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In November 2020, the AI group DeepMind announced it had developed a program called AlphaFold that could rapidly predict this information using an algorithm. Since then, it has been crunching through the genetic codes of every organism that has had its genome sequenced, and predicting the structures of the hundreds of millions of proteins they collectively contain.

Last year, DeepMind published the protein structures for 20 species – including nearly all 20,000 proteins expressed by humans – on an open database. Now it has finished the job, and released predicted structures for more than 200m proteins.

“Essentially, you can think of it as covering the entire protein universe. It includes predictive structures for plants, bacteria, animals, and many other organisms, opening up huge new opportunities for AlphaFold to have an impact on important issues, such as sustainability, food insecurity, and neglected diseases,”

In May, researchers led by Prof Matthew Higgins at the University of Oxford announced they had used AlphaFold’s models to help determine the structure of a key malaria parasite protein, and work out where antibodies that could block transmission of the parasite were likely to bind.

“Previously, we’d been using a technique called protein crystallography to work out what this molecule looks like, but because it’s quite dynamic and moves around, we just couldn’t get to grips with it,” Higgins said. “When we took the AlphaFold models and combined them with this experimental evidence, suddenly it all made sense. This insight will now be used to design improved vaccines which induce the most potent transmission-blocking antibodies.”

AlphaFold’s models are also being used by scientists at the University of Portsmouth’s Centre for Enzyme Innovation, to identify enzymes from the natural world that could be tweaked to digest and recycle plastics. “It took us quite a long time to go through this massive database of structures, but opened this whole array of new three-dimensional shapes we’d never seen before that could actually break down plastics,” said Prof John McGeehan, who is leading the work. “There’s a complete paradigm shift. We can really accelerate where we go from here

“AlphaFold protein structure predictions are already being used in a myriad of ways. I expect that this latest update will trigger an avalanche of new and exciting discoveries in the months and years ahead, and this is all thanks to the fact that the data are available openly for all to use.”

For centuries humans felt they were watched and judged by an all-seeing God who could condemn them to hell if they sinned heavily. The fear of divine punishment shaped private behaviour, applying a brake on some of our worst impulses.

it also seems sensible to assume that in the absence of an all-seeing deity threatening fire and brimstone, the brakes on devious or selfish behaviour in private will be eased, resulting in more “what’s the harm?” behaviour, more dabbling in the grey area between right and wrong, more secretive cruelty or casual selfishness.

Gradually, the fear of being watched by God and going to hell is being replaced by a fear of being recorded by technology and suffering the hell of public shame.

scandals might also act as a warning that in the age of the smartphone, the space for “getting away with it” has shrunk considerably.

the need for regulation to maintain the reliability of essential aspects of the economy like electricity supply and the monetary system.

Which is why I’m calling the modern American right antisocial — because its members reject any policy that relies on social cooperation, and they want us to return instead to Hobbes’s dystopian state of nature

why Republicans have become fanatics about cryptocurrency, to the extent that one Senate candidate has defined his position as being “pro-God, pro-family, pro-Bitcoin.” The answer, I’d argue, is that Bitcoin plays into a fantasy of self-sufficient individualism, of protecting your family with your personal AR-15, treating your Covid with an anti-parasite drug or urine and managing your financial affairs with privately created money, untainted by institutions like governments or banks.

In the end, none of this will work. Government exists for a reason. But the right’s constant attacks on essential government functions will take a toll, making all of our lives nastier, more brutish and shorter.

the stage was set for the major transformation, which began in 2009: the intensification of viral dynamics.

Before 2009, Facebook had given users a simple timeline––a never-ending stream of content generated by their friends and connections, with the newest posts at the top and the oldest ones at the bottom

That began to change in 2009, when Facebook offered users a way to publicly “like” posts with the click of a button. That same year, Twitter introduced something even more powerful: the “Retweet” button, which allowed users to publicly endorse a post while also sharing it with all of their followers.

“Like” and “Share” buttons quickly became standard features of most other platforms.

Facebook developed algorithms to bring each user the content most likely to generate a “like” or some other interaction, eventually including the “share” as well.

Later research showed that posts that trigger emotions––especially anger at out-groups––are the most likely to be shared.

By 2013, social media had become a new game, with dynamics unlike those in 2008. If you were skillful or lucky, you might create a post that would “go viral” and make you “internet famous”

If you blundered, you could find yourself buried in hateful comments. Your posts rode to fame or ignominy based on the clicks of thousands of strangers, and you in turn contributed thousands of clicks to the game.

