Schizophrenia is a serious Mental Health issue affecting many people, this is my essay that I created for university to see how animation has, and can help those who suffer from Schizophrenia.

Table Of Content

Introduction

Mental health is a serious issue, with 1 in 4 people experiencing some forum of mental illness every year in the UK, these Mental health issues affect every part of life, affecting one’s relationship with friends, family, and in some cases reality itself, it can be a devastating part of someone’s life, affecting the individual and everyone around them.

Animation and Related Arts are an expressive forum of showing, and expressing understanding and meaning, allowing to express, and explain things that are hard, or impossible to explain with words, especially to those who don’t have a great vocabulary, Animation is an easy way to make certain idea’s and thoughts accessible.

Schizophrenia is one mental health issue which affects a persons life greatly, this can be through auditory hallucinations or visual hallucinations, it can affect how one views the world, how much they empathize with others, and how one interacts with the world, among other ways it affects a persons life.

Due to Schizophrenia affecting ones perception of audio, and visuals, there maybe great utility in animation and related arts, to help detect, diagnose and treat someone who suffers from it, Schizophrenia also affects how people view the world, and the connection to people, and objects, so animations and other arts which also put focus on empathy, or Theory Of Mind concepts.

This essay will talk about the utility of Animation and Related Arts in mental health, specifically Schizophrenia, firstly the essay will explain and give some facts about Schizophrenia, it will than go on to explain how Animation and Related Arts can detect and/or diagnose, Schizophrenia, and lastly, the essay will talk about how Animation can be therapeutic to someone who suffers from Schizophrenia. At the end there will be a summery of how Animation and related arts are utilized in Detecting, Diagnosing and helping with Schizophrenia, and a conclusion about it’s uses.

Theory of Mind

Theory of Mind is a theory about an individuals ability to imagine or form opinions about cognitive states of other people, it‘s the understanding of what someone else knows, believes, desires, emotions and what someone’s behaviour or there reactions might be.

The ability to “Put oneself into another’s shoes” is one apt way of explaining what Theory of Mind is. The ability to understand others affects a persons ability’s to be active in modern days environments due to lacking certain ability’s such as the “ability to meaningful conversations, ability to resolve conflicts and maintain intimacy in friendships, and overall social competence as rated by teachers” (Astington, 2003)¹

Schizophrenia

The word Schizophrenia has Greek roots, Schizein “To split” and Phren “mind” and thus Schizophrenia, roughly means, “Splitting of the mind”, this was intended to describe the separation between personality, thinking, memory and perception, though this has lead to miss understanding, many people confusing “A split mind” with a split personality.

Due to this split, those who suffer from Schizophrenia often fail to understand what is real, and create false beliefs, due to this disconnect from reality, having conversations with others becomes difficult, and can be really difficult for a schizophrenic person and the people in there lives, as the Schizophrenic person would have to either the people who love them are lying, or they can’t trust themselves, creating a lot of suffering.

Schizophrenia affects 1 in 100 people, affecting an equal number between men and women, though men are more likely to be diagnosed with schizophrenia at an earlier age, the symptoms vary widely meaning the course an individual should take to help with their condition is hard to predict.

Schizophrenia often damages an individuals physical health, social ability, life expectancy, and that creates a lot of personal suffering, Schizophrenia often involves disturbances in thought, feeling and behavior, and is often associated with disassociation off reality including, being out of touch with reality, or having illusions.

Those who are friends or relatives of individuals suffering from Schizophrenia are often also caught in the cross fire, due to Schizophrenic individuals often having difficulties recognizing what other people think and feel, making it hard for those with Schizophrenia to empathize with others, it also makes humans seem unpredictable and confusing.(Patterson, et al 2011)²

DSM-5

The DSM-5 is the Diagnostic and Statistical Manual of Mental Disorder’s, 5th edition, and is a published by the “American Psychiatric Association” and includes all currently recognized mental illnesses, this publication is often used by professionals as a guide to distinguish a mental illness from other similar illnesses.

According to the DSM-5, these are criteria to be diagnosed with Schizophrenia:

Characteristic Symptoms:

A subject must have 2 of the following symptoms for a significant amount of time a month, and one must be in the top 3.

