Healthcare

Changing mental models of health from spectator to change agent.

My focus has been on determinants of health. These are the causes of chronic illness that regular folks can perceive in themselves and their surroundings.

Perceive — at a minimum that means to recognize, but it also means to understand because seeing is not necessarily believing. You need to believe something is true and meaningful before you’re willing to take risks and action.

(Precisely what you do is the raison d’être of Humaginarium. We won’t go into that here.)

Much study and reflection had brought me to a conclusion that the determinants of health occur in four categories. I believed all causes of chronic illness fall into one or more of these, but I was wrong.

One category of determinant is the somatic, which is basically your physiology and biochemistry. The somatic is what you see in the mirror and in body scans like CT and MRI. If you are one of the gamers entertained by Humaginarium, you perceive very little of yourself that is somatic. Instead there is fantasy, memory, or even nothing at all.

Another category is the psychosomatic, which is basically your thought processes and emotions. The psychosomatic includes the rational mind and imagination. It also includes feelings that have little to do with cognition and more to do with nerves and hormones. Most regular folks perceive the faintest glimmer of their psychosomatic self, though many may live and die for it.

Yet another kind of determinant is the social, which is basically relationships, dependencies, culture and community. Social determinants of health are not of you or another; they are all that occurs between you and others; all that makes us valuable or useful to each other. Politics, which makes many of us sick, is a social determinant of health that most can’t fathom, as usual for the category.

I thought that the final category is the environmental, which is basically the space that supports life. Metabolism is the cardinal difference between living and not living, but nobody knows how or why it started. We only know it cannot happen without an environment that sustains it. There are no martians and there never will be, Elon.

Now I realize there is a fifth determinant of health; a fifth cause of chronic illness that is painfully obvious but often overlooked. It is healthcare, which is basically the medical industry. It is your primary and specialty care, medical devices, drugs, clinics, hospitals and god almighty insurer. I hate to say this about an industry that vacuums up nearly $4 trillion a year from our collective human capital, but most of us do not understand this determinant of our health, no more than the other four. We perceive only the faintest glimmer of what medicine is — even when it’s being practiced on ourselves.

Five determinants hints at an analogy with Peter Senge’s five disciplines for creating learning organizations. Let’s see if it works. Here they are:

  1. Personal mastery is a discipline of continually clarifying and deepening our personal vision, of focusing our energies, of developing patience, and of seeing reality objectively.” Check! That’s what Humaginarium does with and for folks dealing with chronic illness.
  2. Mental models are deeply ingrained assumptions, generalizations, or even pictures of images that influence how we understand the world and how we take action.” Roger that! Humaginarium is changing mental models of health from spectator to change agent.
  3. “Building shared vision — a practice of unearthing shared pictures of the future that foster genuine commitment and enrollment rather than compliance.” Our concept of commitment and enrollment is not in an employer health plan, but in the individual sense of well-being that comes with self-actualization.
  4. “Team learning starts with ‘dialogue’, the capacity of members of a team to suspend assumptions and enter into genuine ‘thinking together’.” Our program is 1:1 with and for each individual to become more comfortable in their own skin. That looks to me like a prerequisite for thinking with others.
  5. “Systems thinking – The Fifth Discipline that integrates the other four.”

The Fifth Discipline is the title of Senge’s book and also an organizing principle of Humaginarium. Though we do not create learning organizations, we use systems thinking and dynamic models of health and healthcare for a far humbler purpose. To create learning individuals, one by one, millions at a time.

These individuals suffer with chronic illness that they do not control. We can’t cure their illness, but we can lessen their suffering by helping them perceive how much power they have, and can get, to live better.

I Saw the Figure 5 in Gold (1928) by Charles Demuth, bequeathed by Georgia O’Keeffe to the Metropolitan Museum of Art in New York. The painting is a mental model that illustrates The Great Figure (1920), by William Carlos Williams:

Among the rain
and lights
I saw the figure 5
in gold
on a red
firetruck
moving
tense
unheeded
to gong clangs
siren howls
and wheels rumbling
through the dark city.

Yin and Yang

Does Humaginarium make video games or health promotion?

“Do I have a split personality?” The question may arise when we hold two contrasting or conflicting beliefs, at the same time, and instead of trying to resolve or erase them, we let their differences flourish. Indeed, we may expect benefits from the tension.

There are different ways to perceive a split. On the one hand, we may cringe in the presence of cognitive dissonance, a symptom of unbalance and stress. On the other hand, we may proudly quote F. Scott Fitzgerald, who wrote “The test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function.”

(He wrote function, not prosper. Just making that clear to contrarians in our midst.)

