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The more I used my watch to monitor my stress, the higher my stress levels rose.

“It’s like you’re trying to win at this game instead of living your life. Instead of learning what your body feels like, you have a number.”

Add a social or competitive component, as in the fitness app Strava or the community features on Peloton, and the feelings of control and empowerment that fitness can foster can morph quickly into the opposite.

If it feels like an addiction, that’s because it can work similarly to smartphone and other digital addictions. Dependency is what these devices are designed to foster.

in fact, we very much can become compulsively fixated on these wearable devices — in a way that is akin to addiction.”

These devices don’t just record your behavior — they influence it and keep you coming back. You become dependent on external validation.

you can’t quantify your way to good health. The reality is much harder.

I know I got fitter. But I started to feel that my health wasn’t grounded in my own body anymore, or even in my mind.

Exercise wasn’t helping me rebound from pressure anymore; it was adding to it.

Of course these watches can be useful: for health data, reminding you to move more or maybe even that emergency call if you wind up falling in the woods. Many of us make better choices when we know we’re being watched.

it’s worth acknowledging that adhering to these necessary rules cuts against some core aspects of human nature. I’m of the opinion that people should not bring their “whole self” to work — no one owes an employer that — but it’s also impossible to bring none of your personal self to work.

There are good reasons that both formal and informal boundaries are a necessity in the workplace and academia

Reaching hesitant families means withholding the kind of judgment that kept her ashamed, and understanding that people have legitimate concerns that need to be addressed.

Being consistent and visible within the community is important, Autar said. “It can’t be just a moment here and now type of thing – ‘When we have a surge, we’re going to come back out and galvanize all those resources.’ No, we still are in a pandemic. And we need to still remain visible within hesitant communities. And that’s hard work.”

He added: “Our approach has always been ‘we’re here to educate you about the vaccine, your options, your choices’, rather than take the approach of ‘you need to get this vaccine’.”

“They may not change their mind overnight, but by taking your time, you’re ensuring that they could change their minds,” Greene said. “But if it becomes this conflict and it’s a negative experience, you’re basically closing that door off completely.”

“There’s so much pressure for moms to do everything perfectly,” Greene said. Among middle-class mothers, for instance, there’s a message that “you can afford all these products to do better, and so you don’t need vaccines – vaccines are for poor people

hose promises have also fueled anxiety over how people will be able to compete for jobs outsourced to eerily refined machines or trust the accuracy of what they see online.

Officials with the San Francisco lab said GPT-4’s “multimodal” training across text and images would allow it to escape the chat box and more fully emulate a world of color and imagery, surpassing ChatGPT in its “advanced reasoning capabilities.”

A person could upload an image and GPT-4 could caption it for them, describing the objects and scene.

AI language models often confidently offer wrong answers because they are designed to spit out cogent phrases, not actual facts. And because they have been trained on internet text and imagery, they have also learned to emulate human biases of race, gender, religion and class.

GPT-4 still makes many of the errors of previous versions, including “hallucinating” nonsense, perpetuating social biases and offering bad advice. It also lacks knowledge of events that happened after about September 2021, when its training data was finalized, and “does not learn from its experience,” limiting people’s ability to teach it new things.

Microsoft has invested billions of dollars in OpenAI in the hope its technology will become a secret weapon for its workplace software, search engine and other online ambitions. It has marketed the technology as a super-efficient companion that can handle mindless work and free people for creative pursuits, helping one software developer to do the work of an entire team or allowing a mom-and-pop shop to design a professional advertising campaign without outside help.

it could lead to business models and creative ventures no one can predict.

sparked criticism that the companies are rushing to exploit an untested, unregulated and unpredictable technology that could deceive people, undermine artists’ work and lead to real-world harm.

the company held back the feature to better understand potential risks. As one example, she said, the model might be able to look at an image of a big group of people and offer up known information about them, including their identities — a possible facial recognition use case that could be used for mass surveillance.

OpenAI researchers wrote, “As GPT-4 and AI systems like it are adopted more widely,” they “will have even greater potential to reinforce entire ideologies, worldviews, truths and untruths, and to cement them or lock them in.”

“We can agree as a society broadly on some harms that a model should not contribute to,” such as building a nuclear bomb or generating child sexual abuse material, she said. “But many harms are nuanced and primarily affect marginalized groups,” she added, and those harmful biases, especially across other languages, “cannot be a secondary consideration in performance.”

OpenAI said its new model would be able to handle more than 25,000 words of text, a leap forward that could facilitate longer conversations and allow for the searching and analysis of long documents.

