Virtual Unreality

The latest virtual reality (VR) technology can produce worlds so absorbing, you could almost believe you were there. For many people who experience psychosis however, their sometimes fantastical and frequently distressing worlds cannot be switched off at the touch of a button. Psychosis typically includes hallucinations ('hearing voices' is not uncommon), distortions of perception and meaning, and the scattering of thought and behaviour into fragmented or eccentric threads. Excited by the increasingly realistic environments available to the would-be creator of VR worlds, researchers have recently begun to make the conceptual leap, from trying to simulate reality, to simulating the unreality of psychosis.

One such project is the brainchild of psychiatrist Peter Yellowlees and computer scientist Jasmine Banks. Aiming to produce an interactive learning environment for students of psychology and psychiatry, they worked closely with Sandy, a patient who experienced intense psychotic episodes. Using descriptions of her experiences, work began on creating a prototype environment, including a simulation of the intrusive hallucinations that were described to the research team. These included a cacophony of abusive and derogatory voices, the experience of receiving threatening messages from the newspaper and radio, and even an image of the Virgin Mary, who transformed from a comforting vision to a vindictive and insulting apparition without warning.

Despite the limitations of using computer software to simulate what is often a complex Jasminlive experience, Sandy was generally positive when she saw the finished version, recounting to the researchers that the simulation was a good approximation that captured the essence of her own psychotic episodes. So accurate in places, that having her hallucinations available to others caused an initial pang of anxiety: "This is such private stuff in a way", she remarked, "your hallucinations are things only you see; no one else sees them. It's exposing a part of me that no one else has ever seen before".

However, Banks' and Yellowlees VR simulation was written for the high power computers and wall to wall screens of the University of Queensland's Advanced Visualisation and Computing Laboratory. As it was intended as a public education tool, it became clear that their project would need to run on nothing more than a desktop PC if it was to move beyond the confines of academia.

By this time, Yellowlees had moved to California to continue his work at the University of California, Davis and by chance met James Cook, an employee of Linden Lab. Linden Lab had designed and created Second Life, an online community designed partly as an updated version of the text-based MOOs, a form of interactive adventure game popular during the internet's early years. Like many of the MOOs of times past, Second Life is designed mostly for social activity and gives users significant leeway in building their own corner of an online world for others to enjoy. Unlike a MOO, Second Life is represented as a 3D graphical environment that takes advantage of the latest developments in desktop hardware to produce a feature-rich multimedia experience. Cook, a qualified doctor, joined Linden Lab after becoming jaded with the relentless pace of primary care medicine, and became intrigued about the possibilities of using Second Life as a platform to bring Yellowlees' psychosis-simulation project to a wider audience.

Although technically accomplished, Second Life was not designed to be a graphically realistic representation of reality and the building tools are designed for flights of fancy rather than serious medical simulation. Despite these challenges, Cook set about creating Second Life's first psychiatric ward, where visitors could experience what it might be like for someone experiencing acute psychosis. "I built most of the objects myself and I'm not much of an artist" Cook admits. Despite this, exploring Cook's psychotic corner of the Second Life world can be an unsettling experience. While wandering the corridors, the casual explorer is assaulted by derogatory voices ("You're nothing. Kill yourself. Do it now"). Pictures and reflections warp and change as you examine them, and the seemingly-solid changes unpredictably. In one instance the floor falls away to reveal nothing but sky below, and in another a spotlighted handgun appears menacingly on a table.

Disquieting it may be, but some might ask how accurately virtual reality can simulate such a convoluted and confusing state-of-mind. Both Jo and Abbey have experienced psychosis and both have an interest in this developing field.

