Experience

A video game is a process more than a product.

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

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

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

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

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

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

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

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

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

Material

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

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

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

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

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

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

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

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

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

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

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

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

Pathways

We breathe, we metabolize, we live.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Think

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Conditioning

Experience is the best teacher.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Outcomes

What are the outcomes of Diabetes Agonistes?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hairy Balls

The best of all lives, now and forever.

There was a day last week when I juggled three hairy balls. It made me tense. It wasn’t fun. I kept thinking: I don’t know how to do this; I don’t want to do this; I can’t do this; I just won’t! Yet I persisted as my stress increased.

Those four escalations — from not knowing to not trying — may be typical of Humaginarium customers. It’s what I expect. I’m asking folks to play very, very challenging video games that are damn hard to figure out and win. At the same time I’m asking them to dwell on an illness they have, or most likely will get: something they prefer not to think about at all, ever.

Yet despite these difficulties, I expect folks to persist. Despite feelings of inadequacy, ignorance, vulnerability, resignation, victimhood, anxiety, helplessness, anger, resentment, anguish, denial — despite who they think they are — I expect them to get better.

Better as in happier, calmer, stronger, smarter, healthier. Better as in more confident, centered, resilient, competent and accepting no matter what their circumstances may be. Better not because of what Humaginarium does for them but because of what they choose to do for themselves. Not wishing for a life they can’t have, but honoring the one they do have: for each of them, after all is said and done, the best of all lives, for now and forever.

My juggling a few days ago was nowhere near that lofty. I was investigating and trying to master, within my own pathetic mindscape, three subjects that seemed to defy easy understanding: metabolism, time management, and illustration. Everybody knows these words. Everybody thinks they know what the words mean. Until they try to use them and suddenly the ground rumbles and crevasses open in the ice and they no longer know where to put the next step.

The hairy ball of metabolism is a subject so vast and complicated that it seems like a name for God. It is the process of turning death into life, other into self, entropy into growth… and so forth. It happens on the atomic level of synthesizing molecules right up to the organismal level of masticating calamari, and on all the barely perceptible gradient levels in between; and maybe on the cosmic level too, since we are stardust. Metabolism is the epic subject of Diabetes Agonistes.

The hairy ball of time management is business rather than science. In the course of configuring the beta version 2 of OfficeTime, I had to think very carefully about how I spend my time, which is not normal for me. As with money, I spend my time somewhat cavalierly, mostly going on habit, intuition and instinct, rarely thinking about systems. Now I was applying systems thinking to my role of CEO at Humaginarium. When I finally got the app running, it broke.

The hairy ball of illustration is technology rather than business or science. For years I have dipped into Adobe Illustrator like a pilgrim visiting a shrine, gazing cravenly at its burning candles. Lately I have been taking Deke McClelland’s 20-hour Lynda course Illustrator 2020 One On One Fundamentals. The Illustrator app is so complicated and powerful that sometimes I feel I am watching a course on advanced astrophysics rather than basics of digital art. Upon closer inspection I see that the candles are a burning bush. Thanks, Deke.

Juggling all three of these balls in the same day represented an enormous cognitive load: intrinsic, extraneous and germane. Extremely hairy and requiring much self-determination to persist in the face of probable defeat and very uncertain payoff. But I did persist, and I am continuing.

Why? Because by juggling hairy balls, I myself walk the talk of Humaginarium. I do these things (and others like them) not because they are enjoyable and rewarding (though they’re fun during bivouacs), but because they are hard and push me right up to my suffocating limits. Not in order to stop there and wonder, but rather to put my foot on the opposite edge of the crevasse and step over the yawning blighter.

Writing

George Mallory had similar thoughts, standing at the foot of Mount Everest.

One year to write 20 pages! That is how long they took. Even for me — the slowest of the slow, the latest of the late — this is a personal best. How did it take so long?

