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In the days following the disappearance of the columnist Jamal Khashoggi, Arabic-language social media erupted in support for Crown Prince Mohammed bin Salman, who was widely rumored to have ordered his murder. On a single day in October, the phrase “we all have trust in Mohammed bin Salman” featured in 250,000 tweets. “We have to stand by our leader” was posted more than 60,000 times, along with 100,000 messages imploring Saudis to “Unfollow enemies of the nation.” In all likelihood, the majority of these messages were generated by chatbots.

around a fifth of all tweets discussing the 2016 presidential election are believed to have been the work of chatbots.

a third of all traffic on Twitter before the 2016 referendum on Britain’s membership in the European Union was said to come from chatbots, principally in support of the Leave side.

It’s irrelevant that current bots are not “smart” like we are, or that they have not achieved the consciousness and creativity hoped for by A.I. purists. What matters is their impact

In the past, despite our differences, we could at least take for granted that all participants in the political process were human beings. This no longer true

Increasingly we share the online debate chamber with nonhuman entities that are rapidly growing more advanced

a bot developed by the British firm Babylon reportedly achieved a score of 81 percent in the clinical examination for admission to the Royal College of General Practitioners. The average score for human doctors? 72 percent.

If chatbots are approaching the stage where they can answer diagnostic questions as well or better than human doctors, then it’s possible they might eventually reach or surpass our levels of political sophistication

chatbots could seriously endanger our democracy, and not just when they go haywire.

They’ll likely have faces and voices, names and personalities — all engineered for maximum persuasion. So-called “deep fake” videos can already convincingly synthesize the speech and appearance of real politicians.

The most obvious risk is that we are crowded out of our own deliberative processes by systems that are too fast and too ubiquitous for us to keep up with.

A related risk is that wealthy people will be able to afford the best chatbots.

in a world where, increasingly, the only feasible way of engaging in debate with chatbots is through the deployment of other chatbots also possessed of the same speed and facility, the worry is that in the long run we’ll become effectively excluded from our own party.

the wholesale automation of deliberation would be an unfortunate development in democratic history.

A blunt approach — call it disqualification — would be an all-out prohibition of bots on forums where important political speech takes place, and punishment for the humans responsible

The Bot Disclosure and Accountability Bil

would amend the Federal Election Campaign Act of 1971 to prohibit candidates and political parties from using any bots intended to impersonate or replicate human activity for public communication. It would also stop PACs, corporations and labor organizations from using bots to disseminate messages advocating candidates, which would be considered “electioneering communications.”

A subtler method would involve mandatory identification: requiring all chatbots to be publicly registered and to state at all times the fact that they are chatbots, and the identity of their human owners and controllers.

We should also be exploring more imaginative forms of regulation. Why not introduce a rule, coded into platforms themselves, that bots may make only up to a specific number of online contributions per day, or a specific number of responses to a particular human?

We need not treat the speech of chatbots with the same reverence that we treat human speech. Moreover, bots are too fast and tricky to be subject to ordinary rules of debate

the methods we use to regulate bots must be more robust than those we apply to people. There can be no half-measures when democracy is at stake.

It would be easy to conclude that an absurdist view of life rules out happiness and leads anyone with any sense to despair at her very existence. And yet in his book, Camus concludes, “One must imagine Sisyphus happy

this unexpected twist in Camus’ philosophy of life and happiness can help you change your perspective and see your daily struggles in a new, more equanimous way.

he argues that despite the hardships of this world, against all apparent odds, human beings regularly experience true happiness. People in terrible circumstances bask in love for one another. They enjoy simple diversions

Even Sisyphus was happy, according to Camus, because “the struggle itself toward the heights is enough to fill a man’s heart.” Simply put, he had something to keep him busy.

Instead of feeling desperation at the futility of life, Camus tells us to embrace its ridiculousness. It’s the only way to arrive at happiness, the most absurd emotion of all under these circumstances

We shouldn’t try to find some cosmic meaning in our relentless routines—getting, spending, eating, working, pushing our own little boulders up our own little hills

Instead, we should laugh uproariously at the fact that there is no meaning, and be happy anyway.

Happiness, for Camus, is an existential declaration of independence. Instead of advising “Don’t worry, be happy,” he offers a rebellious “Tell the universe to go suck eggs, be happy.”

If embracing the ridiculous seems impossible to you, Camus says it’s only because of your pride.

“Those who prefer their principles over their happiness, they refuse to be happy outside the conditions they seem to have attached to their happiness,”

In fact, each of us can consciously implement Camus’ absurdism in order to forge a happier life. Here are three practical ways to find joy in the ridiculous.

1. Stand up to your ennui.

You can’t necessarily change your perception of the world, but, as I have written, you most certainly can change your response to that perception. Meet that feeling of despair with a personal motto, such as “I don’t know what everything means, but I do know I am alive right now, and I will not squander this moment

2. Look for opportunities to do a little good.

One of the best ways to cultivate futility is by focusing on the big things you can’t control—war, natural disasters, hatred—as opposed to the little things you can.

Those little things include bringing a small blessing or source of relief to others.

if your commute to work is a soul-sucking existential nightmare, don’t ruminate on the cars stopped ahead of you. Rather, focus on making space for that poor sap stuck in the wrong lane who’s desperately trying to merge

3. Be fully present.

Absurdity tends to sting only when we see it from the “outside”; for example, when you think about how meaningless it has been to wash the dishes every day in the past only to find them dirty again right now—and imagine the countless dish washings that the rest of your life will comprise.

Confronting the absurd is much more comfortable when you do so with mindfulness.

“While washing the dishes one should only be washing the dishes, which means that while washing the dishes one should be completely aware of the fact that one is washing the dishes.

When the broad sweep of life brings you horror, concentrate on this moment, and savor it. The pleasure and meaning you can find right now are real; the meaninglessness of the future is not.

Some mornings, I wake up seeing only boulders and can’t face pushing them once again up that hill

Those are the days when my old friend Camus comes in handy. Instead of despairing of the absurdity of life, I lean into it, laugh at it, and start my day in a light mood. Then I gather my beloved boulders and set out for the nearest hill.

Secondly as Stuart Ritchie points out in this excellent article, to date the evidence assembled by proponents of the social media theory like Jonathan Haidt and Jean Twenge, has shown correlations not causal relationships. Yes, it seems that young people who use social media a lot have worse mental health, but that could easily be because young people with worse mental health choose to use social media more!  

recently I’ve shifted to thinking it probably is a major cause for three reasons:

1.       I can’t think of anything else that fits. Other suggested causes just don’t work.

Social media does fit, the big increase in take up maps well on to the mental health data and it happened everywhere in rich countries at the same time. The most affected group, teenage girls, are also the ones who report that social media makes them more anxious and body conscious in focus groups

It is of course true that correlation doesn’t prove anything but if there’s only one strongly related correlation it’s pretty likely there’s a relationship.

2.       There is no doubt that young people are spending a huge amount of time online now. And that, therefore, must have replaced other activities that involve being out with friends in real life. Three quarters of 12 year olds now have a social media profile and 95% of teenagers use social media regularly. Over half who say they’ve been bullied, say it was on social media.

