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.

Mechanics Redux

Adventure is agon. Not merely fighting, but fighting for something that matters.

Mind Mapper. Experience in the morbid frontier is enchanting, intriguing, dangerous, bewildering. As a meaning maker, your job there is to filter experience for things that matter – things you can use – and relate them to an obscure metabolic condition that is ominously unfolding in the shadows. Like an archeologist, you interrogate each shard you pull from the biomuck for the story of what it is, how it works, where it came from, what it wants and why. The shards are tangible things with familiar, physical properties; moreover they are metaphors for other tangible things that were beyond your ken before Humaginarium: atoms, molecules, cells, tissues, fluids, organs, mechanisms. You capture their stories with the aid of dynamic mind mapping. This is the visual equivalent of “mapping sentences” that distill coherence from a churning chaos.

Dorian Gray. Users in the morbid frontier are not told what to do or forced to do anything. They do what they want in light of self-interest; which means, whatever it takes to win. Most users will do anything to win, yet their moral and intellectual lights are dim to begin with; and they lack wisdom to make good choices intuitively. So they wind up making and having to cope with bad decisions and failures. How does that affect them? The way crime affects Dorian Gray in Oscar Wilde’s novel: by scourging the alter ego. Users who do bad things for the sake of quick wins – such as skirting or accommodating rather than confronting and controlling morbidity – may appear outwardly heroic, but they are wounded warriors in Diabetes Agonistes. They can eventually heal their wounds by atoning (changing, compensating) before it’s too late; or allow wounds to fester and settle into disability.

Monsterography. Maybe the worst thing about chronic morbidity in real life is transparency. You can’t see, hear or touch this disgusting thing that’s inside you, but is not you. You feel it when it flares, but even when that happens all you can see and hear and touch is not disease, but the tracks that disease leaves on your flesh and psyche after the ravages. The physical evidence indicates that your body itself is the disease: the perpetrator rather than the victim. You blame the victim for your pain and suffering. You’re revolted by your own body that is relentlessly harming you. You fear, you’re angry and you deny the body the way a prisoner despises a jail cell. “What have I done to deserve this? My body hates me.” But unlike life, in Diabetes Agonistes morbidity is not transparent. It appears as it feels: monsters in the body, but not of the body. Horrible monsters that you can more than revile: you can, if you’re clever, destroy them without ever mistaking them for the world they occupy. Monsters here are personified, parasitic, repulsive chronic diseases that users capture and kill while the godlike body lives on.

Combat. My game mechanics stress cognitive and emotional affordances. I want users to perceive and think their ways through challenges, not randomly shoot them down like snipers in a carnival booth. “Nice shot, lad! Here, have this worthless trinket as your reward.” I daresay I’m bored by meaningless kinesis in play of any kind including video games; and I believe that many adult players feel the same way. We want adventure much more than effects; and adventure by definition is purposeful risk-taking. In most play and in Diabetes Agonistes in particular, adventure is experienced as agon. Not merely fighting, but fighting for something that matters. That something – here and now – is wellness. The fighting that wins wellness is tense, noisy, horrifying, vicious, calamitous, brutal, raw, hopeless, heroic. Fun for its own sake, yes, but these many fights accrete into an epic struggle, a true adventure. Humaginarium rewards wins not with trinkets but with tokens that reinforce users for later, harder, nobler existential challenges.

I have a few other core mechanics for this post, but instead I will end with a reminder about context. Diabetes Agonistes is a simulation. It’s a system simulation of physiology and biochemistry; it’s also an experiential simulation of health literacy tempering medical self-efficacy. As a game simulation, interactivity is maximal; passive displays are minimal. Several times a minute during hours of play, users must ask themselves and the game tech: “What is this? What does it mean? How can I use this? What should I do?” Simulation then is our ultimate game mechanic. The faithful, behavioral representation of how chronic illness manifests inside the human body. Damn hard to get your head around, and incredibly fun to try.

Mechanics

Health may be a human right for others, but you’re going to fight for it.

Users cross the morbid frontier with a plan, a map, a wallet, provisions and a cache of clues. They have a tough job ahead in Diabetes Agonistes. Seize the minions of chronic illness! Reclaim the birthrights of strength and safety! End the pain; end the suffering; end the fear of your own body!

