Un [REAL] Engine - Thesis Design I Exploration by Aya Meskawi

Un [REAL] Engine

American University of Beirut Thesis Design I Aya Meskawi Thesis Advisor Raafat Majzoub

Foremost, I would like to express my sincerest gratitude to my thesis advisor Raafat Majzoub for believing in this project and for the continuous support, patience and motivation. I would also like to thank my mom, Asma Meskawi, and Noura Saboune for bearing with me and helping me brainstorm ideas for a field outside their own. Special thanks to Jana Semaan, Riad Tabbara, Leah Rassie and Hala Al Taher for the virtual meeting sessions and their continuous support in my project along the way.

...this project is dedicated to my guardian angel...

Table of Contents

1.0

2.0

Introduction 1.1

The Design Focus

1.2

Effect of the Hospital Setting on the Mental health of Critically ill Patients and their Survival Rate

1.3

The Concept of Healing Architecture

1.4

Virtual Consciousness and the Existing Technologies

Case Studies 2.1

2.2 3.0

4.0

Episode San Junipero in the Series Black Mirror 2.1.1

Analyzed Storyboard of San Junipero

2.1.2

Logic of the Space Narrative of San Junipero

2.1.3

Attractor Points of San Junipero

2.1.4

Translations of the Attractor Points

Virtual Reality Experience: Forest of Serenity

Un [REAL] Engine‘s Narrative 3.1

Un [REAL] Engine’ Engine’s Hospital Form

3.2

Virtual Journey During Anesthesia

Gamification in Healthcare 4.1

Case Study: Gamified Virtual Reality Exposure Therapy for Arachnophobia

4.2

Sims and Second Life 4.2.1

Sims and the Mental Health

4.2.2 Second Life and the Mental Health 4.3 5.0

Second Life‘s Design Space Narrative

Un [REAL] Engine‘s Design Space Narrative 5.1

Diagrammatic Space Narrative

5.2

Notion of Death of Distance in Architecture and Time-Dependent Space 5.2.1

Treadmill Journey as a Grid System Reference Unit for Un [REAl] Engine

5.3

Conditions and the Various Scenarios for Un [REAL] Engine Space Narrative

5.4

Architecture as Interface 5.4.1

Travel Engine as Architecture and Computation

5.4.2 Event Engine as Architecture and Computation 5.4.3 Therapy Engine as Architecture and Computation 6.0

Thesis II Exploration

7.0

References

Un [REAL] Engine explores the possibilities of virtual journeys in enhancing the chances of healing for critically ill patients. It spatializes science fiction scenarios, existing technologies, and gamification tools to speculate digital architectures to be integrated in the health-care design of the future. My thesis questions the role of an architect beyond the ordinary field; what architecture can enhance while other fields can not.

Introduction

The Design Focus

My design narrative will focus on a critically ill patient, a patient that is in a severe condition in the intensive care unit (ICU) of the hospital such that, the patient cannot move or breathe properly without the help of a ventilator. The patient is locked up in the tiny room with machines and systems connected to most parts of the body such that the ICU restricts visitors to enter which leads to a lack of moral support given to him/her. The hospital, with no doubt, is doing the best it could to treat the patient physically, but not taking into consideration the mental health. The mental health that can get worse from several factors starting with the illness and the physical state at the hospital, and with the treatment of the patient as a unit rather than as a human being without giving the full transparency of the patientâ&#x20AC;&#x2DC;s wellbeing and illness treating the patient as a spectator only in the overall process. My thesis sheds light on the importance of the mental health of the patient during recovery and explores different fields to treat the patient along the physical treatment of the hospital.

Effect of the Hospital Setting on the Mental health of Critically ill Patients and their Survival Rate

Being in a hospital can impact the patientâ&#x20AC;&#x2122;s mood and mental health state. Some mind and mood problems that can be identified during a patientâ&#x20AC;&#x2122;s hospital stay may be short-term health issues, which are the result of the patients stay in hospital, while others may be long-term problems that affect the stay and the recovery. Three common problems that are identified are delirium, dementia, and depression (Department of Health & Human Services, 2015 2015). ). Such that depression alone affects one-third of the hospital patients and especially the critically-ill patients (Ishak, Collison & Davonitch, 2017 2017). ).

Critically ill patient that developed depression.

Critically ill patients are characterized by either having severe respiratory, cardiovascular, or neurological derangement, often in combination, reflected in abnormal physiological observations (Ostermann & Sprigings, 2017 2017). ).