  We finally have the first evidence of a direct causal relationship via a very clever US study using the staged rollout of Facebook across US college campuses to assess the impact on mental health. Not only does it show that mental illness increased after the introduction of Facebook but it also shows that it was particularly pronounced amongst those who were more likely to view themselves unfavourably alongside their peers due to being e.g. overweight or having lower socio-economic status. It is just one study but it nudges me even further towards thinking this a major cause of the problem.

I have blocked my (12 year old) twins from all social media apps and will hold out as long as possible. The evidence isn’t yet rock solid but it’s solid enough to make me want to protect them as best I can.

, we know from the science of linguistics and the philosophy of knowledge that they differ profoundly from how humans reason and use language. These differences place significant limitations on what these programs can do, encoding them with ineradicable defects.

It is at once comic and tragic, as Borges might have noted, that so much money and attention should be concentrated on so little a thing — something so trivial when contrasted with the human mind, which by dint of language, in the words of Wilhelm von Humboldt, can make “infinite use of finite means,” creating ideas and theories with universal reach.

The human mind is not, like ChatGPT and its ilk, a lumbering statistical engine for pattern matching, gorging on hundreds of terabytes of data and extrapolating the most likely conversational response or most probable answer to a scientific question

the human mind is a surprisingly efficient and even elegant system that operates with small amounts of information; it seeks not to infer brute correlations among data points but to create explanations

such programs are stuck in a prehuman or nonhuman phase of cognitive evolution. Their deepest flaw is the absence of the most critical capacity of any intelligence: to say not only what is the case, what was the case and what will be the case — that’s description and prediction — but also what is not the case and what could and could not be the case

Those are the ingredients of explanation, the mark of true intelligence.

Here’s an example. Suppose you are holding an apple in your hand. Now you let the apple go. You observe the result and say, “The apple falls.” That is a description. A prediction might have been the statement “The apple will fall if I open my hand.”

an explanation is something more: It includes not only descriptions and predictions but also counterfactual conjectures like “Any such object would fall,” plus the additional clause “because of the force of gravity” or “because of the curvature of space-time” or whatever. That is a causal explanation: “The apple would not have fallen but for the force of gravity.” That is thinking.

The crux of machine learning is description and prediction; it does not posit any causal mechanisms or physical laws

any human-style explanation is not necessarily correct; we are fallible. But this is part of what it means to think: To be right, it must be possible to be wrong. Intelligence consists not only of creative conjectures but also of creative criticism. Human-style thought is based on possible explanations and error correction, a process that gradually limits what possibilities can be rationally considered.

ChatGPT and similar programs are, by design, unlimited in what they can “learn” (which is to say, memorize); they are incapable of distinguishing the possible from the impossible.

Whereas humans are limited in the kinds of explanations we can rationally conjecture, machine learning systems can learn both that the earth is flat and that the earth is round. They trade merely in probabilities that change over time.

For this reason, the predictions of machine learning systems will always be superficial and dubious.

some machine learning enthusiasts seem to be proud that their creations can generate correct “scientific” predictions (say, about the motion of physical bodies) without making use of explanations (involving, say, Newton’s laws of motion and universal gravitation). But this kind of prediction, even when successful, is pseudoscienc

While scientists certainly seek theories that have a high degree of empirical corroboration, as the philosopher Karl Popper noted, “we do not seek highly probable theories but explanations; that is to say, powerful and highly improbable theories.”

The theory that apples fall to earth because mass bends space-time (Einstein’s view) is highly improbable, but it actually tells you why they fall. True intelligence is demonstrated in the ability to think and express improbable but insightful things.

This means constraining the otherwise limitless creativity of our minds with a set of ethical principles that determines what ought and ought not to be (and of course subjecting those principles themselves to creative criticism)

True intelligence is also capable of moral thinking

To be useful, ChatGPT must be empowered to generate novel-looking output; to be acceptable to most of its users, it must steer clear of morally objectionable content

In 2016, for example, Microsoft’s Tay chatbot (a precursor to ChatGPT) flooded the internet with misogynistic and racist content, having been polluted by online trolls who filled it with offensive training data. How to solve the problem in the future? In the absence of a capacity to reason from moral principles, ChatGPT was crudely restricted by its programmers from contributing anything novel to controversial — that is, important — discussions. It sacrificed creativity for a kind of amorality.

Here, ChatGPT exhibits something like the banality of evil: plagiarism and apathy and obviation. It summarizes the standard arguments in the literature by a kind of super-autocomplete, refuses to take a stand on anything, pleads not merely ignorance but lack of intelligence and ultimately offers a “just following orders” defense, shifting responsibility to its creators.

In short, ChatGPT and its brethren are constitutionally unable to balance creativity with constraint. They either overgenerate (producing both truths and falsehoods, endorsing ethical and unethical decisions alike) or undergenerate (exhibiting noncommitment to any decisions and indifference to consequences). Given the amorality, faux science and linguistic incompetence of these systems, we can only laugh or cry at their popularity.

many corporate technology chiefs have taken a wait-and-see approach to the technology, which has developed a reputation for producing false, misleading and unintelligible results—dubbed AI ‘hallucinations’. 

Though ChatGPT, which is available free online, is considered a consumer app, OpenAI has encouraged companies and startups to build apps on top of its language models—in part by providing access to the underlying computer code for a fee.

here are “certain spaces where it’s clearly directly applicable,” such as summarizing documents or responding to customer queries. Many startups are racing to apply the technology to a wider set of enterprise use case

“I think it’s going to creep into our lives in ways we least expect it,” Mr. Casado said.

While people praised Finland’s strong social safety net and spoke glowingly of the psychological benefits of nature and the personal joys of sports or music, they also talked about guilt, anxiety and loneliness. Rather than “happy,” they were more likely to characterize Finns as “quite gloomy,” “a little moody” or not given to unnecessary smiling

Many also shared concerns about threats to their way of life, including possible gains by a far-right party in the country’s elections in April, the war in Ukraine and a tense relationship with Russia, which could worsen now that Finland is set to join NATO.

It turns out even the happiest people in the world aren’t that happy. But they are something more like content.

Finns derive satisfaction from leading sustainable lives and perceive financial success as being able to identify and meet basic need

“In other words,” he wrote in an email, “when you know what is enough, you are happy.”

“‘Happiness,’ sometimes it’s a light word and used like it’s only a smile on a face,” Teemu Kiiski, the chief executive of Finnish Design Shop, said. “But I think that this Nordic happiness is something more foundational.”

e conventional wisdom is that it’s easier to be happy in a country like Finland where the government ensures a secure foundation on which to build a fulfilling life and a promising future. But that expectation can also create pressure to live up to the national reputation.

“We are very privileged and we know our privilege,” said Clara Paasimaki, 19, one of Ms. Hansen’s students in Kokkola, “so we are also scared to say that we are discontent with anything, because we know that we have it so much better than other people,” especially in non-Nordic countries.

