Speaking to no one: ontological dissonance and the double bind of conversational AI

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Authors: Hugh Brosnahan, Izabela Lipińska
Cited by: 1
References: 28

Abstract

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.

Fields of Study & Subjects

Digital Mental Health Interventions Psychology of Moral and Emotional Judgment Mental Health via Writing

Publication details

Journal / source
Medicine Health Care and Philosophy
Publisher
Springer Science and Business Media LLC
Volume
29
Issue
3
Pages
683-695
Publication date
2 May 2026
Language
EN