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This pervasive claim that “I have my rights” but “I don’t have responsibilities” is unraveling our country today.

But societal immunity “is a function of trust,”

“When trust in institutions, leaders and each other is high, people — in a crisis — are more willing to sublimate their cherished rights and demonstrate their sense of shared responsibilities toward others, even others they disagree with on important issues and even if it means making sacrifices.”

When our trust in each other erodes, though, as is happening in America today, fewer people think they have responsibilities to the other — only rights that protect them from being told by the other what to do.

completely ignored the four most important statistical facts about Covid-19 today that highlight our responsibilities — to our fellow citizens and, even more so, to the nurses and doctors risking their lives to take care of us in a pandemic.

First, unvaccinated adults 18 years and older are 16 times more likely to be hospitalized for Covid than fully vaccinated adults

Second: Adults 65 and older who are not vaccinated are around 50 times more likely to be hospitalized for Covid than those who have received a full vaccine course and a booster.

Third: Unvaccinated people are 20 times more likely to die of Covid than people who are vaccinated and boosted.

the emotional toll and other work conditions brought on by the pandemic contributed to some two-thirds of nurses giving thought to leaving the profession.

many hospitals today are experiencing an unprecedented 20 percent annual turnover rate of nurses — more than double the historical baseline. The more nurses leave, the more those left behind have had to work overtime.

Especially when so many dying unvaccinated patients tell their nurses, “I wish I had gotten vaccinated,”

none of these statistics were mentioned during that podcast

“You can listen to the entire 186-minute lovefest between Rogan and Malone and have no idea that our hospitals are overloaded with Covid cases,” wrote Levy, “and that on the day their conversation transpired, 7,559 people worldwide died of Covid, 1,410 of which were in the United States. The vast majority of them were unvaccinated.”

“When Malone uncorks questionable allegations about disastrous vaccine effects and the global cabal of politicians and drugmakers pulling strings, Rogan responds with uh-huhs and wows.”

That was Rogan’s right. That was Spotify C.E.O. Daniel Ek’s right.

But who was looking out for the doctors and nurses on the pandemic front lines whose only ask is that the politicians and media influencers who are privileged enough to have public platforms — especially one like Rogan with an average of 11 million listeners per episode — use them to reinforce our responsibilities to one another, not just our rights.

He could start by offering his listeners a 186-minute episode with intensive care nurses and doctors about what this pandemic of the unvaccinated has done to them.

That would be a teaching moment, not only about Covid, but also about putting our responsibilities to one another — and especially to those who care for us — at least on a par with our right to be as dumb and selfish as we want to be.

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.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

In the summer of 2020, “public-health experts” decided that racism is a public-health crisis comparable to the coronavirus pandemic. It was therefore, they claimed, within their purview to express public support for the Black Lives Matter protests following the murder of George Floyd and to argue that the benefits of such protests outweighed the increased risk of spreading the disease. Those supposed experts actually knew nothing about the likely effects of the protests. They made no concrete predictions about whether they would in any way ameliorate racism in America, just as Nature can make no concrete predictions about whether its political endorsements will actually help a preferred candidate without jeopardizing its other important goals. The political action was expressive, not evidence-based...

as is often the case, a debate which appears to be about the neutrality of institutions is not really about neutrality at all... Rather, it is about whether there is any room left for soberly weighing our goals and values and thinking in a measured way about the consequences of our actions rather than simply reacting to situations in an impulsive and expressive manner, broadcasting our views to the world so that people know where we stand.

Our goals and values might not be “neutral” at all, but they might still be best served by procedures, institutions, and even individuals that follow neutral principles.

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

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 internet stripped institutions of their gatekeeping powers, thus making it possible for anyone to publish—and making it inevitable that many writers would create audiences independent of media institutions.

The internet destroyed the apprenticeship system that had dominated American journalism for generations. Under the old system, an aspiring writer took a low-level job at a media institution and worked her way up the ladder until she was trusted enough to write.

Under the new system, people started their careers writing outside of institutions—on personal blogs—and then were hired by institutions on the strength of their work.