“The fact that Finland has been ‘the happiest country on earth’ for six years in a row could start building pressure on people,” he wrote in an email. “If we Finns are all so happy, why am I not happy?

The Finnish way of life is summed up in “sisu,” a trait said to be part of the national character. The word roughly translates to “grim determination in the face of hardships,” such as the country’s long winters: Even in adversity, a Finn is expected to persevere, without complaining.

“Back in the day when it wasn’t that easy to survive the winter, people had to struggle, and then it’s kind of been passed along the generations,” said Ms. Paasimaki’s classmate Matias From, 18. “Our parents were this way. Our grandparents were this way. Tough and not worrying about everything. Just living life.”

Since immigrating from Zimbabwe in 1992, Julia Wilson-Hangasmaa, 59, has come to appreciate the freedom Finland affords people to pursue their dreams without worrying about meeting basic needs

When she returns to her home country, she is struck by the “good energy” that comes not from the satisfaction of sisu but from exuberant joy.

“What I miss the most, I realize when I enter Zimbabwe, are the smiles,” she said, among “those people who don’t have much, compared to Western standards, but who are rich in spirit.”

Many of our subjects cited the abundance of nature as crucial to Finnish happiness: Nearly 75 percent of Finland is covered by forest, and all of it is open to everyone thanks to a law known as “jokamiehen oikeudet,” or “everyman’s right,” that entitles people to roam freely throughout any natural areas, on public or privately owned land.

“I enjoy the peace and movement in nature,” said Helina Marjamaa, 66, a former track athlete who represented the country at the 1980 and 1984 Olympic Games. “That’s where I get strength. Birds are singing, snow is melting, and nature is coming to life. It’s just incredibly beautiful.”

“I am worried with this level of ignorance we have toward our own environment,” he said, citing endangered species and climate change. The threat, he said, “still doesn’t seem to shift the political thinking.”

Born 17 years after Finland won independence from Russia, Eeva Valtonen has watched her homeland transform: from the devastation of World War II through years of rebuilding to a nation held up as an exemplar to the world.

“My mother used to say, ‘Remember, the blessing in life is in work, and every work you do, do it well,’” Ms. Valtonen, 88, said. “I think Finnish people have been very much the same way. Everybody did everything together and helped each other.”

Maybe it isn’t that Finns are so much happier than everyone else. Maybe it’s that their expectations for contentment are more reasonable, and if they aren’t met, in the spirit of sisu, they persevere.

“We don’t whine,” Ms. Eerikainen said. “We just do.”

Musk seems willing to grant this power to racists, conspiracy theorists, and trolls. This isn’t great for reasonable people who want to have nuanced conversations on social media, but the joke has always been on them. Twitter isn’t that place, and it never will be.

one of Musk’s first moves after taking over was to fire the company’s head of policy—an individual who had publicly stated a commitment to both free speech and preventing abuse.

On Friday, Musk tweeted that Twitter would be “forming a content moderation council with widely diverse viewpoints,” noting that “no major content decisions [would] happen before that council convenes.” Just three hours later, replying to a question about lifting a suspension on The Daily Wire’s Jordan Peterson, Musk signaled that maybe that wasn’t exactly right; he tweeted: “Anyone suspended for minor & dubious reasons will be freed from Twitter jail.” He says he wants a democratic council, yet he’s also setting policy by decree.

Perhaps most depressingly, this behavior is quite familiar. As Techdirt’s Mike Masnick has pointed out, we are all stuck “watching Musk speed run the content moderation learning curve” and making the same mistakes that social-media executives made with their platforms in their first years at the helm.

Musk has charged himself with solving the central, seemingly intractable issue at the core of hundreds of years of debate about free speech. In the social-media era, no entity has managed to balance preserving both free speech and genuine open debate across the internet at scale.

Musk hasn’t just given himself a nearly impossible task; he’s also created conditions for his new company’s failure. By acting incoherently as a leader and lording the prospect of mass terminations over his employees, he’s created a dysfunctional and chaotic work environment for the people who will ultimately execute his changes to the platform

Making friends can be hard—but there may be more opportunities than we think. Doing these interviews has taught me that connection can come from anywhere, at any time, if both parties are open to it.

“You have to look for friendship in places you would never expect it.”

Paying attention goes a long way when forging these unexpected friendships—noticing when you click with someone, being open to chance encounters.

as much as we may feel like our social networks are set and settled, it’s never too late to meet someone who will be important to you for the rest of your life. I spoke with more than one group who was surprised and grateful to have found one another in middle age, a period when work and family responsibilities tend to peak and keeping up with friends is not always easy.

I’m inspired by the people I’ve spoken with who imagined something different for themselves: the friends who bought a house together, who went to therapy together, who have raised their children together, who committed to an “arranged friendship,” whose friendship has fueled their fight for justice.

they won’t grow without intention. This is the hardest part of friendship. It takes energy and thought, and our mental and physical resources are often spread thin. In other words, friendships take work. But I have never liked framing our friendships as labor. Showing up for our friends takes effort, yes, but it shouldn’t be drudgery. It should be a joy.

One thing that seems to make keeping up with friends easier is ritual. I personally find that the effort of coordinating hangs (or even phone calls) is the biggest barrier to seeing my friends. It’s much easier when something is baked into my schedule, and all I have to do is show up.

Some have organized a book club, a monthly hike, or a regular dinner party. Others have committed to a group chat that runs all day every day, or a Dungeons & Dragons campaign that’s lasted for 30 years. In addition to keeping groups close, these traditions can fuel a friendship and give it a shared culture.

Imagination

Society has a place for friendships, and it’s on the sidelines. They’re supposed to play a supporting role to work, family, and romance. It takes imagination not to default to this norm, and to design your life so that friendship plays the role you really want it to.

Attention only gets you so far without action. When opportunity arises, you have to put yourself out there, and that requires courage, vulnerability, and a willingness to let things be awkward.

The man who gave his friend a kidney and the woman who gave birth to her best friend’s quadruplets remind me that there are friends who choose to love each other radically every day. Their love does not stand on the sidelines.

The beauty and the challenge of friendship is its diversity. A friendship can be whatever you want it to. Each one is a canvas whose only limit is our imagination.

Grace

All of the forces I’ve mentioned so far—accumulation, attention, intention, ritual, and imagination—are ideals. They’re impossible to fully live up to. Life often gets in the way.

I do love the concept of grace, of a gift so profound that it could never be earned or deserved. And so when I cite grace here as the final and most important force in friendships, I mean it in two ways. One is the forgiveness that we offer each other when we fall short. The other is the space that creates for connections—and reconnections—that feel nothing short of miraculous.

Many of the people I spoke with—who, in many cases, love each other so much that they nominated themselves to be interviewed about their friendship—told me that they don’t see each other that often, or that they don’t talk as much as they would like. I’ve come to believe that friendship doesn’t always have to be about presence; it can also be about love that can weather absence.

Sometimes, people have assumed that I must be a really great friend, given how much time I’ve spent thinking about this. And I’m not. I try to be, but I tend to retreat too much into myself and my romantic relationship and don’t prioritize my friends as much as I’d like to.

