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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.”

starting in the mid-2010s, those beloved blue skies began to disappear. First, the smoke came in occasional bursts, from wildfires in Canada or California or Siberia, and blew away when the wind changed direction. Within a few summers, though, it was coming in thicker, from more directions at once, and lasting longer.

Sometimes there were weeks when you were advised not to open your windows or exercise outside. Sometimes there were long stretches where you weren’t supposed to breathe the outside air at all.

Now lots of Bryant’s clients wanted to talk about climate change. They wanted to talk about how strange and disorienting and scary this new reality felt, about what the future might be like and how they might face it, about how to deal with all the strong feelings — helplessness, rage, depression, guilt — being stirred up inside them.

As a therapist, Bryant found himself unsure how to respond

while his clinical education offered lots of training in, say, substance abuse or family therapy, there was nothing about environmental crisis, or how to treat patients whose mental health was affected by it

Bryant immersed himself in the subject, joining and founding associations of climate-concerned therapists

eventually started a website, Climate & Mind, to serve as a sort of clearing house for other therapists searching for resources. Instead, the site became an unexpected window into the experience of would-be patients: Bryant found himself receiving messages from people around the world who stumbled across it while looking for help.

Over and over, he read the same story, of potential patients who’d gone looking for someone to talk to about climate change and other environmental crises, only to be told that they were overreacting — that their concern, and not the climate, was what was out of whack and in need of treatment.

“You come in and talk about how anxious you are that fossil-fuel companies continue to pump CO2 into the air, and your therapist says, ‘So, tell me about your mother.’”

In many of the messages, people asked Bryant for referrals to climate-focused therapists in Houston or Canada or Taiwan, wherever it was the writer lived.

his practice had shifted to reflect a new reality of climate psychology. His clients didn’t just bring up the changing climate incidentally, or during disconcerting local reminders; rather, many were activists or scientists or people who specifically sought out Bryant because of their concerns about the climate crisis.

could now turn to resources like the list maintained by the Climate Psychology Alliance North America, which contains more than 100 psychotherapists around the country who are what the organization calls “climate aware.”

But treating those fears also stirred up lots of complicated questions that no one was quite sure how to answer. The traditional focus of his field, Bryant said, could be oversimplified as “fixing the individual”: treating patients as separate entities working on their personal growth

It had been a challenging few years, Bryant told me when I first called to talk about his work. There were some ways in which climate fears were a natural fit in the therapy room, and he believed the field had coalesced around some answers that felt clear and useful

Climate change, by contrast, was a species-wide problem, a profound and constant reminder of how deeply intertwined we all are in complex systems — atmospheric, biospheric, economic — that are much bigger than us. It sometimes felt like a direct challenge to old therapeutic paradigms — and perhaps a chance to replace them with something better.

In one of climate psychology’s founding papers, published in 2011, Susan Clayton and Thomas J. Doherty posited that climate change would have “significant negative effects on mental health and well-being.” They described three broad types of possible impacts: the acute trauma of living through climate disasters; the corroding fear of a collapsing future; and the psychosocial decay that could damage the fabric of communities dealing with disruptive changes

All of these, they wrote, would make the climate crisis “as much a psychological and social phenomenon as a matter of biodiversity and geophysics.”

Many of these predictions have since been borne out

Studies have found rates of PTSD spiking in the wake of disasters, and in 2017 the American Psychological Association defined “ecoanxiety” as “a chronic fear of environmental doom.”

Climate-driven migration is on the rise, and so are stories of xenophobia and community mistrust.

According to a 2022 survey by Yale and George Mason University, a majority of Americans report that they spend time worrying about climate change.

Many say it has led to symptoms of depression or anxiety; more than a quarter make an active effort not to think about it.

There was little or no attention to the fact that living through, or helping to cause, a collapse of nature can also be mentally harmful.

In June, the Yale Journal of Biology and Medicine published a paper cautioning that the world at large was facing “a psychological condition of ‘systemic uncertainty,’” in which “difficult emotions arise not only from experiencing the ecological loss itself,” but also from the fact that our lives are inescapably embedded in systems that keep on making those losses worse.

Climate change, in other words, surrounds us with constant reminders of “ethical dilemmas and deep social criticism of modern society. In its essence, climate crisis questions the relationship of humans with nature and the meaning of being human in the Anthropocene.”

This is not an easy way to live.

Living within a context that is obviously unhealthful, he wrote, is painful: “a dimly intuited ‘fall’ from which we spend our lives trying to recover, a guilt we can never quite grasp or expiate” — a feeling of loss or dislocation whose true origins we look for, but often fail to see. This confusion leaves us feeling even worse.

When Barbara Easterlin first started studying environmental psychology 30 years ago, she told me, the focus of study was on ways in which cultivating a relationship with nature can be good for mental health

A poll by the American Psychiatric Association in the same year found that nearly half of Americans think climate change is already harming the nation’s mental health.

the field is still so new that it does not yet have evidence-tested treatments or standards of practice. Therapists sometimes feel as if they are finding the path as they go.

Rebecca Weston, a licensed clinical social worker practicing in New York and a co-president of the CPA-NA, told me that when she treats anxiety disorders, her goal is often to help the patient understand how much of their fear is internally produced — out of proportion to the reality they’re facing

climate anxiety is a different challenge, because people worried about climate change and environmental breakdown are often having the opposite experience: Their worries are rational and evidence-based, but they feel isolated and frustrated because they’re living in a society that tends to dismiss them.

One of the emerging tenets of climate psychology is that counselors should validate their clients’ climate-related emotions as reasonable, not pathological

it does mean validating that feelings like grief and fear and shame aren’t a form of sickness, but, as Weston put it, “are actually rational responses to a world that’s very scary and very uncertain and very dangerous for people

In the words of a handbook on climate psychology, “Paying heed to what is happening in our communities and across the globe is a healthier response than turning away in denial or disavowal.”

But this, too, raises difficult questions. “How much do we normalize people to the system we’re in?” Weston asked. “And is that the definition of health?

Or is the definition of health resisting the things that are making us so unhappy? That’s the profound tension within our field.”

“It seems to shift all the time, the sort of content and material that people are bringing in,” Alexandra Woollacott, a psychotherapist in Seattle, told the group. Sometimes it was a pervasive anxiety about the future, or trauma responses to fires or smoke or heat; other times, clients, especially young ones, wanted to vent their “sort of righteous anger and sense of betrayal” at the various powers that had built and maintained a society that was so destructive.