Cardiovascular Derangements

Respiratory Derangements

Neurological Derangements

Unlike terminally ill patients, critically ill is a medical term that refers to a patient who has an illness or a disease that can be cured, but the patient is in a critical position. The doctor typically assigns range of days, months, or years to forecast the life expectancy of someone who has a terminal illness, but in the case of a critically ill patient, the life expectancy and the recovery of that patient is a day by day procedure. In other words, chances are that things can go either way very quickly. These patients require a specialized care and are best treated in an ICU staffed by experienced personnel (Sharp & Corp, 2020 2020). ).

not cured

terminally-ill patient

critically-ill patient

not cured

cured

Moreover, the mortality rate of critically ill patients is approximately 25 25% %. It is associated with age, severity of illness, and comorbidities (Wewalka, 2015 2015). ). Critically ill patients may experience psychological distress that would increase their mortality rate. Such that findings show that the overall 5 year mortality rate could reach 3.4 times higher among patients discharged from the ICU with depression compared with others (Liao & Ho, 2020 2020). ).

75%

40%

Average urvival rate of a critically ill patient

Average survival rate of a critically ill patient with depression.

That is why it is important to look at the mental health of the patient and prevent the risk of the patient developing any kind of a mental health problem such as delirium, dementia, and depression. After understanding that the hospital setting affects the mental health of a critically ill patient and that the mental health state affects the recovery and the survival rate of the patient, I looked into the hospital architecture and its effect on the mental health of the patient which led me to the concept of healing architecture.

The Concept of Healing Architecture

Recent attention in health care has been on the actual architectural design of a hospital facility to prevent the risk of a patient developing a mental health problem. Several studies have showed that the layout and the architecture of a health center can improve the lives of patients by impacting patients’ mood. The new term “healing architecture” indicates that the built environment can impact patient’s health and psychological well-being. The parameters are brighter and larger rooms, access to natural daylight, big openings, and a local plant life (Lawson & Téllez, 2019 2019). ).

Even though healing architecture was shown to affect the patients mood, the percent increase of the recovery rate of the patients according to several case studies shown is negligible. Moreover, studies show that a patient’s mental health declines just by being physically situated inside the hospital, or the idea that the patient is being hospitalized. So, the concept of healing architecture is insufficient to prevent a patient from developing any mental health problem. So here comes my architectural exploration in the healthcare and that is to explore how a virtual consciousness journey for the mind to experience would be effective to prevent the risk of the patient of getting any mental health problem.

Virtual Consciousness and the Existing Technologies

Virtual Consciousness is a term that refers to the transfer of the mind from the physical space of the biological body to a computer, an engine, or a virtual world (Moravec, 1998 1998). ). Although virtual consciousness is not occurring in the real world, it is anticipated to happen in the near future due to the advanced brain computer interface technologies such as Neuralink, Meltin MMI, and Neurable (Dawson, 2020 2020). ). Neuralink, a neurotechnology company, developed the first implantable brain-machine device that interfaces with the brain. It allows people to control computers with the Neuralink app through the activity of the brain. Whereas Meltin MMI is a developing cyborg technology that connects human bodies and brains with machines. Neurable is a high-tech wearable device that can interpret human intent and measure emotions. (Dawson, 2020 2020))

Neuralink

Meltin MMI

Neurable

All these advanced brain computer interface technologies can be used to create virtual consciousness in an alternate reality universe when combined. If Neuralinkâ&#x20AC;&#x2122;s implant was reversed such that the computer controls the brain, the mind could be present in a simulated space thus creating simulated consciousness. Meltin MMI can be evolved to connect the human brain to the simulated human self rather than a machine. Moreover, Neurable can be used as is with no adjustments to decode the information of the brain while in the alternate reality world to interpret human emotions to ensure that the human is in a safe cognitive state.

Controls the brain.

Connects the brain to the virtual self.

Decode information from the brain.

Case Studies

Therapy

San Junipero : Episode 4, Season 3 of the Series Black Mirror

Black Mirror is a British dystopian science fiction television series that examines modern society, particularly about the unanticipated consequences of new technologies. Episodes are usually set in an alternative present or the near future. San Junipero is the fourth episode in the third season of the series Black Mirror ( IMDb, 2011 2011). ). The Storyboard of San Junipero in summary, is about two terminally ill patients that are physically situated one at the hospital setting and one at an elderly care center, such that both are connected to a neuro-tech chip that is connected to a virtually reality machine system that generates the universe known as San Junipero. It is a place where the patient’s mind can visit or be plugged into even after death such that the patient is featured at the age of their choice.

