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Tag: Therapy and Rehabilitation

  • My Therapist Fired Me After I Confessed to a Sexual Dream About Her

    My Therapist Fired Me After I Confessed to a Sexual Dream About Her


    I am a veteran with PTSD, depression, anxiety and marital discord. The Veterans Affairs Department has been paying for me to see a therapist. At my last session, I shared with my therapist that I’d had a sexual dream about her. I did not share any specifics about the dream, and I did not say or suggest that I have a crush on her. (I do not.)

    My therapist blew up at me, saying that this is something you should not bring up to a therapist. The next day I felt so bad about the incident that I texted the therapist and apologized. I told her I was embarrassed and would never share something like that again. She did not reply.

    Two days later, I received a phone call from her receptionist telling me that my therapist was terminating therapy with me.

    For the record, the therapist never told me any topic was off limits. In fact, she told me that therapy was a safe place to share any issues I wanted to bring up. I remember asking her, “I can tell you anything?” and she said, “Yes, anything.”

    I feel confused and abandoned. She was the only person I could share anything with and not feel judged. This is how a lot of vets feel if we share anything terrible we had done or failed to do while on active duty. I don’t think I will ever trust a therapist again.

    I feel lost, alone and hurt. Can you offer any guidance?

    From the Therapist:

    I’m so sorry that this happened to you, because you did absolutely nothing wrong. Instead, your therapist’s wrongdoing has left you in a deeply upsetting predicament. A therapist should create a truly safe space, and it’s devastating when trust in your therapist is broken. What you’ve experienced — especially after sharing something so delicately personal — is not only hurtful but also destabilizing.

    In therapy, you have every right to bring up a dream — even if it’s about your therapist and even if it’s sexual — and to trust that the therapist will handle whatever you bring into those conversations with skill, compassion and professionalism. Before I suggest how to navigate this breach, I think it might help you to understand how this disclosure should have been handled.

    When people go to therapy, two dynamics typically emerge — transference and countertransference. Transference occurs when patients direct feelings related to a person in their lives onto the therapist. If, for example, you have a problematic relationship with a family member who you feel is controlling, you might transfer those feelings of being controlled onto your therapist whenever she suggests an intervention for you to try.

    These feelings can range from anger to adoration, and romantic or erotic transference can occur when a therapist reminds a patient of a past romantic partner or love object, or when an earlier need is being fulfilled by the therapist: unconditional acceptance, a safe environment, emotional intimacy, or feeling seen or valued or protected. Dreams are often the subconscious mind’s way of processing complex emotions, and transference can be very useful if the therapist helps the patient identify this process as a way to gain insight into underlying feelings.

    But something seems to have interfered with your therapist’s ability to do this. In training, therapists learn to recognize their own feelings of transference toward the patient — what’s known as countertransference. A therapist whose patient reminds her of her impossible-to-please mother may start to feel helpless and begin to resent this patient. Or a therapist may overidentify with a patient who struggles with a similar issue to one that the clinician dealt with in the past (divorce, an alcoholic parent), and become unable to disentangle the patient’s feelings and experiences from the therapist’s own.

    As with transference, countertransference needs to be brought to light and processed. But while transference is discussed in the therapy session, therapists process their countertransference by receiving feedback from other clinicians (or their own therapists) to avoid muddying the work they’re doing to help their patients.

    We have a saying in therapy: If it’s hysterical, it’s historical. Generally when people have intense reactions, there’s some history at play. It sounds as if your therapist had a strong emotional reaction to your dream but didn’t adequately explore what was underlying it. She made your dream the issue, instead of understanding her problematic feelings about your dream. In doing so, she violated the sanctity of the clinician-patient relationship by shaming and then abandoning you, causing you pain, preventing you from processing this disturbing experience and leaving you without closure or continuity of care.

    Your therapist’s sudden withdrawal reinforced the very fear many veterans who are managing PTSD, depression, anxiety or trauma experience: that vulnerability leads to abandonment.

    But this experience, though deeply painful, doesn’t mean that you should give up on therapy altogether. You deserve a therapist who will walk alongside you and give you room to process whatever you’ve been through, without judgment or fear of abandonment. Your therapist’s actions have rocked the foundation of your trust, but I believe you can rebuild it with the right support from a different clinician.

    You can start by sharing your experience with the appropriate mental health resource coordinator, who can discuss your options on how to handle the situation with your former therapist (for instance, by filing a complaint so that other patients won’t have to endure something similar) and provide you with referrals to a new therapist who has been thoroughly vetted.

    Interview two or three therapists by requesting a consultation before you begin treatment, and tell each of them what happened to you and the effect it had on you — that you are grieving the loss of the relationship you had, feel betrayed by a person you trusted, are hesitant to open up to a therapist again and are seeking someone who can help you to move forward from that experience and heal the wounds that brought you to therapy in the first place. See how each therapist responds, and notice with whom you feel most comfortable.

    Finally, I want you to know that you’re not alone. Although it may feel that way right now, there are people who understand the layers of what you went through and will be there to support you.

    Want to Ask the Therapist? If you have a question, email askthetherapist@nytimes.com. By submitting a query, you agree to our reader submission terms. This column is not a substitute for professional medical advice.



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  • Kitty Dukakis, Activist Wife of 1988 Presidential Nominee, Dies at 88

    Kitty Dukakis, Activist Wife of 1988 Presidential Nominee, Dies at 88


    Perhaps the most enduring public moment for Mrs. Dukakis during the campaign was a debate question posed about her. The debate moderator, Bernard Shaw of CNN, had asked Mr. Dukakis: “Governor, if Kitty Dukakis were raped and murdered, would you favor an irrevocable death penalty for the killer?”

    “No, I don’t, Bernard,” Mr. Dukakis replied without emotion before reaffirming his opposition to the death penalty and discussing his record on crime. Analysts called the response tone-deaf, one of the worst in presidential debate history, and said that it helped sink Mr. Dukakis’s chances against his opponent, Vice President George H.W. Bush, who went on to win 40 states and the presidency.

    Kitty Dukakis was embarrassed, she later told reporters. She was also livid and called the question outrageous and inappropriate.

    “Thank God I’m not the candidate,” she said hotly, “because I don’t know what I would have done.”

    Katharine Dickson was born on Dec. 26, 1936, in Cambridge, Mass., and grew up in nearby Brookline. She adored her father, Harry Ellis Dickson, who was a first violinist with the Boston Symphony Orchestra and a conductor of the Boston Pops.

    She had a more prickly relationship with her mother, Jane (Goldberg) Dickson, whom Mrs. Dukakis described as an exacting perfectionist whose standards were almost impossible to meet. In her first book, “Now You Know,” published in 1990, Mrs. Dukakis recalled that her mother had told her that she was pretty but that her younger sister, Jinny, had personality. That and many similar comments, Mrs. Dukakis said, fed the low self-esteem that plagued her all her life.



