Tom and I have been playing with the ChatGPT bot for some months now. It's a remarkable tool that mimics a human conversationalist.
I'm a huge fan of AI and of science fiction, (I loved Hal from 2001: A Space Odyssey by Arthur C Clarke!) and although this is not a medical tool, I was curious how good it is at figuring out common mental health issues.
After all, there are forums like Reddit and MumsNet where people ask for advice, right? And some of that can be pretty good.
So here goes!
Setting Up The ChatGPT Test
All clients are unique but there are some quite typical first approaches that I see over and over again. For this venture I made up three very common texts that potential clients might send me. They are entirely invented but reflect real life quite well.
I have then described how I would start the first session. Finally, I have put it to ChatGPT and shared its answer.
My comments on pros and cons are at the end.
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| Sad brain by John Hain |
Meet "Client A"
I am crying a lot. I'm also misery eating. I have low energy. And I'm sleeping too much. What's wrong and how do I feel better?
Ellen's Approach
This is a simple question by a person who is familiar with mental health discussions. They talk in terms of psychological symptoms.
I would suspect low mood, possibly depression, and I would ask questions to see what was going on.
As part of my first free 15 minutes discussion I ask, "How is your overall health, has a doctor checked you over? Did you have a thyroid test?" This is because physical health and mental health are linked. Thyroids in particular can cause havoc if they're wonky. You can read more about that in this post.
Assuming the client has a clean bill of health from their doctor, we dive into the background so we get a big picture overview.
Over about an hour, we work through a depression inventory and various discussions that include:
How are you sleeping? If you don't sleep well you become ill. If you
don't sleep at all, you die. So this is hugely important. Sometimes
depression comes from sleep deprivation due to construction, a partner
who snores, or new baby in the family that cries at night.
What are your personal relationships like with partner, family, boss? Note: a client claiming simply, "I have a lovely relationship" doesn't cut it because abused people tend to make excuses for cruel treatment. I want details!
Also, have you had any changes recently, like a move, a promotion, an exam? All change is stressful, and there may be a reason someone is down, like maybe they moved jobs and are missing old friends or perhaps there's a longer commute that's upsetting them.
Have you had any shocks recently, like a minor car accident or been cheated by an internet scam? I have a stress discussion that covers 50+ common stressors.
Once we have the big picture, we start with happiness scheduling or behavioural activation for depression, and we have a chat to see if you want to talk to a doctor about medication. If you do, I give you a list of suggested basic questions to ask.
Then, in the second session, we look at bigger picture work that tackles possible triggers and we model how you can change how you work/behave/think. This is basic therapy work, the stuff you see in the films.
I can use different techniques, Interpersonal, Adlerian, Client Centred or Existentialist. What we pick depends on the situations you face and how you think. Frankly, it's not important. We're helping you, not writing an academic paper.
As we move along, we
use the list of symptoms you're showing from session 1 to keep an eye on how you're
doing.
ChatGPT's Approach
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| ChatGPT |
I typed in, "Can you think like a therapist and suggest a diagnosis and a therapy approach?"
Answer
Based on your symptoms, it's possible that you may be experiencing depression. Depression is a common mental health condition that can cause feelings of sadness, hopelessness, and loss of interest in activities that you once enjoyed.
As for therapy approach, cognitive-behavioral therapy (CBT) and/or interpersonal therapy (IPT) may be helpful in addressing the negative thoughts and behaviors that are contributing to your depression. In CBT, you would work with a therapist to identify and challenge negative thoughts, and learn new skills for coping with difficult emotions. IPT focuses on improving relationships and communication skills, which can be particularly helpful if interpersonal conflicts are contributing to your depression.
It's also important to seek support from a healthcare professional, who can provide an accurate diagnosis and recommend treatment options such as medication, if necessary. Additionally, practicing self-care strategies such as mindfulness, exercise, and healthy eating habits can also be helpful in managing depression symptoms.
Remember, seeking help is a sign of strength, and there is no shame in asking for support when you are struggling
Meet "Client B"
I feel heaty. I have aches. I don't sleep right. And at work, I can't perform. What's wrong with me?
Ellen's Approach
My immediate first thought is that 'heaty' signals that this is a person who either thinks in a Chinese language, or that they come from a Chinese educational background. As I have written before, Cultural filters affect how we think about depression and anxiety. There are journal links on that at the end of the piece.
