Therapy and the metaverse

Mark Kizelshteyn (SL: Chronos Laval) is a virtual world researcher and one of two principals at virtual worlds developer Popcha!. As part of his recent university studies he completed a paper called Therapy and The Metaverse: Second Life and The Changing Conditions of Therapy For Convalescent and Chronically Ill Users, which will be published in Washington University’s Undergraduate Research Digest – you can download the full article here.


Kizelshteyn will be discussing his work in Second Life on January 22nd between 1 and 2 pm SLT / PST (8am Friday 23rd January AEDST), with John Lester (Pathfinder Linden) launching proceedings. The venue will Popcha! headquarters. If you’d like to attend you’ll need to RSVP to Chronos Laval in Second Life. The paper itself is a useful overview of what virtual worlds like Second Life offer in regards to engagement, a sense of community and the ability to experience presence in ways that may not be feasible in real-life for people with chronic illnesses. The case study in the article (Amy the DJ) is well encapsulated and illustrates the power of the interaction in Second Life really well.

There’s no dearth of health research going on and even broad articles like this illustrate the depth of work going on. With virtual world development businesses realising the potential in the market, there’s also a growing realisation whilst that rigour in approach to development for health presences needs to mirror the discipline applied to health endeavours themselves.

The View from a Wheelchair

Australian Second Life resident, Seshat Czeret, provides her second guest post. Thanks Seshat!


There is always a lot of talk about ‘accessibility’, so-called ‘making things usable for the disabled’. You also hear a lot about phrases like ‘discrimination’, ‘equal opportunity’ and ‘political correctness’. It can be difficult to work out what is actually needed to help a disabled person live a fulfilling and useful life, and what is excessive ‘correctness’. Hearing what life is like for a disabled person can help.

I’m disabled. I use Second Life extensively. This is my story.

In the atomic world, the fleshworld, I’m almost totally housebound. I can only do chores – or SL work – for a short time before I have to rest. I only have a few hours a day in which I’m functional, and even for those I’m not fully functional. I haven’t been since I was a teenager. Some days – even some weeks or months – I have even less, or am not functional at all.

When I do go out, I have to use a mobility scooter or a wheelchair. I can walk, but walking the length of a mall would tire me out to the point where I’d need several hours of sleep to recover. For various reasons – which would probably be boring – even with the assistance of the scooter or the wheelchair, going out is very stressful and leaves me tired. I have to plan outings carefully.

So I can’t do atomic world work. By the time I got to work, I’d be too weak to achieve anything. I’ve tried, over and over again, many times in the last two decades. I’ve done it, but only at the cost of aggravating my problems.

Fortunately for me, I live in the 21st Century. I can do work from home! I’ve done voluntary work for the Open Source community. I’ve done other sorts of online voluntary work. I’ve written articles, and twice written a book. Unfortunately, the pace of work expected of an author of books exceeds what I can do – the first time I wrote a book, I was more than a year recovering.

But in Second Life, I can be useful.

In Second Life, I teach. I only have to be focussed for an hour and a half or so at a time, which is a stretch of time I can manage. And I don’t have to leave my house, exhausting myself, to do so. I can teach in text, with student questions also in text, so my hearing problems don’t matter. Much of the typing is done in advance, so I don’t overstrain my arms and hands, and only have to type the personalisation of the class for the individual students I’m teaching that day.

In Second Life, I am an NCI helper. I sit and listen in on the NCI chat/questions group channel. When there’s a problem I can help with, I can choose to respond – or not! If I’m having a high pain day, I let others catch that question. If I’ve responded to too many questions and need a break, I let others catch that question. If I can answer, however, I will.

In Second Life, I run a business. I don’t have to be there all the time, I can set things up and then go collapse into my bed. I can create things that other people like, in the times when I am functional, and rest when I’m not. I can do the business management stuff when I’m capable of it, not to someone else’s timeframe.

Best of all, in Second Life, my body works. I can run, and dance, and fly, and ‘talk’, and ‘hear’. I can attend art shows, or watch people creating art in sandboxes.

In Second Life, I am a person and not a disability.