OpenAI developers said GPT-4 was more likely to provide factual responses and less likely to refuse harmless requests

Duolingo, the language learning app, has already used GPT-4 to introduce new features, such as an AI conversation partner and a tool that tells users why an answer was incorrect.

The company did not share evaluations around bias that have become increasingly common after pressure from AI ethicists.

GPT-4 will have competition in the growing field of multisensory AI. DeepMind, an AI firm owned by Google’s parent company Alphabet, last year released a “generalist” model named Gato that can describe images and play video games. And Google this month released a multimodal system, PaLM-E, that folded AI vision and language expertise into a one-armed robot on wheels: If someone told it to go fetch some chips, for instance, it could comprehend the request, wheel over to a drawer and choose the right bag.

The systems, though — as critics and the AI researchers are quick to point out — are merely repeating patterns and associations found in their training data without a clear understanding of what it’s saying or when it’s wrong.

GPT-4, the fourth “generative pre-trained transformer” since OpenAI’s first release in 2018, relies on a breakthrough neural-network technique in 2017 known as the transformer that rapidly advanced how AI systems can analyze patterns in human speech and imagery.

The systems are “pre-trained” by analyzing trillions of words and images taken from across the internet: news articles, restaurant reviews and message-board arguments; memes, family photos and works of art.

Giant supercomputer clusters of graphics processing chips are mapped out their statistical patterns — learning which words tended to follow each other in phrases, for instance — so that the AI can mimic those patterns, automatically crafting long passages of text or detailed images, one word or pixel at a time.

In 2019, the company refused to publicly release GPT-2, saying it was so good they were concerned about the “malicious applications” of its use, from automated spam avalanches to mass impersonation and disinformation campaigns.

Altman has also marketed OpenAI’s vision with the aura of science fiction come to life. In a blog post last month, he said the company was planning for ways to ensure that “all of humanity” benefits from “artificial general intelligence,” or AGI — an industry term for the still-fantastical idea of an AI superintelligence that is generally as smart as, or smarter than, the humans themselves.

“My first and biggest wish is that we had known early that Covid-19 was airborne,”

, “Once you’ve realized that, it informs an entirely different strategy for protection.” Masking, ventilation and air cleaning become key, as well as avoiding high-risk encounters with strangers, he says.

Instead of washing our produce and wearing hand-sewn cloth masks, we could have made sure to avoid superspreader events and worn more-effective N95 masks or their equivalent. “We could have made more of an effort to develop and distribute N95s to everyone,” says Dr. Volckens. “We could have had an Operation Warp Speed for masks.”

We didn’t realize how important clear, straight talk would be to maintaining public trust. If we had, we could have explained the biological nature of a virus and warned that Covid-19 would change in unpredictable ways.  

We didn’t know how difficult it would be to get the basic data needed to make good public-health and medical decisions. If we’d had the data, we could have more effectively allocated scarce resources

In the face of a pandemic, he says, the public needs an early basic and blunt lesson in virology

and mutates, and since we’ve never seen this particular virus before, we will need to take unprecedented actions and we will make mistakes, he says.

Since the public wasn’t prepared, “people weren’t able to pivot when the knowledge changed,”

By the time the vaccines became available, public trust had been eroded by myriad contradictory messages—about the usefulness of masks, the ways in which the virus could be spread, and whether the virus would have an end date.

, the absence of a single, trusted source of clear information meant that many people gave up on trying to stay current or dismissed the different points of advice as partisan and untrustworthy.

“The science is really important, but if you don’t get the trust and communication right, it can only take you so far,”

people didn’t know whether it was OK to visit elderly relatives or go to a dinner party.

Doctors didn’t know what medicines worked. Governors and mayors didn’t have the information they needed to know whether to require masks. School officials lacked the information needed to know whether it was safe to open schools.

Had we known that even a mild case of Covid-19 could result in long Covid and other serious chronic health problems, we might have calculated our own personal risk differently and taken more care.

just months before the outbreak of the pandemic, the Council of State and Territorial Epidemiologists released a white paper detailing the urgent need to modernize the nation’s public-health system still reliant on manual data collection methods—paper records, phone calls, spreadsheets and faxes.

While the U.K. and Israel were collecting and disseminating Covid case data promptly, in the U.S. the CDC couldn’t. It didn’t have a centralized health-data collection system like those countries did, but rather relied on voluntary reporting by underfunded state and local public-health systems and hospitals.

doctors and scientists say they had to depend on information from Israel, the U.K. and South Africa to understand the nature of new variants and the effectiveness of treatments and vaccines. They relied heavily on private data collection efforts such as a dashboard at Johns Hopkins University’s Coronavirus Resource Center that tallied cases, deaths and vaccine rates globally.