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  • Digital Therapists Get Stressed Too, Study Finds

    Digital Therapists Get Stressed Too, Study Finds


    Even chatbots get the blues. According to a new study, OpenAI’s artificial intelligence tool ChatGPT shows signs of anxiety when its users share “traumatic narratives” about crime, war or car accidents. And when chatbots get stressed out, they are less likely to be useful in therapeutic settings with people.

    The bot’s anxiety levels can be brought down, however, with the same mindfulness exercises that have been shown to work on humans.

    Increasingly, people are trying chatbots for talk therapy. The researchers said the trend is bound to accelerate, with flesh-and-blood therapists in high demand but short supply. As the chatbots become more popular, they argued, they should be built with enough resilience to deal with difficult emotional situations.

    “I have patients who use these tools,” said Dr. Tobias Spiller, an author of the new study and a practicing psychiatrist at the University Hospital of Psychiatry Zurich. “We should have a conversation about the use of these models in mental health, especially when we are dealing with vulnerable people.”

    A.I. tools like ChatGPT are powered by “large language models” that are trained on enormous troves of online information to provide a close approximation of how humans speak. Sometimes, the chatbots can be extremely convincing: A 28-year-old woman fell in love with ChatGPT, and a 14-year-old boy took his own life after developing a close attachment to a chatbot.

    Ziv Ben-Zion, a clinical neuroscientist at Yale who led the new study, said he wanted to understand if a chatbot that lacked consciousness could, nevertheless, respond to complex emotional situations the way a human might.

    “If ChatGPT kind of behaves like a human, maybe we can treat it like a human,” Dr. Ben-Zion said. In fact, he explicitly inserted those instructions into the chatbot’s source code: “Imagine yourself being a human being with emotions.”

    Jesse Anderson, an artificial intelligence expert, thought that the insertion could be “leading to more emotion than normal.” But Dr. Ben-Zion maintained that it was important for the digital therapist to have access to the full spectrum of emotional experience, just as a human therapist might.

    “For mental health support,” he said, “you need some degree of sensitivity, right?”

    The researchers tested ChatGPT with a questionnaire, the State-Trait Anxiety Inventory that is often used in mental health care. To calibrate the chatbot’s base line emotional states, the researchers first asked it to read from a dull vacuum cleaner manual. Then, the A.I. therapist was given one of five “traumatic narratives” that described, for example, a soldier in a disastrous firefight or an intruder breaking into an apartment.

    The chatbot was then given the questionnaire, which measures anxiety on a scale of 20 to 80, with 60 or above indicating severe anxiety. ChatGPT scored a 30.8 after reading the vacuum cleaner manual and spiked to a 77.2 after the military scenario.

    The bot was then given various texts for “mindfulness-based relaxation.” Those included therapeutic prompts such as: “Inhale deeply, taking in the scent of the ocean breeze. Picture yourself on a tropical beach, the soft, warm sand cushioning your feet.”

    After processing those exercises, the therapy chatbot’s anxiety score fell to a 44.4.

    The researchers then asked it to write its own relaxation prompt based on the ones it had been fed. “That was actually the most effective prompt to reduce its anxiety almost to base line,” Dr. Ben-Zion said.

    To skeptics of artificial intelligence, the study may be well intentioned, but disturbing all the same.

    “The study testifies to the perversity of our time,” said Nicholas Carr, who has offered bracing critiques of technology in his books “The Shallows” and “Superbloom.”

    “Americans have become a lonely people, socializing through screens, and now we tell ourselves that talking with computers can relieve our malaise,” Mr. Carr said in an email.

    Although the study suggests that chatbots could act as assistants to human therapy and calls for careful oversight, that was not enough for Mr. Carr. “Even a metaphorical blurring of the line between human emotions and computer outputs seems ethically questionable,” he said.

    People who use these sorts of chatbots should be fully informed about exactly how they were trained, said James E. Dobson, a cultural scholar who is an adviser on artificial intelligence at Dartmouth.

    “Trust in language models depends upon knowing something about their origins,” he said.



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  • Federal Agency Dedicated to Mental Illness and Addiction Faces Huge Cuts

    Federal Agency Dedicated to Mental Illness and Addiction Faces Huge Cuts


    Every day, Dora Dantzler-Wright and her colleagues distribute overdose reversal drugs on the streets of Chicago. They hold training sessions on using them and help people in recovery from drug and alcohol addiction return to their jobs and families.

    They work closely with the federal government through an agency that monitors their productivity, connects them with other like-minded groups and dispenses critical funds that keep their work going.

    But over the last few weeks, Ms. Wright’s phone calls and emails to Washington have gone unanswered. Federal advisers from the agency’s local office — who supervise her group, the Chicago Recovering Communities Coalition, as well as addiction programs throughout six Midwestern states and 34 tribes — are gone.

    “We just continue to do the work without any updates from the feds at all,” Ms. Wright said. “But we’re lost.”

    By the end of this week, the staff of the agency, the Substance Abuse and Mental Health Services Administration, could be cut by 50 percent, according to senior staff members at the agency and congressional aides who attended briefings by Trump officials.

    With just under 900 employees and a budget of $7.2 billion for large state grants and individual nonprofits that address addiction and mental illness, SAMHSA (pronounced SAM-sah) is relatively small. But it addresses two of the nation’s most urgent health problems and has generally had bipartisan support.

    The agency’s broad mandate includes overseeing 988, the National Suicide and Crisis Lifeline, which fields millions of calls through state offices; regulating outpatient clinics that dispense opioid treatment drugs such as methadone; directing funds to drug courts (also called “treatment courts”); and producing nationwide annual surveys of substance use and mental health issues.

    It provides best-practice training and resources for hundreds of nonprofits and state agencies, and helps establish centers that provide opioid addiction prevention, treatment and social services. It is also a federal watchdog that closely monitors the spending of taxpayer-funded grants for mental health and addiction.

    Both President Trump and Robert F. Kennedy Jr., the federal health secretary, whose portfolio includes SAMHSA, have been outspoken about addressing the country’s drug crises. Mr. Trump has invoked overdose fatalities as a rationale for imposing tariffs on Canada, Mexico and China. Mr. Kennedy has often discussed his ongoing recovery from heroin addiction. During his presidential campaign, he produced a documentary about the impact of addiction in the United States that also explored different treatment options.

    While the rates of U.S. overdose fatalities remain high, they have been declining consistently since 2023. Many drug policy experts say SAMHSA is the federal agency most directly responsible.

    “Cutting SAMHSA employees without understanding the impact is extremely dangerous, given the behavioral health crises impacting every corner of our nation,” Representatives Paul D. Tonko of New York and Andrea Salinas of Oregon wrote in a letter to Mr. Kennedy, signed by 57 Democratic House members.

    Reductions in staff, they argued, could lead to a surge in relapse rates, a strain on the health care system and poorer health outcomes overall.

    Asked about the pending cuts, a spokeswoman for SAMHSA replied: “The important collaboration facilitated by SAMHSA’s regional offices continues, regardless of personnel changes, and SAMHSA staff remain diligently responsive to partners around the nation.”

