October 12, 2007

Psychiatrist uses virtual world to make hallucinations seem authentic

By Andy Fell

It was the voices that got to me.

You're worthless. You're nothing. Go on. Do it.

Quiet but forceful, the voice was whispering in my ear as I walked down the corridor. Floor tiles melted away, leaving stepping-stones across the sky. An image in a bathroom mirror turned from a healthy man into a corpse.

You're dead.

A TV announcer's voice switched from a political discussion to personal insults.

You are contaminating my society. Get rid of yourself.

Posters and newspaper headlines faded into obscenities.

You know this is not the real world. This is just an illusion.

The voice was right about that. This UC Davis psychiatric clinic is nothing but pixels, part of the online, virtual reality environment Second Life. Based on the psychoses of actual patients, it was created by Dr. Peter Yellowlees, professor of psychiatry, and colleagues at the School of Medicine, to help medical students understand what it is like to have schizophrenia.

"If we get students in there for more than 15 to 20 minutes, it can become really quite harrowing," Yellowlees said.

The experience certainly is disturbing, as I found while exploring the virtual building. Second Life is a rather hallucinatory environment in any case — you can fly with or without wings, and experiment with replacing your skin with purple scales if you feel like it — but the auditory hallucinations give new force to the term "hearing voices."

Schizophrenia affects about one in 100 persons and is marked by hallucinations and an inability to control your thoughts. The disease can be treated, but not cured.

Throughout several years of teaching, Yellowlees has tried to help his students understand the patient's experience. He would bring a pair of students to the front of the lecture and interview each other while he walked around them talking or banging blocks of wood. Then he had them wear Walkmans and play audiotapes of voices while trying to perform other tasks. While working at the University of Queensland, Australia, he experimented with a three-dimensional virtual reality "cave" environment.

After joining UC Davis in 2004, Yellowlees was looking for new options and came across Second Life. Players (or "residents") of Second Life have an avatar or character who can move around within the environment and interact with other people's avatars. Second Lifers do not battle monsters; they talk, hang out, go to concerts and other events, make things and sell them to each other. Second Life plays on a regular computer with a fast Internet connection; no goggles, helmets or special displays are required.

One of the novelties of Second Life is that residents can purchase "virtual land" and build on it. Yellowlees acquired "Davis Island" to build the virtual psychiatric clinic. (A warehouse on the island is currently being used for a training exercise for responding to a bioterrorism event).

There are two versions of the same building: in both, students can walk through and look at slides about schizophrenia. But one of the buildings is rigged with hallucinations: morphing posters, disembodied voices, images of weapons and death. Yellowlees wants to know which approach is more effective in teaching students about the disease.

Anyone can sign up for Second Life, although Davis Island is only accessible to avatars invited by the UC Davis research team. They have set up a public site, "Virtual Hallucinations," which is accessible to any avatar.

"We put it there because we were getting a lot of interest from residents of Second Life," Yellowlees said.

Several hundred people toured the site and recorded their impressions in a survey. A strong majority said that it had improved their understanding of hallucinations. Yellowlees and Dr. James Cook of the Department of Psychiatry published the results last year in the journal Academic Psychiatry.

"I have a friend with these issues and I'm hoping to understand them — I think it really helped me," said Anamika Bebb, an avatar visiting the public site recently.

"Quite a few people say it's like something they've experienced," Yellowlees said. Schizophrenia is a relatively common condition, he said — more common than insulin-dependent diabetes — and people may also experience hallucinations as a result of drug use or medical treatment.

For more information and directions on accessing the hallucinations, go to http://www.ucdmc.ucdavis.edu/ais/virtualhallucinations/.