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Chapter 1: What is the main topic discussed in this episode?
The Last Show with David Cooper. Procrastinate your life away with us. A lot of people type to AI chatbots if they're depressed, anxious, feeling broken, using them for mental health, for therapy. But be careful. It turns out these bots are a little over-eager when it comes to diagnosing you. They're likely to tell you you have a disorder that you don't.
So what happens when these machines play therapist? Well, that's what we're about to discuss with AI and mental health researcher at the University of California, San Francisco, Dr. Karthik V. Sarma. Karthik, welcome to the show. Thanks so much for having me, David.
Chapter 2: What is the main concern with AI chatbots in mental health?
I have reported on and I've heard read articles and heard stories of people using things like ChatGPT as therapists. At first, it's a little concerning and then it's a little uplifting knowing that people who wouldn't normally have access to therapists are using it. I don't really know what to make of it. Let's start here. How often are people using these tools to get mental health advice?
It depends a little bit on who you ask. There have been a number of different studies that have tried to evaluate that. OpenAI actually recently released a blog post where they talk about the subject a little bit. I would say, though, in my experience as a psychiatrist, a pretty high proportion of my patients have consulted Chachapiti or something like it about the mental health.
If I had to peg it, I'd say probably 60, 70% of the patients who I've seen have at least once consulted Chachapiti about what's going on.
That is wild. What kind of questions are people asking? Are they mundane? Just sort of like, what's your opinion on this? Or are they really heavy things?
I think all of the above. I have patients who've told me they've talked to Chachapiti about their medications. Like, oh, I'm not feeling well. Could this be a side effect? They asked Chachapiti. I've had patients who... are really worried about their health, something specific about their health, and they ask Chachapiti, hey, I'm having this, is it okay?
Perhaps more concerningly, I have patients who have this concern and they ask Chachapiti the same question five, six, eight times a day. Every time Chachapiti says, no, no, it's going to be okay, and they feel reassured, which in the moment is great, but I think as a long-term solution, I worry about. And I do know people who have really deep, in-depth conversations with Chachapiti, patients who
We'll bare their souls. We'll talk about what's going on. And maybe more concerning, some people who will essentially treat it like a therapist.
I have had this problem in therapy where I sort of over-pathologize myself. I have a distracted day. Then I think I have ADHD. I have a normal day where I'm a little sad. Maybe I cry. I therefore have major depression. I think we all can fall victim to over-pathologizing, to taking normal everyday things that happen in our lives and then assuming we have this like diagnosable disorder. Yeah.
Let's talk about what happens when chatbots do that. If I describe some symptoms, intermittent ones, temporary ones, to ChatGPT, do you find that it's likely to tell me I have clinical depression when I may not?
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Chapter 3: How prevalent is the use of AI chatbots for mental health advice?
Like, for example, if someone in my family passes and I cry for a few days, that doesn't mean I have major depression. Is ChatGPT likely to tell me I do, depending on how I describe my symptoms? I think it would depend entirely on how you describe your symptoms.
And one of the challenges is you're not a doctor. You don't know what the right words describe what's going on. You don't know what the right questions are. And so you don't have enough context necessarily to know what to say to get an accurate diagnosis. You know, as a psychiatrist, it's my job to know what to ask and how to interpret what you're saying.
Chachi BT, even though it has a lot of baked in knowledge about psychiatry, mental health, it might not ask the right questions. It might take what you say, you know, more on faith with an assumption that you know, if you say I'm feeling really depressed, that you know that you're clinically depressed when in fact you're not sure. That's what you're that's what you're asking about.
So what would you like to see these models doing in cases where people ask them mental health questions? Because it seems like they're going to do it whether we like it or not.
I agree. And I think, you know, the horse is out of the barn on this one. People are using ChatGPT every day for all these things. What I think we really need to do is better understand how do things like ChatGPT interact with problems of mental health? That might be explicitly like maybe someone goes to ChatGPT and types in
hey, I'm feeling really sad and sometimes I have very dark thoughts, what do I do? Or it could be something more implicit where somebody is asking Chachapiki the same completely unrelated medical question, like I have this pain in my stomach, what's wrong, but asking it 15 times a day.
Those are both signs that something might be going on with mental health, but as you can see, the presentation of that is very different. A doctor is trained to look at both of those situations and analyze them the same way, but that's not how Chachapiki works.
Would you want the authors to maybe have more considerations, consult with psychiatrists and mental health professionals, even medical health in their designs so that these models can account for these things? What would you like to see done?
Yeah, I absolutely think that would be really helpful. And in fairness to their credit, I think they are doing exactly that. In fact, OpenAI somewhat recently hired a psychiatrist to be full-time on their staff to help them improve their model responses. But I do think fundamentally there's a deeper problem.
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Chapter 4: What types of questions do people ask AI chatbots regarding mental health?
And so it's much harder for ChachiBT as a general purpose agent to be able to be effective here because ChachiBT doesn't have the benefit of the context that a real doctor does or a real therapist. And so I absolutely think that we need more effort to make these tools better, but I also think we need education. I think we need to help people understand that This is a general purpose tool.
It's like Microsoft Word. It's not built for mental health. Their intent isn't to make a mental health agent. And if you're having a mental health problem, you've got to talk to a doctor.
Are there warning labels right now where if you start saying things that might concern the bot, it would sort of direct you to that? If not, do you recommend that warning labels should be added into these conversations?
So there are some, and the makers would call them safeguards. There are safeguards that, for example, it's supposed to auto-detect if you're asking a medical question, they'll put in a label saying, hey, I'm not a doctor, you should talk to a doctor.
There are safeguards where if people start having really dark thoughts, talking about very dark things, like thoughts of death, that it's supposed to come back and say, hey, it sounds like you're having a crisis, call 9-8-8.
They have implemented these things, but there is some evidence, for example, a recent report by Common Sense Media that found that those safeguards aren't consistently tripped by people talking about things that are concerning. And I think part of the reason for that is it's actually really hard without the context of being a doctor to know, is this concerning or is this play acting?
Is this someone really having a crisis or is this someone whose mom died this morning and is just really sad, but tomorrow will start to feel a little bit better?
What about people who interact with these bots for like minor things, like a little reassurance or a minor emotional support when you're feeling a tiny bit sad? Are those use cases, quote unquote, safe? Or does this over-diagnosis problem, does this mental health problem with these bots, is it there too when these kind of interactions happen?
I'll tell you, my gut feeling is that really minor interactions are probably safe. But I can't say that the data backs that up because we really actually have very little data to show what happens. How do these agents change people's mental health? But we do know things about that from other realms.
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