Healing Minds with Virtual Reality

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<p>It’s the smell that most easily takes Tommy Furlong back to 2010, back to when he was a Marine Corps infantry officer living in a mud hut in Afghanistan—burning garbage, diesel fuel, residue from recently fired weapons. One whiff of the distinct cocktail and Furlong is mentally transported to a different time, a different place, all while sitting safely in an office in downtown Boston. Smell is just the beginning. Slipping on a virtual reality headset, Furlong can open his eyes and find himself in the passenger’s seat of a Humvee with a digitized driver and gunner standing beside him, steadily rolling past Afghan hills while a distant radio jabbers in the background. A pad beneath his feet rumbles to simulate the jostling of the vehicle. He also holds a fake gun, the approximate size and weight of the type he carried during his service.</p><p>“It brings back that muscle memory,” Furlong says. “You get right back into that mode. You put on the headphones and start hearing that radio chatter and it just comes right back to you.”</p>
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<img alt="Tommy Furlong" class="richtext-image full-width" src="https://www.pbs.org/wgbh/nova/media/images/tommy-furlong.width-990_5TNlIL2.jpg"/>
<figcaption>Tommy Furlong demonstrates a virtual reality experience based on the war in Afghanistan.
        
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<p>Furlong, who served abroad in 2010 and is now the director of outreach and peer support for the Red Sox Foundation and Massachusetts General Hospital <a href="http://www.homebaseprogram.org/">Home Base Program</a> , says that this virtual reality world looks, smells, and sounds very similar to where he lived in Afghanistan. Today, part of his work involves to demonstrate the program to those who want to learn more about it and to discuss how easily this virtual experience brings up rich memories of his service abroad. Reliving a piece of that service history is exactly what therapists here at the Home Base Program want. A clinical care and support services organization for service members, veterans, and their families, <a href="http://www.homebaseprogram.org/general-information.aspx">Home Base</a> is one of a handful of facilities across the country that uses virtual reality as a tool for treating post-traumatic stress disorder.</p>
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<p>“Folks are able to get more details out more quickly with virtual reality.”</p>
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<p>Designed to recreate some of the combat conditions under which trauma began, the Virtual Iraq and Virtual Afghanistan modules that Home Base uses were created to augment traditional talk therapy says Peg Harvey, a psychologist and director of the Intensive Program for Home Base. “It seems that folks are able to get more details out more quickly” with virtual reality, Harvey says. It can take more sessions with talk therapy alone.</p><p>Currently, many combat veterans are treated with prolonged exposure therapy, which requires them to recount their traumas with guidance from a therapist. Typically, prolonged exposure therapy starts off slowly with patients describing the scene, then gradually builds as patients add in more details about the trauma. Reliving their trauma in a safe, clinical setting can help patients process their emotions and “develop a less fear-inducing, more balanced response to the memory,” Harvey says.</p>
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<img alt="The smell set up" class="richtext-image full-width" src="https://www.pbs.org/wgbh/nova/media/images/the-smell-set-up.width-990_uOohBp8.jpg"/>
<figcaption>Jars contain the various compounds that recreate the scents that add to a scene's realism.
        
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<p>But prolonged exposure therapy works best when patients can emotionally and cognitively connect with the memory, which is sometimes a tough challenge. Virtual reality exposure therapy supplements memories by providing visual, auditory, tactile, and olfactory cues that can be customized to a patient’s experiences. As combat vets talk through their trauma while immersed in Virtual Iraq or Virtual Afghanistan, therapists can add in pixelated people, scenery or improvised explosions to make the experience match the patient’s memories as closely as possible. Those extra cues can sometimes help patients who have either plateaued or don’t respond to traditional therapies.</p><p>“Generally, [virtual reality] can be used as a tool to help folks that are either having difficulty remembering events or difficulty emotionally engaging in the memory,” Harvey says, adding that about eight patients have used VR exposure therapy since Home Base added it a year and a half ago. “I feel like treatment goes a little more quickly [with virtual reality], and that’s what the research has shown.”</p><p>Post-traumatic stress disorder isn’t the only mental health condition that’s getting a boost from virtual environments. As the cost of VR comes down, researchers are increasingly looking to the technology to help study and treat everything from phobias to addictions to <a href="http://www.brainhealth.utdallas.edu/pdfs/Virtual%252520Reality%252520Social%252520Cognition%252520Training%252520for%252520Young%252520Adults%252520with%252520High-Functioning%252520Autism.pdf">autism</a> . It’s also being used as a tool to help those on the other side understand what it’s like to live inside a brain that processes information differently. For example, Viscira, a company that creates interactive technologies for the life sciences industries, recently produced a <a href="http://www.viscira.com/cms/index.php/press-releases/122-viscira-named-one-of-the-top-100-fastest-growing-private-companies-in-bay-area-5">virtual reality experience designed to simulate schizophrenia</a> , complete with voices echoing inside the user’s head.</p><h2>New Avenues</h2><p>The brain reacts almost identically in VR as it does in real life scenarios says <a href="http://ict.usc.edu/profile/albert-skip-rizzo/">Skip Rizzo</a> , <a href="http://www.virtuallybetter.com/virtual-iraq/">creator of Virtual Iraq</a> and Virtual Afghanistan and director for medical virtual reality at the University of Southern California’s Institute for Creative Technologies. “If you model something in VR—and you do a halfway decent job with it—and somebody’s interacting in that space, pretty much similar areas of the brain light up,” Rizzo explains. “You can fool the brain. It doesn’t have to be an exact replica of reality for people to suspend belief and interact with the digital content as if it’s the real thing.”</p>
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<img alt="" class="richtext-image full-width" src="https://www.pbs.org/wgbh/nova/media/images/vr-therapy-humvee.width-990_iF5Hdbz.jpg"/>
<figcaption>A virtual reality scene inside a military Humvee
        