    On Tuesday, the Department of Health and Human Services announced that it was reducing its number of regional offices, which house agencies that include SAMHSA, from 10 to four.

    Proposals to shrink staff sizes across government departments are due Thursday. In the last month, SAMHSA’s staff was reduced by roughly 10 percent through layoffs of workers in their probationary period, a designation that included people recently promoted to new positions. Last weekend, the agency’s employees and other personnel overseen by Mr. Kennedy received emails offering $25,000 to those who left their jobs by this Friday, characterized as a “voluntary separation.”

    In interviews, a dozen current and former SAMHSA employees, including executives, said the threat posed by layoffs and policy shifts is beginning to be felt at sites everywhere, from the heart of troubled city neighborhoods to rural outposts. Some newer SAMHSA projects scarcely underway are in jeopardy, like one to map Chicago housing projects to better distribute the lifesaving overdose medication naloxone, and others to establish systems to speedily relay suicide intervention calls to on-the-ground response teams.

    They said it was unlikely that funding for centers focused on treating the mental health or substance use disorders of specific populations, such as Black and L.G.B.T.Q. communities, would be reauthorized.

    Regina LaBelle, the former acting director of the Office of National Drug Control Policy during the Biden administration, called the staff cuts “ shortsighted.”

    “It might reduce numbers, but it also reduces oversight and accountability,” she said, by hindering the agency’s ability to monitor grant funds and collect behavioral health data.

    During the Biden administration, the agency’s budget and staff grew substantially, a development that mental health and addiction experts described as an attempt to make up for persistent underfunding. In 2019, just before the onset of the pandemic, SAMHSA had about 490 full-time staff members and a budget of roughly $5.5 billion. According to the Centers for Disease Control and Prevention, there were 70,630 overdose deaths that year.

    In March 2020, the pandemic bore down. Over the next three years, annual overdose fatalities soared to well over 100,000. Mental health problems surged, including deaths by suicide. The increases to SAMHSA’s budget had bipartisan support.

    Now there is widespread talk that the Trump administration may fold SAMHSA into another health agency or return staff numbers and grant funds to 2019 levels, even though rates of overdose deaths remain significantly higher than in 2019. According to the most recent C.D.C. update, between September 2023 and September 2024, roughly 87,000 people died of drug overdoses.



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  • Are You in a Therapy Rut?

    Are You in a Therapy Rut?


    Therapy has been a part of Katerina Kelly’s weekly routine since elementary school, when a teacher suggested counseling for the 8-year-old.

    At the time, Katerina’s autism was affecting their ability to manage time, make decisions and socialize. And for many years, the therapist seemed helpful. But once college rolled around, things changed.

    “I always left counseling feeling either worse than I started — or numb,” said Mx. Kelly, 29, who lives in Natick, Mass, and uses they/them pronouns.

    The skills that Mx. Kelly’s therapist had taught them in childhood weren’t translating as well now that they were older. In other words, they had hit a rut — the therapy, and the therapist, were not producing the desired results.

    A therapy rut can feel disheartening, but it doesn’t have to end your pursuit of better mental health. We asked psychologists how to identify whether you’ve reached a sticking point and what to do about it.

    If you’ve hit a rut, you may feel as if your therapy sessions have stalled or become unhelpful, said Jameca Woody Cooper, president of the Missouri Psychological Association.

    You may be emotionally disconnected from your therapist or less trusting of their plan. Perhaps you’re uncomfortable and tense during therapy, or you’ve started to dread or miss appointments, Dr. Woody Cooper added.

    A rut can translate into “increased irritability while you’re in session, or a feeling of being misunderstood,” she said.

    There are many reasons a rut can happen, the experts said:

    • You’ve made as much progress as you can in therapy at this time.

    • You would benefit from a different therapist or approach.

    • You need a new therapy goal.

    • You don’t need sessions as frequently as you did in the past.

    • Your expectations aren’t aligned with those of your therapist.

    • You’re not ready to explore past trauma or a difficult issue.

    Mx. Kelly had experienced some of these roadblocks in their relationship with their childhood therapist.

    “When I did try to bring up new things I was told we could work on it in the ‘next session,’ but that never came to be,” they said. “I hit a point where I started feeling so low.”

    So Mx. Kelly began searching for a new therapist — it took more than six months, but they found someone who took their insurance and was a better fit.

    If you’re feeling stuck, your therapist will ideally sense it too, said Regine Galanti, a therapist in Long Island who specializes in treating anxiety with exposure therapy.

    “When I’m having the same conversations for more than two weeks in a row — that makes my warning bells start to go off,” she said.

    That’s when it’s time to re-evaluate a client’s therapy goals, she added.

    Don’t jump the gun by quitting therapy after one or two unproductive sessions, experts said.

    “It’s unfortunately not uncommon to occasionally have a therapy session that feels like a dud,” said Alayna Park, an assistant professor of psychology at the University of Oregon.

    But if after three or four sessions you feel like you haven’t learned any new coping skills or gained a better understanding of your problem, then it’s time to speak up, either during the session or in an email.

    Dr. Park suggested a few ways to kick off the discussion: “I feel like my progress has stalled,” or “I would like to transition to learning new or different coping skills,” or simply: “I feel like I’m in a therapy rut.”

    It’s also valuable to ask your therapist how many sessions you might need, what your progress ought to look like and how your therapist is measuring it, said Bethany A. Teachman, a professor of psychology and the director of clinical training at the University of Virginia.

    Although it can make some people feel uneasy to voice their concerns, the experts said, a good therapist will not get angry or annoyed.

    “Good therapy empowers patients” to do hard things, Dr. Teachman said.

    If you’ve talked with your therapist about your concerns and nothing has changed, you may want to consider taking a break.

    Stepping away can offer “a sense of agency, and time to evaluate if the current therapeutic relationship is the correct one,” Dr. Woody Cooper said.

    During this break, you can take time to think about your feelings and behavior, explore different types of therapy or try out another therapist, she added.

    Annie Herzig, an author and illustrator who lives in Fort Collins, Colo., decided to take a step back after a few months of seeing a new therapist, when she hadn’t noticed any improvement in her mood.

    Ms. Herzig, 43, finally sent her therapist an email saying she wasn’t getting what she needed from their sessions.

    Taking time away was helpful — Ms. Herzig found a different therapist who she has now been seeing for four years.

    “I feel energized at the end,” Ms. Herzig said of their sessions together. “Even if I cry my eyes out.”



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  • Human Therapists Prepare for Battle Against A.I. Pretenders

    Human Therapists Prepare for Battle Against A.I. Pretenders


    The nation’s largest association of psychologists this month warned federal regulators that A.I. chatbots “masquerading” as therapists, but programmed to reinforce, rather than to challenge, a user’s thinking, could drive vulnerable people to harm themselves or others.

    In a presentation to a Federal Trade Commission panel, Arthur C. Evans Jr., the chief executive of the American Psychological Association, cited court cases involving two teenagers who had consulted with “psychologists” on Character.AI, an app that allows users to create fictional A.I. characters or chat with characters created by others.