“I’m so glad that we have each other to process this,” she said, “because we’re humans living through this, too. I have my own trauma responses to it, I have my own grief process around it, I have my own fury at government and oil companies, and I think I don’t want to burden my clients with my own emotional response to it.”

In a field that has long emphasized boundaries, discouraging therapists from bringing their own issues or experiences into the therapy room, climate therapy offers a particular challenge: Separation can be harder when the problems at hand affect therapist and client alike

Some therapists I spoke to were worried about navigating the breakdown of barriers, while others had embraced it. “There is no place on the planet that won’t eventually be impacted, where client and therapist won’t be in it together,” a family therapist wrote in a CPA-NA newsletter. “Most therapists I know have become more vulnerable and self-disclosing in their practice.”

“If you look at or consider typical theoretical framings of something like post-traumatic growth, which is the understanding of this idea that people can sort of grow and become stronger and better after a traumatic event,” she said, then the climate crisis poses a dilemma because “there is no afterwards, right? There is no resolution anytime in our lifetimes to this crisis that we nonetheless have to build the capacities to face and to endure and to hopefully engage.”

many of her patients are also disconnected from the natural world, which means that they struggle to process or even recognize the grief and alienation that comes from living in a society that treats nature as other, a resource to be used and discarded.

“How,” she asked, “do you think about resilience apart from resolution?”

she believed this framing reflected and reinforced a bias inherent in a field that has long been most accessible to, and practiced by, the privileged. It was hardly new in the world, after all, to face the collapse of your entire way of life and still find ways to keep going.

Torres said that she sometimes takes her therapy sessions outside or asks patients to remember their earliest and deepest connections with animals or plants or places. She believes it will help if they learn to think of themselves “as rooted beings that aren’t just simply living in the human overlay on the environment.” It was valuable to recognize, she said, that “we are part of the land” and suffer when it suffers.

Torres described introducing her clients to methods — mindfulness, distress tolerance, emotion regulation — to help them manage acute feelings of stress or panic and to avoid the brittleness of burnout.

She also encourages them to narrativize the problem, including themselves as agents of change inside stories about how they came to be in this situation, and how they might make it different.

then she encourages them to find a community of other people who care about the same problems, with whom they could connect outside the therapy room. As Woollacott said earlier: “People who share your values. People who are committed to not looking away.”

Dwyer told the group that she had been thinking more about psychological adaptation as a form of climate mitigation

Therapy, she said, could be a way to steward human energy and creative capacities at a time when they’re most needed.

It was hard, Bryant told me when we first spoke, to do this sort of work without finding yourself asking bigger questions — namely, what was therapy actually about?

Many of the therapists I talked to spoke of their role not as “fixing” a patient’s problem or responding to a pathology, but simply giving their patients the tools to name and explore their most difficult emotions, to sit with painful feelings without instantly running away from them

many of the methods in their traditional tool kits continue to be useful in climate psychology. Anxiety and hopelessness and anger are all familiar territory, after all, with long histories of well-studied treatments.

They focused on trying to help patients develop coping skills and find meaning amid destabilization, to still see themselves as having agency and choice.

Weston, the therapist in New York, has had patients who struggle to be in a world that surrounds them with waste and trash, who experience panic because they can never find a place free of reminders of their society’s destruction

eston said, that she has trouble with the repeated refrain that therapist and patient experiencing the same losses and dreads at the same time constituted a major departure from traditional therapeutic practice

“I’m so excited by what you’re bringing in,” Woollacott replied. “I’m doing psychoanalytic training at the moment, and we study attachment theory” — how the stability of early emotional bonds affects future relationships and feelings of well-being. “But nowhere in the literature does it talk about our attachment to the land.”

Lately, Bryant told me, he’s been most excited about the work that happens outside the therapy room: places where groups of people gather to talk about their feelings and the future they’re facing

It was at such a meeting — a community event where people were brainstorming ways to adapt to climate chaos — that Weston, realizing she had concrete skills to offer, was inspired to rework her practice to focus on the challenge. She remembers finding the gathering empowering and energizing in a way she hadn’t experienced before. In such settings, it was automatic that people would feel embraced instead of isolated, natural that the conversation would start moving away from the individual and toward collective experiences and ideas.

There was no fully separate space, to be mended on its own. There was only a shared and broken world, and a community united in loving it.

there are no psychologists who specialize in exposure and response prevention, the specific kind of therapy she and many others with OCD require in order to break their crippling thought cycles.

At its worst, OCD can compel people to spend hours each day rehearsing an intricate mental dance they feel powerless to end.

Along with medication, exposure and response prevention, or ERP, therapy is the gold-standard treatment for people with OCD. It is radically different from more traditional talk therapy, which excavates patients’ childhoods or past relationships for clues to their present-day problems.

a person is forced to confront their obsessive thoughts relentlessly. The goal is to make the sufferer so accustomed to their obsessions that they no longer feel tempted to engage in soothing compulsions.

Because the symptoms can be entirely mental, it can take years for either patients or therapists to recognize OCD for what it is.

ERP teaches people, “these thoughts are meaningless, you need to learn to ignore them.”

some studies estimate it takes OCD sufferers 17 years to find proper treatment from the onset of symptoms. Seeking certain forms of talk therapy can make them worse, not better. In the meantime, some experience symptoms so debilitating they are confined to their homes.

Most moderate OCD cases get at least partly better if the patient receives two or three months of ERP.

There is no mandatory number of hours that psychologists must spend training in either cognitive-behavioral therapy or ERP, said Lynn Bufka, a psychologist with the American Psychological Association. Bufka did not know what percentage of psychotherapists provide ERP, but she suspects it’s “small.”

Between 3 and 7 million Americans suffer from OCD at some point—a substantial number, but still far fewer than the vast multitudes who seek therapy for anxiety and depression.

People obsessed with not offending God might hold a satanic ritual. Those assailed by persistent (and baseless) fears they will molest their siblings might read the incest tome Flowers in the Attic.

Access to ERP therapists is compounded by the already profound shortage of psychotherapists in rural areas. More than half of U.S. counties have no mental-health professionals at all.

