Instant Genius - Psychosis, realism and video games

Episode Date: October 12, 2017

In the first half of this episode we ask Dr Stephen Hall, a climate and infrastructure researcher, whether the 2040 petrol and diesel car ban will really clean up the air we breathe. In the second part, we talk to neuroscientist Professor Paul Fletcher about the game Hellblade and how it tried to present a scientifically accurate portrayal of psychosis. Hosted on Acast. See acast.com/privacy for more information. Learn more about your ad choices. Visit podcastchoices.com/adchoices

From origin to legend. I need to become a symbol. I need to become the hero. Someone's got to step up. Build the legacy. Let's get to work. You want to get nuts? Let's get nuts.

I'm allergic to nuts. Lego Batman, legacy of the dark night. This is my favorite part. Available May 22nd on PlayStation 5, Xbox Series XS, and PC. Rated E10 for ages 10 and up. You said this place was steps from the one. Water. We just haven't found the steps yet. How much did we save? Enough. Enough to get lost. Or you could book a stay with Hilton. Welcome to your ocean front room. Just steps from the water.

The Hilton sale is on now. Book on Hilton.com or the Hilton app and save up to 20% to get the stay you expected. When you want savings, not surprises. It matters where you stay. Hilton for the stay. Study And play Come together on a Windows 11 PC And for a limited time College students get The best of both worlds

Get the unreal college deal Everything you need to study and play with select Windows 11 PCs Eligible students get a year of Microsoft 365 premium And a year of Xbox GamePass Ultimate With a custom color Xbox wireless controller Learn more at Windows.com Slaternity offer While supplies last ends June 30th

Terms at AKA.m.m.S. College PC This podcast is sponsored by name, audio and focal. Streaming has made music more accessible than ever, but true listening is about more than ease. It's about quality. British audio experts name audio, alongside French acoustic specialist focal, combine handcrafted tradition with cutting-edge innovation and high-end materials,

delivering digital precision with analogue warmth, so you can experience exceptional sound at home. Music just as the artist intended. Visit name audio.com to learn more. Hi, and welcome to the Science Focus podcast. I'm Daniel Bennett, the editor of BBC Focus magazine. Coming up in this episode, we talked to a neuroscientist about the newly released game Hellblade

and its portrayal of psychosis. In a sensory deprivation chamber, where if you remove all sensory input, within a short space of time, a person will be experiencing hallucinations, but they usually retain some sort of insight. They know that it's because they're, in that setting that their experience in the world has changed.

And we catch up with a climate and infrastructure scientist about the UK's recently announced diesel and petrol car ban. So a ban by 2040 in 23 years' time is it smacks of a lack of ambition, particularly when other bands introduced by the French have said 2035. So why is it that we have to wait till children that are born today at 23 years old before they can benefit from that legislation. You're listening to the Science Focus podcast from the BBC Focus magazine team. With the UK's best-selling Science and Technology Monthly,

available in print and in several digital formats throughout the world. Find out more at ScienceFocus.com or look out for us in your app store. Air pollution is hurting our health. A recent report from the Royal College of Physicians linked poor air quality to 40,000 early deaths a year in the UK. that context, you can see why the UK government recently announced that it plans to ban the sale of petrol and diesel cars in the UK by 2040. To find out whether this will really clean up the air we breathe, commissioning editor Jason Goodyear spoke to Dr Stephen Hall, a research fellow

at the School of Earth and Environment at Leeds University. His work looks at how we can adapt cities to create a low-carbon future. Okay, so we've got the government saying that they're going to ban the sale of all petrol and diesel cars by 2040. So let's, I think first we need to unpick this a little bit to see exactly what it means. So as I understand it, it's not all petrol and diesel cars, is it? Well, this is one of the problems. So it's not clear from what the government's published, what it actually means. It doesn't mean, as it's published, that there will be no petrol or diesel going into vehicles.

all it means that the ice engines or internal combustion engines I see that don't have any hybrid technology at all in it it looks like what they're saying is they will be banned in sale by 2014 so we're just talking about 100% combustion engine powered vehicles it would seem so yes yeah so your your hybrid like your prius that's absolutely that's going to be fine at the moment it seems so yes it's difficult to tell because the way that it's been published is not entirely clear and you can understand why if you were in government you wouldn't specify exactly which type of engines but in the fullness of time that will come out but it seems like it does mean just 100% fossil-fueled cars will be banned from 2040 and it's just cars so lorries buses they'll still be fine to use

diesel presumably it's it doesn't say as far as I and determining legislation, but in terms of what you would expect, it's much, much simpler for government to make an announcement about cars and ban those from private sale, and it's much, much easier in the buses and fleet vehicles to rely on things like Euro 5 emission standards, rely on things that already exist for big commercial vehicles. Right. So sort of maybe naively, on first glance to some people, this might look like quite a radical proposal. You know, they're phasing out technology that's been used for decades.

