Psychoneuroimmunology

Producing outcomes without being a healthcare company.

Humaginarium is not a healthcare company. We’re unlike startups whose therapies heal or cure; also unlike those who manage medical service delivery. Nothing we do for patients requires access to medical records or histories; nothing we deliver to patients requires prescription, clinical control or reimbursement. In fact we rarely think of users as patients at all, but as regular folks.

Likewise Humaginarium doesn’t cater to providers, payers or suppliers of the healthcare industry. We don’t make things for them to buy or ask them to finance what we make for consumers. True, we are working to earn their versions of the Good Housekeeping Seal of approval, but not because it has monetary value. The effort to gain healthcare industry blessing will simply make us a better company.

All of the foregoing seems rather odd and uneconomical positioning for a health tech startup, but hopefully it’s rational. I’ll try to explain.

Humaginarium is an entertainment company. We develop video games and ancillary apps that amuse and inform. We use our programs to educate and empower people; not about everything, of course, but about their bodies and health; in particular about chronic illness they have or risk getting. Why? So they themselves can actually do something about it!

The foregoing category description rests on four functional pillars known as health promotion, health literacy, health education, and health equity. With a difference. Most programming within those pillars is behaviorist. It’s about conditioning: what, how and when to do things in order to become healthier. It’s rarely about learning: why something is and why it can be different.

Humaginarium is all about that why. As artists and educators we know there is only a dotted line between understanding and making a difference in real life. Our project turns those dots into a solid line with an arrow pointing to personal empowerment.

Yet as a high-tech artist and educator, am I certain that Humaginarium won’t heal or cure? I’m really not sure of that, so I don’t claim that it will; but I think it’s possible. Moreover likely.

I say this because I believe, from study and experience, in causal connections between mind and body; between mental and physical. The clinical term for such connections is psychoneuroimmunology (PNI). Everybody experiences PNI throughout their lives, practically every day and certainly when enjoying great entertainment, but science is only beginning to recognize and explain it. Clinicians by and large don’t have a clue. But it’s real.

A palpable example of PNI is the placebo effect, by which perceptions and beliefs improve health outcomes. Peer-reviewed research has proven (beyond any reasonable doubt) that the way people think and feel about themselves and their environment alters the biochemistry of their bodies. In plain English, our state of mind can actually make us well or sick. Everybody knows that, but why is it?

“Theorists propose that stressful events trigger cognitive and affective responses which, in turn, induce sympathetic nervous system and endocrine changes, and these ultimately impair immune function.” Did you get that? So for example, job insecurity or marital difficulty can, and often does, make people literally frail, vulnerable and symptomatic.

But what are job insecurity and marital difficulty? They are types of stress produced by the same thing: a lack of control. The same kind of stress that occurs with chronic illness. You have it, you don’t understand it, you can’t predict it, you can’t avoid it. It feels like a bewildering constant threat, like an asteroid heading towards your personal planet.

As such chronic illness is a self-perpetuating condition. The more fearful and anxious and angry the patient gets, the worse the disease may become. That’s fact, not fiction.

Humaginarium answers that fact with fiction. Literally, with fantasy in which users can face and understand and oppose and overcome illness in their minds. Fantasy of this kind is not merely an escape from reality, it’s an engine for belief in oneself; belief that “I am the master of my fate.”

When discussing PNI in the context of his long medical career, Sherwin Nuland wrote, “The question that remains is how these three major networks – the nervous system, the endocrine system, and the immunologic system – interact and, how, by understanding these interactions in precise quantitative terms, we can learn to predict and control them.”

That question is for scientists including positive psychologists, but not for artists and educators like me. We already know PNI works, though we can’t yet explain the molecular and cellular dynamics. If it works, we want to use it right now, not after decades of clinical trials, for the benefit of folks who have or risk getting a miserable chronic illness.

That is what Humaginarium is doing, and that is why I expect to produce meaningful outcomes without being a healthcare company.

Behavior

Without getting to the why there is no getting to behavioral outcomes.

Is scientific entertainment™ an offshoot of behavioral science or behavioral medicine? With the FDA approving video games as therapy for the first time, the question is hardly idle. The answer may explain how Humaginarium achieves meaningful outcomes.

Behavioral science is the study of human behavior through observation, modeling, and experiment. Behavioral scientists investigate why people do what they do, and how they might do better. The scientists have a voracious appetite for meaning, so they stir separate disciplines into a unified mode of inquiry, wrangling diverse epistemology in order to discern and use truth in more holistic and robust ways.

Behavioral medicine is likewise the study of human behavior with a unified mode of inquiry. Practitioners study why people are unhealthy or at risk of illness, prone to injury, difficult to treat, heal, or cure; why they’re frail or short lived, and how they can manage health with more than biomedicine. Having a voracious appetite for meaning, practitioners look beyond clinic to identify environmental, psychological and social dimensions, causes, or palliations of disease – and try to make good use of them.

I now think that scientific entertainment is indeed an offshoot of these correlates; that it’s “behavioral entertainment.” It involves depictions of human behavior derived from observation, modeling, and experiment. It relates why people do what they do, and how they might do better. For example, why they often increase risks rather than avoid or control them; and how they might act differently to produce more desirable outcomes.

Could it be that standup comedy on The Daily Show is also behavioral entertainment; likewise animation by Pixar, theater by Lin Manuel Miranda, painting by Banksy, fiction by Margaret Atwood, movies by Guillermo Del Toro, music by Bob Dylan, and video games by Will Wright? All of these make audiences feel good while moving them to create and use new meaning.

If scientific entertainment in Humaginarium is behavioral, it’s important to remember that behavior is more than how people act; it’s also why. As Robert Sapolsky makes abundantly clear, without getting to the why there is no getting to behavioral outcomes.

In humans, “why” leads through a morass of conscious choices and decisions, through nervous reactions of the senses, all the way to the tremulous molecules that compose our bodies and microorganisms that live in and on us – some keeping us alive and others just the opposite.

I’m claiming to be behavioral, but not behaviorist. I don’t suppose that humans are machines that can be programmed with external conditioning. More in line with behavioral economics, I think people should not be trained, conditioned, or forced to do anything they prefer not to do.

The job of scientific entertainment in Humaginarium is to help them recognize choices and make decisions in what they believe is their own self-interest. That’s our nudge to wellness™.

The nudge is what allows us to generate behavioral outcomes. As I have often heard the butterfly say to the fish, “the best thing in the world you can be is yourself.” People who find themselves in Humaginarium may grow more confident that they’re incredibly beautiful and brave and may become ever more so.