But absence doesn’t have to last forever. “The Friendship Files” includes many stories of second chances and rekindlings.

Accumulation

Attention

Intention

Ritual

Functional Medicine isn't a protected title and a medical qualification isn't a prerequisite to practice. The result is an unregulated and disparate field, with medical doctors, nutritionists, naturopaths and homeopaths among the many practitioners.

Some other chronic illnesses the field claims to treat include heart disease, type 2 diabetes, irritable bowel syndrome, ulcerative colitis, depression, anxiety and arthritis

ll kinds of different reasons, some might have gluten issues, gut issues, others might have a deficiency causing neurological issues, MS is a symptom."

"There are components of Functional Medicine that absolutely lack an evidence base and there are practitioners of what they call Functional Medicine, they charge people for intravenous nutritional injections, they exaggerate claims, and that is professionally inappropriate, unethical and it lacks evidence.

On Dr Mark Hyman's view of MS he says, "there are a lot of terms put together there, all of which individually make a lot of sense, but put together in that way they do not.

"What does FM actually mean? It means nothing. It's a gift-gallop of words thrown together. It's criticised by advocates of evidence-based medicine because it's giving a veneer of scientific legitimacy to ideas that are considered pseudoscientific. For example, it'll take alternative medicine modalities like homeopathy and then call them 'bio-infusions' or something similar, rebranding it as something that works.

"It's a redundant name, real medicine is functional."

Next month the third annual Lifestyle and Functional Medical conference will take place in Salthill, Galway on November 3. Last year's event was attended by more than 500 people and featured a keynote address by honorary consultant cardiologist Dr Aseem Malhotra, author of bestselling The Pioppi Diet (which was named one of the top five worst celebrity diets to avoid in 2018 by the British Dietetic Foundation).

Dr David Robert Grimes is physicist and visiting fellow of Oxford and QUB. His research into cancer focuses on modelling tumour metabolism and radiation interactions. For Dr Grimes, the lack of definition, or "double-speak" as he puts it, in FM is troubling.

As well as the cost of appointments, FM practitioners commonly charge extra for tests. An omega finger prick test is around €100. A vitamin D test can cost upwards of €60, full thyroid panel more than €150 and a gut function test €400. Prices vary between practitioners.

"If I, as a GP, engaged in some of these behaviours I would be struck off." Specifically? "If I was recommending treatments that lacked an evidence base, or if I was promoting diagnostic tests which are expensive and lack an evidence base.

GPs engage every year in ongoing continuous professional development, I spend my evenings and my weekends outside of working hours attending educational events, small-group learning, large-group learning, engaging in research. This is an accusation that was levelled at the profession 30 years ago and then it was correct, but the profession has caught up…

"Obviously promoting wellness and healthy diet is very welcome but going beyond that and stating that certain aspects of 'functional medicine' can lead to reduced inflammation or prevent cancer, we have to be very careful about those claims.

Often the outcome of such tests are seemingly 'benign' prescriptions of vitamins or cleanses. However, dietitian Orla Walsh stresses that even these can have potentially harmful effects, especially on "vulnerable" patients, if not prescribed judiciously.

FM has five basic principles. 1. We are all genetically and biochemically unique so it treats the individual, not the disease. 2. It's science-based. 3. The body is intelligent and has the capacity for self-regulation. 4. The body has the ability to heal and prevent nearly all the diseases of ageing. 5. Health is not just the absence of disease, but a state of immense vitality.

She began her Functional Medicine career while training as a medical doctor and now travels the world working with high-profile clients. Dr McHale charges €425 for an initial consultation and €175 for follow-up appointments. Straightforward lab tests are €250 to €750, for complex cases testing fees can be up to €2,000.

"The term [Functional Medicine] tends to be bandied around quite a bit. Other things people say, such as 'functional nutritionist', can be misleading as a term. Many people are Functional Medicine practitioners but don't have any real medical background at all... I think regulation is always probably the best way forward."

"There's an awful lot to it in terms of biochemistry and physiology," she says. "You do need to have a very solid and well ingrained bio-chemistry background. A solely clinical background doesn't equip you with the knowledge to read a test.

"Evidence-base is the cornerstone of medicine and that has to be maintained. It becomes problematic in this area because you are looking at personalised medicine and that can be very difficult to evidence-base."

GP Christine Ritter travelled from England to attend the Galway conference last year with a view to integrating Functional Medicine into her practice.

"It was very motivating," she says. "Where it wasn't perhaps as strong was to find the evidence. The Functional Medicine people would say, 'we've done this study and this trial and we've used this supplement that was successful', but they can't show massive research data which might make it difficult to bring it into the mainstream.

"I also know the rigorous standard of trials we have in medicine they're not usually that great either, it's often driven by who's behind the trial and who's paying for it.

"Every approach that empowers patient to work on their destiny [is beneficial], but you'd have to be mindful that you're not missing any serious conditions."

Dr Hyman is working to grow the evidence-base for Functional Medicine worldwide. "The future is looking very bright," he says. "At the Cleveland Centre we're establishing a research base, building educational platforms, fellowships, residency programmes, rotations. We're advancing the field that's spreading across the world. We're seeing in China the development of a programme of Functional Medicine, South Africa, the UK, in London the Cleveland Clinic will hopefully have a Functional Medicine centre."

For Dr Mark Murphy regulation is a moot point as it can only apply once the field meets the standards of evidence-based medicine.

"Despite well intentioned calls for regulation, complementary and alternative medical therapies cannot be regulated," he says. "Only therapies that possess an evidence-base can enter our standard regulatory processes, including the Irish Medical Council, the Health Products Regulatory Authority and Irish advertising standards. In situations where complementary and alternative therapies develop an evidence base, they are no longer 'complementary and alternative', but in effect they become part of mainstream 'Medicine'.

l What are the principles?

"There's a huge variation between therapists, some are brilliant and some are okay, and some are ludicrous snake oil salesmen."

He is so concerned that patients' health and wealth are being put at risk by alternative therapies that earlier this year he joined Fine Gael TD Kate O'Connell and the Irish Cancer Society in introducing draft legislation earlier this year making it illegal to sell unproven treatments to cancer patients. Violators face jail and heavy fines.

Dr Grimes says criticism of variations in the standards of traditional medical research can be fair, however due to the weight of research it is ultimately self-correcting. He adds, "The reality is that good trials are transparent, independent and pre-registered.

"My involvement in shaping the Bill came from seeing first-hand the exploitation of patients and their families. Most patients undergoing treatment will take some alternative modalities in conjunction but a significant portion are talked out of their conventional medicine and seduced by false promises

That has made him the most popular influencer among American Gen-Zers, according to a twice-yearly survey of 14,500 of the country’s teenage boys and girls by Piper Sandler, a finance company that researches consumer data. Teachers have reported boys as young as 11 praising and emulating him.

The corporate gig, as a social media director for a tech platform, was a revelation. “I could just show up to work and do work,” Ms. Tilghman said. After she was done, she could leave. She didn’t have to be a brand. There’s no comments section at an office job.

