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Will the Metaverse Impact Mental Health?

Evidence suggests links between virtual lives and psychoses.

Publicity has been given to the planned creation of a ‘metaverse’ by Facebook. A ‘metaverse’ is a term given to the evolution of the internet into a virtual world in which people interact through digital selves or avatars. Some attribute the idea to Neal Stephenson’s 1992 novel, Snow Crash, but the concept of an immersive digital technology that corrupts is a central theme in Stephen King’s 1975 book, Lawnmower Man. Even 100 years ago, in Fritz Lang’s Metropolis, electricity is used to create an evil alter-ego to the heroine. According to Facebook: “In the coming years ... people will transition from seeing us primarily as a social media company to seeing us as a metaverse company … In many ways the metaverse is the ultimate expression of social technology.1 The motivation behind this development is somewhat unclear, and the public justifications given by the company to date are scientifically incoherent or improbable. However, there is research evidence that helps us understand the likely outcomes of a metaverse for mental health.

The most striking potential impact of engaging in virtual interactions concerns psychoses—especially those involving delusions and/or hallucinations. These are not the only possible consequences, or even the most common, so we need to be clear about that. Overuse of digital technology is associated with many mental health issues, such as somatic symptoms (6%), depression (4%), psychoticism (0.5%), paranoid ideation (0.5%), and serious mental illness (2%)2. However, psychoses are among the most serious, and so they deserve some consideration, especially if a company that has an estimated 1.9 billion daily users is suggesting a move to a digitally-immersive experience. The Reality Labs Division of Facebook is apparently creating the outline of their metaverse, and how it will produce virtually the feeling of interacting with others, rather like in a game1.

So that this outline of the evidence not be misunderstood as anti-digital propaganda, or an attempt to silence people’s freedom, as has been expressed by Facebook representatives3, the first thing to say is that there is the possibility that such virtual interaction will help people who experience delusions. In controlled clinical trials, virtual reality has helped people with delusions and hallucinations, indeed people with many psychoses, to cope4. However, the proposed metaverse will not be a controlled clinical environment, and there are suggestions that the help such virtual environments provide is simply escape from problems, and that they do not deliver a lasting solution5. More on this impact later, but the fact is that there is growing evidence of an association between digital use and clinical problems associated with delusions and hallucinations.

Schizotypal personality traits, which include unusual experiences, impulsive nonconformity, and cognitive disorganisation, have received attention in relation to excessive use of digital technology6,7. Schizotypy is regarded as a sub-clinical syndrome similar to schizophrenia. Exploring schizotypy is often done in preference to examining people with schizophrenia, due to the difficulties that studies with schizophrenia can incur. In one such study6, 100 20- to 30-year olds were measured for problematic internet use (PIU), depression, anxiety, and schizotypal traits. About 30% of these people exhibited signs of PIU. Over and above the well-known associations between PIU, depression, and anxiety2, PIU was associated with schizotypal personality traits. Another study explored the correlation of schizotypy symptoms, Facebook use, and PIU7. Two hundred seventy 18- to 30-year olds participated, and it was found that schizotypy levels predicted PIU, and frequency of Facebook use. Disorganised schizotypy was the best predictor of PIU. There are more studies in this vein, but the findings are all largely similar: There is an association between digital use and schizotypy symptoms of the sort that parallel schizophrenia and other psychoses.

The question remains: Does the digital use cause the schizotypy (including delusions and cognitive distortions), or do those with schizotypy and cognitive distortions gravitate to using digital technology? While the first possibility is the most obviously scary, either relationship is worrying for a metaverse, and there is little direct evidence on this point. One study5 suggests why people with schizotypy might engage in virtual worlds, especially those connected to gaming. The Reality Labs Division of Facebook is highly populated by people with gaming knowledge1; thus, this study5 is pertinent to the projected metaverse. In this report5, 83 participants who engaged in massively multiplayer online role-playing had their levels of schizotypal traits measured. Schizotypal traits predicted game-playing—that is, those with higher levels of schizotypy were more likely to use this digital technology. One of the clever things about this study, however, was that it measured these traits both in real life and when game-playing. Schizotypal traits were lower when in-game compared to in real life. The authors suggested that one reason why so many people with schizotypy are attracted to such virtual worlds is that it allows them to escape from the real world that provokes some of their problems. These findings imply that visiting the metaverse may incur a greater level of contact with individuals whose grasp on reality is not all that it might be—and that can provoke some unpredictable, or even difficult, interactions.