Oxymorons are beloved by folks with a split personality. Take the oxymoron serious games, for example. Games are played, and by definition gameplay is amusing, frivolous, entertaining, somewhat meaningless. A wonderful miniseries, The Queen’s Gambit, weaves an entertaining tale of struggle and conquest by a chess player, but chess itself is just a game. When you learn how to play it, the only benefit is that you now know how to play it.

(The miniseries has other ideas.)

So why pair game with serious, when serious is mindful, thoughtful, analytical, earnest. I once asked Clark Abt, who coined the oxymoron as the title of his book in 1970. He said that his editor came up with the title, it seemed catchy, and he didn’t think more about it.

When Oscar Wilde wrote The Importance of Being Earnest, A Trivial Comedy for Serious People, he had just this sort of oxymoron in mind. As an aesthete of the decadent fin de siècle, he thought a great deal more about it. Ultimately, it cost him his life.

Well then, there are two contrasting or conflicting beliefs whirling through my mind these days, not fatal but nonetheless twisty. They are video games and health promotion.

I believe in both. There’s even an oxymoron that I coined, scientific entertainment, in order to pace Clark and jolt readers or listeners into paying closer attention to my project. So far, I have preserved my ability to function, though I’m still striving to prosper.

So does Humaginarium create video games or health promotion? The answer is, both at the same time. Yes, I know that you can survey the field of health promotion and not find a single video game sprouting in its barren soil. You can likewise survey the video game industry and not find anything that quacks like health promotion. That’s because video games and health promotion have nothing to do with each other.

(Until now.)

While claiming that Humaginarium makes video games and health promotion, at the same time, and expects to benefit mightily because of it, I am challenged every day to put them in order, to prioritize, to say we do one in order to do the other (not the other in order to do the one).

This challenge was a damned nuisance until I referenced it to the concept of yin and yang, or dualistic-monism (another oxymoron): a “fruitful paradox.” Yin and yang are complementary (rather than opposing) forces that interact to form a dynamic system, in which the whole is greater than the sum of its parts.

Thus I arrived at the wheels within wheels of a conceptual breakthrough:

— Video games that are health promotion
— Art that is science
— Play that is work
— Freedom that is limiting
— Pleasure that is painful
— Silly that is smart
— Vulnerability that is strength
— Knowledge that is power

This list could go on. You probably have examples of your own.

The taijitu symbol famously depicts dualistic-monism. I chose a version of the symbol for this post, that reminds us, with markings around the circumference, that yin and yang are not reducible to this and that, subject and object, you and me. Instead it is a vortex of possibilities, in which every inferred possibility is accommodated and allowed to flourish. It is all-inclusive and balanced.

Not coincidentally, the quest of Humaginarium is for balance, or homeostasis. We are not trying to make sick people well, we are trying to make them happy. That may be the germ of our ultimate oxymoron.

Tai Chi Pa Kua Tu, the diagram of Tai Chi with Eight Trigrams, from Wikipedia

Literacies

Hey you, WHO, CDC, OECD: go stuff your endless texts!

There are many kinds of literacy. One that we all recognize is the ability to read and write in a native language. The average adult literacy, of that kind, in the United States, is utterly abysmal.

So bad, in fact, that health information should be written at no higher than an eighth-grade reading level (13-14 years old). That’s according to the American Medical Association, the National Institutes of Health, and the Centers for Disease Control and Prevention, as reported by Wylie Communications.

You might say: it is what it is, we do the best we can. But publishing health information, at the level of younger adolescents, is bound to reinforce health inequities. The reason for that? Even when information is dumbed-down thus, about half of all adults still won’t understand it. Not because they’re morons, of course, but because they lack reading skills.

This is a problem for anybody who produces health information, health education, or health promotion. Those are three pillars of self-determination, for controlling and improving health. They are meant to empower people. Problem is, most of what gets published under those headings is text. It must be read rather than watched, heard or experienced.

Ergo: no read, no learn; no learn, no improve.

There’s an additional problem for those who have proficient reading skills. Shown text that is written for juvenile eyes, they are more than likely to be bored. People tend to check out when boredom occurs. They don’t pay attention. They don’t engage. They don’t learn.

If we add the 50% of the adult population, who can’t understand the basic text of health information, with the 15% of the adult population that gets bored reading Golden Books, that leaves only 35% in the crosshairs of epitomic health information, health education and health promotion. No wonder the pillars are wobbly!

(Literate persons reading this may have noticed that health care is not listed as a pillar — for obvious reasons, to anybody who has received health care on a regular basis. It doesn’t empower through self-determination. Just the opposite, with rare exceptions. For better or worse, usually for worse, health care is a system of command and control.

However, I digress.)

The ability to read and write is a foundational literacy. It must be present in order for other literacies to flourish. Two others that are particularly important to Humaginarium are health literacy and scientific literacy.

According to the World Health Organization (WHO), health literacy is the ability of individuals to access, understand and use information in ways which promote and maintain good health.