This new game encouraged dishonesty and mob dynamics: Users were guided not just by their true preferences but by their past experiences of reward and punishment,

As a social psychologist who studies emotion, morality, and politics, I saw this happening too. The newly tweaked platforms were almost perfectly designed to bring out our most moralistic and least reflective selves. The volume of outrage was shocking.

It was just this kind of twitchy and explosive spread of anger that James Madison had tried to protect us from as he was drafting the U.S. Constitution.

The Framers of the Constitution were excellent social psychologists. They knew that democracy had an Achilles’ heel because it depended on the collective judgment of the people, and democratic communities are subject to “the turbulency and weakness of unruly passions.”

The key to designing a sustainable republic, therefore, was to build in mechanisms to slow things down, cool passions, require compromise, and give leaders some insulation from the mania of the moment while still holding them accountable to the people periodically, on Election Day.

The tech companies that enhanced virality from 2009 to 2012 brought us deep into Madison’s nightmare.

a less quoted yet equally important insight, about democracy’s vulnerability to triviality.

Madison notes that people are so prone to factionalism that “where no substantial occasion presents itself, the most frivolous and fanciful distinctions have been sufficient to kindle their unfriendly passions and excite their most violent conflicts.”

Social media has both magnified and weaponized the frivolous.

It’s not just the waste of time and scarce attention that matters; it’s the continual chipping-away of trust.

a democracy depends on widely internalized acceptance of the legitimacy of rules, norms, and institutions.

when citizens lose trust in elected leaders, health authorities, the courts, the police, universities, and the integrity of elections, then every decision becomes contested; every election becomes a life-and-death struggle to save the country from the other side

The most recent Edelman Trust Barometer (an international measure of citizens’ trust in government, business, media, and nongovernmental organizations) showed stable and competent autocracies (China and the United Arab Emirates) at the top of the list, while contentious democracies such as the United States, the United Kingdom, Spain, and South Korea scored near the bottom (albeit above Russia).

The literature is complex—some studies show benefits, particularly in less developed democracies—but the review found that, on balance, social media amplifies political polarization; foments populism, especially right-wing populism; and is associated with the spread of misinformation.

When people lose trust in institutions, they lose trust in the stories told by those institutions. That’s particularly true of the institutions entrusted with the education of children.

Facebook and Twitter make it possible for parents to become outraged every day over a new snippet from their children’s history lessons––and math lessons and literature selections, and any new pedagogical shifts anywhere in the country

The motives of teachers and administrators come into question, and overreaching laws or curricular reforms sometimes follow, dumbing down education and reducing trust in it further.

young people educated in the post-Babel era are less likely to arrive at a coherent story of who we are as a people, and less likely to share any such story with those who attended different schools or who were educated in a different decade.

former CIA analyst Martin Gurri predicted these fracturing effects in his 2014 book, The Revolt of the Public. Gurri’s analysis focused on the authority-subverting effects of information’s exponential growth, beginning with the internet in the 1990s. Writing nearly a decade ago, Gurri could already see the power of social media as a universal solvent, breaking down bonds and weakening institutions everywhere it reached.

he notes a constructive feature of the pre-digital era: a single “mass audience,” all consuming the same content, as if they were all looking into the same gigantic mirror at the reflection of their own society. I

The digital revolution has shattered that mirror, and now the public inhabits those broken pieces of glass. So the public isn’t one thing; it’s highly fragmented, and it’s basically mutually hostile

Facebook, Twitter, YouTube, and a few other large platforms unwittingly dissolved the mortar of trust, belief in institutions, and shared stories that had held a large and diverse secular democracy together.

I think we can date the fall of the tower to the years between 2011 (Gurri’s focal year of “nihilistic” protests) and 2015, a year marked by the “great awokening” on the left and the ascendancy of Donald Trump on the right.

Twitter can overpower all the newspapers in the country, and stories cannot be shared (or at least trusted) across more than a few adjacent fragments—so truth cannot achieve widespread adherence.

fter Babel, nothing really means anything anymore––at least not in a way that is durable and on which people widely agree.

Politics After Babel

“Politics is the art of the possible,” the German statesman Otto von Bismarck said in 1867. In a post-Babel democracy, not much may be possible.

