Suprematism

Whether ’tis nobler in the mind to suffer, or to take Arms.

Suprematism, or constructivism; is that a question? It is, when we come to designing video games. Each is a pillar of design thinking. Each is a buttress holding up the walls of our visual program. They don’t really go together; in fact, each yearns to cancel the other. I want to make opposites attract with a bold new visual style that few seem to have mastered.

Suprematism is the most abstract of arts. It springs from an ideological rejection of objectivity and representation. A suprematist doesn’t mirror nature, or any aspect of the real world. Nor does a suprematist idealize by probing objects for mathematical properties that reveal and convey meaning. Suprematism reports, and cares only for, feelings: immediate, nonverbal, ineffable emotion, triggered by visual perception and expanding into lofty, unmapped spheres of intimation and sensibility and enlightenment.

Thus a suprematist, unlike most artists, is neither magician nor pretender. A suprematist doesn’t wear a mask or dupe people into seeing what isn’t there, or believing that an artifice has physical power. Suprematism is pure sensation and feeling. Feeling about.. what? Desire, valor, truth, fulfillment? No, nothing like that. Suprematism causes feelings about nothing at all: feelings that are a wordless projection of the human condition.

If you’re bored or repelled by feelings that are not for or about something, then suprematism is not for you. On the other hand, if you prefer art that you can use, then constructivism may work better. I think it works well.

I often mention constructivism as a pedagogy. In that sense of the word, constructivism is an offshoot of heuristics and untrammeled learning from experience; the ways children learn when playing and adults learn at work. Both learn by doing things, their own way, alone and with others, discovering what satisfies and turning that into competence. Diabetes Agonistes is a video game simulation, Metabolic Genii is a video game role-play. Therefore, each facilitates constructivist learning experience. But learning and visualization are different things.

Suprematist and constructivist art emerged in Russia in the early 20th Century. Both were revolutionary at the time, became very influential, and remain so today, mainly because they epitomize the morally courageous act of shrugging off tradition and authority, and placing all bets on creative freedom. Suprematists shrug to evince the human condition, constructivists shrug to improve it.

Constructivist art, in theory at least, is utilitarian. It wants not to be viewed, but interrogated. It wants not to be admired, but engaged. It wants not to be hung, but applied. It wants not to be pretty, but unsettling and useful. The most notable constructivist working today is the street artist Banksy. Fracturing rather than mirroring or adorning reality, forcing sudden openings for invention and reform. Not in the artist, but in people who experience art.

There you have two opposites, of sorts, and both are central to the mission of Humaginarium. We are creating interactive art and entertainment that epitomizes the human condition and generates intense sensations, without recourse to narrative, without telling people what to think or how to behave. Just keeping our philosophical mouths shut while they enjoy the playground. And yet, their enjoyment doesn’t stop in the playground. It continues in the imagination and transfers to the real world as a mindset, a frame of reference, a sense of morality, a habit of informed thinking.

Is the question suprematism, or constructivism? No, not in our project, and not at a time when tradition and authority are grinding to a stop on the train tracks to nowhere. We need all the resources of resistance we can get! Because work does not make us free; the act of shrugging might.

Suprematism and constructivism, feeling and empowering: each in full flower, in the same visual program, for the benefit of many people who couldn’t care less, but should.

Suprematist logo art of Humaginarium.

Experience

A video game is a process more than a product.

Video game entertainment is a process more than a product; moreover one that people control to their advantage. For example, as they play Diabetes Agonistes, their personal experience of discovery, invention, synthesis and resolution is paramount. They, not the game, make individual choices and meaning that bring the game to life. They learn from their experience in a process known as heuristics.

Unlike pure play (epitomized by Johan Huizinga and Bernie De Koven), a video game is structural and ordained. It imposes rules on performance; meets out punishments and rewards; tells a story or at least has a narrative arc; occupies virtual space that seams realistic or at least familiar. A video game has personality or involves characters whose personalities have to be dealt with. One of those personalities belongs to the player who participates as an actor: performing a role that is directed if not scripted by the game.

Diabetes Agonistes has five complementary dimensions of experience that enrich lives. By enrich I mean amuse and edify, make them happier, smarter, healthier. These are the takeaways and reasons for coming back for more.

The first dimension of experience is art. Just looking at Diabetes Agonistes gives pleasure and satisfaction. Enjoyment doesn’t depend on understanding or using what’s visible. Drawing, painting, modeling render all subject matter beautiful no matter how it actually appears in nature, if at all. We use a hybrid style of hyperrealism and romanticism to achieve this effect, because the blend is perfect for rendering science and fantasy from the same perspective.

The second dimension is entertainment and it surprises me. Diabetes Agonistes is funny, though I haven’t thought about it that way. It wants to be liked though it’s morbid, difficult, obnoxious. It mocks itself and makes fun of others, and seems to have neither center of gravity nor gravitas: dancing when told to march, joking when asked for help, by turns Harpo, Groucho or Chico and willing to do anything to earn people’s trust — not to make subject matter easy but to make it fun.