As a freelance programmer, Jo has worked on a number of notable free-software and commercial projects. During a time of intense activity her mind began racing with thoughts and revelations that initially seemed beautiful and significant, but eventually turned into an intense paranoid psychosis. Although intrigued by VR projects like James Cook's, she remains a little sceptical about how successfully it could represent an experience like her own. "What seems problematic", she says, "is the experience [of psychosis] has a deeply subjective content which I don't think VR would be able to replicate without access to my subconscious. Perhaps it is evasive to say that this is not communicable to anyone who hasn't experienced the same thing, but perhaps it is not communicable at all". "It does seem to risk reducing the whole thing to a novelty", she worries, although she is not totally dismissive and sees promise in being able to relate visual sensations like the "hyper-patternedness" she experienced, or the "snatches of familiar voices muttering things I'm not conscious of thinking".

Abbey (not her real name) experienced a similarly unusual version of reality during a severe bout of clinical depression. Now a research psychologist studying mental illness, she has a particular interest in novel ways of understanding psychosis. She feels that her own hallucinatory experiences could be accurately portrayed by virtual reality, but like Jo, thinks some of the core features would be poorly represented. "During the early stages", she remembers, "I had an intense feeling of perplexity. I knew something strange was happening, but I could not work out what, and later, during the intense psychosis, I was often unaware that my beliefs and perceptions were unrealistic". Although she thinks such complex mental states could never be simulated by computer, she feels the educational aspects of VR simulation may still be valuable, but not as they presently stand. "Without context, or if presented as a mish-mash of several people's experiences, I think the waters are being muddied too much. But presented in the context of someone's background, situation and wider mental state, there is potential for a richer understanding of their experience".

As a clinician himself, Cook is happy to acknowledge some of the shortcomings, admitting that some people "may have difficulty believing this sort of environment can be used for serious education". Although even with the potential drawbacks, feedback from his Second Life project has generally been very positive. The majority of visitors said that although they found the experience disturbing, they also found it educational and would recommend it to a friend.

Hoping to overcome some of the conceptual difficulties, an alternative approach has been tried by researchers from London's Institute of Psychiatry. They recently created a VR simulation of a library, where simulated people mill around or sit reading. Instead of trying to replicate radical changes in perception, their environment is designed to be as stable as possible. Crucially, they ask participants in the project what they thought of the other, virtual library users. They are interested in a certain subset of their participants who experience the people in the library as suspicious or malevolent, despite them being designed to act in an entirely neutral manner. By creating a controlled environment, and assessing how some people interpret a non-threatening situation as menacing, researchers aim to get a handle on the psychology of paranoia, one of the aspects that other 'virtual psychosis' projects have not been able to successfully tackle.

Ultimately however, it may be impossible to simulate the full experience of psychosis whichever technique is used. Yet prototypes such as the Cook's Second Life simulation may be having a positive effect none-the-less. Education is an ongoing process and can be accomplished with tools much simpler than high-end computer hardware. In this case, virtual reality is perhaps better considered as a complement, rather than a replacement, for traditional methods of education. "It may not be perfect", Cook says, "but if it raises awareness about mental illness and makes people a little more understanding, the technology has been well used".

Virtual hallucinations is not for treatment

I'm the James Cook mentioned in the article. Dr. Yellowlees and I built the virtual hallucinations site in Second Life.

Just to clarify something that has come up in the comments: the virtual hallucinations site is intended as an educational tool for people who are not mentally ill. We've only put two people with schizophrenia in the environment, and they were not sick at the time. We showed them the environment because it was based on their descriptions of their own hallucinations and we wanted to validate that it was a reasonable reconstruction.

We really don't have any idea if this is useful for treatment. My guess would be that it isn't helpful in general, particularly showing patient A's hallucinations to patient B. It might be helpful if you could show a patient his own hallucinations and try to do some sort of desensitization, like in treating phobias. But that's a big open question.

My primary hope is that this will be useful in ways like the movie "A Beautiful Mind". That movie does a poor job of accurately depicting hallucinations. But it's a great film, and a great benefit to the mental health community.

I'd hope that giving people an approximation of what it's like to hear voices and see illusions increases their sympathy for people with schizophrenia, and teaches them something about the disease.