Easier question: why didn’t it take longer? Answer: because there was a time limit imposed by somebody else. A timer was set in April 2019, giving me no more than one year to finish or be damned. Not liking the eternal-infernal option, I finished my writing with precisely four days to spare (phew).

Same sort of thing happened in 1975, when I “finished” (i.e. stopped) my doctoral dissertation in English Letters at the end of a fifth year living in the UK. There is evidently something about limits that makes me want to exceed or at least ignore them, as long and as much as possible.

My recent year of writing was an NSF SBIR Phase 1 proposal. Together with documentation it turned out to be 10 x 20 pages, but the Pareto principle applies to just those measly 20 pages comprising the Project Description and Technical Discussion of a game changer known as Diabetes Agonistes.

The National Science Foundation does very nice things for aspirants and martyrs who want to cross the chasms of technical innovation. They carefully publish an explicit Solicitation telling applicants how to write a proposal; and they reinforce the Solicitation with a Proposal and Award Policies and Procedures Guide that kind of “tells ‘em what you’re going to tell ‘em” — with more detail in different words. They further reinforce those helpful documents with myriad web pages of procedural, referential, social and historical information that strikes aspirants with awe and turns some of them into martyrs. Reading this stuff feels a bit like gazing at a Himalayan summit from a safe distance and thinking, “it’s not that tall after all.” All told, there are hundreds of fact-packed government pages that are not only helpful, but also debilitating. Even for me, a person who loves reading for its own sake, that textual mountain was a lot to take in. Consequently much of my year spent writing was actually devoted to getting ready to write and then afterwards checking to make sure that my text was complete and compliant with standards. Even now I’m not sure that it is. The summit is shrouded in mist, and there is a throbbing red glow within it.

As usual with anything related to health care (e.g. Diabetes Agonistes), there is a way to leapfrog the labor by delegating it, with cash. You can hire a consultant, one who is well versed in government documents, as your sherpa. The consultant tells you what to write, and when to write it, and how to revise it until it is ready for primetime. Alternatively, you can hire a consultant as your ghostwriter and project manager: a magus who will use you as a subject-matter expert, write a splendid proposal for you to sign, and afterwards (if successful) manage the entire project for a reasonable fee.

I considered consultants. I attended a two-day workshop hosted by one of the best, and interviewed four others who came highly recommended. I chose not to engage one because (idiot that I am) I wanted to learn and master this writing process myself. I felt there is no text in the English language that I can’t wrestle to the mat (hubris), and if I don’t do the heavy lifting myself, I won’t do all the necessary thinking either. Then I would lose an ineffable chance to experience something new: crossing one of the wider chasms of technical innovation. I’m sure that George Mallory had similar thoughts, standing at the foot of Mount Everest.

Apart from reading and processing freight cars full of documentation, another cause of my slowness was poetics (so-called). Hard as it may be for readers of this blog to believe, I am very careful about every word I write, often writing them over and over in different ways until they sort of chime in my ear and look good to my eye. For this reason, what I want to express is perhaps 30% of my writing. Wordsmithing is 70%. The nutty thing about that is, my subject matter here for the most part is technology, and literary style is certainly not one of the criteria for evaluation of my proposal. Nonetheless, I can’t help myself. My muse insists.

As soon as my writing job was done a few days ago, I turned to (what else?) more writing. I quickly wrote a Project Pitch for educational technology that may bend the curve of COVID-19. Fascinating proposal which will go nowhere, of course, but deserved to be written. Then I started writing an SBIR Phase 1 proposal for the National Institute of Diabetes and Digestive and Kidney Diseases, one of the National Institutes of Health. And also began writing a series of briefs for the NSF project team, in case that proposal isn’t kicked out like a stray dog.

Will I set a new record for slowness with NIH? I think not. Having practiced and sort of mastered the process of parsing technical documentation with NSF, I am likely to cross the next chasm like a hare rather than a tortoise. I will certainly let you know when that happens.