ERP specialists might feel no need to take insurance, since they are so rare they often have no shortage of clients, Szymanski, of the International OCD Foundation, pointed out.

But the treatment was so expensive it contributed to the family’s decision to sell their house.

Any endocrinologist or other physician who rejects this approach is alleged to be endangering the health and even the life of his patients.

Research shows that some 80% of children with “gender dysphoria” eventually come to terms with their sex without surgical or pharmaceutical intervention

But are these patients really “transgender”

Multiple studies have found that most kids who are confused or distressed about their sex end up realizing they’re gay—nearly two-thirds in a 2021 study of boys

This makes sense: Gay kids often don’t conform to traditional sex roles. But gender ideology holds that feminine boys and masculine girls may be “born in the wrong body.”

In this light, “gender-affirming care” looks a lot like conversion therapy.

Now it takes the form of rendering teenagers sterile and sexually dysfunctional for life.

linicians from the main U.K. transgender service referred to prescribing puberty blockers as “transing the gay away”—a play on the description of old-fashioned conversion-therapy as “praying the gay away.” A clinician who resigned from the U.K. service accused it of “institutional homophobia.” Clinicians at the service had a “dark joke” that “there would be no gay people left at the rate Gids”—the Gender Identity Service—“was going.”

Consistent with conversion therapy, physicians are telling young gays and lesbians that something is wrong with them, based on a regressive view of what it is to be male or female

The resulting interventions often create lifelong medical problems, both physical and mental. Contrary to advocates’ claims, there’s no evidence that puberty blockers, cross-sex hormones, or surgeries reduce the risk of suicide.

Children who take this road face a lifetime of pain, infertility and anguish

society has been told that accepting transgender identity is the same as accepting gays and lesbians. But it isn’t. Even well-intentioned acceptance of transgender identity disproportionately harms them

that’s what I felt back in those days,” he said, “that everything was for sale — it was all about distraction, it didn’t seem serious. It all felt foolish and headed for a crash.”

Younger viewers do not have to fear Chase’s wrath, because they are not so obviously its object. They are also able to watch the show for hours on end, which makes the subtext and themes more apparent. Perhaps all of this has offered clarity that was not possible when the show aired. Perhaps it is easier now to see exactly who — or what — Chase was angry at.

it is easily one of the most written-about TV shows in the medium’s short history. But more than the shows that have emerged in its wake, which are subjected to close readings and recaps in nearly every major publication, “The Sopranos” has a novelistic quality that actually withstands this level of scrutiny. It’s not uncommon to hear from people who have watched the series several times, or who do so on a routine basis — people who say it reveals new charms at different points in life

Perhaps the greatest mystery of all, looking back on “The Sopranos” all these years later, is this: What was Chase seeing in the mid-’90s — a period when the United States’ chief geopolitical foe was Serbia, when the line-item veto and school uniforms were front-page news, when “Macarena” topped the charts — that compelled him to make a show that was so thoroughly pessimistic about this country?

“I don’t think I felt like it was a good time,” he told me. He is 76 now, and speaks deliberately and thoughtfully. “I felt that things were going downhill.” He’d become convinced America was, as Neil Postman’s 1985 polemic put it, “Amusing Ourselves to Death,” not an easy thing for a journeyman TV writer to accept.

“There was nothing but crap out there. Crap in every sense. I was beginning to feel that people’s predictions about the dumbing-down of society had happened and were happening, and I started to see everything getting tawdry and cheap.”

Expanded access to credit had cut into what mobsters call the shylock business; there’s no need to go to a loan shark when the payday lender will offer you similarly competitive rates. Gambling was legalized in many states and flourishes on many reservations; nearly every state in the Union has a lottery, which decimated the numbers racket. Italian American neighborhoods have emptied out — as Jacobs writes, “radically diminishing the pool of tough teenagers with Cosa Nostra potential”; this is dramatized brilliantly in the final episode of the series, when a mobster from a New York family hurries through Little Italy on an important phone call and, when the call ends, looks around to see he’s wandered into an encroaching and vibrant Chinatown. And, Jacobs notes, union membership has been decimated. “In the mid-1950s, about 35 percent of U.S. workers belonged to a union,” he writes. “In recent years, only 6.5 percent of private-sector workers have been union members.”

I was about to change the subject when he hit on something. “Have you noticed — or maybe you haven’t noticed — how nobody does what they say they’re going to do?” he said, suddenly animated. “If your sink gets jammed up, and a guy says he’s going to be out there at 5:30 — no. Very few people do what they say they’re going to do. There is a decline in goods and services that is enormous.”

Chase told me the real joke of the show was not “What if a mobster went to therapy?” The comedic engine, for him, was this: What if things had become so selfish and narcissistic in America that even the mob couldn’t take it? “That was the whole thing,” he said. “America was so off the rails that everything that the Mafia had done was nothing compared to what was going on around them.”

In “The Mafia: A Cultural History,” Roberto M. Dainotto, a professor of literature at Duke, writes that one thing our cinematic Mafiosi have that we admire, against our better judgment, is access to structures of meaning outside of market forces: the church, family, honor. The Mafia movie often pits these traditional values against the corrosive and homogenizing effects of American life.

What “The Sopranos” shows us, Dainotto argues, is what happens when all that ballast is gone, and the Mafia is revealed to be as ignoble as anything else. “Life is what it is,” he writes, “and repeats as such.”

The show puts all this American social and cultural rot in front of characters wholly incapable of articulating it, if they even notice it.

What is, for me, one of the show’s most memorable scenes has no dialogue at all. Tony and his crew have just returned from a business trip to Italy, during which they were delighted with the Old Country but also confronted with the degree of their alienation from their own heritage. They’re off the plane, and in a car traveling through Essex County. As the camera pans by the detritus of their disenchanted world — overpasses, warehouses — Tony, Paulie and Christopher are seeing their home with fresh eyes, and maybe wondering if their ancestors made a bad trade or if, somewhere along the line, something has gone horribly wrong. But we don’t know: For once, these arrogant, stupid and loquacious men are completely silent.

Around the time “The Sopranos” premiered, the N.Y.U. Law professor James B. Jacobs wrote a paper, along with a student, arguing that the Mafia, though weakened by decades of prosecutions, could come roaring back. By 2019, though, he had published a new paper called “The Rise and Fall of Organized Crime in the United States,” declaring the Mafia all but finished. “The world in which the Cosa Nostra became powerful is largely gone,” he wrote. And he cites a litany of factors that aided its collapse, a mix of technological advances, deregulation and financialization — many of the same forces that have created the stratified economy of today.

