Until it is, nurses and other healthcare providers may want to try to help identify this “condition.”
It would have been difficult for Patsie McCandless to imagine a better, more appropriate gift for her 2nd Grade class. It was 1980, and every classroom in the elementary school that she was teaching at was receiving a computer for students. Going to school would never be the same for students and teachers alike. At the time, the introduction of the “compact” desktop computer was beginning to revolutionize technology and people’s ability to gather and store information electronically. Personal computers were becoming more commonly found in homes and schools in the United States, and in just a few short years the Apple MacIntosh (and its television commercial) would officially plant the seeds for many American families to feel the need to own their own computer.
Fast-forward nearly 40 years later, and McCandless, an educator to this day who today provides most of her teaching outside of the classroom setting, is among a growing number of adults who are doing what they can to restrict the use of computers in classrooms, and even in homes, across the country. No, they are not the equivalent of digital book-burners who are seeking censorship. The flames of their ire are directed at only one specific type of computer actually — you know it as the smartphone, a device that an estimated 5 billion people worldwide carry around with them every day, everywhere.1 Anyone of us would be hard pressed to remember the last time we walked into a restaurant and did not observe the majority of patrons using their phones. Today we can talk or text through the use of our phones as we walk down the street just as easily as we can do from the comfort of our couch. Our phones go with us into our cars, the airport (and on the plane), and are commonly found by our side in our places of work. There are laws that prohibit their use while operating a car and movie theaters have taken the brazen approach to remind us that we should not be on our phones while others are trying to watch a film. And, yes, they have increasingly made their way into the classroom among students of all ages, although more schools are restricting, or at least attempting to restrict, their presence2,3 due to concerns that they cause problems ranging from a lack of concentration and violence to anxiety, sleep disorders, and depression. In July 2018, the French government passed a law banning cell phones in schools. The policy is now in effect and impacts students in kindergarten through the 9th grade.
How could what was once looked at as a blessing for students now be viewed as a detriment? That’s part of what has officially become a conundrum and popular conversation. The volume of cell phone usage today has led many to wonder if they are inherently so convenient that people simply can put them to good use in almost all aspects of our daily lives, or if they are systematically designed to lure us into believing that we must rely on them to get through each and every day. Are we graced by their presence, or are we becoming addicted to them? Count McCandless, author of the children’s novel Becoming Jesse: Celebrating the Everyday Magic of Childhood, and an award-winning artist, among those who believe they are an addictive nuisance more than they are a helpful companion. Not only is she a proponent of the banning of cell phones in schools, she suggests that parents not let their phones come within eyesight of their young children, and she certainly is against any child using a phone prior to reaching school age. Although she does own a cell phone, she insists that her phone usage is so limited that it rarely leaves her purse, much to the disappointment of her husband when he is trying to connect with her. “The cell phone is one of society’s greatest challenges,” she said. “These phones, especially with the apps, just give too much stimulation. It is a terrible scourge on our children, teenagers included, but it really starts with the parents.” She believes that nurses and other healthcare professionals can have a great impact on helping people to identify unhealthy cell phone use that may be causing physical and emotional consequences and help their patients to kick any underlying cell phone habits. The first step, and a significant challenge itself, may be helping people recognize that there’s a problem in the first place.
Can Phone Addiction be Defined?
According to the Diagnostic and Statistical Manual of Mental Disorders, cell phone/digital screen use shows indications of behavioral addiction; but is not defined as a clinical addiction in the way gambling is classified. Things may one day be rewritten, however. Video games have been declared as addicting by the World Health Organization4 and one physician has gone as far as to label video screens as “digital heroin.”5 The game Fortnite has come under scrutinty for its time-consuming tendencies, and McCandless doesn’t see much difference between it and the use of phones. What may appear to be innocent enough, McCandless said phones are intentionally attention grabbing so that our brains develop a need to check them. “These cell phones are built by technicians who completely understand Pavlovian techniques and set every little bleep, burp, and emoji to get your attention,” she said. This “classical conditioning” refers to a learning procedure in which a biologically potent stimulus is paired with a previously neutral stimulus and the learning process that results from this pairing, through which the neutral stimulus comes to elicit a certain response that is usually similar to the one elicited by the potent stimulus.6 “Every light change, every text message, every notification — and the marketing ensures endless scrolling,” McCandless continued. “This is not something that has been clinically defined as an addiction, but I believe that it is an addiction because of the way the phone is able to adapt the brain into wanting more, which is what an opioid would do.”
McCandless points to symptoms such as an urgency to use the phone, a dependency on the phone, and a difficulty to control how many times the phone is picked up among the troubling signs of overwhelming phone use. There is a feeling of needing to be connected, and the intended of the use of one’s phone can be positive in nature and still be problematic, said McCandless, citing a seemingly constant need to access social media through a phone to see if someone “liked” your comment no less burdensome than continuously engaging in a heated debate on social. It’s an anxiety that can build to an unhealthy condition if the poor habit is not recognized and corrected.
