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Simulating Psychosis II: Virtual Unreality

By Vaughan in Science
Thu Oct 28, 2004 at 04:44:20 AM EST
Tags: Science (all tags)

Psychologists and neuroscientists have spent several decades producing theoretical models of the mental processes and neural networks that might be involved in the kaleidoscopic state of psychosis. Largely concerned with simulating the nuts-and-bolts of the mind and brain, these computer models generate results that tend only to be of interest to researchers and their scientific colleagues. More recently, scientists have decided to harness the power of virtual reality, in an attempt to move beyond the confines of theory, to simulate the experience of psychosis itself.

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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 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".


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Related Links
o producing theoretical models
o psychosis
o Peter Yellowlees
o Jasmine Banks
o an interactive learning environment
o University of Queensland's
o Advanced Visualisation and Computing Laboratory
o University of California, Davis
o Linden Lab
o Second Life
o MOOs
o Second Life's first psychiatric ward
o experience like her own
o alternativ e approach
o Institute of Psychiatry
o get a handle on the psychology of paranoia
o Also by Vaughan

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Simulating Psychosis II: Virtual Unreality | 30 comments (29 topical, 1 editorial, 0 hidden)
Mental State (3.00 / 10) (#2)
by MichaelCrawford on Wed Oct 27, 2004 at 05:48:25 PM EST

I started hallucinating again during the summer of 2003, for the first time since 1994.

Mostly what I saw were police cars. There was usually something really there, like a flash of sunlight from a piece of glass, but what I would perceive were squad car lights.

It wouldn't be hard to simulate this in VR, but what would be missing would be how I felt about it - afraid, very afraid.

The fear would strike me before I realized I was seeing a police car.


Live your fucking life. Sue someone on the Internet. Write a fucking music player. Like the great man Michael David Crawford has shown us all: Hard work, a strong will to stalk, and a few fries short of a happy meal goes a long way. -- bride of spidy

Man (2.00 / 4) (#6)
by trane on Wed Oct 27, 2004 at 09:03:02 PM EST

How many times have I experienced that same hallucination. That's when you start shoving the drugs into your socks...

[ Parent ]
Or mistaking roof racks for squad car lights [n/t] (1.00 / 3) (#19)
by HyperMediocrity on Thu Oct 28, 2004 at 01:27:30 PM EST

[ Parent ]
That's probably a common paranoia... (none / 0) (#26)
by hans on Sat Oct 30, 2004 at 05:36:18 PM EST

...for people who spend a lot of time driving fast.  Just be careful it doesn't spill over into a persecution complex.

[ Parent ]
I tried Second Life once. (2.85 / 7) (#3)
by ZorbaTHut on Wed Oct 27, 2004 at 06:12:27 PM EST

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 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.

Oh, I also forgot to mention (2.50 / 2) (#4)
by ZorbaTHut on Wed Oct 27, 2004 at 06:16:39 PM EST

the party I stumbled into. A few dozen people, off near the newbie zone, just hanging around. Amazing costumes. I remember one person with enormous insect wings, and another who'd built themselves what looked like a futuristic suit of armor, vaguely reminiscent of Gunvalkyrie. Some just looked like normal people. I remember one that was pregnant. One that seemed to be made out of pure flame. A few that looked like Neo.

It was impressive, and fascinating.

I keep meaning to go back and learn the construction system, but my brief experience with it was so painful that I'm really hesitant. But I do recommend that people check it out, if only in passing. It's a small download and a free trial, and a $10 flat fee for permanent lifetime membership.

It's worth it just to see what they'll come up with next.

[ Parent ]

Yeah, it's ugly compared to, say, GTA. (none / 1) (#9)
by Russell Dovey on Thu Oct 28, 2004 at 12:47:35 AM EST

But it can be quite pretty with enough effort. What keeps me coming back to SL, apart from the fun playing-with-digital-blocks aspect, is the ambition of the designers. They're attempting to build the Metaverse, and so far they're on track to do it.

"Blessed are the cracked, for they let in the light." - Spike Milligan
[ Parent ]

Yeah (none / 1) (#12)
by ZorbaTHut on Thu Oct 28, 2004 at 04:41:06 AM EST

I've got a pretty low frustration threshold, so it'll probably be a while until I hang out there long-term. But it's a damn impressive idea. I can't wait to see it in a few years.