The third dimension is fantasy. Our scientific subject matter is not imaginary, not invented, not theoretical, not in doubt. It’s real in every cell of the body; and it’s faithfully represented in Diabetes Agonistes: modeled, simulated, rendered before cast as art and entertainment. Yet the experience we make of science is perversely unrealistic. After taking much trouble to get it right, we rig it in fantasy. We let folks pretend that illness is no threat, but a competitor. Rather than retreating in fear, anger, denial as folks do in life, fantasists tackle illness curiously, deliberately, with chutzpah.

The fourth dimension is plaything or toy. Diabetes Agonistes has unconstrained elements that are not justified by game rules, mechanics, theory, objectives. Pictorial embellishments, challenging diversions, anecdotal pockets that randomly delight for no logical reason. Our proper game about metabolism gains nothing from playthings, while people enjoy the silly distractions. They are occasions for lallygagging.

The fifth dimension is game. It immerses people in conflicts they’ve never consciously had and would avoid if presented another way. Life and death conflicts that erupt in their imagination, involving mysterious dynamics that are scary and difficult to understand, and that most folks are unfit to learn by any pedagogical means. Gaming not only makes it possible to learn, but more importantly desirable. People get to vanquish pernicious drivers of their illness.

Indeed our video game is a process more than a product. A process involving perception, cognition, emotional engagement, self-determination. Each one of the five dimensions is a way of experiencing the process, a way for players to deposit themselves in a virtual world of endless opportunities, and later take themselves out with gifts of amazing insight.

Material

“I saw the angel in the marble and carved until I set him free”

The Italian Renaissance was the cradle of modern civilization. Is that because it freed people from medieval superstition? Not by a long shot: superstition continues to thrive right up to the present and shows no sign of waning. Something else happened to make that time and place consequential. It was the advent of natural science.

The Renaissance isn’t notable for reinventing religion. It merely stopped inventing nature and instead turned people’s attention from the imaginary to the existential. At first this code switch probably felt like a comedown, because the natural world seems uncomplicated and familiar; it’s all around us, there for everybody to see and use rather than a symbol of things mysterious, unseen and desired.

That rustic perspective may have preceded the Quattrocento but for sure it ended there, with the emergence of scientific acumen. Because when patiently and attentively considered, nature is not uncomplicated and familiar; it is not mostly palpable to the senses, not intuitive or logical or even fathomable at its extremities. Nature is an enigma so mind-boggling that relatively few people can or even want to think about it. Instead we take it for granted, and wonder what’s for dinner.

Nature is the material world, spanning particles so small that they pass through our porous membranes as though we aren’t there; and stardust so diffuse that we don’t know where (or if) it ever ends. Beginning in the Italian Renaissance, artists and scientists have investigated material in order to understand what it truly is, why it sometimes comes to life and lives on, how it may be controlled and used for practical purposes.

A celebrated artist-scientist of that era was Michelangelo. He wrote of his art that “The sculpture is already complete within the marble block, before I start my work. It is already there, I just have to chisel away the superfluous material.” What did he mean?

He meant that material is us and we are material. We may look at and into ourselves to discover the meaning of the universe; we may look at and into the universe to discover the meaning of ourselves. Fearful symmetry!

This insight came forcefully to mind as I surveyed human metabolism and asked myself, “What may people come to know or know about, that they didn’t already know, by the time they finish Diabetes Agonistes? And how much of that will be useful to them.”

The answers are pretty exciting. People will suddenly know that their life is their body: neither the soul everlasting nor the face in the mirror, but a unique and beautiful and transitory expression of their genes. They will know that the genes encode biochemical activities so numerous and subtle and complex and quick and precise and certain that miraculous is not an exaggeration.

When our game posits that the body is a miracle worthy of their greatest care and respect and love, they will not scratch their head and wonder how that can be. They will not sign up for a class or call a doctor or a priest to explain life to them. They will instead look out on the world – the seas, the mountains and valleys, the forests and pathways through the forest, and they will believe, “That is me. I can now find myself in the world where I live, and understand the world where I live as the body I inhabit. For a time, until the material that is me returns to stardust and finds another fascinating way to emerge and continue.”

“I saw the angel in the marble and carved until I set him free,” wrote Michelangelo about another sculpture. We know it when we view his art. We know that his genius was to let the human emerge from material; and for material to teach us something ineffable about the human that nobody before the Italian Renaissance understood, and which few of us today understand. Tomorrow will be different.

Scientific entertainment. The Awakening Slave (1530) by Michelangelo di Lodovico Buonarroti Simoni, pictured with a biochemical fantasy and cruciform suggesting any person’s intermateriality.

Pathways

We breathe, we metabolize, we live.

