I found the perfect JAMA article explaining that sycophancy is programmed into Artificial Intelligence (AI) therapy chatbots.
This reminded me of Marvin the paranoid android (“Life! Don’t talk to me about life!”) in the book series “The Hitchhiker’s Guide to the Galaxy” by Douglas Adams. Marvin is an incredibly depressed robot who would never make a good psychotherapist.
There’s even a Facebook page listing someone posts of questions to ChatGPT about non-inspirational quotes from Marvin.
If programmers can make sycophantic AI therapists, there should be a way to make them less sycophantic. For more specific information, you can check out this relatively recent article published in Psychiatric Times by Dr. Allen Francis, MD and Justin Angel, a tech expert. I would probably substitute the term “confabulation” for “hallucinations” in most places where you read the latter.
I saw an excellent post on Artificial Intelligence (AI) in Dr. George Dawson’s post today, “The Problems With AI Are More Readily Apparent.” He mentions AI producing confabulations which are sometimes called hallucinations in AI. I distinguish hallucinations from confabulations because the former are sensory or perceptual problems while confabulations are making things up. In dementia, confabulations are often described as attempts to fill in gaps in knowledge or memory without any intention to deceive.
I sometimes read that AI is being sycophantic in its interactions with humans, which sounds a little strange to me. The definition of sycophancy is more about trying to please someone else by being obsequiously flattering. It’s puzzling but I have gotten that impression from AI, yet it’s a machine and I don’t know how anyone would program AI to be sycophantic because it’s a human trait.
On the other hand, I got a comically sycophantic reply from AI to my question inquiring about the definition of Calvinball Cribbage. It’s just a made-up term and, to be fair, I’ve also gotten bluntly frank denials from AI that there is any such thing as Calvinball Cribbage.
As a reminder, Calvinball is a term that arose from a comic strip called Calvin and Hobbes. In the strip, the characters invent a game called Calvinball and the only rule is making up the rules as you go along, although there is a goal of capturing your opponent’s flag. But you can’t play it the same way twice.
The most recent hilarious AI confabulation I’ve previously posted about was when Sena and I played our game of 11-card cribbage. There are cribbage players out there who make fun of such variations from standard 6-card cribbage and the name for it from one such player was “Calvinball crib.” My simple question was as usual, “What is Calvinball Cribbage?” The reply is copied below:
“Calvinball Cribbage is a humorous mashup of the chaotic, rule-free game from Calvin & Hobbes with traditional Cribbage, often involving themed boards or rule modifications, where the core idea is applying Calvinball’s fluid, make-it-up-as-you-go spirit to Cribbage’s scoring and play, adding wild, non-sensical rules like using mallets, changing hand values, or scoring points for silly actions, making each round unique and unpredictable, not a single defined game but a creative approach to Cribbage.
What it is (The Calvinball Aspect):
No Fixed Rules: Just like original Calvinball, there’s no single set of rules; the players invent them as they go.
Rule Changes: A key rule is that rules can’t be repeated, and players constantly invent new scoring, actions, or penalties.
Props & Actions: You might use mallets, balls, trees, or make up actions like “scoring three points for pointing at a cloud” or “losing a turn for looking left”.
How it Applies to Cribbage:
Themed Boards: You can find or make custom cribbage boards featuring Calvin & Hobbes, adding visual flair.
Modified Scoring: Instead of just points for pairs and runs, you might add a “Hobbes Bonus” for a specific card or penalize for “too much logic”.
Strategic Chaos: Players still play cribbage (cards, pegs, crib), but the gameplay is constantly disrupted by invented rules, turning strategic plays into potential jokes or absurd victories.
Example Calvinball Cribbage “Rules”:
“If you play a 7, you must hop on one foot until your next turn”.
“The crib gets 5 points if it contains a card with a face on it” (referencing Calvin’s drawings).
“A ‘skunk’ is achieved by making your opponent laugh out loud”.
In essence, Calvinball Cribbage is about injecting unpredictable fun and silliness into the structured world of cribbage, making it a game of spontaneous creativity rather than strict strategy. “
This could be an example of sycophantic confabulation because almost all of it was probably cooked up by AI from scanning my blog posts about the subject. What’s a little eerie about it is that I never published any specific rules or strategies about the fictional game of Calvinball crib. You can actually find and purchase a Calvin and Hobbes cribbage board from a shop in Canada.
While this is an example of the occasional comicality of AI, that shouldn’t lead us to deny that it can do scary things, some of which Dr. Dawson describes. My early experiences a couple of years ago with what used to be called Google Bard were somewhat alarming because it confabulated then. And it still does.