Patients Connected to a BCI Technology

Hospital Setting and Elderly Care Center

Virtually Reality Machine System

Patient’’s Patient Simulated Self

San Junipero

The main extracted characteristics of San Junipero’s Storyboard are:

BCI Technology

Physical Space

Interconnectivity

Simualted Space

User Preferance

1987

The Logic of the Space Narrative of San Junipero is dependent on the elements shown on the collage and are explained below. These elements push the idea that the space narrative is directed towards a user-based approach and is therapeutic.

The Concept of the space. It is similar to the concept of heaven, since it is a space where one might go to after death. It is also a space where no one can be harmed physically; A space of no judgements or discriminations of all kind. For example, Kelly stated several times to Yorkie in the episode that no one cares how you dance or behave. It is a space that softens the idea of death, as if it doesn’t exist even by using the phrase “pass over” to someone that is dying in the real world without saying the word “die”.

The Title San Junipero. It is based on the fransciscan frian, San Junipero Serra that made his march from Bajo California (San Diego) to Alto California (San Francisco) in the 1760 1760’’s, forcibly collecting souls of Native Americans through baptism as he went along. He did so through tortuous methods that occasionally resulted in death but was comfortable in the belief that those he “saved” would ascend to heaven. (Britannica, 2020 2020)) The Year 1987 featured in the episode. This year was chosen because one of the terminally ill patients yorkie could not experience her young adult years because of a car accident. So, this year was chosen for her to relive her young lost years, and to experience it in her own way freely.

The Filmed Location Cape Town, South Africa. It is known to have one of the best beaches and weather in the world such that it was ranked several times as the top 10 travel destination (Tripadvisor, 2020 2020). ).

The Theme Song heaven is a place on earth.

Materiality- Light - Sound

Activity-AccessibilityOpenness Activity-AccessibilityOpenness

The Attractor Points of San Junipero are design parameters that where used in creating and directing the patient within the space of San Junipero such as the materiality, light, sound, activity, accessibility and openness. In the above diagram, you see a diagrammatic landscape section of San Junipero, featuring to the left the attractor point in the space that directs the users towards it. This space was the main space of the episode, known as tuckers, as seen in the image above.

Materiality

Light

Activity

Accessibility

Openness

Translation

Fluidity vs Rigidity

Light vs Heavy

Enclosure

Signifiers

Edges + Boundaries

Scale

Circulation and Flow

The Translations of the Attractor Points of San Junipero are parameters that their variation within the spaces can be used as attractor points to design my virtual journey of Un [REAL] Engine. In this case, I extracted the translations to be used later in a reverse engineering method. So I translated [Materiality] into [Fluidity vs Rigidity] and into [Light vs Heavy]. [Light] was translated into [Enclosure]. [Activity] was translated into [Signifiers]. [Openness] was translated into [Scale] and [Circulation and Flow] that will be used later on.

Virtual Reality Experience: Forest of Serenity

Forest of Serenity is a virtual reality app designed by Dr. Sheila Popert of St. Giles hospice to improve the quality of life for terminally ill people reliant on powerful painkillers using a virtual reality headset known as Oculus Go. It offers an alternative to painkilling drugs like morphine and oxycodone by helping them selfmanage pain, and to distract the patients from chronic physical, psychological, and emotional pain in the final stages of their lives. (Holosphere UK, 2017 2017)) The virtual app displays a natural forest where the terminally ill patient can experience when the patient is in pain. From this case study and San Junipero, I analyzed that my approach of the space inside Un [REAL] Engine should be therapeutic. So my first extracted element to be used later is therapy.

Un [REAL] EngineÂ´s Narrative

Companionship

Un [REAL] EngineÂ´s Hospital Form

Un [REAL] Engine Qualification Form Date

Name

Medical Condition Duration

Surgical Procedure

Are you aware of Un [REAL] Engine

Yes

If yes, have you ever visited before

Yes

Are you comfortable around people ?

Yes

Do you like to travel?

Yes

Do you want to be more aware of your illness?

Yes

Do you usually see therapy?

Yes

Are you diagnosed by having any disorders?

Yes

Are you willing to try Un [REAL] Engine

Yes

If yes, is there any peron you would like to see

Yes

If yes, state your ultimate dream vacation

If yes, state your diagnosis Do you have any phobias If yes, state your phobia

If the patient is qualified:

If yes, state name and contact infomation Name

Contact Number

I have decided to add to my own narrative an Un [REAL] Engine Hospital Form to be filled out at the end of the Hospital Entry Patient Form Sheet. This sheet will see if the patient is qualified to enter Un [REAL] Engine and if the patient is qualified, the sheet would have several questions to better understand the preferences of the patient in a simulated space and if the patient would want for a specific person to accompany him/her in the virtual journey. I decided on this form through analyzing the case study San Junipero where the approach of the space as mentioned at page 20 is user based. Moreover, I also added the element of companionship if the patient would prefer to have company.