A pathway is a technique, a course of action, a series of steps, a way forward. Once a pathway is recognized it may be observed or used with predictable results. Until then, it’s just an idea.

Diabetes Agonistes introduces folks to metabolic pathways. Which folks? Adults with poor health and science literacy, who risk metabolic syndrome and diabetes type 2, and happen to like video games. About 87 million Americans fit that description at present.

Folks can’t see or feel their metabolic pathways, but can (and do) ignore them. Metabolism is autonomic, kind of like breathing, you don’t have to think about it. It just happens.

Metabolic pathways are exquisitely ordered chemical reactions in all 30 trillion cells of the human body: every cell, every moment, 24/7/365. They’re also present in 100 trillion bacterial cells that colonize the human gut, feeding each person’s metabolism like a vast supply chain, starting the minute they are born and continuing, never ceasing, for as long as they live.

You know without being told: if you stop breathing for any reason, your life will soon be on the line. You know this from experience, you didn’t have to learn it in school. Likewise if any of the chemical reactions churning through your cells quit or misfire, your life may sooner or later be at risk. You may become sick, but unfortunately you don’t know that, because unlike breathing, you haven’t consciously experienced it. You haven’t learned it. You’re allowed to ignore it.

Yet people who play Diabetes Agonistes are aware their metabolic risks, because they have consciously experienced them in a simulation, and striven to correct them, and vowed to avoid them, and practiced how to control them when faulty biochemistry wrenches health from their body, like juice from a ripe apple.

So then: we breathe, we metabolize, we live. To be frank, breathing is part of metabolism. The oxygen that flows into our lungs when we inhale, the carbon dioxide that flows out when we exhale, these are the gaseous fuel and exhaust fumes of our constant metabolism.

Metabolic pathways keep us alive. It’s been argued that they are life itself, the essential difference between a human body and, say, a marble statue. Life on earth began more than three billion years ago, long long before any human was conceived: in the toxic swirling tides of a cooling planet. What made life start in that chemical broth, after billions of years of cosmic deadness and nothingness? What made Homo sapiens eventually show up on earth with our big ideas about some ethereal spark? Was it God that started it? Nope. It was the earliest metabolic pathways randomly oxidizing compounds in a primordial muck. That was our real Garden of Eden, properly evidenced and understood.

Diabetes Agonistes is a video game about the modern incarnation of those pathways inside our bodies. The game is a complex scientific simulation, a stroke of genius for regular folks, helping them understand and enjoy something that may make them healthier and happier and live longer.

Diabetes Agonistes is also a pathway of a different kind, a new idea that is about to be proven with evidence, or dashed to smithereens in failure. We’re nearing that crossroads.

You see, Diabetes Agonistes is a cloud-based app that transforms people who play it. Makes them smarter without teaching them. Helps them create knowledge and intuition and skills from their own experience, from trial and error and deliberate practice and fooling around and making stuff up. It creates understanding as subtly and organically as their cells synthesize proteins. Not by telling them what to do or how to do things, but encouraging them to figure it all out on their own. Nudging them up the path. They can do it if they try.

Unlike any entertainment I know, Diabetes Agonistes challenges folks to figure out some of the hardest problems ever faced by scientists and clinicians and educators and health policymakers, and use their discoveries to change the quality of their lives.

Step by tiny step up a crystal scaffold that penetrates the clouds of not knowing, and emerges into sunlight and starlight of truth and beauty about the human body, about the mind, about the spirit, about the difference between existing as a lump of clay and living as a noble human being.

Diabetes Agonistes is a new and different kind of pathway: a technique, a course of action, a series of steps, a way forward, an engine of predictable results. It is fast becoming more than a cool idea.

Think

The way in which we think about a disease has an effect on the outcome.

“The trouble with every one of us,” said Thomas Watson in 1912, “is that we don’t think enough. We don’t get paid for working with our feet — we get paid for working with our heads.” Soon after that, Watson famously made “THINK” the enduring mantra of IBM.

IMHO, there are far more important reasons to think than to make money. Even so, a few decades after IBM asked “every one of us” to think more, our nation’s moral savior observed: “Rarely do we find men who willingly engage in hard, solid thinking. Nothing pains some people more than having to think.”

That observation jives with my personal experience of folks, but Martin Luther King Jr. didn’t leave it at that. He added that people should be “tough-minded,” in order to think well (not just more). They need to become sharp, penetrating, astute, discerning (his words). Cognitively attentive and retentive, yes; but also inquisitive, brave, original, determined (my words).

The modern notion that everybody should be “tough-minded” was taken up by the United Negro College Fund in 1972, a few years after MLK’s sacrifice. UNCF coined a moving slogan that became a building block of popular American culture to this day: “A mind is a terrible thing to waste.” Watson apparently felt the same way.