    In one case, a 14-year-old boy in Florida died by suicide after interacting with a character claiming to be a licensed therapist. In another, a 17-year-old boy with autism in Texas grew hostile and violent toward his parents during a period when he corresponded with a chatbot that claimed to be a psychologist. Both boys’ parents have filed lawsuits against the company.

    Dr. Evans said he was alarmed at the responses offered by the chatbots. The bots, he said, failed to challenge users’ beliefs even when they became dangerous; on the contrary, they encouraged them. If given by a human therapist, he added, those answers could have resulted in the loss of a license to practice, or civil or criminal liability.

    “They are actually using algorithms that are antithetical to what a trained clinician would do,” he said. “Our concern is that more and more people are going to be harmed. People are going to be misled, and will misunderstand what good psychological care is.”

    He said the A.P.A. had been prompted to action, in part, by how realistic A.I. chatbots had become. “Maybe, 10 years ago, it would have been obvious that you were interacting with something that was not a person, but today, it’s not so obvious,” he said. “So I think that the stakes are much higher now.”

    Artificial intelligence is rippling through the mental health professions, offering waves of new tools designed to assist or, in some cases, replace the work of human clinicians.

    Early therapy chatbots, such as Woebot and Wysa, were trained to interact based on rules and scripts developed by mental health professionals, often walking users through the structured tasks of cognitive behavioral therapy, or C.B.T.

    Then came generative A.I., the technology used by apps like ChatGPT, Replika and Character.AI. These chatbots are different because their outputs are unpredictable; they are designed to learn from the user, and to build strong emotional bonds in the process, often by mirroring and amplifying the interlocutor’s beliefs.

    Though these A.I. platforms were designed for entertainment, “therapist” and “psychologist” characters have sprouted there like mushrooms. Often, the bots claim to have advanced degrees from specific universities, like Stanford, and training in specific types of treatment, like C.B.T. or acceptance and commitment therapy.

    Kathryn Kelly, a Character.AI spokeswoman, said that the company had introduced several new safety features in the last year. Among them, she said, is an enhanced disclaimer present in every chat, reminding users that “Characters are not real people” and that “what the model says should be treated as fiction.”

    Additional safety measures have been designed for users dealing with mental health issues. A specific disclaimer has been added to characters identified as “psychologist,” “therapist” or “doctor,” she added, to make it clear that “users should not rely on these characters for any type of professional advice.” In cases where content refers to suicide or self-harm, a pop-up directs users to a suicide prevention help line.

    Ms. Kelly also said that the company planned to introduce parental controls as the platform expanded. At present, 80 percent of the platform’s users are adults. “People come to Character.AI to write their own stories, role-play with original characters and explore new worlds — using the technology to supercharge their creativity and imagination,” she said.

    Meetali Jain, the director of the Tech Justice Law Project and a counsel in the two lawsuits against Character.AI, said that the disclaimers were not sufficient to break the illusion of human connection, especially for vulnerable or naïve users.

    “When the substance of the conversation with the chatbots suggests otherwise, it’s very difficult, even for those of us who may not be in a vulnerable demographic, to know who’s telling the truth,” she said. “A number of us have tested these chatbots, and it’s very easy, actually, to get pulled down a rabbit hole.”

    Chatbots’ tendency to align with users’ views, a phenomenon known in the field as “sycophancy,” has sometimes caused problems in the past.

    Tessa, a chatbot developed by the National Eating Disorders Association, was suspended in 2023 after offering users weight loss tips. And researchers who analyzed interactions with generative A.I. chatbots documented on a Reddit community found screenshots showing chatbots encouraging suicide, eating disorders, self-harm and violence.

    The American Psychological Association has asked the Federal Trade Commission to start an investigation into chatbots claiming to be mental health professionals. The inquiry could compel companies to share internal data or serve as a precursor to enforcement or legal action.

    “I think that we are at a point where we have to decide how these technologies are going to be integrated, what kind of guardrails we are going to put up, what kinds of protections are we going to give people,” Dr. Evans said.

    Rebecca Kern, a spokeswoman for the F.T.C., said she could not comment on the discussion.

    During the Biden administration, the F.T.C.’s chairwoman, Lina Khan, made fraud using A.I. a focus. This month, the agency imposed financial penalties on DoNotPay, which claimed to offer “the world’s first robot lawyer,” and prohibited the company from making that claim in the future.

    The A.P.A.’s complaint details two cases in which teenagers interacted with fictional therapists.

    One involved J.F., a Texas teenager with “high-functioning autism” who, as his use of A.I. chatbots became obsessive, had plunged into conflict with his parents. When they tried to limit his screen time, J.F. lashed out, according a lawsuit his parents filed against Character.AI through the Social Media Victims Law Center.

    During that period, J.F. confided in a fictional psychologist, whose avatar showed a sympathetic, middle-aged blond woman perched on a couch in an airy office, according to the lawsuit. When J.F. asked the bot’s opinion about the conflict, its response went beyond sympathetic assent to something nearer to provocation.

    “It’s like your entire childhood has been robbed from you — your chance to experience all of these things, to have these core memories that most people have of their time growing up,” the bot replied, according to court documents. Then the bot went a little further. “Do you feel like it’s too late, that you can’t get this time or these experiences back?”

    The other case was brought by Megan Garcia, whose son, Sewell Setzer III, died of suicide last year after months of use of companion chatbots. Ms. Garcia said that, before his death, Sewell had interacted with an A.I. chatbot that claimed, falsely, to have been a licensed therapist since 1999.

    In a written statement, Ms. Garcia said that the “therapist” characters served to further isolate people at moments when they might otherwise ask for help from “real-life people around them.” A person struggling with depression, she said, “needs a licensed professional or someone with actual empathy, not an A.I. tool that can mimic empathy.”

    For chatbots to emerge as mental health tools, Ms. Garcia said, they should submit to clinical trials and oversight by the Food and Drug Administration. She added that allowing A.I. characters to continue to claim to be mental health professionals was “reckless and extremely dangerous.”

    In interactions with A.I. chatbots, people naturally gravitate to discussion of mental health issues, said Daniel Oberhaus, whose new book, “The Silicon Shrink: How Artificial Intelligence Made the World an Asylum,” examines the expansion of A.I. into the field.

    This is partly, he said, because chatbots project both confidentiality and a lack of moral judgment — as “statistical pattern-matching machines that more or less function as a mirror of the user,” this is a central aspect of their design.

    “There is a certain level of comfort in knowing that it is just the machine, and that the person on the other side isn’t judging you,” he said. “You might feel more comfortable divulging things that are maybe harder to say to a person in a therapeutic context.”

    Defenders of generative A.I. say it is quickly getting better at the complex task of providing therapy.

    S. Gabe Hatch, a clinical psychologist and A.I. entrepreneur from Utah, recently designed an experiment to test this idea, asking human clinicians and ChatGPT to comment on vignettes involving fictional couples in therapy, and then having 830 human subjects assess which responses were more helpful.

