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Thursday, September 09, 2004

A LEVER TO MOVE THE MIND

On the Southern coast of Sedig, a medical doctor recreates the nightmarish experience of schizophrenia...

The fear of wrong things begins as a spidery prickle on the back of your neck. You feel a sweet chill, as it begins to skitter up your skull, then becomes a soft, sickly expanding pressure in your chest. This isn’t the kind of fear you feel from most computer games; it’s not like the jack-in-the-box shock you get, for example, when an animated ghoul pops its head out from behind a dark corner. This is a cloying, helpless, desperate panic, and it’s no fun at all.

The Virtual Hallucinations building arrived on Sedig's southern shoreline a few days ago (coordinates: 45, 25), but I had a chance to visit the place in August, when the building resided on a private island owned by the medical research arm of a California university. The brainchild of Nash Baldwin—“Nash”, named after John Nash of A Beautiful Mind, for reasons that’ll soon become obvious—the building contains a closely researched recreation of visual and aural hallucinations, based on interviews of real schizophrenics. Baldwin transplanted the simulation to Second Life's public continent, to give residents a chance to try it out, and to collect their feedback afterward (there’s a survey-taking device at the end of the tour), and as I first watched residents enter the doors, yesterday, I wondered if they’d feel the same kind of terror I did, last month.

Fred Extraordinaire, a tall goth with red hair, re-emerges from the building, and pronounces himself “sickened.”

He pauses, as if to collect his thoughts. “I don’t like the feel of asylums.”

But the sickness doesn’t come from the realism of the graphics, which are, as Baldwin would be the first to admit, rudimentary. The interior of the building is a recreation of a real hospital ward—for that is typically where schizophrenics will be, when their worst episodes hit—but unfortunately for Baldwin, few Second Life architects spend much time working on anything that would be useful for making a mundane hospital floor. (He scrounged through twelve different in-world marketplaces, but nothing doing.)

"Everyone has all these glamorous textures,” Baldwin grouses, “but you can't find office ceiling tile textures! It's all cool looking fancy stuff!" (And here’s another reason for taking the demonstration public: He’s hoping that some resident artists who live near Sacramento contact him with offers to build “boring stuff, like office furniture, hospital outfits. I'd kill for a great doctor avatar.”) So Baldwin, who has a Masters degree in Computer Sciences and a medical degree, but not much in the way of 3D rendering skills, ended up building the place himself.

Not that this matters so much, when it comes to the actual experience. At the entrance, a note cautions, “If you have a history of mental illness, particularly a psychotic disorder, you may not want to tour this facility,” and it’s not an idle warning. As non-descript and rough hewn as it is, something about the hospital changes, when you enter. And as it happens, so do you. (And residents who plan on visiting the Sedig facility may not want to read beyond this point, until they have.)

Kill yourself!
Do it! Do it now!
Dead! Dead!
You're nothing-- you don't even exist.

It’s the voices in your head that devastate you. Baldwin has built an audio attachment, so you hear these several voices in stereo, as if they’re speaking directly into your ears. And again, these aren’t the voices you’d hear in a horror movie— no gravel-throated demonic roars. They’re conversational, almost cheerful, and they never let up.

You're not sick.
You are contaminating my society.

The concept of creating a visual recreation of a purely internal experience originated with Baldwin’s colleague Dr. Peter Yellowlees, an Australian psychiatrist who often treated his patients in the Outback remotely, via video conferencing. This inspired his idea to visualize the hallucinations associated with schizophrenia, a mental illness that afflicts some one percent of the population (mostly people in their teens and 20’s). To determine what they hallucinated, Yellowlees compiled interviews with his patients, to draw out specifics. What kind of voices? How many voices? Like a police sketch artist of the mind, an artist drew out the visual descriptions, and Dr. Yellowlees integrated the results into a computer mockup. The first attempt was produced on a Silicon Graphics machine, and took nine months to build from scratch. ("Which doesn't look anything as good,” Nash promises me, as we begin the tour, “as what you're about to see.") By contrast, Baldwin put his Second Life version together in some three weeks.

You're nothing-- you don't even exist.
Join us in the world of the dead.

Things change, as you approach them, but the shift is subtle. A poster suddenly shifts to contain obscenities; a single word in a newspaper headline suddenly becomes the only word you see. A bookshelf seems to contain nothing but volumes about fascism. And most disturbing to me, a bathroom mirror which contains your reflection becomes, when you come closer, a bloody death mask. The man in the mirror is actually a model, but the hallucination is based on the testimony of a schizophrenic who stopped shaving, because when he looked in the mirror, he’d see his corpse staring back at him. (And when you get close enough to the sink, you hear the strains of bagpipes— because this is the music the man heard too, when he glimpsed his own death.)

