the issue of “what exactly threatens me?” That is, am I threatened by the disease or by the diseased person? And in issuing warnings regarding the seriousness of the threat, Elbe argues, that frequently the state is effective in demonizing the individual and warning others off from contact with the individual – rather than warning them to take precautions against the disease. What Does Securitization Look Like in China? The analysts Curley and Herrington (2011 143) warn that the securitization of health issues within the international community cannot be treated as a monolithic process. Rather, they note that various types of states (authoritarian, democratic, failing) respond differently to infectious disease emergencies, arguing that the language of security may be manipulated by the state to appeal to a particular audience. Ole Waever, the major representative of the Copenhagen School approach to securitization argues that security is a subjective rather than an objective or value-neutral concept (quoted in MacLean, 485). As he describes the process, the act of securitization begins when a “securitizing actor” (such as an authoritative figure in government, bureaucracy or civil society) identifies an existentialist threat to a referent object. He then notes the ways in which a “speech

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act” designates the threat to be deserving of extraordinary measures beyond those of “normal politics.” If the targeted audience is convinced of the authenticity of the threat, he concludes, and then the securitization act is successful. Here, it appears that the Chinese government has made a convincing case to its people regarding the validity of internet addiction as an epidemic requiring securitization, while researchers and government officials in the US, Australia and Europe have not. As Meerkert et al. note, there is very little consensus among Western researchers regarding the parameters of the internet addiction program, since there is also no consensus regarding which tests are reliable, valid and practical. However, if one looks at trends, it is unclear that over time Western researchers have largely revised their estimates regarding the numbers of internet addicts downward, while Chinese researchers have revised theirs upwards. The Asian consensus is that internet addiction is still increasing and that it is a serious problem which necessitates taking policy steps to address. Here, we need to consider the possibility that it is in China’s interest to believe that the problem is large and severe, in order to justify large-scale social policies aimed at combatting the problem. In contrast, in the West, there has been no significant movement to describe social policies aimed at curbing internet addiction. In addition, as noted earlier in this work, the construction of the typical internet addict varies widely from one nation to another. The typical American internet addict is often a stay at home mother, an elderly person or someone who is unemployed, while the typical Chinese internet addict appears to be a high achieving male student. Thus, the argument that “an epidemic of internet addiction is costing us our most valuable citizens” might be made more compellingly in China. Here, as Curley and Herrington note (2011, 144), in order for a disease to be successfully securitized, it must be perceived as an extreme threat to social wellbeing, going beyond the individual to the community, or as an extreme threat to a referent which a particular audience values. Critics of the securitization paradigm have suggested that it is used predominantly by Western analysts who are unable to think beyond traditional Western values, in determining whether or not an issue actually represents the sort of existential threat which could lend itself to securitization. However, in recent years, analysts like Vuori (2008, 69) have noted that “all types of political orders securitize their core values – which form the major referents for security.” Here, one can make an argument (as I do in Chapter 5) that in point of fact, internet addiction is more threatening in China, and therefore security language may resonate more strongly with a Chinese audience. In particular, internet addiction is seen by individuals as threatening to two core values – Confucian family structures and order values, as well as the value of balance. In addition, on a governmental or societal level, internet addiction is seen as presenting a threat of social unrest. Finally, the “epidemic” of internet addiction may appear as a risk to the state because it raises the possibility of one’s state falling behind in international competitiveness. The internet itself thus appears as

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dangerous to the state because providing increased access to it means that the state risks losing a vital part of its productive population, which may have ramifications for economic and military competition in the future. Therefore, the internet and the threat of internet addiction are actually perceived as more risky and dangerous in the Chinese context than it might be in a Western context. Because of cultural, social and political differences, attempts by, for example, the US government to securitize discussion of internet addiction would fail, while in Singapore, Taiwan, Korea or China they might be more likely to succeed. It is easier to legitimize internet addiction as a genuine threat within an Asian context than it is within a Western context. In addition, securitization is more likely to occur in a Chinese context since there are few avenues open to citizens or medical practitioners wishing to protect the application of a securitization paradigm to the discussion of internet addiction. Thus, securitization speech acts are more likely to be accepted in China. Furthermore, Elbe notes that once an issue has become securitized, state representatives can invoke security to silence the opposition and justify the imposition of emergency measures. Thus, the securitization of internet addiction might explain why there is not more discussion about the possibility that the internet provides benefits as well as risks, as well as a querying of the notion that internet addiction exists and is a threat. As we think about the securitization of internet addiction, we can see that the Chinese government in particular’s decision to treat it as a national (if not global) epidemic has had certain positive effects: the various government actors (Ministry of Defense, Health, Culture and Education) have been able to come together quickly to create detailed plans for attacking the problem. They were able to find significant amounts of funding for studies of the problem, the development of sophisticated survey instruments, the carrying out of surveys, and the development of treatment facilities and regimes. They have also been able to work together with the legislature to quickly pass laws aimed at preventing and curing internet addiction. Here, it is my contention that in the Chinese context in particular, public health authorities (many of whom work for the Department of Defense) understand and accept the connection between national security, international competitiveness and the mobilization of healthy individuals for war-fighting. Public health is increasingly concerned with border security and protection from health threats originating abroad; with population politics, and with identifying and responding to health threats which might affect China’s ability to launch a military mobilization or achieve economic competitiveness in the global system. In the past, China has implemented strong standards regarding birth rates, the growth of minority populations within its state, and upheld standards regarding where the population can live within the country. Thus, it is not surprisingly that China would also be concerned about any public health problem (or perceived public health problem) which would affect the ability to mobilize citizens during both war and peacetime, particularly when the disease in question appears mostly to

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afflict those of draft age. In short, it may be that people do not have the “right” to be insane or psychologically disturbed when they are viewed as a vital national resource in times of war. This frame helps to explain why the words epidemic and contagion appear so often in media discussions of internet addiction and why the state has been able to mobilize such a great amount of resources to combat internet addiction, while so many other public health initiatives in China fail, and the government is loath to even recognize the existence of other diseases. For example, the World Health Organization has expressed concern about the development of an AIDS epidemic in China (AIDS in China 2005). Though the AIDS crisis has been securitized in other countries, leading to large-scale public health movements and international cooperation, China has not reacted to this nascent threat with security language, nor have the same resources or energy been applied to combatting AIDS – in comparison to the combatting of the internet addiction epidemic. Here, one possible explanation for the separate stances which public health officials have had towards talking about internet addiction – versus talking about industrial waste and the cancers which have resulted – is that internet addiction is regarded largely as a foreign or exogenous risk which is generated outside of China, while industrial waste and pollution is an internal or endogenous risk. Therefore, for Chinese officials to admit that cancer villages exist, as well as to have an open conversation about their causes and the cure for this hazard, they would first be forced to acknowledge the complicity of the Chinese state in creating the hazard. In contrast, Chinese public health officials (and Korean, Thai and Vietnamese public health officials) do not encounter the same threat to their credibility or trustworthiness when they discuss internet hazards – since they are more easily able to claim that this is an imported problem, which comes from outside the country. Thus, they may assume the role of protector or guardian of the people from an outside evil which threatens the stability and order of China. They themselves are in no way implicated in the creation of the hazard. Rather, the biosecurity model rests on the assumption that internet addiction is a “western disease” or foreign threat which is being imported from outside. This has implications for the treatment models which have emerged to fight and cure this disease. Writing in a Chinese newspaper, the analyst Can Tran draws a line between China’s internet addiction epidemic and other epidemics elsewhere in the world, implicitly placing internet addiction on the same level of seriousness as a disease like AIDS or cholera. He writes: While Zimbabwe is fighting a continued growing epidemic of cholera, China has a new epidemic that it must fight. … In that respect, the Chinese government is taking action. (Tran 2009)

And the controversial Chinese psychiatrist, Dr. Yang Yongxin, director of the Internet Addiction Treatment Center, a “boot camp” type facility associated with the Linyi Mental Hospital in Linyi, Shandong province writes:

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If we cannot effectively control the spread of internet addiction, it would mean “the death of the party and the nation” and would mean the entire Chinese people “would be without children and grandchildren,” that it would make America’s 1970s policy of “victory without war” become a reality, allowing Chinese culture to perish under the onslaught of online imperialism. (Yong 2009)