The ideological distance between the two parties began increasing faster in the 1990s. Fox News and the 1994 “Republican Revolution” converted the GOP into a more combative party.

So cross-party relationships were already strained before 2009. But the enhanced virality of social media thereafter made it more hazardous to be seen fraternizing with the enemy or even failing to attack the enemy with sufficient vigor.

What changed in the 2010s? Let’s revisit that Twitter engineer’s metaphor of handing a loaded gun to a 4-year-old. A mean tweet doesn’t kill anyone; it is an attempt to shame or punish someone publicly while broadcasting one’s own virtue, brilliance, or tribal loyalties. It’s more a dart than a bullet

from 2009 to 2012, Facebook and Twitter passed out roughly 1 billion dart guns globally. We’ve been shooting one another ever since.

“devoted conservatives,” comprised 6 percent of the U.S. population.

the warped “accountability” of social media has also brought injustice—and political dysfunction—in three ways.

First, the dart guns of social media give more power to trolls and provocateurs while silencing good citizens.

a small subset of people on social-media platforms are highly concerned with gaining status and are willing to use aggression to do so.

Across eight studies, Bor and Petersen found that being online did not make most people more aggressive or hostile; rather, it allowed a small number of aggressive people to attack a much larger set of victims. Even a small number of jerks were able to dominate discussion forums,

Additional research finds that women and Black people are harassed disproportionately, so the digital public square is less welcoming to their voices.

Second, the dart guns of social media give more power and voice to the political extremes while reducing the power and voice of the moderate majority.

The “Hidden Tribes” study, by the pro-democracy group More in Common, surveyed 8,000 Americans in 2017 and 2018 and identified seven groups that shared beliefs and behaviors.

Social media has given voice to some people who had little previously, and it has made it easier to hold powerful people accountable for their misdeeds

The group furthest to the left, the “progressive activists,” comprised 8 percent of the population. The progressive activists were by far the most prolific group on social media: 70 percent had shared political content over the previous year. The devoted conservatives followed, at 56 percent.

These two extreme groups are similar in surprising ways. They are the whitest and richest of the seven groups, which suggests that America is being torn apart by a battle between two subsets of the elite who are not representative of the broader society.

they are the two groups that show the greatest homogeneity in their moral and political attitudes.

likely a result of thought-policing on social media:

political extremists don’t just shoot darts at their enemies; they spend a lot of their ammunition targeting dissenters or nuanced thinkers on their own team.

Finally, by giving everyone a dart gun, social media deputizes everyone to administer justice with no due process. Platforms like Twitter devolve into the Wild West, with no accountability for vigilantes.

Enhanced-virality platforms thereby facilitate massive collective punishment for small or imagined offenses, with real-world consequences, including innocent people losing their jobs and being shamed into suicide

we don’t get justice and inclusion; we get a society that ignores context, proportionality, mercy, and truth.

Since the tower fell, debates of all kinds have grown more and more confused. The most pervasive obstacle to good thinking is confirmation bias, which refers to the human tendency to search only for evidence that confirms our preferred beliefs

search engines were supercharging confirmation bias, making it far easier for people to find evidence for absurd beliefs and conspiracy theorie

The most reliable cure for confirmation bias is interaction with people who don’t share your beliefs. They confront you with counterevidence and counterargument.

In his book The Constitution of Knowledge, Jonathan Rauch describes the historical breakthrough in which Western societies developed an “epistemic operating system”—that is, a set of institutions for generating knowledge from the interactions of biased and cognitively flawed individuals

English law developed the adversarial system so that biased advocates could present both sides of a case to an impartial jury.

Newspapers full of lies evolved into professional journalistic enterprises, with norms that required seeking out multiple sides of a story, followed by editorial review, followed by fact-checking.

Universities evolved from cloistered medieval institutions into research powerhouses, creating a structure in which scholars put forth evidence-backed claims with the knowledge that other scholars around the world would be motivated to gain prestige by finding contrary evidence.

Part of America’s greatness in the 20th century came from having developed the most capable, vibrant, and productive network of knowledge-producing institutions in all of human history

But this arrangement, Rauch notes, “is not self-maintaining; it relies on an array of sometimes delicate social settings and understandings, and those need to be understood, affirmed, and protected.”

