The American Medical Association (AMA) votes this week on a set of recommendations that caused a stir earlier this month by suggesting that video-game addiction might belong in the next edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual (DSM) of Mental Disorders. Other recommendations include calls for parents to pay more attention to what games kids play and for how long, and calls for the industry to better regulate itself. The recommendations are part of a report by the Council on Science and Public Health with the subject "Emotional and behavioral effects, including addictive potential, of video games."

The report singles out massive multiplayer, online, role-playing games (MMORPGs) as a cause for concern, saying that video-game overuse is most common in the 9 percent of gamers who play MMORPGs:

"MMORPGs are simultaneously competitive and highly social, and provide interactive real-time services. Researchers have attempted to examine the type of individual most likely to be susceptible to such games, and current data suggest these individuals are somewhat marginalized socially, perhaps experiencing high levels of emotional loneliness and/or difficulty with real life social interactions. Current theory is that these individuals achieve more control of their social relationships and more success in social relationships in the virtual reality realm than in real relationships."

Current evidence of video-game addiction comes from case studies and surveys that recognize varying symptoms of addiction. The report loosely defines overuse as "a constellation of behaviors observed in persons using the Internet to such an extent that it began to cause other aspects of their lives to become dysfunctional," and it compares video game addiction to pathological gambling. Anywhere from very few to 15 percent of players may overuse video games, according to the report, which calls for more research.

In light of the danger of overuse and the well-known concerns about violence in video games, the report recommends that parents be sure that their children under 18 limit their "screen time" (video games, television, and the Internet) to one to two hours a day. Martin Wasserman, executive director of MedChi, the Maryland State Medical Society, explains, "There are many tasks you have to learn in adolescence, and you don't have time to do that if you're playing seven hours a night."

Seven hours does seem excessive, but how many adults--especially the technologically inclined--limit themselves to two daily hours of screen time? In my own life, screen time is a way of engaging with news, literature, music, culture, and friends (through e-mailing), and it's a way of socializing (through the MMORPG that I play, for example). Sometimes I passively take in information, but other times I actively participate in online activities. When friends and I get together in an MMORPG, we chat about the game, books, work, and spouses, much as people might chat over a game of cards. Sometimes we tell stories about our fictional characters, mixing acting and writing. One of the things I really appreciate about the game is that it's available whenever I want to play: when I wake up at 7 A.M. on a Saturday, I can visit my in-game friends at a time of day when local friends don't want to hear from me.

It's good for kids to go outside and get exercise and sunlight, but there's a lot going on inside these days. Nottingham Trent University psychologist Mark Griffiths, who researches games and game addiction, says, "People only engage in leisure activities that are psychologically and socially rewarding for them."

The report by the Council on Science and Public Health mentions the potential benefits of video games in a list that includes health and educational applications, but it then goes on to say, "However, the vast majority of games are developed solely for entertainment purposes, and with more widespread use, the detrimental health effects of gaming are most often the focus of research."

Entertainment is a mix of art and play. It may be hard to quantify how art and play are beneficial, but I think they are.

I'm glad the AMA is thinking of ways to help people who have gone too far, but I worry that concerns about video-game overuse and violence will overlook the psychological and social value people find in games. If the recommendation to suggest adding video-game addiction to the DSM is approved, it will be up to the APA to decide whether to add it and how to define its symptoms. Certainly if someone is playing video games when he or she doesn't want to, that's not really playing, is it? On the other hand, I'm worried that the AMA doesn't understand online gamers--a real community existing in a virtual world. The virtual world, and the fantasy world of games, holds real value, or the majority of gamers who are healthy wouldn't devote so much time to it.