Yang Yongxin (or “Uncle Yang” as he is sometimes known) has been accused by human rights groups of using the sorts of public confession methods and psychological breakdown tactics which characterized the reeducation efforts of the Cultural Revolution at his boot camp. (China Digital Times 2009) Here, it appears that he uses securitization language as a way of justifying these methodologies as necessary to mobilize against this threat from abroad. In addition, as Vuori (2008 67) argues, China’s government has a historic track record of applying securitization language to social issues. Here he points to the ways in which the 1999 Falun Gong movement in China (a group of religious dissidents) was labeled a security risk which thus provided a justification for a government security crackdown on the organization. As he notes, in China’s press, Falun Gong was described as endangering the general mood of society, social stability and the overall political situation. It was also described as a hostile foreign plot. As Qualtiere et al. (2003, 22) point out the idea that a particular state might be targeted by a disease from abroad is hardly new. Rather, he argues that in the 1800’s, the British suffered from an epidemic of the so-called “French pox” or syphilis, thought to be have been transmitted widely by Napoleonic troops. Here, he argues that Britain’s citizens behaved as though they had been attacked by a type of foreign biological warfare, questioning the motives of foreign agents of transmission and regarding them with suspicion. He notes as well that there are elements of moralizing in the narrative. The disease is not simply a biological fact but a “scourge,” perhaps representing some type of punishment for one’s moral failings. Similarly, one can see representations in China’s press of the idea that China is suffering both individually and as a nation from internet addiction, because they have drawn too close to America and western ideals. They are thus being punished with internet addiction, transmitted through the internet from America. The implementation of a type of quarantine, thus, in the form of internet filtering serves two purposes: protecting China both biologically and morally from a foreign scourge. Here, one can consider the quick and decisive way in which the nations of Asia, including China, mobilized to confront the problem of SARs which emerged in 2003. The issue was perceived as being one which threatened the vitality of many Asian nations and as a result, government officials moved quickly to stem citizen movements from affected regions and implemented quarantine and regulation programs. In this case, the prompt actions of Asian governments received high praise from the international community. As Risse (1999, 577) notes, a state (or group of states) which takes the lead in combating illness and ill health and in

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providing for its citizens can obtain a high degree of credibility and enhance its reputation in the international system. Acting quickly and decisively to combat a health threat can thus gain credibility for the state in the international system – perhaps in the same way that having state of the art military weapons does. However, a state which acts too vigilantly to safeguard public order through disciplining its unwell citizens arguably runs the risk of having its actions misunderstood or misinterpreted by other outside observers. Thus, the question becomes: If the SARs response provided a sort of model for the governments of China, Singapore, Malaysia, Korea and Taiwan as they thought about the problem of internet addiction and moved to stem the problem and keep it from growing, then why have Chinese efforts to combat the internet addiction epidemic not received the same type of high praise from the international community. What makes the two situations fundamentally different? Arguably, the difference is that SARS was regarded as a legitimate epidemic whereas internet addiction is not regarded the same way by the international community. Thus, efforts by China’s government to use extraordinary resources and political force in confronting internet addiction may look like the application of legitimate security measures to Chinese public officials, but may look like government repression to outside observers. This may explain why we have not seen widespread international cooperation aimed at combatting the problem of internet addiction, in comparison to the efforts we have seen in combatting other extreme public health threats on an international level. This is due to a lack of international consensus because of differences in defining and treating, as well as measuring this disease. There is simply not enough consensus about the existence and parameters of the internet addiction threat, nor the parameters of this threat for there to be either a global consensus or a global mobilization. However, when seen through this historic lens of population politics, one can frame an argument that states have a right, perhaps even an imperative to carry out these practices, and that in doing so, states are not violating human rights, or engaging in abusive behaviors. Indeed, in periods of rapid social and economic change, new health threats often emerge, and states often take strict stances to confront them; particularly in the age of globalization. Is Internet Addiction Really an Epidemic? Thus far, I have attempted to show how it is possible both to construct internet addiction as an epidemic, and what the benefits are to the state of doing so. However, there are three factors about the disease itself which make it different than other types of diseases which have typically been classified as an epidemic. First, some medical personnel note that it is more rational to think of internet addiction as a chronic disease – which one may contract and live with for one’s whole life (Van Grove 2005) – than as a virulent virus which quickly attacks and ravages a host population. Indeed, there is little data indicating that anyone has ever died directly

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as a result of internet addiction – though Chinese media have stressed the two or three rare cases of an internet game player dying of exhaustion or a heart attack after a severe and prolonged round of gaming. And as I showed in the previous chapter, many physicians do not believe that internet addiction is contagious, nor that everyone is equally capable of contracting it. Finally, we have historically applied the label of “epidemic disease” to physical rather than mental illness. And as Peterson (2002) points out, catastrophic or infectious disease outbreaks have traditionally created particular types of social disruptions, including refugee flows, orphans and social destabilization. For this reason, they have precipitated conflict both regionally and in the international system. In contrast, none of these types of events have been linked with outbreaks of internet addiction. In addition, it is difficult to sort out the causal mechanisms at work here. Did the securitization of the problem lead to the development of a consensus in terms of defining, measuring and treatment it in China, or did the development of a consensus about the problem lead to its securitization? In the final chapter of this work, I explore the unique Asian context in which internet addiction needs to be understood. I lay out the core values which internet addiction is seen to contradict and threaten, and allow the Chinese researchers to have a voice in presenting their arguments regarding the threat which internet addiction presents to their society. Thus, we come full circle – exploring a variety of arguments regarding the genesis of internet addiction threat talk, from the most extreme anti-psychiatric approach to one which makes a relativist argument which in essence argues that “if you feel threatened, then you are.” Endnote 1  My thinking here is influenced by the writings of the psychiatrist Steven Miles (2006) who has expressed the ways in which American military doctors serving at Guantanamo Bay, and at Abu Ghraib faced the question: Who is my patient?.

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Chapter 5

Internet Addiction and the Assault on Chinese Values In this chapter, I attempt to give a voice to Chinese officials – and attempt to construct the narrative of internet addiction and public health through Chinese eyes. That is, utilizing a post-modern stance, I suggest that there are actually several quite different narratives that can be constructed to answer the question, “Does China have an internet addiction epidemic and is internet addiction actually a threat?” Here, I suggest that where you stand depends on where you sit. That is, both risk perceptions and actual measurements of the severity and amount of risk associated with a new technology may vary greatly from one cultural, social and political context to another. Thus the case can be made that perhaps internet addiction actually is a bigger danger in China, and that therefore at least some of the Chinese policy stance is justifiable. Here, I argue that China’s government has a right to conceptualize of population health in their own terms – and I ask what it might mean to be healthy in Chinese terms. I consider the ways in which Chinese medicine has typically thought about the principles of balance and preventive care, showing how to a typical Chinese parent or even a typical Chinese health practitioner, the tendency of an individual to spend most of his waking hours on the internet might indeed seem “unbalanced.” Thus, it is possible to make a claim that to the Chinese citizens themselves, spending too much time on the internet might indeed seem like a form of mental illness. In addition, I consider the ways in which Chinese efforts to establish balance frequently have a preemptive component. Here, I suggest that the western notion of health citizenship as a “right of man” (Porter 2009, 5) in which every individual has the right to make autonomous decisions about his health practices in a climate of full health information is not a universal norm but rather a Western norm. I suggest that health citizenship may look different from an Asian perspective. In their work, Bleakley and Bligh (2008) indict western medicine as colonialist. They note that the American medical community in particular has frequently gone about imposing certain forms of knowing and practices of learning and curing on others – without acknowledging their western bias. Here, I attempt to show the ways in which the Chinese have traditionally thought about mental illness, as well as the ways in which they have traditionally conceptualized of patient autonomy. Here, I argue that for the Chinese traditionally, medicine has been understood within a collective, rather than an individual context. Thus, Western human rights organizations, the media and politicians have frequently characterized Chinese internet addiction treatment practices as harsh