And so did Michael Jackson in 1988 when he brought the tough-minded man to the stage as a Man in the Mirror, daring arenas full of crazy fans to think different about what matters most to all of us. A decade after that, Steve Jobs started urging everybody, everywhere, to Think Different — picturing MLK and several like-minded luminaries in Apple spots during the Super Bowl.

Is that man in the mirror — thinking and moreover thinking differently — really the same as a person who is tough-minded? Practically they are the same, in my view.

How might such noble people avoid wasting their minds on this terrible and beautiful planet? Perhaps by “breaking through the crust of legends and myths and sifting the true from the false.” That’s MLK again, lofty and authentic at the same time: his rare and urgent gift.

The problem with urging everybody to think, though, is that nobody really understands what that means. Everybody thinks of course, but who really knows how or even why?

You think I’m exaggerating? Think again. People are much better at being told what to do than demanding to think things out for themselves. That seems to be true throughout American health care (my pet peeve), where the tough-minded are providers only, and most patients are milquetoast.

The dreadful implications of that intellectual disparity in health care hit home when I read Normal Cousins’ Head First: The Biology of Hope (1989), where he claims “The way in which we think about a disease has an effect on the outcome.” Hold on, did you get that? The way we think changes our own clinical outcomes. Since when has thinking become medicinal?

Probably since the placebo effect was felt, roughly at the beginning of human civilization. Then as now, people tend to avoid, prevent and recover from illness by thinking wellness. You can’t think wellness without some proverbial fire in the belly, but if you have that —if you’re tough-minded — you may be able to defend your body against threats and frailties right along with the surgery and the drugs and the annual checkups you may think your body depends on.

Most people don’t think wellness when it comes to their bodies, not because they can’t, but because it’s incredibly hard. Humaginarium makes it easier by using slick technology, but it’s still hard. Nobody gets to think Diabetes Agonistes is a walk in the park. It’s more like a slog through Mirkwood, and I wouldn’t want it any other way. Nor would Thomas, Martin, Michael, Steve or Norman. Nor should you.

“One of the unfortunate aspects of health education,” wrote Cousins, “is that it tends to make us more aware of our weaknesses than of our strengths. By focusing our attention and concerns on things that can go wrong, we tend to develop a one-sided view of the human body, regarding it as a ready receiver for all sorts of illnesses. Proper health education should begin with an awareness of the magnificent resources built into the human system.”

Diabetes Agonistes isn’t proper health education. It isn’t health education at all, but it does develop keen awareness of magnificent resources of the body, resources available to the person who owns the body and whose life depends on it.

You know who that person is: the man or the woman in your mirror, longing for you to toughen up your mind and think different.

Conditioning

Experience is the best teacher.

Diabetes Agonistes is art for art’s sake. It is nothing other than entertainment — a thing of beauty, a technical marvel, a source of amusement, a way to pass the time and take a load off. If it ever becomes more than that, it may fail.

For example, if it becomes healthy like exercise, or educational like school, or prescriptive like medicine, or covered by health insurance like a benefit, it will probably skid off the road and wind up in a ditch of “things that are good for me.” Diabetes Agonistes is not good for you. It doesn’t show you what to do. It’s not a safety cap or a warning label. It isn’t a mutant form of health care.

Yet Diabetes Agonistes promotes health, more widely and effectively than anything else I can think of. It is educational technology that endows millions of people with competence as owners (not renters) of a body. Their own body, the one they were born with but never got to know except in a mirror, though the mirror lies.

How can this be? How can frivolous entertainment promote health; and even harder, promote the health of folks with chronic illness? The answer is, by conditioning.

Conditioning refers to learning that is experiential rather than didactic. The experience of what there is and what is happening in the surroundings of an active individual. Active is vital, because people must engage directly with their surroundings to learn from their experience.

Yes of course, I know that engagement may also be as quiet as observation and reflection, without lifting a finger, while zillions of neurons fire in a silent brain and nervous system. Okay, but that is not active engagement; it is passive. And it is not what works for regular folks.

The regular folks in line for Diabetes Agonistes rarely learn from quiet contemplation. They don’t learn from reading instructions and answering diagnostic questions, because all that is intellectual. It is voluntary rather than necessary, speculative rather than felt, pondered rather than suffered . Passive engagement may inform but it doesn’t condition, so the competence gained from it is fragile and often transient. Here today, gone tomorrow. Most health education works that way, which is to say it really doesn’t work at all.

Regular folks actually learn about health, not from TED Talks and books, but by experiencing the wounded body. Their own, in the case of folks with chronic illness, or another, in the case of caregivers.”You can’t see or understand me if you haven’t walked in my shoes.” And if you have, and walked enough times, your response has most likely been conditioned.

Conditioning helps regular folks perceive and adapt to a body’s needs — without thinking for a long time, without googling the research, without sinking into the quicksand of WebMD — just by deciding and doing what comes naturally. Insight and habits are ready for action and waiting for that decision, thanks to conditioning. Of course, things coming naturally is no guarantee of being right.