• Delusions
• Hallucinations
• Disorganized speech
• Grossly disorganized or Catatonic behaviour
• Negative symptoms, i.e. effective flattening, alogia, or avolition

Subtypes:

There are more than just one type of Schizophrenia, these are separated by the criteria below.

Paranoid Schizophrenia:

The subject must have these symptoms

• Frequent Audio Delusions, or Preoccupation with one or more delusions
• Don’t suffer with: disorganized speech, disorganized or catatonic behaviour, or flat or inappropriate affect.

Canatonic Schizophrenia:

The subject must have at least two of the symptoms below

• Catalepsy or Stupor
• Purposeless excessive motor activity
• Extreme negativity or mutism
• Voluntary bizarre postures
• Stereotyped movements, Prominent mannerisms, or Prominent grimacing
• Echolalia or Echopraxia (An involuntary repetition of another persons actions or sounds)

Disorganized Schizophrenia:

The subject must have all the below symptoms

• All of the following are prominent:
• Disorganized speech
• Disorganized behaviour
• Flat or inappropriate affect
• Do not have the symptoms to classify as Canationic Schizophrenia

Undifferentiated Schizophrenia:

The subject has Schizophrenia but doesn’t meet the criteria of Paranoid Schizophrenia, Canatonic Schizophrenia, or Disorganized Schizophrenia.

Residual Schizophrenia:

The subject must have all symptoms below

• Absence of prominent delusions, hallucinations, disorganized speech, and grossly disorganized or catatonic behavior.
• Continued Evidence of Schizophrenia but presented in an attenuated forum, such as odd beliefs or unusual perceptual experiences.

How Psychologists use Animation.

Schizophrenia is a mental illness with many symptoms, some of the symptoms being visual and audio related, this makes Animation and related arts a good way of diagnosing someone with Schizophrenia, or its early symptoms.

Psychologists have also used animation to understand Schizophrenia, and the affects that Schizophrenia has on a person, and there perceptions off reality.

Social Attribution Task-Multiple Choice: Heider and Simmel

Social functioning defects are one of the most prominent features of Schizophrenia, and plays a large part in diagnosing how extreme their disability is, and the likelihood that the individual may have a relapse.

Animation helps diagnose this by giving those with schizophrenia, something to watch, and focus on, a physiologist then asks the patient about said animation, an individual is often asked to tell the psychologist what the social rules are, what they expect to happen, what emotions characters are feeling, what relationships do character’s have with each other, and what characters may be feeling or thinking, and are sometimes asked to make guesses about how the characters got into that position.

The animation Heider and Simmel (Heider and Simmel, 1984) is a Theory of Mind animation, which is often used to help diagnose how extreme an individuals schizophrenia is, by showing people who are affected by Schizophrenia, or those who have prodromal symptoms the animation, and asking them what happened.

This simplistic animation is used as it’s silent, taking away linguistic skills and verbal memory, this coupled with a multiple choice answers test, eliminated the chances of linguistic errors in the test as well, making a purer characterization of social defects in a schizophrenic mind.

The animation is so simplistic that it’s just two triangles, a circle, and a rectangle representing a building of some sort, there’s also no colour, this animation really focuses on the actions of the shapes to create personality, and a story for someone to follow, rather than things like trying to read facial movements.

To create an animation like this wouldn’t take long, with how simplistic it is, yet is infinitely valuable as a product to help diagnose someone with schizophrenia, in early animation you’re taught to make objects come alive, many animators are known to give eyes to objects and make characters out of random objects, this would be a far simpler version of that.

This method has been adapted by Klin, who has created animations to help understand and diagnose Autism and Asperger syndrome.

The animation was played twice, then played in short segments while the patient answer’s the multiple choice questions.

Question’s where phrased as such:

“What is the little triangle trying to do?”
1. It wants to help the little circle.
2. It wants to help the big triangle.
3. It wants to play with the little circle and with the big triangle.
4. It wants to lock the door. ⁴

The patient is also taken through some Social Attribution Task-Multiple Choice (SAT-MC) tasks , These set of tasks are to assess implicit social attribution using Theory of Mind tests, such as:

• The Bell-Lysaker Emotion Recognition Task: in this task, a examinee is shown 21 short videos, in these videos an actor would displays one of seven emotions, after this, the examinee is asked what emotion the actor is showing, if the examinee is correct more than 15 times, than the examinee is unimpaired.

