Comment by rsfern
2 days ago
I agree that accessibility is a big problem, and take your point about ignoring technology that could help, but if the technology if not there yet then I think more research and discourse is warranted before deploying it widely. As a society we need to decide what kind of requirements we expect of these systems, then agree on standards of performance
Is it ok for models to offer specific mental health interventions, or just provide neutral information? To what degree is that technically achievable? Does the answer depend on the scenario?
Health care workers have mandated reporting responsibilities (in the US, I assume other countries are similar) for some situations. Should models be bound by this responsibility as well? (I think yes but it is a thorny question). How to achieve that while preserving patient privacy for issues that don’t fall under mandated reporting rules?
We also have standards of care for health workers. Benchmarks are good, but that’s similar to a licensing requirement, and we have accountability mechanisms when people don’t adhere to their ethical and professional duties. What should be the liability situation when a model responds out of standard resulting in harm (to the standard of evidence we would hold a human health worker)?
Maybe I am not plugged in to this space enough, but my impression is these questions aren’t really in the foreground
I think the expectation that ChatGPT will be your therapist is wrong, however the expectation that you can build a therapeutic system using LLMs is not necessarily wrong. You are right that there are regulatory aspects, and liability, as well as guard rails built into our system (but less for mental health than medical as it’s largely a neglected aspect of our care delivery).
Also, it’s a different mode of delivery. Some people work well remotely, others better in person. Likewise some people open up more easily to a machine than a person. One doesn’t replace the other.
Further, LLMs can be very useful for diagnostic work in addition to a psychologist to help accurately classify mental and personality disorders. This is my fathers speciality and he finds modern LLMs to be fairly adept at classifying.
A lot of psychologist work in a clinical setting is case notes and an LLM can be quite skilled at producing standard expected case note structures from clinical notes, improving the time spent by the professional in care vs paperwork.
All of these are opportunities for use of LLMs as specialist models, agentic frameworks around general models, guard rails, delivery mechanisms, etc. I wouldn’t look at the world being OpenAI and Anthropic, but as model providers as providing screws and bolts and it’s up to us to build the products. LLMS are trained with an enormous corpus of witting on mental illness, but also writings by the mentally ill, care professionals, and all sorts of other materials. By eliciting all these dimensions the applications to mental health are enormous - it is a giant learned model of human thought and experience, not just of factual information, but the entire complex.
Here’s an idea I’ve talked to my dad about - how about using a model set trained on the writing of many people of specific mental illnesses. Then you can interact with them and they will produce responses likely of someone with that illness. This can be used to train clinicians, but also to build better inventories and diagnostics since you know the classification of the responses to some reasonable degree. This should accelerate research into mental illnesses.
The possibilities are vast, limited by our imagination and biases.
> Likewise some people open up more easily to a machine than a person. One doesn’t replace the other.
This is a fundamental personal failure. Not being able to open up to a professional whose purpose is to help you. The first step is to be honest with yourself, then honest with the person whose entire professional purpose is to help you.
AI psychologists will only ever be able to do so much, but I imagine it will be a whole lot of “you’re right” with very few harsh truths, criticisms, or personal development.
Dude, in that lens, all mental health is a personal failure.
The fact is a lot of people have trust issues, anxieties, social issues. Some are paranoid, suffer extreme neuroses, or panic in a social situation. Some have felt betrayed by professionals seeking to help them, putting them into inpatient care against their wishes, or medicating them with debilitating medications to sedate them, which is common for people experiencing mania. That’s not a personal failure, that’s just personal issue. And someone seeking mental help is having personal issues more often than not, unless they’re just seeking life coaching.
Ascribing these as fundamental personal failures, and therefore they deserve their personal hells with no relief unless they comply with your view of how people must be, is cruel.
The sycophantic behavior you’re outlining is a result of reinforcement learning and alignment, not a fundamental property of generative language models.