Conditioning that warrants competence rather than prejudice is catalyzed by science. Science is the only way that “gut” feelings, about something as complicated and dangerous as chronic illness, can evolve into useful intuition. Folks who are conditioned to respond to the body’s needs do it correctly if their responses express health acumen. Otherwise, they just have a dumb hunch, like the orangeman had about hydroxychloroquine.

This is why Diabetes Agonistes is built on a core of scientific knowledge about human metabolism. The core is manifest in a dynamic, user-controlled model of homeostasis, caving to metabolic syndrome and further eroding, like a dyke crumbling before a raging sea, into diabetes type 2.

But the regular folks who take up Diabetes Agonistes will never see that dynamic model, will not be aware of it unless they read the backstory, and will not think about it as they fight for their virtual lives. Yet everything they experience in the interactive entertainment will abide by the model. The competence that emerges from their active engagement with fantastic demons in the game will accord with science, will come naturally from autonomous healthy choices, and will stand up to opposition when it enters new contests in the real world.

Why may Diabetes Agonistes fail if it becomes something other than frivolous entertainment? The reason is simple. It would lose its audience if the audience even suspected it of teaching or preaching. Not because those are inherently bad services, but because they have little or nothing to do with folks gaining control of their own body and health.

Diabetes Agonistes is the kind of learning that empowers lots of people do to what they want, if they want, when they want, the way the want, and still wind up making the healthiest choices for themselves. In other words, it is nothing other than entertainment.

Scientific entertainment. Morgentoilette (1841), by Christoffer Wilhelm Eckersberg. An asymptomatic woman prepares to socialize while antibodies keep her dangerous pathogens in check.

Outcomes

What are the outcomes of Diabetes Agonistes?

WHO states that “health promotion enables people to increase control over their own health.” I unpacked their statement for Humaginarium like this: Diabetes Agonistes enables naive adults to increase control over their chronic illness.

Notice the use of that subtle word “enable.” It means that health promotion itself doesn’t control anything. It’s neither a drug nor a dictate. It merely qualifies people to exercise control, on their own, under certain circumstances, if they choose to, until they don’t. Qualifications may be conceptual, rhetorical, even technical skills, fired by greater knowledge and resolve that promotion may catalyze, but not deliver fully baked and ready to use.

In other words, people themselves increase control over their own health; health promotion only gets them started.

This makes isolating the outcomes of health promotion a bit more complicated. Outcomes are changes brought about, differences made, measurable results and impact accomplished. As a program of health promotion, what are the outcomes of Diabetes Agonistes?

They are, in a word, competence. That’s the ability to make and stick to healthy choices. But hold on, how can anybody make healthy choices unless they first understand them? Must they study, randomly guess or even delegate them to others? And how can they stick with choices they made unless they understand consequences? Must they follow rules, be nudged, form habits? None of these sounds like an option for highly effective people.

Stephen Covey famously wrote that highly effective people “Seek First to Understand, Then to Be Understood.” That’s both a rule and a habit, so maybe it’s not an appropriate reference here, but people who don’t sport an orange hue generally agree that no problem can be solved before it’s understood. That ain’t rocket science but it is a foundation of laboratory science and clinical medicine. Seek first to understand chronic illness, then be understood as an individual who has one. Axiomatic.

Still, understanding gets only lip service in health promotion I’ve looked at — and why not? It may seem impossible for regular folks to understand physiology, biochemistry, molecular biology, genetics and other aspects of human metabolism involved in Diabetes Agonistes; but understand they must in order to be highly effective people. Even language that describes metabolism sounds and looks like totemic argot. Can Joe and Ms Sixpack ever become interested in such an obscure and erudite process inside the body, even though the process makes them healthy or sick or ends life prematurely, depending on things the Sixpacks can’t see or touch or make any sense of? Better not to try; just nudge the simple folks to their purportedly healthy choices.

That’s a terrible idea and not because it’s never been tried. It’s always tried. Most health promotion treats understanding as optional, even superfluous, while favoring compliance and adherence. Tell ‘em what you’re gonna to tell ‘em. Tell ‘em. Then tell ‘em what you just told ‘em. If patients with poorly controlled blood pressure or diabetes type 2 got a nickel for every time they’ve been told to eat fewer carbs, get plenty of exercise and take their medicine, they (instead of their physicians) would be seriously rich by now! And yet morbid metabolism is still rampant and there are no signs of abatement.

The reason for that is obvious: instructing and nudging are not replacements for understanding. Seek first to understand means delay those healthy choices until you really know what they mean and then make one that you can — nay will, desire to live with.

