Eugenie Lee's Seeing is Believing: VR in pain management

 

Eugenie Lee explaining her artwork, Seeing is Believing, 2018. Photo: Daniel Lawrance. © MOD. 2018
Eugenie Lee explaining her artwork, Seeing is Believing, 2018. Photo: Daniel Lawrance. © MOD. 2018

According to artist Eugenie Lee, “VR is the ultimate empathetic tool.” Eugenie Lee’s Seeing is Believing (2016–18) is an ambitious work that has undergone significant development since it was first exhibited in The Patient curated by Bec Dean for the UNSW Galleries in 2016. In its most recent iteration at MOD., the outcome of a residency at the University of South Australia, the work has enlarged its script and process of engaging with participants in a 1:1 performance contributing to the analysis and experience of pain.

Having experienced Lee's work twice (once in 2016 and again in 2018), I have been witness to this expansion of her working processes and applied research. The progression of Lee’s artwork took place over three distinct stages, from 2014 until 2016. In 2014, she received an “Amplify your art” professional development grant from Accessible Arts. With this support, she began her residency at Body in Mind (BiM) at the University of South Australia, a research group conducting behavioural research in humans to developing better treatments and preventative strategies for people who suffer from chronic pain. She studied with researchers Lorimer Moseley, Tasha Stanton and Valeria Bellan to learn about the neuroscience of pain.

An Australian Network for Art Synapse (ANAT) residency allowed Lee to continue with BiM during 2015. She describes this year as instrumental for bringing her project to fruition and embracing an interdisciplinary practice. The final stage was the involvement of Bec Dean and her support in turning Lee’s work into an inaugural performance in 2016.

Prior to her residency, Lee had never thought of using VR in her art practice. The exposure to the applications of VR in research at BiM gave Lee the idea of flipping her treatment strategy. Instead of using VR to relieve patients, Lee would use VR to give the experience of pain to others, as a way of sharing her personal experience. Describing VR as “the ultimate empathetic tool,” Lee sees VR as simply another instrument in the hands of an artist.

Eugenie Lee, Seeing is Believing, 2018. Virtual view of participant’s hand undergoing deformations, Photo: Daniel Lawrance. © MOD. 2018
Eugenie Lee, Seeing is Believing, 2018. Virtual view of participant’s hand undergoing deformations, Photo: Daniel Lawrance. © MOD. 2018
The VR experience, from Eugenie Lee, Seeing is Believing, 2018. Virtual view of participant’s hand undergoing deformations, Photo: Daniel Lawrance. © MOD. 2018
The VR experience, from Eugenie Lee, Seeing is Believing, 2018. Virtual view of participant’s hand undergoing deformations, Photo: Daniel Lawrance. © MOD. 2018

Through the 1:1 performance as an interactive experience, in Seeing is Believing Lee takes on the role of a clinician in consultation with the patient. The twist is that her bedside manner aims not to assuage fears and anxieties, but rather to fuel and flame them. None of this is done with malicious intent. Lee herself suffers from endometriosis and is committed to communicating the complexities of the experience of chronic pain to others. Lee’s performance is about what the participant brings to the encounter.

A 2018 national survey for sufferers of chronic pain found that in response to the question “What do you wish the public would understand about living with chronic pain?”, among the top answers was “My pain is real … I’m not making it up”. Nine out of ten respondents felt that they faced stigma or negative attitudes because of their chronic pain, Lee’s work supports helping those who don’t have chronic pain empathise with those who do.

When Lee began performing in 2016, her work was strongly influenced by the BiM research group who had concerns about the ethics around privacy and the public communication of the research through art. As the first artist to work with the group, Lee was herself something of a test case and acknowledged the creative constraints at times made her feel that her role as an artist was dispensable and that anyone in her position could read the script. It also became apparent that psychological and emotional preconceptions affect performance outcomes.

When she performed at UNSW in 2016, her work was viewed as an entertainment experience. But the gallery was also a safe space for participants, and as a result, very few people experienced real discomfort or trauma. In the same year, Lee performed at the Australian Pain Conference in Adelaide and was met with a dramatically different reaction by conference attendees, including clinicians, health professionals and researchers, all of whom were there to discuss diseases, symptoms and treatments. When signing up for Lee’s exhibit, they were more likely to be carrying an expectation of simulated pain in some form or another. Notably, most participants did experience real pain.

By the time of her exhibition at MOD., earlier this year, Lee had reason to claim a degree of maturity through a deeper understanding of pain, both personally and scientifically, and had come a long way in being better able to manage and theorise the experience of pain, working both to navigate her own body and thoughts, and communicate these more nuanced expressions and exchanges with project participants.

