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Haidt isn’t helping himself any. The term “culture of victimhood” reminds many people of the “snowflake” insult, the idea than anyone from a marginalized background who complains about injustice is really just self-involved and weak.

I find his predictions about how these dynamics will somehow undermine American capitalism to be unconvincing, running towards bizarre. If social media is making our kids depressed and anxious, that is the reason to be concerned, not some tangled logic about national greatness.

I think that suffering is the only truly universal endowment of the human species.

ecause Haidt talked about a culture of victimhood, he was immediately coded as right-wing, which is to say on the wrong side of the culture war

(The piece notes that the age at which children are allowed to play outside alone has moved from 7 or 8 to 10 or 12 in short order.)

the critics of someone like Haidt, the most coherent criticism they mount is that talk of toughness and resilience can be used opportunistically to dismiss demands for justice. “You just need to toughen up” is not, obviously, a constructive, good-faith response to a demand that the police stop killing unarmed Black people

I don’t think that’s the version Haidt is articulating

Yes, we must do all we can to reduce injustice, and we need to be compassionate to everyone. But we also need to understand that no political movement, no matter how effective, can ever end suffering and thus obviate the need for resilience.

I’m really not a fan of therapy culture, where the imperatives and vocabulary and purpose of therapy are now assumed to be necessary in every domain of human affairs. But that’s not because I think therapy is bad; I think therapy, as therapy, is very good. It’s because I think everything can’t be therapy, and the effort to make everything therapy will have the perverse effect of making nothing therapy.

It’s a trap, which maybe seeking out a little more deliberate boredom – also known as stillness - could help us avoid

Thomas Merton, whose praises I have sung in these pages before, framed it:

being bored might be a good start for healing what ails us.

But the purity of our conscience has a natural proportion with the depth of our being and the quality of our acts: and when our activity is habitually disordered, our malformed conscience can think of nothing better to tell us than to multiply the *quantity* of our acts, without perfecting their quality. And so we go from bad to worse, exhaust ourselves, empty our whole life of all content, and fall into despair

There are times, then, when in order to keep ourselves in existence at all we simply have to sit back for a while and do nothing. And for a man who has let himself be drawn completely out of himself by his activity, nothing is more difficult than to sit still and rest, doing nothing at all. The very act of resting is the hardest and most courageous act he can perform: and often it is quite beyond his power.

Our being is not to be enriched merely by activity or experience as such. Everything depends on the *quality* of our acts and our experiences. A multitude of badly performed actions and of experiences only half lived exhausts and depletes our being. By doing things badly we make ourselves less real. This growing unreality cannot help but make us unhappy and fill us with a sense of guilt

even with all the excitement, I couldn’t sustain any. I was bored by the excitement. Or rather, I craved boredom, finding all the excitement dull in a not-this-shitshow-again sort of way. For the last decade or so, we’ve been too over-excited, over-provoked, and overstimulated.

Microsoft leaders felt “enormous urgency” for it to be the company to bring this technology to market, because others around the world are working on similar tech but might not have the resources or inclination to build it as responsibly, says Sarah Bird, a leader on Microsoft’s responsible AI team.

One common starting point for such models is what is essentially a download or “scrape” of most of the internet. In the past, these language models were used to try to understand text, but the new generation of them, part of the revolution in “generative” AI, uses those same models to create texts by trying to guess, one word at a time, the most likely word to come next in any given sequence.

Wide-scale testing gives Microsoft and OpenAI a big competitive edge by enabling them to gather huge amounts of data about how people actually use such chatbots. Both the prompts users input into their systems, and the results their AIs spit out, can then be fed back into a complicated system—which includes human content moderators paid by the companies—to improve it.

, being first to market with a chat-based AI gives these companies a huge initial lead over companies that have been slower to release their own chat-based AIs, such as Google.

rarely has an experiment like Microsoft and OpenAI’s been rolled out so quickly, and at such a broad scale.

Among those who build and study these kinds of AIs, Mr. Altman’s case for experimenting on the global public has inspired responses ranging from raised eyebrows to condemnation.

The fact that we’re all guinea pigs in this experiment doesn’t mean it shouldn’t be conducted, says Nathan Lambert, a research scientist at the AI startup Huggingface.

“I would kind of be happier with Microsoft doing this experiment than a startup, because Microsoft will at least address these issues when the press cycle gets really bad,” says Dr. Lambert. “I think there are going to be a lot of harms from this kind of AI, and it’s better people know they are coming,” he adds.

Others, particularly those who study and advocate for the concept of “ethical AI” or “responsible AI,” argue that the global experiment Microsoft and OpenAI are conducting is downright dangerous

Celeste Kidd, a professor of psychology at University of California, Berkeley, studies how people acquire knowledge

Her research has shown that people learning about new things have a narrow window in which they form a lasting opinion. Seeing misinformation during this critical initial period of exposure to a new concept—such as the kind of misinformation that chat-based AIs can confidently dispense—can do lasting harm, she says.

