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.

Arcade Redux

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

I’ll describe that provisioning in my next post.

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

Learning

The most desperate problems emerging from chronic illness have a surname: Vulnerability.

Humaginarium is entertainment for consumers who have, risk, or wonder about chronic illness. Participation is voluntary. Nobody is forced or cajoled to join. Like a carnival barker, the only promise we make is fun. It’s important to say this because unlike presenters of classic health education, Humaginarium must offer art that regular folks like and want for its own sake, whether or not it solves their problems.

Thanks to art, Humaginarium probably has more in common with medicine than bland health education does. Truly? Well yes, because medicine historically is a mixture of art and science, with art doing the lion’s share of the job until the mid 20th century. Even today in the technical vanguard of biomedicine, art is a critical component of what matters to most people: healing and wellness. When medical arts are eclipsed by instrumentation and data, health care can begin to seem manipulative and futile, if not ridiculous, to the folks it serves.

Humaginarium likewise is a mixture of art and science. Though we don’t boast about solving problems, that’s actually why we exist. Real-life problems; often unacknowledged, misunderstood, denied, hidden, scorned, or ignored by the kinds of folks who buy video games for escapist fantasy rather than useful information. As they enjoy the experiences we prepare for them, their health issues are pulled through an aesthetic ringer I call catharsis. That’s pretty much the same ringer that doctors and shamans have used for millennia and still use today.

In my view all the most desperate problems caused by chronic illness have a surname: Vulnerability. By that I mean weak defenses against illness and the clueless pursuit of wellness. Vulnerable consumers don’t make themselves better; they let things get worse. They don’t relish the esoteric complexity of the body; they’re obsessed with appearances. They don’t ask hard questions they can’t begin to answer; they delegate that to experts who know everything. Experience eventually shows how little medical experts actually know and how risky and inefficient such delegation can be.

As a problem solver, Humaginarium is not paternalistic. It doesn’t tell consumers what to think or do beyond one simple command: win the game. That’s their mandate. Thing is, they have to figure out how to win. On their own. They can share ideas and experience with peers, but they can’t delegate.

Instead players build their own knowledge and make their own choices in their own self-interest; and health literacy emerges. This learning style is called constructionism. You’ll find it in healthcare simulations for medical students and physicians, but you won’t find it in health education for patients who need it just as much. Why? That doesn’t matter. It’s about to change.

Consumers initially come to Humaginarium not for information or simulation or education of any kind, but to be amused. To enjoy a virtual experience of the human body in its battle with unfair, unfeeling, out-of-control destiny. As in all their favorite video games, players must develop new competencies to win. But this time their gains deliver more than make-believe victories.

Capabilities learned in Humaginarium are wholly transferable. A fight for health in our fantasy prepares people for a similar fight in real life where, maybe for the first time, they’ll deeply understand and strive to control existential threats like diabetes, cancer, or heart disease. We want them to bring better defenses against illness and longings for wellness to the battle. Ones that fit their own circumstances more or less perfectly.

When that happens, Humaginarium may perform like a magical healing art of the 21st Century.