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and punitive. However, arguably, the Chinese have not treated internet addiction any differently than they treat any other form of mental illness, or perhaps any other form of sickness. The patient is considered – particularly when he is a minor – as part of the family, rather than as an autonomous subject. The family is closely involved in discussions of his treatment, and in certain instances may even keep information from the patient or overrule his wishes – including a wish not to be admitted for long term treatment. Thus, what seems like incarceration to a Western observer might actually seem more like “care-taking” to a Chinese observer. And what seems like “surveillance” to a Western observer might actually seem again like preventive caretaking to a Chinese observer. (Similarly, what looks like caretaking in a western context may look more like abandonment or neglect through Chinese eyes.) The point of this chapter is not to defend human rights abuses or to offer an apology for them. It is rather to show, as I have attempted to show throughout this work, how the same narrative may look very different – depending on who is doing the looking, the language which is used, and the parts of the story which are highlighted or downplayed. As Briggs and Briggs (2002, 256) note, one tends to assume that statistical renderings of disease patterns are somehow objective. The assumption is that statistical measurement and profiling doesn’t have a politics. Rather, one ostensibly reports and then measures the number of cases of disease, the patterns of disease and the effectiveness of measures taken to combat disease. However, in reality, states may have competing interests which affect how they report disease, how they understand disease patterns, and the ways in which they choose to portray the consequences of actions taken to combat disease. This is particularly true when it comes to the reporting of mental health statistics. While there are procedures in place which aim to regularize the reporting of health statistics internationally through the World Health Organization, these generally do not apply to the reporting of mental health statistics. In general, mental health is an area which has thus far been low on the agenda of international health bodies – both in terms of seeking data about the parameters of the problem, and in terms of laying out far-reaching programs for the treatment and diagnosis of mental illness (Patel 2011). However, as I show in this chapter, understandings of mental illness, its meaning and consequences for society are largely idiosyncratic throughout the world, as are the reports and compilation of statistics on the phenomena in an international context. The chapter is organized as follows: First, I begin by discussing how illness is defined and diagnosed in the Chinese cultural context. Here I consider the Confucian emphasis on restoring balance and harmony in the body itself, and in the relationship between the body and its environment. I highlight the Confucian emphasis on the family as the basic unit of society, and the ways in which that affects the understanding and construction of sickness and illness in the Chinese context. Finally, I consider whether the establishment of a diagnosis of an “unhealthy dependence on technology” may vary cross-culturally.

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In the second part of this chapter, I consider cultural differences in the area of treatment – focusing in particular on the principles of patient autonomy (and voluntary versus involuntary commitment). I also lay out the differences between prevention, surveillance and caretaking. Finally, I consider the question of risks – describing the ways in which mental illness has traditionally been stigmatized in Chinese society. Here, I argue that the prospect of developing a mental illness may be much more threatening to a Chinese citizen than it is to someone in the US, because of the ways in which one’s life (and one’s life prospects) are impacted by the diagnosis. I also consider the risks related to the loosening of traditional social bonds in Chinese society, arguing that many behavioral practices (such as spending large amounts of time alone playing computer games) which do not seem real or threatening in an American context may be much more significant to a Chinese citizen and the Chinese government. In the conclusion to this chapter, I tie together the various strands of argument which have been presented so far: the antipsychiatry perspective, the critical psychiatry perspective, the securitization perspective and the post-modern perspective to theorize about how each perspective might help us to answer the question: Do the Chinese have the “right” to feel threatened by internet addiction and can it be construed as a genuine or legitimate threat? Illness through the Lens of Chinese Medicine I begin my analysis of what it means to diagnose someone with internet addiction by posing an ontological query: Is internet addiction actually a different disease in China than it is in the US? In her work, the medical anthropologist Anne-Marie Mol (2007) argues that different individuals may have a profoundly different “lived experience” of disease. She argues that one sufferer from atherosclerosis, a disease of the leg veins, may experience the illness as largely about a loss of mobility as they can no longer walk long distances, bicycle to work or live on the second floor of a house. In contrast, she argues that another user’s experience of the illness might be one of chronic pain, or of the humiliation of having to ask others for help with basic life tasks, thus exhibiting dependence. Arguably, for each sufferer, atherosclerosis is a different disease – if one considers both the different symptoms each has, and the meaning which each individual attaches to the disease. Indeed, even the notion of “health” may be different from one user to another. As Rose (2007) notes, medicine is a system which is always practiced on a body – but the body may look different and be experienced differently in one society rather than another. (For example, to give an example from the world of psychology, Americans may regard someone who is inhibited in their public behavior and social interactions as suffering from shyness, which is defined as a type of mental disorder. In another, more traditional society, such an individual might be praised for her modesty and shy demeanor. The same individual might

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thus feel herself to be ill and need of treatment in one culture but not in another.) As a result of differences in the way in which the body is experienced from one culture to another, certain practices of curing may be more expected and more often practiced in one culture than another, and what looks like irrational superstition to one culture may actually be a form of medicine in another. Following this logic, it is not too great a leap to suggest that societies may also have different means and philosophies regarding how much to interfere in citizens’ relation to technology – and what level of citizen interaction with technology might be regarded as healthy or unhealthy. (For example, in some cultures, like the US, there is more of an expectation that everyone, regardless of age, should learn to use the internet. As Reed (2002) points out, the term “technophobe” is in many ways a judgment about what levels of technological helplessness or disinterest are acceptable within a particular society. Indeed, writing in international organizations on the subject of the “digital divide” assumes that the only reason someone might not wish to acquire new technological skills is because they do not have an opportunity to acquire new technology (Shukla and Rogers 2001). The “digital divide” construct in particular assumes that every current non-user is someone who wishes to use technology but can’t. There is no acknowledgement of the possibility that someone might consciously choose to reject technology or do without.) Thus, even if we accept Szasz’s argument that mental illness is primarily about having an inability to function within society, it may be that this dysfunction is differently manifested depending on the society in which one lives. As Glackin notes, “social requirements, with respect to which we attribute dysfunction or disability, are in the first place evaluative and concern the performance of tasks to which a particular society attaches some importance” (2010, 455). Thus, the notion of “having a healthy relationship with technology” may have completely opposite meanings in the US and China. Health is symbolic. How one defines “health” is chosen and shaped within a specific context. Glackin gives the example of dyslexia, a disorder which significantly impairs one’s functioning in today’s modern world. However, he suggests that there may have been dyslexic individuals during the Stone Age who were never diagnosed or treated, or labeled as ill, since literacy was not a requirement – or a possibility – within that society. Thus, definitions of good social functioning can change from one culture to another, as well as over time. Thus, the question becomes: might internet addiction be perceived as a disabling condition in some societies but not others? In the Chinese context, arguably, too much time spent on the internet inhibits both the development of strong family bonds – seen as sacred in the traditional Confucian belief system – and the achievement of traditional academic success, seen as a key mechanism for achieving economic and social success in society. In that sense, one who is unnaturally bound to the internet might be as crippled in terms of participating in normal society as one who is agoraphobic, depressed or suffering from obsessive-compulsive disorder. And if illness is regarded as a type of “harmful dysfunction,” then it is important to consider who might be harmed by the individual patient’s dysfunction. In the

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case of internet addiction, Chinese media reports in particular tend to focus more on the ways in which internet addiction harms society and the family, while American medical reports focus on the ways in which individual “addicts” are harmed by their behaviors. Chinese commentators frequently note that the whole family’s economic future is resting on the achievements of a family’s single child (Wang et al. 2010). Thus, the development of internet addict affects not simply the individual sufferer, but rather than whole economic unit, including both the nuclear and extended families. Here, Kimberly Young, one of the original architects of the “internet addiction” paradigm, argues that individuals in China have a very different experience of having the disease largely because of the setting or environment in which the disease is performed or lived. Statistics indicate that more than 25 percent of China’s internet users do not own a computer, but instead use the internet primarily in public settings, including internet cafes and libraries. Outside of major urban areas, this can be 80 percent of internet users (HRI China.org). Thus, as Young notes (personal conversation), in China internet addiction is most often performed in public. Thus, Americans and Europeans may be less aware of the problem of internet abuse, because the typical internet abuser may be a spouse who stays up late at night surfing the internet after the other family members are asleep. In contrast, China’s typical internet abuser is usually portrayed as a youth who is not at home with his family but instead is out until all hours in an internet café, breathing in noxious cigarette fumes and associating with the internet gamblers sitting at the next table. Thus, internet addiction may be perceived quite differently in the two societies. In China, it is a public problem and thus is more likely to be the subject of public regulation. In contrast, overusing the internet in an America context might be regarded more as a personal habit which has grown out of control than as a widespread social problem. The ability to draw a connection between public internet abuse and public internet behavior thus doesn’t exist in the American context. This distinction becomes important when considering the specific risk that an internet user might run of being involuntarily hospitalized due to his “addiction.” Arguably, American doctors are less likely to see the internet addict as dangerous, and also less likely to see the patient as criminal, since it is conceptualized largely as a private problem, rather than a menace to society. Here, one can also advance the thesis that addiction is understood differently within an Asian context, as well. As Edwin Hui (1999) points out, the Chinese concept or construct of health is different from the Western construct – for a number of reasons. In the Chinese context, to be “healthy” means to be in balance. As far back as the Chou Dynasty (1122-250 BC), medicine placed an emphasis on balance, which was to be acquired through the development of deep breathing, engaging in physical exercise and practicing temperance (Porter 2009, 13). Chinese healing principles stressed the idea that one should strive to have a balance of elements within one’s body, and one should strive to keep one’s body in balance with one’s surroundings, including the community and the environment. (Hui 1999, 34-47). Thus, a person who is “healthy” is not merely disease-free, but