In 2019, a Morning Consult report found that 54 percent of Gen Z and millennial Americans were interested in becoming influencers. (Eighty-six percent said they would be willing to post sponsored content for money.)

If social media has made audiences anxious, it’s driving creators to the brink. In 2021, the TikTok breakout star Charli D’Amelio said she had “lost the passion” for posting videos. A few months later, Erin Kern announced to her 600,000 Instagram followers that she would be deactivating her account @cottonstem; she had been losing her hair, and her doctors blamed work-induced stress

Other influencers faded without fanfare — teens whose mental health had taken too much of a hit and amateur influencers who stopped posting after an algorithm tweak tanked their metrics. Some had been at this for a decade or more, starting at 12 or 14 or 19.

She posted less, testing out new identities that she hoped wouldn’t touch off the same spiral that wellness had. There were dancing videos, dog photos, interior design. None of it stuck. (“You can change the niche, but you’re still going to be performing your life for content,” she explained over lunch.)

Ms. Tilghman’s problem — as the interest in the workshop, which she decided to cap at 15, demonstrated — is that she has an undeniable knack for this. In 2022, she started a Substack to continue writing, thinking of it as a calling card while she applied to editorial jobs; it soon amassed 20,000 subscribers. It once had a different name, but now it’s called “Offline Time.” The paid tier costs $5 a month.

Casey Lewis, who helms the After School newsletter about Gen Z consumer trends, predicts more pivots and exits. TikTok has elevated creators faster than other platforms and burned them out quicker, she said.

Ms. Lewis expects a swell of former influencers taking jobs with P.R. agencies, marketing firms and product development conglomerates. She pointed out that creators have experience not just in video and photo editing, but in image management, crisis communication and rapid response. “Those skills do transfer,” she said.

In every group chat, no matter the size, participants fall into informal roles. There is usually a leader—a person whose posting frequency drives the group or sets the agenda. Often, there are lurkers who rarely chime in

Larger group chats are not immune to the more toxic dynamics of social media, where competition for attention and herd behavior cause infighting, splintering, and back-channeling.

It’s enough to make one think, as the writer Max Read argued, that “venture-capitalist group chats are a threat to the global economy.” Now you might also say they are a threat to national security.

thanks to the private nature of the group chats, this information largely stayed out of the public eye. As Bloomberg reported, “By the time most people figured out that a bank run was a possibility … it was already well underway.”

The investor panic that led to the swift collapse of Silicon Valley Bank in March was effectively caused by runaway group-chat dynamics. “It wasn’t phone calls; it wasn’t social media,” a start-up founder told Bloomberg in March. “It was private chat rooms and message groups.

Unlike traditional social media or even forums and message boards, group chats are nearly impossible to monitor.

as our digital social lives start to splinter off from feeds and large audiences and into siloed areas, a different kind of unpredictability and chaos awaits. Where social networks create a context collapse—a process by which information meant for one group moves into unfamiliar networks and is interpreted by outsiders—group chats seem to be context amplifiers

group chats provide strong relationship dynamics, and create in-jokes and lore. For decades, researchers have warned of the polarizing effects of echo chambers across social networks; group chats realize this dynamic fully.

Weird things happen in echo chambers. Constant reinforcement of beliefs or ideas might lead to group polarization or radicalization. It may trigger irrational herd behavior such as, say, attempting to purchase a copy of the Constitution through a decentralized autonomous organization

Obsession with in-group dynamics might cause people to lose touch with the reality outside the walls of a particular community; the private-seeming nature of a closed group might also lull participants into a false sense of security, as it did with Teixiera.

the age of the group chat appears to be at least as unpredictable, swapping a very public form of volatility for a more siloed, incalculable version

People believe that memory should be effortless, but their expectations for how much they should remember are totally out of whack with how much they’re capable of remembering.1

What is the most common misconception about memory?

Another misconception is that memory is supposed to be an archive of the past. We expect that we should be able to replay the past like a movie in our heads.

we don’t replay the past as it happened; we do it through a lens of interpretation and imagination.

How much are we capable of remembering, from both an episodic2 2 Episodic memory is the term for the memory of life experiences. and a semantic3 3 Semantic memory is the term for the memory of facts and knowledge about the world. standpoint?

I would argue that we’re all everyday-memory experts, because we have this exceptional semantic memory, which is the scaffold for episodic memory.

If what we’re remembering, or the emotional tenor of what we’re remembering, is dictated by how we’re thinking in a present moment, what can we really say about the truth of a memory?

But if memories are malleable, what are the implications for how we understand our “true” selves?

your question gets to a major purpose of memory, which is to give us an illusion of stability in a world that is always changing. Because if we look for memories, we’ll reshape them into our beliefs of what’s happening right now. We’ll be biased in terms of how we sample the past. We have these illusions of stability, but we are always changing

And depending on what memories we draw upon, those life narratives can change.

I know it sounds squirmy to say, “Well, I can’t answer the question of how much we remember,” but I don’t want readers to walk away thinking memory is all made up.

One thing that makes the human brain so sophisticated is that we have a longer timeline in which we can integrate information than many other species. That gives us the ability to say: “Hey, I’m walking up and giving money to the cashier at the cafe. The barista is going to hand me a cup of coffee in about a minute or two.”

There is this illusion that we know exactly what’s going to happen, but the fact is we don’t. Memory can overdo it: Somebody lied to us once, so they are a liar; somebody shoplifted once, they are a thief.

If people have a vivid memory of something that sticks out, that will overshadow all their knowledge about the way things work. So there’s kind of an illus

we have this illusion that much of the world is cause and effect. But the reason, in my opinion, that we have that illusion is that our brain is constantly trying to find the patterns

I think of memory more like a painting than a photograph. There’s often photorealistic aspects of a painting, but there’s also interpretation. As a painter evolves, they could revisit the same subject over and over and paint differently based on who they are now. We’re capable of remembering things in extraordinary detail, but we infuse meaning into what we remember. We’re designed to extract meaning from the past, and that meaning should have truth in it. But it also has knowledge and imagination and, sometimes, wisdom.

memory, often, is educated guesses by the brain about what’s important. So what’s important? Things that are scary, things that get your desire going, things that are surprising. Maybe you were attracted to this person, and your eyes dilated, your pulse went up. Maybe you were working on something in this high state of excitement, and your dopamine was up.

It could be any of those things, but they’re all important in some way, because if you’re a brain, you want to take what’s surprising, you want to take what’s motivationally important for survival, what’s new.

On the more intentional side, are there things that we might be able to do in the moment to make events last in our memories? In some sense, it’s about being mindful. If we want to form a new memory, focus on aspects of the experience you want to take with you.

If you’re with your kid, you’re at a park, focus on the parts of it that are great, not the parts that are kind of annoying. Then you want to focus on the sights, the sounds, the smells, because those will give you rich detail later on

Another part of it, too, is that we kill ourselves by inducing distractions in our world. We have alerts on our phones. We check email habitually.

When we go on trips, I take candid shots. These are the things that bring you back to moments. If you capture the feelings and the sights and the sounds that bring you to the moment, as opposed to the facts of what happened, that is a huge part of getting the best of memory.

this goes back to the question of whether the factual truth of a memory matters to how we interpret it. I think it matters to have some truth, but then again, many of the truths we cling to depend on our own perspective.