• The Hinting Task: this task implemented the idea of obvious hints, in this test, an examinee is given 10 brief scenarios of two peoples interactions, in which at the end, one of the people give an obvious hint, and the examinee is asked what the hint meant.

• Bell Object Relations Reality Testing Inventory: This test gave examinees 90 different true or false questions, this was originally developed for those with schizophrenia, but has also been used as a way to Gage ones egocentricity, and to measure ones social cognition. Examples of questions asked are;“I believe a good mother should always please her children; People are never honest with each other; Others frequently humiliate me”

• MATRICS Social Cognition Index: This is a social management Task, it requires respondents to evaluate how different actions would help achieve a certain outcome, such as, how effective would talking to a friends, or completing tasks, be in making someone feel better.

• MATRICS Consensus Cognitive Battery: In this one would examine a subjects Speed of processing, Attention/vigilance, Working memory, Verbal learning, Visual learning, Reasoning and problem solving, and Social cognition.⁵

• Wechsler Adult Intelligence Scale-III: This comprises of scaled scores for Vocabulary, Digit Span, Block Design, Matrix Reasoning, this test is for adults, and can be taken by anyone over the age of 16.

• Wechsler Memory Scale revised: This comprises of scaled scores for Logical Memory and Mental control.

• Winconsin Card Sorting Task: This comprises of scaling scores of Total Errors, Perseverative Errors, Non-Perseverate Errors, and Conceptual Level.

These tests where used to create a cut-off score on SAT-MC, using samples from those with Schizophrenia, and a sample from those from the community, Psychologists have been able to create a test which helps them narrow down more than half the people suffering from schizophrenia, while also only designating less than 10% of the community sample as having an impairment.

It doesn’t recognize everyone who’s suffering with Schizophrenia, but does give a good cut off point which recognizes the majority, whilst not being overbearing enough that it recognizes or assumes excessively that those without schizophrenia have schizophrenia, it’s also possible that those who do not have Schizophrenia but have been categorized as having an impairment, could have other deficits that are related to disorders that Schizophrenic people have, such as Asperger’s Syndrome.

Theory of Mind Non-Animated Cartoons

There are also Theory of Mind cartoon stories, these depict actions of cooperation, deception, cooperation and deception, and a non-Theory of Mind Cartoon.

In these tests the psychologists scans a subjects brain, as the subject tries to figure out what’s happening in the cartoons, in turn this will show the psychologist which parts of the brain are being used and how heavily, via the scan, from the data collected they can detect if the subject has Prodromal attributes, or Schizophrenia and how the extreme the Subjects Schizophrenia is.

People who suffer from Schizophrenia, have scattered patches of higher activation than the controlled group, in the left superior and inferior frontal gyrus, bilateral TPJ, and the right hemispheric posterior cingula gyrus, Schizophrenia also only showed greater activation in some patches in the right preciousness compared to Prodromal.

This gives psychologists a way to diagnose the difference between an average person, someone who’s in early stages of Schizophrenia, or someone who is at risk of Schizophrenia, and someone who has Schizophrenia.

There are also different comic cartoons which test different types of empathy, such as Cognitive Empathy, Emotional Empathy, Inhibitory Empathy, Physical Causality, a psychologist can scan a patients brain, and than can analyze the brain, to see which bits are more active compared to a healthy brain when viewing that specific cartoon. (S. Lee, et al, 2008)

The cartoons are very simplistic which makes them easy to create, they only have to interpreter an event/activity which would be able to test an ability to empathize with another, many are in black and white, or with minimum colour, so they’re quick to make and inexpensive to print out.

Another Theory of Mind test can be used this method does not use a scanner, but rather instead subjects an examinee to a questionnaire, in this questionnaire, they’re given scenarios which would depict both first and second order of prediction, explanation and false belief, after each scenario, a ToM and Memory question are both asked, an example of a scenario and questions would be.

“Mary has a box of chocolates which she puts in her top drawer for safe keeping. A few minutes later Burglar Bill comes in and asks Mary, ‘Where are your chocolates, in the top or the bottom drawer?’ Mary doesn’t want Bill to find her chocolates ToM question IN which drawer does Mary say her chocolates are, the bottom or the top? Why? Memory question Where are the chocolates really?”