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<p>Because the brain is so eager to believe the sensory input it’s receiving, therapists don’t always need to show blood and gore in order to get patients sufficiently immersed enough to exhibit PTSD symptoms. Rizzo has recently built and is currently testing a VR scenario for survivors of sexual trauma, but those who use it will never actually see a simulated attack. “We’re building the places but only in so far as they lead up to a point where you feel that loss of control or you’re feeling trapped,” he says, which should elicit enough response for treatment. “It’s more Hitchcock than <i>Hurt Locker</i> .”</p><p>Virtual reality also allows scientists to create research contexts they may not be able to otherwise, for either practical or ethical reasons. Patrice Renaud, <a href="https://www.pinel.qc.ca/profile.aspx?navid=1757&amp;CultureCode=fr-CA">principal researcher</a> at Institut Philippe-Pinel de Montréal, a maximum security psychiatric facility in Canada, has studied sex offenders since 1994. Up until relatively recently, it was difficult to observe sex offenders as they were being aroused and thus figure out what triggers those urges. Since arousal often requires having images or videos of real people, showing those materials can be ethically problematic, especially if children are involved. Virtual avatars can’t be harmed in the same way that real people can, making them the perfect tool for studying arousal. Since using virtual reality, <a href="http://eds.b.ebscohost.com/eds/pdfviewer/pdfviewer?sid=8c785a60-56c0-489f-9b2e-5e2a4ba5114e%252540sessionmgr111&amp;vid=3&amp;hid=114">Renaud’s research</a> has uncovered motor and eye movement patterns in sex offenders that are different from those of ordinary people during arousal. He says that examining what’s happening in offenders physiologically, psychologically, and neurologically at the moment they’re triggered could help researchers understand more about offender recidivism and could lead to more effective treatments in the future.</p>
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<h2>The Limits</h2><p>Virtual reality therapies aren’t a panacea though. They simply don’t work for some patients for reasons that are unclear, though it’s also worth noting that they do work for a certain subset of patients who don’t respond to traditional therapy. Researchers also don’t know how long the effects of these therapies last. Though scientists have used virtual reality to do everything from improving speech patterns to reducing racial biases, there aren’t many longitudinal studies to show how well those changes fare in the real world.</p><p>Cost is a major obstacle as well, though not for long. A full VR set up that includes sight, sound, smell and touch cues currently costs around $30,000, reports Michael Jacobson, CEO of Virtually Better, Inc., the company that sells Virtual Iraq, Virtual Afghanistan, and produces about 50 other VR modules which address problems ranging from alcoholism to astraphobia, fear of storms. But the prohibitive costs of VR may radically change soon. With lower-cost technologies like the Oculus Rift gaming headset and Samsung’s Gear VR headset, which transforms specially-adapted smartphone apps into VR experiences, Jacobsen says that he believes his company will be able to deliver smartphone virtual reality apps that only have visual and audio cues for under $500 next month.</p>
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<figcaption>A VR simulation of an improvised explosive device, or IED, hitting a Humvee
        
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<p>Still, cheaper technology alone won’t completely eliminate the cost barriers of virtual reality. Building a specially tailored virtual world is costly, especially if it’s for a study or treatment that requires participants to be fully immersed. Patrick Bordnick, associate dean of research and <a href="http://www.uh.edu/socialwork/New_research/VRCRL/">director</a> of the University of Houston’s Virtual Reality Clinical Research Lab, recently spent $40,000 on two custom-designed virtual heroin dens, no hardware included. He’ll use both for a National Institute on Drug Abuse-funded study on extinguishing cravings in drug users.</p><p>Because the study is contingent on triggering actual cravings in drug users, Bordnick needed the world to feel real and to include as many accurate environmental and psychological details as possible. That meant doing serious field research on how addicts interact in triggering environments—Bornick’s virtual heroin house is accurate right down to the way addict avatars lean back in their chairs to “coast” after snorting or injecting—and investing in a highly detailed visual environment that can trick the mind into believing it’s real. In Bordnick’s previous research on using VR to reduce cravings from smokers and alcoholics, developers spent months creating virtual cigarette smoke that wafts just like the real thing and digital drinks that reflect light in the same way that actual drinks do.</p><p>“In virtual reality, we have to build all that but if you didn’t have those [cues] there, your mind would sense something is off,” Bordnick says. “If you did that with enough things in the environment, it’s going to seem fake.”</p><p>Lowering the cost of virtual technology may not change how much it costs to create a highly realistic VR world, but it will impact how VR therapy is done. JoAnn Difede, <a href="http://www.patss.com/">director</a> of the Program in Anxiety and Traumatic Stress Studies at Weill Cornell Medical College, has developed VR software and treatment for patients who showed signs of PTSD as a result of the 2001 World Trade Center terrorists attacks. Currently her team is working on portable VR software that patients can use at home on a smartphone or computer to practice the coping skills they’ve learned in therapy sessions.</p><p>“We’re not going to give people the entire virtual world. We don’t want them to be overwhelmed,” she says. Rather, they will be given limited experiences. Homework, for example, might include walking through peaceful, virtual scenarios of things that people with PTSD could find difficult, like going to the grocery store. “That would make an even gentler transition into confronting what you’re afraid of in the real world,” she says.</p><p>We won’t really understand how virtual reality-augmented therapies stack up to the treatments mental health professionals have traditionally used until there’s more data that measures results over the long term. Several studies have shown that VR therapy reduces symptoms of PTSD as far as six months after patients stop treatment, but there isn’t any research on how well patients fare several years later. Patrick Bordnick and Skip Rizzo both say that they’re encouraged by the few studies that do follow up with patients months after their VR exposure treatment has ended. “You see the results holding up,” Rizzo says.</p>
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<p>Immersive virtual-reality environments are helping psychologists treat everything from PTSD to autism.</p>

Recovering from Hate

<p>Science is revealing the stimuli that drive extremism—and how people can escape its grasp.</p>

Data gleaned from images available online can help determine where photos for escort ads were taken.