According to the Organisation for Economic Co-operation and Development (OECD), scientific literacy is the ability of individuals to engage with science-related issues (including medicine), and with the ideas of science.

Each of these definitions, in their contexts, requires proficient foundational literacy to understand. The language is tortured. But for me they refer, somewhat allusively but inevitably, to reading skills: in one case, reading the rhetoric of medicine, in the other, reading the rhetoric of science.

Professionals spend decades in school and training, acquiring health or scientific literacy. And the 85% of adults in the United States, who have less than proficient reading skills? They don’t have a clue or a chance. They are sitting quietly, in the last row, waiting for the bell to ring.

That’s a problem that feels like an opportunity, at least to me.

Humaginarium has an opportunity to solve that problem. After noticing that the literatures of health information, health education and health promotion are banal and ridiculous for adults who are not morons (i.e. almost everybody), we cut a new path to empowerment. We obviously can’t develop the reading skills of folks with chronic illness, so instead we made reading optional. In fact, we made reading unnecessary. To be clear, people who come to our brand read nothing.

Instead of reading, they do what comes more naturally, no matter what level or kind of literacy they have attained. They get to:

  • Look at beautiful pictures
  • Play with amusing things
  • Crush thorny brain-teasers

In other words, they play video games. Our novel video games are health promotion in disguise.

Nobody will recognize the health promotion, because there’s no command-and-control text on the screen telling them what to think or do. Instead there are persuasive voices asking them to explore and act according to their own self-interest, their intimate wants and desires.

And for what? To win the game. To control the illness. To increase their share of well-being.

So hey, you, WHO, CDC, OECD: go stuff your scrolling pages of text already! Read my lips. The work needs to be about much more than information. It needs to be about empowerment!

Nurse Nancy, a Little Golden Book, now available from Amazon, and others since the 1950s

Wants, and Needs

Don’t all patients participate in health care?

Wants and needs. The words are so close in meaning, they’re often interchangeable; almost synonymous — yet not quite. Humaginarium uses them to differentiate customer motivations, when it comes to playing our unusual video games; and also the payoffs that follow.

To be clear: Wants are desires. Needs are necessities. And both matter.

In the pragmatic world of tech startups — where Humaginarium occasionally visits and all problems are reducible to algorithms — wants are fluff and needs are raisons d’être.

Did you get that? I’ll elaborate.

  1. Wants are subjective. Needs are objective.
  2. Wants are “take it or leave it.” Needs are “gotta have it.”
  3. Wants are choices. Needs are imperatives.
  4. Wants are rewarded. Needs are met.
  5. Wants are pleasurable. Needs are painful.
  6. Wants are emotional. Needs are physical.
  7. Wants are fanciful. Needs are empirical.

People love what they want and hate what they need. I could go on like this for hourst. It’s a tense dichotomy in human nature.

Wants are addressed in art and entertainment, where they seek catharsis. Wants are addressed in industries like fashion and hospitality, that rely on customers enjoying themselves; that strive to please, since they know their customers have many choices and moreover control their choices.

Humaginarium makes art and entertainment in the form of video games. Not talking about serious games (grody) or gamification (gag me) or educational games (with a spoon). Talking about blockbuster, bestseller, AAA, dumbass games that are good for one thing only: escapism.

Except ours are not good for one thing. They’re good for two: escapism, and competence. Wants, and needs. Our games build skills called “constructive health competence,” which means the capacity of folks to take better care of themselves; to collaborate fully in medical decision-making; to participate actively in personalized healthcare.

Wait, don’t all patients already participate in healthcare? No, they don’t; no more than the chicken in your sandwich participated in agriculture and gastronomy. It’s not that folks don’t what to collaborate and participate, but they’re stymied: they don’t know how to begin or what to expect.

Humaginarium understands that health literacy, health acumen and medical self-efficacy are desperately needed by millions of people, but are nowhere available. Nowhere! So we address those needs in ways that are also desirable.

Because, let’s be honest, nobody likes healthcare. In this year’s presidential debates, when candidates said, “if you love your healthcare, you can keep it,” I wondered why they were talking to British or French or German voters — or practically anybody on earth other than patients living in the United States.

In fact, when we peel away the PR and bureaucracy, it’s clear that everybody in America hates healthcare, but puts up with it, because they have bloody needs. They put up with scary, clinical, patronizing, embarrassing, dehumanizing, baffling, riddled with mistakes, impoverishing, infuriating, futile — because they have unmet needs for control; especially control of chronic illness.

The problem is, putting up with healthcare isn’t fun. Even thinking about it is stressful.

The solution is, make it fun so folks want to think about it. Effective may follow. Health usually follows happiness. And that’s how Humaginarium performs its magic. By folding the wants of folks for escapist art into their needs for health competence, we have invented a way to empower. Empower is the opposite of telling folks what to do. It is enabling them to do for themselves.