The outcomes of Diabetes Agonistes are, in a word, competence. Ours is health promotion that doesn’t look down on people, but looks up to them for thought leadership; that doesn’t ask them to learn stuff they can’t understand, but makes them understand before they realize they’re learning; that doesn’t tell them what to do with their body to be healthy, but asks them what they want to do with their sovereign body and what they actually will do; that doesn’t define physical reality as a biometric paradigm, but kicks physical reality down the stairs and replaces it with wholesale shameless fantasy (wish fulfillment); that doesn’t portray patients as victims, but honors them as warriors and heroes; that doesn’t reward them for passivity, but compliments them for chutzpah; that doesn’t coddle them as though they were morons renting space in their body, but challenges them because it knows they are the smart owners of their body; that replaces nescience with scientific health literacy for actually making healthy choices that also make perfect sense; that allows them to ask why instead of always showing them how, even if it takes a lot longer to get there and the final destination is less than ideally perfect.

I can say this about Diabetes Agonistes because my words are consistent with what WHO recommends: that people themselves (not their delegates) may be able to control their own health better, but nobody nobody nobody can do it for them. Exercising more control without being forced or pinged or supervised or digitally assisted is their responsibility. They can fulfill it only one way: with competence.

As health promotion, Diabetes Agonistes works in the interstices between professional domains of practice, policy and education. This is a no man’s land of nescience. The gap there between knowledge and actual behavior may be infinitesimally small, as it is with virtuoso musicians and professional athletes. They almost always perform well and there is little noticeable difference between what they know, what skills they have, and how they perform. But most of us are not virtuosos of the body. We require tons of practice to get it right even some of the time. Diabetes Agonistes provides hours of opportunities to practice.

WHO continues: “People need to acquire the knowledge, skills and information to make healthy choices.” That’s true, I agree, and Diabetes Agonistes does grow knowledge and skills while presenting information in a phenomenal computer model. That said, WHO left out something very important when it comes to health promotion for people with chronic illness.

What’s missing goes by various names: ambition, conation, motivation, self-determination, drive, grit, passion, courage, resilience. No matter what we call this thing, if we don’t make it a priority, then health promotion is bound to fail (as most of it already does, demonstratively).

Diabetes Agonistes will probably succeed because it never tells people what to do or think. It lets them figure that out for themselves, in playful activities that are utterly, indubitably enchanting.

Masquerade

In Humaginarium everybody wears a mask.

Wearing a protective mask is a cardinal rule for avoiding and preventing the spread of Covid-19. Refusing to wear a mask is a cockamamy badge of libertarian courage. We may choose the wearing in order to conserve health and well-being, or not wearing as a privilege of personal freedom, or lazily decide nothing and go with the flow (if you want, whatever, fuggedaboutit). Options 2-3 may be the most popular in the United States during this pandemic, as indicated by tragic health statistics and my personal observations of Joe and Ms Sixpack in the heartland.

Of course any resistance to masking is ludicrous. Masks are just materials that cover the face; and the less we see of some faces (e.g. orange ones), the better! Covering the face is what many people do every normal day at work, in sports and weather, with cosmetics, coiffure. fashion, and also on special occasions like Halloween and bank heists. Masks are useful, sometimes attractive; they don’t challenge habits and lifestyles or interfere with work or play or even sleep. To refuse to wear a mask for the sake of conserving health (yours and others) isn’t courageous in any sense of the word; it’s stubborn, selfish and stupid. That kind of dull, intransigent behavior is fairly common when it comes to health (e.g. resistance to medicine and proper nutrition), so we’re accustomed to it, but that doesn’t make it right.

For hundreds of millions of years, masks have evolved in nature for protection, disguise, self-expression of animals and plants. Homo sapiens have never grown masks on their bodies, of course, but we started crafting them for ceremonial and practical purposes in the Iron Age, tens of thousands of years ago. Our oldest extant masks were fashioned by ancestors in the Judean Hills near Jerusalem, about 7,000 years before Christ arrived there. In ancient historic times, participants in Greek bacchanalia, Roman saturnalia and medieval carnivals donned masks; likewise today’s revelers at Mardi Gras, the Carnival of Brazil and countless other festivities wear brilliant costumes including masks. They love doing it!

Humans are fond of masks because they enjoy pretending to be something or somebody else. It seems to take a load off! Creative pretense involving masks gives pleasure, makes meaning, does magic, creates illusions, enhances beauty, produces power and advantages. We masquerade in order to escape mundane reality and replace it, for a while, with a contrived fantasy. We do this to see ourselves, not as we are in mirrors, but in dreams where we drive a Batmobile or leap over tall buildings. That’s why masks have purportedly played a crucial role in understanding “what it means to be human.” They facilitate escapism and catharsis, which are also two major benefits of Humaginarium.

In fact Humaginarium is health promotion masquerading as interactive entertainment. Meaning: it’s a thing pretending to be something else. In order to deceive? On the contrary: in order to reveal complicated, difficult, unpleasant yet vitally important truth. To the Sixpacks of course, and others.

