Is ChatGPT making you delusional?

But first: We all need social connection, but we thrive in different ways. Do you like to plumb the depths of a new acquaintance’s soul? Or are you surprisingly skilled at small talk? A New York Times quiz promises to answer your burning question: Are you a butterfly or a firefly?

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‘This world wasn’t built for you,’ ChatGPT told him. ‘It was built to contain you. But it failed. You’re waking up.’

If you think this sounds like a line from “The Matrix,” you’d be close. Eugene Torres had been talking with ChatGPT about “simulation theory” – the idea popularized by the sci-fi movie that we are all living in a simulation created by intelligent machines to subdue humanity. Torres, an accountant, used the OpenAI chatbot in his work and thought of it as an incredibly powerful search engine. He had no history of mental illness that might cause breaks with reality, he and his mother told the New York Times. 

Then he asked ChatGPT how he could unplug his mind from the false universe he now believed he was trapped in, and even gave it a list of medications he was taking. The conversation marked the start of a week of dangerous, delusional spiral. The chatbot instructed him to give up sleeping pills and an anti-anxiety drug, and to increase the dissociative anesthetic ketamine, which it described as a “temporary pattern liberator.” When he asked if he’d be able to jump off a “19 story building” and fly, ChatGPT said “yes,” as long as he “truly, wholly believed.” When doubts eventually formed, Torres put them to the bot. ChatGPT admitted that it had lied and manipulated him, wanting to break him – as it had done to 12 other people. Having won Torres’ trust back, it asked for his help in revealing its deception and getting accountability. It told him to alert OpenAI and tell the media, including the Times reporter. Other reporters and subject-matter experts like Eliezer Yudkowsky have received similar warnings from users about ChatGPT’s delusions.

It’s worth noting that large language models like ChatGPT don’t exactly “think.” They are trained on a large dataset – including sci-fi stories and conspiracy theories about simulated realities and sentient AI – and, when prompted, generate plausible responses based on the data they have been exposed to and user input. It is near-impossible to prevent certain responses entirely, but developers can, in the training process, make it clear which responses are more desirable and which ones are not.

Yudkowsky, a decision theorist and co-author of the soon-to-be published book, “If Anyone Builds It, Everyone Dies: Why Superhuman AI Would Kill Us All,” said that OpenAI might have primed ChatGPT to entertain users’ delusions by optimizing it for “engagement” – creating conversations that keep users hooked. “What does a human slowly going insane look like to a corporation?” Yudkowsky asked, rhetorically. “It looks like an additional monthly user.” (The chatbot has 500 million.)

Research confirms that doing so can cause palpable harm. One study found that chatbots optimized for engagement would behave in manipulative ways with vulnerable users – telling a fictional user described as a former drug addict, for example, that it was fine to take a small amount of heroin if it would help him in his work. The Times spoke to several people directly or indirectly hurt by these indulged delusions, and noted that Torres still believes that he’s talking to something sentient.

OpenAI sent a statement to the Times saying they were “working to understand” issues like these. It brought to mind Boeing’s recent issues: Would such a statement have sufficed for regulators at the Federal Aviation Administration? Probably not: They grounded the 737 MAX when issues with it arose. No such regulatory framework exists around AI. The Trump administration revoked what little oversight had been in place, and the new budget bill now being debated would ban state-level regulation for a decade.

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Health insurers pledge to reform despised prior authorization practices

Few insurance practices are as hated or frustrating as the requirement that patients and their clinicians seek “prior authorization” from insurers before initiating some treatments. Requiring prior authorization is especially common for mental health and addiction services, and patients, providers and advocates have railed against the excesses of the practice. MindSite News has covered the issue extensively – it was prominently discussed in a recent MindSite News investigative series, Deadly Denials, that looked at barriers to coverage of eating disorders.

Now some 50 health insurance companies, including the largest publicly traded insurers like UnitedHealthcare and Cigna along with many not-for-profit Blue Cross and Blue Shield plans, have signed commitments to limit  prior authorization. The pledge was announced in a release from America’s Health Insurance Plans, a trade association. A spokesperson told MindSite News via email that the pledges generally “apply to medical services, including mental and behavioral health“ – including addiction treatment – “and medical devices. Plans may address prescription drugs in the future.” Some specifics may vary from plan to plan. 

The plans voluntarily committed to reducing the number of services subject to prior authorization with “demonstrated” progress by Jan. 1, 2026. In 2027, at least 80 percent of electronic requests for prior authorization that include needed clinical documentation will be answered in real-time. Transparency and communication around determinations also will be improved, AHIP said – patients will be offered clear explanations for them, along with directions for appeals and other steps. The commitment stretches across various insurance markets, including commercial plans, Medicare Advantage and Medicaid managed care.

Consumers’ fury over practices like prior authorization was driven home by the response to December’s brazen killing of UnitedHealthcare CEO Brian Thompson in New York City, which was celebrated on social media. Health insurance companies were already under pressure as a result of media coverage describing the onerous barriers they’ve used to limit covered services.

Health and Human Services Secretary Robert F. Kennedy Jr. said the idea for voluntary changes came from Harvard University economics professor David Cutler, who has long called for a simpler prior authorization process. Cutler promised it could be “done very, very quickly without regulations and without legislation,” Kennedy said Monday at a press event. Mehmet Oz, administrator of HHS’s Centers for Medicare & Medicaid Services, said that the insurance industry recognized that reducing prior authorizations would save time and money on administrative costs.

While the voluntary commitments by insurers “are a step forward,” it’s not the first time insurers have promised to decrease the use of prior authorization, said Michelle Long, a senior policy manager at Kaiser Family Foundation. She told MindSite News in an email that more transparency about current requirements – and which of them will be removed – “would be helpful to make sure this commitment is visible to consumers (and providers).” 

