It’s one thing to be told that schizophrenia often involves a person who hears or sees things that aren’t there. It’s another to ‘experience’ it yourself, via Second Life. (Although I’m not sure I’d call it ‘experiencing’ something by watching it on a screen, but I digress.) But a press release that came across our desk the other day did make it seem like this has some potential to help people with understanding a component of schizophrenia.
A University of California-Davis professor of psychiatry has helped develop an Internet-based virtual reality (VR) environment that simulates the hallucinations of people with schizophrenia. The vast majority of individuals who have toured the environment self-reported that it improved their understanding of the auditory and visual hallucinations experienced by people with schizophrenia.
“Using traditional educational methods, instructors have difficulty teaching about the internal phenomena of mental illnesses, such as hallucinations,” said Peter Yellowlees, professor of psychiatry and director of Academic Information Systems at UC Davis Health System.
Developed by Yellowlees and colleagues in the UC Davis Department of Psychiatry and Behavioral Science, the virtual reality system is being used as a teaching tool at the UC Davis School of Medicine. Yellowlees and his team created the virtual environment to replicate the experiences and world of a schizophrenia patient to provide medical students with a better understanding of this mental illness.
Schizophrenia is a severe mental illness that affects 1 percent of the population. Most people with schizophrenia experience auditory hallucinations, particularly hearing voices, and about one-fourth of those with the disorder experience visual hallucinations.
The researchers took photographs of an inpatient ward and hospital furnishings at UC Davis Medical Center to create their virtual setting. The team constructed simulations of auditory and visual hallucinations based on recorded audio samples and digital images described in interviews with schizophrenia patients. The researchers inserted the hallucinations as individual objects that would appear automatically throughout the ward, triggered by the presence of an avatar, an electronic image represented and manipulated by a computer user.
The hallucinations in the virtual environment included:
- Multiple voices, occasionally overlapping, criticizing the user
- A poster that would change its text to obscenities
- A newspaper in which the word “death” would stand out in a headline
- A floor that would fall away, leaving the user walking on stepping stones above a bank of clouds
- Books on bookshelves with titles related to fascism
- A television that would play a political speech, but then criticize the user and encourage suicide
- A gun that would appear under a cone of light and pulse, with associated voices telling the user to take the gun and commit suicide
- A mirror in which a person’s reflection would appear to die, becoming gaunt with bleeding eyes
Over a two-month period, the virtual psychosis environment was toured 836 times and received 579 valid survey responses. Large majorities of the responders said the tour improved their understanding of auditory hallucinations (76 percent), visual hallucinations (69 percent) and schizophrenia (73 percent). Eighty-two percent said they would recommend the tour to others.
One user said, “That tour was amazing. I didn’t think it would affect me, but about halfway through, I wanted to shout, ‘Stop it!’”
Another user said, “My first husband was schizophrenic. I have experienced visual hallucinations and they are disturbing enough.”
Yelllowlees and his colleagues acknowledged some important limitations of their pilot project, including their survey population not being a representative sample of the general population. Also, because users did not take a pre-test, the researchers cannot prove that participants improved their knowledge. Lastly, because the virtual environment focuses only on hallucinations, it may give inappropriate weight to these symptoms, rather than a fuller view including other symptoms such as delusions, and disordered speech and behavior.
However, despite those limitations, Yellowlees and his team believe their approach is promising. They plan to perform a more formal evaluation of its effectiveness in teaching students about psychotic experiences as compared to traditional teaching approaches. In addition, they intend to use the virtual environment to teach caregivers attending an early intervention program for patients experiencing a first episode of psychosis.