This, I believe, is what happened to many of America’s key institutions in the mid-to-late 2010s. They got stupider en masse because social media instilled in their members a chronic fear of getting darted

it was so pervasive that it established new behavioral norms backed by new policies seemingly overnight

Participants in our key institutions began self-censoring to an unhealthy degree, holding back critiques of policies and ideas—even those presented in class by their students—that they believed to be ill-supported or wrong.

The stupefying process plays out differently on the right and the left because their activist wings subscribe to different narratives with different sacred values.

The “Hidden Tribes” study tells us that the “devoted conservatives” score highest on beliefs related to authoritarianism. They share a narrative in which America is eternally under threat from enemies outside and subversives within; they see life as a battle between patriots and traitors.

they are psychologically different from the larger group of “traditional conservatives” (19 percent of the population), who emphasize order, decorum, and slow rather than radical change.

The traditional punishment for treason is death, hence the battle cry on January 6: “Hang Mike Pence.”

Right-wing death threats, many delivered by anonymous accounts, are proving effective in cowing traditional conservatives

The wave of threats delivered to dissenting Republican members of Congress has similarly pushed many of the remaining moderates to quit or go silent, giving us a party ever more divorced from the conservative tradition, constitutional responsibility, and reality.

The stupidity on the right is most visible in the many conspiracy theories spreading across right-wing media and now into Congress.

The Democrats have also been hit hard by structural stupidity, though in a different way. In the Democratic Party, the struggle between the progressive wing and the more moderate factions is open and ongoing, and often the moderates win.

The problem is that the left controls the commanding heights of the culture: universities, news organizations, Hollywood, art museums, advertising, much of Silicon Valley, and the teachers’ unions and teaching colleges that shape K–12 education. And in many of those institutions, dissent has been stifled:

Liberals in the late 20th century shared a belief that the sociologist Christian Smith called the “liberal progress” narrative, in which America used to be horrifically unjust and repressive, but, thanks to the struggles of activists and heroes, has made (and continues to make) progress toward realizing the noble promise of its founding.

It is also the view of the “traditional liberals” in the “Hidden Tribes” study (11 percent of the population), who have strong humanitarian values, are older than average, and are largely the people leading America’s cultural and intellectual institutions.

when the newly viralized social-media platforms gave everyone a dart gun, it was younger progressive activists who did the most shooting, and they aimed a disproportionate number of their darts at these older liberal leaders.

Confused and fearful, the leaders rarely challenged the activists or their nonliberal narrative in which life at every institution is an eternal battle among identity groups over a zero-sum pie, and the people on top got there by oppressing the people on the bottom. This new narrative is rigidly egalitarian––focused on equality of outcomes, not of rights or opportunities. It is unconcerned with individual rights.

The universal charge against people who disagree with this narrative is not “traitor”; it is “racist,” “transphobe,” “Karen,” or some related scarlet letter marking the perpetrator as one who hates or harms a marginalized group.

The punishment that feels right for such crimes is not execution; it is public shaming and social death.

anyone on Twitter had already seen dozens of examples teaching the basic lesson: Don’t question your own side’s beliefs, policies, or actions. And when traditional liberals go silent, as so many did in the summer of 2020, the progressive activists’ more radical narrative takes over as the governing narrative of an organization.

This is why so many epistemic institutions seemed to “go woke” in rapid succession that year and the next, beginning with a wave of controversies and resignations at The New York Times and other newspapers, and continuing on to social-justice pronouncements by groups of doctors and medical associations

The problem is structural. Thanks to enhanced-virality social media, dissent is punished within many of our institutions, which means that bad ideas get elevated into official policy.

In a 2018 interview, Steve Bannon, the former adviser to Donald Trump, said that the way to deal with the media is “to flood the zone with shit.” He was describing the “firehose of falsehood” tactic pioneered by Russian disinformation programs to keep Americans confused, disoriented, and angry.

artificial intelligence is close to enabling the limitless spread of highly believable disinformation. The AI program GPT-3 is already so good that you can give it a topic and a tone and it will spit out as many essays as you like, typically with perfect grammar and a surprising level of coherence.

Renée DiResta, the research manager at the Stanford Internet Observatory, explained that spreading falsehoods—whether through text, images, or deep-fake videos—will quickly become inconceivably easy. (She co-wrote the essay with GPT-3.)

American factions won’t be the only ones using AI and social media to generate attack content; our adversaries will too.

In the 20th century, America’s shared identity as the country leading the fight to make the world safe for democracy was a strong force that helped keep the culture and the polity together.