I’m sure you’ve seen the recently published articles on the web encouraging people to try exercising to treat depression. The articles rely on a new systematic review by the Cochrane Database, which you need to carefully interpret—not necessarily the whole paper; you could just skip to the bottom line in the Authors’ Conclusions:
“Authors’ conclusions: Exercise may be moderately more effective than a control intervention for reducing symptoms of depression. Exercise appears to be no more or less effective than psychological or pharmacological treatments, though this conclusion is based on a few small trials. Long-term follow-up was rare. The addition of 35 RCTs (at least 2526 participants) to this update has had very little effect on the estimate of the benefit of exercise on symptoms of depression. If further research is to take place, it should focus on improving trial quality, assessing which characteristics of exercise are effective for different people, and exploring health equity.”
Clegg AJ, Hill JE, Mullin DS, Harris C, Smith CJ, Lightbody CE, Dwan K, Cooney GM, Mead GE, Watkins CL. Exercise for depression. Cochrane Database Syst Rev. 2026 Jan 8;1(1):CD004366. doi: 10.1002/14651858.CD004366.pub7. PMID: 41500513; PMCID: PMC12779368.
As usual, though, several science news web sites talk it up as though it were a big deal. They usually do that at the top and then gradually toward the end of the story they slowly start to confess the truth about the limitations of the review.
I think this type of story could be called filler. It’s content that doesn’t really tell you anything new or earthshaking and most of the time it’s just to fill space left over from the bigger stories.
It’s almost like snake oil. Initially it sounds really good but you know the old saying: If it sounds too good to be true, it probably isn’t true.
This reminds me of my early career as an assistant professor of psychiatry at The University of Iowa. My superiors thought it was a great idea for me to give a major presentation (and it might have even been an Internal Medicine Grand Rounds) about adjustment disorders. I admit I was a new guy and somebody had to talk about something that non-psychiatrists might misdiagnose as a major mood or anxiety disorder.
There’s really not a whole lot to say about how to treat adjustment disorders, but it’s important to distinguish them from other major mood and anxiety disorders. That’s not to say adjustment disorders are unimportant. They can cause considerable distress and even some impairment. By and large, clinicians don’t often recommend treating adjustment disorders with medication, although there are exceptions. The diagnostic criteria are pretty clear. Psychotherapy is often the preferred intervention.
On the other hand, exercise could be one way to address the discomfort of some of those who struggle with adjustment disorders.
There’s a reason for why I so often tell Dad jokes. In keeping with my post from yesterday about Dr. Martin Luther King, Jr’s biographies:
I glued myself to my autobiography. You may not believe it, but that’s my story and I’m sticking to it.
We’ve ordered a couple of biographies about Dr. King. One of them is his autobiography and the other is Jonathan Eig’s book, “King: A Life.”
I’m getting to be too old to write my own autobiography—guess it’ll have to be done by autopen. Sorry about that one (no I’m not).
I’m a psychiatrist so I know when I’m using humor as a defense mechanism. A lot of good that does.
I’ve never seriously considered writing my autobiography. I could have it tattooed on my back—it would be my backstory.
Seriously—no, I guess that’s impossible. On the other hand, every year about MLK Day, I think about the blog I wrote that the Iowa City Press Citizen published in 2015 on January 19th. It’s becoming almost something like a tradition. I think I need to repost it annually around this time. The title is “Remembering our calling: MLK Day 2015.”
“Faith is taking the first step, even when you don’t see the whole staircase.”
-Martin Luther King, Jr.
That quote is interesting because Jonathan Eig’s biography of MLK can be said to reveal more of the staircase, so to speak, at least from the standpoint of his flaws as well as his strengths. But I stray from the tradition:
As the 2015 Martin Luther King Jr. Day approached, I wondered: What’s the best way for the average person to contribute to lifting this nation to a higher destiny? What’s my role and how do I respond to that call?
I find myself reflecting more about my role as a teacher to our residents and medical students. I wonder every day how I can improve as a role model and, at the same time, let trainees practice both what I preach and listen to their own inner calling. After all, they are the next generation of doctors.
But for now, they are under my tutelage. What do I hope for them?
I hope medicine doesn’t destroy itself with empty and dishonest calls for “competence” and “quality,” when excellence is called for.
I hope that when they are on call, they’ll mindfully acknowledge their fatigue and frustration…and sit down when they go and listen to the patient.
I hope they listen inwardly as well, and learn to know the difference between a call for action, and a cautionary whisper to wait and see.