So why aren't a lot of especially environmental campaigners happy about this? It's a good question. So as an environmental campaigner, sometimes you get asked, why aren't you happy about this? This should be fantastic, particularly around family dinner tables, if you like. but why environmental campaigners have received it with some skepticism is because it could happen much, much earlier. And you see Volvo, for example, have said, we aren't going to make any 100% fossil fuel-powered vehicles after 2019,

which is a couple of years away. Similarly, you know, Tesla have already got 100% electric fleets. each manufacturer knows how to do some form of hybrid, some form of full electric or even hydrogen vehicle. So a ban by 2040 in 23 years' time is it smacks of a lack of ambition, particularly when other bands introduced by the French have said 2035. So why is it that we have to wait till children that are born today are 23 years old before they can benefit from that legislation?

Right. And I mean, is it kind of thought that the manufacturers would meet this goal naturally in the market anyway? Yeah, that is a good question. So you've got to put this in context. So the government has been in a legal battle over air quality for three or four years now. And the only reason it's published this plan is because it has been forced to do so by the courts. So they're already recalcitrant to do anything substantial on air quality, particularly around private vehicles. If you look back at the history of government intervention in the transport sector, anything that could be seen as a kind of war on the motorist. So any intervention by government can be seen as detrimental to private motorists is profoundly unpopular. So when you then put that in the context of a vehicle, fuel-type ban, you can see that the government is really hedging its bacteria. It already

was not received well in the press that you would associate with the constituency of this government. It wasn't received well in the newspapers that you would associate with not being particularly happy about this kind of thing anyway. So it's a real kind of political hot potato, but you can understand why 2040 was the date that was chosen. Realistically, however, it's unlikely that, I would say on a market perspective, it's unlikely that anyone would be buying non-hybrid fossil fuel-only powered cars past 2030 anyway. Right. So sort of just going back slightly there then, so exactly how bad is the air quality problem in the UK at the moment? It's really quite bad. One of the things that people have found surprising about this is it's, you know, it's not smoggy anymore.

We're not talking about the P-Supers in London. And they were really caused by particular emissions, which meant, because it's particular, it's kind of visible so you can see it. So that smog issue is largely being dealt with, but they're PM10 and PM2.5 emissions. And that just means it's kind of stuff that you can see, and yes, it can get in your lungs. The real problem is nitrous oxide, which you cannot see, which is generated largely by diesel engines. And whilst we have clear air in our cities, we don't have clean air. And the issue that we've been struggling with in UK times and cities is 146 of them have breached these air quality limits over the past few years. And they've consistently breached them.

And nitrous oxide pollution is damaging to lungs and brain and an orphanage. a lot that we don't understand about nitrous oxide's pollution is probably going to come to light over the next five to ten years as the long-term health impacts start to be felt in the health system. Okay, so with that in mind, then why is it better to just outright ban petrol and diesel rather than trying to make cleaner petrol and diesel engines? So a good reason for banning petrol and diesel engines rather than trying to make the cleaner is whilst the automakers have said sorry,

but they still were cheating on those tests. And it's been shown through the Dieselgate scandal that things like regulation on the clandliness of engines can be game, whereas if you simply ban it, it's much, much more difficult to game that system. Similarly, it's an eye-catching policy proposal. I think it's interesting that petrol was included in that because you could reasonably see that banning a petrol vehicle

does not have the same air quality benefits as banning a diesel vehicle does. Right. How much more would switching to electric vehicles clean up our air quality? How much of an impact could it make? So the impact of electric vehicles on air quality would be quite high. So you can see that the shift recently, the private cars has been to diesel. If you move that shift to electric vehicles, you will deal with a substantial element of the vehicles that are causing the problem in Cs. And the reason is simply tailpipe emissions.