In the 21st century, America’s tech companies have rewired the world and created products that now appear to be corrosive to democracy, obstacles to shared understanding, and destroyers of the modern tower.

What changes are needed?

I can suggest three categories of reforms––three goals that must be achieved if democracy is to remain viable in the post-Babel era.

We must harden democratic institutions so that they can withstand chronic anger and mistrust, reform social media so that it becomes less socially corrosive, and better prepare the next generation for democratic citizenship in this new age.

Harden Democratic Institutions

we must reform key institutions so that they can continue to function even if levels of anger, misinformation, and violence increase far above those we have today.

Reforms should reduce the outsize influence of angry extremists and make legislators more responsive to the average voter in their district.

One example of such a reform is to end closed party primaries, replacing them with a single, nonpartisan, open primary from which the top several candidates advance to a general election that also uses ranked-choice voting

A second way to harden democratic institutions is to reduce the power of either political party to game the system in its favor, for example by drawing its preferred electoral districts or selecting the officials who will supervise elections

These jobs should all be done in a nonpartisan way.

Reform Social Media

Social media’s empowerment of the far left, the far right, domestic trolls, and foreign agents is creating a system that looks less like democracy and more like rule by the most aggressive.

it is within our power to reduce social media’s ability to dissolve trust and foment structural stupidity. Reforms should limit the platforms’ amplification of the aggressive fringes while giving more voice to what More in Common calls “the exhausted majority.”

the main problem with social media is not that some people post fake or toxic stuff; it’s that fake and outrage-inducing content can now attain a level of reach and influence that was not possible before

Perhaps the biggest single change that would reduce the toxicity of existing platforms would be user verification as a precondition for gaining the algorithmic amplification that social media offers.

One of the first orders of business should be compelling the platforms to share their data and their algorithms with academic researchers.

Prepare the Next Generation

Childhood has become more tightly circumscribed in recent generations––with less opportunity for free, unstructured play; less unsupervised time outside; more time online. Whatever else the effects of these shifts, they have likely impeded the development of abilities needed for effective self-governance for many young adults

Depression makes people less likely to want to engage with new people, ideas, and experiences. Anxiety makes new things seem more threatening. As these conditions have risen and as the lessons on nuanced social behavior learned through free play have been delayed, tolerance for diverse viewpoints and the ability to work out disputes have diminished among many young people

Students did not just say that they disagreed with visiting speakers; some said that those lectures would be dangerous, emotionally devastating, a form of violence. Because rates of teen depression and anxiety have continued to rise into the 2020s, we should expect these views to continue in the generations to follow, and indeed to become more severe.

The most important change we can make to reduce the damaging effects of social media on children is to delay entry until they have passed through puberty.

The age should be raised to at least 16, and companies should be held responsible for enforcing it.

et them out to play. Stop starving children of the experiences they most need to become good citizens: free play in mixed-age groups of children with minimal adult supervision

while social media has eroded the art of association throughout society, it may be leaving its deepest and most enduring marks on adolescents. A surge in rates of anxiety, depression, and self-harm among American teens began suddenly in the early 2010s. (The same thing happened to Canadian and British teens, at the same time.) The cause is not known, but the timing points to social media as a substantial contributor—the surge began just as the large majority of American teens became daily users of the major platforms.

What would it be like to live in Babel in the days after its destruction? We know. It is a time of confusion and loss. But it is also a time to reflect, listen, and build.

In recent years, Americans have started hundreds of groups and organizations dedicated to building trust and friendship across the political divide, including BridgeUSA, Braver Angels (on whose board I serve), and many others listed at BridgeAlliance.us. We cannot expect Congress and the tech companies to save us. We must change ourselves and our communities.

when we look away from our dysfunctional federal government, disconnect from social media, and talk with our neighbors directly, things seem more hopeful. Most Americans in the More in Common report are members of the “exhausted majority,” which is tired of the fighting and is willing to listen to the other side and compromise. Most Americans now see that social media is having a negative impact on the country, and are becoming more aware of its damaging effects on children.

The girls who came to us had many comorbidities: depression, anxiety, ADHD, eating disorders, obesity. Many were diagnosed with autism, or had autism-like symptoms. A report last year on a British pediatric transgender center found that about one-third of the patients referred there were on the autism spectrum.

This concerned me, but didn’t feel I was in the position to sound some kind of alarm back then. There was a team of about eight of us, and only one other person brought up the kinds of questions I had. Anyone who raised doubts ran the risk of being called a transphobe. 