I hope they won’t be paralyzed by doubt when their patients are not able to speak for themselves, and that they’ll call the families who have a stake in whatever doctors do for their loved ones.
And most of all I hope leaders in medicine and psychiatry remember that we chose medicine because we thought it was a calling. Let’s try to keep it that way.
You know, I’m on call at the hospital today and I tried to give my trainees the day off. They came in anyway.
I used to joke that they would erect a playdoh statue of me in the Quad (Quadrangle Hall was there) on the University of Iowa campus someday. Unfortunately, the Quad was demolished in 2016, so I guess I can’t put that in my autobiography.
Since I retired in 2020, I keep meaning to write my memoirs, but I never get around to it. I guess that makes it my oughta biography.
I just learned today about the new biography of Dr. Martin Luther King, Jr. written by Jonathan Eig. It was published a couple of years ago and I found a lot of YouTube interviews of him. I didn’t look through hardly any of them and saw only one in its entirety, which is below.
Like many people, I was surprised by what Eig found out about Dr. King’s life. It’s pertinent for the upcoming observation of the upcoming MLK holiday. It’s probably not going to be without some controversy. No doubt, some might find it a bit cringeworthy at times. It’s noteworthy that he consulted many who were personally acquainted with Dr. King.
During Eig’s presentation, I was uncomfortably aware of never having read any of the biographies of Dr. King that have already been published, including his autobiography. I was stunned to hear that there has not been a new biography published since the early 1980s.
I was just musing on Philip Rivers. You know about him. I blogged recently about his coming out of retirement to play quarterback for the Indianapolis Colts. I guess you already know this, but he retired again.
Unlike Philip Rivers, I’ve not even considered coming out of retirement since I left my position at The University of Iowa Health Care (UIHC) over 5 years ago. I never looked back.
But that doesn’t mean I never think about looking back. I look back a lot and that’s mostly because I’m an old guy. I was a consulting psychiatrist in the general hospital.
Anyway, occasionally I search my name on the web and laugh at what comes up. I never went to Baylor College of Medicine, much less graduated from there.
I did a few things when I was a doctor. Not all of them were about work, but most of them were.
Those who know me know that I always hated Maintenance of Certification (MOC). I checked the American Board of Psychiatry & Neurology website and my MOC contribution to continuing education is still there. It’s a clinical module on Delirium, which a lot of doctors and other health care practitioners see every day in the hospital. Dr. Emily Morse worked on it as well. She’s still working at UIHC.
I co-edited a book about consultation-liaison psychiatry with my former chair of the Psychiatry Dept, Dr. Robert G. Robinson, may he rest in peace. It’s “Psychosomatic Medicine: An Introduction to Consultation-Liaison Psychiatry.” You can buy it on Amazon—please.
I wrote a case report on catatonia caused by withdrawal from lorazepam (a benzodiazepine), and it’s still available. It was first published in Annals of Psychiatry.
But one of the things I’m proudest of doing was writing a short article for the University of Iowa Library for Open Access Week.
In it, I tell a short anecdote about my lofty (OK, a better word is “greedy”) thoughts about how much money I could make shoveling snow. I was just a kid and I never made it outside to shovel anybody’s walk because I was too busy calculating my income. I wrote that way back when I had another blog, The Practical Psychosomaticist. The photo of me shows my Leonard Tow Humanism in Medicine pin fixed to my lapel—another thing I’m proud of. By the way “Tow” rhymes with “Wow.”
Libraries have always been my one of my favorite places to hang out. Anyway, I’ve got more time to do things like hang out in general. I think Philip Rivers will adjust.
I watched the first half of the Colts vs 49ers game last night and I thought Philip Rivers didn’t look half bad for a 44-year-old guy who’s been out of the game for five years. Did you know he has 10 kids? OK, now that I’ve got that out of my system and that would be, what—the 44th time you’ve heard that since he took the field?
So what the Colts lost? His big family was up in the stands going crazy, cheering him on.
I read an article this morning which had Steve Young saying he could make a comeback at his age—which is 64. I couldn’t believe it. The same story mentions that George Blanda played for the Oakland Raiders when he was 48 back in 1975.
It got me wondering whether I could make a comeback as a general hospital consulting psychiatrist. Could I gallop up 6-8 floors of University of Iowa Health Care? You bet your bottom dollar—I couldn’t.
It’s hard to retire. Every once in a while, I miss hiking up and down the hospital with my camp stool, deftly swinging it around and sitting with the patients and families, telling medical students and residents all kinds of lies (I mean “wise old adages and pearls of clinical wisdom”).