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is rather someone who is in balance with his body, his nature and his surroundings. Hui (1999) notes that “balance” may include the cultivation of a good character – which includes elements of personal autonomy and harmony with the community. Thus, health is related to the assumption of social responsibility and the carrying out of socially responsible behavior. Here, Lo (2010, 471) quotes a key text of the Ming Dynasty which notes that “all humans are endowed with a body which consists of a self-regulating, health-maintaining, harmonious mechanism. We can stay healthy as long as we maintain a healthy lifestyle.” The Chinese concept of health is thus deeper and more nuanced than the Western conception, where the label may simply mean that one is free of disease (Anderson and Kirkham 1999, 48). Here, we can make the argument that within the Chinese context, the state of illness is thus not regarded as an abrupt departure from the state of wellness but rather as part and parcel of the human condition. Thus, arguably, Western medicine tends to regard health and illness as dichotomous, while the Chinese system is more likely to view them as existing along a continuum. In this situation, therefore, one does not suddenly become someone different when one becomes sick, and the sick identity is not fundamentally different from the well identity. Rather, one can visualize a spectrum running from severely unbalanced to completely balanced, with most of us falling somewhere along that spectrum and moving back and forth at different points of our lives. That is, the Western notion that one is somehow immediately incapacitated and disempowered in “falling ill” or being “struck down by illness” is perhaps less true within the Chinese context. Thus, one can argue that in existing along a continuum between wellness and illness, preventing illness may be more acceptable and less seen as a threat to one’s identity as a well individual. Thus, in China, the addiction construct in particular in interpreted within the notion of balance. To be addicted is to be out of balance – both internally and within the context of one’s surroundings. Addiction thus also becomes a sort of spiritual disease, since physical health is linked to moral and spiritual well-being, through the achievement of “cosmic harmony.” Thus, someone who is addicted to the internet is someone who is out of balance physically and spiritually, since he places too much emphasis on technology, in relation to other priorities, including one’s family, one’s education and one’s community. As Anderson and Kirkham (1999) note, Chinese medicine also puts a heavy emphasis on the notion of preventing as well as curing disease. Thus, Chinese patients might drink teas or eat certain foods in an attempt to prevent themselves from getting sick, through restoring a healthy balance to their bodies. Here, the emphasis on implementing preemptive measures to guard against developing internet addiction can be interpreted in the Chinese context not as a type of medical surveillance, but rather as a natural extension of the activities which Chinese healers do. The successful healer is thus seen not simply as one who cures, but also as one who prevents patients from becoming sick in the first place (Anderson and Kirkham 1999, 47). The healer’s job is thus to protect the patient from unhealthy

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practices and influences (Peng 2010, 350). Within this context, Tao Ran’s remarks about “protecting children from the internet” acquire greater resonance. As Lo explains, the physician is thus seen as acting on behalf of Heaven to restore order and harmony in the cosmos, through healing bodies which are out of balance. This understanding is fundamentally incompatible with Foucault’s statements regarding the ways in which the medical system is a system of domination which subjugates or does violence to the patient. Instead, as Lo explains (2010, 471): “Therapy … is a human act of merely assisting the restoration of equilibrium, balance and harmony to the bodily processes, which our body is capable of doing to begin with.” The Chinese Confucian view of the role of the physician is thus fundamentally incompatible with both the anti-psychiatric and the critical psychiatric approach. The physician is respected and his function is seen as in keeping with the Chinese system of religious belief. Lo (2010) describes the function of the physician, quoting a Confucian source who asks: “What is the origin of medicine? The lifegiving force of Heaven endorses human beings with health-qi but cannot protect them from dying young and the infection of epidemic diseases. Hence it provides the remedy by making use of the interpromotion and inter-restraint relationships among things and delegates the power to medical practitioners.” In considering the unique historical context of the development of Chinese medicine, one can thus begin to better understand certain facets of Chinese health practices having to do with internet addiction – including the emphasis on profiling or identifying the would-be addict. And the emphasis on preempting the acquisition of addiction (versus treating it once it occurs). One can also better understand the Chinese emphasis on creating a healthy internet environment both in cyberspace and in reality. Arguably, the internet café presents a specific risk within Chinese society due to its perception as an unhealthy environment. In considering the role of equilibrium in Chinese medicine, one must also consider the ways in which the individual is situated within the family, and the relationship which he must maintain in balance. As Chen writes, “Confucians recognize 3 cardinal human unities, terming them gang, bonds: the bond between husband and wife; parent and child; and ruler and minister” (2010, 577). Thus, Confucian culture holds that an individual is always a member of the family that acts as a whole. Here, the family is seen as an eternal social reality in which both past ancestors and future descendants are included. (Thus, Chinese analysts distinguish between the Western notion of a family formed by consent in a sort of contractual arrangement, whereby one can choose from a variety of semipermanent, short or long term living and/or marital arrangements and the Chinese conception, where one is born into a family and it is inalterable.) Thus, in China, to disturb family relations is in some fundamental way to disturb the order of the universe, and the order of society – both in the present and into the future. As the Great Learning, another Confucian class, states, “the foundation of the country is the family, if the family is not appropriately in order, the country cannot be well governed.” Within this context, the ability of the internet to harm family

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relations gains much greater resonance, and the risks which the internet presents can become magnified. As Wang and Wang (2010, 207) explain: From the Confucian perspective, one’s individual body does not belong only to oneself. As it originates from one’s parents, the body also belongs to one’s parents. In other words, it is the Confucian perspective that one’s body should more appropriately be appreciated as belonging to the whole family.

Thus, internet addiction threatens not only the individual, but the extended family as well. Here, one can also make an argument that in many ways the internet itself rests on a Western model of individual empowerment, and that conversations about identity in cyberspace implicitly contain a Western bias. In particular, analysts like Flichy have argued that cyberspace is “liberating,” since one can approach others within this new environment without the baggage that we all carry with us by virtue of our identities as men or women; persons of the majority or minority race; people who are heterosexual or homosexual; and people of a certain nationality or socioeconomic class. Initial writing about social relations in cyberspace contained a normative bias in favor of the creation of an unfettered identity – where one could pretend to be anyone one wanted, and where no one really knew anything about anyone else’s past or position in society. However, arguably, this same environment which is described as liberating by Western analysts might seem very threatening to those within a traditional society, who perhaps have no desire to “lose” their identity based on nationality, profession or position within an extended family. As Li explains (2010, 593), “concepts core to contemporary Western ethics, such as individual liberty, equality, democracy, human rights and justice, presuppose a unique sociohistorical background which was shaped by traditional Western religious, cultures and moral understandings.” Chinese individuals are thus perhaps less likely to value or appreciate the “liberating” potential of the internet. In addition, Chinese citizens might be less likely to value a technology which allows one to reinvent oneself or to engage in dynamic development of one’s personality, since arguably identity is seen as more fixed and permanent within the Asian context, and thus changing one’s identity is regarded as less desirable. Here, Li (2010, 590) argues that family relations are the building blocks on which Chinese society rests, noting that: “Given that family relations are the human relations cardinally important for human flourishing, shared family determination is the normal way of life for individuals to pursue human flourishing.” Therefore, one can argue that Chinese citizens are less likely to see the internet as a source of life improvement within their societies, particularly if it is presented or viewed as being an impediment or threat to the establishment of strong family relationships. And Chinese parents (and authorities) may have even less interest in having their children lose their familial identity in favor of an unanchored cyberspace identity. They might also be more likely to view activities in cyberspace as zero-sum, in which the internet appears to be “stealing” individuals away from

