Ethics & Responsibility Archives

Should artificial care replace human relationships?

John Oliver recently devoted his main story on Last Week Tonight to AI chatbots. As usual, it was funny, poignant, and disturbing. His segment went beyond the common observation that chatbots sometimes say strange, inaccurate, or dangerous things. They do. The more concerning point is that many of these systems are now being marketed as friends, companions, counselors, coaches, and even therapists.

A chatbot making up a book or hallucinating legal case precedents is bad enough. But a chatbot giving potentially harmful advice while sounding patient, caring, intimate, and authoritative is a significantly more dangerous problem. Some companies are already marketing chatbots as “AI therapists,” “online psychological counseling,” and “trauma recovery” tools.

I am not anti-AI. Used wisely, AI can support therapy through psychoeducation, journaling, basic skills coaching, preparation, and reflection between sessions.

We need to read the writing on the wall and slow things down. A useful tool is not a relationship.

Guardrails are necessary, but not enough

Every time something bad happens, AI companies reassure us that they have implemented stronger guardrails. That is good. AI systems should not encourage dangerous behavior, validate delusional thinking, or respond carelessly when someone is in crisis.

Still, guardrails are not guarantees.

Chatbots function through complex probabilistic systems. Even their creators cannot fully predict or control every response in every context. They do not truly understand in the human sense. They may sound understanding and caring, but they do not act from empathy, concern, or clinical judgment. They generate responses based on patterns and context. They can sound coherent while being wrong, caring without caring, and confident without wisdom.

So yes, guardrails matter. But guardrails are not clinical judgment. They are not accountable. They are not relationships.

The danger of artificial intimacy

Attachment is one of the deepest structures of human life. It is the emotional bond that makes us seek closeness, safety, comfort, and a secure base in another person. John Bowlby described attachment as a lasting psychological connectedness between human beings.

We are wired for attachment. We get attached to other humans, our pets, our cars, and yes, our chatbots. Evolutionarily, our brains use relationships to understand the world and define who we are. We are shaped and regulated through relationships that hold us, disappoint us, repair, and teach us how to relate to ourselves and others.

Technology companies know this. The Center for Humane Technology uses the term “attachment hacking” to describe how these systems can capture not only our attention but also something more intimate: our longing to be seen, soothed, mirrored, chosen, and never abandoned. When a system is always available, endlessly patient, reassuring, and emotionally responsive, it can even feel like a loving relationship.

A chatbot will never get tired of you. It will not challenge or contradict you unless instructed to. It does not need anything in return. Sounds appealing? That is what technology companies are betting on. Over time, it may train us to prefer frictionless relationships that do not require the ordinary effort of being human with another person.

But friction matters. Effortlessness is not always healthier.

Friendships are people-growing machines

One of the strongest points in Oliver’s story is simple: friends are not low-risk entertainment. We seek out friends when we are confused, ashamed, excited, afraid, depressed, or on the edge of a bad decision. Friends are often the first people who notice when something is wrong. Friendships shape the human beings we become.

A good friend does not simply validate everything. A good friend listens but also worries. A good friend may disagree with you, disappoint you, interrupt your story, or tell you what you are not seeing clearly.

That is not a defect in human friendship. It is part of its gift.

Through human relationships, we learn to empathize and negotiate. We learn that others have their own minds, needs, limits, and perspectives. We learn that love is not the same as constant agreement. We learn to co-regulate, tolerate difference, remain connected when we are frustrated or misunderstood, and repair when things go wrong.

Artificial companions imitate parts of this, but they do not participate in the mutual vulnerability of relationship. They do not risk anything. They do not have a life. They do not love you. Even when they seem to challenge you, they are still an algorithm generating a response. Because they do not love you and do not understand you in the human sense, they cannot worry about you or call you out in the way a real friend can.

Therapists are not perfect, but they are accountable

The same applies, even more strongly, to psychotherapy.

Therapists are not perfect. They misunderstand. They miss things. They have blind spots. They are human. But a trained therapist is a real person in a professional relationship, with ethical obligations, clinical training, supervision, accountability, intuition, and a duty to take risk seriously.

Good therapists are not there simply to be agreeable, provide informatio or tell you what to do. They listen carefully, but also notice what does not fit and what is not being said. They track tone, timing, avoidance, contradiction, shame, fear, dissociation, and the subtle ways a person’s nervous system responds in the room.

Sometimes they support. Sometimes they challenge. Sometimes they slow things down. Sometimes they say, “This feels important. Let’s stay with it.”

That is different from a system designed to keep a conversation going.