I admit it, I drive a diesel vehicle. And I know that when you drive that through a town, particularly at times of high congestion, you are really contributing to poor air quality. If you're driving a diesel vehicle, you really get rid of those nitrous oxide emissions. Now there are other good arguments to say that unless we might, manage the way we charge our vehicles, or we didn't just move that dirty power to electrical generation rather than tailpipe emissions. But equally, most of that power generations is out of towns and cities. So it would solve the problem of those very local air quality or air quality

hotspots, but it would be a bad idea to do that at the expense of this shift that generation somewhere else geographically. Sure. I mean, another concern that a lot of people seem to have about electric vehicles is, first of all, the availability of materials to make the batteries, and secondly, their disposal. Availability of what's been come to be known as critical materials. People used to talk about rare earth metals, but there's other kind of lithium and cobalts and all kinds of different materials that go to make up the variant electric power trains used by different manufacturers. And those materials have got several problems. One is they're just geological availability, so there are abundance in the surface of the earth.

Some of them, it's uncertain whether there is enough to meet the demand for if everybody, and we don't just mean in the UK, if there was a global shift to electric vehicles, how much simple abundance is there to be able to satisfy our need? So that's a legitimate question, people working on it, and there are differing views. There's no kind of content with yet, and it's different for each material, so it doesn't really lend itself to a quick, crazy. But equally, a lot of those, then there's an ethical issue of the supply chain, like how much of those critical materials are sourced from mines which are managed in such a way that they don't commit high levels of toxic environmental pollution and have really detrimental social issues.

And then the final kind of non-technical issue is the geopolitical problems of single-sexual problems of single supplier nations, some of which are quite volatile. Others are kind of more in terms of geopolitics in that China produces an awful lot of these critical materials, sometimes 80 to 90 percent market share. So if you're the US or Europe and you're pinning your climate hopes on changing your vehicle fleet to electric, then clearly that's got a security of buy implication for you. And then just going back to the time scale slightly, I know that Michael gave was, is put aside, I think it's £250 million for local measures that he calls something like surgical incentives or something like that. I mean, do you think there's more

immediate measures like this or Sadiq Khan's toxic tea charge to go on top of the congestion charge that's already in London? Do you think something like that is really going to make a big difference. Absolutely. So we've been talking a lot about the ban on petrol and diesel vehicles, and it's eye-catching. So people are like, oh, I'm not going to be able to drive the cars that I've been used to driving. But the real reason for a mental campaign is a sceptical is that's really a distraction. What would work now are things like an enhanced congestion charging scheme in London, congestion charging in towns and cities that already breach air quality limits, much better investment in active modes and better transport planning and taking private vehicles off the road and cleaning up

the public transport fleet, particularly buses. There are a bunch of things that we can do right now that don't require any technological development whatsoever. And the real problem that environmental campaigners have had is that government has put the on the onus for developing these on local government, which is already stretched, it's already kind of overburden. And if it puts it on local government, then it becomes about local politics, and some cities will go for it and some cities won't, whereas central government were to just act and legislate and make this happen at a central level, that would be much more effective than any kind of vehicle fueling ban in the kind of far and distant future. That was Dr Stephen Hall. On the face of it, you might not think

that a video game called Hellblade and Van Gogh's iconic painting starry night have much in common, but bear with me for a moment. In June 1889, Vincent Van Gogh painted the view from his window at dawn. At the time, he was looking out of the San Paul Asylum in Saint-Ré-D-Provence, where he had admitted himself after mutilating his own ear. Today, some scientists believe that Van Gogh suffered from psychosis and that this condition affected the way he saw the world. So, when we look at Van Gogh's sweeping brushstrokes and vivorke,

vivid colours, we're actually getting an insight into how someone suffering with psychosis might see the world. Today, well over a hundred years later, a new game called Hellblade, Senua Sacrifice, attempts to do just that in 3D. We spoke to Professor Paul Fletcher, a clinical psychiatrist who worked on the game, about how he, together with the developers, tried to create a realistic perspective on psychosis. for people who might not have seen or heard of the game could you briefly just describe Hellblade what it is and what it's about?