Whoa, whoa, not so fast. Everything you try in this godforsaken fantasy will be challenged or opposed. What you see and feel is a fraction of what’s actually there; and much of that is out to get you. So be careful.

The minions you’re chasing are feral, ugly, numerous, devious, nuanced, complicated and uncannily intelligent. They’re thriving like a nest of vipers while you gingerly probe their squirming skins. When you grasp one it may throttle or bite, or emit begging sighs that lure you inward or downward, but probably not onward. After all, you want to live strong but the minions of chronic illness frankly want you to die. They might go so far as to kill you! It’s not hopeless though. Their crushing powers to confuse and depress may yield eventually, but not to chemical or nuclear weapons. Only to insight tempered with rare, gemlike passion you store in your heart for this quest. Health may be a human right for others, but you’re going to fight for it.

There are structural mechanics in the morbid frontier. By that I mean programmatic activities. Remember you’re in a video game now where NOTHING happens unless you trigger it. The good news is that your path is packed full of affordances. They are the logical, functional, evocative, riveting means to your ends. They’re also symbolic and deeply disturbing. Purpose-built to ignite learning and motivation. In the morbid frontier, everything you’ll do to overcome The Problem inflames your own personal desire to learn and go farther, and accomplish more.

Let’s begin to envision the game mechanics of Diabetes Agonistes.

Trusted Advisor. You may traipse solo through the morbid frontier, if that’s your style; or bond with a droid who has special powers. To interpret clues, weigh choices, fabricate tools, detour into branches, avoid pitfalls, barter, negotiate, interrogate, assassinate. All handy services, but beware of friends. Droid talents and loyalties are time and place dependent, devilishly restricted. You won’t know their limits until you test them; and you won’t be able to test a droid until you badly need it. You must learn when to fire and replace trusted advisors before they steer you into deep shit.

Meaning Maker. You may journey through the morbid frontier for the fun of it, as though it were some grotesque carnival. That would be thrilling and satisfying, but not winning. To win you must continuously make meaning from your experience. The meaning you make guides you onward, makes you more resilient. Emerging knowledge gradually transforms you into a master of fate. Take note of this. Diabetes Agonistes doesn’t teach you; it teaches you nothing. You force the quest to reveal truths that you can use. Making meaning is like fetching the key that turns the lock, from a ring of glittering duds.

Highways and Byways. You enter the morbid frontier with a map. Unfortunately, the map is a character with a quirky personality, a hidden agenda, and is somewhat unreliable. It doesn’t show you which way to go; doesn’t show all the ways to go; it merely indicates topography and suggests possibilities. You interpret the map, filling in gaps with your intuition and discoveries. You treat the map as a data store rather than a bundle of insight. You filter it for wisdom while suspecting it may be lying to you or mistaken. By improving the map in time you will gradually become a skilled cartographer for higher, more difficult levels of the morbid frontier.

Profit and Loss. You carry a digital wallet, starting in the Arcade and throughout Diabetes Agonistes. The wallet is initially stocked with enough capital to float your quest; but not enough to complete it. The wallet holds identity cards, credit cards, biocurrency and tokens that have specialized uses and surprising half-lives. In the morbid frontier you draw down this capital to pay for provisions and clues, bail, gadgets, services like protection, ferries and contract kills, healing balms and magic incantations. You may replenish your capital by earning rewards, trading objects, robbing minions and their bosses, ransacking their troves, trading on the Metabolic Exchange. The wallet is your permanent and personal property. It goes with you when the game is over and you’re on to a new quest in Humaginarium.

Are there more mechanics than these I’ve just shared? Indubitably. I want to keep writing about them. I’ll resume in my next post.

Morbid Frontier

This frontier is a newfangled transubstantiation of the body.

The exposition of Diabetes Agonistes turns on goal-setting, surveillance, and discovery of The Problem – by users who are going to experience and try solving it. In the real world The Problem is called metabolic syndrome – a nexus of chronic illness including diabetes mellitus type 2. In the fantasy of Diabetes Agonistes The Problem has no name. It’s an ominous presence, an irresistible force that manifests metaphorically, visually, dramatically as a vague, existential threat. More suicide bomber than complex medical condition.