“There are statistics that claim Americans are checking their phones every 10 minutes,” she said. ““And for teenagers, it’s really devastating when nobody ‘likes’ your comments. With young people, especially among girls, being on social media and in the ‘in crowd’ might require you to post something to your page that’s outrageous, if you want to ‘belong.’ It’s hideous.”
Poor habits are not exclusive to children, however, she says. “We’re really talking about the same things when it comes to adults; it just takes a little longer to manifest an anxiety because they tend to be more able to talk themselves out of their bad feelings.”
In November of 2016, Yu-Hsuan Lin, Chih-Lin Chiang, Po-Hsien Lin, et al proposed and published a set of diagnostic criteria that they believe could serve as the basis for making a clinical diagnosis for phone addiction.7 Based on a study of more than 280 college students that developed 12 candidate criteria for characteristic symptoms of addiction and four criteria for functional impairment caused by excessive phone use, core symptoms paralleled those seen with substance-related and addictive disorders. Symptoms included an inability to resist the impulse to pick up the phone, an anxious feeling when the phone was taken away (akin to physical withdrawal), and phone use that exceeded a longer-than-intended amount of time. “Even though there is no clinical diagnosis [for cell phone addiction], the clinical diagnosis of anxiety, depression, and ADHD have skyrocketed,” McCandless said. “And, yes, there are other factors involved, but the cell phone really does a job on this.”
McCandless also said that cell phone usage should also be considered a culprit among those who experience body pain, particularly in the neck, back, fingers, and thumbs; vision problems, including early onset of macular degeneration; obesity; anxiety, and sleep disorders. The separation anxiety [that occurs when someone cannot access their phone] is indeed real,” she said. “And teenagers sleep with their phones, and they want to be awakened all night long by these bleeps and burps. Americans are said to check their phones on an average of 80 times per day, and those who are millennials are said to be checking 150 times per day, on average.
The term “nomophobia” has been prosed as a phobia of being out of cellular phone contact that has been considered as a symptom or syndrome of problematic digital media use in mental health,8,9 though the definitions are not standardized.
Nurses as Advocates
While the jury is still out as to when a patient’s medical record may reveal a cell phone addiction diagnosis, nurses today can begin to help their patients uncover a potential unhealthy cell phone habit when they are being treated for other diagnoses, McCandless said.
“When I speak to nurses, many of them tell me that they see families on their phones beginning in the waiting room, much like you might see a family sitting on their phones in a restaurant. And nurses are the frontrunners for a conversation about this.”
She suggests that nurses encourage patients to try limiting their phone use to less than two hours per day, because it has been reported that more than two hors can increase anxiety and stress. “They can also think about suggesting that their patients restrict the use of their phones, perhaps to only in the house. And they can children to times when they are not in school. When confronted with parents who may not be comfortable with their child going to school without a phone due to the occurrence of mass shootings and other violent acts, she suggests that they consider “call necklaces” that are commonly known as devices for senior citizens.
“You don’t want to wag your finger, but nurses know what’s really going on with their patients. And the more people who know about this the better,” she said.
- The Mobile Economy 2018 GSMA. 2018. Accessed online: www.gsma.com/mobileeconomy/wp-content/uploads/2018/05/The-Mobile-Economy-2018.pdf
- Carter B. Students begin school year with new cell phone ban at district. FOX. 2019. Accessed online: https://fox17online.com/2019/08/26/students-begin-school-year-with-new-cell-phone-ban-at-district
- Benman K. Schools begin cracking down on students using cell phones
WWNY. 2019. Accessed online: www.wwnytv.com/2019/08/19/schools-begin-cracking-down-students-using-cell-phones
- Gaming disorder. WHO. 2018. Accessed online: www.who.int/features/qa/gaming-disorder/en
- Kardaras N. It’s ‘digital heroin’: How screens turn kids into psychotic junkies. New York Post. 2016. Accessed online:nypost.com/2016/08/27/its-digital-heroin-how-screens-turn-kids-into-psychotic-junkies
- Pavlov’s Dogs and Classical Conditioning. Psychologist World. 2019. Accessed online: www.psychologistworld.com/behavior/pavlov-dogs-classical-conditioning
- Lin Y-H, Chiang C-L, Lin P-H. Proposed diagnostic criteria for smartphone addiction. PLoS One. 2016;11(11):e0163010.
- D’Agata C. Nomophobia: fear of being without your cell phone. CBS News. 2008. Accessed online:https://web.archive.org/web/20080412042610/http://www.wsbt.com/news/health/17263604.html
- Jayakumar A. Break free from nomophobia, drunkorexia. Mid-day.com. 2008Retrieved 2011-08-10