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.

Miracles

Belief in miracles is central to the mission of Humaginarium.

According to Merriam-Webster, the spiritual meaning of miracle is an extraordinary event manifesting divine intervention in human affairs. A miracle may also be a divinely natural phenomenon experienced humanly as the fulfillment of spiritual law. Can the miraculous, when candidly understood, really have anything to do with modern biomedicine?

Well, from the perspective of Humaginarium, the answer is yes. I am long known for saying (every time I get the chance) that “your body is a miracle.” No matter how young or old, how well or sick, how strong or weak, how happy or sad, how beautiful or ugly; our bodies are miraculous!

Oddly though, my claim has never been challenged. It’s odd because Humaginarium is scientific, technical. It leverages high-fidelity simulation of human physiology and biochemistry. Can miracles occur and be expressed in an environment like this? I say they can; moreover they must.

Belief in miracles is central to the mission of Humaginarium. You don’t have to believe in them when you first come to play; you don’t even have to believe when you tour homeostasis in the Arcade. However by the time you cut a path through the Morbid Frontier and killed or captured disease that haunted and persecuted you, you will gladly believe. And belief may change your life.

With miracles, am I referring to fantasy that overlays biology in our scientific entertainment? Are the miracles I speak of just figments of the imagination? They are not. They are tangible, objective and real. Rather than argue this point logically, I prefer to cite two authorities who come at it from different experiential perspectives: one a physician, the other a patient.

The physician is Sherwin B. Nuland (1930-2014), an eminent surgeon at Yale who wrote several books and articles about practicing medicine. In The Wisdom of the Body (1997) he reflected:

Centuries ago, when little was known of science, the mystery of the body’s internal machinery enthralled ordinary people and tantalized the educated. It seemed a miracle, this bustling edifice of thought and action – beyond the capacity of mere mortals to comprehend, and yet providing here and there a hint that the inscrutable might somehow be understood if only properly directed efforts were made. In time, the right direction was indeed found and the efforts were rewarded, yet the tantalizing and the mystery not only did not lessen; they actually grew. The more became known, the more miraculous seemed the intricacies of the whole and the more urgent the drive to expand our knowledge.

The patient is William Ernest Henley (1849-1903). At age 12 Henley was diagnosed with tubercular arthritis that eventually forced the amputation of a leg just below the knee; the other foot was saved only through a radical surgery. As Henley healed in the infirmary, he began to write poems, including Invictus (1875). This famously inspiring poem seems to be about many things, but in fact it is about one thing: a debilitating chronic illness that eventually killed him:

Out of the night that covers me,
Black as the pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.

The soul that Henley celebrated is the miracle that Nuland found in his practice of medicine. It is the courage that users unleash in themselves as they explore Humaginarium. Miraculous because science can’t explain it; unconquerable because medicine doesn’t eclipse it; courageous because it is the unfettered expression of the human spirit in our mortal, phenomenal bodies.

Scientific entertainment. Prometheus Creating Man in Clay (1845), by Constantin Hansen. Pictured with a swarm of microbes and viruses like those that swarm our bodies.