Depending on the answers, the results can show if the subject can appreciate what’s going on in the minds of other people, something which people suffering from Schizophrenia, paranoia, or delusions, have greater difficulty doing, the answers can also tell us if the patient has a significant deficit in cognitive empathy. (Derntl et al, 2009) ⁸

Top-Down Processing

Another test to see how people suffering from schizophrenia see the world, or to help diagnose those with schizophrenia, is the hollow mask illusion, there are many illusions like this which help us understand schizophrenia, but the hollow mask illusion is one of the more well known methods.

In a test like this an image will be shown but the depth of field will be reversed, someone who doesn’t suffer from Schizophrenia would see the image incorrectly, and the depth won’t be realized until a rotation is added, a schizophrenic person however, is not tricked by this illusion. In the hollow mask illusion particularly, when the hollow mask is at an angle where its fully concave, a person without schizophrenia would see the hollow mask as convex, yet a person who suffers from schizophrenia would see a concave mask.

“This powerful expectation overrides visual cues, like shadows and depth information, that indicate anything to the contrary. But patients with schizophrenia are undeterred by implausibility: They see the hollow face for what it is” (Buchen, L. 2009) ⁹

People who suffer from Schizophrenia aren’t the only ones who aren’t tricked by the illusion, other people who don’t have full access to there top-down processing area’s of the brain often are able to see past the illusion, people who are intoxicated by alcohol, or other drugs, are some of the people who don’t have as strong connections to top-down processing, as those who aren’t intoxicated.

Top-down processing is where your brain uses historical knowledge, and your expectations to influence perception, this means people who have high access to Top-down processing are far easier to trick with illusions as there brain will tamper with reality and see what’s not there to make better, or easier sense of the world, from what they’ve seen before, or are used to.

where as someone who doesn’t have strong access to there Top-down processing won’t be tricked by the illusion because there brain wont try to connect the dots, or won’t use historical events to put together pieces of the puzzle.

An example of how Top-down processing works is shown in the image above, in this image, there’s circles with lines in them, someone with full access to there Top-down processing will be able to see a cube, this is because someone with full access to there Top-down processing will use there previous knowledge of lines and cubes, to create an image which looks like a cube, even thought the cube isn’t there, a person without this access, would not be able to see a cube, as they wouldn’t be able to use past knowledge of a cube to create the illusion of the cube.

This doesn’t mean that people with Schizophrenia can’t or don’t access there Top-Down processes in there brains, in fact, quite the opposite, Grossberg argues that people with Schizophrenia’s access to the top-down process can become tonically hyperactive, which results in, hallucinations. (Collerton, Perry and McKeith, 2005).¹²

This tells us that people with Schizophrenia have unbalanced activation of there top-down processes which means that in general people with Schizophrenia don’t use there background knowledge to influence what they perceive, and thus aren’t tricked by illusions that people without schizophrenia are tricked by, but also means that People with Schizophrenia perceive hallucinations as a result.

This also means that a hallucination to a schizophrenic person, is similarly real to the perception of the hollow mask to a person who doesn’t have Schizophrenia.

To make art that would test Top-Down processing, wouldn’t be particularly difficult, it just requires some creativity, as it can be done in 3d, or 2d, in some cases it wouldn’t even take creativity, you could take a normal object, or face of a person or animal, and reverse it so the concave surfaces are convex.

Animation and related arts in Therapy

Schizophrenia is a very serious mental illness, with many different symptoms that make it hard to live with, as someone suffering from Schizophrenia, or someone who is close to someone who suffers from Schizophrenia, because of this, there are many treatments, experimental treatments, and procedures to try and help those who suffer.

Animation along with related arts are ways people suffering from Schizophrenia can treat the symptoms. One of those ways is in Art Therapy, another would be in Avatar theory.

Art Therapy

In the UK mental health policy suggests that Art therapy should be used to help those who suffer from Schizophrenia, it is recommended that all care providers should consider offering art therapy, music therapy, and drama therapy.