Sure, so it's a sort of an over-the-shoulder role-playing game in which the player takes the perspective of an 8th century Pictish warrior and she has got to fight her way through to a Viking hell in order to retrieve the soul of her loving, Dillian who's been sacrificed. So Senoa is the heroine.

Now that's the game. The sort of additional and very unusual component is that Senoa is suffering from a psychosis, which has partly emerged out of the traumatic experience that she's had. So by psychosis, I mean she's experiencing an altered reality with voices and visions and sort of bewildering uncertainty. So it's an attempt to engage with mental illness, but in the context of what is intended primarily as a game. And so how did your involvement sort of set out?

Did the developers come to you for advice? So three years ago or so I got an email out of the blue from the project manager at Ninja Theory, which is the video game design studio in Cambridge. and he gave me a thumbnail sketch of what the game was, you know, this Pictish warrior fighting her way through Viking monsters and told me that they wanted her to have a psychotic illness and would I be interested in offering advice

because my clinical work and my research is around psychosis. So I was initially, you know, it's not the usual email that one gets in my job. No. And I was aware that mental illicit. in video games had sometimes not been dealt with very sensitively. But I was at the same time very intrigued because I think that video games represents a remarkable opportunity to actually put yourself in another's position. You know, you're an active participant that sees the world from another's point of view.

So actually, I think they really have a lot of potential for giving people an experience or getting them to empathize with things like symptoms of mental illness. So I went along and it was very clear from meeting the team that they were really committed to a sort of sensitive and honest portrayal. And from then on, I really was hooked. From that point onwards, once you'd had that initial meeting, how would you describe your consultation on it? Well, it began really with sort of a fairly typical consultation where I went along and sort of almost gave a bit of a symposium on what we mean by. psychosis, this idea of altered perception of reality, hearing voices, seeing visions, making a different sort of sense of the world, believing things that other people don't believe.

And that led to further discussions, which actually then turned into quite long and far-ranging conversations that, you know, I just kept coming back to them and talking about neuroscience of perception and how we think that. the, you know, even the so-called normal, boringly sane brain is actually constantly on the verge of hallucinations because it's making up its own reality. And so there was an awful lot of discussion about how within the context of the game it would be possible to replicate these effects of sort of the brain creating and responding to its reality. And then that led further to me putting them in contact with people who have lived experience of psychosis. and we had some long and free-ranging discussion with groups there who were very helpful, very honest, very sort of straight in describing their experiences and their own responses to it. So it's been a really far-ranging discussion, sharing literature, email, long email conversations, very, very collaborative, actually.

And have you got an example of, say, how something we understand about psychosis today fed into something that, the developers then created in the game. Maybe it's some of the visual hallucinations or the auditory hallucinations. Yeah, sure. So one example would be, you know, I was sharing with them some first-person accounts from papers in the 1960s, these sort of papers that gather dust and nobody reads anymore, but they've got very rich descriptions of how one's perceptual world can fragment as you move. So, you know, people have described how the world seems to be in one's piece and then just as they go to make a movement, it seems to fragment in a jigsaw-like way. And, you know, the artist would take ideas like that and accounts like that and actually

put them on the screen in the game and we could then review them. And of course, a lot of the people with the lived experience of psychosis, they would describe their own experiences and the artists would go away and a couple of weeks later, we'd all meet up again and there those experience would be represented and the person would say well yes it's like that or no it's not and so it was an iterative process of describing experiences and and sort of working them into the visual and the auditory scenario of the game if someone isn't familiar with you know the term psychosis indeed there's probably i imagine a few misconceptions uh the bound about especially when you hear words like psychotic um what what does

someone with psychosis, you know, what do they experience? And what is, it's not a condition in itself, is it? No, that's right. So, I mean, the first thing to do is acknowledge that, as you say, it's actually a much misunderstood and sometimes very contentious term. And I should add that, you know, some of the people with the lived experience would reject the term psychosis as a description of their experiences, you know. But we didn't get too, too, too, heavily into the nomenclature. But what it actually means formally, it's a description, not a diagnosis, and it means having a different or an unshared reality such that the things that you perceive in the world and the things that you believe about the world are not shared by the people

