In 2014, the National Institute of Mental Health Sciences (NIMHANS) in Bengaluru did something extraordinary. It started a facility that exclusively deals with the intersection between technology and psychological wellness. In the four years since, the Service for Healthy Use of Technology (SHUT) Clinic has now become something of a pioneer in the field.
Since its inception, the SHUT clinic has dealt with several cases of addiction to gaming, social media, pornography and so on. Located at the NIMHANS Centre for Wellbeing in BTM Layout, the SHUT clinic is run primarily by Dr Manoj Sharma, who has over a decade’s experience in dealing with behavioural addiction.
The beginning
Before 2008, Dr Manoj, a clinical psychologist, had been working in the area of substance addiction. He later took up a few studies exploring the association between addictive use of the internet and underlying psychological issues. When this hypothesis was confirmed, he conducted more studies with diverse age groups including teens, young adults, working professionals and even NIMHANS staffers.
The results showed a trend of technology-related unhealthy behaviours and mental health issues. “People, as well as parents of teens affected by this, wanted to know what they could do and where they could seek guidance and expertise,” Dr Manoj says. And so, in 2014, the SHUT clinic was established with a three-point agenda – to create awareness, to further research, and to train manpower in skills and intervention for such cases.
The cases
From just one, the SHUT clinic now gets eight or more cases per week. After four years of being at the clinic, Dr Manoj can now point to the most common issues that they see. “Most of our patients are between 15 and 20, because parents are able to recognise the changes in behaviour and effect of unhealthy use of technology better when the patients are in the late teens,” he says. “We do get some people who are 21 to 30 age group as well, but they are fewer in number.”
In both age groups, the majority of patients are male, but it’s not as though women and girls are not impacted by unhealthy technology use, Dr Manoj says. A major chunk of the cases that SHUT clinic sees is of gaming addiction, followed by addictive internet browsing and porn addiction. Dr Manoj adds that porn addiction may be a much bigger issue, but due to secrecy and the silence surrounding sex, people are less likely to come forward, even if they do recognise that they have a problem.
Especially for teens, technology addiction can be a manifestation of existing stressors. “When we studied technology use in 13 to 17-year-olds few years ago, technology addiction was a result or exacerbation of academic stress, family-related stress, and even related to sexual content that they see online. They don’t know how to process this information and cannot confide in parents because they fear losing access to the internet,” Dr Manoj observes.
Ask him about the most challenging cases at the SHUT clinic, Dr Manoj simply says, “Each case is challenging because it shows the manifestation of a range of issues." He elucidates with an example of a PU second-year student whose parents got him to the clinic due to his gaming addiction. “He would play into late in the night and after a point, stopped going to college altogether. He would only interact with his gaming community friends online. He would not speak much to his parents or with people offline in general,” Dr Manoj narrates.
Contrary to what one might think, the addiction itself is not the first thing that gets addressed here — the obvious way of directly cutting off access to gaming or the internet. “We zeroed down on three issues here – the need for recognition that the child was not getting from his parents; the need for approval and validation; and the lack of offline interaction. So, the first thing we started with was lifestyle changes – food habits, physical activity, increase in family time and so on,” he explains.
The parents are also counselled in these cases because children are likely to look online for the support they lack in real life. Home and school environment often have a role to play here. “In a particular case, the parents also started having marital issues because of their son’s behaviour. That added to the toxic environment at home,” the psychologist says. Only after addressing these issues can you focus the remaining issues of the addiction itself.
This particular case took about six months, and an average case of addiction can take a minimum of three months. “The time it takes can reduce if the addict is particularly determined. Conversely, it can take longer than usual if there are relapses of no proper follow-ups,” Dr Manoj says.
A dynamic discipline
Taking a cue from SHUT clinic, Dr Manoj says that the All India Institute of Medical Sciences in New Delhi also started a Behavioural Addictions Clinic (BAC) in 2016, and even the Armed Forces Medical College in Pune and SGPGI in Lucknow started similar facilities.
Over time, the people at the SHUT clinic have learnt and developed protocols for dealing with technology de-addiction cases that were not there before. Also in the works is a standardised intervention model and screening tool for unhealthy tech usage. “We have already launched a Digital Detox app which people can use to monitor their tech usage. This may help them acknowledge that they have a problem at least,” Dr Manoj says.
In today’s world where online interactions are fast replacing face to face ones, Dr Manoj says communication is key. “If there is communication between all the stakeholders – parents, children, teachers, peers – there will be trust to talk about issues they may have. The second thing is cyber literacy. Right from the moment they hand their phones and gadgets to their kids, parents need to be educated and start educating their kids on the pros, cons and healthy usage. They need to set a good example too,” Dr Manoj suggests.