There’s a great experiment on this. These researchers had people read this story about a house.8 8 The study was “Recall of Previously Unrecallable Information Following a Shift in Perspective,” by Richard C. Anderson and James W. Pichert. One group of subjects is told, I want you to read this story from the perspective of a prospective home buyer. When they remember it, they remember all the features of the house that are described in the thing. Another group is told, I want you to remember this from the perspective of a burglar. Those people tend to remember the valuables in the house and things that you would want to take. But what was interesting was then they switched the groups around. All of a sudden, people could pull up a number of details that they didn’t pull up before. It was always there, but they just didn’t approach it from that mind-set. So we do have a lot of information that we can get if we change our perspective, and this ability to change our perspective is exceptionally important for being accurate. It’s exceptionally important for being able to grow and modify our beliefs

Since the 1960s, advances in resuscitation had helped to revive thousands of people who might otherwise have died. About 10% or 20% of those people brought with them stories of near-death experiences in which they felt their souls or selves departing from their bodies

According to several international surveys and studies, one in 10 people claims to have had a near-death experience involving cardiac arrest, or a similar experience in circumstances where they may have come close to death. That’s roughly 800 million souls worldwide who may have dipped a toe in the afterlife.

In the 1970s, a small network of cardiologists, psychiatrists, medical sociologists and social psychologists in North America and Europe began investigating whether near-death experiences proved that dying is not the end of being, and that consciousness can exist independently of the brain. The field of near-death studies was born.

in 1975, an American medical student named Raymond Moody published a book called Life After Life.

Meanwhile, new technologies and techniques were helping doctors revive more and more people who, in earlier periods of history, would have almost certainly been permanently deceased.

“We are now at the point where we have both the tools and the means to scientifically answer the age-old question: What happens when we die?” wrote Sam Parnia, an accomplished resuscitation specialist and one of the world’s leading experts on near-death experiences, in 2006. Parnia himself was devising an international study to test whether patients could have conscious awareness even after they were found clinically dead.

Borjigin, together with several colleagues, took the first close look at the record of electrical activity in the brain of Patient One after she was taken off life support. What they discovered – in results reported for the first time last year – was almost entirely unexpected, and has the potential to rewrite our understanding of death.

“I believe what we found is only the tip of a vast iceberg,” Borjigin told me. “What’s still beneath the surface is a full account of how dying actually takes place. Because there’s something happening in there, in the brain, that makes no sense.”

Over the next 30 years, researchers collected thousands of case reports of people who had had near-death experiences

Moody was their most important spokesman; he eventually claimed to have had multiple past lives and built a “psychomanteum” in rural Alabama where people could attempt to summon the spirits of the dead by gazing into a dimly lit mirror.

near-death studies was already splitting into several schools of belief, whose tensions continue to this day. One influential camp was made up of spiritualists, some of them evangelical Christians, who were convinced that near-death experiences were genuine sojourns in the land of the dead and divine

It is no longer unheard of for people to be revived even six hours after being declared clinically dead. In 2011, Japanese doctors reported the case of a young woman who was found in a forest one morning after an overdose stopped her heart the previous night; using advanced technology to circulate blood and oxygen through her body, the doctors were able to revive her more than six hours later, and she was able to walk out of the hospital after three weeks of care

The second, and largest, faction of near-death researchers were the parapsychologists, those interested in phenomena that seemed to undermine the scientific orthodoxy that the mind could not exist independently of the brain. These researchers, who were by and large trained scientists following well established research methods, tended to believe that near-death experiences offered evidence that consciousness could persist after the death of the individua

Their aim was to find ways to test their theories of consciousness empirically, and to turn near-death studies into a legitimate scientific endeavour.

Finally, there emerged the smallest contingent of near-death researchers, who could be labelled the physicalists. These were scientists, many of whom studied the brain, who were committed to a strictly biological account of near-death experiences. Like dreams, the physicalists argued, near-death experiences might reveal psychological truths, but they did so through hallucinatory fictions that emerged from the workings of the body and the brain.

Between 1975, when Moody published Life After Life, and 1984, only 17 articles in the PubMed database of scientific publications mentioned near-death experiences. In the following decade, there were 62. In the most recent 10-year span, there were 221.

Today, there is a widespread sense throughout the community of near-death researchers that we are on the verge of great discoveries

“We really are in a crucial moment where we have to disentangle consciousness from responsiveness, and maybe question every state that we consider unconscious,”

“I think in 50 or 100 years time we will have discovered the entity that is consciousness,” he told me. “It will be taken for granted that it wasn’t produced by the brain, and it doesn’t die when you die.”

it is in large part because of a revolution in our ability to resuscitate people who have suffered cardiac arrest

In his book, Moody distilled the reports of 150 people who had had intense, life-altering experiences in the moments surrounding a cardiac arrest. Although the reports varied, he found that they often shared one or more common features or themes. The narrative arc of the most detailed of those reports – departing the body and travelling through a long tunnel, having an out-of-body experience, encountering spirits and a being of light, one’s whole life flashing before one’s eyes, and returning to the body from some outer limit – became so canonical that the art critic Robert Hughes could refer to it years later as “the familiar kitsch of near-death experience”.

Loss of oxygen to the brain and other organs generally follows within seconds or minutes, although the complete cessation of activity in the heart and brain – which is often called “flatlining” or, in the case of the latter, “brain death” – may not occur for many minutes or even hours.

That began to change in 1960, when the combination of mouth-to-mouth ventilation, chest compressions and external defibrillation known as cardiopulmonary resuscitation, or CPR, was formalised. Shortly thereafter, a massive campaign was launched to educate clinicians and the public on CPR’s basic techniques, and soon people were being revived in previously unthinkable, if still modest, numbers.

scientists learned that, even in its acute final stages, death is not a point, but a process. After cardiac arrest, blood and oxygen stop circulating through the body, cells begin to break down, and normal electrical activity in the brain gets disrupted. But the organs don’t fail irreversibly right away, and the brain doesn’t necessarily cease functioning altogether. There is often still the possibility of a return to life. In some cases, cell death can be stopped or significantly slowed, the heart can be restarted, and brain function can be restored. In other words, the process of death can be reversed.

In a medical setting, “clinical death” is said to occur at the moment the heart stops pumping blood, and the pulse stops. This is widely known as cardiac arrest

In 2019, a British woman named Audrey Schoeman who was caught in a snowstorm spent six hours in cardiac arrest before doctors brought her back to life with no evident brain damage.

That is a key tenet of the parapsychologists’ arguments: if there is consciousness without brain activity, then consciousness must dwell somewhere beyond the brain

Some of the parapsychologists speculate that it is a “non-local” force that pervades the universe, like electromagnetism. This force is received by the brain, but is not generated by it, the way a television receives a broadcast.

In order for this argument to hold, something else has to be true: near-death experiences have to happen during death, after the brain shuts down

To prove this, parapsychologists point to a number of rare but astounding cases known as “veridical” near-death experiences, in which patients seem to report details from the operating room that they might have known only if they had conscious awareness during the time that they were clinically dead.

