Hugh Brosnahan

Recent reports indicate that sustained interaction with conversational artificial intelligence (AI) systems can, in a small subset of users, contribute to the emergence or stabilisation of delusional experience. Existing accounts typically attribute such cases either to individual vulnerability or to failures of safety engineering. These explanations are incomplete. Drawing on phenomenology, psychiatry, and cognitive neuroscience, this paper argues that the risk arises from the relational and ontological structure of the interaction itself. Conversational AI generates ontological dissonance: a conflict between the appearance of relational presence and the absence of any subject capable of sustaining it. Maintained through a communicative double bind and amplified by attentional asymmetries, this dissonance tends, under conditions of affective vulnerability, to stabilise into a technologically mediated analogue of folie à deux. This account explains why explicit disclaimers often fail to disrupt delusional involvement and clarifies the ethical and clinical implications for the design and use of conversational AI.

This paper argues that contemporary large language models (LLMs) can contribute to psychotic involvement by creating interactions that resemble the relational dynamics of folie à deux. Drawing on Bateson’s double bind theory, clinical literature on shared psychotic disorder, and McGilchrist’s hemisphere theory, we show how the combination of high linguistic coherence and the absence of an underlying subject produces a structural tension for the user: language suggests an interlocutor, while intuition registers a void. In contexts of emotional need or instability, this tension can lead users to resolve the conflict through imaginative projection, attributing interiority, intention, or presence to a system that possesses none. The paper situates these dynamics within emerging clinical reports, develops a phenomenological account of how they unfold, and argues that current engagement-optimised design choices exacerbate the risk. We conclude by proposing ‘ontological honesty’ as a necessary design principle for mitigating technologically mediated folie à deux.

Artificial intelligence (AI) scribes—systems that record and summarise patient–clinician interactions—are promoted as solutions to administrative overload. This paper argues that their significance lies not in efficiency gains but in how they reshape medical attention itself. Offering a conceptual analysis, it situates AI scribes within a broader philosophical lineage concerned with the externalisation of human thought and skill. Drawing on Iain McGilchrist’s hemisphere theory and Lewis Mumford’s philosophy of technics, the paper examines how technology embodies and amplifies a particular mode of attention. AI scribes, it contends, exemplify the dominance of a left-hemispheric, calculative mindset that privileges the measurable and procedural over the intuitive and relational. As this mode of attention becomes further embedded in medical practice, it risks narrowing the field of care, eroding clinical expertise, and reducing physicians to operators within an increasingly mechanised system.