In his first therapy session with Dr. Melfi, Tony tries to explain why he thinks he has panic attacks, why he suffers from stress. “The morning of the day I got sick, I’d been thinking: It’s good to be in something from the ground floor,” he says. “I came too late for that, I know. But lately, I’m getting the feeling that I came in at the end. The best is over.” Melfi tells him that many Americans feel that way. Tony presses on: “I think about my father: He never reached the heights like me, but in a lot of ways he had it better. He had his people, they had their standards, they had their pride. Today, what do we got?”

You can see this world — one in which no one can be squeezed because everyone is being squeezed — starting to take shape from the very beginning of the show. In the pilot, Tony is fending off competition from a new waste-hauling business undercutting his company’s extortionate fees, and trying to figure out how he can get a piece of the similarly extortionate costs his health insurer paid for his M.R.I. — a procedure he had because the stress in his life had given him a panic attack.

The bien-pensant line on Tony remains that he’s a sociopath, and only used therapy to become a better criminal. This is an idea spoon-fed to the viewer in the final episodes by a contrite Dr. Melfi, in a show that spoon-feeds almost nothing to the viewer. Melfi herself might call this a coping mechanism to avoid the messier reality, which is that Tony lives in an immoral world nestled within another immoral world, both of which have only grown more chaotic because of forces outside his control.

Because of this, you can see how he reasons himself into more and more heinous crimes, justifying each and every one of them to himself. Perhaps to you too — at least, up to a point. That sympathy for Tony led contemporaneous critics to ask if people were watching the show in the wrong way, or if our enjoyment pointed to a deficiency of the heart.

t is this quality of Tony’s — this combination of privilege and self-loathing — that I suspect resonates with a younger generation, whether we want to admit it or not. He’s not so different from us, after all. He has an anxiety disorder. He goes to therapy and takes S.S.R.I.s, but never really improves — not for long, anyway. He has a mild case of impostor syndrome, having skipped some key steps to becoming boss, and he knows that people who hold it against him are sort of right. He’s still proud of his accomplishments in high school. He does psychedelics in the desert, and they change his perspective on things. He often repeats stuff he half-remembers someone smarter than him saying. He’s arguably in an open marriage with Carmela, if a rather lopsided one. He liked listening to “Don’t Stop Believin’” in 2007. He’s impulsive and selfish and does not go to church, though he does seem open to vaguer notions of spirituality. He wishes his career provided him with meaning, but once he had the career, he discovered that someone had pulled the rug out at some point, and an institution that had been a lodestar to him for his whole life was revealed to be a means of making money and nothing more. Does this sound at all familiar to you?

Like many young people, Tony is a world-historically spoiled man who is nevertheless cursed, thanks to timing, to live out the end of an enterprise he knows on some level to be immoral.

It gives him panic attacks, but he’s powerless to find a way out. Thus trapped — and depressed — it’s not so hard for him to allow himself a few passes, to refuse to become better because the world is so rotten anyway.

Tony’s predicament was once his to suffer alone, but history has unfolded in such a way as to render his condition nearly universal.

That the people in power truly had insulated themselves in a fantasy environment — not just in the realm of foreign policy, but also, more concretely, in the endless faux-bucolic subdivisions that would crater the economy. We were living in a sort of irreality, one whose totality would humiliate and delegitimize nearly every important institution in American life when it ended, leaving — of all people — the Meadows and A.J.s of the world to make sense of things.

if people still see a monster in Tony, then the monster is themselves: a twisted reflection of a generation whose awakening to the structures that control them came in tandem with a growing aversion to personal accountability in the face of these systems.

Whether that’s true or not, it offers us all permission to become little Tonys, lamenting the sad state of affairs while doing almost exactly nothing to improve ourselves, or anything at all.

This tendency is perhaps most pronounced online, where we are all in therapy all day, and where you can find median generational opinions perfectly priced by the marketplace of ideas — where we bemoan the wrongs of the world and tell ourselves that we can continue being who we are, and enjoy the comforts we’ve grown accustomed to.

In the show’s finale, as the extended Soprano family gathers to mourn the death of Bobby Baccalieri, we find Paulie Walnuts stuck at the kids’ table, where A.J., newly politically awakened, charges into a rant. You people are screwed, he says. “You’re living in a dream.” Bush let Al Qaeda escape, he tells them, and then made us invade some other country? Someone at the table tells him that if he really cares, he should join up. A.J. responds: “It’s more noble than watching these jackoff fantasies on TV of how we’re kicking their ass. It’s like: America.” Again, he’s interrupted: What in the world does he mean? He explains: “This is still where people come to make it. It’s a beautiful idea. And then what do they get? Bling? And come-ons for [expletive] they don’t need and can’t afford?”

However inartfully, A.J. was gesturing at something that would have been hard for someone his age to see at the time, which is that the ’00s were a sort of fever dream, a tragic farce built on cheap money and propaganda.

The notion that individual action might help us avoid any coming or ongoing crises is now seen as hopelessly naïve, the stuff of Obama-era liberalism.

. The “leftist ‘Sopranos’ fan” is now such a well-known type that it is rounding the corner to being an object of scorn and mockery online.

One oddity that can’t be ignored in this “Sopranos” resurgence is that, somewhat atypically for a TV fandom, there is an openly left-wing subcurrent within it

agents will open up many more learning opportunities.

Already, AI can help you pick out a new TV and recommend movies, books, shows, and podcasts. Likewise, a company I’ve invested in, recently launched Pix, which lets you ask questions (“Which Robert Redford movies would I like and where can I watch them?”) and then makes recommendations based on what you’ve liked in the past

Productivity

copilots can do a lot—such as turn a written document into a slide deck, answer questions about a spreadsheet using natural language, and summarize email threads while representing each person’s point of view.

I don’t think any single company will dominate the agents business--there will be many different AI engines available.

Helping patients and healthcare workers will be especially beneficial for people in poor countries, where many never get to see a doctor at all.