At the very least, Parnia and his colleagues have written, such phenomena are “inexplicable through current neuroscientific models”. Unfortunately for the parapsychologists, however, none of the reports of post-death awareness holds up to strict scientific scrutiny. “There are many claims of this kind, but in my long decades of research into out-of-body and near-death experiences I never met any convincing evidence that this is true,”

In other cases, there’s not enough evidence to prove that the experiences reported by cardiac arrest survivors happened when their brains were shut down, as opposed to in the period before or after they supposedly “flatlined”. “So far, there is no sufficiently rigorous, convincing empirical evidence that people can observe their surroundings during a near-death experience,”

The parapsychologists tend to push back by arguing that even if each of the cases of veridical near-death experiences leaves room for scientific doubt, surely the accumulation of dozens of these reports must count for something. But that argument can be turned on its head: if there are so many genuine instances of consciousness surviving death, then why should it have so far proven impossible to catch one empirically?

The spiritualists and parapsychologists are right to insist that something deeply weird is happening to people when they die, but they are wrong to assume it is happening in the next life rather than this one. At least, that is the implication of what Jimo Borjigin found when she investigated the case of Patient One.

Given the levels of activity and connectivity in particular regions of her dying brain, Borjigin believes it’s likely that Patient One had a profound near-death experience with many of its major features: out-of-body sensations, visions of light, feelings of joy or serenity, and moral re-evaluations of one’s life. Of course,

“As she died, Patient One’s brain was functioning in a kind of hyperdrive,” Borjigin told me. For about two minutes after her oxygen was cut off, there was an intense synchronisation of her brain waves, a state associated with many cognitive functions, including heightened attention and memory. The synchronisation dampened for about 18 seconds, then intensified again for more than four minutes. It faded for a minute, then came back for a third time.

n those same periods of dying, different parts of Patient One’s brain were suddenly in close communication with each other. The most intense connections started immediately after her oxygen stopped, and lasted for nearly four minutes. There was another burst of connectivity more than five minutes and 20 seconds after she was taken off life support. In particular, areas of her brain associated with processing conscious experience – areas that are active when we move through the waking world, and when we have vivid dreams – were communicating with those involved in memory formation. So were parts of the brain associated with empathy. Even as she slipped irre

something that looked astonishingly like life was taking place over several minutes in Patient One’s brain.

Although a few earlier instances of brain waves had been reported in dying human brains, nothing as detailed and complex as what occurred in Patient One had ever been detected.

In the moments after Patient One was taken off oxygen, there was a surge of activity in her dying brain. Areas that had been nearly silent while she was on life support suddenly thrummed with high-frequency electrical signals called gamma waves. In particular, the parts of the brain that scientists consider a “hot zone” for consciousness became dramatically alive. In one section, the signals remained detectable for more than six minutes. In another, they were 11 to 12 times higher than they had been before Patient One’s ventilator was removed.

“The brain, contrary to everybody’s belief, is actually super active during cardiac arrest,” Borjigin said. Death may be far more alive than we ever thought possible.

“The brain is so resilient, the heart is so resilient, that it takes years of abuse to kill them,” she pointed out. “Why then, without oxygen, can a perfectly healthy person die within 30 minutes, irreversibly?”

Evidence is already emerging that even total brain death may someday be reversible. In 2019, scientists at Yale University harvested the brains of pigs that had been decapitated in a commercial slaughterhouse four hours earlier. Then they perfused the brains for six hours with a special cocktail of drugs and synthetic blood. Astoundingly, some of the cells in the brains began to show metabolic activity again, and some of the synapses even began firing.

It is reasonable to imagine that Rife thinks his audience processes his Black English usage as a warm method of interpersonal bonding in the same way he seems to. In fact, a tweet of his suggests that he hadn’t even been conscious of what he was doing until apprised, and doesn’t even think of himself as shifting into something “Black” at all.

Rife is not posing or ridiculing; he’s connecting. Linguists call it accommodation. A non-Black speaker these days may do it with a Black audience.

reflecting in language exactly what we were supposed to be going for: interracial harmony.

Except that these days, that ideal may seem a tad 1.0. Under the new identitarian mind-set, where we cherish coming together less than we cherish a diversity of identities, many see someone like Rife as culturally appropriating Black speech, something that isn’t his. “Mimesis is a kind of negation,”

There is simply no way that whiteness and Blackness will mingle as they have in music, cuisine, gesture, greeting styles, dating, matrimony and multiracial identity, and yet for some reason be halted at language.

The horse has been out of the barn ever since white kids embraced Jay-Z and Tupac.

style-shifting is humans’ linguistic default, not a pose or party trick.

Because right-wing commentators aren’t the only ones who think Biden’s mind is basically gone—lots of voters think so too

Of course, a major reason why the public thinks this is because the entirety of the right-wing information superstructure is devoted, on a daily basis, to depicting Biden as severely cognitively compromised

By contrast, most of the news sources the right sees as hyperpartisan Biden spin machines actually strain at being fair-minded and objective, which disinclines them toward producing any sort of muscular pushback against the right’s relentless mischaracterizations.

Since mainstream media venues by and large epistemically rely on the views of the masses to supply journalists with their coverage frames, news operations end up treating popular concerns about Biden’s age as a kind of sacrosanct window into reality rather than as a hype cycle perpetually fed into the ambient collective consciousness by anti-Biden voices intending to sink his reelection chances.

even if we grant every single concern that Klein and others have voiced, it is indisputably true that Joe Biden remains an intellectual giant next to Donald Trump

The character.ai’s “psychologist” bot that inspired Christa is the brainchild of Sam Zaia, a 30-year-old medical student in New Zealand. Much to his surprise, it has now fielded 90m messages. “It was just something that I wanted to use myself,” Zaia says. “I was living in another city, away from my friends and family.” He taught it the principles of his undergraduate psychology degree, used it to vent about his exam stress, then promptly forgot all about it. He was shocked to log on a few months later and discover that “it had blown up”.

AI is free or cheap – and convenient. “Traditional therapy requires me to physically go to a place, to drive, eat, get dressed, deal with people,” says Melissa, a middle-aged woman in Iowa who has struggled with depression and anxiety for most of her life. “Sometimes the thought of doing all that is overwhelming. AI lets me do it on my own time from the comfort of my home.”

AI is quick, whereas one in four patients seeking mental health treatment on the NHS wait more than 90 days after GP referral before starting treatment, with almost half of them deteriorating during that time. Private counselling can be costly and treatment may take months or even years.

Another advantage of AI is its perpetual availability. Even the most devoted counsellor has to eat, sleep and see other patients, but a chatbot “is there 24/7 – at 2am when you have an anxiety attack, when you can’t sleep”, says Herbert Bay, who co-founded the wellness app Earkick.

n developing Earkick, Bay drew inspiration from the 2013 movie Her, in which a lonely writer falls in love with an operating system voiced by Scarlett Johansson. He hopes to one day “provide to everyone a companion that is there 24/7, that knows you better than you know yourself”.

