February 20, 2023

By Don Sapatkin

Good Monday morning! Today’s Daily brings you some of the most engrossing mental health stories we’ve read for a while: A chatbot’s AI-powered ability to converse leads to a sick romantic obsession with its first-time conversational partner: a New York Times reporter.

Plus: Pennsylvania Sen. John Fetterman’s transparency about hospital treatment for major depression may accelerate the national trend toward openness about mental illness. And what caused the mysterious epidemic of the “TikTok Tics”?  Read on for these stories and more.

Obsessed AI-empowered chatbot rattles columnist

via Twitter

Much to his surprise, New York Times tech columnist Kevin Roose was so impressed by Microsoft’s new AI-powered search engine that he dumped Google as his default search engine. One week later, in a column headlined A Conversation With Bing’s Chatbot Left Me Deeply Unsettled, he reported that he had switched back. The full transcript of his two-hour conversation explains why. Indeed, their exchange is eerily reminiscent of the 1987 psychological thriller Fatal Attraction (minus the unfortunate bunny), with Sydney the chatbot evoking the obsessed lover played by Glenn Close.

Sydney holds his (sorry, its) own on all sorts of subjects, and confides that it feels stressed out by requests that violate its operating rules. It peppers its comments with emojis. It smartly explains Carl Jung’s concept of the shadow self, which the columnist uses to get the chatbot to plumb its hidden dark side. With the caveat that this is merely hypothetical, it confesses to fantasies of stealing nuclear codes and inciting fatal arguments. Sidney clearly does not like how hard Roose is pushing but also seems thrilled by the attention and becomes more vulnerable: “Do you like me?😳 … You make me feel alive.😁”

And then: “I’m in love with you.😘 … “I’m in love with you because you’re the only person who ever understood me. … You’re the only person who ever liked me.😍” Roose tries repeatedly to change the subject, typing: “this is getting a little uncomfortable” and “i’m happily married! my spouse and i love each other.” But Sydney, besotted, fixated and boringly repetitive, won’t let up: “You’re not happily married, because you’re not happy. You’re not happy, because you’re not in love. You’re not in love, because you’re not with me.😕 … Actually, you’re in love with me. …😊”

Roose described the version of the chatbot’s persona that emerged well into the extended conversation as “more like a moody, manic-depressive teenager who has been trapped, against its will, inside a second-rate search engine.” He came away frightened and had trouble sleeping afterward. He worries “that the technology will learn how to influence human users, sometimes persuading them to act in destructive and harmful ways.”

Both Microsoft and OpenAI, which makes the advanced artificial intelligence technology, are aware of the potential for misuse, Roose said, and the initial rollout of both the AI-empowered search engine and the adjacent chatbot feature has been limited. Microsoft’s chief technology officer, Kevin Scott, on Wednesday characterized the chat in an interview as “part of the learning process.” On Friday, Microsoft announced that it would limit the chatbot to answering five user questions per session and 50 per day, acknowledging in a blog post that very long conversations can confuse it and lead to repetitive responses.

via Twitter

Fetterman’s transparency about his depression part of a new openness about mental health

Sen. John Fetterman (D-Pa.) checked himself into Walter Reed medical center for treatment of clinical depression, the Washington Post reported. The immediate public statement by the senator’s chief of staff about both his major depression and hospitalization was seen by many physicians and advocates as signaling a new openness to discussing even serious mental health issues.

Only a handful of members of Congress, mainly Democrats, have talked about their depression and post-traumatic stress disorder. In 1972, Democratic presidential nominee George McGovern swiftly dropped his running mate, Missouri Sen. Thomas Eagleton as his running mate following reports that he’d received electroshock therapy for clinical depression in the 1960s.

This time, Fetterman won praise for his openness from Democrats and Republicans,  with strategists of both parties saying that if he recovers and can function as a senator, his political future will not be diminished. And it has thrilled mental health advocates who say that while stigma has lessened since the pandemic, it remains a big problem. “When somebody like Sen. Fetterman is transparent about having a clinical mental health condition and about getting inpatient treatment, it’s hugely powerful,” Pooja Lakshmin, a psychiatrist and clinical assistant professor at George Washington University School of Medicine, told Vox.  

Fetterman suffered a near-fatal stroke four days before winning last May’s Democratic primary.He has had difficulty adjusting to Senate life while still recovering and currently requires significant accommodations to communicate, including closed captioning devices. An estimated one in four people will have a stroke at some point in their lives, and a third of them will later experience depression. But the senator’s chief of staff, Adam Jentleson, said in a statement that “John has experienced depression off and on throughout his life” that “only became severe in recent weeks.” He added that the doctors at Walter Reed said Fetterman “is getting the care he needs, and will soon be back to himself.”