Dr. Kidd likens OpenAI’s experimentation with AI to exposing the public to possibly dangerous chemicals. “Imagine you put something carcinogenic in the drinking water and you were like, ‘We’ll see if it’s carcinogenic.’ After, you can’t take it back—people have cancer now,”

Part of the challenge with AI chatbots is that they can sometimes simply make things up. Numerous examples of this tendency have been documented by users of both ChatGPT and OpenA

These models also tend to be riddled with biases that may not be immediately apparent to users. For example, they can express opinions gleaned from the internet as if they were verified facts

When millions are exposed to these biases across billions of interactions, this AI has the potential to refashion humanity’s views, at a global scale, says Dr. Kidd.

OpenAI has talked publicly about the problems with these systems, and how it is trying to address them. In a recent blog post, the company said that in the future, users might be able to select AIs whose “values” align with their own.

“We believe that AI should be a useful tool for individual people, and thus customizable by each user up to limits defined by society,” the post said.

Eliminating made-up information and bias from chat-based search engines is impossible given the current state of the technology, says Mark Riedl, a professor at Georgia Institute of Technology who studies artificial intelligence

He believes the release of these technologies to the public by Microsoft and OpenAI is premature. “We are putting out products that are still being actively researched at this moment,” he adds. 

in other areas of human endeavor—from new drugs and new modes of transportation to advertising and broadcast media—we have standards for what can and cannot be unleashed on the public. No such standards exist for AI, says Dr. Riedl.

To modify these AIs so that they produce outputs that humans find both useful and not-offensive, engineers often use a process called “reinforcement learning through human feedback.

that’s a fancy way of saying that humans provide input to the raw AI algorithm, often by simply saying which of its potential responses to a query are better—and also which are not acceptable at all.

Microsoft’s and OpenAI’s globe-spanning experiments on millions of people are yielding a fire hose of data for both companies. User-entered prompts and the AI-generated results are fed back through a network of paid human AI trainers to further fine-tune the models,

Huggingface’s Dr. Lambert says that any company, including his own, that doesn’t have this river of real-world usage data helping it improve its AI is at a huge disadvantage

In chatbots, in some autonomous-driving systems, in the unaccountable AIs that decide what we see on social media, and now, in the latest applications of AI, again and again we are the guinea pigs on which tech companies are testing new technology.

It may be the case that there is no other way to roll out this latest iteration of AI—which is already showing promise in some areas—at scale. But we should always be asking, at times like these: At what price?

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

“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.

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

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

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

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

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

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

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

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

Imagination

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

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

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

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

Grace

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

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

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

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

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

Accumulation

Attention

Intention

Ritual

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

l What are the principles?

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

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

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

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

That’s an extraordinary thing to hear from a corporate CEO. Daunt wanted to run a bookstore that was “intellectually satisfying” and “feeds your mind.

If you want to sell music, you must love those songs. If you want to succeed in journalism, you must love those newspapers. If you want to succeed in movies, you must love the cinema.

You don’t fall in love for logical reasons, and you could never convince someone else to do so on the basis of arguments. People either feel it or they don’t. That’s true whether you love your spouse or you love something more intangible like a song or a book or a movie.

But even if you can’t teach this kind of love, you know it when you see it. There are people who are passionate about these things. They believe in them with ardor and devotion. You can find them and hire these people—and those are the individuals you can trust.

Before the introduction of Botox and hyaluronic acid dermal fillers in 2002 and 2003, respectively, aesthetic work was serious, expensive. Nose jobs and face lifts required general anesthesia, not insignificant recovery time, and cost thousands of dollars (in 2000, a facelift was $5,416 on average, and a rhinoplasty $4,109, around $9,400 and $7,000 adjusted).

In contrast, the average price of a syringe of hyaluronic acid filler today is $684, while treating, for example, the forehead and eyes with Botox will put you out anywhere from $300 to $600

We copied the beautiful and the rich, not in facsimile, but in homage.

In 2018, use of Botox and fillers was up 18% and 20% from five years prior. Philosophies of prejuvenation have made Botox use jump 22% among 22- to 37-year-olds in half a decade as well. By 2030, global noninvasive aesthetic treatments are predicted to triple.

The trouble is that a status symbol, without status, is common.

Beauty has always been exclusive. When someone strikes you as pretty, it means they are something that everyone else is not.

It’s a zero-sum game, as relative as our morals. Naturally, we hoard of beauty what we can. It’s why we call grooming tips “secrets.”

Largely the secrets started with the wealthy, who possess the requisite money and leisure to spare on their appearances

Botox and filler only accelerated a trend that began in the ’70s and ’80s and is just now reaching its saturation point.

we didn’t have the tools for anything more than emulation. Fake breasts and overdrawn lips only approximated real ones; a birthmark drawn with pencil would always be just that.

Instagram Face, on the other hand, distinguishes itself by its sheer reproducibility. Not only because of those new cosmetic technologies, which can truly reshape features, at reasonable cost and with little risk.

built in to the whole premise of reversible, low-stakes modification is an indefinite flux, and thus a lack of discretion.