Scientific entertainment. Female nude, back view (1831), by Alexandre-Jean Dubois-Drahonet. Pictured with coronavirus on the prowl.

Biology as a Second Language

We understand the body about as well as we understand my first paragraph.

When the amygdala perceives sensory information from the thalamus to be threatening, it engages the paraventricular nucleus in the hypothalamus resulting in the stimulation of corticotropin-releasing hormone (CRH), which begins the stress hormone cascade. This hormone then stimulates the pituitary to release another hormone called adrenocorticotrophic hormone (ACTH). This hormone travels down to the adrenal cortex gland, which produces the stress hormone cortisol. Cortisol in turn will feedback to the hypothalamus and the pituitary.

I’m quoting above from a book named The Science of Stress. The authors explain to the general reader how the HPA axis responds to internal and environmental stressors of the human body. I bring this up here for two reasons.

First, the axis is implicated in metabolic syndrome and diabetes mellitus type 2, the subject of our prototype projects Diabetes Agonistes and Metabolic Genii. The HPA axis is a kind of tripwire: the cause of and the mechanism for incredible biological activity in our bodies: every body, every hour of every day. The axis keeps us healthy or makes us sick depending on forces that we, rather than it, control. If the axis didn’t work properly, with phenomenal speed and precision, we would suffer and even die. Yet most of us willfully undermine the axis with some of the behavior typical of our personalities.

Personality is a vague concept, but I think it’s fair to say that personality or self (ego, id, superego) is neither inherited nor determined by environment. It’s a product of the individual imagination – a creative projection of the mind – that tends to take the body for granted. “I think therefore I am.” Until – inevitably – the body breaks down and it’s hard to think straight. We choose to behave as we please, often dangerously, because we understand the body about as well as we understand my first paragraph; i.e. we’re clueless.

My second reason for quoting The Science of Stress is to make a point about health literacy. We know that literacy is the ability to write and read language. And in our society, basic literacy is purportedly equivalent to eighth-grade communication skills. In other words, to be nominally literate in America, in 2019, is to communicate like an adolescent.

That is why my first paragraph is a challenge for regular folks. It is written in English that a scientist or clinician, with abundant education, easily understands. It is not written in the English that the vast majority of their fellow Americans can even read, and none could ever write. For that reason, the meaning of the paragraph doesn’t exist for them. They can’t interpret or use it, and that’s a problem.

You could say those scientists and clinicians are certified BSL: biology as a second language. They’ve been trained to read and write the language of biology. Not for its own sake of course, but in order to use biology in their professions. The humanities majors among us, and the greater number who never got past high school, are literate in that adolescent way. We are not BSL certified. We can’t understand and use biology because it’s wrapped in esoterica.

Or can we? Of course we can’t teach BSL to the masses. We could however extricate biology from its language wrapper and render it in forms that regular folks can easily understand – and even enjoy. That’s what Humaginarium is doing with the biology of chronic illness. Making it animated and visual with symbols and pictorial narrative. Making it tangible so folks can touch it, play with it, fight with it, figure it out and master it. Not biology as a second language, but biology in a visual language of color and shape that folks are already fluent in, and capable of probing for meaning.

Now, some would say that regular folks cannot understand biology, not because they’re baffled by the language, but because biology is way too complicated. This may be why most promotions of health literacy avoid science like a plague and focus on behavioral adherence to rules. I’m betting those promoters are wrong. Based on my experience as a parent, a patient and an educator, there is nothing in or about biology that is beyond the capacity of an average adult to understand.

All those average adults are organisms at the top of the food chain. They are outcomes of billions of years of evolution. Their minds are the most wonderful things that nature has ever made. They are not stupid! They certainly have the capacity and the motivation to understand, interpret and use science to fight chronic illness. Only first, they have to take off the gloves, and we have to take off those bewildering, jargony wrappers.

Scientific entertainment. Dante and Virgil in Hell, by William-Adolphe Bouguereau; pictured with histology of the pituitary gland.

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.