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But one piece of advice almost no one is giving? Be lucky. Pediatrician Neil Stone says that there’s no “secret” for staying Covid-19 free because there’s just too much luck involved.

As for me, I have some data that can, to an extent, quantify and explain my own good luck in avoiding Covid so far. I’m participating in a study on immunity which allowed me to learn that my blood still carries loads of antibodies induced by my vaccine and December booster shot, and no signs of any prior infection. Not everyone’s antibodies wane at the same rate, and in some people, the antibodies don’t wane much at all. (At some point it should become routine to collect this information to help people decide whether to get additional booster shots.)

My high level of vaccine antibodies probably explains my success more than my behavior. I make some effort to avoid Covid, but have been far from perfect. And I’ve been potentially exposed at least twice: Once last December, when someone at a small holiday gathering I’d attended developed symptoms the next day, and more recently, when I shared a large indoor space with two people who later tested positive. But according to my lab work, I’ve never had even a silent infection.

It’s possible I was protected by my high antibodies, or that some quirk of air flow meant I never breathed in enough virus to get sick. Or perhaps I benefited from a different form of luck. There’s another facet to immunity called the innate immune system, which acts as a first line of defense and sometimes knocks out a virus or other pathogen before it replicates enough to elicit the production of antibodies. Good innate immunity might help explain something many of us have experienced — not getting a cold or flu even when sleeping in the same bed with the sick person through the whole illness.

Stress, diet, general health and even sunlight might all affect innate immunity. So could other factors. There’s so much we still don’t know about the immune system. And that’s one reason we talk about “luck.”

understanding how the luck works could help other people avoid Covid, whether for the first time or for the second or third time. Taking a closer look at what passed for luck helped researchers like Gary Taubes discover that public health had obesity all wrong, and the standard high carb/low fat diets were causing people to gain weight.

avant-garde composer John Cage. When Cage presented his discordant orchestral piece “Atlas Eclipticalis” at Lincoln Center in 1964, many patrons walked out. Members of the orchestra hissed at Cage when he took his bow; a few even smashed his electronic equipment. But Cage’s work inspired other artists, leading “historians and museum curators to embrace him as a crucial figure in the development of postmodern art,” which in turn led audiences to pay respectful attention to his work

“There was a virtuous cycle for Cage: His originality, mystery and influence provided him artist status; this encouraged serious institutions to explore his work; the frequent engagement with his work imbued Cage with cachet among the public, who then received a status boost for taking his work seriously,” writes Marx.

The internet, Marx writes in his book’s closing section, changes this dynamic. With so much content out there, the chance that others will recognize the meaning of any obscure cultural signal declines

in the age of the internet, taste tells you less about a person. You don’t need to make your way into any social world to develop a familiarity with Cage — or, for that matter, with underground hip-hop, weird performance art, or rare sneakers.

people are, obviously, no less obsessed with their own status today than they were during times of fecund cultural production.

the markers of high social rank have become more philistine. When the value of cultural capital is debased, writes Marx, it makes “popularity and economic capital even more central in marking status.”

there’s “less incentive for individuals to both create and celebrate culture with high symbolic complexity.”

It makes more sense for a parvenu to fake a ride on a private jet than to fake an interest in contemporary art. We live in a time of rapid and disorientating shifts in gender, religion and technology. Aesthetically, thanks to the internet, it’s all quite dull.

Behavioral economics is at the center of the so-called replication crisis, a euphemism for the uncomfortable fact that the results of a significant percentage of social science experiments can’t be reproduced in subsequent trials

this key result was not replicated in similar experiments, undermining confidence in a whole area of study. It’s obvious that we do associate old age and slower walking, and we probably do slow down sometimes when thinking about older people. It’s just not clear that that’s a law of the mind.

And these attempts to “correct” human behavior are based on tenuous science. The replication crisis doesn’t have a simple solution

Journals have instituted reforms like having scientists preregister their hypotheses to avoid the possibility of results being manipulated during the research. But that doesn’t change how many uncertain results are already out there, with a knock-on effect that ripples through huge segments of quantitative social scienc

The Johns Hopkins science historian Ruth Leys, author of a forthcoming book on priming research, points out that cognitive science is especially prone to building future studies off disputed results. Despite the replication crisis, these fields are a “train on wheels, the track is laid and almost nothing stops them,” Dr. Leys said.

These cases result from lax standards around data collection, which will hopefully be corrected. But they also result from strong financial incentives: the possibility of salaries, book deals and speaking and consulting fees that range into the millions. Researchers can get those prizes only if they can show “significant” findings.

It is no coincidence that behavioral economics, from Dr. Kahneman to today, tends to be pro-business. Science should be not just reproducible, but also free of obvious ideology.

Technology and modern data science have only further entrenched behavioral economics. Its findings have greatly influenced algorithm design.

The collection of personal data about our movements, purchases and preferences inform interventions in our behavior from the grocery store to who is arrested by the police.

Setting people up for safety and success and providing good default options isn’t bad in itself, but there are more sinister uses as well. After all, not everyone who wants to exploit your cognitive biases has your best interests at heart.