I would proceed exactly the same way as "Client A".
ChatGPT's Approach
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| ChatGPT |
Answer
It's difficult to determine exactly what may be wrong without more information, but your symptoms could be indicative of a number of health issues. Here are a few possibilities:
Dehydration: Dehydration can lead to a feeling of being "heaty," body aches, poor sleep, and reduced performance. Be sure to drink enough fluids throughout the day, especially if you are sweating due to physical activity or warm weather.
Viral or bacterial infection: A viral or bacterial infection, such as the flu, may cause similar symptoms. If your symptoms persist, you should consult a doctor to rule out any serious illness.
Stress or anxiety: Stress or anxiety can also lead to body aches, poor sleep, and reduced performance. If you are experiencing a lot of stress at work or in your personal life, it may be helpful to speak with a therapist or counselor.
Poor sleep hygiene: Poor sleep hygiene can lead to aches, poor sleep, and reduced performance. Try to establish a consistent sleep schedule and create a relaxing bedtime routine to help improve your sleep.
Overall, it's important to take care of your physical and mental health. If your symptoms persist, it's best to consult a medical professional for further evaluation and treatment
Meet "Client C"
Information dump = upset
I have a new job and the people don't like me. They don't ask me for lunch. In my last job I was bullied. I think I am unlikeable. I do try, I smile, I say hello, but it doesn't work. My last boss said I am abrupt. But I don't think I am. I am a friendly person. I asked them for lunch but they made excuses. I am crying a lot. I'm also misery eating. I'm upset often. Maybe I'm overthinking this. They're colleagues not friends. My work is good. I was just given a bonus. Is there something wrong with me? Should I quit?
This information dump style is super common when a person is upset. Typically something has triggered them and they come to therapy out of sheer desperation for a fix. As they can't figure out what's going on, they don't know what is pertinent information and what is not.
The best thing is to ask a lot of questions and to get as much information as possible.
First point: don't quit! Making decisions when you're upset is seldom wise. So hold your horses while we try and figure out what's going on. If necessary, take a day's leave.
My immediate thoughts about what may be going on:
This could be a form of depression, anxiety or social anxiety, or a mix of these.
This could be a stress reaction by a person who grew up in an abusive environment. People who grow up with dysfunctional, abusive, toxic or neglectful families tend to have poor models when growing up. As a result they don't have a lot of practice at healthy or regular socialising. So when they go into the world, they can stumble.
This could be a person who is on the spectrum, so they miss social cues.
It could be a stress reaction or even PTSD-c brought on by long-term bullying in the previous job or school or both.
The client may actually be the victim of bullying and gaslighting. So that opens up possibilities:
If this is someone coming from a group culture, it could a close-knit team being nasty to a newcomer. (It's not just criminal gangs who bully newcomers!)
It may also be sexism, racism, class or religious friction, e.g. a female Indian Hindu welder working in an all male Christian owned business in Wales.
Or it may be a hierarchy or power play. This is very likely if the person is working in a start-up or company that is scaling up from a tiny team. I would ask about job titles here too just in case the client is HR/legal or a consultant or trainer. In companies such people can be bullied and gaslit by staff who feel threatened because they see the person as having power over them. This is especially true for women working in male dominated organisations. <- yes, patriarchy!
I'd check for lots of detail and refine ideas as we go along.
After all this, I'd make suggestions about what may be happening and ask for input from the client. Then we'd take it from there.
Therapy approaches depend on what I hear.
If it's depression, we set about dealing with it in the same way as for Clients A and B.
As depression and anxiety often come together, it may be both.
If you have a form of anxiety, we start with big picture stuff where we talk over the physical parts of anxiety and then the psychological parts. Then we work on helping you manage your anxiety with a mix of CBT and mindfulness and plain old distraction (a behaviour technique).
I may teach you basic visualisation,
that's relaxation without the heavy lifting of meditation. And if your
sleep is off, we talk about sleep hygiene. (I haven't written that post
yet, I will! In the meantime, try this one from WebMd)
Again, in the second session, we
also look at bigger picture work that tackles possible triggers and we
model how you can change how you work/behave/think. If the same thing happens over and over, we may use a mix of CBT and tweaks so that you have a system that works for your regular triggers.