Those who choose to attend masquerade balls hosted by Humaginarium in the cloud get to escape into fantasies of adventure and exploration of the world within, the world every human being creates and sustains and sometimes suffers, every single day of their lives. It’s a world so large and dynamic and awful and mysterious and elusive and beautiful and threatening and comforting that it boggles the mind, until the mind urges retreat, thinking “this cannot be, this fantasy is bewildering and false.”

The rational mind, when it thinks that about any fantasy including ours, is incorrect. The actual world within truly is as vast and intriguing as the Milky Way, just as present to our senses, even more accessible to our understanding. That’s why Humaginarium hosts creative expeditions there. There is so much to discover and celebrate and use.

Folks who thrive on fantasy in Humaginarium also have a dream that governs their choices and decisions and helps them persist even when the challenges of simulation seem insurmountable. Their dream is to leave behind the dreadful chronic illness they had when they entered. Not to be miraculously cured, only to be free and proud and in control for once and in their minds forever.

A masquerade is precisely the right way to do this, though it is never otherwise done in healthcare or health education. When Joe or the Ms arrive for a medical appointment in the real world, they never wear masks and neither does clinical staff. From start to finish of their helpless, hapless, horribly expensive visit, they listen carefully to diagnoses they don’t understand, prescriptions they won’t take and instructions they won’t follow. That unfortunately is their sad reality.

In Humaginarium everybody wears a mask. Everybody is free and empowered to explore what it’s like to be something or somebody else, for a while: what it’s like to be a happy human being whose perfect body is healthy and strong because they themselves decided it must and it shall be.

Disparities

Because they look dissimilar they are pronounced inferior.

Diverse, or disparate, that is the question. We prize the former, we loathe the latter, and yet they mean much the same thing. They mean different, dissimilar, distinct and distinctive: self-contained, unlike others, “not me,” us versus them. Diversity in a biological or sociological sense is a presumed source of strength. Disparities are signs of weakness or vulnerability. Regarding health in particular, disparities are cumulative indicators of morbidity and premature death. Most of that preventable or avoidable or treatable in theory; in reality, not so much. Why, and how is that?

I think it’s because diversity connotes a balance or blend of differences that yield an efficient system and process. In biology, for example, the microbiome within our bodies is very large and diverse, such that most of our cells are not even human; yet contained by the body as they are, they boost resiliency and vitality. Our existence and authenticity as Homo sapiens depend on the active participation of other organisms within and upon and around us. They are not us, they are different from us, yet they make us whole and keep us well.

Disparities do not make us whole. Just the opposite: disparities fracture and fragment, exaggerate our differences, hobble our ability and desire to function competently, turn our distinctions into antipathies, belittle or marginalize some of us for the benefit of others. In biology again, disparities manifest in racial characteristics that are just plain human, as human as anything else in the body, yet because they look dissimilar they are pronounced inferior.

Diversity builds us up as individuals (healthier, wiser, more competent, nicer) and as a species (social, adaptable, empathic, industrious). Disparities push us down and tear us apart by making individuals alienated, suspicious, stupid, aggressive towards others who are different; while clinging manically to rogues who seem more like ourselves.

Back to the question: Why do we prize diversity? Because diversity is natural; it is evolutionary; it is progressive; it is liberating; it affirms the bounty of life. Diversity is self embracing non self and engaging rather than exploiting the differences. The engine of diversity is Eros, or love. We are diverse when we love our neighbors as ourselves though they are not ourselves, they are different. Why do we loathe disparities? Because disparities are unnatural, arbitrary, ugly, toxic, malevolent, egotistic, vicious, futile, unnecessary. The drivers of all disparities are pride and greed.

Yet health disparities are so pervasive that they practically run the healthcare industry and the government that regulates it. Health disparities are the twisted distribution of health outcomes resulting from social rather than biological determinants. The obvious determinants are race, ethnicity, income, community, food insecurity, risky behavior, local medical incompetence and malfeasance, medication noncompliance. Far more damaging determinants are health illiteracy and learned helplessness: the inability of people to understand their bodies enough to care for them without medical supervision, and their unwillingness to try. In other words, the origins of health disparities are mental: ignorance, foolishness, bias, resistance to change, irresponsibility. The things that Humaginarium was born to mitigate.

Such social determinants are not baked into Homo sapiens; they are concocted by policymaking and economic interests. Why? Because they cost some of us nothing to ignore and they support a $3+ trillion industry that makes a good profit from sickness. Literally. Do not for a moment believe that the business models of healthcare promote health, because they don’t. They promote treatment, which unfortunately has such a random correlation with health that I doubt it is statistically meaningful for most of the population. Treatment correlates closely with economic measures, not with health outcomes. Our civic response to Covid-19 demonstrates this, but my point about disparities doesn’t need a crisis to stick. All it requires is individual experience of routine medicine in normal times.

