Thursday, September 09, 2004

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A LEVER TO MOVE THE MIND

Schizo_01

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.”

Schizo_03

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.

Schizo_07

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.)

Schizo_09

Schizo_08

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.

Schizo_10

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.

Schizo_04

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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Glaunel

I think it's good for people to get a better understanding of the illness.

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