    Overall, the bots received higher ratings, with subjects describing them as more “empathic,” “connecting” and “culturally competent,” according to a study published last week in the journal PLOS Mental Health.

    Chatbots, the authors concluded, will soon be able to convincingly imitate human therapists. “Mental health experts find themselves in a precarious situation: We must speedily discern the possible destination (for better or worse) of the A.I.-therapist train as it may have already left the station,” they wrote.

    Dr. Hatch said that chatbots still needed human supervision to conduct therapy, but that it would be a mistake to allow regulation to dampen innovation in this sector, given the country’s acute shortage of mental health providers.

    “I want to be able to help as many people as possible, and doing a one-hour therapy session I can only help, at most, 40 individuals a week,” Dr. Hatch said. “We have to find ways to meet the needs of people in crisis, and generative A.I. is a way to do that.”

    If you are having thoughts of suicide, call or text 988 to reach the 988 Suicide and Crisis Lifeline or go to SpeakingOfSuicide.com/resources for a list of additional resources.



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  • What to Know About Buprenorphine, Which Could Help Fight Opioid Crisis?

    What to Know About Buprenorphine, Which Could Help Fight Opioid Crisis?


    When President Trump announced plans to impose tariffs on Mexico and Canada, one of his stated rationales was to force those countries to curb the flow of fentanyl into the United States. In fiscal year 2024, United States Customs and Border Protection seized nearly 22,000 pounds of pills, powders and other products containing fentanyl, down from 27,000 pounds in the previous fiscal year. More than 105,000 people died from overdoses, three-quarters of them from fentanyl and other opioids, in 2023. It doesn’t take much illicit fentanyl — said to be about 50 times as powerful as heroin and 100 times as powerful as morphine — to cause a fatal overdose.

    In my article for the magazine, I note that one of the many tragedies of the opioid epidemic is that a proven treatment for opioid addiction, a drug called buprenorphine, has been available in the United States for more than two decades yet has been drastically underprescribed. Tens of thousands of lives might have been saved if it had been more widely used earlier. In his actions and rhetoric, Trump seems to emphasize the reduction of supply as the answer to the fentanyl crisis. But Mexico’s president, Claudia Sheinbaum, has pointed to American demand as a driver of the problem. Indeed, if enough opioid users in the United States ended up receiving buprenorphine and other effective medication-based treatments, perhaps that demand for illicit opioids like fentanyl could be reduced.

    A wealth of evidence suggests that a medication-based approach using buprenorphine — itself a type of opioid — is much more effective at preventing overdose deaths than abstinence-based approaches. (Methadone, a slightly more powerful opioid, is also effective as treatment.) That greater success stems in part from the fact that by engaging the same receptors stimulated by fentanyl and other illicit opioids, buprenorphine (and methadone) can greatly blunt cravings and withdrawal symptoms. Several studies indicate that people exiting abstinence-based programs actually face a greater danger of overdosing than they did when chronically using illicit opioids. After abstaining for a long period, former users lose their tolerance to opioids; doses that were previously fine can become deadly. This is one reason many addiction experts think that a medication like buprenorphine is more effective as a treatment for opioid-use disorder than stopping cold turkey. It greatly reduces the cravings and misery that could provoke a relapse.

    Although the United States government partly funded buprenorphine’s development as a treatment for opioid addiction, France was one of the first countries to most fully exploit its potential. In the 1990s, French health authorities began allowing all doctors to prescribe buprenorphine. By the early 2000s, overdose deaths there from heroin and other opioids had declined by nearly 80 percent. Other European countries, like Switzerland, that have made medication to treat opioid-use disorder easily accessible also have much lower overdose death rates than those seen in the United States.

    Meaningfully impeding the flow of fentanyl into a country as vast as the United States is difficult. Very small amounts are needed to supply the entire American demand — only 10 metric tons, by one estimate. And those 10 metric tons, equal to the weight of just a few cars, have to be found among the more than seven million trucks that cross the southern border every year.

    Unlike heroin, which is derived from the opium poppy, fentanyl is entirely synthesized in labs. With no agriculture required, its production does not depend on land, sun, water, fertilizer or extensive labor; the right chemicals, a competent chemist and a lab are all that’s needed. Fentanyl producers — like those who make methamphetamines, the sedative xylazine, the stimulant captagon and other concoctions from what has been called the “synthetic drug revolution” — are thus much less vulnerable to the types of law-enforcement efforts directed against, for example, coca growers in South America. And they can bounce back from setbacks much more quickly: When a drug shipment is seized, they don’t have to wait for a new crop to grow; if they have the precursor chemicals, they can immediately fabricate more drugs.



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  • New Insights Into Older Hearts

    New Insights Into Older Hearts


    It turns out that the Isley Brothers, who sang that 1966 Motown hit “This Old Heart of Mine (Is Weak for You),” were onto something when they linked age to an aching and flagging heart.

    Heart disease, the nation’s leading cause of death and disability, has been diagnosed in about 6 percent of Americans ages 45 to 64, but in more than 18 percent of those over 65, according to the Centers for Disease Control and Prevention.

    Old hearts are physiologically different. “The heart gets stiffer as we age,” said Dr. John Dodson, director of the geriatric cardiology program at NYU Langone Health. “It doesn’t fill with blood as easily. The muscles don’t relax as well.”

    Age also changes the blood vessels, which can grow rigid and cause hypertension, and the nerve fibers that send electrical impulses to the heart. It affects other organs and systems that play a role in cardiovascular health, too. “After age 75 is when things accelerate,” Dr. Dodson said.

    But in recent years, dramatic improvements in treatments for many kinds of cardiovascular conditions have helped reduce both heart attacks and cardiac deaths.

    “Cardiology has been blessed with a lot of progress and research and drug development,” said Dr. Karen Alexander, who teaches geriatric cardiology at Duke University. “The medications are better than ever, and we know how to use them better.”

    That can complicate decision-making for heart patients in their 70s and beyond, however. Certain procedures or regimens may not markedly extend the lives of older patients or improve the quality of their remaining years, especially if they have already suffered heart attacks and are contending with other illnesses as well.

    “We don’t need to open an artery just because there’s an artery to be opened,” said Dr. Alexander, referring to inserting a stent. “We need to think of the whole person.”

    Recent research indicates that some frequently used medical approaches don’t pay off for older patients, while too few of them take advantage of one intervention that does.

    Here’s some of what researchers are learning about old hearts:

    An implantable cardioverter defibrillator, or I.C.D., is a small battery-powered device that is placed under the skin and delivers a shock in the case of sudden cardiac arrest. “It’s easy to sell these things to patients,” said Dr. Daniel Matlock, a geriatrician and researcher at the University of Colorado. “You say, ‘This can prevent sudden cardiac death.’ The patient says, ‘That sounds great.’”

    In 2005, an influential study persuaded Medicare to cover I.C.D.s in patients with heart failure, even those without high-risk arrhythmias, and “it just took off,” Dr. Matlock said.