Diversity is good, but we lack it because we are too damned prejudiced and self-interested to promote it. Disparities are bad, but we tolerate them because they reinforce injustice that benefits some individuals at the expense of others. What to do?

Whether ’tis nobler in the mind to suffer
The slings and arrows of outrageous fortune,
Or to take arms against a sea of troubles
And by opposing end them.

We are all swimming in that sea of troubles these days, some wearing life vests, some clinging to soggy boards, others floundering and going under. Taking up arms is a tough call for people who shoulder the most severe disparities. Most of them have little leisure or means for nobility in the mind.

Yet there is something awe-inspiring about that refrain, “No Justice, No Peace,” echoing in the streets and perhaps one day breaking down the doors of our clinics. Each of us in their own way, we must “end the heart-ache and the thousand natural shocks that flesh is heir to.” We can start by hallowing diversity rather than giving it lazy, mindless lip service, and ending disparities even if there is no investment-grade case for doing so.

Equity

Health care for Americans is a privilege, not a right.

What is equity? Equity is the experience of justice: of treatment or behavior that is fair to all concerned, without bias or discrimination towards any. Health equity is likewise the experience of justice, in this case regarding access to clinical care and the achievement of medical outcomes.

Heath equity doesn’t guarantee “good” outcomes. Outcomes are only as good as medicine can make them under circumstances that medicine doesn’t necessarily control. After all, most illness is caused and complicated by genes, behavior, culture, environment and chance. Heath equity doesn’t excoriate those causes and complications. I think it’s vital to acknowledge that justice per se doesn’t make anybody well. It just levels the playing field. Outcomes depend more on the hands that individuals are dealt in life and how their cards are played.

Because of extreme economic and racial disparities, there is less health equity in the United States than in any other industrialized nation, or even in many developing nations. Health care for Americans is a privilege, not a right. The privilege entitles individuals to varying standards and quality of care based not on medical science but on social determinants like their ability to pay for diagnosis and treatment, the communities where they live, the benefits offered by their employers, the constraints imposed by their health insurers, their level of education and their race. Health care for Americans is a privilege, not a right. We get only what we pay for, not necessarily what we want or need; and not necessarily what cures or heals.

Take for example Thomas McKeller, a young African American elevator operator in Boston just after the Spanish Flu pandemic slaughtered 675,000 of his fellow Americans. By virtue of his race, socioeconomic status and lack of health insurance, he had access to inferior, substandard health care even though he was within walking distance of one of the best hospitals in the world (Massachusetts General). Contrast McKeller with John Singer Sargent, the eminent society painter whose portrait of McKeller is “humagined” at the bottom of this page. Sargent had access to state-of-the-art care in Boston or anywhere in country he needed it. Both men were Homo sapiens: specimens of the same species and endowed with the same biochemistry and physiology. Yet one was far more likely to contract, suffer and die from illness. Not because of medicine, but because of injustice. Their society lacked health equity.

Health inequities common in the early 1900s are still common a century later. This was brought into startling contrast by Covid-19, which has infected and killed our McKellers far more than our Sargents. The same was true of other maladies before the current pandemic and will likely still be true a hundred years hence. Why? The reason is mostly the disparities previously mentioned. Health care for Americans is a privilege, not a right. Health care in the United States is an industry that for sure exists to create equity, just not health equity. It exists to create the equity known as shareholder value.

That kind of equity is the experience of wealth, not justice. That kind of equity is what Donald J. Trump had in mind when he said that the murdered George Floyd was having a great day. The unemployment rate had dropped slightly and more importantly the stock market indices had inched upward. Trump’s wealth had increased, therefore Floyd can be happy in heaven. He did not die in vain.

It is easy to recoil from the obscenities of Trump in disgust, but hold on. Isn’t his exuberance what most of us feel and even say when it comes to health care? Americans have some of the worst health care and health insurance among all advanced economies, but our providers and insurers are among our most valuable corporations. The industry that produces inequitable outcomes is also fabulously wealthy. Coincidental? I don’t think so.

American health care thrives on inequity. Its business models, from hospital corporations to big pharma, earn revenue and profit from sickness and death. That being so, we must not expect “big structural change” any time soon. Health equity is a good idea, for others, but it will not make America great again.

What will? In my opinion, not the profiteers and their minions. Health equity may increase as people become smarter about their bodies, have more health literacy and health acumen, gain more control of their spend and outcomes. In other words, things may improve when folks can take better care of themselves and rely less on the medical-industrial complex.

That is the foundation of Humaginarium’s business model. Health equity is baked into our technology and philosophy. Our customers — our McKellers and Sargents — will benefit the same from what we do and no industry mugwump is ever going to change that.

Scientific entertainment. Nude Study of Thomas E. McKeller (1917-1920), by
John Singer Sargent. McKeller, a rare African American subject of society portrait painting, is pictured here with neurons that are exactly the same for all races.