The rise and rise of the Game Widow

(From our sister site, Metaverse Health)

This article in the Canadian publication, the London Free Press, describes in detail a couple of case studies of gaming addicts. The case studies themselves paint a fairly standard picture of someone with a compulsion for intensive gaming, though some effort has been made to provide balanced coverage of the issue.

The premise of the article is the establishment of a support service for gaming addicts in London, Ontario – apparently the first such group in Canada. What caught my eye was that the wife of one of the addicts described in the article, Wendy Kays, has written a book called Game Widow. (we’ll hopefully be reviewing the book soon).

The term ‘game widow’ has been around for years and it’s increasingly resonating with the broader public. It further emphasises the need for more research in the area as well as a vigilance toward not typecasting all gamers as addicts. Terms like ‘game widow’ also accentuate the gender divide in some gaming genres. There are surely ‘game widowers’ out there but they’re likely to be in a distinct minority.

One final comment to the author of the article – online roleplaying did not begin with Everquest in 1999.

Second Life is my wheelchair.

There’s all sorts of talk about accessibility, particularly around making computers, the Internet, and online services like Second Life accessible to those who are differently abled. From the chaps in Japan, with their innovative solutions that allow folks with very minimal physical capabilities to use Second Life, to the Imprudence team and Jacek Antonelli – just one of a number of groups looking to improve the accessibility of Second Life clients. Then there’s accessibility specialists who look at Second Life from a legal view (current US law, Section 508 of the Disabilities Act), and thus investigate the content of Second Life. There’s so much focus on how it might be accomplished.

Then someone goes and, distressingly, asks, why? Why should should we put all this effort, money and man-hours into these projects? Surely it’s not worth all the expense?

Let’s examine some of the whys behind the accessibility push.

According to the U.S. Census Bureau, around 17% of the U.S. population, aged 16 and over, lives with some form of disability.

Kippie Friedkin, 11/09/2008

If the US is representative of much of the world with regards to its Census results, close to 1/5th of the world’s population lives with some form of disability. This equates roughly to a staggering 1.36 billion people across the globe. That’s a huge number of people, all of whom are already at some disadvantage due to their disabilities. They would be disadvantaged further if accommodations are not made for them. Every one of these people has likely experienced some form of discrimination, or one or all aspects of the terrible trio: loneliness, isolation and depression. Because of their disability, these are perhaps the people who stand to benefit the most from the social revolution occurring online, and yet as it stands, they are the ones with the least access to it.

A wheelchair gives someone with limited mobility to walk, but otherwise functional in the real world, the ability to go out and do things and be a functional member of the community. Because of the nature of my disabilities, a wheelchair is insufficient. However, SL permits me to do things without leaving the protected environment of my home where I have an ergonomic setup that allows for my disabilities.

From my computer chair, I can teach, run a business, have an active social life, and be a functioning member of a community. Second Life is my wheelchair.

– Seshat Czeret, 18/09/2008

Seshat Czeret runs a successful clothing and furniture business in Second Life. She runs classes for the NCI, and is a respected member of their staff. She has several friends whom she is routinely in contact with, and many more people she communicates with regularly. She is an avid roleplayer. All these things would not be possible without access to her high-end computer and broadband connection which enable her to access Second Life.

In the physical world, Seshat suffers from a painful disability which leaves her mostly housebound. She is unable to work away from home, to leave the house for social visits, or to participate in her local community.

For Seshat, a virtual environment is a tool. It’s an extra accessory than allows her new, sometimes unexpected but often welcome, freedoms. It opens up her world. It’s a place where she can be an asset, not a liability.

In another sense, virtual environments are also a good pain management tool. Seshat is able to focus strongly on what she is doing, thereby putting some of her pain aside. If she can be said to “escape” into Second Life, it is not in the sense of “escape into fantasy”, but rather in the sense of “escape from persecution.” It is just the same as focusing on walking, or reading, or gardening, thereby creating a meditative state through focus on an activity.


