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Understanding dementia first-hand

You’re standing on the roof of a building, the tips of your feet planted right up against the edge. You look down curiously at the three-storey drop in front of you and wonder idly why you’re standing so close to the brink. Just as you’re about to take a cautious step backwards, a woman suddenly appears at your left. She’s smiling calmly in bizarre contrast to the windy precariousness of the scene around her. Her knees are bent slightly, her arms out beside her bracingly, in the posture of someone teaching a toddler to walk for the first time. After the shock of her sudden appearance starts to wear off you begin to register what she’s saying:

“It’s okay, you can do it! Take a step.”

You turn away from her in horror only to find a man suddenly appear at your right, bent in the same posture, the same bracing, clinical calmness, repeating the same thing. “Shall we count down together?” he suggests cheerfully. They start: “One, two, three…”

You peer over the edge and the long face of the building cascades out in front of you. You shout and plea with the two, “Stop stop stop,” as they gently guide you into the chasm.

VR dementia simulation jumping off the roof

Just a simple step forward

This is where the VR simulation ends. This shortest one is only a few minutes long. It’s with some relief that you can remove the VR eyewear and headphones and reconnect with a world where your mind registers your surroundings just as they are— no tricks, no distortions. Lucky for you that you can re-enter this world with a simple headset removal. But about 4.6 million people across Japan do not have this easy out. This is the alternate reality that you enter with Silver Wood Corp.’s VR technology—the world of a person living with dementia.

“To really understand,” explains Maiko Kuroda, a representative for Silver Wood, “you need to experience what’s going on in their mind with your own eyes. With VR, you can experience this and connect to their understanding of the world.”

The dementia time bomb

Dementia is becoming a global health issue as people all over the world live longer, but no where is the problem more pronounced than in Japan, with its long life expectancies and the highest elderly population ratio in the world. In Japan, the issue is so severe it’s been alternately called a “crisis,” a “dementia pandemic,” and a “time bomb.” This is because, if the current stats seem alarming, it’s nothing to what’s coming. The Japan health ministry expects the number of dementia cases—already at record highs today, afflicting a staggering 1 in 25 people—to nearly double over the next decade.

To ask the Silver Wood VR project team, much of dementia patients’ pain and suffering is the result of a total misunderstanding of the disease by everyone around them. Silver Wood first started as a family manufacturing business several years ago, making steel-plate construction materials. But in 2005, they turned their sights to building apartment complexes for the elderly, and this is what introduced them to the misery of living with dementia in Japan.

Oculus Rift dementia VR at Silver Wood office

Inside a VR simulation of a person with dementia

“In Japan, at that time, in 2005, there were a lot of nursing homes where the dementia patients living there were basically trapped,” Kuroda recalls.

In traditional nursing homes in Japan at that time, dementia-stricken residents were locked in so they wouldn’t wander out and get lost. But in other countries, like Denmark, the company was shocked to find dementia-stricken residents come outside and personally greet them. They were friendly and welcoming and seemingly well-adjusted.

The difference seemed to be the public attitude towards the disease. It’s not that the caregivers or doctors in Japan were unsympathetic, but they genuinely didn’t understand what their patients were going through and were consequently less helpful. Dementia patients were excessively monitored and infantilized and this just contributed to a worsening of their symptoms.

The lesser-known side

Silver Wood began construction of 12 nursing homes in 2005 where the atmosphere would be very different. Their dementia-stricken residents would never be locked in involuntarily—they would have complete freedom to go outside as they wished.

For the caregivers assisting their residents, Silver Wood decided they needed to be better educated if they were really going to be able to care for their patients. And with that, the dementia VR project began.

Silver Wood staff working in the office

The Silver Wood office in Tokyo

Silver Wood’s dementia VR simulations (six in all) were designed in collaboration with actual people living with dementia. One major misconception that Silver Wood is trying to overthrow with its VR technology is the idea that the only symptom of dementia is forgetfulness. In fact, the symptoms vary from person to person and can include weird distortions of the scene in front of them or flat-out hallucinations.

The rooftop VR simulation is an example of this. This frightening 3-minute video is followed by a sort of explanatory video, where suddenly you find yourself (the dementia patient) stepping out the door of a parked minivan. The sadistic couple that had been guiding you off the roof to your death turns out to be two kindly caregivers helping you out of the car. For a moment, the 15cm height difference from the minivan floor to the concrete below appeared as a multiple-storey drop.