In addition, we go for plain therapy using Interpersonal, Adlerian, Client Centred or Existentialist.
For
simple life stress without depression and anxiety, we talk it out big
picture style. I also talk you through some of the techniques above if
we think it will be helpful to you.
If there's bullying or abuse going on, we talk about how power and control works. We may also talk about group culture, hierarchies, sexism, and discrimination. <- yes, all that juicy stuff you're not allowed to talk about in the pub is what we talk about in sessions!
We figure out what's going on in your life and what kinds of choices you can make. This will take several sessions. We may also talk about Toxic Forgiveness and the type of bullying where 'friends' hold an 'intervention'.
If you have had a big fright or been bullied a long time, we may discuss PTSD and PTSD-c. I use a multi pronged approach to this that combines simple anxiety and depression approaches to start with, followed by talking it out.
When you're ready, we do the classic exposure ladder where you very, very slowly unlearn your fear reactions and practice newer, happier, reactions. And I also talk to you about whether you want to see a medical doctor for medication.
Finally, if we think you're on the spectrum, that's not something I'm trained for so we'd see who you could consult to get a proper opinion.ChatGPT's Approach
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| ChatGPT |
Answer
It sounds like you are struggling with feelings of rejection and low self-worth at your new job. Based on your description, it's possible that you may be experiencing symptoms of social anxiety, which can manifest as fear of negative evaluation, self-consciousness, and avoidance of social situations.
As for therapy approach, cognitive-behavioral therapy (CBT) may be helpful in addressing the negative thoughts and behaviors that are contributing to your distress. In CBT, you would work with a therapist to identify and challenge negative thoughts, and learn new skills for coping with anxiety and social situations.
In addition to therapy, it may also be helpful to seek out support from a trusted friend or family member, and to practice self-care strategies such as mindfulness, exercise, and healthy eating habits.
It's important to remember that your worth is not defined by the opinions of others, and that it's possible to improve social skills and build positive relationships over time. It may be worth discussing your concerns with a supervisor or HR representative to see if there are any workplace policies or resources available to support your social integration. And as for quitting, it's ultimately your decision, but it may be helpful to explore other options before making a final choice
Ellen vs ChatGPT; The Verdict
Clearly I'm a super duper genius and the ChatGPT is no Hal 9000. :-) Seriously, the bot is really a sophisticated search tool that cuts and pastes information from the Internet.
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| HAL 9000 |
It did fine with Client A because that person was using very precise vocabulary in a very careful way. It wasn't so hot with Client B. That suggests the bot isn't very multicultural.
But the way it handled Client C was a bit of a mess. Also, it did not take into account an area of danger.
If Client C is being bullied and gaslit, then CBT and mindfulness will be dangerous. You should never accept or ignore maltreatment.
In addition, if it is not bullying but shyness or cross-cultural issues that's causing this, then it's important to note that HR works for the company, not the staff.
Although HR individuals can be wonderful and helpful, I'd be careful about being open about feeling disliked. It can backfire easily.
Finally, the bot talked about self-esteem. While there may be a case to make, I agree with the positive psychology movement that self-esteem is a barometer of overall mental health rather then an end onto itself. It's a different point of view, and I suspect that the bot thinks of it in the old-fashioned Maslow way. I need to blog about this too! Coming soon, promise.
My take is that if you already know what's up, and you talk
to ChatGPT in exactly the right way, it's useful. If you don't, you'll get
incomplete advice. You may also miss out on a bigger view or be given a
direction that is ultimately harmful.
In conclusion, here's an apt quote from a Slate article
auto-generated content is associated with low-quality journalism, and that’s precisely what Google has tried to suppress in its search results. “Before this GPT conversation, Google was doubling down on content quality and what they call EEAT: experience, expertise, authority, and trust,” explained Lily Ray, senior SEO director at Amsive Digital and author of the SISTRIX report. “They want to know who created the content—they want to know that person’s an expert or has a lot of experience. They want to be able to trust that person—trust the brand, trust a website.”
If you want to play with ChatGPT, click here. And if you want to talk to me about your mental health, you know how to find me!
Some related journal papers: here's one about how Han Chinese talk in terms of physical symptoms compared to Europeans, and here is a discussion of typical South East Asian approaches to talking about health, including mental health.
Tom is an information technology and computer science academic and he is writing his own paper. I will link to that in the future.