[“Written by all the members of wilde, but namelessly for their protection and greater transparency”]

most of us, if not all of us, have had things stolen from us, because we were disabled

many of us, if not all of us, have been slapped or abused physically, and several times

all of us have been verbally abused– a lot! which hurts by the way!!

we’ve had our money taken from us

perhaps the greatest pain when our dignity has been taken, stolen.

our humanity, feelings, kicked around and abused

control. people take control. they take control of our things, our decisions. they force their will and preferences upon us. no we cant buy that. no we cant eat that. no we have to watch this. no i dont have time now. no you cant go anywhere. no you will be unable to move for awhile. no…

wilde Cunningham, 05/12/2004

“The nine souls of wilde Cunningham”, a group of nine adults with cerebral palsy, wrote the piece above in 2004.

The take-away lesson from this piece is that people with disabilities often have control, in every facet of life, taken away from them. Accessibility options are just a small way in which the world can return that control. The option to have new experiences, travel outside your room or residence, socialize with people you wouldn’t usually get to meet, have a job or run a business – suddenly more of these become available to people to whom it matters most poignantly.

In Second Life they are on a equal setting and we don’t see the handicaps.

Toy LaFollett

Virtual environments which do not show the user’s face nor use voice put more people on an equal footing. What harm is there in ignoring, in failing to display one’s disabilities, when common reactions are those of pity or of prejudice – both of which have a tendency to lead to a lack of control and shame for the disabled individual?

Being in Second Life is how I imagine an innocent man who had been locked up wrongly feels when he is finally set free. In Second Life I get to call the shots.

John S.

Additional thanks go to Shelley Schlender, for her thought-provoking article.

Healthcare giants: have clue, will build.

Whyville Bioplex

When it comes to the use of virtual environments, the healthcare industry is no less prone to fall into marketing pits of doom than any other industry. Static data, presented in a slap-dash fashion like posters on a wall. Huge, unused buildings that serve no particular purpose, and the occasional video. This seems to be the standard fare presented by companies and organisations coming into virtual environments who are not sensible about use of the medium. Often, these folk would have been better served by a well-organised Web page than the mish-mash they present within virtual environments. Indeed, their attempts are distinctly reminiscent of the early days of the Web, before people got a handle on that medium.

It’s not all bad, however. A couple of companies and organisations have produced useful and significant services that are appropriate for virtual environments. They have clearly thought about how best to discharge the services they already provide to demographics containing the folks they previously had a great deal of trouble reaching. People who use virtual environments, and who:

a) are unable or unwilling to leave their homes to obtain health information or care;
b) suffer from chronic illnesses that require some maintenance by the patient that can be bolstered by health information or care delivered online;
c) are young, not requiring specific healthcare, but can benefit from information delivery.

One of the best efforts open to the public eye is Palomar West hospital, a venture by Cisco, Palomar Pomerado Health, and metaverse developers Millions-of-us. The Second Life version of the hospital, built before the real version, is an exact model of what you can expect to see in San Diego in 2011, to the extent that several rooms are fully kitted-out with the sort of equipment that will fill the real thing. The Second Life exhibit is quite interactive, and provides an excellent idea of how things might operate in reality. Cisco Systems will power the real hospital. A central, internal network will be created to support the operation of the hospital, from patient locations via RFID tags, to room temperature and lighting via bedside screens, to the robotic technology that enables surgeons to operate remotely and automated systems for diagnostic work. Incidently, when we wandered past the site to take a closer look, a research study was being conducted. It’s good to know that this virtual environment replica is useful not only for future patients, and public healthcare at that level of education, but also for medical and other professionals.

Another ongoing project that has proved to be successful is one put on by the CDC in Whyville. Whyville is a virtual scientific learning environment for kids aged 8 to 15 years old. During the influenza season in the real world, Whyvillians are also placed at risk of developing the “Why-flu”, which causes sneezing and red spots on the avatar’s face. Not only were kids given the chance to have their avatar inoculated prior to the Why-flu season beginning, during the season those who caught the flu had a chance to buy remedies from the pharmacy, which were time-limited, and which came at a cost. During the second round of the project in 2007-2008, Whyvillians were encouraged to invite their grandparents to come and be virtually inoculated also. Thus information was disseminated across several generations online, and no doubt further than that offline, to other family members, and from there into the wider population.

This year the CDC has teamed up with CIGNA to produce a healthcare island in Second Life.

“About 90% of what we’re doing with chronic disease management involves behavior change. We could do more for our patients who have diabetes, weight problems or hypertension by helping them relieve their stress and achieve better mental health.” This is what they hope to cover in the virtual environment.