I get a kick out of just wondering what it would be like. I get a vision of myself with a big, golden glowing aura of greatness around my head—until I come to my senses. Hey, nobody’s going to pay me a quarter million dollars to run the consult service for the few months I’d be able to limp around the hospital, falling off my camp stool when my legs go numb or the chair breaks.
It’s not like I can just throw a football like it’s nothing after 5 years. I’d have to prove I still have enough clinical smarts to figure out how to introduce myself (Hi! I’m Philip Rivers and you need to go long!”).
The Maintenance of Certification Circus is still a thing and it’s worse. I’m not saying doctors don’t undertake the arduous task of essentially retraining to be what they once were—because that’s not good enough anymore.
Last night, the camera caught Phil more than once being just as hard on himself as he was with other members of the team who weren’t in the right spot at the right time. Most physicians are perfectionists and if you’ve been out of the game for a while and you try to squeeze back in, you could wind up mumbling to yourself, “They don’t make footballs like they used to!”
I didn’t stay up for the second half of football game. It wasn’t because of anything Philip did or didn’t do on the field.
I read this article about swearing being a good thing to do to increase your workout performance or whatever. There’s a link to the study that a researcher says supports that conclusion. I mean this story is talking about really bad words being good for you. It reminds me of a time when I was a pre-teen kid and broke my wrist falling out of a barn loft. I don’t remember exactly how I got to the emergency room. We didn’t have a car so our next-door neighbor must have driven me with my crooked arm and my hysterical mom to the hospital.
My mom was in the emergency room with me. When I cut loose with a torrent of really bad words, nurses had to practically carry her out because she fainted. This was right after I asked the doctor if it was OK if I swore and he said “Go ahead,” injected anesthetic—and immediately started to manhandle my wrist. I don’t think I ever swore in front of my mom before that.
I don’t remember if the swearing helped me withstand the pain or not. I don’t think so.
There was my other trip to a hospital for chest surgery when I was in my early teens. I had a chest tube after the operation. My roommate had undergone some kind of abdominal surgery. We had a lot of stitches and were in a lot of pain, which was bearable if we didn’t move at all. It even hurt to breathe. But the other factor was the TV in our room. It was way across the room and there was some kind of comedy show on. It was really funny—which made us feel really terrible. We could barely move and even had to talk quietly, yet this funny show made us laugh, which expanded our chest and abdomen areas, stretching the sutures. It was excruciating.
Even swearing would have hurt, not to mention laughing out loud. We really couldn’t stand to laugh and it was too bad I can’t describe the sound of two guys trying not to even chuckle. If you e4ver watched Loony Tunes cartoons and remember how Elmer Fudd sounded with he laughed—that was how we sounded because we were trying to suppress laughing. It was funny but pitiful. My roomie finally made this desperate slow motion move out of bed, crept to the TV and shut it off. I was so grateful. Neither one of us ever swore.
The other thing this swearing for power reminds me of is the movie Signs, which starred Mel Gibson as Graham Hess. It was about an alien invasion and in one scene, some people/aliens (they don’t’ yet know what) are running around the house and Graham’s brother Merril (Joaquin Phoenix) are getting set to chase them. Merril tells Graham to yell and curse, although because Graham is a former Episcopal priest, swearing is beyond him:
All right, listen, we both go outside, move around the house in opposite directions. We act crazy, insane with anger, make them crap in their pants, force them around till we meet up on the other side.
Graham Hess: Explain “act crazy”.
Merrill: You know, curse and stuff.
Graham Hess: You want me to curse?
Merrill: You don’t mean it. It’s just for show. What?
Graham Hess: Well, it won’t be convincing. It doesn’t sound natural when I curse.
Merrill: Just make noises, then.
Graham Hess: Explain “noises”.
Merrill: Are you gonna do this or what?
Graham Hess: No, I’m not.
Merrill: All right, you want them stealing something in the house next time?
[outside light comes on]
Merrill: On the count of three. One…
Graham Hess: All right.
Merrill: two… three!
Graham Hess: Ahh! I’m insane with anger!
Merrill: We’re gonna beat your ass bitch! We’re gonna tear your head off!
Graham Hess: I’m losing my mind! It’s time for an ass-whupping!
[Merrill and Graham meet each other]
Graham Hess: I cursed.
Merrill: I heard.
Anyway, I think we have to make a distinction between cursing about something or cursing at someone before we start claiming, like the author of the study says:
“Swearing is literally a calorie-neutral, drug-free, low-cost, readily available tool at our disposal for when we need a boost in performance.”—psychology researcher Richard Stephens of Keele University in the UK.
Go Retire Psychiatrist 