How Artificial Intelligence Can Stop Sex Trafficking

<p>For Matt Osborne, finding exploited children typically starts with a walk on the beach, and it ends with hands cuffed behind his back. It’s almost always the same—Osborne and a few friends travel somewhere that’s known for sex tourism and walk along the beach or hang in area nightclubs, not to look for girls but to be seen themselves. A group of white American men is easy to spot in heavily-touristed resort towns in Asia, Central America, and South America, so it doesn’t take long to make a connection.</p>
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<p>“They approach us,” Osborne says. “At first, everything is innocuous. Want to go jet ski or parasailing? Buy a margarita or beer? They offer us drugs, and the conversation always turns to girls. And if you let them talk long enough and say, ‘What else do you have? What else do you have?’ Then sooner or later, they always offer us young girls.”</p><p>“They offer us drugs, and the conversation always turns to girls.”</p><p>For Osborne, that’s where the real work begins. A former CIA analyst, Osborne is senior vice president for rescue and rehabilitation at Operation Underground Railroad (OUR), a California-based nonprofit that extracts children from sex trafficking rings across the globe. Working undercover with local law enforcement officials, Osborne’s team makes contact with a pimp and arranges to have kids, usually girls, brought to a party packed with male operatives posing as wealthy American buyers and middlemen while female operatives pose as their girlfriends. Traffickers and victims are searched for weapons upon arrival and “girlfriends” take the kids to a back room under the pretense of dressing them in lingerie for the party, though the costume change never actually happens. Meanwhile, a few male operatives finish the financial transaction, with Osborne’s team secretly recording the entire process.</p>
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<figcaption>Matt Osborne getting "arrested" during a sting operation in Latin America.
        
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<p>Once the right evidence is gathered, Osborne gives the signal, local cops rush in, and everyone, operatives and victims included, is handcuffed and taken away. After questioning, victims are released to their parents or family, if that’s a safe option. If it’s not, they go to pre-vetted shelters where they receive food, medical treatment, and psychological counseling, sometimes on OUR’s dime, while Osborne’s team quietly slips out of the country. Local authorities often take sole credit for the bust. Osborne’s team regroups to do it all again somewhere else.</p><p>“It is the most gut-wrenching thing to have to look into these girls’ eyes and have to pretend that I’m sizing them up,” Osborne says. “I see in their eyes, the eyes of my 14 year-old and my 11 year-old. We’ve rescued girls younger than that.”</p><h2>Tracking Down Traffickers</h2><p>Since OUR’s launch in late 2013, the nonprofit says it has assisted in rescue operations for 571 victims (180 of whom were minors) in 12 countries and assisted in arrests for 250 suspected traffickers. The organization only extracts when invited to do so by local governments and works with local prosecutors, law enforcement, and the U.S. embassy for months before an operation to carefully choreograph how a bust will go down and what evidence is required for conviction. Sometimes aiding a trafficking case means posing as buyers. Other times it means providing financial, technological, or training resources in cash-strapped countries where neither is accessible.</p>
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<img alt="" class="richtext-image full-width" src="https://www.pbs.org/wgbh/nova/media/images/our-op-photo-4.width-990_FawnRYG.jpg"/>
<figcaption>This still was taken from a video moments before police arrived to arrest the traffickers and rescue the victims.
        
