Photo of virtual environment Researchers took photographs of an inpatient ward and hospital furnishings at UC Davis Medical Center to create their virtual setting.

A major cause of frustration and alienation among people with schizophrenia is the inability of their therapists, family members and caregivers to fully understand their experiences, especially the auditory and visual hallucinations that often are symptoms of the disease.

However, a UC Davis professor of psychiatry has helped develop an Internet-based virtual reality environment that simulates the hallucinations of schizophrenia patients. The vast majority of individuals who have toured the environment indicated that it improved their understanding of the auditory and visual hallucinations experienced by people with schizophrenia.

“That's freaky,” wrote one of the users in a survey completed after taking the tour. “The scary bit is that I could identify. I was diagnosed as borderline.”

“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.

To create the virtual environment, the researchers used commercially available software, which they say offers substantial advantages in the development of educational environments.

“Compared with custom software development, using an existing software system cut development time for our psychosis environment by a factor of 10,” Yellowlees said.

In addition, the ability of any personal computer user with a broadband Internet connection to access the virtual psychosis environment permits large numbers of people to tour it.

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.

Yellowlees' initial attempt to use virtual reality to simulate the experience of psychosis involved the creation of room-sized environments. Based on interviews with stable, well-treated schizophrenia patients, Yellowlees and his research team employed computer programmers and visual artists to create a virtual psychiatric ward and simulations of auditory and visual hallucinations. The final 3D product effectively recreated hallucinatory phenomena but it took two years to create. And, because the virtual hallucinations could be experienced only within a costly visualization laboratory, they were largely inaccessible to potential students.

To increase access, Yellowlees and his fellow researchers have created a virtual psychotic environment available over the Internet via personal computer graphics systems. Anyone with a Windows or Macintosh computer and a broadband Internet connection can access the environment, which takes the form of an inpatient hospital ward.

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
The researchers made the virtual hospital ward available on a San Francisco-based company's three-dimensional, online, computer-based simulated environment. A survey collection system placed at the end of the ward allowed users to respond to questions immediately after their tour and while they were still inside the environment.

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.”

Yellowlees 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.

Those interested in accessing the virtual hallucinations environment can find instructions for doing so on the Web at