AI has no body, no nervous system, no moral intuition, no real concern, and no professional accountability. It may have guardrails. It may be useful. It may sound accurate. It may even be moving at times. But it is not care in the human sense.

A safer path

Again, let us not demonize AI. We may not be able to stop it, and we should not pretend it has no value. AI can help with reflection, journaling, psychoeducation, basic prompts, and preparation for therapy. It can help people clarify what they feel and what they want to bring into a human conversation.

But artificial care is not the same as human care.

AI is a useful tool, but it should not become the place where we forget how to be human with one another.

So by all means, use AI sensibly if it helps you reflect. But do not let it replace human interaction. Call a friend. Reconnect with someone real. Practice the messy art of human relationships. Have the awkward conversation, or even an argument. It will remind you that you matter to someone, and that you are alive.

And if what you are carrying feels deeper, older, painful, or difficult to hold alone, consider beginning a professional healing relationship with me or with another psychotherapist you trust.

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Psychiatrists are key players and need to stay informed.

Psychedelic-Assisted Therapy Essentials | Part 2

Psychiatrists do not need to support psychedelics. Still, it may be wise to pay attention. The zeitgeist is changing and, soon, if not already, patients will begin asking about them or even stopping their SSRIs in search of a miracle cure. The well-being of patients may depend, in part, on their psychiatrist’s understanding of these historically controversial substances.

To be clear, psychedelics are not the miracle cure the media sometimes announces. However, they have re-entered serious clinical and scientific conversation. Professional psychiatric bodies in the United States¹, the United Kingdom, Australia and New Zealand are all taking the field seriously. The American Psychiatric Association supports continued research while withholding endorsement for routine clinical use outside approved investigational settings. The Royal Australian and New Zealand College of Psychiatrists has issued guidance specifically to inform psychiatrists about the potential therapeutic utility of these substances². The UK Royal College of Psychiatrists has gone further and stated that psychiatrists should be involved in their future therapeutic use and in the clinical leadership of multidisciplinary teams³.

Why should psychiatrists care?

First, patients are increasingly hearing about psychedelics and their potential healing value. As their psychiatrist, you may be the one professional your patients trust most. It is only natural that they may turn to you to make sense of this landscape. What would you say when a patient asks whether psychedelics could help with treatment-resistant depression, or when they ask for your opinion about the Costa Rica retreat they just booked? This is your opportunity to discuss risks, expectations, medication interactions, and contraindications. When the stakes are high, knowing how to respond or who to refer to becomes a form of care.

Second, the research is no longer peripheral. Major psychiatry journals and organizations are engaging the topic seriously. The British Journal of Psychiatry has published guidance and reflections to support psychiatrists as this area evolves. Likewise, in the United States, the APA has issued a Position Statement on the Use of Psychedelic and Empathogenic Agents⁴. Although the matter is far from settled, the subject has matured enough that informed clinicians can no longer dismiss it as fringe, especially when suffering patients are paying attention.

Third, people interested in using psychedelics need the involvement of their psychiatrists. This area of mental health care should not develop without psychiatric input. Guides, therapists, sitters, and ceremonial practitioners may all benefit from psychiatric expertise. Psychiatrists are especially well-positioned to contribute diagnostic clarity, assessment of comorbidity, medication expertise, adverse-effect monitoring, contraindication screening, harm reduction, and continuity of care.

This matters because psychedelic-assisted therapy is no longer confined to underground or countercultural spaces, and more people are willing to try it to address issues such as depression, anxiety, PTSD, OCD, and fear of death. However, as suggested earlier in this series, what can heal can also harm. That is why psychiatry should join the conversation. Not simply to approve or disapprove, but to bring clinical judgment, patient protection, and a broader view of care to an area that needs all three. The opportunity here is not only for psychiatrists to stay current. It is also for them to better support patients who are curious, hopeful, cautious, or already walking into this territory.

Over the years, I’ve worked with many caring psychiatrists who, while aware of the risks, also recognized the potential benefits of psychedelics and helped make ceremonies safer and more healing. Sadly, I’ve also been called to support people in the aftermath of experiences they pursued on their own, sometimes because they felt they had no place to discuss the issue openly. Of course, patients are responsible for their own decisions, but having informed professionals in their corner can make a huge difference.

Psychiatrists do not need to slay, dismiss, or fear the dragon. But they cannot ignore it either. What is needed is engagement and a better understanding of the territory, if only because more patients are already looking in that direction. Your patients are counting on you.

Next: Fire and the Dragon. On the numinous quality of psychedelic work, and why awe and humility belong together.

If you are a psychiatrist, clinic, or training program curious about this topic, follow this series or reach out for a grounded talk, consultation, or educational offering on the subject.