We are yet to experience the island for ourselves, however given the success of the Whyville project, it seems that the CDC have an excellent idea of what it takes to sell healthcare information to the younger generation; it will be interesting to see what tack they take for older folk. Most people like to take their medicinal information with a spoonful of sugar – experience will tell whether games will be the sweetener required, or whether talks and general social interaction are the preferential nectar.

Another site of note: the Second Health hospital or Polyclinic, Second Health London in Second Life. In a similar fashion to the West Palomar site (though in less detail), the Polyclinic displays a 3D representation as it might exist in real life. The establishment can be toured, though perhaps the machinima made at the site in Second Life, with accompanying information, is more enlightening. Though an entire medical campus has been built, with signs denoting the areas in which GPs and specialists will see patients, the acute care clinic and diagnostic facilities, none of the detail of equipment or functioning of the clinic has been created.

Yet another fantastic use of virtual environments is exemplified by the folk over at Play2Train. A town and two hospitals have been fitted out to enable “Strategic National Stockpile (SNS), Simple Triage Rapid Transportation (START), Risk Communication and Incident Command System (ICS) Training”.”Play2Train provides opportunities for training through interactive role playing.”

For a quick round up of other nifty virtual doings in healthcare, visit this link.

There is a vast diversity of healthcare information that needs to be delivered, both to professionals and to the general public. Virtual environments may only slowly be coming into their own in this realm, however, there is hope for them yet.

Introducing: Metaverse Health

I’m really pleased to introduce a new sister site to The Metaverse Journal: Metaverse Health. It’s a completed site now but expect further enhancements in coming weeks.

In the time we’ve been covering virtual worlds, health is one of the key areas that pops up time and time again as both a key opportunity and pivotal challenge. Whether it be the power of thought-controlled avatars for those with profound physical disabilities, the spectre of virtual world addiction or sex education for teenagers, there’s no shortage of stories to bring you.

As always, comments and feedback welcome. Also, if health and virtual worlds is a passion and you’d like to write about it, contact us to discuss your ideas further.

Are you a Virtual World Whore? Virtual Addiction, Part 1

Do you crave the fun, excitement, and pleasure of virtual worlds to the detriment of the rest of your life? Would you do anything, give anything, just to be able to spend another couple of uninterrupted hours in a virtual space, Multi-User Virtual Environment (MUVE) or gaming environment?

Smoking - one of the legal addictions.

You have a problem. You are a virtual world addict.

What does it mean to be “addicted”?

The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) uses the term “dependency”. The upcoming DSM-V will use the term “addiction” once again to describe the condition, since “dependency” has other connotations that confuse the issue. “Addiction” is the term used by many physicians and most lay people.

Under the DSM-IV, “substance dependency”, the condition from which the diagnostic criteria for behavioural conditions was extrapolated, is paraphrased as follows:

  1. The substance is required for normal functioning, and withdrawal, a physical and psychological reaction, occurs when the substance is suddenly withdrawn. Additionally, any adverse consequences, be they physical, psychosocial, financial, etc, are endured for the sake of getting and taking the substance.
  2. The substance initially causes pleasure, euphoria and/or feelings of well-being, though this experience diminishes in intensity over time, so that more of the substance must be taken in to experience the same effect. This is known as tolerance.
  3. Any substance in which a person indulges in uncontrollably is addictive.
  4. A “reward circuit” is set up by substance dependency, in the brain; that is, taking the substance leads to a reward, and the brain undergoes a neuro-plastic change, so that the brain is then primed to desire the reward again.

What does it mean to have a behavioural addiction?

Being addicted to a particular behaviour bears a strong resemblance to substance dependency or addiction. The difference is the behaviour is carried out, in place of a substance being taken. The following items hold true:

  1. The behaviour needs to be carried out to maintain normal functioning, and withdrawal occurs if it is not.
  2. The behaviour induces pleasure; tolerance is built up over time, so that the behaviour must be carried out more or more often in order to achieve the same level of pleasure.
  3. Any behaviour in which a person indulges in uncontrollably is addictive.
  4. Changes in the brain occur in response to the repeated pleasure and withdrawal pattern.