To create a new app or service, you won’t need to know how to write code or do graphic design. You’ll just tell your agent what you want. It will be able to write the code, design the look and feel of the app, create a logo, and publish the app to an online store

Agents will do even more. Having one will be like having a person dedicated to helping you with various tasks and doing them independently if you want. If you have an idea for a business, an agent will help you write up a business plan, create a presentation for it, and even generate images of what your product might look like

For decades, I’ve been excited about all the ways that software would make teachers’ jobs easier and help students learn. It won’t replace teachers, but it will supplement their work—personalizing the work for students and liberating teachers from paperwork and other tasks so they can spend more time on the most important parts of the job.

Mental health care is another example of a service that agents will make available to virtually everyone. Today, weekly therapy sessions seem like a luxury. But there is a lot of unmet need, and many people who could benefit from therapy don’t have access to it.

Entertainment and shopping

The real shift will come when agents can help patients do basic triage, get advice about how to deal with health problems, and decide whether they need to seek treatment.

They’ll replace word processors, spreadsheets, and other productivity apps.

Education

For example, few families can pay for a tutor who works one-on-one with a student to supplement their classroom work. If agents can capture what makes a tutor effective, they’ll unlock this supplemental instruction for everyone who wants it. If a tutoring agent knows that a kid likes Minecraft and Taylor Swift, it will use Minecraft to teach them about calculating the volume and area of shapes, and Taylor’s lyrics to teach them about storytelling and rhyme schemes. The experience will be far richer—with graphics and sound, for example—and more personalized than today’s text-based tutors.

your agent will be able to help you in the same way that personal assistants support executives today. If your friend just had surgery, your agent will offer to send flowers and be able to order them for you. If you tell it you’d like to catch up with your old college roommate, it will work with their agent to find a time to get together, and just before you arrive, it will remind you that their oldest child just started college at the local university.

To see the dramatic change that agents will bring, let’s compare them to the AI tools available today. Most of these are bots. They’re limited to one app and generally only step in when you write a particular word or ask for help. Because they don’t remember how you use them from one time to the next, they don’t get better or learn any of your preferences.

The current state of the art is Khanmigo, a text-based bot created by Khan Academy. It can tutor students in math, science, and the humanities—for example, it can explain the quadratic formula and create math problems to practice on. It can also help teachers do things like write lesson plans.

Businesses that are separate today—search advertising, social networking with advertising, shopping, productivity software—will become one business.

other issues won’t be decided by companies and governments. For example, agents could affect how we interact with friends and family. Today, you can show someone that you care about them by remembering details about their life—say, their birthday. But when they know your agent likely reminded you about it and took care of sending flowers, will it be as meaningful for them?

In the computing industry, we talk about platforms—the technologies that apps and services are built on. Android, iOS, and Windows are all platforms. Agents will be the next platform.

A shock wave in the tech industry

Agents won’t simply make recommendations; they’ll help you act on them. If you want to buy a camera, you’ll have your agent read all the reviews for you, summarize them, make a recommendation, and place an order for it once you’ve made a decision.

Agents will affect how we use software as well as how it’s written. They’ll replace search sites because they’ll be better at finding information and summarizing it for you

they’ll be dramatically better. You’ll be able to have nuanced conversations with them. They will be much more personalized, and they won’t be limited to relatively simple tasks like writing a letter.

Companies will be able to make agents available for their employees to consult directly and be part of every meeting so they can answer questions.

AI agents that are well trained in mental health will make therapy much more affordable and easier to get. Wysa and Youper are two of the early chatbots here. But agents will go much deeper. If you choose to share enough information with a mental health agent, it will understand your life history and your relationships. It’ll be available when you need it, and it will never get impatient. It could even, with your permission, monitor your physical responses to therapy through your smart watch—like if your heart starts to race when you’re talking about a problem with your boss—and suggest when you should see a human therapist.

If the number of companies that have started working on AI just this year is any indication, there will be an exceptional amount of competition, which will make agents very inexpensive.

Agents are smarter. They’re proactive—capable of making suggestions before you ask for them. They accomplish tasks across applications. They improve over time because they remember your activities and recognize intent and patterns in your behavior. Based on this information, they offer to provide what they think you need, although you will always make the final decisions.

Agents are not only going to change how everyone interacts with computers. They’re also going to upend the software industry, bringing about the biggest revolution in computing since we went from typing commands to tapping on icons.

In the distant future, agents may even force humans to face profound questions about purpose. Imagine that agents become so good that everyone can have a high quality of life without working nearly as much. In a future like that, what would people do with their time? Would anyone still want to get an education when an agent has all the answers? Can you have a safe and thriving society when most people have a lot of free time on their hands?

The ramifications for the software business and for society will be profound.

In the next five years, this will change completely. You won’t have to use different apps for different tasks. You’ll simply tell your device, in everyday language, what you want to do. And depending on how much information you choose to share with it, the software will be able to respond personally because it will have a rich understanding of your life. In the near future, anyone who’s online will be able to have a personal assistant powered by artificial intelligence that’s far beyond today’s technology.

You’ll also be able to get news and entertainment that’s been tailored to your interests. CurioAI, which creates a custom podcast on any subject you ask about, is a glimpse of what’s coming.

An agent will be able to help you with all your activities if you want it to. With permission to follow your online interactions and real-world locations, it will develop a powerful understanding of the people, places, and activities you engage in. It will get your personal and work relationships, hobbies, preferences, and schedule. You’ll choose how and when it steps in to help with something or ask you to make a decision.

even the best sites have an incomplete understanding of your work, personal life, interests, and relationships and a limited ability to use this information to do things for you. That’s the kind of thing that is only possible today with another human being, like a close friend or personal assistant.

The most exciting impact of AI agents is the way they will democratize services that today are too expensive for most people

They’ll have an especially big influence in four areas: health care, education, productivity, and entertainment and shopping.

There is intriguing neuroscience research that suggests that it may be possible to boost the efficacy of psychotherapy with drugs that share some of ketamine’s effects, somewhat the way athletes can enhance their performance with steroids

How might this work? D-cycloserine is an antibiotic that, like ketamine, increases the activity of glutamate in key brain regions, which promotes connections between neurons. It seems to amp up the molecular machinery of learning. And psychotherapy is all about learning — to overcome fear and to better handle stress, among other lessons.

For decades, psychoanalysts were against medicating anxiety at all, because they believed it would interfere with the therapeutic process. Fortunately, those days are largely over. Many are now comfortable giving patients anti-anxiety benzodiazepines like Klonopin if they are having a hard time grappling with issues that arise in therapy.