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<p>“It’s very, very difficult a lot of times to gain convictions because each country’s trafficking laws are different,” Osborne says, though he adds that having a trafficking transaction captured in high-definition audio and video can significantly help prosecutors. “Some countries don’t even know what their trafficking laws are because they’ve never pursued these types of cases.”</p><p>OUR and an increasing number of researchers across the U.S. are building technologies to improve capture and conviction rates and help law enforcement go after trafficking kingpins. Working in partnership with the cybercrime analytics company Delitor, Inc., OUR is developing proprietary software to track trafficker travel routes and help law enforcement determine if an escort ad was posted by an organized trafficking ring.</p><h2>ID Via Machine Learning</h2><p>Following a trafficker’s online footprints is tough, says Wade Shen, a program manager for the U.S. Defense Advanced Research Projects Agency (DARPA), in part because traffickers are good at evading commercial web indexing bots that search engines like Google use to catalogue the web. Traffickers post escort ads on both sites that are low-priority for indexing bots and on anonymous “deep web” sites that aren’t indexed by bots at all. Ads are often altered or removed after ten to 15 minutes, contact information changes frequently, and posts use a variety of non-standard writing formats to make them less searchable.</p><p>Shen is part of a multi-million dollar effort to develop better ways of mining the web to track illegal activity. Starting work in 2015, DARPA’s Memex program is a partnership of 17 contracting teams building tools that can collect content ignored by or unavailable to commercial search engines, analyze that content for hidden patterns, and build models to predict behavior. Focusing on trafficking for its first year, Memex has debuted <a href="http://opencatalog.darpa.mil/MEMEX.html">50</a> software programs and tools aimed at enhancing online search capabilities, some of which law enforcement officials are currently using to find leads and build cases against traffickers. Memex has also analyzed more than 100 million escort ads and uncovered new indicators that can help agents separate organized trafficking rings from adult prostitutes working solo. One of those indicators is price data, Shen says, a factor enforcement agents historically haven’t used to build cases.</p><p>If the prices listed in an ad increase or decrease depending how safe or physically dangerous the advertised sex acts or situation is, “then it’s much more likely that they are an independent contractor,” Shen says, adding that traffickers who aren’t personally taking on risks like catching a sexually-transmitted disease through unprotected sex tend to use less variable pricing structures. When combined with other information, such as the number of ads uploaded by a single person and the number of escorts represented in the same ad, “you can actually start to model behavior of rings of human traffickers.”</p><p>Identifying pimps is a small piece of the problem. Gathering enough evidence to prove sex trafficking and get a conviction is often a much bigger obstacle. The United Nations’ International Labour Organization estimates that <a href="http://www.ilo.org/global/topics/forced-labour/lang--en/index.htm">4.5 million</a> people worldwide are victims of forced sexual exploitation. In the US, nearly <a href="http://traffickingresourcecenter.org/states">2,700</a> sex trafficking cases have been reported in the first half of 2016—roughly 15 cases every day—according to statistics gathered by the National Human Trafficking Resource Center. If the second half of the year is comparable, 2016 will see a nearly 30% increase in cases over the previous year. Prosecuting those cases is difficult in the U.S. and almost impossible in other countries. A 2014 <a href="http://www.unodc.org/documents/data-and-analysis/glotip/GLOTIP_2014_full_report.pdf">report</a> by the United Nations’ Office on Drugs and Crime collected data from 128 countries and found that while more than 90% of reporting nations criminalized human trafficking (including labor trafficking), 40% reported less than 10 convictions per year. Nineteen countries did not have any convictions between 2010 and 2012.</p><h2>Vital Tools</h2><p>Tim Hoppock, a detective with the Austin Police Department in Texas, has worked in the Human Trafficking and Vice Unit for three years. The department makes roughly one arrest per month but Hoppock says that getting convictions is often a challenge. To get a first-degree felony conviction, which comes with sentences of up to life in prison along with a lifetime requirement to register as a sex offender, Texas requires prosecutors to prove that a victim is either under age 18 or is an adult that has been continuously trafficked for at least 30 days and engaged in forced labor or sex at least twice in that period. It can take months of gathering evidence and corroborating victims’ stories to prove uninterrupted trafficking over that time, and once evidence is assembled, cases can potentially get derailed or dropped if victims leave town, won’t testify, or are unreliable on the stand. Charges can also be pled down and sentences negotiated, Hoppock says, meaning that traffickers may be tried for a second-degree felony even though they were picked up for a first-degree crime.</p><p>“These cases are difficult from start to finish,” Hoppock says. “Even the prosecutors aren’t very comfortable with our cases because they’re so few and far between.”</p>
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<p>Human trafficking cases can live or die based on how quickly detectives gather evidence. Several emerging technologies aim to speed up that process, including Traffic Jam, a software program launched in 2013 that combs through escort ads and uses machine learning to find patterns that can connect ads across multiple geographic locations to the same organization or pimp. In addition to tracking standard search metrics like contact information and search terms in escort descriptions, Traffic Jam can also identify similar photos that appear across different ads as well as stylistic markers like spelling errors and writing patterns that often follow an ad writer wherever they post. Instead of manually finding a few ads, waiting for a subpoena, then going back for more, Hoppock says that Traffic Jam fast-tracks the process by pulling a more comprehensive list of ads from across the country, including ones he wouldn’t immediately recognize as having a shared author.</p><p>Traffic Jam can identify similar photos that appear across different ads as well as stylistic markers like spelling errors and writing patterns.</p><p>“If I punch in a phone number into Traffic Jam and it gives me one ad with that number but it links to 50 ads on a different phone number that I previously didn’t know about, that can help me identify new victims,” he says. “It can definitely help me corroborate a victim’s story about where they’ve been and for how long.”</p><p>Marinus Analytics, the company that makes Traffic Jam, reports that the program is used by hundreds of law enforcement agencies across the U.S. and Canada, and has aided in rescue operations for at least 300 victims. They’re not the only player in the field. In the past two years, several programs aimed at mining escort ads have emerged including <a href="https://www.wearethorn.org/spotlight/">Spotlight</a> —produced by the Ashton Kutcher/Demi Moore-founded nonprofit, Thorn—and DIG, an open source Memex-backed project that catalogues about 5,000 webpages every hour and transforms that content into a searchable database of escort ads.</p><p>Ad-mining algorithms require data and lots of it. To train machines to identify information across varying formats—to understand, for instance, that an “eight” in a phone number could also be written as “8” or “e1ght”—researchers need thousands of examples of different ways each piece of information could be written. To get enough training data, DIG uses Amazon Mechanical Turk to recruit people to read escort ads and highlight key information like eye color, hair color, and the working name of people featured in escort ads.</p><p>Since trafficker ads already use a variety of writing formats and are designed to evade search methods, getting clean data is the project’s biggest obstacle, says Pedro Szekely, the University of Southern California computer scientist who co-founded DIG. “We’re dealing with data where people are actively lying to go undetected, where people are doing a lot of spam,” Szekely says. “Just teasing out what is real data and what is bad data is already a big challenge.”</p><h2>Data Hidden in Photos</h2><p>Mining ads isn’t the only way that computer scientists are tackling traffickers. Released last year, Microsoft’s free PhotoDNA tool goes through pictures uploaded to social media and photo-sharing services, and identifies images depicting sexual abuse. Using a process called hash-matching—which involves dividing images into a grid and assigning numerical “hash” values for individual pieces—PhotoDNA compares the hash set of the pulled image from hash sets derived from a series of known illegal images provided by the National Center of Missing and Exploited Children. Taking a completely different approach, <a href="http://traffickcam.org/">TraffickCam</a> , a program created last year, is building a crowdsourced database of hotel room images law enforcement officials can use to determine where photos from escort ads were taken, and how traffickers are moving victims. Anyone can download TraffickCam’s smartphone app and upload interior photos of hotel rooms to the program’s collection of 1.5 million images.</p>
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<img alt="Bangkok Sukhumvit Red Light District" class="richtext-image full-width" src="https://www.pbs.org/wgbh/nova/media/images/bangkok-sukhumvit-red-light-district.width-990_bvAIMFg.jpg"/>
<figcaption>Data gleaned from images available online can help determine where photos for escort ads were taken.
        
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<p>At Carnegie Mellon University’s CyLab Biometrics Center, director Marios Savvides is focused on victim identification, a problem that’s particularly tough when victims are young.</p><p>“If a baby is abducted, for example at the age of two or three, at the age of five or six, even their parents won’t be able to identify them facially,” Savvides says. “How do you identify those victims?”</p><p>Children’s faces change as they grow up, but their eyes, specifically their irises, generally don’t. Savvides has developed a long-range iris scanner that captures data from up to 40 feet away. Originally designed to help soldiers ID people in combat zones, Savvides hopes to one day apply the technology to trafficking cases, potentially by allowing law enforcement to install scanners at major transit hubs to identify victims from a distance. Successful iris identification requires cops to have a picture of the victim’s iris. Instead of waiting for tragedy to strike, Savvides is modifying smartphone cameras to enable them to capture high-resolution iris photos. An accompanying app would allow parents to upload photos of their children’s eyes in case law enforcement needs them now or later.</p><h2>A Never Ending Battle</h2><p>Regardless of how good new trafficking programs and technologies get, there are obstacles to putting them into widespread use, says Wade Shen from DARPA Memex.</p><p>“Somebody has to actually invest in the maintenance and upkeep of collection platforms and tools,” he says. “Software we think of as a living thing, and if people aren’t updating it and maintaining it and keeping it running on platforms, it will eventually die.”</p><p>Shen doesn’t believe that new technologies will end trafficking entirely, but they are a step in that direction.</p><p>“It will of course change the tactics traffickers use, but that’s a good thing,” he says. “We want to raise their costs.”</p>
<p>Photo credits: OUR, <a href="https://www.flickr.com/photos/digimeister/13998891453/">vinylmeister/Flickr (CC BY-NC)</a></p>
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The Psychological Trauma of Defecting from North Korea