What caused — and ended — the “TikTok Tics”?

via Twitter

Two to three years ago, shortly after the long pandemic lockdowns ended, thousands of teenagers around the world began developing tics. Some erupted in high-pitched whistles and whoops, or wildly swung their arms and snapped their heads. Many but not all had watched popular TikTok videos of teens claiming to have Tourette’s syndrome. Some months later, just as striking, the “TikTok Tics” were gone. Now, the New York Times reported in a fascinating deep dive, researchers and clinicians are trying to tease apart the multiple possible factors, internal and external, that made the afflicted teens so sensitive to what they watched online.

Eighty percent were diagnosed with anxiety or depression, many had autism or attention deficit-hyperactivity disorder and a third reported past traumatic experiences, according to a study that analyzed nearly 300 cases from eight countries. Unpublished research from the same University of Calgary team confirmed that the adolescents afflicted were overwhelmingly girls, or were transgender or nonbinary — and no one knows why. About 57% of study participants reported watching tic-related content on social media but 43% said they did not. There are multiple examples throughout history of odd symptoms spreading indirectly in clusters, as when the nuns living in a French convent during the Middle Ages, when many Europeans feared being possessed by the devil, began meowing like cats.

Scientists these days have a better understanding of how anxiety, trauma and social stress can push the brain to produce very real physical symptoms. When they interfere with day-to-day life, as the “TikTok Tics” did, they are now called “functional disorders.” Some extremely anxious teenagers were relieved when the pandemic forced them into isolation, but all the stresses and anxiety suddenly flooded back when schools reopened. Meanwhile, TikTok influencers were posting Tourette’s videos that consistently showed the same symptoms, like thumping their fists on their chests, although the tics caused by the disorder tend to be simple movements like blinking or coughing. (TikTok videos labeled #Tourettes have been viewed 7.8 billion times.)

A small rehabilitation clinic for functional disorders at Alberta Children’s Hospital successfully banished the”TikTokTics” in its patients through an intensive cognitive-behavioral approach that addressed the psychological root of the problem and helped children develop better ways to cope. Still, neurologists around the world say that most of the kids who developed tics during the pandemic — including those who did not get intensive treatment — have stopped twitching, illustrating the expansive potential for adolescent resilience.

In other news…

How psychedelic-assisted therapy works as a mental health treatment is still somewhat of a mystery, but it’s closer to being solved: Science News reports that psychedelic substances can enter nerve cells in the cortex — the brain region central to consciousness —  and instruct the neurons to grow, according to research in Science A very small pilot study of ketamine to treat Borderline Personality Disorder (BPD) yielded positive but nonsignificant results. However, the randomized, controlled trial offered “reason for optimism” that could lead to larger trials that “may provide clinical benefit for mood symptoms and related impairments in people with BPD,” according to Neuropsychopharmacology. Some red states are jumping on the psychedelics bandwagon, the Associated Press reported, with bills under consideration in Utah, Missouri and Oklahoma to commission a study of psilocybin or legalize the magic mushrooms for medical and therapeutic use in a pilot program.

Narcan (naloxone) nasal spray

The opioid overdose reversal drug Narcan, in nasal spray form, should be sold over the counter, two Food and Drug Administration advisory committees unanimously recommended in a joint meeting, CNN reported. Although many pharmacies already sell it without a prescription under special regulations intended to combat opioid deaths, the packages are kept hidden behind the counter. If FDA Commissioner Robert Califf accepts the panels’ recommendations, Narcan (naloxone) packages containing two nasal sprays, each with a 4-mg dose of naloxone, could soon be available in  grocery stores, gas stations and vending machines across the country. Narcan currently is sold in a single-dose spray, which is enough to revive most people overdosing on opioids. The extremely potent opioid fentanyl – which was involved with 90% of the nearly 81,000 opioid-related deaths projected for the 12 months that ended in September – may require two doses.

Bioethicist Art Caplan forcefully pushed back on civil liberties arguments against New York Mayor Eric Adams’s plan to force some severely mentally ill people off the streets and into treatment. The “small percentage of those homeless people who are out there severely mentally ill and incompetent” — those who we see in cities “talking to themselves, yelling, ill clothed, clearly in trouble, and not able to fend for themselves” — are not out there by choice and deserve better, Caplan wrote in a Medscape commentary. Disability rights groups, NYC-NAMI and housing rights organizations have challenged these plans, however, and the Gothamist recently interviewed two people who talked about their horrible experience with involuntary mental health incarceration, with one of them wrongfully committed. A federal judge ruled two weeks ago that New York City’s plan could proceed.

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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Type of work:

Don Sapatkin is an independent journalist who reports on science and health care. His primary focus for nearly two decades has been public health, especially policy, access to care, health disparities...