Up to this point, users have glimpsed and probed the borders of a frontier full of hazards and portentous implications. They’ve observed and gathered biological phenomena that eerily materialized before their eyes – each unpacking different clues and warnings about what lies ahead in a quest. The clues suggest where and how The Problem may be found, observed, engaged. Warnings promise enrichment and fun to “all ye who enter here,” while darkly insinuating ambush and horror for hapless adventurers.

The frontier I’m talking about is a new transubstantiation of the human body. Rather than body into wafer, this is body into earth and sea. The frontier is underpinned by computational models of physiology and biochemistry that we’ve exploded and reorganized, reshaped and robed as a chronological, three-dimensional space like Eä and Arda and Middle-earth. Those dreamscapes are symbols of nature at every level and civilization in every moment. They are make-believe geography and history that were created to be explored, claimed and defended by questers pursuing salvation and truth along with victory and peace. Somewhat like the mythos of yesteryear, our new biological fantasy evokes metabolic structures, forms, content, mechanics and processes of a diseased human body; not as a body per se, but as a world that users bravely traverse and strive to master.

A typical user enters this frontier by choosing among three trails that present different perspectives on The Problem. Each trail attracts a different kind of user, but all lead precariously to the same endgame.

The first trail is elemental. It winds through the biochemistry of a metabolically disordered body at its least visible and experiential; its most enigmatic and elusive. From the elemental perspective, the constituents of metabolism have existed for billions of years – since life on earth began in the primal slime – and will continue long after their human hosts have departed. They are like the Valar. They make human life possible; they can sustain or end it in a snap; but all the same they are woefully indifferent to it. Their concern is all life, not human life in particular; and their fate is not bound to ours. This is a molecular agon.

The second trail is combinative. It makes its way among microbial tribes of the afflicted body, populated by wholly formed and determined agents who have unique personalities and life stories. Some tiny organisms are virtuous, others malevolent; some are brilliant, others mechanical; some are empathetic, resilient, capable of serving the greater good; others selfish and moronic, having little on their minds beyond the next meal and procreation. Neither immortal nor transcendent, they persist as long and as well as their tribe does; causing or enduring metabolic disorders and maybe overcoming them alone or with help; but rarely able to survive far from home. The whole of their population is equal to the sum of its parts. This is a cellular agon.

The third trail is civic. It cuts across the anatomy of an unwell body in which relations between tribes are modulated by rules, authorities, competing interests and economic pressures. The actors encountered here are systems rather than molecules or cells. When they are not disoriented by morbidity, they rest in balance and harmony: the endgame of homeostasis. However they are extremely vulnerable to attack, and in defending themselves these organs, tissues and fluids may spiral into conflict and chaos that end badly. This is a physiological agon.

Three trails through one frontier, with discrete beginnings but myriad links, dependencies and interferences. No matter where users begin, their quest ranges through all, interweaving their bewildering and frightful perspectives. What will it be like to play on and in them? That’s for my next post.

Quick Wins

She tries to do the right thing and she counts on quick wins to hold it all together.

I’m observing a typical user of Diabetes Agonistes: a woman in her mid-30s, perched on the lower rungs of the middle class; a little large she is with high blood pressure and sugar. She’s attractive, gregarious, restless when she isn’t busy, dreamy when she has time for herself. Years ago she finished high school and landed a sales job in the local mall; now she’s a merchant. A single mother whose days are stretched to the breaking point; but to her it feels heroic. She works hard, plays nice, is conscientious about her family and customers. She reads little for pleasure, but has her favorite shows and podcasts. She tries to do the right thing even when that isn’t easy or obvious or cheap, and she counts on quick wins to hold it all together. Quick wins are also why she plays video games, most days for an hour or less; in the train on the phone, at home on the computer. Her favorite kinds of games stymie her as much as life sometimes does, but they also throw off hot sparkling bursts of light, the crackling noise of walls collapsing, the thrill of snatching well-earned victories from the jaws of near defeat.