[ Parent ]
It is being worked on, it's called croquet. (none / 0) (#25)
by ultimai on Sat Oct 30, 2004 at 04:42:43 AM EST

See opencroquet.org.
It's in an alpha 0.1 stage right now although.

[ Parent ]
Psychosis cognitive, not only visual (3.00 / 6) (#5)
by cactus on Wed Oct 27, 2004 at 07:54:35 PM EST

How can a simulation really hope to capture a disorder that is fundamentally cognitive rather than purely visual?

Example: Someone who is psychotic might see a dog that isn't there, but be absolutely convinced that it is an emissary of god. He might "hear" it tell him to kill his neighbors, but it's the cognitive disorderf that makes him believe that it is the word of god and must be obeyed!
"Politics are the entertainment branch of Industry"
-- Frank Zappa
this is not solving the problem (1.75 / 4) (#7)
by Liberal Conservative on Wed Oct 27, 2004 at 09:25:16 PM EST

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

miserable failure

   liberal conservative

That was spooky (nt) (none / 1) (#11)
by bml on Thu Oct 28, 2004 at 04:13:41 AM EST

The Internet is vast, and contains many people. This is the way of things. -- Russell Dovey
[ Parent ]
That is not the point of the article (2.50 / 2) (#16)
by Highlander on Thu Oct 28, 2004 at 12:32:27 PM EST

You are imagining things


I didn't read anywhere that it was supposed to help the patients directly. It helps the helpers by giving them ideas about how a psychosis might feel to the affected, and it raises acceptance by the general public, because people can better understand why the affected act to weird.

Well, there might be an angle to it that helps the patients, their situation might improve if they have to talk and think about their perceptions.

However, trying to cure them by subjecting them to act inside "their world" might be a double-edged sword which would help some but worsen others. Maybe you could combine it with bio-feedback. If they could be taught to avoid the strange areas because they were dangerous, for example.

Moderation in moderation is a good thing.
[ Parent ]

dude (none / 1) (#22)
by trane on Thu Oct 28, 2004 at 05:19:35 PM EST

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

Mankind has been changing the reality that nature gave us for something like 15 thousand years, at least.

Drugs are one way; vr is another way. I say combine them for synergistic effects!

[ Parent ]

agree (3.00 / 2) (#23)
by tuj on Thu Oct 28, 2004 at 07:24:07 PM EST

I really sort of hate to say this, but take 15 grams of dried mushrooms or 5 hits of really good (+150 ug/hit) acid and see if you don't gain an empathy towards the mentally ill.

Once upon a time I read this great book about functional psychosis, and how this doctor had actually had two psychotic experiences (w/o drugs) and several 'induced' psychoses.  He had worked trying to give patients the tools to understand their own mental conditions, sharing with them academic literature on the topic.  He seemed to think that this had positive benefits on his patients, and saw several to recovery (aka get out of the mental hospital).

Sadly, I can't remember the title or the author.

Anyway, my point is that virtual reality is always something that will be perceived thru the senses as a virtual environment.  I think the parent makes a great point.  You have to effect that which is  I N S I D E  you to have a real affect on your consciousness.  When you feel like a month has been compressed down into one second of your existence... only then can you really perceive mental afflication.

I don't claim to have ever beeen psychotic.  Yet I recognize the dissilussion that comes with the beauty of certain chemicals.  The key difference was that I knew what had caused it.  And that was what let me understand (although not experience) what true psychosis must be like.

[ Parent ]

I think I have like (2.00 / 4) (#8)
by five volt on Wed Oct 27, 2004 at 10:18:43 PM EST

Happiness psychosis or something. Happiness totally saps away your motivation. It's hard to think of it as a problem, much less try to find a solution.

I'm making a recovery, slowly but surely. Right now I'm figuring out anger and jealousy.

I hope to one day be so unhappy that I take over the world. Baby steps.


Ruthlessness kicks ass.

you could almost believe you are there... (1.33 / 3) (#10)
by dimaq on Thu Oct 28, 2004 at 03:23:08 AM EST

...only if you're a nutter. and event than hardly.

what's your point? state it clearer in the abstract please.

i thiink the best way to explain psychological (2.88 / 9) (#13)
by circletimessquare on Thu Oct 28, 2004 at 05:51:01 AM EST

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 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

The tigers of wrath are wiser than the horses of instruction.

Tricky one (none / 0) (#27)
by GenerationY on Fri Nov 05, 2004 at 01:35:54 AM EST

I agree with you that its important to try and demystify these things.