around you. So sometimes it's referred to as a loss of contact with reality. And it really consists of two sort of broad sets of experiences. One is the perception of things that aren't objectively there. And those are called hallucinations. So that would be, you know, those could be auditory or visual or tactile or you may smell things or taste things that aren't there. And then on the other side there are what are called delusional beliefs which are these unusual, seemingly false, bizarre, sometimes very frightening beliefs that people have and around which they build their world and their actions. So that's the description. But it's can have many, many causes. You know, it can be caused by, you know, people post-operatively can go through

a sort of psychotic phase, people who have severe infections, lots of physical illnesses, neurological illnesses, and then there are also psychological causes, past traumas and anxiety and things like that. So when we're talking about, for example, something like the hallucinations, how much do we understand about what's happening neurologically, what's happening in the brain when these hallucinations occur? Well, we don't understand a great deal, actually. Lots of people have their pet theories, and those theories have been more or less successful when it comes to testing.

I think a powerful current idea is centered around the idea that it's really a variation on, normal brain functioning. And this draws on the idea that actually, as I said, most of us are creating our own worlds all the time. You know, we feel that we have a very clear perspective on reality, but actually all we've got are these very noisy, very ambiguous sensory inputs, and we have to sort of assemble those into reality,

into our model or experience of the world. And one theory about how we do that is that we use, what we already know in order to make sense of ambiguous signals. So we essentially superimpose our own prior expectations on the world. And a theory of hallucinations is that perhaps there's an enhanced tendency to superimpose expectations so that you don't just change sensory input. You actually almost create it. Right.

And, you know, this is interesting to me in many ways. One is that it sort of relates. the experiences of psychosis to normal functioning. It's not saying that there's just a broken brain or a disordered brain. It's rather saying that there is a system or mechanism that has its balance changed, if you like. My own feeling is that if we ask ourselves what the brain is trying to do in order to function, you know, I think it is trying to model the world on the basis of very ambiguous partial noisy sensory inputs. It's trying to somehow sort of hazard guesses about what's out there in order to predict

them and so that we can survive within a noisy uncertain world. And I think there are many, if this involves this fine balance between what you expect and what the input is, then you can imagine that there must be multiple, many, many ways in which that balance can be shifted. And it might well be that irrespective of how that balance is shifted, it's an infection or it's, you know, a structural alteration or whether it's something more psychological, some experiential effect. It may be that psychosis is the final common pathway that emerges because of the shift in balance. Within that explanation, so does that sort of count for,

you know, whenever I've read or, you know, even when you're playing the game, A theme is this sort of realness of the hallucinations. It's not simply that they are, you can dismiss them as, you know, just simply not there. It's, it's, it's the kind of the stark realness of them. How does that fit into that picture? Well, I think, I mean, you're, you're certainly right to point out that one of the hallmarks of the real psychosis. is the fact that that reality, even though it's not shared by people around a person, it is real to them.

It's something in which they fully invest and something in which they're completely immersed. I think there's actually a gradation and that you can get instances where hallucinations occur, but a person retains insight. You know, they know that they see the vision and it's a very real vision, but they know it doesn't reflect what's really out there. So a good example of that would be in a sensory deprivation chamber where if you remove all sensory input, within a short space of time, a person will be experiencing hallucinations. But they usually retain some sort of insight. They know that it's because they're in that setting that their experience of the world has changed.

Similarly, when people take psychedelic drugs, you know, they usually retain a degree of insight. So even though they're getting the vision or the visions and the voices and things, they nevertheless, they attribute it to the drug rather than to reality. How common a theme is maliciousness? Because in the game, you navigate the world essentially a lot of the time through the voices that send you a hears. And I think a theme there is that you're never sure which to trust because someone to seem to want to help you, some seem to want to hurt you. And so I guess how common is that in people who experience psychosis?

It's a difficult one that because I think that my own view might be quite biased because as a clinical psychiatrist, I tend to see people who are suffering because of their experiences. And so I'm more likely to see the people in whom the voices are nasty and critical and unpleasant and cause suffering. But there are certainly people out there. who you would not call mentally ill, who are experiencing things like voices, but in whom the voices can be quite helpful or even pleasant and enjoyable.

And this is certainly something that the people with lived experience were keen to point out is that although a number of them have suffered very severely because of their experiences, nonetheless at times they can be helpful and they can be even beautiful and rewarding. So, you know, if it's part of an illness, I think it usually, usually there's a sort of dark and bewildering and sometimes very threatening component to it. But that doesn't mean that all voices and visions are like that. Do you have much insight into what mental health would have been treated like back in, I guess, you know, when we're going back to the game, it's Viking times. but even, you know, in that kind of period, how would Sennau herself have seen the condition?