<p>In an apartment in Seoul, South Korea, Lee So-yeon wakes in the night, thankful that everything she’s just seen is in the distant past.</p><p>She dreams of her former life in North Korea, of swimming the icy waters of the Tumen River, of being captured by traffickers in northern China and subjected to a new set of horrors. She dreams of a failed suicide attempt, of being bound and thrown back into the river unconscious, of the North Korean soldiers who dragged her body from the Tumen, keeping her alive but condemning her to 13 days of starvation and physical brutalization in one of the country’s prisons. She dreams of being stripped naked there and forced to lie on a bed with four other women as a guard examined her bodily cavities, keeping the same unsterilized gloves on to search all five women. She dreams of the darkness of her cell, punctuated by smells of her own excrement and compares it to the black of being kicked unconscious by guards.</p>
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<p>But she also dreams of release—getting out of prison, swimming the Tumen again, and taking a boat to Seoul, beginning the resettlement process in 2008, two years after her first escape attempt. She dreams of the day when, for the first time, a doctor told her that the nightmares and flashbacks were symptoms of post-traumatic stress disorder, a condition many defectors face, and the hopelessness and despondency that hung over her waking life were symptoms of depression. Unlike what she was taught growing up, other North Koreans experienced these conditions too, and in Seoul, she could talk about them without fear of being sent to an institution few ever leave.</p><p>“They educate people that North Korea is the best, healthiest country in the world. The premise is that there is no one who has any problems mentally,” Lee says through a translator. “There is no concept like depression in North Korea.”</p><p>For resettlement and medical professionals working with North Korean migrants like Lee, a major step in providing effective mental health interventions is convincing defectors that the issues they face are diagnosable and treatable. While defectors are generally aware that mental health exists, they know little to nothing about specific conditions, the prevalence of mental health issues, and treatment strategies. Defectors show high rates of psychological trauma. It can be caused by everything ranging from starvation or abuse to fearing capture after resettlement or retribution taken out on loved ones left behind. Despite the suffering, research shows that North Korean migrants are frequently averse to even basic mental health help.</p>
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<figcaption>Lee So-yeon
        
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<p>“One of the best ways that North Koreans describe life outside the country to me is that it’s like waking up out of a time capsule,” says Sokeel Park, director of research and strategy for Liberty in North Korea, a non-governmental organization that operates a 3,000-mile underground railroad that picks up defectors in northeastern China and smuggles them to safety. “They go to the bathroom and they don’t know how to use it. They go out into society and people are Korean, and so fundamentally look the same and speak the same language, but it’s like a sci-fi future…It’s a huge culture shock and a lot of things to get used to.”</p><p>Developing effective mental health treatment strategies requires understanding attitudes and treatment protocols within the Democratic People’s Republic of Korea, or DPRK, as North Korea is formally known. Concrete information about the mental health system within North Korea is scarce, but from what is known through defector testimony and limited scientific literature, the DPRK system is modeled after psychiatric practices popularized under Stalin in early 20 th century, and it’s rooted in suppression and erasure. There, psychiatric conditions are often considered to be the patient’s fault and a source of deep shame for friends and family, says Katharine Moon, a professor of political science at Wellesley College in Massachusetts and a nonresident senior fellow at the Brookings Institution in Washington, D.C. Psychiatric conditions are also inextricably tied to politics and ultimately the country’s caste system, known as “songbun,” Moon adds.</p><p>Started in the late 1950s and implemented throughout the ’60s, the songbun system categorized citizens into one of three broad castes: the loyal “core” class, the wavering “basic” class, and the “hostile” class. Castes are designated by two criteria—“ancestral songbun,” which is determined based on the political roles and actions of an individual’s ancestors during the Japanese colonial period and later the Korean War, and “social songbun,” which is determined by the individual’s own loyalty and political orientation. Ancestral songbun is permanent, but social songbun can be modified depending on behavior.</p>
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<figcaption>Adherence to norms is strictly enforced in North Korea. Here, performers participate in the Arirang Mass Games, usually held annually.
        
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<p>The songbun system is divided into 51 subcategories, according to <a href="http://www.hrnk.org/uploads/pdfs/HRNK_Songbun_Web.pdf">a 2012 report</a> by the Committee for Human Rights in North Korea, and has historically determined a citizen’s access to, and quality of, education, employment, housing, healthcare, and food, among other things. Though the caste system has become more fluid in recent years—primarily due to the rise of black markets which allow some in lower castes to earn money outside of their government-assigned jobs and buy their way into higher society—discrepancies between the castes dictate a significant portion of North Korean life, Moon says. Higher castes enjoy benefits like the ability to permanently live in the capital city of Pyongyang—one of many luxuries that those in lower castes can access with enough money—while lower castes suffer widespread discrimination and are relegated to undesirable jobs. Based on the information that’s available, the songbun system also influences mental health perceptions, Moon says.</p><p>“Mental health and politics have become conflated,” she says. “If you come from a questionable line in terms of your political loyalty, then it’s sometimes believed that you’re more prone toward mental health disorders than you are if you come from a revolutionary line.”</p><h2>Mental Health Inside North Korea</h2><p>Both the regime and state-run media hide evidence that mental illness exists, says Michael Glendinning, director of the European Alliance for Human Rights in North Korea, a nonprofit defector support organization registered in the United Kingdom. Families have incentive to hide mental illness, too, out of fear that government officials will take steps to remove those considered different from the mainstream.</p><p>“There’s not a chance to be open about disabilities,” he says. “There’s not a chance to be open about mental health issues because, if you are, you place yourself and your family members at risk of being pushed out into the northern provinces where things are a lot harder.”</p><p>“Doctors in North Korea have no access to modern knowledge and training in medical science.”</p><p>For families, hiding mental illness may also be an act of protection and compassion for the patient. Those with obvious psychiatric conditions run the risk of being sent to state-run facilities called Number 49 hospitals that are often located in remote areas, isolated from the general population, Moon says. Lee So-yeon confirms that these wards are known throughout the country—when friends are acting strange, North Koreans joke that they’re being “number 49”—but neither citizens nor outsiders know exactly what goes on inside. Sung Kil Min, a psychopharmacology researcher in Seoul who has interviewed a few medical doctors that have left the DPRK, says that Number 49 hospitals are “very poor” facilities that are “built for keeping ‘mad’ people in custody” and frequently rely on sedatives and antipsychotics to control patients. Lee has not been to a Number 49 ward herself, but says that stories abound in which the seriously sick are tied to their beds and others are forced to do hard labor. Should someone in the labor group deteriorate or get sick due to the strenuous work, they may also be sedated and bound to their bed.</p><p>“It’s a vicious circle,” Lee says.</p><p>It isn’t clear what exactly North Korean medical schools teach in terms of mental health, but Min says that knowledge of both psychiatry and psychopathology is “very low,” with doctors he’s observed unable to recognize common conditions like depression, anxiety, trauma, and stress. Symptoms of mental health conditions, especially mood and stress-related disorders, are often chalked up to “regulatory dysfunctions of the autonomic nervous system”—which directs unconscious functions such as breathing and heartbeats—and may be treated by internists or neurologists rather than mental health professionals.</p><p>“Doctors in North Korea have no access to modern knowledge and training in medical science, no knowledge about new medicines and treatments,” says Joanna Hosaniak, deputy director general of Citizens’ Alliance for North Korean Human Rights. “They don’t have access to internet to teach themselves, so even general medical services are below standards.”</p>
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<img alt="Poster In Hospital In North Korea -" class="richtext-image full-width" src="https://www.pbs.org/wgbh/nova/media/images/north-korea-hospital-poster.width-990_PQWX2ct.jpg"/>
<figcaption>A poster in a hospital in North Korea
        