I certainly saw this at the center. One of my jobs was to do intake for new patients and their families. When I started there were probably 10 such calls a month. When I left there were 50, and about 70 percent of the new patients were girls. Sometimes clusters of girls arrived from the same high school. 

There are no reliable studies showing this. Indeed, the experiences of many of the center’s patients prove how false these assertions are. 

The doctors privately recognized these false self-diagnoses as a manifestation of social contagion. They even acknowledged that suicide has an element of social contagion. But when I said the clusters of girls streaming into our service looked as if their gender issues might be a manifestation of social contagion, the doctors said gender identity reflected something innate.

To begin transitioning, the girls needed a letter of support from a therapist—usually one we recommended—who they had to see only once or twice for the green light. To make it more efficient for the therapists, we offered them a template for how to write a letter in support of transition. The next stop was a single visit to the endocrinologist for a testosterone prescription. 

When a female takes testosterone, the profound and permanent effects of the hormone can be seen in a matter of months. Voices drop, beards sprout, body fat is redistributed. Sexual interest explodes, aggression increases, and mood can be unpredictable. Our patients were told about some side effects, including sterility. But after working at the center, I came to believe that teenagers are simply not capable of fully grasping what it means to make the decision to become infertile while still a minor.

Many encounters with patients emphasized to me how little these young people understood the profound impacts changing gender would have on their bodies and minds. But the center downplayed the negative consequences, and emphasized the need for transition. As the center’s website said, “Left untreated, gender dysphoria has any number of consequences, from self-harm to suicide. But when you take away the gender dysphoria by allowing a child to be who he or she is, we’re noticing that goes away. The studies we have show these kids often wind up functioning psychosocially as well as or better than their peers.” 

Frequently, our patients declared they had disorders that no one believed they had. We had patients who said they had Tourette syndrome (but they didn’t); that they had tic disorders (but they didn’t); that they had multiple personalities (but they didn’t).

Here’s an example. On Friday, May 1, 2020, a colleague emailed me about a 15-year-old male patient: “Oh dear. I am concerned that [the patient] does not understand what Bicalutamide does.” I responded: “I don’t think that we start anything honestly right now.”

Bicalutamide is a medication used to treat metastatic prostate cancer, and one of its side effects is that it feminizes the bodies of men who take it, including the appearance of breasts. The center prescribed this cancer drug as a puberty blocker and feminizing agent for boys. As with most cancer drugs, bicalutamide has a long list of side effects, and this patient experienced one of them: liver toxicity. He was sent to another unit of the hospital for evaluation and immediately taken off the drug. Afterward, his mother sent an electronic message to the Transgender Center saying that we were lucky her family was not the type to sue.

How little patients understood what they were getting into was illustrated by a call we received at the center in 2020 from a 17-year-old biological female patient who was on testosterone. She said she was bleeding from the vagina. In less than an hour she had soaked through an extra heavy pad, her jeans, and a towel she had wrapped around her waist. The nurse at the center told her to go to the emergency room right away.

when there was a dispute between the parents, it seemed the center always took the side of the affirming parent.

Other girls were disturbed by the effects of testosterone on their clitoris, which enlarges and grows into what looks like a microphallus, or a tiny penis. I counseled one patient whose enlarged clitoris now extended below her vulva, and it chafed and rubbed painfully in her jeans. I advised her to get the kind of compression undergarments worn by biological men who dress to pass as female. At the end of the call I thought to myself, “Wow, we hurt this kid.”

There are rare conditions in which babies are born with atypical genitalia—cases that call for sophisticated care and compassion. But clinics like the one where I worked are creating a whole cohort of kids with atypical genitals—and most of these teens haven’t even had sex yet. They had no idea who they were going to be as adults. Yet all it took for them to permanently transform themselves was one or two short conversations with a therapist.

Being put on powerful doses of testosterone or estrogen—enough to try to trick your body into mimicking the opposite sex—-affects the rest of the body. I doubt that any parent who's ever consented to give their kid testosterone (a lifelong treatment) knows that they’re also possibly signing their kid up for blood pressure medication, cholesterol medication, and perhaps sleep apnea and diabetes. 