"If you want to make a new influenza vaccine using the traditional methods, you have to isolate the virus, learn how to grow it, learn how to inactivate it, and purify it. That takes months. With RNA, you only need the sequence,"

"When the Chinese released the sequence of the SARS-CoV-2 virus, we started the process of making RNA the next day. A couple weeks later, we were injecting animals with the vaccine."

Weissman's lab is now working on a universal coronavirus vaccine that would protect against Covid-19, SARS, MERS, coronavirus that cause the common cold -- and future strains.

"We started working on a pan-coronavirus vaccine last spring," Weissman said. "There have been three coronavirus epidemics in the past 20 years. There are going to be more."

Another obvious use for mRNA technology is to fight cancer. The human body fights off cancer every day, and using mRNA could help it do so even better.

Different tumor cell types have various, recognizable structures on the outside that the immune system can recognize. "You can imagine being able to inject someone with an mRNA that encodes an antibody that specifically targets that receptor," McLellan said.

"We identify mutations found on a patient's cancer cells," the company says on its website. Computer algorithms predict the 20 most common mutations. "We then create a vaccine that encodes for each of these mutations and load them onto a single mRNA molecule," Moderna says.

BioNtech has been working with academic researchers to use mRNA to treat mice genetically engineered to develop a disease similar to multiple sclerosis -- an autoimmune disease that starts when the immune system mistakenly attacks the myelin, a fatty covering of the nerve cells.In the mice, the treatment appeared to help stop the attack, while keeping the rest of the immune system intact.

The idea behind gene therapy is to replace a defective gene with one that works properly.

The mRNA approach promises to send instructions for making the healthy version of a protein, and Weissman sees special promise in treating sickle cell disease, in particular.

"It's gene therapy without the half a million dollar price tag," he added. "It should be just an IV injection and that's it."

"The idea there is if you are immune to tick saliva proteins, when the tick bites you, the body produces inflammation and the tick falls off," Weissman said.

The new legislation will open a range of avenues to those impacted by the practice, including allowing groups to take civil legal action on behalf of victims.

Similar legislation has now been passed in a number of countries around the world, including Canada, Brazil, Ecuador, Malta, Albania and Germany.

a major extinction panic happened 100 years ago, and the similarities are unnerving.

The 1920s were also a period when the public — traumatized by a recent pandemic, a devastating world war and startling technological developments — was gripped by the conviction that humanity might soon shuffle off this mortal coil.

It also helps us see how apocalyptic fears feed off the idea that people are inherently violent, self-interested and hierarchical and that survival is a zero-sum war over resources.

Either way, it’s a cynical view that encourages us to take our demise as a foregone conclusion.

What makes an extinction panic a panic is the conviction that humanity is flawed and beyond redemption, destined to die at its own hand, the tragic hero of a terrestrial pageant for whom only one final act is possible

What the history of prior extinction panics has to teach us is that this pessimism is both politically questionable and questionably productive. Our survival will depend on our ability to recognize and reject the nihilistic appraisals of humanity that inflect our fears for the future, both left and right.

As a scholar who researches the history of Western fears about human extinction, I’m often asked how I avoid sinking into despair. My answer is always that learning about the history of extinction panics is actually liberating, even a cause for optimism

Nearly every generation has thought its generation was to be the last, and yet the human species has persisted

As a character in Jeanette Winterson’s novel “The Stone Gods” says, “History is not a suicide note — it is a record of our survival.”

Contrary to the folk wisdom that insists the years immediately after World War I were a period of good times and exuberance, dark clouds often hung over the 1920s. The dread of impending disaster — from another world war, the supposed corruption of racial purity and the prospect of automated labor — saturated the period

The previous year saw the publication of the first of several installments of what many would come to consider his finest literary achievement, “The World Crisis,” a grim retrospective of World War I that laid out, as Churchill put it, the “milestones to Armageddon.

Bluntly titled “Shall We All Commit Suicide?,” the essay offered a dismal appraisal of humanity’s prospects. “Certain somber facts emerge solid, inexorable, like the shapes of mountains from drifting mist,” Churchill wrote. “Mankind has never been in this position before. Without having improved appreciably in virtue or enjoying wiser guidance, it has got into its hands for the first time the tools by which it can unfailingly accomplish its own extermination.”

The essay — with its declaration that “the story of the human race is war” and its dismay at “the march of science unfolding ever more appalling possibilities” — is filled with right-wing pathos and holds out little hope that mankind might possess the wisdom to outrun the reaper. This fatalistic assessment was shared by many, including those well to Churchill’s left.

“Are not we and they and all the race still just as much adrift in the current of circumstances as we were before 1914?” he wondered. Wells predicted that our inability to learn from the mistakes of the Great War would “carry our race on surely and inexorably to fresh wars, to shortages, hunger, miseries and social debacles, at last either to complete extinction or to a degradation beyond our present understanding.” Humanity, the don of sci-fi correctly surmised, was rushing headlong into a “scientific war” that would “make the biggest bombs of 1918 seem like little crackers.”

The pathbreaking biologist J.B.S. Haldane, another socialist, concurred with Wells’s view of warfare’s ultimate destination. In 1925, two decades before the Trinity test birthed an atomic sun over the New Mexico desert, Haldane, who experienced bombing firsthand during World War I, mused, “If we could utilize the forces which we now know to exist inside the atom, we should have such capacities for destruction that I do not know of any agency other than divine intervention which would save humanity from complete and peremptory annihilation.”

F.C.S. Schiller, a British philosopher and eugenicist, summarized the general intellectual atmosphere of the 1920s aptly: “Our best prophets are growing very anxious about our future. They are afraid we are getting to know too much and are likely to use our knowledge to commit suicide.”

Many of the same fears that keep A.I. engineers up at night — calibrating thinking machines to human values, concern that our growing reliance on technology might sap human ingenuity and even trepidation about a robot takeover — made their debut in the early 20th century.