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<p>Medical misinformation, shame, and inhumane treatment of those with disabilities have devastating humanitarian consequences, especially in the outer provinces where resources are more limited, Hosaniak says.</p><p>“If a child is born with some visible disorder, then usually the doctors inform the parents that this child might be disabled and it’s better to get rid of the child,” she says. “There is infanticide going on. They inform the parents that if you put the child immediately upside down, the child will not be able to breathe after some time and will die.”</p><p>These factors, combined with the constant fear and paranoia that comes with living in a surveillance state, all ingrain distrust into the mental fiber of defectors, support organizations report, and serve as sometimes insurmountable obstacles for counselors and healthcare professionals who want to help.</p><h2>Life on the Other Side</h2><p>How many people leave North Korea is unknown. China is estimated to hold anywhere from 100,000 to 300,000 defectors while South Korea’s Ministry of Unification calculates their defector population to be over 30,000, with thousands more spread across the globe. Roughly 70% of defectors are female—a factor some link to higher levels of unemployment among North Korean women—and more than half are in their 20s or 30s, in part because people at the peak of their physical fitness are the most prepared to swim rivers and weather the journey.</p><p>Resettlement is often the first time that defectors encounter concepts like mental health counseling and treatment, and they process these ideas while learning to exist in a brand new universe. In addition to coping with traumas experienced in North Korea and on the journey out, refugees also contend with learning new languages, laws, technologies, financial systems, and cultural mores, often without being able to contact anyone they know and frequently in countries where they are stigmatized and unwanted. Even in South Korea, where the language is similar to the North Korean dialect, defectors experience significant discrimination. For some, the adjustment is overwhelming and untenable. A few defectors have told the press that they regret their decision, and a very small minority attempt to return to North Korea.</p><p>“What you see more is people kind of withdrawing” for a period of time, says Sokeel Park. “It’s kind of like, what do I do now? I’m a fully grown baby in a society. Do I get a job? Do I try and study? Do I try and make friends? It can be an overwhelming paradox of choice… Some North Koreans describe this as all of a sudden having too much freedom.”</p><p>To receive resettlement support from the South Korean government, including housing subsidies and help with the citizenship process, defectors must complete a three-month education and assimilation program conducted through the Hanawon resettlement support center. The program includes mental health evaluation and some treatment. After they leave, defectors receive continued support through satellite Hana centers located throughout South Korea.</p><p>Even with funded support programs in place, mental health professionals face massive challenges with defectors. A small <a href="https://www.ncbi.nlm.nih.gov/pubmed/16281207">2005 study</a> found that nearly one in three defectors in South Korea suffered from PTSD, though some experts believe this figure is low. Depression, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3101050/">anxiety</a> , <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701687/">insomnia</a> , <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3440469/">social withdrawal</a> , substance abuse, mood, attention, and stress-related disorders run rampant within North Korean defector communities and are frequently exacerbated by other health problems this population faces. Suicide rates are nearly triple those of South Korean citizens, reports the Ministry of Unification. A separate study found that 70% of defectors did not know the roles of counseling centers or psychological counselors while more than half said the same about psychiatrists.</p><p>“When North Koreans arrive here and they are diagnosed that they should continue some sort of therapeutic work with psychotherapy, they usually avoid that,” Joanna Hosaniak says. “They are suspicious. They are afraid of this social stigma. They think that depression, this is something wrong that they have a really serious mental disorder and they are crazy. They don’t trust, very often, these counselors. That is a big problem with the support here.”</p><p></p>
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<p>Getting through to this population sometimes requires a different approach, Hosaniak adds. Instead of sending refugees directly to a doctor, some organizations train informal coaches to establish a rapport with migrants, build trust, outline basic mental health concepts, and steer migrants towards professionals only after they realize they have a problem and want help.</p><p>“Why would I need to tell my story to that person? What will that person do with that story?”</p><p>Effective treatment is also dependent on knowing typical patterns of refugee behavior. Social withdrawal often isn’t immediate. Inability to find work or make friends are warning signs. Wellbeing may slide as refugees become embedded in their new culture, especially in South Korea and other countries where discrimination exists against defectors and mental health treatment in general. The broader scientific literature on the mental health of refugees from other regions of the world shows that home and community-based treatment strategies are <a href="http://www.tandfonline.com/doi/full/10.1080/15332985.2015.1080205?needAccess=true">generally more effective</a> than office-based counseling. <a href="http://tpcjournal.nbcc.org/counseling-people-displaced-by-war-experiences-of-refugees-from-the-former-yugoslavia/">Connecting</a> with others from their home country and continuing culture and traditions from back home can also help refugees gain a sense of belonging.</p><p>“They really need someone that they can trust,” Hosaniak says. “The trust is completely broken in North Korea, given the totalitarian regime surveillance and the fear that is everywhere. This is a problem with mental services. You go to a person, a doctor, that doesn’t know you. You don’t trust him, and why would I need to tell my story to that person? What will that person do with that story?”</p><p>Eight years after successfully leaving North Korea, Lee So-Yeon is on a mission to spread knowledge about how common trauma and human rights abuses are for defectors. In the process, she hopes to break down the power held by the regime. After completing a decade of military service where she and 30 other women in her unit were raped by a commanding officer, Lee was forced to sell goods on the black market to avoid starvation. While there, she heard an illegal radio broadcast that featured a defector discussing life in South Korea. She began watching foreign television shows and films stored on contraband devices and talking to people who had crossed the border. She began to dream of leaving.</p><p>Now, Lee is now a driving force behind the technological infiltration of her former country. The New Korea Women’s Union, a nonprofit organization she co-founded in 2011, records defectors detailing human rights abuses they’ve experienced and discussing life and women’s rights outside of the DPRK. That media is loaded onto USB drives and memory sticks, about 10,000 of which are smuggled into North Korea every year and left in public spaces for anyone to pick up. The New Korea Women’s Union also provides support for those who have already left the DPRK, including job training and psychological counseling. By helping defectors outside of North Korea heal, and increasing education about trauma and the outside world within the DPRK, Lee hopes to steadily chip away at regime’s hold.</p><p>“We’re doing the kind of thing the North Korean government hates the most,” she says.</p>
<p>Photo credits: Lee So-yeon, <a href="https://www.flickr.com/photos/fljckr/1028111184/">(stephan)/Flickr (CC BY-SA)</a> , Eric Lafforgue/Gamma-Rapho via Getty Images</p>
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Taking Politics Out of Climate Change