In practice, these outsiders were primarily hired not on the merits of their work, but because of the size of their audience.

what it really did was transform the nature of audiences. Once the internet existed it became inevitable that institutions would see their power to hold audiences wane while individual writers would have their power to build personal audiences explode.

this meant that institutions would begin to hire based on the size of a writer’s audience. Which meant that writers’ overriding professional imperative was to build an audience, since that was the key to advancement.

Twitter killed the blog and lowered the barrier to entry for new writers from “Must have a laptop, the ability to navigate WordPress, and the capacity to write paragraphs” to “Do you have an iPhone and the ability to string 20 words together? With or without punctuation?”

If you were able to build a big enough audience on Twitter, then media institutions fell all over themselves trying to hire you—because they believed that you would then bring your audience to them.2

If you were a writer for the Washington Post, or Wired, or the Saginaw Express, you had to build your own audience not to advance, but to avoid being replaced.

For journalists, audience wasn’t just status—it was professional capital. In fact, it was the most valuable professional capital.

Everything we just talked about was driven by the advertising model of media, which prized pageviews and unique users above all else. About a decade ago, that model started to fray around the edges,3 which caused a shift to the subscription model.

Today, if you’re a subscription publication, what Twitter gives you is growth opportunity. Twitter’s not the only channel for growth—there are lots of others, from TikTok to LinkedIn to YouTube to podcasts to search. But it’s an important one.

Twitter’s attack on Substack was an attack on the subscription model of journalism itself.

since media has already seen the ad-based model fall apart, it’s not clear what the alternative will be if the subscription model dies, too.

All of which is why having a major social media platform run by a capricious bad actor is suboptimal.

And why I think anyone else who’s concerned about the future of media ought to start hedging against Twitter. None of the direct hedges—Post, Mastodon, etc.—are viable yet. But tech history shows that these shifts can happen fairly quickly.

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.”

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

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

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

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

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

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

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

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

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

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

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

That’s because real people — and yes, even professional economists — tend to process the parallel rise of prices and wages in quite different ways.

In brief, researchers have found that we tend to internalize the gains due to inflation and externalize the losses. These different processes yield different emotional responses.

Let’s start with higher prices. Sticker shock hurts. Even as someone who closely studies the inflation statistics, I’m still often surprised by higher prices. They feel unfair. They undermine my spending power, and my sense of control and order.

in reality, higher prices are only the first act of the inflationary play. It’s a play that economists have seen before. In episode after episode, surges in prices have led to — or been preceded by — a proportional surge in wages.

Even though wages tend to rise hand-in-hand with prices, we tell ourselves a different story, in which the wage rises we get have nothing to do with price rises that cause them.

But then my economist brain took over, and slowly it sunk in that my raise wasn’t a reward for hard work, but rather a cost-of-living adjustment

Internalizing the gain and externalizing the cost of inflation protects you from this deflating realization. But it also distorts your sense of reality.

The reason so many Americans feel that inflation is stealing their purchasing power is that they give themselves unearned credit for the offsetting wage rises that actually restore it.

younger folks — anyone under 60 — had never experienced sustained inflation rates greater than 5 percent in their adult lives. And I think this explains why they’re so angry about today’s inflation.

While older Americans understood that the pain of inflation is transitory, younger folks aren’t so sure. Inflation is a lot scarier when you fear that today’s price rises will permanently undermine your ability to make ends meet.

Perhaps this explains why the recent moderate burst of inflation has created seemingly more anxiety than previous inflationary episodes.

More generally, being an economist makes me an optimist. Social media is awash with (false) claims that we’re in a “silent depression,” and those who want to make American great again are certain it was once so much better.

in reality, our economy this year is larger, more productive and will yield higher average incomes than in any prior year on record in American history

And because the United States is the world’s richest major economy, we can now say that we are almost certainly part of the richest large society in its richest year in the history of humanity.

The income of the average American will double approximately every 39 years. And so when my kids are my age, average income will be roughly double what it is today. Far from being fearful for my kids, I’m envious of the extraordinary riches their generation will enjoy.

Psychologists describe anxiety disorders as occurring when the panic you feel is out of proportion to the danger you face. By this definition, we’re in the midst of a macroeconomic anxiety attack.

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.”