She heard about Humaginarium from a boyfriend. He said it’s pretty cool, “but you might not go for it because it’s gory.” Pretty cool as in really nice looking, gory as in bloody; yet no gratuitous violence, and that detail got her attention. She’s bored by dumbass shooters and bosomy warriors. It’s free, he added; it streams so it starts right up, no downloads, hardly any latency. “It’s different from anything I’ve ever played,” he allowed, so maybe she’ll have a look? He got into it two weeks ago and he’s still working through the first level. “Damn thing reminds me of Jules Verne” – 3D science fiction fantasy, clue-finding and brainy calculation, mysteries locked in enigmas that are supposedly true – TRUE – “as the human body itself.”

Her eyebrows went up when she heard that. “The human body? Is it a sex game?” He pondered, “actually more sensuous than sensual.” She wasn’t sure what that meant and neither was he. “Rated M, not A.” Okay, good enough!

One night after brushing her teeth she entered Humaginarium in a browser on her laptop and soon found herself wandering a fabulous Arcade. It was confusing and disorienting, yet funny. “Like I’m Alice in Wonderland,” she mused, “or Spirited Away” as she watched and touched things that seemed to have minds of their own. Lots of colors and movement, fractal images and eerie sound effects, curious linkages that eventually made her suspect something was going on: it wasn’t just random game mechanics. She was witnessing the “miracles” of birth, growth, decay and death of the body as though they were magic shows. They helped her form mental models of wellness that are religion in Humaginarium: things to adore and believe in. A firm grasp of wellness finally unlocked a portal into a different and strangely hidden world, one fraught with danger and mystery yet irresistibly beautiful; the hidden world of morbidity.

She wanted to stop right there, not because she wasn’t curious; she was actually intrigued. But over an hour had passed as she explored the Arcade and turned that lock in the portal. It was past midnight now and her alarm clock was set for 6:00 AM. She wondered, “what will happen if I just stop?” Would she lose everything and have to start over? “This is ridiculous, it’s just a game,” and she decided to exit. Before closing the app asked, Do you want to keep your Humaginarium Key? “Sure, why not? What for?”

The next day on the commute to work she had a few minutes to spare, so she started Humaginarium on an iPad. “This won’t work,” she murmured. Wrong! It worked just fine. The app retrieved her Key from Dropbox, authenticated her identity, and transported her right back through the gates of … what … Heaven? Hell? It’s fun is not knowing which. On the other side of the portal she learned she has to quest. She can start right away and collect greater honors and rewards for speed. Or she can slow down a bit and learn before she leaps. She didn’t have time to decide. As the train approached her stop she had to exit.

Sadly she didn’t return to the game until the end of the week, for reasons that have nothing to do with this history. When she regained her previous position in Humaginarium she watched a quick replay of everything that previously happened to her. Now she was ready to forge ahead. She spent an hour collecting raw intelligence about her adversaries and allies in this weird biological fantasy. When she had enough of that, she entered a path that led to…. We’ll find out where in my next post.

Scientific entertainment. La Baigneuse Valpinçon (1808), by Jean-Auguste-Dominique Ingres; pictured with microbiota in the human alimentary canal.

Provisioning

Success depends not on what users know but what they discover and use.

This is the game objective of Diabetes Agonistes:

  • Seize the causes of metabolic disorders
  • Confound their powers to harm
  • Claim the birthright of homeostasis

Reminder: this serious objective is met with play, not with study. It’s pursued in a fantasy; not real life. Users solve tough problems on a personal quest through the make-believe. Yes, they will eventually do similar things in their own real life; and they will do it better because they practiced first in Diabetes Agonistes. But I’m not concerned with that now. Right now I’m thinking only about how to play a really good game.

Each of the three jobs I mentioned – seize, confound, claim – is an agon. Each is beautiful and magical, yet difficult and messy. Users who don’t carefully prepare before questing will fail fast and often.

Players who are MDs and RNs – there will be plenty (real and aspiring) among our play testers – may opt to ‘damn the torpedoes’ because they’re confident of their scientific and clinical acumen; they may plunge headlong into the fight to prove they can beat this silly game sim in record time. By design though, they’ll get plastered by adversaries who have even more confidence, and with good reason.

Preparation for questing is necessary and also voluntary. Like everything else in Diabetes Agonistes, success here depends not on what users know but what they choose to discover and then use. It depends on clue finding and strategy. Diabetes Agonistes does not leverage motor skills like an arcade game.