<p>Climate change has become politicized in the last 20 years, but now conservatives and liberals are tackling the issue.</p>

Arizona State University’s "Haptic Chair" communicates social cues to the user through vibration patterns emitted from the chair’s lining. Image credit: Arizona State University's Center for Cognitive Ubiquitous Computing

Augmenting Social Cues for the Disabled

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<p></p><p>For the first time in 12 years, Bryan Duarte is sensing a smile. The 30 year-old software engineering student became blind at age 18 after a motorcycle accident. He spent years after the accident learning to navigate the world in darkness and figuring out how to communicate in a culture that largely relies on visual cues.</p><p>“I was very good at reading people’s body language, their nonverbal language,” Duarte says. “To not have access to that information now, it makes things pretty difficult in social situations… without those social cues, you don’t know if someone is looking at you, if you have their attention. You don’t know if you maybe offended them. You don’t know if they’re smiling, if they’re engaged.”</p><p>Now, for the first time since the accident, Duarte is getting those nonverbal cues. In Arizona State University’s Center for Cognitive Ubiquitous Computing, Duarte is sitting in what appears to be a typical black desk chair. It has a USB port built into the back where users can plug in a computer with a webcam. Sitting across from Duarte, with a webcam aimed at his face, is Troy McDaniel, associate director for CUbiC. During conversation, a built-in facial recognition system reads whether McDaniel looks happy, surprised, or neutral and communicates that information back to Bryan through specific vibration patterns emitted from the chair’s lining.</p><p>These patterns are designed to mimic the way our mouths convey glee, boredom or despair. When McDaniel adopts a neutral gaze—straight-lipped, no smile or frown—Duarte feels a strip of pancake motors in the chair vibrate in a straight line, starting from the right of his lower back and moving to the left. When McDaniel looks happy, Duarte feels a U-shaped vibration that mimics the way lips curve upwards when they smile. This demonstration of ASU’s “Haptic Chair” is the first time in more than a decade that Bryan has been able to get a sense for how his conversation partner is reacting without directly asking. During the 45-minute demonstration that I watch via Skype, Duarte excitedly tells me when he can feel McDaniel’s body language shift.</p><p>“He’s smiling right now. I can tell you that,” Duarte says. “When he was talking, I was getting kind of a mix between smiles and surprised looks, which is good because he might not have been exactly smiling, he might not have been exactly surprised, but to know he had emotion going on throughout that conversation is in a lot of ways the important aspect… As a blind guy, it’s really cool to be able to sit across from somebody and know even when they’re quiet what they’re doing.”</p><h2>Sensing Social Cues</h2><p>The Haptic Chair is currently a proof of concept and is a long way from being ready for the commercial market. As of now, the chair’s facial recognition system doesn’t work when speakers wear glasses and it’s not capable of identifying negative emotions like sadness and fear which generally aren’t as visually distinguishable as happiness or surprise. McDaniel’s team is planning a series of user studies where they hope to tweak the system to better accommodate blind users.</p><p>When—and if—the Haptic Chair reaches the commercial market, it may be the only product of its kind. While a wide range of assistive technologies help the visually impaired accomplish specific tasks, “most of the focus has always been how do we help people navigate? How do we help people to read?” says Sethuraman Panchanathan, director of the ASU’s Center for Cognitive Ubiquitous Computing. “There hasn’t been as much focus on social interactions.”</p><p>And as a growing body of research suggests that social health is directly linked to physical health, that’s a major problem. A meta-analysis of more than 70 independent studies published last year in Perspectives on Psychological Science showed that social isolation is directly linked with higher mortality rates and is even riskier than obesity. Separate research published in PLOS Medicine analyzed 148 studies that tracked the social lives of participants for an average of seven and a half years. They found that participants with strong social relationships had a 50% higher chance of survival over that time period compared to those with weak social connections. More recent research links the lonely with a 29% increased risk of heart disease and a 32% increased risk of stroke than the well-connected. In fact, long-term loneliness can have such devastating consequences on the body that some researchers characterize it as a public health concern.</p><p>But solving social interaction issues is a huge challenge. Developing technologies that work in real time requires high processing speeds, not to mention a design that can deliver feedback without disrupting the flow of conversation or burdening the user with clunky machinery to carry around. The goal of creating assistive devices that function as fast and seamlessly as the human brain means that some of the most accessible technologies, like smartphones and laptops, devices already owned by many disabled people, aren’t always ideal since using them draws attention away from a conversation.</p><p>Samson Cheung, director of the Multimedia Information Analysis Lab at the University of Kentucky in Lexington, is currently developing assistive social technologies for people with autism using Google Glass. One of Cheung’s autism-related apps aims to help users maintain eye contact—a common problem experienced by those with mild to severe autism. When the user’s face is roughly in line with the face of someone looking back, a yellow smiley face appears on top of the Google Glass camera feed, allowing the user to better align their head with their conversation partner and “basically giving visual feedback to the user that OK, you’re doing great,” Cheung says. Should the user’s head turn away from the conversation partner, a sad face appears, letting the user know to make adjustments. Cheung has also created a similar app that monitors when a user’s voice volume is appropriate relative to the ambient noise level of a room, and he envisions both apps being used, not just in everyday social interactions, but also in professional settings like a job interview.</p><p>Despite Google halting production of the original Google Glass last year, the technology is still a favorite among researchers developing ways to help autistic people better understand social cues in real time. SayWAT, a program created by researchers at the University of California, Irvine, and the Ensenada Center for Scientific Research and Higher Education in Mexico, gives autistic users live feedback on the tone and rhythm of their voice while Stanford’s Autism Glass Project has developed a wearable behavioral aid that helps autistic children read facial expressions and maintain eye contact. The project is currently recruiting families with autistic children ages 6 to 16 for a clinical study.</p><p>“A small 3D printer has radically changed the social lives of some residents at The Boston Home.”</p>
