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 heard a song on the KCCK Big Mo Blues Show that I first heard in June of 2025. The song is “Artificial” by Walter Trout.
At first blush, I agree with what I think is the point of the song, which is basically a protest against artificiality which could manifest in a range of ways from superficiality and dishonesty in communications, attitudes, style of clothing, relationships, and all the way to Artificial Intelligence (AI).
The other connection I make is to the artist himself. Walter Trout developed Hepatitis C (eventually leading to liver transplant) according to a Wikipedia article which connected his lifestyle to contracting the disease. In my role as a consultation-liaison psychiatrist, I saw many patients with Hepatitis C who were referred to psychiatry from gastroenterology.
I was the main psychiatrist who evaluated them for treatment with Interferon-alpha. At the time it was the only treatment for Hepatitis C and was frequently associated with many side effects including depression. I was also one of the psychiatrists consulted as part of liver transplant evaluations.
Trout got very sick from Hepatitis C and made a remarkable (even miraculous) recovery after his liver transplant. Interferon is no longer used to treat Hepatitis C. It has been replaced by direct-acting antiviral (DAA) agents. They’re much better-tolerated and more effective.
The other aspect relevant to Trout’s song is ironic. The newest scientific literature supports the idea that AI can be helpful for diagnosing Hepatitis C, predicting its progression and response to treatment.
That doesn’t mean I’m completely sold on AI.
Aside from that, there’s interesting research suggesting that there may be a link between schizophrenia and bipolar disorder and Hepatitis C infection (which could be hiding deep in the brain’s choroid plexus lining the cerebral ventricles). In other words, some people might have mental illness because of the liver disease itself.
If you think about the dictionary definition of the word “artificial,” you can hardly dismiss this kind of research as insincere.
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 want to give a shout-out to Dr. George Dawson on his post today, “Enthusiasm is a plus…” It’s right on the mark.
Having a zest for medicine is the reason why many physicians undertook the rigorous training in medical school, residency, and beyond. A sense of humor is evident in George’s essay—and he doesn’t need to be comedian.
His essay reminded me of the many trainees who took their rotation through the psychiatry consultation service when I was running it (or tried to, anyway!). Many deserve a shout out as well for not only working hard on the service but teaching as well. I prevailed on them to make a short presentation during the rotation. I called it the Dirty Dozen.
They picked a topic often about an interesting consultation case we had seen and put together a talk with a dozen slides. They gave a Dirty Dozen called: “Neurology and Psychiatry: Divided or United?” It included some of Dr. Ron Pies ideas on a subtopic of whether psychiatry and neurology can ever be combined as a discipline (three diagrams of his are in the slides). You can also see a sense of humor, especially in the first slide.
Note: Because I couldn’t locate all of the trainees to get their permission to leave their names on the title slide, I chose to identify them as “Trainees.” I’m still very proud of all of them.
Slides from trainees on Neurology and Psychiatry: Divided or United? from UIHC Psychiatry Consultation Service, 2017. Figures included from Dr. Pies’ article in Psychiatric Times (see below):
Citations:
Arzy, S. Danziger, S. (2014).. “The Science of Neuropsychiatry: Past, Present, and Future.” The Journal of neuropsychiatry and clinical neurosciences 26.4 2014): 392-395.
Daly, R. Pies, R. (2010). Should Psychiatry and Neurology Merge as a Single Discipline? Psychiatric Times.
Fitzgerald, M. (2015). Do psychiatry and neurology need a close partnership or a merger? BJPsych Bulletin, 39(3), 105–107.
Pies, R. (2005). Why psychiatry and neurology cannot simply merge. J Neuropsychiatry Clin Neurosci; 17: 304-309.
Schildkrout, B., Frankel, M. (2016). Neuropsychiatry: Toward Solving the Mysteries That Animate Psychiatry. Psychiatric Times.
Price, BH., Adams RD., Coyle, JT. (2000). Neurology and psychiatry, closing the great divide. Neurology January 11, 2000 vol. 54 no. 18
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.
Sena just found a blogger psychiatrist who wrote the blog “The Good Enough Psychiatrist,” and her former blog link is still on my blog site. Dr. Jenna Cheng has a new blog and podcast, and it’s called “Attached and Enlivened Psychiatry.” The link is on the menu.
The featured image for this post is the Kintsugi pottery picture, which I first learned about from her blog and later blathered about back in September this year some more, relating to my link between it and blues music. She actually hit the like button on it.
When you get a chance, by all means check out the podcast that Dr. Cheng and Dr. Patrick Kelly run. “It’s called Good Enough Shrink, which rings a bell. I listened to “Münchausen and Münchausen by Proxy: Harming Self and Others to Play the Sick Role.” They did a great job!
I just want to send a link to Dr. George Dawson’s post The Phenomenological Suicide Assessment – The Legacy of Dr. H. It’s a great Christmas gift to teachers and learners everywhere. Happy holidays to George and everyone else.
Sena bought some device for neck and shoulder massage called the Shiatsu cordless heat massager today. She tried it and then wanted me to try it. I’m not up for massagers of any kind, especially after seeing the extraterrestrial massage torturer I posted about early this month, “So, Is This Anything?”
She didn’t want it for various reasons. It doesn’t get warm enough, it’s difficult to hold on to it, and has this general weirdness that’s difficult to describe. That’s why I made a little video about it. Sena made me do it.
Go Retire Psychiatrist 