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their family, in favor of time spent acting as an autonomous individual. Thus, Lin et al. (2008, 451) describe internet addiction as a contagious virus which is bred on university campuses. In the case of Lin’s theorizing, there are dangers to simply letting internet addiction spread unchecked. Researchers note only the ways in which physical health is affected by long periods of time spent on the internet without sleeping, eating or resting. They note also the ways in which social and family relationships may be affected. For example, Yeh et al. (2008, 485) notes that “people may develop a new lifestyle through internet activities which may cause a worsening in their actual social relationships.” Here, the problem is understood within a context of Asian medicine which stresses the maintenance of social harmony and balance, and which also asserts the necessity of acting preemptively to restore a balance which threatens to become disordered. Internet addiction can thus be seen as threatening such Chinese core values as balance, harmony, the collective of the family, and thus it is understandable that the issue would become securitized, and that security discourse would resonate with Chinese citizens. Treating Internet Addiction within a Chinese Context The Chinese worldview based on Confucian values affects not only how citizens think about the acquisition of health. It also affects the ways in which citizens conceptualize of the processes of treating disease. In particular, the Asian medical system rests on a familial model in which medical decision-making regarding treatment options is seen not as the province of the patient, but rather as the province of the patient and his family. For any important individual decision in China – about marriage, schooling, one’s career path, or one’s medical treatment, the family’s consent is also required. Accordingly, the Chinese practice of informed consent for medical treatment is family oriented and in this way differs dramatically from the pattern of Western individualist tradition that emphasizes individual self-determination and personal autonomy. As Li (2010, 587) explains, the Chinese physician has historically depended not on the patient autonomy model, but on the Confucian family determination model (also described as “familism”), which he traces back to the Zhou dynasty (1046-771 BCE). In this model, the family decides how much to involve the patient in decision-making (Li, 588) and a family member signs the consent form for treatment. The emphasis on family involvement in medical decision-making is both accepted culturally and codified in law. Indeed, the text of a 2008 ethical guideline issued in China specifically refers to “the patient or his/her family members” vs. “the patient.” Indeed, the physician may see his primary relationship, due to familialism, as the one between himself and the patient’s family, rather than the one between himself and the patient. Thus, as Li describes the situation (2010 590): “It is unusual to make an important personal decision independent of one’s closest family members or to claim “this is my own business, please leave me alone.” And within the Chinese context it would even be considered appropriate for family members to

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withhold information from a patient about his condition if it was thought that he might suffer undue psychological stress if the full details of his condition were revealed to him. Chen (2010, 575) notes that “any information that may increase the psychological burden of the patient should first be offered to the family or a legitimate guardian.” Thus, it is not unusual to neglect to share the news that a condition is terminal with an elderly relative, but rather to attempt to cheer them up with the thought that their condition will gradually improve (Peng 2010, 35). Chinese norms regarding patient rights exist both as the result of cultural understandings and legislation. As Peng notes, the Chinese Ministry of Public Health has developed an ethical code which spells out how health care personnel should interact with patients. This code has been in force since 1988. However, as Wenyong points out, the mentally disabled in China do not officially have a national bill of rights. Rather, rules for how such patients are to be treated may vary greatly from one locality to another (Wenyong 2010, 1). Furthermore, the Chinese concept of patient rights includes only the concepts of fair treatment, privacy and confidentiality. It does not include the notion of patient autonomy and self-determination in making medical decisions, nor does it include the idea of informed consent. Therefore, within a Chinese cultural framework, a parent who makes decisions on behalf of a child – including the decision to seek treatment for internet addiction, or a decision to preemptively act to prevent the child’s acquiring this disorder – is seen neither trampling the child’s rights nor engaging in abusive acts, despite what Western authorities may think they are seeing. Rather, as Li (2010, 591) points out, within the Chinese context it would seem natural to involve the whole family in medical decision-making, just as they are involved in making decisions about other important life matters. Indeed, it would seem unnatural not to involve the family. Thus, the Chinese and American cultural systems consider the ability of a teenager to make autonomous decisions regarding how he spends his time and how he conducts himself quite differently. As Wang et al. (2010) note, most Chinese physicians and specialists were opposed to the 1989 United Nations Convention on the Rights of the Child. The authors state that the convention attempts to reduce parental authority, reducing them to “mere trustees of the best interests of the child” (2010, 493). The convention is viewed as an attempt to free or remove children from parental authorities and to reduce the bestowal of parental attention upon them. The medical community was particularly opposed to the so-called “participatory rights” outlined in Articles 12 and 13 – which have been interpreted as a right to participate in pediatric decision-making, including the child’s right to be informed and have access to information about his health, and the right to express their opinions on the subject. Chinese physicians disagree with the assumption that an “early adolescent” could and should be an effective and mature decision-maker. The Convention was widely interpreted as a Western attempt to establish and impose a Western norm regarding the institution and meaning of childhood and adolescence on non-Western cultures, and in doing so trampling many long-standing cultural and religious understandings about the family and

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the institution of parental authority. Here, Li (2010, 592) argues that the Chinese family-oriented model is a natural outgrowth of China’s history as an agricultural society, equating the more “modern,” individual autonomy model with Western patterns of urbanization and industrialization that perhaps do not apply to China. Risks of Internet Addiction – Through Chinese Eyes Thus far, I have suggested that internet addiction is seen as threat to core values in China – and in Asian nations in general – in ways in which it is not in the West. Internet addiction is seen as presenting a threat to family cohesion and to the notion of balance. One final risk which we must consider here is the risk which diagnosis may carry in the Asian context, since mental illness in particular carries a great stigma in many Asian countries. As Boorse (1974 50) notes, judgments about health are implicitly judgments about morality and about what is socially acceptable. As he notes “To call a condition unhealthy is at least in part to condemn it.” Thus, an individual who risks becoming unhealthy through failing to discipline himself to use the internet responsibly also undertakes a secondary risk – that of acquiring the designation of being a diseased person or a disease suffer and the social approbation which might accompany acquiring that designation. That is, in becoming ill, one also risks being judged – collectively by the medical profession (Boorse 1974, 54), as well as by society, by his family and his peers. In the case of internet addiction, the primary risk which citizens are asked to consider as they establish their computer usage patterns is the possibility of developing (and being diagnosed with) what is considered to be a mental illness. The effects of being labeled both an addict and a medical patient – particularly one diagnosed with mental illness – vary according to culture. Western analysts tend to assume that modern norms of patient autonomy and patient’s rights are universal. However, they exist within a cultural context. Because of these differences, the social risks associated with being labeled an internet addict are very different from one society to another. In China, one runs the social risk of becoming a medical subject. Here the patient is rendered powerless in relation to the complex of doctors and hospitals which exist to cure him or her, in many cases working in concert with the state. Thus, for a Chinese citizen the most important risk may not come from “developing” internet addiction – but rather from “being diagnosed with” internet addiction. In China, in particular, mental illness is a diagnosis frequently kept secret by the sufferer since mental illness is associated in many minds with having committed a sort of moral failure, or suffering from poor character. As Yang notes, Chinese culture views mental illness as a violation of Confucian principles governing social order and harmony. Confucianism states that each individual is morally obligated to fulfill his social role, and mental illness is seen as preventing him from doing so (Yang 2007, 977).

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In addition, mental illness is usually treated in popular culture as something which is either inherited or created by a dysfunctional family situation. Thus, mental illness and health in general is seen to reflect not only upon the individual but upon the family unit. The stigma attached to the illness is seen as “contaminating” the whole family – perhaps making other family members unmarriageable or unemployable as well. Chung and Wong (2007) present research from a survey of clinic patients in Hong Kong in which over half of the respondents identified those suffering from mental illness as being untrustworthy unmarriageable, dangerous, unintelligent, unemployable and unlikely to be a good friend. Yang notes that individuals in Asian societies who are mentally ill are likely to suffer discrimination on many levels – both individually and structurally. In the US, in contrast, strides in public health in the last 30–40 years have meant that mental illness no longer carries the same degree of social stigma. (One is thus less likely to lose one’s job or custody of one’s children as a result of developing an unhealthy internet addiction in the US, in comparison to China.) Thus, it is not surprising that in those societies where there is a high degree of stigma attached to a diagnosis of mental illness, physicians have devoted more time and attention to the development of diagnostics which can describe the individuals who are most likely to develop internet addiction. Here, physicians may attempt to treat would-be sufferers preemptively, in order to ensure that they do not develop the disease. Thus, the Chinese model of internet addiction may contain several interlocking ideas, including the concepts of stigma and discrimination, as Figure 5.1 shows. Depending on how one understands the genesis of internet addiction, the proposed policies for treating it will be very different. In Germany and in Scandinavia, physicians accept the statement that society itself bears some of the blame for creating internet addiction – through failure to provide enough leisure time and green space for young people to get healthy exercise. Thus, treatment regimens frequently focus on teaching young people how to safely experience recreation in the real world. In contrast, regimens tend to be much more punitive in societies where individuals are viewed as complicit in creating their own disease through defects of character or a lack of morality. And if you subscribe to the Western model of individual patient autonomy, then you could also make the argument that in China, if one becomes an internet addict, one also risks losing many human rights – instead being forced into a treatment regime which may allow for being treated against his will, even imprisoned. As Shao et al. point out, there is still no existing national level of legislation in China governing mental health practices (Shao et al. 2010, 52), though individual cities including Shanghai, Ningbo, XuZi, Hangzhou, and Beijing have implemented legislation aimed at guaranteeing patients basic services and on prohibiting discrimination against those who are mentally ill (53). In China, treatment regimens for the mentally ill are generally oriented towards assuring public safety, rather than on safeguarding the rights of the patient (Shao 2010, 52). Provisions for allowing involuntary psychiatric commitment are also more general