Users who earnestly examine their surroundings for clues soon find a checklist that helps them prepare. The checklist is for provisioning. It helps them acquire and create things they’ll need to survive an agon. A checklist guides individual discovery of things like:

  • Who are my adversaries?
  • Why are they adversaries?
  • What are their powers?
  • Where are they now?
  • Do they morph and mutate or always stay the same?
  • Are they immortal or can they be killed?
  • Who are my allies?
  • What can they do for me now and later?
  • Why should I join this quest; what’s my purpose here?
  • What do I win; what larger difference may I make?

Our principal mechanic for clue finding in Diabetes Agonistes is a metaphor for geolocation. Users can (if they wish) lease a dirigible airship with credits stored in their key. They can steer this airship above a phantasmagoric terrain that elegantly symbolizes human biology and physiology. This landscape is not a funky realistic model of the human body as in most healthcare simulations; it’s not like Lemuel Gulliver in Brobdingnag, or Frankenstein’s cadaver, or a Russian scientist in the movie Fantastic Voyage. Instead it’s an experiential metaphor that showcases metabolism in the human body as a fabulous, habitable world.

Users survey this world from high and low altitudes. They probe it for insights that can be used when pursuing the game objective, but they don’t do that peacefully. Adversaries who dominate the terrain have radar; they sense when their empire is being scrutinized and they don’t like it. The knowledge of others inflames them! Once detected, they do everything they can to capture or kill users who spy on them, knowing that those who escape may come back to haunt them.

In addition to geolocation, users may discover clues in curious containers. Some containers explode when touched inappropriately, others open when gently coaxed; some open freely, others unlock with credits stored in a key; some are unique and can’t be shared, others can be traded. Some are useful and endow users with powers to heal or cure, others are evil and extremely dangerous.

When users guess they have all the clues they need for what comes next, their questing may begin. I’ll describe that beginning in my next post.

Dark Glass

Diabetes Agonistes is more than adventure: it’s also a system simulation of human physiology.

In the Humaginarium Arcade, new users create their own mental model of wellness: a grail most worthy of questing. Each model releases a unique and reusable key to a magic portal. The portal itself is a translucent barrier, beyond which users see only darkly and with longing – like the shadow of death. They can use their key to open the portal, then plunge inward and downward into a labyrinth of exquisite beauty and danger.

The first instance of Humaginarium is a prototype with just one quest on the far side of the portal. Once we decide the best way to make and deliver interactive adventure, that is also edifying, then the far side of the portal will resemble catacombs, starting in a lobby with networked branches that dissolve into mystery. Users will choose branches according to their needs and interests; and for the prospect of challenge and fun.

For now though, the first and only branch is called Diabetes Agonistes. This is an adventure with metabolic syndrome and diabetes mellitus type 2. In the fantasy of Humaginarium, these are not diseases; they are adversaries.

When users arrive in the lobby of catacombs, they are given a job to do: prepare to enter the labyrinth in search of adversaries and their minions. Find and overcome them, and win back the grail that they imprisoned and maligned, maybe destroyed.

Be careful though! Adversaries do not forgive trespass; they come after users who invade their empire. As users put up defenses, they may be out-smarted, out-maneuvered, out-foxed by brainless pathogens, genomic saboteurs, biochemical cannibals and their ilk. Failure in this fantasy is not just an option; it may seem unavoidable.

How do users prepare for questing in Humaginarium? By sizing up their adversaries, probing them for weakness, arming themselves for conflict, ideating a plan that is not utterly hopeless. All of this is possible in Humaginarium because Diabetes Agonistes is more than adventure: it’s also an engaging system simulation of human physiology.

To prepare for engagement, users can hover over that system, like a balloonist over a battlefield, zooming points of interest, soaring higher to avoid detection and attack, dropping surveillance robots or provisions in places where they may be needed in the approaching journey. This hovering is limited in duration and resources. It can be steered and stretched within limits to increase its utility, but it doesn’t obviate the risks and dangers of questing. It informs users about their adversaries but doesn’t weaken or reveal their adversaries’ secrets.

Before this, users left the Humaginarium Arcade with an individualized mental model of wellness. Now they complete their prep for questing with an individualized mental model of illness. They have made ready to play in a fantasy where all hell will break loose.