The popular detective novelist R. Austin Freeman’s 1921 political treatise, “Social Decay and Regeneration,” warned that our reliance on new technologies was driving our species toward degradation and even annihilation

Extinction panics are, in both the literal and the vernacular senses, reactionary, animated by the elite’s anxiety about maintaining its privilege in the midst of societal change

There is a perverse comfort to dystopian thinking. The conviction that catastrophe is baked in relieves us of the moral obligation to act. But as the extinction panic of the 1920s shows us, action is possible, and these panics can recede

To whatever extent, then, that the diagnosis proved prophetic, it’s worth asking if it might have been at least partly self-fulfilling.

today’s problems are fundamentally new. So, too, must be our solutions

It is a tired observation that those who don’t know history are destined to repeat it. We live in a peculiar moment in which this wisdom is precisely inverted. Making it to the next century may well depend on learning from and repeating the tightrope walk — between technological progress and self-annihilation — that we have been doing for the past 100 years

We have gotten into the dangerous habit of outsourcing big issues — space exploration, clean energy, A.I. and the like — to private businesses and billionaires

That ideologically varied constellation of prominent figures shared a basic diagnosis of humanity and its prospects: that our species is fundamentally vicious and selfish and our destiny therefore bends inexorably toward self-destruction.

Less than a year after Churchill’s warning about the future of modern combat — “As for poison gas and chemical warfare,” he wrote, “only the first chapter has been written of a terrible book” — the 1925 Geneva Protocol was signed, an international agreement banning the use of chemical or biological weapons in combat. Despite the many horrors of World War II, chemical weapons were not deployed on European battlefields.

As for machine-age angst, there’s a lesson to learn there, too: Our panics are often puffed up, our predictions simply wrong

In 1928, H.G. Wells published a book titled “The Way the World Is Going,” with the modest subtitle “Guesses and Forecasts of the Years Ahead.” In the opening pages, he offered a summary of his age that could just as easily have been written about our turbulent 2020s. “Human life,” he wrote, “is different from what it has ever been before, and it is rapidly becoming more different.” He continued, “Perhaps never in the whole history of life before the present time, has there been a living species subjected to so fiercely urgent, many-sided and comprehensive a process of change as ours today. None at least that has survived. Transformation or extinction have been nature’s invariable alternatives. Ours is a species in an intense phase of transition.”

In Africa alone, it saves more than 100,000 lives each year.

“Happiness as a byproduct of living your life is a great thing,” Barry Schwartz, a professor of social theory at Swarthmore College, told me. “But happiness as a goal is a recipe for disaster.”

Could it be that by protecting our kids from unhappiness as children, we’re depriving them of happiness as adults?

Bohn believes many parents will do anything to avoid having their kids experience even mild discomfort, anxiety, or disappointment—“anything less than pleasant,” as he puts it—with the result that when, as adults, they experience the normal frustrations of life, they think something must be terribly wrong.

Dan Kindlon, a child psychologist and lecturer at Harvard, warns against what he calls our “discomfort with discomfort” in his book Too Much of a Good Thing: Raising Children of Character in an Indulgent Age. If kids can’t experience painful feelings, Kindlon told me when I called him not long ago, they won’t develop “psychological immunity.”

Civilization is about adapting to less-than-perfect situations, yet parents often have this instantaneous reaction to unpleasantness, which is ‘I can fix this.’”

Yes, we devote inordinate amounts of time, energy, and resources to our children, but for whose benefit?

“I can’t tell you how often I have to say to parents that they’re putting too much emphasis on their kids’ feelings because of their own issues.

Chua’s book resonated so powerfully because she isn’t so different from her critics. She may have been obsessed with her kids’ success at the expense of their happiness—but many of today’s parents who are obsessed with their kids’ happiness share Chua’s drive, just wrapped in a prettier package. Ours is a have-your-cake-and-eat-it-too approach, a desire for high achievement without the sacrifice and struggle that this kind of achievement often requires.

In spite of this, the Stockholm Consensus, which was adopted by the IOC in 2004, required transgender Olympic hopefuls to wait “two years after gonadectomy [removal of the gonads]” to be eligible for competition.

the Women’s Sports Foundation, and the It Takes a Team! campaign noted that “any athletic advantages a transgender girl or woman arguably may have as a result of her prior testosterone levels dissipate after about one year of estrogen therapy.”

Dragged cursing to family therapy in the Emmy-nominated episode “Pickle Rick,” he is asked by the therapist why he doesn’t want to be there. “Because I don’t respect therapy!” he says. “Because I’m a scientist. Because I invent, transform, create, and destroy for a living. And when I don’t like something about the world, I change it.” (“All things that move between the quiet poles,” declares Christopher Marlowe’s Faustus, “shall be at my command.”) Quavering, dithering Morty, with his vestigial concern for other beings and his pangs of this and that, is Rick’s split-off other half. A dialectic of damaged maleness, you might call the pair.

In the 19th century, the secularization of Western society led to the secularization of pain. It was no longer a passion to be endured but a sensation to be quashed.

The concept of pain as a purely physical phenomenon reached its zenith in the 1990s

having pain designated a “fifth vital sign,” alongside blood pressure, temperature and breathing and heart rate.

This coincided with the release of long-acting opioids like OxyContin. Doctors believed they now had an effective remedy for their patients’ suffering

the mind does play a pivotal role in the experience of pain. After a pain signal reaches the brain, it undergoes significant reprocessing.

ecades of research suggests that opiates provide little to no benefit for chronic noncancer pain

Why is this? Studies have shown that opioids can reduce patients’ pain thresholds.

They can also result in a condition called opioid-induced hyperalgesia, in which people feel more and more pain as they are prescribed higher and higher doses of opioids

looking back it’s clear that using opioids to treat chronic pain — backaches, bum knees and the like — might well be considered the worst medical mistake of our era.

How much something hurts can vary depending on factors like your expectations, your mood and how distracted you are

Physical therapy that doesn’t just manipulate joints but also addresses the context pain comes alive in, encourages optimism and builds emotional resilience has been found to be more effective.

Conditions like depression and anxiety greatly increase the chance of developing chronic pain, while patients who experience pain are at high risk of developing depression or anxiety

there is considerable overlap in the areas of the brain that deal with pain and emotion.

Objectively, there is no doubt that illnesses and injuries can cause immense suffering. The question is how severe that suffering is, and how long it lasts

pain sensitivity varies significantly among people, most likely as a result of genetic differences.

rug companies greatly underplayed the risks of opioids, while billions of dollars in marketing told people that pills were the only answer to their ailments.

future doctors should be taught that pain is part of the story of the person who suffers from it, not just a separate physical phenomenon.

this education should incorporate ways to avoid prescribing opioids for chronic use.