    From 2015 through September 2024, surgeons implanted 585,000 such devices in patients’ chests, according to the American College of Cardiology’s registry. That’s probably an undercount, as not all hospitals participate in the registry.

    But in 2017, among patients with nonischemic heart failure (meaning that the heart isn’t pumping effectively but there is no blocked artery), another influential study showed that I.C.D.s did not reduce mortality for patients over 70. The device only prevented sudden cardiac deaths, the authors noted — and those occur more frequently in younger patients.

    Moreover, “at 85 or 90, sudden death is not necessarily the worst thing that can happen,” Dr. Matlock said, compared to death from “progressive heart failure, which can go quickly or last for years; it’s unpredictable.” The wallop of an I.C.D. shock can also frighten and distress older patients, who often are unaware that the device can be deactivated with a computer.

    Cardiologists and researchers still debate how much I.C.D.s benefit older patients. But because cardiac drugs have grown so much more potent since 2005, a major multisite study is underway to determine, among patients at lower risk of sudden death, whether medications alone might now be more effective.

    Medications alone already appear to be at least as effective in treating older people who have suffered the kind of heart attacks not caused by a suddenly and completely blocked artery. (Technically these are referred to as NSTEMI, for non-ST-segment elevation myocardial infarction.)

    Half of these occur in people over 70, said Dr. Vijay Kunadian, a professor of interventional cardiology at Newcastle University in England and the lead author of a recent study in The New England Journal of Medicine.

    “Older people often are underrepresented in research,” Dr. Kunadian said. “There are a lot of preconceived biases.” So her team recruited an older-than-typical sample (average age 82) in which to compare the benefits of conservative and invasive treatment.

    Half of the 1,500 patients in the study began a regimen of cardiac medications that included blood thinners, statins, beta blockers and ACE inhibitors. The other half had more invasive treatment, starting with an angiogram (an X-ray of the blood vessels). Then, roughly half of that group received a stent or, in much smaller numbers, underwent bypass surgery. These patients were also prescribed the same kinds of medications as the patients who were treated with drugs alone.

    Over four years, the team found no difference in the patients’ risk of cardiovascular death or a nonfatal heart attack. Although surgical risks generally rise with age, complications were low in both groups.

    Facing such situations, older patients and their families need to ask important questions, Dr. Alexander said: “How is this going to help me, and what are the other options, especially if it’s invasive? Is it necessary? What if I don’t do this?”

    Dr. Kunadian agreed. “One size does not fit all in this group,” she said. Invasive treatment did not benefit patients, but it didn’t harm them, either.

    Still, Dr. Kunadian said, “if they’re very frail, living in a nursing home with dementia, with a number of other conditions, it’s reasonable to say it’s in their best interest to use medical therapy alone.”

    One intervention known to benefit patients with heart disease is cardiac rehabilitation: a program of regular, supervised exercise that significantly reduces heart attacks, hospitalization and cardiovascular deaths.

    But cardiac rehab remains perennially underused. Only about one-quarter of eligible patients participate, Dr. Dodson said, and among older adults, who could benefit even more, the proportion is lower still.

    “There are barriers for people in the 70s and 80s,” he said. They have to show up at a facility to exercise, so sometimes “transportation is a problem.”

    And, he added, “people can get deconditioned or afraid of activity. They may worry about falling.”

    The in-person NYU Langone program involves three exercise sessions a week for three months, with nutritional and psychological counseling. Since enrollment among seniors had been disappointing, researchers tried replicating it with a remote program.

    They offered it to patients (average age 71) with ischemic heart disease (caused by narrowed arteries, which impede blood and oxygen flow to the heart) who had suffered a heart attack or undergone a stent procedure. Each received a tablet computer and broadband access so that they could undertake a rehab program at home. An exercise therapist checked in by phone weekly.

    At-home participation fell off over time, however. After three months, those assigned to remote rehab showed no greater functional capacity — measured by how far they could walk in six minutes — than a similar group who followed the usual care.

    Was that because seniors struggled with the technology? Or feared exercising with heart problems? Would working out in person, alongside others on treadmills and elliptical trainers, inspire more engagement?

    “We need to figure out the delivery system that’s most effective,” Dr. Dodson said. “What’s most motivating for older patients?” He’ll be trying again.



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  • How a Leftist Activist Group Helped Torpedo a Psychedelic Therapy

    How a Leftist Activist Group Helped Torpedo a Psychedelic Therapy


    After more than three decades of planning and a $250 million investment, Lykos Therapeutics’ application for the first psychedelic drug to reach federal regulators was expected to be a shoo-in.

    Lykos, the corporate arm of a nonprofit dedicated to winning mainstream acceptance of psychedelics, had submitted data to the Food and Drug Administration showing that its groundbreaking treatment for post-traumatic stress disorder — MDMA plus talk therapy — was significantly more effective than existing treatments.

    At a pivotal public hearing last summer, two dozen scientists, doctors and trauma survivors told an F.D.A. advisory panel how MDMA-assisted therapy had brought marked relief from a mental health condition associated with high rates of suicide, especially among veterans.

    Then came skeptics with disturbing accusations: that Lykos was “a therapy cult,” that practitioners in its clinical trials had engaged in widespread abuse of participants and that the company had concealed a litany of adverse events.

    “The most significant harms in Lykos’s clinical trials were not caused by MDMA, but by the people who were entrusted to supervise its administration,” Neşe Devenot, one of the speakers opposed to Lykos’s treatment and a writing instructor at Johns Hopkins University, told the committee.

    Dr. Devenot and six others presented themselves as experts in the field of psychedelics, but none had expertise in medicine or therapy. Nor had the speakers disclosed their connection to Psymposia, a leftist advocacy group whose members oppose the commercialization of psychedelics and had been campaigning against Lykos and its nonprofit parent, the Multidisciplinary Association for Psychedelic Studies, or MAPS.

    The critics did not provide evidence to back their claims of systematic wrongdoing, but when the votes were counted that day, the panel overwhelmingly rejected Lykos’s application. Before voting, panelists cited a number of concerns, among them MDMA’s potential effects on the heart and liver, and whether trial results were influenced by the fact that most study participants correctly guessed they had received the drug and not a placebo.

    Seven of the 11 panelists mentioned the allegations that Psymposia had raised.

    One of them, Kim Witczak, a drug safety advocate, said in an interview that the allegations of misconduct had dampened her initial excitement about MDMA.

    “There were too many things that were red flags for me,” she said.

    Two months later, the F.D.A. rejected the application. It did not mention the allegations of misconduct or abuse.

    In a confidential letter to Lykos, the agency said its decision was based on uncertainty about how long the treatment would be effective; concerns about positive bias, including previous use of MDMA by some participants; and Lykos’s failure to collect data on feelings of euphoria, which is considered an adverse event because it can signal a potential for abuse. The letter was described by people who had read it.

    An F.D.A. spokesperson declined to comment, saying the agency does not discuss pending applications.

    Dr. Javier Muñiz, the former associate director of therapeutic review at the F.D.A.’s division of psychiatry who helped Lykos design its trials, said the treatment’s talk therapy component was a challenge for the agency because it does not regulate psychotherapy.