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Figure 5.1 Components of Chinese internet addiction paradigm and vague than those suggested by the World Health Organization. Authorities need to confirm merely that the patient has a diagnosed mental disorder, but are not required to show that the patient is a danger either to himself or others (Shao 2010, 54). Thus, arguably, a Chinese internet addict has a much higher risk of being involuntarily committed (or “imprisoned in a mental hospital”) since there are no patient advocates during involuntary commitment proceedings in China, as there are in other countries. In contrast, Western norms of patient autonomy mean that it is possible to be “sick” in America without necessarily losing one’s rights to make decisions. A mentally ill America is likely to be expected to act in concert with doctors to care for one’s health (Chodoff 1984, 385) while a mentally ill Chinese citizen might expect to be treated like a child by a paternalistic doctor, as well as to be treated like a child by family members who step in to make decisions on his behalf. Thus, developing an unhealthy relationship with technology carries different costs for a Chinese citizen than for an American citizen.

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The American medical establishment places a greater emphasis on choice – the patient can choose to seek treatment, the patient can accept the diagnosis and comply with a treatment regime, and he can choose to believe that he is ill. However, Turoldo argues that the model of the patient as an autonomous chooser of his medical care is largely a Western construct – coming out of a Western understanding of human rights and personal autonomy. This understanding became institutionalized as a result of the Nuremberg trials after World War Two, where the norm developed that treating a medical subject without his consent was a violation of human rights, and that patient autonomy was a universal right. As Turoldo point out, it has not always been thus. Rather, he argues that the practice of anesthesia was developed at least in part for the purposes of subduing a person who did not wish to be the subject of medical ministrations (2007, 542). In contrast, the Chinese medical model is different. It is much more hierarchical. The physician defines the disease – which is not regarded as a construct or a matter of choice. The disease label is not codified or applied in consultation with the patient. To someone viewing the situation with Western eyes, the Chinese treatment model seems punitive, particularly since the patient doesn’t necessarily seek treatment but is rather forced into it by family members. In addition, there is perhaps an assumption that American practitioners are devoted to curing and helping patients while Chinese practitioners are more interested in punishing internet addicts, or perhaps making them into symbolic exemplars that would serve to scare would-be internet addicts into reigning in their own fascinations with the technology. (That is, providing large amounts of media coverage of the institutions and regimes for treating internet addiction in China is actually a way of using symbolic power to deter others from coming too close to the technology.) In this American narrative, both involuntary treatment and the use of electroconvulsive therapy (or ECT) are held up as signs that Chinese mental hospitals function more like jails, constructed specifically with the intent of punishing Chinese internet addicts – rather than curing them. Arguably, the construct of the “lunatic asylum” as a type of jail is an artefact as much of American and Western cultural prejudices than it is an objective statement of the work of residential mental illness facilities. Here, Watts (1997, 21) argues that in the rhetoric of the Western Enlightenment, the “pesthouse” (which served to confine those sickened by plague in the Middle Ages) was viewed as a backward construct, which “civilized” nations were expected to have gone beyond. Furthermore, cultural differences exist in the way the psychiatry communities in the US and China think about treatment options. Here, Americans have been affected by the historic movement to deinstitutionalize the mentally ill in the 1960s (Turner 1964); by cultural influences such as films like “One Flew Over the Cuckoo’s nest” and by the strong influence of pharmaceutical lobbies (Shorter, 243-245) which have led Americans to view the provision of drugs and medication as a far more humane treatment option than other types of practices, like Electroconvulsive Therapy. That is, events which occurred in the US –

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including a turn towards pharmaceuticals, the deinstitutionalization movement, and the development of “a human rights model” of psychiatry, influenced by Szasz, largely did not happen in China. China is at a different developmental stage, has different cultural values and thus its internet addiction policy has grown up much differently, reflecting different Chinese cultural values. Thus, even if it were possible to establish risk probabilities (using statements like “for every additional hour your teenager spends on line, the likelihood that they will be the subject of internet predators goes up by a value of five”), it is unlikely that doing so will change how users and societies think about these risks – since the process of risk assessment is also socially determined. This observation helps to explain why, for example, Chinese citizens evince a much higher rate of concern regarding the dangers of the internet even amongst those who spend a great deal of time on-line (Markoff 2010), as well as why exposure to social institutions alone over time does not necessarily alter perceptions of risk and threat inherent in these institutions. They may be socially and culturally preconditioned to think differently about the risks and dangers associated with internet use. As Wildavsky and Douglas state the argument, “risk perceptions are derivative of social norms. … We choose which risks to attend to in the same package as we choose our social institutions” (quoted in Braman and Kahan 2006, 1292). Bijker makes a similar point in his discussion of “risk cultures.” In comparing the ways in which the United States and the Netherlands have dealt with the threat of catastrophic floods in the wake of Hurricane Katrina, Bijker argues that the two societies think differently about two factors: First, societies differ in their assessments of who should prepare for catastrophe and participate in the calculation or risks – whether preparing for risk is largely an individual task or one which should be shared among society and the state. Secondly, societies may differ regarding how much monetary and organizational emphasis should go towards preempting an event, and how much should go towards mitigating an event once it has occurred. As Douglas and Wildavsky tell us: The choice of risks and the choice of how to live are taken together. Each form of social life has its own typical risk portfolio. Common values lead to common fears and, by implication, to a common agreement not to fear other things. (1984, 8)

As these analysts pointed out, nearly 30 years in their ground-breaking work on environmental risk analysis, the average technology user is rather ill-equipped to think objectively about the threats and risks which he encounters on either a daily or a long term basis through his exposure to the technology – even if he wanted to. The user is unable to formulate a rational proposition about what constitutes an unacceptable risk from the technology since he either doesn’t have all of the information, doesn’t understand that information, or chooses to ignore it. In the face of these obstacles to a perfect weighing of threat and risk, Wildavsky and Douglas suggest that each society or culture may engage in certain heuristics and

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shortcuts as a way of “organizing their bias.” They will choose certain aspects of the threat equation to focus on while choosing to ignore others. The weighing of threat and risk thus rests at least partially on culture and history, and the process is far from objective. Previously, I had suggested that it does not mean the same thing to be mentally ill in China as it does to be mentally ill in the US. In China, the likelihood that one would lose one’s autonomy, one’s social status and would be stigmatized is much greater. Thus, the social risks associated with internet addiction are much higher in one culture than another, though the actual statistical probability of developing a problem controlling one’s use of the technology may not vary from one culture to another. Particularly when people are thinking about brand-new technological risks which are novel (like the internet and the threat of war in cyberspace), there is very little past evidence that analysts or users can go on in making these conclusions. Rather, in such a situation, each state might undertake a search in which they gather lessons from past experiences with the introduction of new technology. Thus, each state is likely to use and weigh different evidence in evaluating threats and will reach different conclusions as a result. Each state thus uses its own historic and cultural lens to make sense of and explain the puzzle of new technological risks stemming from the internet.