“It's a compulsive behavior, and it doesn't matter if it's Everquest, Second Life, World of Warcraft, City of Heroes, Internet porn or gambling.

How is “Internet” addiction different, new, or special? (For “Internet”, read browsing, email, Instant Messaging, online porn, online gaming, and participating in MUVEs).

Short answer: very little. The specifics of the type of pleasure engendered, the type of withdrawal experienced, and the consequences of enacting the behavior differ from other addictions as other addictions differ from each other – otherwise there would be no point in having a different classification for each. The basics, though, are identical to the basics for all behavioral addictions.

“It’s a compulsive behavior, and it doesn’t matter if it’s Everquest, Second Life, World of Warcraft, City of Heroes, Internet porn or gambling,” states Tateru Nino. The sufferer “could not find balance.”

The essential problem seems to be that people mistake the medium for the message. When they hear that folks are “addicted to the Internet”, they blame the Internet, the medium, for the problem, whereas the Internet is simply provides a new source of behaviors for people who would have had behavioral addictions anyway. By extension, it’s not the fault of virtual worlds that people become virtual world addicts.

In the next article, On Being a Virtual World Whore – Virtual Addition, Part 2, we investigate the ins and outs of suffering from virtual world addiction: what are the specific classifications for this addiction, what are the withdrawal symptoms, and what are the consequences?

Nursing Education in Second Life

Nurses are one of the most active groups of health professionals in Second Life and I regularly get asked by health professionals what use a virtual world like Second Life is in regard to training. The video below answers that question beautifully:

If you’re a nurse in Second Life, tell us what the experience has brought to your practice. Has it improved your skills at all?

GimpGirl – women, disabilities and Second Life


One of the most interesting email lists I’m involved with is the Second Life Health list. Yesterday I noticed an interesting announcement from a group called GimpGirl:

GimpGirl Community was founded in 1998 by women with disabilities to serve the needs of our community through various on-line mediums. For many years we were primarily using mailing lists, our web site and later on LiveJournal, Facebook and MySpace, but at the end of last year our educational contacts and supporters encouraged us (and gave us the resources) to expand on to Second Life. Through hard work by our core group, as well as the help of volunteers we developed a parcel on Second Life that now has weekly group meetings full of women with disabilities from all walks of life. We will be hosting our first public presentation by sociologist and head of the Avatar Identity Research Center, Rivka Rau this coming weekend. (See details below signature.) Our parcel also hosts an art gallery and vendor area for women with disabilities (both of which are still filling in). We will soon be hosting events for our current partners and the general public to further explore how to empower those in our community. Our transition to Second Life, as well as our continued efforts on-line and off, has been going wonderfully and we’re very excited about what projects and opportunities the future will bring!

Jennifer Cole/JennyLin Arashi (in world), Co-Director and Founder
GimpGirl Community


The Second Life parcel is a fairly standard open ampitheatre style, with events like the following already announced”

“Avatars, Identity, and the Expression of Disability”

Rivka Rau is the director of the Avatar Identity Research Center, and a professor of sociology in real life. The AV-ID Center is the home of the Editing Appearances project, an interview study of avatar embodiment and selfhood in SL. Rivka Rau has conducted over 200 hours of interviews for this project. In addition, through AV-ID she offers a seminar series on topics related to identity and the SL body. She will presenting on our current topic of the month, disability identity on-line, at our Second Life parcel. There will be time for Q & A as well as general discussion.

Open to the public.

Sunday, March 30th, 2008 from 12:00 – 1:30 PM SLT/Pacific Time (3:00 PM Eastern Time)

Second Life location:

You can still attend this presentation online via IRC. To visit our IRC/Second Life chatroom, go to:

…and choose the option that works best for you.

Check it out in-world.

Cisco’s virtual hospital opens

Health and education are two of the standout wins demonstrated in Second Life. The latest health-related build is sponsored by Cisco and it’s a mighty impressive result. As a health professional myself I can see that immersive medical training could bring enormous benefits.


I did have some difficulties getting some of the medical equipment to work with my avatar and there’s also a lot of video content so lag can be a big issue during busy periods. Overall though it’s obvious that significant corporate sponsorhip can bring about very intricate builds in Second Life that benefit the medical community.


Check it out in-world

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