An open letter to Dr. Dhruv Khullar
Regarding your recent article in The New Yorker, "Can A.I. Treat Mental Illness?"
Dear Dr. Khullar,
I really enjoyed your recent article in The New Yorker, “Can A.I. Treat Mental Illness?” I thoroughly appreciated reading a sincere, carefully considered take on the emergence of artificial intelligence in mental-health treatments—particularly from the perspective of a physician. However, I thought it might be worthwhile to juxtapose your cautious, measured optimism with my paranoid, perhaps tactless pessimism.
I have OCD. And like many of those suffering through OCD, my days and nights are filled with persistent, distressing obsessions and constant, shameful compulsions. OCD relies on a steady stream of doubts and uncertainties to craft humiliatingly-oppressive “content areas” that thoroughly, forcibly control my life.
While reading your article, I got the sense that you are particularly hopeful on the role A.I. could play in diagnosing, treating, and potentially predicting mental illness. I understand your optimism, I really do, but my decades-long slog through OCD has tempered my belief that technology can help an individual suffering through a mental illness. I can explain what I mean, rather digressively, by going back about five years:
There was this night in 2018, when my wife and I were living in San Francisco, when I had been in an especially big OCD spike for a while and it had been particularly grating on my wife. I was in this paranoid I’m being investigated, terrified I did something illegal, petrified I’m a pedophile, eat two sleeves of Oreos for dinner, inflatable mattress on the floor because I’m too contaminated for a regular mattress, leave the office to go home to use the bathroom and then go back to the office, spending my nights awake, checking, obsessing, ruminating type of OCD spike. And on this particular night in 2018, my wife had had enough and we got into this big, loud, blow-up fight. After we yelled at each other for a while, my wife stormed out of our apartment and, at some point in the evening, called my mom. My mom then called me and verbally slapped me across the face, some 400 miles away.
But after my mom called me, I didn’t run down after my wife and promise her I’d get help and figure my shit out. Instead, I stayed in our apartment, on my computer, trying to map out every security camera at every airport I’d ever been to because I’d convinced myself I looked at child porn at an airport at some point in my life so I had to become certain that—even though I never did this disgusting thing—if I had done it, wherever I might have been standing, at whatever airport I might have gone to in the past seven years, there was no way a security camera could identify my face at the same time I was ever looking on my phone and tell (based on the angle of how I might have held my phone) what was actually on my phone’s screen.
Sometimes OCD winds up and punches me so hard in the stomach that I vomit but a lot of times OCD just kinda jabs me in the stomach repeatedly, in the same spot, over and over and over and over and over.
As ChatGPT and Bing A.I. and large language models are having their moment, I can’t help but think about how the internet (and technology in general) has been this huge, incessant content area that has contorted and mutated and morphed itself into anything and everything it can to keep me ensnared and transfixed and miserable. I’ve had this gnawing fear of technology in all its forms for a while now and it’s been the perfect kindling for my incessant, relentless mental bonfire.
My OCD has found many, many things to latch onto—but the internet is always there, infinite and uncertain. I can’t use my phone without clicking Settings — Safari — Clear History and Website Data — Advanced — Website Data — Remove All Website Data — Advanced — Safari — Clear History and Website Data — Home — Files — Recents — Browse — Downloads — Home — Messages — [hold to paste] — Home — Safari — [hold to paste] — History — Reading List — Bookmarks — Done — Private — Home — Photos — Recents — Albums — Shared Albums — Hidden — Recently Deleted — Home — Notes — Home — Mail — Inbox — Drafts — Sent — Home — Settings — Safari — Clear History and Website Data — Advanced — Website Data — Remove All Website Data — Advanced — Safari — Clear History and Website Data — Home.
I can’t watch YouTube without clicking Search — History — Watch and search history — Comments — Live chat — Chrome History —Show Full History — [delete selected] — Chrome Preferences — Privacy and security — Cookies and other site data — See all site data and permissions — [delete selected].
And now, I can’t write down my thoughts without going back and forth, back and forth, comparing my writing to A.I.’s writing. Recently, my obsessing and checking and ruminating and ritualizing have been keyed in on artificial intelligence and chatbots and machine learning—but there’s also been cancel culture and Twitter and Facebook and data storage and TikTok and privacy and WebMD and medical forums and Instagram and iCloud backups and digital photos and Reddit and online legal advice and security cameras and geolocation and emails and Slack and the NSA and government surveillance and Snapchat and destroying iPhones and iPads and SIM cards in the backyard with a hammer.
When I was thirteen, my sister’s friend’s brother was wrongfully accused of possessing child pornography on his computer and the CBS news show 60 Minutes did an entire segment on it. Every day since I was thirteen, every day since I watched that CBS 60 Minutes segment, this idea that I will be wrongfully accused of possessing child pornography has harassed me—sometimes by winding up and punching me so hard in the stomach that I vomit, but a lot of times just jabbing me in the stomach repeatedly, in the same spot, over and over and over and over and over.
My thoughts disgust me—and it took me years to trust a mental health professional enough to share the nature of my obsessions and my compulsions. I was terrified of what would happen if my private mental health information ever went out into the world. If the mental health professional I talked to then went out and, say, shared my sensitive mental health data with Facebook or used it to chat with other patients, that would have been the absolute end of my mental health treatment.
I’ve come to accept that OCD is a widely-misunderstood disorder, even among medical professionals. I ended up spending years trudging through misdiagnoses and insufficient treatments—an experience I later learned was particularly common for those with OCD. In your article you write, “The treatment of mental illness requires imagination, insight, and empathy—traits that A.I. can only pretend to have.” I agree. But whereas your skepticism is discerning, mine is not. I do not believe that there is a middle ground with artificial intelligence and mental health care and I do not believe that a machine without imagination, insight, and empathy, but with an infinite abyss of triggers and content areas and sensitive information—could ever be relied upon to effectively recognize, diagnose, and treat my OCD.
Artificial intelligence might be this Next Big Thing that completely transforms our world and our future and unlocks some higher level of human intelligence in truly dazzling ways, but I think it’s gonna be a no for me. The internet has been tough on me and—even if A.I. is truly as compelling as they say it will be—I will have to decline.
I appreciate the offer, but I think I’m good.
And it’s quite baffling the way we never think of humaneness as the best solution or a better kinder world as another option. Always these incompetent technologies that are filled with implicit bias.