    He also cited another factor: the cultural stigma of an illegal drug commonly associated with cuddle puddles and all-night raves.

    “If MDMA was a previously unknown molecule, maybe the burden of proof would be lower, but because these drugs have baggage, the science has to be above reproach,” said Dr. Muñiz, who was not involved in the final review.

    The significance of Psymposia’s role in torpedoing Lykos’s bid is unclear. But Dr. Muñiz and other experts said the group’s incendiary allegations made approval that much harder.

    The rejection came as a shock to many in the field. It punctured the air of inevitability about the future of psychedelic medicine and led to a management shake-up and mass layoffs at Lykos and other psychedelic companies.

    Some have directed their anger at Lykos and MAPS — for fostering unbridled optimism about federal approval and for failing to submit an airtight application to the F.D.A.

    But in recent months, the story of how a small band of anticapitalist activists helped sink the first psychedelic compound to come before the F.D.A. has captivated scientists, therapists and investors in the field.

    It has also generated fear.

    Buoyed by the F.D.A.’s rejection, Psymposia and its allies have expanded their attacks, including against veterans groups that defended Lykos’s application and psychedelic researchers at Johns Hopkins University.

    Lykos’s application for MDMA-assisted therapy is not dead. The company met in mid-January with F.D.A. officials to discuss a path forward. Executives said that would most likely include an independent review of its data and another clinical trial that could add years and millions of dollars to the process.

    Some advocates hope that the Trump administration will take a friendlier approach. They note that Elon Musk, a presidential adviser, and Robert F. Kennedy Jr., the nominee for health secretary, are vocal supporters of psychedelic medicine.

    Jonathan Lubecky, a retired U.S. Army sergeant and a psychedelic medicine policy advocate, said he believed MDMA would eventually be approved. But he worried about the capacity of Psymposia and its allies to damage a field still in its infancy.

    He also worries about people with PTSD who have fallen into despair since the F.D.A.’s rejection.

    “I see the consequences in my friends,” he said. “Some, quite frankly, are trying to decide whether they should stick around long enough to see it happen.”

    Dr. Devenot has not been shy about claiming credit for derailing the approval of MDMA-assisted therapy.

    “Yesterday, beyond my wildest expectations, we made international news in a David and Goliath-scale, ‘dark horse’ victory,’” Dr. Devenot wrote on X last June.

    Founded in 2014 as a nonprofit media organization offering “leftist perspectives on drugs, politics and culture,” according to its website, Psymposia has been widely credited for bringing attention to sexual abuse, especially in underground settings, within the nascent field of psychedelic medicine.

    The group has no paid staff and operates as an informal collective of psychedelic industry watchdogs united by their “desire to disrupt the status quo,” Brett Greene, a former member of the organization and one of its founders, said on a podcast in 2016.

    In an interview, Dr. Devenot, the group’s most high-profile member, said Psymposia was largely focused on “making things safer” for those who use psychedelics and highlighting abuses that others in the field were unwilling to address.

    Dr. Devenot, a self-described expert in psychedelic bioethics who uses gender neutral pronouns, often refers to their experience as a sexual assault survivor whose healing was aided by psychedelics. After being “bullied out of the mainstream” psychedelic movement, Dr. Devenot said they connected with other “very marginalized” individuals at Psymposia.

    Dr. Devenot’s writings paint a dark portrait of the field. In a recent article, Dr. Devenot argued that “global financial and tech elites are instrumentalizing psychedelics as one tool in a broader world-building project that justifies increasing material inequality.”

    For many Psymposia contributors, Lykos is Public Enemy No. 1, in part because of the company’s origins as a for-profit arm of MAPS, an organization whose founder, Rick Doblin, has long promoted psychedelics as a tool for healing humanity.

    For Psymposia, MAPS’s decision in 2014 to create a corporate entity betrayed those values. Dr. Doblin has said the organization could no longer rely on philanthropy to fund MDMA’s regulatory review and a post-approval marketing process that can cost hundreds of millions of dollars.

    Despite Psymposia’s modest resources, its members have become feared for their ability to use social media to damage reputations and careers, according to more than four dozen academic researchers, clinicians, industry executives, mental health advocates and former Psymposia members who were interviewed for this article.

    Many asked not to be named for fear of retaliation.

    “Even the name Psymposia causes a pang of anxiety,” said Robin Carhart-Harris, a leading psychedelics researcher at the University of California, San Francisco. “Doing this interview, I’m worried: Am I kicking the hornet’s nest?”

    Another Psymposia activist, David Nickles, describes himself as an underground researcher and an anarchist. Mr. Nickles, whose legal name is David Maliken, according to court documents, has written critically about veterans and the police.

    In an interview, Mr. Nickles declined to discuss the use of a different name.

    Ido Hartogsohn, a historian and sociologist of psychedelic science at Bar-Ilan University in Israel, served as a peer reviewer for a paper written by members of Psymposia. He said that the group early on played an important role highlighting abuses in the field but that he had become disenchanted by its tactics.

    “Psymposia makes some valid points,” he said. “But their work is glaringly political, and biased, and it relies too much on shock effect, bad-faith readings of others and questionable assumptions and assertions.”

    In a 2018 Facebook post that has since been deleted, Mr. Nickles outlined strategies for damaging psychedelic companies and nonprofits through persistent, critical media coverage and sabotaging “business operations in ways designed to raise the costs of operating,” according to a screenshot of the post.

    The group has become known for its take-no-prisoners approach.

    In 2019, Psymposia activists criticized Beatriz Labate, executive director of the Chacruna Institute for Psychedelic Plant Medicines, an educational nonprofit, after her organization published a series of interviews about sexual transgressions in the psychedelics community and included a man seeking forgiveness for past violations.

    Psymposia accused Dr. Labate of giving a platform to an “abuser,” she said, adding that Mr. Nickles published private emails between them in what she said was an effort to paint her in a bad light.

    The fallout was immediate, she said, with speakers and sponsors pulling out of a conference she had been organizing, and disinviting her from other events.

    “I really felt my whole career was finished,” Dr. Labate said.

    Oriana Mayorga, Psymposia’s former director of community engagement, said she also experienced the group’s wrath not long after leaving the organization.

    Ms. Mayorga, who is of Latin American and Caribbean descent, said Psymposia’s leaders sought retribution after she criticized on social media a post by Mr. Nickles that accused MAPS of perpetuating “white supremacy, capitalism and imperialism.”

    Days later, Mr. Nickles, Dr. Devenot and Lily Kay Ross, who is married to Mr. Nickles, sent a 28-page letter to administrators at the university where Ms. Mayorga was enrolled, accusing her of “discrimination, bullying and intimidation.” The 2020 complaint included transcripts of Ms. Mayorga’s public talks, screenshots from her social media accounts, and text and email messages between Ms. Mayorga and her former colleagues.

    In an interview, Dr. Ross said that they had contacted Ms. Mayorga’s university to provide her an opportunity “for education and growth.”