"You may notice,” Baldwin observes with typical understatement, “it's difficult to concentrate in this environment. Imagine if you had schizophrenia. I can't actually work in this environment; it's so annoying and intrusive, I can't get anything done."

You're not sick, you're not really unwell.
You know this is not the real world-- you're dead.
Join us in the world of the dead.

Other shifts are less subtle. The floor falls away into sky, when you start to walk on it. A gun suddenly appears on a table, and a spotlight is cast on it, while a voice keeps commanding you to pick it up, and kill yourself. (This is based on the testimony of a schizophrenic who was arrested after he tried to snatch the pistol from a police officer’s holster.) A stereo broadcasts a radio news program-- which, if you listen to it for more than a few seconds, begins speaking to you.

Short term, Baldwin’s goal is to build up a library of hallucinations, so that the experience of individual patients can be recreated with fairly accurate specificity. The practical applications, however, are still somewhat inchoate. "Is there any therapeutic use for this?” Baldwin asks rhetorically. “We have no idea, it hasn't been tried.... it's worth a shot." He's also pondering the idea of putting non-schizophrenics through the experience, while they’re hooked up to an MRI imaging system, to see if hallucinations affect the same areas of the brain as a schizophrenic, during an episode.

One application he forsees is more immediate, hands-on, and empathic.

"When someone in your family is diagnosed with schizophrenia,” Nash tells me, “you try to find out what it's like.” And now, “we can pretty quickly mock it up and we can put the patient's family [through] it."

Some Second Life residents who've taken the tour had similar insights. "It had a personal side for me," Ginger Murdoch tells me by e-mail, "as my first husband was schizophrenic, and it allowed me a glimpse into his world... it was freaky!"

Another resident happens to be a graduate student training to be a therapist. “I have seen patients start yelling in the middle of a group session,” Helga Kerensky tells me, “and I would be clueless as to what set the person off. You know when this happens, that it is most likely a hallucination--but you expect that they are seeing something very threatening, the type of things seen in slasher movies. These hallucinations,” referring to those contained in Baldwin’s simulation, “are terrifying in a more Hitchcock sort of way.” Conveying their subtle horror is important, she says, because a schizophrenic “may not gain much sympathy and understanding for saying ‘The paper said I am dead’, as they would if they said 'A man was coming at me with a knife.'” Now it’s possible to see how wracking a newspaper headline can actually be. So, she says, “I believe this virtual lab will help families and medical professionals to develop a better sense of how debilitating this condition is.”

“Let me first say that the idea of psychiatry in virtual reality is kinda weird,” Snowcrash Martov tells me, after taking the tour himself. “This whole world is like an LSD-trip. So your senses are distorted as it is.” Still, he says, “To try and picture yourself as a mentally ill person in the real world while adjusting to an 'insane' world warps the brain more. So yeah... it was disturbing.”

Outside the hospital, Luminia Olsen tells me about her own experience. (Her avatar is a tiny vampire with a black pacifier permanently planted in her mouth, which makes the topic of virtual hallucinations seem even stranger, coming from her.) “[W]hen I came to this place,” Luminia tells me, “I knew nothing about this illness. But once I had a look around, I understand what it’s about.”

As can I, on perhaps a more fundamental level. I can honestly say I’ve never made fun of the mentally ill; I haven't always been above laughing at a joke made at their expense, either. (“Roses are red/violets are blue/I’m a schizophrenic/and so am I”.) After Baldwin’s demonstration, however—which I got while sitting in the middle of Linden Lab’s busy office, in broad daylight, while people chattered around me, and even then, it was unnerving— you know there’s nothing about schizophrenia to laugh about. Nothing at all.

“It genuinely kept me up at night like two days afterward,” I tell Nash later, “I'm not lying.”

“Well,” Baldwin replies, grinning, “you're one of those artistic types. Not such a strong grasp on reality anyhow.”

This project is something of a summation of Nash Baldwin’s two careers, first as a medical doctor, and then as a computer programmer. I originally knew Nash as a developer on the Second Life team itself, when he was known to residents as James Linden. (And I didn’t know he was also a practicing doctor, until shortly before he announced he’d be leaving the company to develop the schizophrenia project with a university.)

“[I] did my residency in internal medicine,” Baldwin says, “[and] did some clinical practice.” Cory Linden had a mutual friend in the game business, however, “and one day Cory called me and asked, “Wanna build ‘Snow Crash’? The rest is history.” But he never even gave up medicine entirely, even when he was a salaried programmer with Linden Lab.

“I did part-time clinical practice about once a month,” Nash says. “Medicine is a tough job, but a wonderful hobby.” Now, he says, “I'm hoping to blend my computer and medical skills-- try to make the world a little better through research projects. Kinda like a lever… clinical practice is a big difference for a small number of people.”