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Index

abstinence 55–7, 62–3, 124 acquired immune deficiency syndrome (AIDS) 99–100, 116, 120, 136 in China 144 securitization of 132–3, 136 addiction 53, 55, 62 and anti-psychiatry 55, 93 degrees of 56 as a disease 62 model of 62–3 social acceptability of 54, 67 and technology 2, 43, 88, 111 see also internet addiction addictive behaviors 43, 65–7, 71 AIDS see acquired immune deficiency syndrome Alcoholics Anonymous 56, 63 alcoholism 50, 55, 84, 120, 136 Alexander, Marcus 15 American Library Association 82 American Psychiatric Association 48, 111 American Psychological Association 65, 111 Diagnostic and Statistical Manual of Mental Disorders (DSM-V) 2, 27, 48–9, 53 American Psychopathological Association 27, 49, 111 American Society of Addiction Medicine 53–4 Anderson, J. 154 anti-psychiatry 37–41, 43, 55, 62, 78, 90, 93, 151 Atwood, Dorothy 1, 83 Australia 75 Barlow, John Perry 103 Barstow, Paul 81 Bayer, R. 48 Beck, Ulrich 58

behavioral questionnaires 67 Belles, A. 46 Bennett, Isabella 103 Beranuy, M. 46 Berkman Center for Internet and Society 18 bicycling 3–4, 6–7 Victorian restrictions on women 7–8, 22–3 Bijker, W.E. 3–4, 6–7, 16, 26, 163 biopolitics 94–6 biosecurity 34, 134, 145 Bishop, Jeffrey 96, 98 Bleakley, A. 117 Bligh, J. 117 Bloch, Sydney 79 Bolton, J. 138 Boorse, C. 95, 112, 159 Borsook, P. 81 Bourgois, Philippe 129 Brandeis University 19–20 Briggs, C. 125, 150 Briggs, G. 125, 150 Bush, George W. 25 Byun, S. 49 Campbell, A. 61, 84–5 Campbell, D. 14 Can, Tran 144 Carbonell, X. 46 Catone, S. 9 Cerf, Vincent 102–3 Chen, J. 47, 62 Chen, X. 155, 158 Chiemeke, S.C. 121 Child Online Protection Initiative 21, 75 child pornography 21, 75 China, People’s Republic of AIDS in 144

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Confucian values 127–8, 142, 150, 152, 155–7, 159 and escapism 86–7 internet access policies of 27–8, 61, 75–6, 78, 124 internet addiction in 2–3, 40–2, 64, 68, 70, 72–4, 83, 85–8, 105–7, 118–19, 153, 161 definitions of 13, 41 as an epidemic 73–4, 86, 131–2, 144, 146–7 and medical research 44–51 politics of 26–34, 42–3, 159 and public health 131–2, 134, 150 scale of 2, 41, 73, 132 security threat from 131, 133–4 sensationalization of 116 treatment of 3, 48, 83, 87–8, 127–9, 162 internet cafes, regulation of 2, 9, 68, 71, 75, 106–7, 132 Law on the Youth of China (2007) 27, 48 Medical Center for Internet Addiction 44 mental illness in 125, 149–50, 158–61 Ministry of Culture 70–1, 129 Ministry of Defense 27, 44, 48 Ministry of Health 128, 158 National Science Council 44 perception of internet risk 9, 22, 59–60, 89, 104–5 policing of the internet 9, 13, 68 psychiatric treatment in 79–80 regulation of online activities in 2, 9–10, 70, 109 and securitization 141–6 Chinese Academy of Sciences 70 Chinese Internet Addiction Scale 44, 47 Chinese medicine 151–7 Chinese Teenager Mental Growth Base 109 Cho, S. 50 Chung, K.F. 160 Clark, Taylor 86 Cohen, A.V. 12 Cole, S. 86 Confucianism 127–8, 142, 150, 152, 155–7, 159

content filtering 12, 20–1, 57, 75, 132 Coser, Rose 119 Covello, V. 32, 105 Crawford, R. 116, 120 critical psychiatry 34, 37–8, 64, 88, 90, 93–8 110, 112–15, 151, 155 Cumming, S. 61 Curley, M. 141–2 cybercafés see internet cafes Cyberpsychology and Behavior 44, 47, 49, 66, 111 cybersecurity 17–18, 104 cyberspace 18–19, 30, 156 and citizenship 11–12, 21, 82–3 declaration of independence in 81, 103 and ethics 103, 156 national approaches to 17–18, 21 politics of 23 risks in 10–11, 33, 136 cyberthreat 18, 104 matrix of 29 cyberwellness 27–8, 72, 74, 95–6, 119 danger and hazard, discourse of see threat talk declaration of independence in cyberspace 81, 103 Diagnostic and Statistical Manual of Mental Disorders see under American Psycho-logical Association differential internet access 64–71 digital rights 11, 81–2 disease 95, 137 categories of 115 and critical psychiatry 97 ontology of 37–8 patterns of 47 and psychology 79 as a threat to the state 133 Dodier, N. 39 Douglas, M. 16–17, 163–4 driving 6 ideology of 14 Saudi Arabian restrictions on women 13–14, 22–3 drug therapies 3, 32, 87–8, 129

Index e-governance 82–3, 103 Elbe, S. 140–1, 143 electroconvulsive therapy 3, 128, 162 epidemics 136, 138 and internet addition 2, 68, 73–4, 86, 131–2, 144, 146–7 scientific definitions of 73 see also territoriality Eriksson, E.A. 23 European Union 81–2 Fallon, D. 9 Falun Gong movement 145 Feldbaum, H. 132, 140 filtering of content 12, 20–1, 57, 75, 132 firearms control 13, 70 Fischer, Claude 64 Fitchen, J. 63 Flichy, Patrice 20, 102, 156 Forster, E.M. 100 Foucault, Michel 90, 93–4, 96, 98, 113–16, 155 Frankenstein 63, 100 Gao, Wenbin 70 Gartner, C. 123–4 ‘gatekeepers’ 7, 12–13 Georgetown University 20 Germany internet addiction in 117 internet treatment programs 85 Gilman, Charlotte Perkins 69–70 Gjelten, T. 105 Glackin, Shane 110, 112, 152 globalization 14, 133 Golub, A. 32, 60 Graham, Loren 89 Greaves, D. 125–7 Greece 73 Green, M.S. 73 Greenberg, Joel 114 Griffiths, M. 64 Guardiola, E. 46 Gusev, Pavel 106 Hacker Code of Ethics 81 hackers 81, 97, 120–1 Hall, W. 123–4

183

Hanson, M. 57 Hathcock, A. 61 Healy, Margaret 99 Herzlich, Claudine 38–9, 98–9, 108, 115, 119 Hirschman, Albert O. 30–1, 86–7 Holdaway, Jennifer 133 homosexuality 21, 99 as a mental disorder 48 Hood, C. 24 Hu Jintao 109 Huang, H. 118 Hughes, I. 61 Hui, Edwin 153–4 human rights 81–2 and internet access 15, 21 and internet addiction treatment 128 and national security 132 Hurricane Katrina (2005) 16, 163 iatrogenesis 38 Illich, Ivan 38, 80, 93, 107 illness 37–9, 95, 99–100 and Chinese medicine 151–7 and the ‘sick role’ 85–6 as a threat to the state 133 Indian Institute of Technology 107 Information Society and Media Directorate 81 Information Technology Research Centre (China) 64 information warfare 105 Ingram, H. 23 International Telecommunications Union 21, 75 internet constructivist perspectives on 15–16 emergent risks and opportunities from 9–10, 18, 20 ideological contexts of 14–16, 18, 20, 103 and social norms 9, 20–1, 110–11, 113–15 state regulation of 2, 9–10, 12 and threat talk 18–22 and US foreign policy 20 usage monitoring 75–7 internet access

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a s a human right 15, 21 national policies on 27–8 internet addiction 1, 9, 42, 65, 67–9, 78–81, 100 and anti-psychiatry 37, 39–40, 55 in China 2–3, 40–2, 64, 68, 70, 72–4, 83, 85–8, 105–7, 118–19, 153, 161 comparative politics of (case study) 26–34 and critical psychiatry 94–5 definitions of 41, 60–1 diagnosis of 2, 27, 37, 41, 43, 49–53, 65, 110 and differential access 64–71 as a disability 112 as a disease 2–3, 42, 131 factors leading to 67 medical research on 43–51 medicalization of 41, 107–13 ‘myth’ of 40, 83 politics of 42–3, 54–5 prevention of 54–5 threat posed by 94–5, 101–7 treatment of 28, 71–2, 85, 87–8, 127–9 Internet Addiction Test 51–3 internet addicts ‘construction’ of 115–21 treatment of 2–3 internet cafes 61, 107, 136 Chinese regulation of 2, 9, 68, 71, 75, 106–7 internet citizenship 22, 81–2 internet health surveillance 121–7 ‘internet junkies’ 62, 106 Internews Network 18, 103–4 Japan 17, 71 Jellinek, E.M. 56 Jiang Qiping 64 Johnson, B. 32, 37, 105 Johnson, N.F. 111 Kandell, Jonathan 115 Keane, H. 129 Keller, A.C. 22–3 Khamis, Sahar 103 Kinsey, Alfred 48