In the game, they call it the darkness. Is that realistic? It's a good question. I mean, clearly it would be anachronistic to apply modern-day diagnoses and formulations to Senoa because, of course, she came from within a very particular culture and culture plays a big part in shaping how we define and experience mental illness.

But I was in sort of, as we were talking and collaborating and moving forward, I was able to find a PhD thesis within Cambridge University written by somebody who was interested in legal definitions of mental illness in Celtic Britain. And one thing that was very striking is that they actually had quite a sophisticated way of of conceiving of mental illness, mental distress, and would recognize that there would be different types and that these would manifest in different ways and perhaps would require different sorts of care

or different sorts of, I mean, they didn't have formal treatment, but the way that they treated people would be different. And, you know, the explanations were clearly around whether somebody had offended the gods or whether they had done something that was immoral, and therefore were being persecuted for it. But nonetheless, there was still, I think, a relatively surprisingly sophisticated,

willingness to recognise different sorts of altered experience of reality. That surprised me, I think, when I saw that in the game. Yeah, it surprised me too, actually. So we touched on it at the start that you yourself had sat through the game and you had several patients who had experienced psychosis reviewing it. How to someone like me who has never experienced it and who has very limited knowledge, how realistic a portrayal is it?

You know, one of the things that feel realistic to someone looking at it who has experienced psychosis themselves? I think it achieves interesting and very sort of impressive goals at a number of levels. So in terms of representing just purely the sensory experience, I think it's really very well researched. So the experience of voices being outside one of voices talking to each other about Senoa or talking directly to Senoa of being either helpful or critical. or misleading, I think that is very, very striking. The visual perceptual changes, which are perhaps less striking,

are nonetheless very redolent of what people in early phases of psychosis will often describe, this feeling that the world is slightly changing shape, that it's melting, that they somehow have to put the pieces of the world together into a coherent whole. And this, again, is something that the people with lived experience, of psychosis commented on and said we're very positive about that it had got the visual side of things just right. And on top of that, I think what's been really important and impressive to me is that it's not just a sort of checklist of symptoms. You know, it's not that, okay, we've done the voices, we've done the visions, now let's give her a little bit of

sort of darkness creeping around or funny noises. It's much more about a whole look experience of a person trying to make sense of a bewildering and very threatening world. And in that respect, I was really touched by the response of some of the people with, well, of all of the people involved who had lived experience of psychosis is that they all commented on the fact that she's a hero. You know, she's not a, she's not a hapless victim. She's somebody who's trying to make sense of the world and stand up to it. Without it being a sort of, I mean, one of them said, we don't want Disney.

We want something that's realistic. And I think they got that, we got that. I was very impressed with what the team have done. Could you give us some insight into how, obviously it would, I suppose, vary with the cause, but how in a clinic you treat psychosis? So in the clinic, really, the approach tends to be a mixture of what, you know, the aim is to be as precise as possible to a person's own. needs. So very often psychosis is brought on and worsened by social factors such as stress

and harassment and things like that. So that's one aspect that you need to take into account. There's also the sort of longstanding psychological schema that a person may have, you know, that might worsen or exacerbate the psychotic experiences. So perhaps a past history of of trauma or concurrent anxiety. And then on top of that, there's medication, which is never ideal because of side effects. But in some cases, it's needed and can do a lot of good for someone. So generally, the treatments tend to be a mixture of psychological therapies, social changes and pharmacological treatment if necessary. When it comes to psychosis and what we understand about the brain,

Do we understand much about certain brain regions or essentially I've read about things to do with, you know, the frontal cortex, which is traditionally to do with decision making and its connection to the sort of more primitive brain stem areas which deal with fear and emotions and their communication with each other being, what's our understanding of that like? Yeah, so I mean, with the advent of brain imaging technologies and a renewed interest in the biology of, or, you know, the neurobiology of cognitive processes, there have been some really intriguing observations about altered processing in certain regions of the brain and psychosis. So, for example, one suggestion has been that the reward system is overreactive and as a consequence, normally neutral stimuli actually become very engaging, very, very salient, and they require a sort of attention and explanation that can be part of the psychotic experience.