A project like this, Nash Baldwin tells me, is a “lever to multiply a small effect to many people.”

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» Mind's eye from arje.net

Virtual Hallucinations appears to be quite an interesting and eerie project. Nash Baldwin, a medical doctor who also has a decree on computer science, created a virtual reali... [Read More]

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» virtual schizophrenia from medmusings

via BoingBoing: Nash Baldwin's an internist-turned-programmer who set up a virtual world approximating the experience of schizophrenics to help loved ones better understand the disease: “[I] did my residency in internal medicine,” Baldw... [Read More]

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» Virtual Schizophrenia from datacloud
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» http://www.cs.northwestern.edu/~rob/blog/index.php?p=40655 from Robert Zubek
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Comments

Thank you for sharing this Nash. I toured your build and was deeply moved by the experience.

Posted by: Aimee Weber at Sep 9, 2004 12:17:58 PM

Nifty place, I felt right at home having spent a few weeks in a rehab in my mid teens with manic depression. My only crit would be the voices are a bit to loud overall, they should be more like whispers in one ear, the type of thing that would startle you like a loud noise in a quite room is the only way I could describe those. Ah kids don't do acid in your youth ;p You will regret it later.

Posted by: Foster at Sep 10, 2004 12:00:03 AM

Hi Wagner,

Is it possible to experience this if you're not a 2nd life subscriber? If so, how would you go about this?

Posted by: Dave at Sep 10, 2004 1:02:02 PM

Dave, nope. It is located within the second life world, so unless you dont want to pay the hilariously large 10$ usd fee, you cant see it.

Im looking foward to seeing this once I get my cable connection back. Despite helping the project a while ago I never checked up on it! (Thank tartarus for that).

Posted by: Ryen Jade at Sep 10, 2004 6:45:18 PM

Dave, as Ryen Jade points out, there is only a one-time $10 account setup fee to use Second Life. That will get you access to the grid, my schizophrenia project, as well as over 250 GB of content.

The company hopes you'll want to stay and buy some land, which is how they make money. But you don't have to do that to play.

Posted by: James Cook/Nash Baldwin at Sep 10, 2004 10:24:42 PM

"Ah kids don't do acid in your youth ;p You will regret it later."

I don't.

From my understanding consuming hallucinogens can be very dangerous for those who have a family or personal history of mental disorders, and has been linked to the onset of disease in those cases. But, if consumed responsibly, hallucinognes can be used recreationally with less risk than other forms of intoxicants.

LSD in particular affects the brain, sepecifically the hypothalimus, in a similar manner to schizophrenia. In this respect, you begin to understand those who are subjected to a lifetime of a 'bad trip' and can grow a deeper emapthy (which i believe was one of the purposes of the computer model). You can gain a very intimate understaning of the very edges of what schizophrenia may be like, but with the knowledge you will likely return to normal in about 8 hours.

In a sense, people who consume LSD have been engaging in an experiment similar to the one created on the computer for years.

Posted by: ian at Sep 11, 2004 12:38:42 AM

This game could propagate harmful stigma against the mentally ill. People need to realize that no 2 people with mental illnesses have the same symptoms or the same experiences.

Posted by: Kat at Sep 11, 2004 3:24:50 AM

WHOA. I heard of this awhile back on TechTV, I think, and more recently I just saw it on Boing Boing. At the least, it's most fascinating.

I have Asperger's Syndrome and while it's not the same as Schizophrenia, I can relate to "differences of reality" and it's hard finding out what what you experience on an everyday basis is not the same or even remotely near, in some cases, to most people's experiences.

There is quite enough stigma and misconceptions against people who are schizophrenic, and I'm sure the software could be adapted for different levels of subtlety and other tweaky settings that could be adjusted to accomodate and adapt to a greater variety of personal experiences, collectivized in technological form.

Posted by: Torley Wong at Sep 11, 2004 5:12:46 AM

I visited this schizophrenia simulator some time ago. It's creepy and disturbing, but I think everyone should see it to get a first person view of what everyday life is like with this disease. Makes me count my blessings.

Posted by: Olympia at Sep 11, 2004 12:13:01 PM

I did some work with virtual hallucinations back in 1998, but they weren't the scary type. Mostly trails and color effects. All the raver kids wanted this stuff built into a Walkman-like device.

Toward Ultimate Reality
http://www.bedoper.com/bedoper/2004/ultimatereality.htm

Posted by: Jason at Sep 11, 2004 6:58:17 PM

Oh stuff your subscription fee, I'm sure someone will copy it somehow and distribute it for free.

