Education About Hallucinations Using an Internet Virtual
Reality System: A Qualitative Survey
Academic Psychiatry, 2006, Volume 30, Number 6, Page 534
Peter M. Yellowlees, James N. Cook
AIMS OF THE STUDY:
Evaluation of VR as an educational tool about psychotic
hallucination. Mainly in regards to Schizophrenia where most patients experience
auditory hallucinations, particularly hearing voices, and approximately
one-quarter of patients experience visual hallucinations.
The researchers wants to see whether they could create a “
virtual psychotic environment” in order to increase its educational reach. They
also wanted to see if personal computer graphics systems could reproduce
hallucinations sufficiently well that users would feel they learned something
from the experience.
METHODOLOGY:
This is a pilot project using Second Life, in which a
virtual reality environment was constructed to simulate the auditory and visual
hallucinations of two patients with schizophrenia. Eight hundred sixty-three
self-referred users took a self-guided tour.
Created a virtual educational environment in the form of a
hospital ward using Second Life.
Inserted the hallucinations as individual objects throughout
the virtual ward so that they appeared automatically, triggered by an avatar’s
presence as the avatar toured the environment.
The hallucinations included: • Multiple voices, occasionally
overlapping, criticizing the user • A poster that would change its text to
obscenities • A newspaper where the word “death” would stand out of 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 TV that would play a political speech, then criticize the user and encourage
suicide • A gun which 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.
A survey collection system was placed at the end of the
ward. This allowed users to respond to questions immediately after their tour
and while they were still inside the environment by simply clicking on the
response of their choice. Their answers were automatically e-mailed to us and
downloaded directly to a spreadsheet for analysis.
MAIN FINDINGS:
- The population
surveyed is a significantly biased convenience sample. Existing users of an
online virtual world system are not a representative sample of the general
population.
- There was no pre-test given, so we cannot prove that
participants improved their knowledge. We relied on the participants’ own
perceptions of educational value.
- The environment
focuses only on the hallucinations of patients with schizophrenia. Users might
therefore give inappropriate weight to these symptoms of the disease, rather
than having a more balanced view incorporating other symptoms, such as
delusions, disordered speech and behaviour, and negative symptoms
BUT
Users of the environment felt it improved their
understanding of the experience of hallucinations. Of the survey responders,
440 (76%) thought the environment improved their understanding of auditory
hallucinations, 69% thought it improved their understanding of visual
hallucinations, and 82% said they would recommend the environment to a friend.
Over a period of 2 months, the virtual psychosis environment
was toured 836 times with 579 (69%) valid survey responses received. The
demographics of the survey responders closely mirrored the demographics of the
Second Life system at large. Most responders were men (N366, 63%), but this
represented a more balanced gender distribution than other online communities.
No significant differences were found when replies were
analyzed by gender, occupation, or income group.
Although the survey object in this first version had no
formal mechanism for narrative comments or feedback from users, many spontaneously
sent comments, showing that engagement was high enough for participants to make
the effort.
This project has demonstrated that an Internet-based virtual
reality system for personal computers can be used to create simulations of
hallucinations and that it is possible to integrate evaluation tools into a
virtual reality environment. Furthermore, users of the Internet based
simulation felt that it improved their understanding of the experience of
hallucinations. More comprehensive studies of this approach to online education
are warranted.
I think that this was a very good demonstration on how SL
and VR can be used to create an empathetic experience for people to begin to
relate to those with psychotic symptoms, I think this is an important part of
health education as it makes understanding patients easier because it can be
personally relatable (though not identical). It could help to decrease stigma
surrounding mental illness, but it is still debateable about whether gaming
tools further ostracise patients because gaming makes someone feel like a
“player” or “character” which has the connotation of the avatar being othered.