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<p>The problem with Google Glass (and many other types of wearable technologies) is that providing real-time feedback takes power—lots of power. Cheung’s apps, for example, drain Google Glass in about 30 minutes, making them impossible to use throughout longer social events without a supplemental power supply. Luckily, increasing social interaction for many disabled people doesn’t require invasive technologies as pricey or as complicated as Google Glass or a Haptic Chair. A small 3D printer has radically changed the social lives of some residents at The Boston Home, a long-term care facility in Massachusetts that serves adults with progressive neurological disorders. Purchased nearly three years ago, the $3,500 printer is mainly used to create objects like customized joysticks, control knobs, and cup holders that can be mounted onto a wheelchair—items that aren’t always covered by insurance companies and may be difficult to find on the commercial market.</p><p>Don Fredette, the adaptive equipment specialist who runs The Boston Home’s 3D printer, says that the printer’s rapid prototyping capabilities allow him to better keep up with the changing needs of patients whose ability levels may change from one day to the next. Last year, Fredette designed a tool that connects a water color paint brush to a mouth stick, allowing the user to adjust the brush to be closer or farther from their face and paint without using their hands. The tool has allowed at least one resident to attend art classes.</p><p>“This is not complicated,” says Fredette, who largely taught himself both printing and design. “This isn’t a prosthetic. It isn’t high-tech… but it’s making a huge difference for the person.”</p><p>Farzin, a 53 year-old man with advanced multiple sclerosis, says that the 3D printed cup, notepad, and remote control holders Fredette created and mounted onto his wheelchair have improved his social life “big time” by decreasing his reliance on nursing staff throughout the day.</p><p>“Basically, I don’t need anybody to help me all the time,” Farzin says. “They dress me and put me in the chair in the morning, and they don’t see me until lunch time. And then they don’t see me until after dinner when I go to bed.”</p><h2>Bridging the Gap</h2><p>Kelly Buckland, executive director of the National Council on Independent Living, says that social interaction is directly tied to broader issues facing the disabled community, such as lack of employment options, transportation, and affordable housing.</p><p>Currently only about 17% of Americans with disabilities hold jobs, reports the Bureau of Labor Statistics, versus nearly 65% of those without disabilities, and federal disability benefits frequently can’t pay the bills either. The average annual income for disabled Americans drawing Supplemental Security Income benefits is less than $9,000 a year—more than $2,800 below the 2016 poverty line, according to a study by the Consortium for Citizens with Disabilities Housing Task Force and the affordable housing nonprofit Technical Assistance Collaborative. That amount frequently doesn’t even cover rent, as the the average monthly cost on a modest one-bedroom apartment exceeds the average SSI check by 4%, and it blocks independent disabled people who rely on federal assistance from renting in sizable swaths of the country. The study found that in four states and Washington DC, $9,000 won’t buy a year of rent in any apartment in any housing market.</p><p>Technologies that make a dent in any of these major structural problems will inherently reduce social isolation, Buckland says, and will “make people with disabilities much more able to live independently.”</p><p>“Currently only about 17% of Americans with disabilities hold jobs.”</p><p>One way to solve some social interaction issues is to ensure that devices developed for the mass market are accessible to disabled populations, says Gregor Wolbring, associate professor in community rehabilitation and disability studies at the University of Calgary. That means incorporating people of varying ability levels into the design process, from early product conception all the way through user testing. But making that shift requires a cultural change in the design and development process, one that would create extra work for developers.</p><p>“We need a way that [disabled] people are automatically part of the discourse, and it’s very hard to do,” says Wolbring. “There are all kinds of issues but I think we have to start with that.”</p><p>Bryan Duarte isn’t waiting around for the design process to change. Duarte is currently working with Arizona State’s Center for Cognitive Ubiquitous Computing to build a wearable version of the Haptic Chair’s feedback system that will provide information on nonverbal cues in real time. One basic goal, he says, is to create a device that lets users know if their conversation partner is still present or if they’ve nonverbally ended the interaction and left.</p><p>“They walk away and you’re still there talking,” he says. “That happens all the time to blind people.”</p><p>Hopefully not for long. Projects like the Haptic Chair may be signs that the landscape of technology accessibility is shifting to include the social and emotional needs of the disabled as well as their physical and logistical needs. That’s not a radically new concept, Duarte says, “but I think it’s starting to get more attention.”</p>
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Ghosts in the Machine

<p>AI systems don’t think exactly like humans, but the algorithms can—and do—play favorites.</p>

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