Definitely not perfect, but might still be useful

It's hardly perfect. I mean if your brain is not working properly, everything else could be normal but you could feel scared/paranoid/angry for no particular reason other than your brain is not working properly. This even happens in dreams.

But I suppose it could be helpful for some people. Developing the ability to have "lucid dreams" apparently helps some people deal with nightmares. So if they get their minds used to being in a different state in a virtual psychotic environment it might help them control their mental state when they experience the real thing.

Also with the mind, belief/faith alone is sometimes good enough to get things fixed. So if it helps them believe that it fixes things, and it does.

That said I wonder if one might also break minds that way if you're not careful! The proverbial last straw on the camel's back.

The best way to explain psychological

Problems to people is by explaining to them that people with psychological problems don't have something we don't have, but that people with psychoogical problems have a little more of or a little less of something we all have

for example: manic depression. we all have moods and cycles, but manic depression is simply this taken to new heights and lows

or obsessive compulsive disorder. we are a little obsessive, this even helps us in some ways. but not all of us need to wash our hands with a new bar of soap 25x a day

even schizophrenia: hearing voices, seeing things that aren't there. we mislabel stimuli all the time... i thought i heard... i thought i saw... the chaturbate rooms sensation doesn't persist or manifest itself for very long, not even past a split second as some sort of corrective feature dampens the impulses... but we all have false impressions that fade away very quickly every day

so i think when communicating psychological problems to "normal" people, i think the thing to do is not focus on what a person with a psychological problem has that we don't have, but that they merely have a deficit or magnfication of what we all have going on in our skulls

and i think this is an important point, because it demystifies and demarginalizes people with psychological problems and makes them less exotic and more accessible

This is not solving the problem

i would propose a metaphor in this case to capture your key take-away points

basically you're saying that if your daughter's hand hurts you should cut it off instead of treating the infection

you claim that virtual reality is helpful because it can put subjects into different environments that may not exist or be available to them directly

i claim therefore that this is nothing better or worse than drug abuse; drugs simply numb us to reality and give us an alternative reality

if this VR can be put to good use for good end results that benefit mankind, then fine

but i doubt it strongly and instead feel that it will waste tax payers' money and sink morale for the handicapped

I tried Second Life once

It was ugly. That's really the first thing that you notice. It would be damn good-looking if this was five years ago, but let's face it, it's not.

The second thing you notice is the sheer detail you can apply to creating a Jasminelive character. Male models have a slider for "package size". I kid you not. I spent about an hour examining my face in the mirror and trying to duplicate it perfectly, just for the challenge of it.

The third thing you notice is that it's *really* ugly. I'd like to say otherwise, but the fact is that it's a real dog of a game, visually.

The fourth thing you notice is that it doesn't really matter.

See, anyone can build something. They can build, really, anything. So I spent some time wandering. I bought a cheap motorcycle and spent half an hour driving it around and discovering how bad the physics model was. I went to the construction zone and played around with moving polygons. And then I browsed things other people had done.

One person had built a giant crystal sculpture. That was impressive.

Another person had built what looked like the demonic crossbreed of a tricycle, a hovercraft, and a preying mantis. That was pretty cool also.

Yet another person had built a six-person flying behemoth. Apparently it was buggy, he hadn't gotten all the kinks worked out of the scripting, but it was still pretty cool-looking.

I took a look at the scripting. It was pain. Like, distilled pain.

In the end, I decided it wasn't for me. But I sent them ten bucks anyway. It's a severely impressive concept, and it feels to me like the only reason it's not yet implemented well is because nobody has a fucking clue how to implement it well. It's a devilishly complicated problem, and they're the only ones seriously working on it.

If it can accomplish things like this, it's worthwhile, and it will only get better. I can hardly wait to see what it looks like once they have a lot more bandwidth and CPU to play with. I have the feeling nobody here has seen the last of Linden.