Burning Man [Graphic Military Injury Content]
I was deeply moved both by the descriptions of Sam Brown’s pain, and the cleverness of the proposed pain treatment. There are some very graphic passages in this article from GQ—I’m excerpting a bit of the description of Hoffman’s work below, but feel free to read the entire piece.
Hunter Hoffman hadn’t set out to help burn patients. As a cognitive psychologist—who had gotten his start back in the ‘80s conducting experiments at Princeton to test the mind’s ability to discern between real and false memories—he had begun experimenting with virtual reality as a treatment for arachnophobes. Using a VR game he’d designed called SpiderWorld (see box), he had helped a number of individuals so crippled by fear that they had to seal up their windows to sleep. Outfitted with virtual-reality goggles, the patient began at the far end of a virtual kitchen, opposite the counter, upon which was a small, barely visible spider. Once the fight-or-flight response had subsided, the patient could inch closer until he could stand being close enough to see the spider’s reflection in the toaster’s chrome finish. Hoffman had created a world that people could enter, reemerging with their nightmares erased. It was an artificial world with the power to transform meaning itself in the so-often-insufferable sphere known as the real.
One day in 1994, a colleague of Hoffman’s told him he’d been observing patients at a burn center using hypnosis to control pain. His colleague wasn’t exactly sure how the treatment worked, but he thought it had something to do with distraction.
“Distraction?” Hoffman said. “I’ll show you distraction,” and he showed his friend SpiderWorld.
Not long after, Hoffman went to meet the hypnotist himself, who agreed VR sounded like a pretty good idea. On the very first
burn patient they tried, SpiderWorld worked. He simply forgot to think about his pain. Still, stoves and toasters didn’t seem right, considering—kind of cruel, really. So Hoffman hired a world builder to make something else, something colder, fireproof.
Later, after Hoffman became director of the Virtual Reality Analgesia Research Center at the University of Washington Human Interface Technology Laboratory, or HITLab, he had some remarkable success. Using $35,000 goggles—the sort of hardware ordinarily used for training fighter pilots—researchers obtained drops in pain ratings by 30 to 50 percent.
If distraction was the key, why not just use over-the-counter video games for a fraction of the cost? To answer that question, Hoffman had run a control experiment. In his first case study, he had a teenager with a severe flash burn play Nintendo Mario Kart while having five staples removed from a skin graft. The data showed that in terms of reducing pain, anxiety about pain, and time spent thinking about pain, playing Nintendo Mario Kart compared poorly to SpiderWorld. The reason VR was so much more effective than a regular video game came down to a quality called “presence”—that sense of being immersed inside an artificial world.
In 2006, Hoffman presented his findings at a DoD conference on combat-casualty care. The most prominent image Hoffman had played on the screen had been a giant digital snowman, somewhat menacing in mien. Yet it was hard for all the high brass in the room to ignore the two 3-D brain scans comparing activity in the region of the mind known as the pain matrix. In the scan of a patient who had received only conventional opioids during wound care, the matrix was lit up like a cortical pool of lava. The other brain—the brain on VR—was a cooling star. “According to our results,” Hoffman said, “VR not only reduces pain perception; it changes the way the brain processes pain signals.” A day or so after the conference, he got a call from Colonel John Holcomb, commander of the army’s Institute of Surgical Research, or ISR, at Brooke Army Medical Center in San Antonio.
ISR was a unit born during World War II, in part out of the need to find better ways to treat thermal injuries, in anticipation of the waves of atomic-burn casualties that many reasonable, if gloomy, individuals regarded as inevitable. Ironically, sixty years later, those new techniques were being used more than ever, in response not to the most sophisticated weapons on earth but to the most crudely effective. An approximate 70 percent of injuries and deaths of U.S. troops this decade have involved an IED.
“Hoffman, we need VR,” Colonel Holcomb said when he called. “Make it happen. Get it over here.”
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