Besides teenage girls, another new group was referred to us: young people from the inpatient psychiatric unit, or the emergency department, of St. Louis Children’s Hospital. The mental health of these kids was deeply concerning—there were diagnoses like schizophrenia, PTSD, bipolar disorder, and more. Often they were already on a fistful of pharmaceuticals.

no matter how much suffering or pain a child had endured, or how little treatment and love they had received, our doctors viewed gender transition—even with all the expense and hardship it entailed—as the solution.

Another disturbing aspect of the center was its lack of regard for the rights of parents—and the extent to which doctors saw themselves as more informed decision-makers over the fate of these children.

We found out later this girl had had intercourse, and because testosterone thins the vaginal tissues, her vaginal canal had ripped open. She had to be sedated and given surgery to repair the damage. She wasn’t the only vaginal laceration case we heard about.

During the four years I worked at the clinic as a case manager—I was responsible for patient intake and oversight—around a thousand distressed young people came through our doors. The majority of them received hormone prescriptions that can have life-altering consequences—including sterility. 

I left the clinic in November of last year because I could no longer participate in what was happening there. By the time I departed, I was certain that the way the American medical system is treating these patients is the opposite of the promise we make to “do no harm.” Instead, we are permanently harming the vulnerable patients in our care.

Today I am speaking out. I am doing so knowing how toxic the public conversation is around this highly contentious issue—and the ways that my testimony might be misused. I am doing so knowing that I am putting myself at serious personal and professional risk.

Almost everyone in my life advised me to keep my head down. But I cannot in good conscience do so. Because what is happening to scores of children is far more important than my comfort. And what is happening to them is morally and medically appalling.

For almost four years, I worked at The Washington University School of Medicine Division of Infectious Diseases with teens and young adults who were HIV positive. Many of them were trans or otherwise gender nonconforming, and I could relate: Through childhood and adolescence, I did a lot of gender questioning myself. I’m now married to a transman, and together we are raising my two biological children from a previous marriage and three foster children we hope to adopt. 

The center’s working assumption was that the earlier you treat kids with gender dysphoria, the more anguish you can prevent later on. This premise was shared by the center’s doctors and therapists. Given their expertise, I assumed that abundant evidence backed this consensus. 

All that led me to a job in 2018 as a case manager at The Washington University Transgender Center at St. Louis Children's Hospital, which had been established a year earlier. 

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.

An aperiodic tiling displays no such “translational symmetry,” and mathematicians have long sought a single shape that could tile the plane in such a fashion. This is known as the einstein problem.

black and white squares also can make weird nonperiodic patterns, in addition to the familiar, periodic checkerboard pattern. “It’s really pretty trivial to be able to make weird and interesting patterns,” he said. The magic of the two Penrose tiles is that they make only nonperiodic patterns — that’s all they can do.“But then the Holy Grail was, could you do with one — one tile?” Dr. Goodman-Strauss said.

now a new paper — by Mr. Smith and three co-authors with mathematical and computational expertise — proves Mr. Smith’s discovery true. The researchers called their einstein “the hat,

“The most significant aspect for me is that the tiling does not clearly fall into any of the familiar classes of structures that we understand.”

“I’m always messing about and experimenting with shapes,” said Mr. Smith, 64, who worked as a printing technician, among other jobs, and retired early. Although he enjoyed math in high school, he didn’t excel at it, he said. But he has long been “obsessively intrigued” by the einstein problem.

Sir Roger found the proofs “very complicated.” Nonetheless, he was “extremely intrigued” by the einstein, he said: “It’s a really good shape, strikingly simple.”

The simplicity came honestly. Mr. Smith’s investigations were mostly by hand; one of his co-authors described him as an “imaginative tinkerer.”

When in November he found a tile that seemed to fill the plane without a repeating pattern, he emailed Craig Kaplan, a co-author and a computer scientist at the University of Waterloo.

“It was clear that something unusual was happening with this shape,” Dr. Kaplan said. Taking a computational approach that built on previous research, his algorithm generated larger and larger swaths of hat tiles. “There didn’t seem to be any limit to how large a blob of tiles the software could construct,”

The first step, Dr. Kaplan said, was to “define a set of four ‘metatiles,’ simple shapes that stand in for small groupings of one, two, or four hats.” The metatiles assemble into four larger shapes that behave similarly. This assembly, from metatiles to supertiles to supersupertiles, ad infinitum, covered “larger and larger mathematical ‘floors’ with copies of the hat,” Dr. Kaplan said. “We then show that this sort of hierarchical assembly is essentially the only way to tile the plane with hats, which turns out to be enough to show that it can never tile periodically.”

some might wonder whether this is a two-tile, not one-tile, set of aperiodic monotiles.