In my next post, I’ll describe the mechanics of preparation. This is a delicate subject because it is an intensely cognitive activity. Can we keep users pumped for questing while they ponder the fearful unknown, before they meet their first disgusting orc?

Arcade Redux

The overarching purpose of Arcade is to ignite the desire to learn and use health science.

In his magisterial medical history entitled The Great Influenza (2004), John Barry evokes the heroism of brilliant, bewildered and ambitious pathologists trying to identify an emerging crisis in public health that would soon kill around 50 million people worldwide:

And the excitement! Each time a student fixed a specimen on a slide and looked through a microscope, an entire universe opened to him! To some, discovering that universe, entering into it, beginning to manipulate it, was akin to creating it; they must have felt almost godlike.

Humaginarium isn’t a microscope; neither is it for clinicians (though some may choose to use it). Even so, that historic experience of hunting flu virus and its collaterals in 1918 is somewhat comparable to the living experience of trouncing disease in Humaginarium.

Our users are adults who have or risk developing chronic illness and coincidentally enjoy challenging video games. Our prototype application is for consumers who are affected by – or have reasons to be concerned about – metabolic disorder (even if they don’t know what that is and are oblivious to the risks it poses).

It’s important to state clearly and emphatically that users stand to benefit mightily from Humaginarium – but that’s not why they use it. They use it because it’s fun and beautiful and enriching and self-actualizing. “That’s entertainment!” Health and educational affordances are consequential and valuable aftereffects.

Our users stream Humaginarium to large and small screens. They may be in classrooms or clinics when they play, but probably not. More likely they’re at home or work or traveling – just hanging out. They’re keen to play rather than learn per se. However their learning experience is so surprising and engaging and useful that they really won’t dismiss it (as they tend to diss traditional health information and education); instead they’ll relish and likely share and build on it.

Our typical users take their first look (through a digital lens) at a biological universe that beggars the imagination; one riddled with fantastic menace like some seething terrorist underground; one they can safely explore and manipulate and maybe even master if they’re clever and fast and keep trying. Like those antique pathologists striving to rescue humanity from gruesome pain and suffering and sudden death, our users may experience the thrill of victory, the agony of defeat when saving themselves (or their family and community, or their generation) from Morgoth-like powers of organic malevolence. Moreover if I do what I intend with Humaginarium, players may indeed feel “almost godlike” because they themselves are creating the meaning of health and life inside a miracle known as “my body.”

Thanks to historian Barry, I know how pathologists discovered the one pestilential ring that ruled them all back in 1918. They did hard, frustrating, relentless science in labs, clinics and the field. How will users destroy a ring of their own in Humaginarium? They’ll start by getting situated in our Arcade.

The overarching purpose of Arcade is to ignite the desire to learn and use health science (to gain the power of health literacy). That’s the unrivaled albeit unconscious goal of all users from the moment they land on our home page. Without a desire to learn, users will experience our game simulations the way inert marbles experience a pinball machine. We don’t want that; it feels too much like industrial health care.

Imagine then an Arcade that dramatically opens on the first of many self-assembling choice architectures we have prepared: a prelude to the quest for wellness. The Arcade interface is desirable, intriguing, tempting and threatening; shimmering, sparkling, promising and ominous; spatial and fluid like gripping and evanescent dreams. Users gaze on this animated tableau for a few seconds and most likely utter “WTF?”

Their eyes are drawn to a stony portal they can see through to observe wonders, but can’t seem to pass. The portal is a metaphorical cut in a border wall between the real world (where we must live) and a hyperreal world (that we long to live for): a world full of promise and pleasure and despair.

To penetrate the portal each individual must make a magic key that becomes a private and powerful identity and credit card in Humaginarium. Like DNA, that key is unique to each player. It cannot be shared or exchanged though it can be edited. The key is a personal credential for playing and learning in Humaginarium. It works forever and grows in power over time, but it may be forfeited under penalty for unworthy behavior. The key is endowed with tangible and symbolic assets that are useful in play and beyond, on both sides of the border wall.

To make a key, each user dips into three wholesome mini games about biological birth, growth and death. These are visual puzzles that users manipulate in order to become deeply situated and immersed in Humaginarium while generating clues to unlocking the portal. All three pose the question “how”: how is the ideal body born; how does it grow; and how does it die. Content is presented in elementary symbolic rhetorics, not in words. Together the solutions inform a mental model of homeostasis (physiological wellness) that is important for future struggles in Humaginarium. For now the mental model is a grail; it triggers an urgent desire to learn.