For much of the pandemic, doctors, epidemiologists, and state and local governments had no way to find out in real time how many people were contracting Covid-19, getting hospitalized and dying

To solve the data problem, Dr. Ranney says, we need to build a public-health system that can collect and disseminate data and acts like an electrical grid. The power company sees a storm coming and lines up repair crews.

If we’d known how damaging lockdowns would be to mental health, physical health and the economy, we could have taken a more strategic approach to closing businesses and keeping people at home.

t many doctors say they were crucial at the start of the pandemic to give doctors and hospitals a chance to figure out how to accommodate and treat the avalanche of very sick patients.

The measures reduced deaths, according to many studies—but at a steep cost.

The lockdowns didn’t have to be so harmful, some scientists say. They could have been more carefully tailored to protect the most vulnerable, such as those in nursing homes and retirement communities, and to minimize widespread disruption.

Lockdowns could, during Covid-19 surges, close places such as bars and restaurants where the virus is most likely to spread, while allowing other businesses to stay open with safety precautions like masking and ventilation in place.  

The key isn’t to have the lockdowns last a long time, but that they are deployed earlier,

If England’s March 23, 2020, lockdown had begun one week earlier, the measure would have nearly halved the estimated 48,600 deaths in the first wave of England’s pandemic

If the lockdown had begun a week later, deaths in the same period would have more than doubled

It is possible to avoid lockdowns altogether. Taiwan, South Korea and Hong Kong—all countries experienced at handling disease outbreaks such as SARS in 2003 and MERS—avoided lockdowns by widespread masking, tracking the spread of the virus through testing and contact tracing and quarantining infected individuals.

With good data, Dr. Ranney says, she could have better managed staffing and taken steps to alleviate the strain on doctors and nurses by arranging child care for them.

Early in the pandemic, public-health officials were clear: The people at increased risk for severe Covid-19 illness were older, immunocompromised, had chronic kidney disease, Type 2 diabetes or serious heart conditions

t had the unfortunate effect of giving a false sense of security to people who weren’t in those high-risk categories. Once case rates dropped, vaccines became available and fear of the virus wore off, many people let their guard down, ditching masks, spending time in crowded indoor places.

it has become clear that even people with mild cases of Covid-19 can develop long-term serious and debilitating diseases. Long Covid, whose symptoms include months of persistent fatigue, shortness of breath, muscle aches and brain fog, hasn’t been the virus’s only nasty surprise

In February 2022, a study found that, for at least a year, people who had Covid-19 had a substantially increased risk of heart disease—even people who were younger and had not been hospitalized

respiratory conditions.

Some scientists now suspect that Covid-19 might be capable of affecting nearly every organ system in the body. It may play a role in the activation of dormant viruses and latent autoimmune conditions people didn’t know they had

 A blood test, he says, would tell people if they are at higher risk of long Covid and whether they should have antivirals on hand to take right away should they contract Covid-19.

If the risks of long Covid had been known, would people have reacted differently, especially given the confusion over masks and lockdowns and variants? Perhaps. At the least, many people might not have assumed they were out of the woods just because they didn’t have any of the risk factors.

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.

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 implicit lesson is that grown-ups aren’t infallible. It’s OK to laugh at them and it’s OK to feel compassion for them and it’s even OK to feel sorry for them on occasion.

The adult figures in children’s literature are also frequently outsiders or eccentrics in some way, and quite often subject to ridicule

yes, adults are often the Other — which makes them a mystery and a curiosity. Literature offers insight into these occasionally intimidating creatures.

In real life, children revere adults and they fear them. It only follows, then, that they appreciate when adult characters behave admirably but also delight in seeing the consequences — especially when rendered with humor — when they don’t.

Nursery rhymes, folk tales, myths and legends overwhelmingly cast adults as their central characters — and have endured for good reason

In somewhat later tales, children investigated crimes alongside Sherlock Holmes, adventured through Narnia, inhabited Oz and traversed Middle-earth. Grown-up heroes can be hobbits, or rabbits (“Watership Down”), badgers or moles (“The Wind in the Willows”). Children join them no matter what because they like to be in league with their protagonists and by extension, their authors.

In children’s books with adult heroes, children get to conspire alongside their elders. Defying the too-often adversarial relationship between adults and children in literature, such books enable children to see that adults are perfectly capable of occupying their shared world with less antagonism — as partners in life, in love and in adventure.

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.

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.”