Kirkham, S.R. 154 Kitcher, Philip 126 Kuhn, Thomas 42–5 Kushlick, D. 141 Laird, W. 23 Laite, J.A. 122 Lane, Christopher 79 LaTour, Bruno 5 Law on the Youth of China (2007) 27, 48 Lee, O.G. 61 LeJeune, R. 86 leprosy 99, 131 Leung, L. 118 Levy, Steven 81 Lewis, James 105 Li, E. 156–7, 159 libertarianism 78–9, 81, 126, 139 Lin, M. 157 Lingley, K. 32, 60 Liu, C. 47 Liu, M. 50 Lo, P. 154–5 Longe, O.L. 121 Lora-Wainwright, A. 118 Lupton, D. 114, 117, 135 Lysaught, M.T. 94–5 MacGregor, James 104 MacLean, Sandra J. 131–5 McLuhan, Marshall 64 McMahon, Robert 103 ‘madness’ 37, 93 May, Christopher 14–15, 40, 46 Medical Center for Internet Addiction (China) 44 medical establishment, the 53, 62, 94 and internet addiction 57, 62, 97 and the state 42–3 medical research, politics of 43–51 medicalization 107–15 medicine Chinese forms of 151–7 politics of 96 Medvedev, Dmitry 60 Meerkerk, G.J. 51, 142 mental illness 38–40, 47, 80, 84, 112, 152 in China 125, 150, 158

Index d iagnosis of 48–9 homosexuality treated as 48 in the United States 48, 87 see also ‘madness’ Mol, Anne Marie 37–8, 111, 151 Morozov, Evgeny 15 Morrison, Catriona 67 National Institute of Health (US) 27, 48 National Science Council (China) 44 National Science Council (Taiwan) 44 National Science Foundation (US) 19 national security 132 Naus, F. 31, 88 el-Nawawy, M. 103 Nelkin, D. 29 nervous exhaustion 70 ‘netaholics’ 62–3 Netherlands, the 16–17 networks of beliefs 5–6 Ni, X. 11, 76 Norway 41, 73 occupational medicine 39 Oldenziel, R. 4–5 online gaming 2, 50, 60–1, 70, 75 opium addiction 31–2, 60, 105 O’Riordan, Timothy 12 Parsons, Talcott 85 Peele, Stanton 55 Peng, W. 49–50, 158 Peterson, S. 147 pharmaceutical industry 40, 42, 44, 48, 162 Pierret, Janine 38–9, 98–9, 108, 115 Pinch, T.J. 3–4, 6–7, 26 Piot, Peter 133 ‘plague’ and ‘plague logic’ 98–9, 135–9 Poirier, S. 69, 126 ‘politicization of connectivity’ 11 Porter, R. 84, 118, 133, 138, 140 Posner, Natasha 99–100 Potter, Will 25 precautionary principle 58–61 problematic internet use 65 prohibition (of alcohol) 55, 136 psychiatric illness 37–8 psychiatry 40, 42, 72, 78, 114, 151

i n China 79–80 political purposes of 62, 114 in the Soviet Union 78–9 see also critical psychiatry psychology 37, 72, 78–9 public health 114, 122–3 and ‘plague logic’ 135–9 policing of 108 politics of 39 and state defense 139–40 threats to 132–4 Putin, Vladimir 59–60, 106 Qualtiere, L.F. 145 Reddaway, Peter 79 Reed, Lori 110, 113, 152 Reid, Julian 11 Reporters Without Borders 20 retreatism 86–7 Ring, Natalie J. 122 risk 8, 70 culture of 16 in cyberspace 23 measurement of 22–3 perceptions of 16–17 state exaggeration of 25, 29 subjective nature of 22 universal 56–8, 62–3, 68 risk assessment 7, 10–14, 16, 22–3 cultural contexts of 23–6 and threat talk 23–6 risk management 10, 18, 24, 33 Risse, G.B. 145–6 Robertson, A. 124–5 Rogers, Everett, M. 59 Rose, N. 151 Rowe, W.D. 10 Russia cyberspace doctrine of 17 government censorship in 9 information warfare 105 internet addiction 9, 61, 71 internet regulation 106 state perception of internet risk 22, 59–60 threat talk in 32 see also Soviet Union

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Russian Orthodox Church 59 Sack, Robert David 136 SARS see severe acute respiratory syndrome Saudi Arabia ban on women drivers 13–14, 22–3 internet censorship in 21 Schmidt, R. 25 Searle, John 4–7 securitization 131, 136, 140–1 in China 141–6 severe acute respiratory syndrome (SARS) 145–6 Shade, L.R. 100 Shanghai Cooperation Organization 105 Shao, Y. 160 Shelley, Mary 63, 100 Shukla, Pratibha 59, 107 ‘sick role’ 85–6 Siew, Alfred 61 Singapore ‘cyberwellness’ in 119 internet addiction research in 47, 51 internet education in 74 social constructivism 4–6 social control 138–9 social norms and risk perceptions 16 and technology 4–8, 10 Sontag, Susan 99 South Korea 50–1, 73 Soviet Union 8, 25, 87, 89 alcoholism in 84 psychiatry in 78–9 see also Russia Spitzer, R. 48 Stewart, C. 83 student internet usage 12, 76–7, 83 monitoring of 12, 28 substance abuse 49, 53, 67 suicide websites 71 Suler, J. 120 Sun, Dongdong 79–80 Szasz, Thomas 37–40, 42–3, 49–50, 52–3, 55–6, 62, 72, 77–80, 83–4, 87, 89–90, 93, 110, 112–13, 152

Taiwan internet addiction research in 44, 46–7, 49, 51, 67, 73 National Science Council 44 Tao, Ran 2, 32, 45, 50, 60, 62, 78, 80, 87, 109, 118, 129, 141, 155 technological diffusion 6, 8, 12 technological literacy 27–8, 74 technology adoption of 6, 8, 12 ideologies of 4–5, 7, 10, 13–15 inappropriate uses of 7 and risk perceptions 17 and social norms 4–8, 10 and threat talk 64, 105 technology addiction 2, 43, 88, 111 telecommunications technology 64, 100–1 territoriality 136–8 Tesh, Sylvia 52, 84 threat talk 7–8, 10, 13–14, 32 in China 9 and the internet 18–22 and the politics of internet addiction (case study) 26–34 and risk assessment 23–6 and technology 64, 105 Tian Bingxin 32, 60 Tung, C.J. 1 Turner, B.S. 86 Turoldo, F. 162 Twitter 105 United Nations Convention on the Rights of the Child 158 Programme on HIV and AIDS (UNAIDS) 133 United States cyberspace doctrine of 17 foreign policy of 20, 104 internet access policies of 27–8, 74 internet addiction research in 44, 47–8, 50, 64, 72 internet risk assessment in 10–11, 28, 89 mental illness in 48, 87 National Institute of Health 27, 48 National Science Foundation 19

Index National Security Strategy (2010) 17–18 politics of internet addiction in 26–34, 42–3 prohibition of alcohol 55, 136 red scare (1947–57) 25 risk culture in 16–17 University of Southern California 19 Unschuld, P. 89, 119 vaccination 78, 123, 136 virtual lives 32, 52, 87 Vladimirov, Artemy 59 Vuori, J.A. 142, 145 Wang, M. 156 Wang, M.X. 158 Wang, X. 156 Watts, S. 136, 140, 162 Weaver, Ole 141 Wen, Yu 106 Wenlei, D. 30, 49 Wenyong, D. 158

187

Widyanto, L. 64 Wildavsky, A. 16–17, 163–4 Willrich, M. 136 Wong, M.C. 160 World Health Organization 47, 144, 150, 161 World Internet Project 20 World Values Survey 20 Wu, C. 49 Wu, Jichuan 104 Yang, J. 128 Yang, L.H. 159 Yang, S.C. 1 Yang Yongxin 144–5 Yen, J. 118 Young, Kimberley 1, 26 , 41, 51–3, 62, 65, 68, 153 Zachman, K. 5 Zhang, E. 128 Zhang Chunliang 59