Physicians debate Internet-related marital problems on CMA's online service
Patrick Sullivan
CMAJ 1997;156:1617-8
[ en bref ]
Patrick Sullivan is news and features editor at CMAJ.
© 1997 Canadian Medical Association (text and abstract/résumé)
In brief
The Internet itself has been the topic recently on the CMA's Internet-based discussion group for physicians, Clinical Q&A. A recent discussion involved physicians from around the country who have dealt with patients with marital problems related to the Internet. They concluded that the Internet may have made problems manifest, but the underlying issue -- marital disharmony -- already existed.
En bref
Le groupe de discussion Internet de l'AMC réservé aux médecins, Q et R cliniques, a discuté récemment d'Internet même. Des médecins de toutes les régions du pays qui ont traité des patients qui avaient des problèmes conjugaux causés par Internet ont participé nécessairement à une discussion. Ils ont conclu qu'Internet peut avoir mis des problèmes en évidence, mais que la grande question sous-jacente -- le manque d'harmonie conjugale -- existait déjà.
The Internet is beginning to make itself felt in physicians' offices, but in ways they probably never expected. A recent discussion in CMA Online's Clinical Q&A section, which is used only by clinicians, involved an exchange about ways the Internet is affecting patients' personal lives. It is the first time the issue has been discussed in Clinical Q&A, which was launched 2 years ago. More than 200 physicians from around the world use the service.
The discussion, which eventually involved doctors from 3 provinces and 1 territory, began with a family physician's query about a patient who complained of insomnia. "After a little probing, the major issue was that the patient had recently signed an unlimited Internet access contract and his wife was now spending hours each day 'chatting' to various men around the world," the physician wrote. "She is up until the small hours of the morning and he has become insanely jealous. He phones from work to see what she is doing, and as often as not she is on the computer. When at home he wants to watch what she is typing but she won't let him. She claims there is nothing wrong -- these people are just friends.
"Has anyone else had similar patients? How did you handle them?"
The resulting exchange provided an inkling of some of the issues developing because of the growth taking place in cyberspace. CMAJ first mentioned growing concern about problems related to Internet use in 1996 (154:1882-3 [in brief / en bref]). The article described how an American psychologist, Dr. Kimberly Young, had established a Centre for Online Addiction; it sparked a flood of calls from media outlets in Canada and the US and received front-page newspaper coverage.
Young used "Internet addiction" to describe a series of problems that can arise when people spend too much time online. "Internet addiction does not cause the same type of physical problems as other addictions, such as alcohol, but the social problems parallel those of other established addictions," she said. "Loss of control, cravings and withdrawal symptoms, social isolation, marital discord, academic failure, excessive financial debt, job termination -- these are just some of the consequences documented in my research."
However, the discussion that ensued in Clinical Q&A indicated that although the Internet may have precipitated marital discord in the case mentioned, it merely brought things to a head. One of the physicians who responded was already dealing with a complaint from a female patient. In that case, the man stayed up late "chatting with his soul mates," leaving his wife feeling "neglected and rejected." Psychotherapy was used in an attempt to determine why the man needed this type of online friendship.
Referring to the initial query, another physician argued that the couple's marriage problems "started way before they got Internet access. What holds their marriage together? She's desperately short of romance in her life and it is sad that she has to find it electronically, but how different is this from reading romantic fiction? The difference is that it is interactive and gives virtual substance to dreams and fantasies.
"I think I'd handle this by trying to get the husband to assess the priorities in his life, and go from there."
The next physician to enter the discussion said doctors have to look beyond Internet-related issues when they face this type of problem. "This is a marital-dysfunction problem, not an Internet problem," he wrote. "The Internet has simply made the problem manifest. It can't be very flattering to be replaced by a machine, and the natural response is to blame the machine instead of examining the relationship and the part you are playing -- or not playing -- in it."
The final comment was equally succinct: "For what it's worth, it strikes me that you might be dealing with an electronically evoked 'Othello syndrome.' "
The comments are only a small part of the discussion taking place regularly on Clinical Q&A, a service that CMAJ Editor-in-Chief John Hoey recently described as an "electronic form of corridor consultation" (156:561 [full text]).
Any practising physician can join the discussion by sending a written request on professional letterhead. It should be sent to Dawna Ramsay, Publications Department, CMA, 1867 Alta Vista Dr., Ottawa ON K1G 3Y6; fax 613 523-0937. The physician's email address and CMA membership number or licensure number must be included. American physicians may use their Drug Enforcement Agency number.
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