Instagram Face has replicated outward, with trendsetters giving up competing with one another in favor of looking eerily alike. And obviously it has replicated down.

Eva looks like Eva. If she has procedures in common with Kim K, you couldn’t tell. “I look at my features and I think long and hard of how I can, without looking different and while keeping as natural as possible, make them look better and more proportional. I’m against everything that is too invasive. My problem with Instagram Face is that if you want to look like someone else, you should be in therapy.”

natural looks have always been, and still are, more valuable than artificial ones. Partly because of our urge to legitimize in any way we can the advantages we have over other people. Hotness is a class struggle.

As more and more women post videos of themselves eating, sleeping, dressing, dancing, and Only-Fanning online, in a logical bid for economic ascendance, the women who haven’t needed to do that gain a new status symbol.

Privacy. A life which is not a ticketed show. An intimacy that does not admit advertisers. A face that does not broadcast its insecurity, or the work undergone to correct it.

Upper class, private women get discrete work done. The differences aren’t in the procedures themselves—they’re the same—but in disposition

Eva, who lives between central London, Geneva, and the south of France, says: “I do stuff, but none of the stuff I do is at all in my head associated with Instagram Face. Essentially you do similar procedures, but the end goal is completely different. Because they are trying to get the result of looking like another human being, and I’m just beautifying myself.”

But the more rapidly it replicates, and the clearer our manuals for quick imitation become, the closer we get to singularity—that moment Kim Kardashian fears unlike any other: the moment when it becomes unclear whether we’re copying her, or whether she is copying us.

what he restores is complicated and yet not complicated at all. It’s herself, the fingerprint of her features. Her aura, her presence and genealogy, her authenticity in space and time.

Dr. Taktouk’s approach is “not so formulaic.” He aims to give his patients the “better versions of themselves.” “It’s not about trying to be anyone else,” he says, “or creating a conveyor belt of patients. It’s about working with your best features, enhancing them, but still looking like you.”

“Vulgar” says that in pursuing indistinguishability, women have been duped into another punishing divide. “Vulgar” says that the subtlety of his work is what signals its special class—and that the women who’ve obtained Instagram Face for mobility’s sake have unwittingly shut themselves out of it.

While younger women are dissolving their gratuitous work, the 64-year-old Madonna appeared at the Grammy Awards in early February, looking so tragically unlike herself that the internet launched an immediate postmortem.

The folly of Instagram Face is that in pursuing a bionic ideal, it turns cosmetic technology away from not just the reality of class and power, but also the great, poignant, painful human project of trying to reverse time. It misses the point of what we find beautiful: that which is ephemeral, and can’t be reproduced

Age is just one of the hierarchies Instagram Face can’t topple, in the history of women striving versus the women already arrived. What exactly have they arrived at?

Youth, temporarily. Wealth. Emotional security. Privacy. Personal choices, like cosmetic decisions, which are not so public, and do not have to be defended as empowered, in the defeatist humiliation of our times

Maybe they’ve arrived at love, which for women has never been separate from the things I’ve already mentioned.

I can’t help but recall the time I was chatting with a plastic surgeon. I began to point to my features, my flaws. I asked her, “What would you do to me, if I were your patient?” I had many ideas. She gazed at me, and then noticed my ring. “Nothing,” she said. “You’re already married.”

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

What is the most common misconception about memory?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

the popular suffix “maxxing” for “maximizing” (e.g., “I’m burritomaxxing” instead of “I’m eating a lot of burritos”) is drawn from the incel idea of “looksmaxxing,” or “maximizing attractiveness” through surgical or cosmetic techniques.

Then there’s the word “cucked” for “weakened” or “emasculated.” If the taqueria is out of burritos, you might be “tacocucked,” drawing on the incel idea of being sexually emasculated by more attractive “chads.

These slang terms developed on 4chan precisely because of the site’s anonymity. Since users don’t have identifiable aliases, they signal their in-group status through performative fluency in shared slang

there’s a dark side to the site as well — certain boards, like /r9k/, are known breeding grounds for incel discussion, and the source of the incel words being used today.

finally, we have the word “sigma” for “assertive male,” which comes from an incel’s desired position outside the social hierarchy.

Memes and niche vocabulary become a form of cultural currency, fueling their proliferation.

From there, those words filter out to more mainstream websites such as Reddit and eventually become popularized by viral memes and TikTok trends. Social media algorithms do the rest of the work by curating recommended content for viewers.

Because these terms often spread in ironic contexts, people find them funny, engage with them and are eventually rewarded with more memes featuring incel vocabulary.

Creators are not just aware of this process — they are directly incentivized to abet it. We know that using trending audio helps our videos perform better and that incorporating popular metadata with hashtags or captions will help us reach wider audiences

kids aren’t actually saying “cucked” because they’re “blackpilled”; they’re using it for the same reason all kids use slang: It helps them bond as a group. And what are they bonding over? A shared mockery of incel ideas.

These words capture an important piece of the Gen Z zeitgeist. We should therefore be aware of them, keeping in mind that they’re being used ironically.

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.”