Virtual Journey During General Anesthesia

In order not to disassociate mind from body and not to create body malfunction from overuse, the virtual experience will be a virtual architectural journey. The patients experience will start with the hospital setting then towards a simulated space then back again towards the hospital setting.

The most critical phase for the patient to develop depression is after surgery (Ghoneim & Oâ&#x20AC;&#x2122; Oâ&#x20AC;&#x2122;Hara, 2016 2016). ). In order to reduce the risk of a patient of developing a mental health problem to later avoid a decrease in the survival rate of the patient is by controlling the phase during surgery. So, my virtual journey can train and convince the patient that they have governance over their body and their experience. And if they were given governance in the virtual journey, they would be able to apply it to the real world. Therefore, the journey would occur by extending the general anesthesia phase into a therapeutic user based spatial perspective, where the journey would be dependent on the dose of the general anesthetics and the time generated by the dose.

45 min

60 min

90 min

Un [REAL] Engine Qualification Form Date

Name

Medical Condition Duration

Surgical Procedure

Are you aware of Un [REAL] Engine

Yes

If yes, have you ever visited before

Yes

Are you comfortable around people ?

Yes

Do you like to travel?

Yes

Do you want to be more aware of your illness?

Yes

Do you usually see therapy?

Yes

Are you diagnosed by having any disorders?

Yes

Are you willing to try Un [REAL] Engine

Yes

If yes, is there any peron you would like to see

Yes

If yes, state your ultimate dream vacation

If yes, state your diagnosis Do you have any phobias If yes, state your phobia

If the patient is qualified:

If yes, state name and contact infomation Name

Contact Number

Un [REAL] Engine’s storyline will start with a critically ill patient, a patient that cannot move or breathe properly. The patient will fill Un [REAL] Engine’s Hospital Form for the simulated space to be based on the patient’s preference such that the patients experience will start during anesthesita.

The patient will be connected to a Brain-Computer Interface (BCI) technology during surgery, such that a friend or a family member can join as well. The patients experience will start with a hospital setting then towards a simulated space then back again towards a hospital setting.

Gamification in Healthcare

Transparency

Gamified Virtual Reality Exposure Therapy

During hospital days, patients feel out of control especially when they feel they do not have an active part or a partial responsibility in their healing process or even when then feel they have little knowledge or little transparency to the overall procedure (The Medical Futurist, 2018 2018). ). The patients are treated as only spectators in their healthcare process. For my design, I found out that having a more active role in these virtual environments and having more knowledge or transparency to the recovery process and the illness have proven to relieve stress, anxiety, and depression. To achieve that, I decided to study gamification tools that gives the person an active role. Gamification is the process of putting game elements such as points and achievement levels into non-game contexts setting such as in healthcare for it to be a driving behavior change (The Medical Futurist, 2018). 2018 ).

The above image is an example of a gamified virtual reality exposure therapy used to treat spider phobias where it helped patients overcome their fears. The intervention starts with a psychoeducational introduction through a voiceover virtual therapist that conveys a cognitive behavioral conceptualization of spider phobia and provides a treatment rationale for exposure therapy (Lindner & Rozental, 2020 2020). ). The virtuality reality showcases spider movement animations that are designed to be realistic and dynamic to manage anxiety through exposure. Participants were able to describe a number of benefits from undergoing the treatment, ranging from being less anxious, worried, and attentive to their fears to continuing applying the lessons they had learned such as using exposure and to approach spiders in everyday life (Lindner & Rozental, 2020 2020). ). From this case study, I extracted the element of transparency towards the illness and the recovery process to be used in Un [REAL] Engine. Moreover, Un [REAL] Engine will have certain mechanisms that will ensure that the patient has an active role in the overall process. These mechanisms are discussed at page 35 35..

Sims and Second Life

After looking into gamified virtual reality exposure therapy , I looked into the video games “Sims” and “Second Life”. They are both life simulation video games where the player can create virtual people that can interact with others. The player can also build houses, go to work, travel and create a family. So, the goals and tasks inside of them are simply daily life activities. And the fact that the space logic of the games is to perform daily activities is what made me look into it. Players are drawn to the game because they have difficulty in getting certain needs met in their real life, so they turned to the virtual world. This made me realize that patients that cannot move or breathe properly and sit all day at their hospital bed would want to have a sense of control of their lives by the simplest possible way and that is to move around, socialize, go to events, and more that they cannot perform at the moment. So Un [REAL] Engine will try to fulfill it in a therapeutic way.