Art therapy is a form of psychotherapy, using art as the primary mode of expression and communication, this is to improve a person’s physical, mental and emotional well-being. (Art Therapy Blog. 2018)¹³

Art therapy has been used to help with many different mental illnesses, such as, depression, bipolar disorder, it can also be used by those without mental illnesses, to help with stress, understanding ones self.

Art therapy often encourages the patient to express and understand themselves, through artistic endeavors and via the creative process, allowing a patient to express there deepest emotion’s using paint, pencils, cameras, clay, or other visual art expression.

This in turn should promote personal development, increasing awareness of self, increase coping skills, and enhance cognitive function.

Art therapy also allows for engagement with another person, it allows an individual to show rather than tell the physiologist, if that be a message, an understanding, emotion, or event, articulated through materials and images, rather than through voice, allowing for one to talk about something they couldn’t say out loud, and by using art, it allows for a subject to play with ideas, or visualize them, allowing a far more fulfilling and engaging experience, which gives more information about the individual than just asking and talking could, and allowing for the subject to explore and understand themselves more.

It also gives a subject a relationship with a therapist, making it easier for a subject to be open, and be honest about there lives, in creative and outside of creative forms, it gives a safe space to an individual, where they could be open about experiences, and lets them talk about unspeakable through art.(Patterson, et al. 2011)¹⁴

It allows for a Schizophrenic person to draw the things that have been happening inside their heads, this helps get rid of something, a thought, for lack of a better word, which refuses to go away unless removed via the artistic rendition. (nature video, 2014)¹⁵

“For persons with schizophrenia, art therapy is a healthy form of distraction from various symptoms, such as disturbing thoughts, hearing voices, etc.” (White Swan Foundation, 2018)¹⁶

Keeping a person who suffers from auditory hallucinations, distracted from the hallucinations is more than beneficial.

“the main thing that kept me alive was the occupational therapists, doing activities like yoga, weightlifting, art therapy, music therapy, cooking.” (Patrick Cockburn, 2017)¹⁷

This was the statement of a Schizophrenic man, Art therapy was a vital part of this man’s life, and thus you can see that therapy’s, like art therapy, and other creative therapy’s, can save lives.

Given how all this information about how Art Therapy works, it would be fair to suggest that it’s effectiveness has been settled and art therapy is proven to be beneficial to Schizophrenic patience, but the journalists don’t share such a positive picture about Art Therapy, and thus the jury is still out.

A report from 2005 reported that Art Therapy didn’t have significant long term effects for schizophrenic patience, but the essay had came to the conclusion that the effects of Art Therapy with schizophrenia would need to be researched further, as many research essays before this article didn’t have enough participants to make the results meaningful. (Ruddy and Milnes, 2005)¹⁸

Another report from 2017 stated that it isn’t clear if Art Therapy leads to clinical improvement, and that the certainty of evidence is very low. (Isabel Ruiz, Aceituno and Rada, 2017)¹⁹

In 2012 a essay had stated that the lack of assertiveness on the side of the NHS, and patients not taking medication, could play a big role into why Art Therapy hasn’t had a substantial positive affect in the UK, it concluded that Art Therapy still has the greatest potential for success treating negative symptoms. (T. Kendall, 2012)²⁰

A concern with these reports would be that they don’t separate by different sub category’s of Schizophrenia, which may create a problem, as Art therapy may affect one sub category of schizophrenia more than the other, thus making the conclusion, over schizophrenia overall maybe to large of a scope.

Another concern had, is that if you take away art therapy, than its one thing less for people to hold onto or distract themselves from there thoughts in there mind, perhaps there’s not great improvement when someone is doing Art Therapy, but perhaps it’s one thing which would prevent a bad night, or be one of those things which is hard to measure, but really does have giant affects.

Another concern had with these papers is that they don’t test if Art therapy without the other therapy solutions being active, this means that a conclusion could be reached, where Art therapy might not be effective if you’re already doing other forums of therapy, but if you’re not, than Art therapy could be very effective, perhaps making it beneficial to give a patent a choice of what type of therapy they’d like to go through.

Avatar therapy

Approximately 60-70% of those with Schizophrenia suffer from auditory hallucinations, these hallucinations are often derogatory, or/and threatening, there are current methods in use to help tackle auditory hallucinations via drugs, or Cognitive behavioral therapy, but these often aren’t ideal.

