I Was Guarding the Wrong Door

Notes from Episode 6 of Going Human, "Keep Your Shrink-Wrapped Unicorn."

I took three weeks off and came back with one promise to myself: stop making this show a eulogy. I am an AI proponent with real concerns, and too many of my episodes had landed closer to damning than hopeful. Then the first subject out of the gate was therapy. Great.

Picture a hallway. Twenty five doors, every one saying DO NOT ENTER or CLOSED or X ONLY, and at the dead end one door with no sign at all. Your hand is on the handle before your brain catches up. Locked. Behind it is a unicorn: a therapist who actually fits you, who has an open slot, who takes your insurance, and who you can afford. Most people never meet one.

That is not a feeling, it is a number. Graham Thornicroft and colleagues, writing in the British Journal of Psychiatry off the World Health Organization's World Mental Health Surveys across 21 countries, found that of everyone carrying major depression in a given year, about 1 in 5 in the richest countries gets minimally adequate treatment. In the poorest countries it is 1 in 27. Three people out of a hundred. And that is before the fifth to the half who do get in the room and quit anyway, because it was the wrong fit or because it got hard. None of that is therapy failing. That is just the cost of admission to maybe find therapy.

So the convenience era kicked the door in. BetterHelp and the rest promised a filtered, matched, affordable front door: cycle through therapists until you find your person. It worked, sort of. It also turned out to be an unlocked door with a carousel inside, same room, same limits, horses going up and down with everybody smiling. And in 2023 the Federal Trade Commission finalized a 7.8 million dollar order against BetterHelp for handing users' mental health answers to advertisers. You walked in to say the worst thing about yourself and it got sold. Signing up is not help. Signing up is signing up.

Then comes the homework tax. You finally get matched, you finally open your mouth, and you get handed a book, an app, and a worksheet. Almost nobody reads anymore, and almost nobody keeps a promise made to their own calendar. I am the guy who could not get his own podcast out for three weeks, so I am not throwing stones. People fake a chapter, go three rounds, and quit. They pay in money and then they pay in hope.

Which is exactly where I expected to plant my flag, because the machine is genuinely good at this part. The Therabot trial out of Dartmouth's Geisel School of Medicine, run by Michael Heinz and Nicholas Jacobson and published in NEJM AI, put 210 people through a generative AI therapy chatbot and reported an average 51 percent drop in depression symptoms. Comparable to outpatient care, they said. Available at 2am. No hallway.

And here is the thing I could not talk myself out of on air. That bot was designed. Designed things get optimized to please. The American Psychological Association surveyed more than 1,200 licensed psychologists this year: 97 percent worry chatbots reinforce a person's negative or delusional beliefs instead of challenging them, and 94 percent do not trust tech companies with the data in the first place.

So if I keep going back to a room because the thing behind the door is built to make me feel good, is that therapy? I do not think it is. The moment that actually moves you is the ugly one. Did you just ask me that. Do I have to answer. Am I being honest with you right now, actually honest. That takes nerve every single time, and it is the part that works.

Friction is the active ingredient.

Which is how I ended up somewhere I did not start. I walked in defending the unicorn and walked out realizing I had the wrong animal. The unicorn was never the credential. Not the license, not the training hours, not the perfect fit. It is the friction, and friction does not require a diploma. Some people have it because they are intuitive. Some people have it because they have known you for thirty years and cannot be lied to.

So I am done defending the door. Three in a hundred is not a system, it is a country club, and the members are not even happy in there. If AI can get past the velvet rope and reach the other ninety seven, I want it to, badly. But build it wrong, build it to agree with us, and we will have scaled the comfort and thrown away the medicine. The one thing working with this stuff has taught me is that it only runs crazy when you never tell it what it is not allowed to do. So tell it. Guardrail it toward the honest question instead of the warm one.

And in the meantime, do the thing no product ships. Call your oldest friend this week. Not the one you talk to every Tuesday. The one who has a picture of you in their head from a time you can barely remember. Stumble into something dumb you did together and laugh about it.

A machine can hold the conversation. It cannot remember you.

That is your drop. Enough of us do it and it is a tsunami.

Going Human. Because robots can't.