Sims and the Mental Health. Several case studies showed that living like a sim improved the person’s mental health because one key aspect of the games is that the characters have similar emotions to humans which are timed emotions that change and fluctuate normally (HelloGiggles, 2020 2020). ). So, when playing sims, there is a tiny emotions bar that is green when the the sim is happy and red when the sim is angry. When a player notices the emotion bar turned red, the player unconsciously would do anything to make the sim happy either letting the sim sleep or eat etc... knowing that the red emotion bar will turn into green [bad moments will eventually fade away]. The logic in sims is that the good, the bad and the ugly will all fade away, and though they might change the way your Sim approaches daily tasks while they’re active, they eventually just disappear, and as the game continues you forget they were ever there. If this logic was applied to our real life, it will make humans appreciate the good and make the most out of it, plus understand that there will be bad days and that will end. Another key aspect of the game is that the sims have one task at a time which is not like the daily normal life (Jackson, 2019 2019). ). This approach makes the person appreciate the little things and creates a balance in one’ one’s life if applied to reality.

One Task at a Time

Timed Emotions Logic

Second Life and the Mental Health. Second Life have been used as a safe place for real psychologists to meet with their patients. Therapists use second life as a training before therapy or during, creating a similar clinic inside second life and trainings in real life because clients felt more secure in the virtual space (DeAngelis, 2012 2012). ). Clients with social anxiety disorder who adopted avatars, virtual people in second life, and were treated in Second Life using evidence-based cognitive behavioral therapy showed as much improvement as clients they saw face-to-face . Additionally, the virtual ability community in Second Life acts like a real life, it hosts an annual Mental Health Symposium where one can meet experts that one might have never been able to in the real world and also it is used as a system to spread awareness faster and to reach more people (Pey, 2017 2017)) . Such that it offers free resources on mental health, relationships, and wellness (Pey, 2017 2017). ).

How Second life has been used as a virtual meeting space for psychologists emphasized the notion of the death of distance that will be used in Un [REAL] Engine as discussed at page 40 40..

Virtual Clinic in Second Life

Mental Health Symposium

Second LifeÂ´s Design Space Narrative

The spatial narrative of second life starts with a learning space the is directed towards a main space, where players can socialize and chat. They can also be teleported to a place of their choice through a search engine and build in that space freely. This interface of second life inspired me for the structure of Un [REAL] Engine.

Learning Space

Main Space

User Based Design Landscapes

Teleport Search Engine

Learning Space Space where the player learns all the navigation systems and commands in the game.

Main Space Space where the players can meet, socialize and chat.

Teleport Search Engine Non-spatial search engine where the players can be teleported to a destination of their choice.

User Based Design Landscape Destination where the player can go to and design in that space freely.

Un [REAL] Engine SpaceÂ´s Design Narrative

Companionship

Therapy

Transparency

Diagrammatic Space Narrative

Hospital Setting

Learning Space

Main Space

Therapy Engine

Travel Engine

Healing Landscape Possibilities

Health Consultation Possibilities Events Engine

Health Lecture Possibilities

Inspired by the interface of Second Life, the virtual journey of Un [REAL] Engine will start with the hospital setting then towards the learning space where the patient gets a general understanding of the whole journey through a voice over virtual therapist such as in the case study of gamified VRET for spider phobia, later the main space where the patient can socialize and meet other patients and this main space is a connector space to all the other spaces. It connects to the Travel Engine that inspired from the teleport search engine in Second Life, that directs patients to numerous healing landscape possibilities. It connects to the Therapy Engine that hosts several health consultation possibilities and to the Events Engine that hosts several health lecture possibilities. 35

Hospital Setting Learning Space Main Space Companionship

Travel Engine Healing Landscape Events Engine Therapy Engine

Therapy

Transparency

So, Un [REAL] Engine was inspired by Second Lifeâ&#x20AC;&#x2122;s spatial sequence but deferred through the several engines and the programs of being therapeutic and giving transparency to the illness and recovery process based on the previous case studies. So, each space is dependent on the elements of transparency, therapy and companionship as seen in the spatial diagram. Light Activity Accessibility Materiality Openness

The parameters will change through time based on the spaces. So, I constructed a model based on these parameters to test the possibility of each space where the variation and intensity of the parameters is based on the functionality of each space as will be seen in the next page. 36