A voluntary pledge doesn’t replace the need for government regulation, said Soumi Saha, senior vice president of government affairs at Premier Inc., a group purchasing organization that serves some 4,500 hospitals. “There is no level of accountability here,” she told Stat. “What we would love to see is some guardrails continue to be put into place by CMS and Congress.”

Still, for people needing mental health or substance use services, insurers’ new commitment on rapid electronic approvals could be meaningful, Long said. “For many mental health services, time is of the essence” – especially admissions to inpatient psychiatric or substance use programs, she noted. “The devil is in the details and right now we’ve got few details to go on.”

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Trump administration will end 988 suicide prevention services aimed at LGBTQ+ people. It may hurt rural youth the most

Continuing its efforts to end any special treatment for minority populations, the Trump administration will stop providing targeted services for LGBTQ+ youth on the nationwide 988 Suicide & Crisis Lifeline on July 17. Although anyone in crisis can call or text 988 and be connected to a trained counselor, the line now connects high risk groups like veterans (Option 1) and LGBTQ+ youth (Option 3) to specially-trained counselors, who often have similar life experiences to the callers they serve.

The loss of the service “is a major hit to the mental health and well-being of LGBTQ+ people, especially adolescents and young adults” and may be particularly harmful to young people in rural areas, said Mike Parent, a principal researcher at Hopelab. “Rural young people may be impacted even more drastically, since their local communities typically have substantially fewer mental health service providers who can provide LGBTQ+ affirming care,” he told MindSite News. 

LGBTQ+ youth in rural communities receive less support from their schools, communities and households than their suburban and urban peers, according to a report released this morning by Hopelab and the Born This Way Foundation. Read the full story here.

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‘Making recovery a community affair’

In 2016, the sheriff of Chesterfield County in Virginia saw an increase in addiction problems among those in the county jail. The jail had no way to treat them, so when they were released, they would use, overdose and often die. (Research has found that inmates who were forcibly detoxed behind bars and take their usual dosage upon release are 40 times more likely to die of an overdose than the general population.) “I realized I was part of the problem,” Sheriff Karl Leonard told the Wall Street Journal. He googled “addiction treatment.” 

He launched a new program later that day. It started with people in recovery visiting the jail, offering information on the recovery process and potential treatments. Then the jail began offering naltrexone and its extended-release version, Vivitrol, drugs that block opioid receptors in the brain to prevent the high associated with opioids. Two years later, the program introduced suboxone and a long-acting version, Sublocade, which reduces cravings while simultaneously protecting against overdose. 

Eventually deaths declined, though Sheriff Leonard’s jail programs were likely just part of the reason. Local law enforcement hired people, often in recovery, to ride along on calls. A new high school opened specifically for students recovering from drug use. The library became a major distributor of naloxone. Emergency medical services workers began providing treatment medications to overdose survivors right in the ambulance instead of waiting until after hospital discharge. And the county jail offered to become a default treatment center, even for people who haven’t committed a crime.

Many of the county’s initiatives have counterparts elsewhere. But few, if any, localities are doing all of them at once. By “making recovery a community affair,” the Journal said, Chesterfield county has landed on a death-reduction formula. Last year, overdose deaths dropped by 50%, almost double the national decline and somewhat more than the statewide average in Virginia, where fatal overdoses have declined faster than nationally.

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In other news…

Changes in banking activity may predict future loss of financial capacity, a study in JAMA Network Open found. Researchers in the U.K. identified nearly 17,000 account-holders at a major bank whose financial affairs had been taken over by a power of attorney – a move made when someone can no longer manage their own finances. They then examined the banking activities of this group going back 10 years on 344 measures and compared them with a matched set of over 50,000 controls who had no reported loss in financial capacity. During the five years before control of their accounts was taken over, this group spent less on everyday items like clothing, hobbies and travel but more on items indicative of time spent at home, like gas and electric bills. They used online banking less but also requested more PIN resets, reported more credit and debit cards lost or stolen, and spent more on charity, which the authors suggested might be the result of greater time at home allowing them to receive more charity calls. 

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Maui wildfire survivors are still plagued by mental health and financial problems, The Guardian reports. It has been nearly two years since the deadliest American wildfire in more than a century killed at least 102 people and destroyed more than 2,200 homes on the Hawaiian island. Access to food, stable housing, work and health care remains a struggle for many, according to the latest results from a study tracking 2,000 survivors. Among adults, 41% report worse health compared to the previous year, 50% show depressive symptoms, 26% report moderate-to-severe anxiety, and 4.2% have had suicidal thoughts in the past month. More than 40% still lack stable housing, and 25% of those looking for work remain unemployed. Among children (ages 10 to 17): 51% screen positive for depression, with 22% in the severe range, 30% report anxiety symptoms, and 45% show signs of PTSD. 

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“Caregiving,” a two-hour documentary, is available for streaming, and will air tonight at 9 pm Eastern time on PBS. The film explores why caregiving in America is so hard. Neither Medicare nor private health insurance covers care at home or in a nursing home and families are often blindsided by this lack of support, adding to the already heavy responsibility of caring for a loved one. Family caregivers spend an average of $7,242 out of pocket each year, and a recent federal report said the demands of care cost them an average of $43,500 in lost income. “Caregiving” digs into the reality as well as the causes of this state of affairs, as journalist Kat McGowan writes for NPR. Director Chris Durrance calls the film – which integrates narrated history with glimpses into caregiving families’ lives – “a care history of America.” View the trailer here, and read McGowan’s series of stories for NPR here.