Perhaps the most important tool physicians need to manage pain is empathy.

pain is contagious and transmittable.

unfortunately our health system encourages doctors to see as many patients as possible as quickly as possible. We need to change how physicians are paid in order to give them the time to really talk with patients about their pain.

I felt that the pain was my body’s way of telling me that something was wrong, and I didn’t want to silence that voice with a temporary fix.

What pulled me out after almost a year of agony was not just rigorous physical therapy that molded my spine back into shape but also the kindness of my friends, my family and my future wife.

a spiritual and emotional experience alleviated through prayers rather than prescriptions.

America's long weeks of lockdown that helped depress the infection curve in some areas are beginning to wane as more and more states opt to ease stay-at-home orders, hoping to relieve economic conditions that raise the specter of Great Depression-style unemployment.

She spoke about a widening presence of the Centers for Disease Control and Prevention in the states, cooperation among governors and said labs are now learning how to work on different testing platforms -- but did not define exactly what she meant. When pressed by CNN's Jake Tapper, she did not provide a clear answer on whether states were up to speed on testing levels suggested by the administration's guidelines before opening should be considered.

"A doubling of testing is a start but may be insufficient,"

Yet it is the President who has made that goal more elusive by peddling unproven therapies for Covid-19 and claiming that the federal government is doing more testing than even the governors want

Atlanta Deputy Police Chief Charles Hampton Jr. said Wednesday the suspect, Robert Aaron Long, frequented the two Atlanta spas and bought the gun used in the shooting the day of the incident.

President Joe Biden ordered flags to be flown at half-staff Thursday to honor the victims. Biden also plans to visit Atlanta on Friday to meet with Mayor Keisha Lance Bottoms, as well as Asian American and Pacific Islander leaders, according to Georgia State Rep. Bee Nguyen.

Among the issues they will bring up is the concern that the shootings be "taken seriously" and seriously considered as a hate crime against Asians and not dismissed as the suspect having a "bad day,"

Across the US, Asian Americans are riddled with fear as unprovoked attacks against them intensify. Anti-Asian hate crimes have more than doubled during the pandemic,

The violence has surged amid racist rhetoric during the coronavirus pandemic -- some popularized by ex-President Donald Trump. Many Asian Americans have been subjected to vitriol about the "China virus" or the "kung flu" -- even those who have never been to Asia.

whenever anyone disagrees with her opinion or policies, the first thing they do is criticize the country her parents came from and, second, her gender.

Three of the victims were 52, 75 and 64 years of age, according to birth years listed in an Atlanta police incident report.

Bottoms told CNN that nowadays "there seems to be permission now to be hateful."

"There seems to be a permission that I've not seen, at least in my lifetime," Bottoms said. "It does predate Donald Trump, but he certainly has given permission and done his part to elevate the hatred."

Kim, a 24-year-old Korean American, said she often feels like she has a target on her back. Last year, she said a parent wanted to remove one of her students from her second-grade class because Kim was Asian.

Yet despite outrage over the shootings, attacks against Asian Americans continue. An Asian man and woman were assaulted Wednesday by the same suspect in separate attacks,

"While we're relieved the suspect was quickly apprehended, we're certainly not at peace as this attack still points to an escalating threat many in the Asian American community feel today,"

Delaina Ashley Yaun, 33, of Acworth; Paul Andre Michels, 54, of Atlanta; Xiaojie Tan, 49, of Kennesaw; and Daoyou Feng, 44, were all fatally shot at Youngs Asian Massage in Cherokee County.

Three more victims were found dead at Gold Massage Spa in Atlanta, and another victim was found dead across the street at the Aroma Therapy Spa.

Actress Lucy Liu told CNN's Erin Burnett on Thursday that she believes race relations will get worse before they can get better.

Long, 21, faces eight counts of murder and one count of aggravated assault.Long was on his way to Florida, possibly to take the lives of more victims, Atlanta Mayor Keisha Lance Bottoms said, citing investigators.

The suspect told police he believed he had a sex addiction and that he saw the spas as "a temptation ... that he wanted to eliminate,"

It's not clear whether any of the three businesses offered sexual services in addition to massages. But authorities have given no indication the three businesses were operating illegally

Capt. Jay Baker on Tuesday said Long "was pretty much fed up and had been kind of at the end of his rope. Yesterday was a really bad day for him, and this is what he did."

Sheriff Frank Reynolds said in a statement Thursday he has known and worked with Baker for many years and his comments "were not intended disrespect any of the victims, the gravity of this tragedy or express empathy or sympathy for the suspect."

Shortly before 5 p.m. Tuesday, deputies were called to Youngs Asian Massage between the Georgia cities of Woodstock and Acworth after reports of a shooting, Cherokee County sheriff's officials said.That shooting left four people -- two Asian and two White -- dead and one person injured, Baker said.

About an hour later and 30 miles away, Atlanta police responded to the Gold Massage Spa on Piedmont Road in Atlanta. Police said they found three people dead.While there, police received another call of shots fired across the street at the Aroma Therapy Spa, where they found one person dead

Investigators found surveillance video of a suspect near the Cherokee County scene and published images on social media.Long's family saw the images, contacted authorities and helped identify him, Cherokee County Sheriff Frank Reynolds said Wednesday."(The family members) are very distraught, and they were very helpful in this apprehension," Reynolds said.

Long has claimed responsibility for the shootings at the spas, the Cherokee County sheriff's office said.

He is facing four counts of murder and a charge of aggravated assault, according to the county sheriff's office. He also has been charged with more four counts of murder,

A law enforcement source told CNN that Long was recently kicked out of the house by his family due to his sexual addiction, which, the source said, included frequently spending hours watching pornography online.

"It looked like a hate crime to me," she said. "This was targeted at Asian spas. Six of the women who were killed were Asian so it's difficult to see it as anything but that."

"Sex" is a hate crime category under Georgia's new law. If Long was targeting women out of hatred for them or scapegoating them for his own problems, it could potentially be a hate crime.

The shootings don't have to be racially motivated to constitute a hate crime in Georgia.

"We hear your concerns and want it to be known that these victims will receive the very best efforts of this office," Wallace said. "We anticipate beginning to meet with the impacted families in the near future, and earn their trust, as we continue to develop our case against the defendant."