Dr. Goodman-Strauss had raised this subtlety on a tiling listserv: “Is there one hat or two?” The consensus was that a monotile counts as such even using its reflection. That leaves an open question, Dr. Berger said: Is there an einstein that will do the job without reflection?

“the hat” was not a new geometric invention. It is a polykite — it consists of eight kites. (Take a hexagon and draw three lines, connecting the center of each side to the center of its opposite side; the six shapes that result are kites.)

“It’s likely that others have contemplated this hat shape in the past, just not in a context where they proceeded to investigate its tiling properties,” Dr. Kaplan said. “I like to think that it was hiding in plain sight.”

Incredibly, Mr. Smith later found a second einstein. He called it “the turtle” — a polykite made of not eight kites but 10. It was “uncanny,” Dr. Kaplan said. He recalled feeling panicked; he was already “neck deep in the hat.”

Dr. Myers, who had done similar computations, promptly discovered a profound connection between the hat and the turtle. And he discerned that, in fact, there was an entire family of related einsteins — a continuous, uncountable infinity of shapes that morph one to the next.

this einstein family motivated the second proof, which offers a new tool for proving aperiodicity. The math seemed “too good to be true,” Dr. Myers said in an email. “I wasn’t expecting such a different approach to proving aperiodicity — but everything seemed to hold together as I wrote up the details.”

Mr. Smith was amazed to see the research paper come together. “I was no help, to be honest.” He appreciated the illustrations, he said: “I’m more of a pictures person.”

Even more absurd is the idea of giving unaccountable tech chiefs some moral licence to pronounce on good and evil, right and wrong, and what is best for the world.

Defining the Anthropocene: nine sites are in the running to be given the ‘golden spike’ designation

Mentioning the Jurassic period, for instance, helps scientists to picture plants and animals that were alive during that time

“The Anthropocene represents an umbrella for all of these different changes that humans have made to the planet,”

Typically, researchers will agree that a specific change in Earth’s geology must be captured in the official timeline. The ICS will then determine which set of rock layers, called strata, best illustrates that change, and it will choose which layer marks its lower boundary

This is called the Global Stratotype Section and Point (GSSP), and it is defined by a signal, such as the first appearance of a fossil species, trapped in the rock, mud or other material. One location is chosen to represent the boundary, and researchers mark this site physically with a golden spike, to commemorate it.

“It’s a label,” says Colin Waters, who chairs the AWG and is a geologist at the University of Leicester, UK. “It’s a great way of summarizing a lot of concepts into one word.”

But the Anthropocene has posed problems. Geologists want to capture it in the timeline, but its beginning isn’t obvious in Earth’s strata, and signs of human activity have never before been part of the defining process.

“We had a vague idea about what it might be, [but] we didn’t know what kind of hard evidence would go into it.”

Years of debate among the group’s multidisciplinary members led them to identify a host of signals — radioactive isotopes from nuclear-bomb tests, ash from fossil-fuel combustion, microplastics, pesticides — that would be trapped in the strata of an Anthropocene-defining site. These began to appear in the early 1950s, when a booming human population started consuming materials and creating new ones faster than ever.

Why do some geologists oppose the Anthropocene as a new epoch?“It misrepresents what we do” in the ICS, says Stanley Finney, a stratigrapher at California State University, Long Beach, and secretary-general for the International Union of Geological Sciences (IUGS). The AWG is working backwards, Finney says: normally, geologists identify strata that should enter the geological timescale before considering a golden spike; in this case, they’re seeking out the lower boundary of an undefined set of geological layers.

Lucy Edwards, a palaeontologist who retired in 2008 from the Florence Bascom Geoscience Center in Reston, Virginia, agrees. For her, the strata that might define the Anthropocene do not yet exist because the proposed epoch is so young. “There is no geologic record of tomorrow,”

Edwards, Finney and other researchers have instead proposed calling the Anthropocene a geological ‘event’, a flexible term that can stretch in time, depending on human impact. “It’s all-encompassing,” Edwards says.

Zalasiewicz disagrees. “The word ‘event’ has been used and stretched to mean all kinds of things,” he says. “So simply calling something an event doesn’t give it any wider meaning.”

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

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.”