However one must make sure that differences in magnitude are emphasised.

E.g., being unhappy vs. being clinically depressed.

The former is unpleasant, the latter debilitating.

Unfortunately it seems there is 'illness inflation' around these days where people capable of not only sitting in a chair but actually using a computer claim they have a "migraine". A similar confusion exists between colds (niggling) and influenza (has killed millions) for example.

I'm not disagreeing with you but I do think there is the other side to it. Its a difficult issue for sure. If I had to come down on one side I'd agree with you because I think its factually truer to say these things are matters of degree rather than kind, albeit the magnitude of difference is very great indeed.

[ Parent ]

Definitely not perfect. But might still be useful (2.66 / 3) (#14)
by Anonymous Hiro on Thu Oct 28, 2004 at 05:53:54 AM EST

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.

psychologists should play DOOM (2.00 / 6) (#15)
by Cloud Cuckoo on Thu Oct 28, 2004 at 06:41:33 AM EST

or the loads of other survival/horror & horror FPSs out there. There's your psychosis simulation for ya. Game's like Clive Barker's Undying, Doom(3), & parts of Alice, Half-Life, FarCry, etc can really give you that sense of paranoid fear psychotics must feel. Especially with the lights off and a pair of headphones.

No way (none / 1) (#17)
by Vaevictis666 on Thu Oct 28, 2004 at 12:34:46 PM EST

Lights off and *surround sound* all the way. Headphones just don't cut it for me anymore for stuff where sounds coming from behind are important.

[ Parent ]
Virtual hallucinations is not for treatment (2.81 / 11) (#18)
by jamescookmd on Thu Oct 28, 2004 at 01:25:00 PM EST

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.


Cool (none / 1) (#20)
by nutate on Thu Oct 28, 2004 at 02:22:36 PM EST

My girlfriend is studying for her neuroscience PhD right now.  And I've personally had a couple of psychotic episodes w/ no hallucinations.  Correct me if I'm wrong, but those are often studied in animals using disassociatives, (ie PCP, ketamine).  In my experience psychosis (racing thoughts, total disconnection with reality, no concern for anyone elses concerns, etc etc) was much more like a psychedelic experience.  Ie the seratonin analogs leading to psychotic experiences just like SSRI's can.

Sort of like living in a dream world that doesn't stop, with ideas that flow like a flooded stream of consciousness, etc. etc.


[ Parent ]

My article on schizoaffective disorder (2.50 / 4) (#21)
by MichaelCrawford on Thu Oct 28, 2004 at 02:49:22 PM EST

Hi Dr. Cook,

Welcome to kuro5hin.

About a year and a half ago I published an article here called Living with Schizoaffective Disorder that you might find interesting.

Please share it with anyone who might enjoy or benefit from it.

There is another copy on my own website that has somewhat nicer formatting. It's been in the top 10 at Google for the query schizoaffective disorder for over a year.


Mike Crawford


Live your fucking life. Sue someone on the Internet. Write a fucking music player. Like the great man Michael David Crawford has shown us all: Hard work, a strong will to stalk, and a few fries short of a happy meal goes a long way. -- bride of spidy

[ Parent ]

Will This Eventually Explain Why...? (none / 1) (#24)
by NeantHumain on Fri Oct 29, 2004 at 11:21:04 AM EST

Will this eventually explain why my dog has grown to the size of my house and now tells me that he's my master and that I'm his slave? I really hope so because I don't like eating this dog food very much.

I hate my sig.

post attempt (x2) (none / 0) (#28)
by bloodnose on Sat Nov 06, 2004 at 11:30:18 AM EST

my brother's excellent blog entry about theopsychosis.

I am attempting the experiment upon mice and rats named muricide. But I will give the mouse flouexetine rather than the rat. Also will use blind placebos.

Thank you K5-kabal if you were trying to save me from Hashassins, but I wilt do upon the writ as I must.

p.s. (none / 0) (#29)
by bloodnose on Sat Nov 06, 2004 at 11:31:36 AM EST

P.S. Using feral rodents, rather than lab bred rodents.

[ Parent ]
context (none / 0) (#30)
by keleyu on Thu May 05, 2005 at 09:06:23 PM EST

"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

Simulating Psychosis II: Virtual Unreality | 30 comments (29 topical, 1 editorial, 0 hidden)
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