Lest it is believed that studies focusing on sub-clinical symptoms associated with schizotypy have little relevance for clinically significant disorders, there are several clinically-verified descriptions of schizophrenia and psychoses in relation to digital use. One clinical case series, published in a reputable journal, documented two patients who had delusions related to Facebook8. The authors considered: “…the context of the nature of social networking media and the internet, including examples of how it has been used therapeutically, as well as the potential for detrimental use8. While severe psychiatric symptoms like these are rare in those with PIU, about 0.5% report such problems as delusions and psychoses2. Even if 10% of those nearly 2 billion daily Facebook users develop PIU, that works out to about 1 million people with a psychosis, or similar symptoms, engaging daily in virtual worlds.

What are we to conclude from this research in the context of immersing many social-media users in a metaverse? At best, such an environment may serve as a temporary ‘safe haven’ for those with schizophrenic-like symptoms. Whether that makes the metaverse a safe space for other people remains to be seen. At worst, it may be that immersion in this digital world would increase the likelihood of being divorced from reality and thus generate delusional or psychotic symptoms. Once again, we are seeing a situation in which a digital technology company is proposing a product that has great destructive potential for public health without being subject to proper scientific risk-testing. Whether the investment by Facebook in 10,000 jobs in countries agreeing to the development of this technology9 has anything to do with that is unclear.

References

1. Broby, D. (30.7.21). Mark Zuckerberg wants to turn Facebook into a ‘metaverse company’ – what does that mean? The Conversation. Mark Zuckerberg wants to turn Facebook into a 'metaverse company' – what does that mean? (theconversation.com)

2. Ha, J.H., Yoo, H.J., Cho, I.H., Chin, B., Shin, D., & Kim, J. H. (2006). Psychiatric comorbidity assessed in Korean children and adolescents who screen positive for Internet addiction. Journal of Clinical Psychiatry, 67(5), 821.

3. Peck, T. (26.10.21). Nick Clegg’s outrageous defence of Facebook is enough to drive anyone to extreme. The Independent. Nick Clegg’s outrageous defence of Facebook is enough to drive anyone to extremes | The Independent

4. Freeman, D., Bradley, J., Antley, A., Bourke, E., DeWeever, N., Evans, N., ... & Clark, D. M. (2016). Virtual reality in the treatment of persecutory delusions: randomised controlled experimental study testing how to reduce delusional conviction. The British Journal of Psychiatry, 209(1), 62-67.

5. Schimmenti, A., Infanti, A., Badoud, D., Laloyaux, J., & Billieux, J. (2017). Schizotypal personality traits and problematic use of massively-multiplayer online role-playing games (MMORPGs). Computers in Human Behavior, 74, 286-293.

6. Truzoli, R., Osborne, L.A., Romano, M., & Reed, P. (2016). The relationship between schizotypal personality and internet addiction in university students. Computers in Human Behavior, 63, 19-24.

7. Mittal, V.A., Tessner, K.D., & Walker, E.F. (2007). Elevated social Internet use and schizotypal personality disorder in adolescents. Schizophrenia Research, 94(1-3), 50-57.

8. Hillier, B., & Sethi, F. (2014). Two case reports: ‘delusions’ arising in virtual reality. Journal of Psychiatric Intensive Care, 10(1), 51-56.

9. BBC (18.10.21). Facebook to hire 10,000 in EU to work on metaverse. Facebook to hire 10,000 in EU to work on metaverse - BBC News

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