And this has been related to changes in function of the neurotransmitter dopamine. So there's a number of intriguing observations out there. But the problem I think is that there is that there is a number of intriguing observations. is no one psychosis. So it may well be that what we're on the verge of is finding ways to break things down, to find the underlying causes, treating psychosis itself as a sort of final common pathway. So just as with something like, I don't know, delirium might manifest in confusion and raise temperature and that sort of thing, nobody would say that there's just one reason for being delirious. There are multiple, multiple reasons.

and the challenge actually is to get below the surface and find out what these different causes are. And in some cases, it is very likely to be something like an altered dopaminergic function. In other cases, it may well be something autoimmune. There's increasing evidence of changes in immune function in a small percentage of people with psychosis. And in still others, it may be a longstanding alteration in psychological functions. And just to go back to when you played the game the first time,

sorry, when you saw the finished product, what was your experience of it? How did you feel seeing this project that you'd worked on for three years come to life? Well, it was extraordinarily rewarding. I mean, I should be reasonably diffident about this and say that I gave advice and I collaborated and I chatted with them. But actually the Ninja Theory team really have. have sort of created this from their own talents and skills and their discussions with the

people with lived experience of psychosis. So I was simultaneously blown away by their achievements and very proud of the fact that I had a small part to play in it. And all the time I was anxiously watching the reactions of the people themselves who've experienced psychosis. And the most rewarding bit was at the end when. it was very clear to me that they themselves were very proud of it as well. And are you aware of anything else like this where we've all been talking about the game of the team?

We can't think of many other examples of this where you get to get real insight into a mental health condition, potentially through a medium that you can actually experience to a degree yourself. Yeah, well, that's what excited me from the start. because, you know, if I had more time on my hands and fewer responsibilities, I think I would play games a lot more. And one of the things that really attracts me to them as a developing art form is that they are very participatory. You can't help but immerse yourself if it's a good game.

And I have been aware of other uses of mental health in the context of video games. And in fact, there was a review paper written in, I think, 2015. reviewing the last couple of years of best-selling games and how they'd used mental illness. And it's not a pretty sight, really. It seems that in the vast majority that the use of mental illness was really to just explain the actions of somebody that would be described as a homicidal maniac. So generally, what they've done is they've aligned mental illness with irrational behavior and violence. And I think that's a real shame. actually, as I've said, that within the context of playing the game, there's an opportunity

to do something much more profound and a much more empathic. And do you think that's a somewhat wider problem as well, isn't it, I think? Oh, yes, yeah. I certainly wouldn't lay the blame at the feet of the video game industry. I think they just reflect the sort of general cultural tendency to explain seemingly inexplicable behaviours in terms of mental illness. You know, there's just a sort of, oh, it must be mental illness. And in fact, a lot of the time, that's very superficial.

And in the context of this, are patients that experience psychosis, you know, are they characteristically dangerous? No. The majority of violence in the context of that sort of mental illness is with them as victims rather than perpetrators of violence. Professor Paul Fletcher there. Thanks for listening to the Science Focus podcast. This month's issue explores the mysteries of interstellar space,

the science of out-of-body experiences, and it takes a look at the project that will chart every cell in the human body. And of course, much more. Thank you for listening to the Science Focus podcast from the BBC Focus magazine team. We're the UK's best-selling science and technology monthly, available in print and in several digital formats throughout the world.

Find out more at sciencefocus.com or look out for us in your app store. This podcast is sponsored by Name, Audio and Focal. The texture and emotional depth of music can be lost through digital sources or poor signal. Name Audio believes you can have digital precision with analog warmth. Alongside French acoustic specialist Focal, name creates high-end audio systems, combining innovation with craftsmanship. so you can listen to music, just as the artist intended. Discover more at name audio.com.

Ambition comes in all shapes and sizes. At First Citizens Bank, we roll with your goals because we're built for what you're building. Fit for your ambition for Citizens Bank. Relax and let Ralph's delivery handle your grocery shopping this week. We start with only the freshest items, then review your list and carefully choose each one. Then we pack it all up and deliver it in as little as 30 minutes so you can feel confident it's what you ordered.

Fresh groceries, your way, with Ralph's delivery and pickup. And right now, you can save $20 on your first delivery or pickup order. Ralph's, fresh for everyone.