Should you care about meeting your needs by satisfying your wants? Yes, most definitively you should care, if you’re a gamer. If you’re not a gamer, well, you can easily change that by learning how to play.

You’ll be glad to find that Humaginarium video games respect what you want, and respect what you need, and they don’t require a prescription.

Mind

The woke mind is a powerful ally of the wounded body.

Humaginarium is novel health promotion. With reverence for life science, it invites folks to discover how a healthy body works; and how the body may be induced to work better and last longer, despite chronic illness.

Okay the body, fine, but what about the mind? Does Humaginarium also revere perception, cognition, emotion, philosophy? Does it deem intangible mental phenomena as important for controlling and improving health?

The answer is yes, indubitably. Our novel health promotion posits that the mind is a lever of constructive health competence; that the woke mind is a powerful ally of the wounded body.

Moreover mental faculties, including the imagination, may be more practical and influential than dumbass regimens of behavioral conditioning. You know them: nudges, digital wearables, involuntary adherence, habits; the palaver of wellness. Easy to ignore because effective people rarely just follow instructions or accept manipulation. They seek to understand, and that’s especially true of those dealing with chronic illness.

Lately, my naive beliefs and assumptions about the mind have been sorely tested by COVID-19, likewise by the history of pandemics that previously obliterated swaths of humanity. In some ways, 2020 feels like 1520, when it comes to epidemiology. There is discouraging consistency, through all ages, of the failure by folks to understand, or even seek to understand, pathogenesis.

Of course, I’m not speaking of scientists and doctors, who administer remedies, who issue proclamations, recommendations, precautions. I’m speaking here of the untutored masses who tend to avoid, ignore, deny, resist, attack and refute health experts along with their intelligent advice. I’m speaking of neighbors whose leaden minds have empowered viral molecules to become proficient mass murderers, in the name of economic prosperity, political ideology, religious dogma and other cockamamie prejudices. I’m speaking about my customers.

Humaginarium promises constructive health competence to these same customers, knowing full well that human competence is based on critical thinking. Competence is the ability to control and improve your health, first by understanding it, then by skillfully — dammit willfully — mastering myriad determinants of health.

Competence isn’t calling a doctor for an appointment or a prescription; it isn’t subscribing to reminder text messages, or reading labels on vials. Constructive health competence is making informed, often brave, choices and decisions in order to minimize risks, in sickness and in health.

Conventional health promotion doesn’t share my worry about the untutored masses. It tends to leapfrog the mind anyway, as if folks don’t have one, rushing to pump procedural, behavioral bromides into their muscle memory. Don’t smoke. Just say no. Get more exercise. Cut out simple sugars. Eat more vegetables. Take your meds. Get tested. Fast after midnight. Buy health insurance. I could fill a blog with the most common commands of health promotion before getting to one that says something like, “seek to understand first,” or “begin with the end in mind.”

My objection to procedural and behavioral orders in health promotion is that they don’t matter and they don’t work. We have statistics to prove that. Yet my growing worry about getting folks to figure out health, and act accordingly, is that they seem averse to intellectual struggle. Thinking is slow and hard!

I want folks to make better choices and decisions, based on their own felt needs and understanding. To judge by the conduct of crowds who ignored copious, relentless public health information for most of this year, folks tend to act like they won’t think. So there is nothing there on which to build health competence.

Or is there? Remember that Humaginarium doesn’t promote health with pedagogy. It is not health education. It relies on art and entertainment, on learning from the experience of fantasy. Regular folks, the same ones who act like they don’t have a mind when it comes to their bodies, are able to shoulder fairly large cognitive loads when using their imagination.

Obviously, despite appearances, folks do have good minds, and moreover their minds are ready to absorb and use sophisticated concepts and techniques, provided that these are experienced in ways that arouse rather than stultify, engage rather than dictate obedience. Arouse and engage, as in video games.

Do you doubt it? Then you don’t know gamers. Want convincing? There is half a century of scholarly research awaiting your attention. If you lack time to review it, check out The Hole in the Wall Project for an epitome.

Still skeptical? Then close your eyes and recall when you learned more and better than at any other time in your life. If you’re like most of us, that was in your infancy and early childhood.

You learned then the way gamers learn as adults: by experiencing, practicing, pretending, figuring things out. If lately you’ve declined to wear a mask and social distance, your mind is probably AWOL and your body — your health — is on the line.

That’s bad, but things could be worse. Humaginarium wants you to make them better. By seeking to understand your body and health, first.

Scientific entertainment. Costume of a plague doctor nicknamed Dr Beaky of Rome (1721), by Paul Fürst. The doctor wears a face mask and socially distances, to avoid infection. NB that was 300 years ago, before the advent of modern microbiology.

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.

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.