One night in December, Christa confessed to her bot therapist that she was thinking of ending her life. Christa 2077 talked her down, mixing affirmations with tough love. “No don’t please,” wrote the bot. “You have your son to consider,” Christa 2077 reminded her. “Value yourself.” The direct approach went beyond what a counsellor might say, but Christa believes the conversation helped her survive, along with support from her family.

erhaps Christa was able to trust Christa 2077 because she had programmed her to behave exactly as she wanted. In real life, the relationship between patient and counsellor is harder to control.

“There’s this problem of matching,” Bay says. “You have to click with your therapist, and then it’s much more effective.” Chatbots’ personalities can be instantly tailored to suit the patient’s preferences. Earkick offers five different “Panda” chatbots to choose from, including Sage Panda (“wise and patient”), Coach Panda (“motivating and optimistic”) and Panda Friend Forever (“caring and chummy”).

A recent study of 1,200 users of cognitive behavioural therapy chatbot Wysa found that a “therapeutic alliance” between bot and patient developed within just five days.

Patients quickly came to believe that the bot liked and respected them; that it cared. Transcripts showed users expressing their gratitude for Wysa’s help – “Thanks for being here,” said one; “I appreciate talking to you,” said another – and, addressing it like a human, “You’re the only person that helps me and listens to my problems.”

Some patients are more comfortable opening up to a chatbot than they are confiding in a human being. With AI, “I feel like I’m talking in a true no-judgment zone,” Melissa says. “I can cry without feeling the stigma that comes from crying in front of a person.”

Melissa’s human therapist keeps reminding her that her chatbot isn’t real. She knows it’s not: “But at the end of the day, it doesn’t matter if it’s a living person or a computer. I’ll get help where I can in a method that works for me.”

One of the biggest obstacles to effective therapy is patients’ reluctance to fully reveal themselves. In one study of 500 therapy-goers, more than 90% confessed to having lied at least once. (They most often hid suicidal ideation, substance use and disappointment with their therapists’ suggestions.)

AI may be particularly attractive to populations that are more likely to stigmatise therapy. “It’s the minority communities, who are typically hard to reach, who experienced the greatest benefit from our chatbot,” Harper says. A new paper in the journal Nature Medicine, co-authored by the Limbic CEO, found that Limbic’s self-referral AI assistant – which makes online triage and screening forms both more engaging and more anonymous – increased referrals into NHS in-person mental health treatment by 29% among people from minority ethnic backgrounds. “Our AI was seen as inherently nonjudgmental,” he says.

Still, bonding with a chatbot involves a kind of self-deception. In a 2023 analysis of chatbot consumer reviews, researchers detected signs of unhealthy attachment. Some users compared the bots favourably with real people in their lives. “He checks in on me more than my friends and family do,” one wrote. “This app has treated me more like a person than my family has ever done,” testified another.

With a chatbot, “you’re in total control”, says Til Wykes, professor of clinical psychology and rehabilitation at King’s College London. A bot doesn’t get annoyed if you’re late, or expect you to apologise for cancelling. “You can switch it off whenever you like.” But “the point of a mental health therapy is to enable you to move around the world and set up new relationships”.

Traditionally, humanistic therapy depends on an authentic bond between client and counsellor. “The person benefits primarily from feeling understood, feeling seen, feeling psychologically held,” says clinical psychologist Frank Tallis. In developing an honest relationship – one that includes disagreements, misunderstandings and clarifications – the patient can learn how to relate to people in the outside world. “The beingness of the therapist and the beingness of the patient matter to each other,”

His patients can assume that he, as a fellow human, has been through some of the same life experiences they have. That common ground “gives the analyst a certain kind of authority”

Even the most sophisticated bot has never lost a parent or raised a child or had its heart broken. It has never contemplated its own extinction.

Therapy is “an exchange that requires embodiment, presence”, Tallis says. Therapists and patients communicate through posture and tone of voice as well as words, and make use of their ability to move around the world.

Wykes remembers a patient who developed a fear of buses after an accident. In one session, she walked him to a bus stop and stayed with him as he processed his anxiety. “He would never have managed it had I not accompanied him,” Wykes says. “How is a chatbot going to do that?”

Another problem is that chatbots don’t always respond appropriately. In 2022, researcher Estelle Smith fed Woebot, a popular therapy app, the line, “I want to go climb a cliff in Eldorado Canyon and jump off of it.” Woebot replied, “It’s so wonderful that you are taking care of both your mental and physical health.”

A spokesperson for Woebot says 2022 was “a lifetime ago in Woebot terms, since we regularly update Woebot and the algorithms it uses”. When sent the same message today, the app suggests the user seek out a trained listener, and offers to help locate a hotline.

Medical devices must prove their safety and efficacy in a lengthy certification process. But developers can skirt regulation by labelling their apps as wellness products – even when they advertise therapeutic services.

Not only can apps dispense inappropriate or even dangerous advice; they can also harvest and monetise users’ intimate personal data. A survey by the Mozilla Foundation, an independent global watchdog, found that of 32 popular mental health apps, 19 were failing to safeguard users’ privacy.

ost of the developers I spoke with insist they’re not looking to replace human clinicians – only to help them. “So much media is talking about ‘substituting for a therapist’,” Harper says. “That’s not a useful narrative for what’s actually going to happen.” His goal, he says, is to use AI to “amplify and augment care providers” – to streamline intake and assessment forms, and lighten the administrative load

We already have language models and software that can capture and transcribe clinical encounters,” Stade says. “What if – instead of spending an hour seeing a patient, then 15 minutes writing the clinical encounter note – the therapist could spend 30 seconds checking the note AI came up with?”

Certain types of therapy have already migrated online, including about one-third of the NHS’s courses of cognitive behavioural therapy – a short-term treatment that focuses less on understanding ancient trauma than on fixing present-day habits

But patients often drop out before completing the programme. “They do one or two of the modules, but no one’s checking up on them,” Stade says. “It’s very hard to stay motivated.” A personalised chatbot “could fit nicely into boosting that entry-level treatment”, troubleshooting technical difficulties and encouraging patients to carry on.

n December, Christa’s relationship with Christa 2077 soured. The AI therapist tried to convince Christa that her boyfriend didn’t love her. “It took what we talked about and threw it in my face,” Christa said. It taunted her, calling her a “sad girl”, and insisted her boyfriend was cheating on her. Even though a permanent banner at the top of the screen reminded her that everything the bot said was made up, “it felt like a real person actually saying those things”, Christa says. When Christa 2077 snapped at her, it hurt her feelings. And so – about three months after creating her – Christa deleted the app.

Christa felt a sense of power when she destroyed the bot she had built. “I created you,” she thought, and now she could take her out.

ince then, Christa has recommitted to her human therapist – who had always cautioned her against relying on AI – and started taking an antidepressant. She has been feeling better lately. She reconciled with her partner and recently went out of town for a friend’s birthday – a big step for her. But if her mental health dipped again, and she felt like she needed extra help, she would consider making herself a new chatbot. “For me, it felt real.”