Interactive “pain chairs” at MOD. As part of the Feeling Human gallery. Photo: Karl Meyer Photo: Daniel Lawrance. © Exhibition Studios, 2018
Interactive “pain chairs” at MOD. As part of the Feeling Human gallery. Photo: Karl Meyer Photo: Daniel Lawrance. © Exhibition Studios, 2018

Lee's work complements several other exhibits at MOD., also the result of collaborations with Moseley and Stanton from Body in Mind. In particular, a pair of interactive “pain chairs” which guide participants through a number of exercises applying BiM research around the influence of attention, distraction, context, and expectation that all impact on the perception of pain.

Seeing is Believing begins the moment the participant walks in the door. The entire performance is planned with attention to subtle behavioural and perceptual manipulations that accompanied the activities and observations helping to convey the conundrum surrounding definitions of chronic pain. For example, by using the word “persistent” during the orientation interview when referring to long‑term pain, rather than the more commonly used, but negatively connotated “chronic,” Lee immediately sets the stage for the role of perception in identifying what we mean by pain that is ongoing.

After the orientation interview to assess the participant and draw out their history with pain and current levels of anxiety, Lee guides visitors through several convincing body‑morphing illusions with the aid of a complex apparatus. Body transfer illusion, or “body ownership,” has been successfully used in the treatment of phantom limb pain (the common and often painful sensation that an amputated or missing limb is still attached).

Inside an invention by Vilayanur S. Ramachandran called the “mirror box,” amputees can see a reflection of their good hand where their residual hand should be. This visual feedback can result in almost immediate relief. The majority of body ownership research has shown that it is possible to incorporate physical objects (or their reflections) into the body representation, while the same methods can also work with entirely virtual objects. By tricking the brain into re‑evaluating the probabilities of what is real, it is possible to produce radical transformations in body ownership.

The main event of Lee’s exhibit involves the participant wearing VR goggles inside an anechoic chamber. Virtual reality illusions are created by exploiting the neurological mechanisms of everyday perception of the body. The combination of incoming signals from the external world is modulated by cognitive processes comparing internal representations of the world, and actual desired and predicted states of the external world. When multiple sensory modalities provide congruent data, the brain is more likely to believe the experience.

A participant watching a body-morphing illusion in 1:1 Session with the artist Eugenie Lee Mirage Machine. Photo: Daniel Lawrance. © MOD. 2018
A participant watching a body-morphing illusion in 1:1 Session with the artist Eugenie Lee Mirage Machine. Photo: Daniel Lawrance. © MOD. 2018

As such, the most compelling VR experiences allow the brain and body to interact in synchrony with the simulated environment. To achieve this congruence in Seeing is Believing, Lee mounts a camera on the front of the VR goggles to provide real‑time feedback on the contents of the visual field. When a participant wiggles their fingers, makes a fist or turns their real hand over, their virtual hand behaves concurrently in the same manner. Additionally, uncomfortable stimuli are applied to the participant’s hand at the same time as their virtual hand undergoes deforming alterations.

Throughout the performance, Lee works the perceptual and emotional levers of her participant, drawing on the neuroscience research she was exposed to during her residency at BiM. For example, during one of the experiences, Lee asks the visitor to tell her about their colour red. This question has a twofold agenda. Firstly, it surreptitiously probes the visitor’s mental state. Should they answer that they associate red with danger, threats, or warning, Lee knows the visitor is primed and will likely experience discomfort, if not pain, during the VR experience. If the association of red is with a favourite lipstick or a sunset, she knows she still has work to do.

Research done by Lorimer Moseley and Arnoud Arntz in 2007, revealed that an extremely cold stimulus (–20°C) applied in the presence of a red visual cue was rated as hot and more unpleasant than the same stimulus associated with a blue visual cue. Given that meaning affects the experience an unpleasant stimulus evokes, dwelling on the colour red reinforces in the visitor an unconscious association with danger and tissue‑damage and sets up the visitor for a more intense experience.

The final stage of the guided experience through this installation is a one‑on‑one decompression with the artist. It is here that participants are prompted to communicate their experience back to Lee. In a post‑event survey, respondents reported that Seeing is Believing was a “fascinating and visceral experience” and that it had “changed my life (for the better).” Many participants also observed that the opportunity helped to communicate complex technical terms to those without advanced training or clinical experience.

The research and understanding of pain have developed significantly, even over the last two years. Where clinicians used to talk about the management of pain, they now talk with confidence about recovery. It is this same confidence that Lee carries with her as a performer, built through her knowledge of neuroscience, reflections on her own pain, and mastery over her performance.

Eugenie lee and a participant in the final stage of decompression (consultation), 2018. Photo: Daniel Lawrance. © MOD. 2018
Eugenie lee and a participant in the final stage of decompression (consultation), 2018. Photo: Daniel Lawrance. © MOD. 2018

 

Dylan DeLosAngeles is Exhibitions Coordinator responsible for the design and implementation of the exhibit on pain at MOD., a futuristic museum of discovery at the University of South Australia. Dylan completed his PhD in cognitive neuroscience in 2011 at Flinders University. Prior to MOD. he worked at Flinders Pain Management Unit investigating the effects of long‑term opioid use in sufferers of chronic pain.

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