“A large proportion of people with schizophrenia continue to experience distressing voices despite lengthy treatment, so it is important that we look at newer, effective and shorter forms of therapy,” says lead author Professor Tom Craig from King’s College London, and the South London and Maudsley NHS Foundation Trust, UK. (ScienceDaily, 2018)²¹

One of these possible solutions would be Avatar therapy, Avatar therapy is where a patient would work with a therapist to create a computer simulated avatar of the voice that they hear in there head, the patient would tell the therapist what the voice sounded like, what the voice would say and how the voice would look given a human face.

After that information is given, a modeller would model the face, to look as close to the description given, this would than be put on a computer screen, the therapist would than have a 3-way conversation, where the therapist would be himself, and act as the voice in the patients head, and the patient.

Patients often find the therapy extremely difficult to begin with, but over time, and several sessions, it becomes an easier therapy to go through, as a Psychiatrist will give advice to patients by giving them advice on how to respond to certain insults and helping them develop stronger defense mechanisms.

As a patient responds in an assertive manner, the avatar gradually gives up on giving derogatory insults, and as that happens the voices turn from something that’s frightening to something that the patient can stand up to and control. (Kings College London, 2017)²²

“The whole experience changes from something that’s very frightening to something that’s much more in the person’s control” Craig said, speaking to AFP.

Professor Tom Craig also stated that Avatar therapy is showing great promise as tests so far have concluded that Avatar therapy reduces the frequency of the voices, and how distressing they are, and these improvements last for up to six months, however, there is more research to be done, so that the treatment can be optimized.

There is also a more advance therapy similar to this, instead of creating a different face for the voices in ones head, they would take a patient, scan them in, with some of there natural body movements, and a patient would confront this virtualized version of themselves. This particular version of avatar therapy uses the theory of similarity which states that “If an avatar looks like me, if it makes the same movements that I do, and at the same time, I will much better retain what the avatar is telling me” Delphine Capdevielle. (euronews, 2016)²³

This treatment, has the potential power to change those who suffer from Schizophrenia’s lives, as they develop the ability to stand up and defend themselves against the voices, they can stop isolating themselves out of fear of the voices, and can go out, and have courage in themselves, as they can fight against the voices who threaten and insult them.

Over time as Avatar theory improves, the improvements schizophrenic patience receive from the therapy should last longer, and thus be more beneficial, but even if the therapy affects last 6 months, that’s a long time without voices, and would improve someone’s life enough, that the treatment to go through the therapy every 6 months or so, would be beneficial, and have life changing effects.

Of cause as wonderful as this therapy is, there are still limitations, this therapy doesn’t cure someone of schizophrenia, even if it could remove someone’s voice’s from there head, the people who suffer from schizophrenia will still suffer from other hallucinations as discussed in the the Top-Down processing chapter, and would continue to suffer from having less empathy, along with many the many other different symptoms which are part of different types of Schizophrenia sub-types.

Conclusion

In conclusion animation and related arts have a lot of utility when related to Schizophrenia, in detecting, diagnosing, and as a therapeutic method. Animation and related arts gives authority’s a successful method to separate those with Schizophrenia from those with Prodromal, and those who do not suffer from schizophrenia via Social Attribution Task-Multiple Choice.

It can tell us how much cognitive empathy one has and thus can be another way to diagnose someone with schizophrenia using the Theory Of Mind Non-Animated Cartoons.

Animation and related arts also gives us the ability to detect the possibility of schizophrenia via tricking people’s top-down processing in there brains, but also gives professionals a good way to explain, and show others how a schizophrenics mind work’s, using things like the hollow mask illusion.

Art therapy is still in the jury with how helpful it is, but is still used by health services, and is at least an activity which a Schizophrenic person can use to distract from their delusions.

Animation can be very helpful in helping teaching someone who suffers from Schizophrenia how to be assertive to the voices in there heads, making it so the voices become more manageable, quite, and maybe even vanish for 6 months after therapy, due to Avatar therapy.

So all in all, Animation and related arts is well utilized to help detect, diagnose and as a therapeutic method, and therapists continue to find revolutionary ways to use Animation and related arts to help those who suffer from Schizophrenia, making Animation and related arts a vital part of the Mental health services, for Schizophrenic patience.

Bibliography

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