Despite all its flaws, behavioral economics continues to drive public policy, market research and the design of digital interfaces.

One might think that a kind of moratorium on applying such dubious science would be in order — except that enacting one would be practically impossible. These ideas are so embedded in our institutions and everyday life that a full-scale audit of the behavioral sciences would require bringing much of our society to a standstill.

There is no peer review for algorithms that determine entry to a stadium or access to credit. To perform even the most banal, everyday actions, you have to put implicit trust in unverified scientific results.

We can’t afford to defer questions about human nature, and the social and political policies that come from them, to commercialized “research” that is scientifically questionable and driven by ideology. Behavioral economics claims that humans aren’t rational.

That’s a philosophical claim, not a scientific one, and it should be fought out in a rigorous marketplace of ideas. Instead of unearthing real, valuable knowledge of human nature, behavioral economics gives us “one weird trick” to lose weight or quit smoking.

Humans may not be perfectly rational, but we can do better than the predictably irrational consequences that behavioral economics has left us with today.

Studies have found that simply talking on the phone while walking actually slows down and disrupts our gait

When our brain is processing complex emotions and stressors, it hinders our ability to function at our best.

As I tell my students, remember to play your whole movie — not just the clip of your latest stumble on repeat

If a phone call is enough to disrupt our performance of basic tasks, we should be especially mindful of cognitive loads associated with grief, loss and general uncertainty about what is to come. All are major triggers for depression and anxiety, and profoundly affect our ability to perform even the most routine, practiced tasks.

holding tightly on to our latest failures is a common phenomenon, thanks to the recency effect — a cognitive bias that prioritizes our most recent experiences over past ones. This natural tendency sends our brain the wrong messages, and makes us forget how skilled, credentialed or qualified we really are

Adult depression and anxiety has climbed by 5.1 percent since the start of the pandemic.

Those things won’t matter nearly as much as their willingness to try again.

Social-media platforms are “preying on your insecurities; they’re preying on your temptations,” Jenn explained to me in an interview that shifted our parasocial connection, at least for an hour, to a mere relationship. “And, you know, I do play a role in this.” Jenn makes money through aspirational advertising, after all—a familiar part of any influencer’s job.

She’s pro–parasocial relationships, she explains to the camera, but only if we remain aware that we’re in one. “This relationship does not replace existing friendships, existing relationships,” she emphasizes. “This is all supplementary. Like, it should be in addition to your life, not a replacement.” I sat there watching her talk about parasocial relationships while absorbing the irony of being in one with her.

The open acknowledgment of social media’s inner workings, with content creators exposing the foundations of their content within the content itself, is what Alice Marwick, an associate communications professor at the University of North Carolina at Chapel Hill, described to me as “meta-content.”

Meta-content can be overt, such as the vlogger Casey Neistat wondering, in a vlog, if vlogging your life prevents you from being fully present in it;

But meta-content can also be subtle: a vlogger walking across the frame before running back to get the camera. Or influencers vlogging themselves editing the very video you’re watching, in a moment of space-time distortion.

Viewers don’t seem to care. We keep watching, fully accepting the performance. Perhaps that’s because the rise of meta-content promises a way to grasp authenticity by acknowledging artifice; especially in a moment when artifice is easier to create than ever before, audiences want to know what’s “real” and what isn’

“The idea of a space where you can trust no sources, there’s no place to sort of land, everything is put into question, is a very unsettling, unsatisfying way to live.

So we continue to search for, as Murray observes, the “agreed-upon things, our basic understandings of what’s real, what’s true.” But when the content we watch becomes self-aware and even self-critical, it raises the question of whether we can truly escape the machinations of social media. Maybe when we stare directly into the abyss, we begin to enjoy its company.

“The difference between BeReal and the social-media giants isn’t the former’s relationship to truth but the size and scale of its deceptions.” BeReal users still angle their camera and wait to take their daily photo at an aesthetic time of day. The snapshots merely remind us how impossible it is to stop performing online.

Jenn’s concern over the future of the internet stems, in part, from motherhood. She recently had a son, Lennon (whose first birthday party I watched on YouTube), and worries about the digital world he’s going to inherit.

Back in the age of MySpace, she had her own internet friends and would sneak out to parking lots at 1 a.m. to meet them in real life: “I think this was when technology was really used as a tool to connect us.” Now, she explained, it’s beginning to ensnare us. Posting content online is no longer a means to an end so much as the end itself.

We used to view influencers’ lives as aspirational, a reality that we could reach toward. Now both sides acknowledge that they’re part of a perfect product that the viewer understands is unattainable and the influencer acknowledges is not fully real.

“I forgot to say this to her in the interview, but I truly think that my videos are less about me and more of a reflection of where you are currently … You are kind of reflecting on your own life and seeing what resonates [with] you, and you’re discarding what doesn’t. And I think that’s what’s beautiful about it.”

meta-content is fundamentally a compromise. Recognizing the delusion of the internet doesn’t alter our course within it so much as remind us how trapped we truly are—and how we wouldn’t have it any other way.

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 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.”