Posted by: The Internet at Sep 12, 2004 2:20:23 PM

I have schizophrenia and i really wish there were more places out there like this. People just do not understand about the disease. It truely is a living hell when you aren't on your medications.
holly

Posted by: Holly at Sep 12, 2004 5:25:41 PM

Although most schizophrenics have auditory hallucinations without the visual disturbances shown in the simulation, the work nonetheless recreates the feelings of fear/paranoia of the schizophrenic for us to empathize.

Posted by: Shenoy at Sep 14, 2004 10:51:42 AM

OMG!!! I finally visited this in Second Life and filled out the survey. What a worthwhile project.

Posted by: Torley Wong at Sep 17, 2004 5:11:05 AM

Wonderful and insightful article, James. As an outsider to gaming and the kind of work these people are involved in I can only assume this is really groundbreaking work. This is an example of how games can be used to help people - an anecdote to the "videogames cause violence" chorus. The work of these men seems like an extension of what RD Laing was attempting - to illuminate the darkness of schizophrenia through another medium.

Posted by: Melanie McBride at Sep 17, 2004 11:25:08 AM

Gratifying words, all-- of course, full credit goes to Nash Baldwin, for bringing his project to the public continent. (And if you live in his area, in California, be sure to check out his request for artists to make his simulation even more effective.)

Posted by: Hamlet Linden at Sep 17, 2004 2:14:41 PM

Wow, that's interesting. A blog about a schizophrenic simulator invites someone to start simulating Tourette's syndrome. :D

Posted by: Travis at Sep 24, 2004 10:33:53 AM

Interesting point, Travis. Also not appropriate to this forum, so out they go, Tourette's or no.

Posted by: Hamlet Linden at Sep 24, 2004 1:24:59 PM

amadeus amadeus

Posted by: Stealth Pentai at Oct 5, 2004 11:48:01 AM

Ian, in fact schizophrenic episodes can be very nearly the same for any two random patients. I've been a psych RN for over 10 years now. Much of the time for a true schizophrenic episode, hearing voices to harm or kill yourself is a fairly common occurance. Visual hallucinations tend to be less common but take on the nightmarish qualities described herein. A few rare schizophrenics I have met have enjoyed their voices or visual hallucinations - one had voices which told him funny jokes all day long, apparently, for example.
If this simulation is still around I'd love to come by and take a look. Also if the creators need any help, I am a two-year vet of SL and have some building experience, add that to the psych RN experiences and I believe I could be of some assistance to you. Cheers - Solitaire Guillaume

Posted by: Solitaire Guillaume at Jan 8, 2005 5:54:52 AM

I'm schizophrenic and on one of my boards some family members were asking what it was like. I started looking and was happy to find basically what I thought should exist. I only have dial up, but I'll still pay the fee and I'm looking forward to the experience.

While it is true that no two people are alike (my voices tend to be much more in the background) there are enough similarities that a good virtual approximation could be made.

Peace
dj

Posted by: Diego Jones at Mar 9, 2005 2:22:17 PM

Thanks for posting, Diego. Unfortunately, dial-up won't work with Second Life. Perhaps you could try it on a friend's computer with broadband?

Posted by: Hamlet Linden at Mar 9, 2005 2:56:45 PM

Thanks for the heads up. I was afraid that would be the case. I'll figure something out.

Cheers
dj

Posted by: Diego Jones at Mar 9, 2005 5:26:45 PM

One of my best friends was diagnosed with paranoid schizophrenia. It breaks my heart to know that what horrible things the voices may be saying to her when really she is one of the most beautiful, creative and intellegent people I ever met. This makes me very sad but I am glad to be able to understand more about the illness.

Posted by: imeeaay Muir at Sep 16, 2005 6:54:34 PM

IF YOU HAVE SCHIZOPHRENIA, IT IS BECAUSE YOU ARE TOO SMART.


Imagine that this world is regulated.

Those who are now approaching the intellectual limits of this regulated system, must be forced to be perceived by others as being mentally unstable. This then forces others away from moving in the same direction towards intellectual progress. This therefore maintains the function of the regulating system itself.

If one surpasses the barrier and finds the massive reality that is on the others side of the barrier, then this person will then be forced to be seen as a person claiming to be a " SPECIAL " person. It will be arranged in such a manner that it will appear to others as a simple and clear cut case of " Delusions of Grandeur ".

The purpose is to ensure that the outer side of the barrier is never to be seen, nor is it to be " BELIEVED " to exist, NOR is anyone who has seen it, ever to be accepted as being sane !

Every trick inside and outside of the book will be used to maintain the function of the regulating system itself.

For info about this brutal regulating system see www.outersecrets.com

Posted by: K. SEAN PROUDLER at Nov 9, 2005 3:35:25 AM