Once through the portal, users leave the Arcade behind and enter an agonizing labyrinth – a framework for quest. In the first instance of Humaginarium (our MVP), there is one modular and multilevel game named Diabetes Agonistes. Eventually there will be hundreds. Before proceeding though, users must discover a little about the problems that lie ahead, as they provision for adventure.

I’ll describe that provisioning in my next post.

Scientific entertainment. Variation on Les Deux Baigneuses (1884), by William-Adolphe Bouguereau. Pictured with a micrograph of menstrual hormones.

Arcade

Abandon all hope, ye who enter here, and resolve to fight.

The first component of our model unit is the landing page: an architecture in the Cloud where consumers meet our brand, create a Humaginarium identity and shop our stuff. A few months ago I cluelessly dubbed this the “platform.” A misnomer! Platform means many things but none describes our landing page. The correct word is arcade.

I pause now because I don’t want to be confused with arcade video games, a classic genre that’s big in sports, gambling and amusement. We don’t make arcade games. On the other hand gamers don’t own the notional concept of arcade; they borrowed it from architecture and it’s much bigger than them.

A traditional arcade is an agora under a roof. A place to shop, discover new things, meet people, catch up on the news, have fun. It’s a precursor of the modern shopping mall. Arcades are also engines of culture; places where communities gather and make meaning together. That’s also a reasonable description of Humaginarium: a place where folks make meaning.

Our arcade is a digital environment loaded with things to view and do. When consumers first land there, they gaze upon the front gates of a labyrinth. A fantastic labyrinth that could have been designed by Jorge Luis Borges if he played video games. They stare in amazement and wonder, Why enter this perilous realm? Why not turn right around and find something normal to play? We don’t tell them why; we let them figure it out themselves by messing with curious knobs and handles. Our arcade is a cabinet of curiosities from a world where science and fantasy have fused and formed a strange new dimension.

In the center of the arcade there is a room for viewing video shorts. How short? Depends on the topic, but anywhere from 10 to 30 seconds. The videos are not eye candy, though they’re incredibly beautiful; some funny, others scary, still other puzzling and a little irritating. The videos are interrelated clue dispensers. Consumers who want to try the labyrinth can’t just enter it; can’t buy a ticket even if they want to pay; can’t use a key even if they have one; can’t make an offer or a trade or sign a waiver. Instead they must find clues in the arcade to crack the code and prove their mettle. They must earn the privilege of entering Humaginarium or forever be stuck outside, peering through display windows at magical intimate things that they can’t touch until they get past the gates.

Why would restless consumers “waste time” collecting and configuring clues like this? Some won’t of course, but many will because it doesn’t feel like wasting time. It feels exhilarating! One, because it’s fun; a lot of fun. Two, because it’s intriguing; like a teleport to somewhere desirable and momentous – and free for those who can turn the lock. Three, because it’s useful; promising a weird kind of entertainment that makes people smarter, more capable, more centered, more in control of their most painful and costly challenges. It bestows a gift of unshackled imagination and the freedom to explore the human body as if they were its creator.

Our arcade is a string of amusements that inspire and motivate. The inspiration is a mental model of perfect wellness. The model presents the formation of the body at birth, its disintegration at death, and its healthy progression through life known as homeostasis: an ideal state that’s impossible for any person to ignore and nearly impossible to attain. Worthy not just of study but of quest! The arcade motivates folks to break into a hall of horrors: a labyrinth where chronic illness is waiting to outsmart, outfox, outmaneuver, outlast any would-be hero who dares to enter. Abandon all hope, ye who enter there, and resolve to fight.

Humaginarium is made for heroes who are not endowed with superpowers. Just regular folks who have, or risk getting, a miserable chronic illness that lasts a lifetime in the real world. In the real world these folks may hope and endure and suffer. In Humaginarium they can choose to fight and control or overcome. Truly that’s a fantasy, but for many of the people landing in our arcade, it’s one of the greatest unreal stories ever told and it’s all about real life.

Coming next: a use case that describes what consumers may experience in our arcade.