To be honest, while decidedly unnerving, there’s a certain video game-like visceral coolness to this simulation, as you careen forwards and watch the empty air loom dangerously before you.

Gearing up for the dementia VR experience

Gearing up for the VR experience

But the next simulation is not fun by any means. In its simplicity and casual realism it fixes the consequences of the disease in your brain in a way that nothing else could. This is the hallucination simulation.

A house of strangers

The setting this time is a modest apartment. An older woman, probably your mother or sister, welcomes you home and leads you inside, past a small kitchen on your left, to a corner of the room where a pair of couches around a coffee table comprise the living area.

A young couple (also family it seems) is already sitting there and welcome you cheerfully. The older woman starts laying out four place settings of cake and tea things while the young man engages the group in light chat.

But there is something terribly wrong in this ordinary picture, and the longer they continue to ignore it, chatting away carelessly, the more baffling and terrifying the scene becomes to you.

Because, from the moment you walked in, there are three complete strangers also in this room that no one is acknowledging. One, sitting so close to the young man talking that he could ruffle his hair if he just reached out his arm, sits crouched on the floor, his arms wrapped around his knees, staring blankly ahead. Another one paces the kitchen. And a last one, wide-eyed and alert, stands in front of a glass cabinet to your left with his hands at his sides, pressing his face right up against the glass door as though trying to bore into it with his mind.

“To understand it, you need to experience it.”

It’s incredible how different the “understanding” of hallucination is from the experience of it. In the VR simulation, there isn’t the comforting disconnect of just watching a creepy movie, because the “characters” are so engagingly fixated on you, and parts of the scene come in and out of view as you crane your neck, creating the all-immersive illusion.

Strangers on a bus in VR dementia simulation

The all-encompassing simulation of dementia

It crystallizes in you just how disturbing the hallucinations are because of their realism—not just flawlessly real in their drawing, but flawlessly real in their integration too. The man crouched on the floor isn’t a foot too tall to be plausible or hovering a few inches from the ground by mistake. In every way, he’s just as real as the family members gathered around you.

What really hits you in this simulation is the awareness, through it all, that this isn’t a fictionalized story—it’s a simulation of someone’s actual reality.

An interview with a person living with dementia

A short interview with the person living with dementia, Higuchi-san, who collaborated on making the video, follows the VR simulation. In the interview, Higuchi advises that, if you see a dementia-stricken person experiencing hallucinations, you should engage with them rather than just dismissing them outright.

“With warmth and a real, open curiosity, you should try asking them ‘What is it you see?’ It makes me really happy to hear that.”

With VR, you can experience this and connect to their understanding of the world.

What her advice seems to amount to is the fact that hallucinations, a less common but by no means rare symptom of dementia, can be a surprisingly lonely experience. To see something that no one else sees or wants to see or will even stand the mention of must be terribly isolating. And a 10-minute VR simulation does more to show and explain this than all of the reading you could do on the subject.

VR for social change

Flushed with the success of their dementia VR project, which has been viewed by over 10,000 people to date in various seminars, schools, nursing homes, and businesses across the country, Silver Wood has lately been expanding its VR projects to tackle other social prejudices.

Oculus Rift and headphones VR setup

Using VR to better understand the real world

At the Tokyo Gay Pride Parade over Golden Week this year, the company unveiled its latest project: LGBT VR. In this simulation, the viewer assumes the role of the central heroine, Suzu, who’s 28-years-old and a closeted lesbian. You follow Suzu in her daily life, her life at work, and her encounter with Saki, a 30-year-old lesbian who’s already out.

Though not necessarily on a level with the national dementia crisis, Silver Wood believes the attitude in Japan towards its LGBT community is another sore point that needs to be addressed, another case where, like the circa-2005 nursing homes, public attitude is woefully and harmfully out of touch.

“Compared to America, Japan is probably 30 years behind [in its attitude towards LGBT people],” Kuroda reflects. “There’s more openness in America, but there’s still a lot of prejudice here.”

Some other projects include Foreign Company Worker VR, wherein Japanese employees can experience the everyday challenges lived by their foreigner colleagues, and Working Mother VR.

In each project, Silver Wood confronts a prejudice and tries to reshape it by allowing you to experience it. Their goal in all this is to lessen our social divides and broaden our close-mindedness. The key, they believe, to unlocking this social change is the empathetic power of VR.


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