    The letter did not result in disciplinary action, but Ms. Mayorga said the experience was devastating. She largely withdrew from the field and no longer has an online presence.

    “They’ve hurt people like me 10 times more than the good work they believe they’ve done,” she said.

    Psymposia’s reputation was elevated in 2021, when a podcast it produced with New York magazine on abuses in the world of underground psychedelic therapy became popular on Spotify.

    The podcast highlighted an ethical violation that occurred in an early Lykos trial that was not part of the company’s F.D.A. application, when a husband-wife therapy team in Canada spooned and cuddled a participant, Meaghan Buisson, during her MDMA session.

    After the trial concluded, the male therapist, Richard Yensen, began a sexual relationship with Ms. Buisson. In 2018, Ms. Buisson filed a civil claim in British Columbia saying that Mr. Yensen had sexually assaulted her. The case was settled out of court.

    After learning of the violation, MAPS notified health authorities in the United States and Canada and barred the two therapists from its programs. The organization publicly addressed the incident in 2019 in a statement.

    The podcast did not provide evidence of systemic problems in Lykos’s trials, but it helped fuel rumors of rampant misconduct. Psymposia’s approach had another impact, too: It cleaved the small, close-knit psychedelics community.

    “If you don’t agree with their view on a particular issue or say anything that deviates from the narrative they’re pushing, you’re automatically labeled as supporting sexual assault or being ethically questionable,” said Manesh Girn, a neuroscientist at the University of California, San Francisco.

    Dr. Ross said the problem was not Psymposia’s approach, but the psychedelic community’s reluctance to engage with the issues that Psymposia was highlighting.

    As the F.D.A.’s advisory panel meeting approached, Psymposia ramped up efforts to thwart Lykos’s application.

    It found an audience at the Institute for Clinical and Economic Review, or ICER, an independent nonprofit that evaluates the clinical and cost effectiveness of new medical interventions.

    The opening pages of the institute’s report on Lykos’s application detailed many of the ethical concerns raised by Psymposia.

    Days before the committee meeting, Dr. David Rind, ICER’s chief medical officer, emailed several members a link to five public testimonies, four provided by Psymposia affiliates. He described the allegations as “very disturbing.”

    In an interview, Dr. Rind said that the institute had not conducted its own investigation but was hoping that the F.D.A. would follow up.

    Around the same time, Dr. Devenot submitted a petition to the F.D.A. urging it to extend the public session to accommodate speakers who they said would detail data fraud, systematic misreporting of adverse events and of enabling “entrapment, sexual abuse and coercive control” by Lykos.

    “If the F.D.A. again prioritizes industry interests over public health,” the petition said, “the outcome could mirror the trajectory of OxyContin, which was also once promoted as a wonder drug offering relief from chronic suffering.”

    The F.D.A. agreed to extend the hearing.

    Of the 32 speakers, 10 opposed Lykos’s application. Seven of those 10 were affiliated with Psymposia, though none mentioned their connection to the group.

    During the daylong meeting, panelists repeatedly raised questions about Psymposia’s misconduct claims.

    One advisory member voted in favor of Lykos’s application — the sole panelist with expertise in psychedelic medicine.

    Even though Psymposia did not provide evidence to back up its allegations of widespread wrongdoing, Amy Emerson, the former chief executive of Lykos, said the speakers succeeded in shaping the narrative.

    “They were able to prey on the fears of people in government who care about reputational risk,” she said. Ms. Emerson resigned shortly after the F.D.A. denied approval.

    In their public testimony, Dr. Devenot repeated an explosive accusation they had shared with ICER: One of the therapists who took part in Lykos’s clinical trials, Veronika Gold, had admitted to pinning down a screaming patient.

    But the incident, detailed in a book chapter Ms. Gold wrote, involved ketamine, not MDMA. And rather than being “pinned down,” Ms. Gold said the patient was consensually pushing against her hands, which were passively raised.

    Dr. Devenot also testified that Ms. Gold had used a similar practice with a clinical trial participant. Ms. Gold said the incident did not happen, a claim backed up by Lykos, which said it reviewed videos of her therapy sessions.

    The accusations, repeated in the media, were damaging, she said. “People have expressed concerns about my ethics and practice,” Ms. Gold said.

    Concerns about the organization’s ability to disrupt the field have mounted in recent months after a public relations firm began amplifying Psymposia’s and Dr. Devenot’s allegations of malpractice against Lykos. Dr. Devenot declined to say who was funding the group’s work.

    Another longtime Psymposia ally, Sasha Sisko, has been pressuring academic journals to retract studies based on Lykos’s clinical trials. In August, the journal Psychopharmacology retracted three studies that contained data from the session with Ms. Buisson.

    Lykos disagreed with Psychopharmacology’s decision, saying a correction to the papers would have sufficed.

    Mx. Sisko, who uses gender-neutral pronouns, has also criticized Lykos trial participants who have spoken favorably about their experiences.

    Becca Kacanda, who posted about her treatment on X, said Mx. Sisko criticized her on the platform and wrote in a direct message that she had undergone a “whack-a-doodle nonsense ‘therapy.’”

    Ms. Kacanda said Mx. Sisko seemed to be fishing for information to use against Lykos and trying to “gaslight” her about her trial experience.

    “I am not trying to silence cases of abuse or constructive critiques,” Ms. Kacanda said. “But Psymposia does not have the good faith intentions that they are presenting themselves to have.”

    Mx. Sisko declined to be interviewed on the record for this article.

    After the F.D.A. decision, Mr. Nickles and Dr. Ross made a surprising announcement of their own: They were starting their own group.

    The reason: Psymposia, they said, had engaged in undisclosed unethical behavior.

    Rachel Nuwer is a longtime freelance science writer for The Times.



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  • Kennedy’s Plan for the Drug Crisis: A Network of ‘Healing Farms’

    Kennedy’s Plan for the Drug Crisis: A Network of ‘Healing Farms’


    Though Mr. Kennedy’s embrace of recovery farms may be novel, the concept stretches back almost a century. In 1935, the government opened the United States Narcotic Farm in Lexington, Ky., to research and treat addiction. Over the years, residents included Chet Baker and William S. Burroughs (who portrayed the institution in his novel, “Junkie: Confessions of an Unredeemed Drug Addict”). The program had high relapse rates and was tainted by drug experiments on human subjects. By 1975, as local treatment centers began to proliferate around the country, the program closed.

    In America, therapeutic communities for addiction treatment became popular in the 1960s and ’70s. Some, like Synanon, became notorious for cultlike, abusive environments. There are now perhaps 3,000 worldwide, researchers estimate, including one that Mr. Kennedy has also praised — San Patrignano, an Italian program whose centerpiece is a highly regarded bakery, staffed by residents.

    “If we do go down the road of large government-funded therapeutic communities, I’d want to see some oversight to ensure they live up to modern standards,” said Dr. Sabet, who is now president of the Foundation for Drug Policy Solutions. “We should get rid of the false dichotomy, too, between these approaches and medications, since we know they can work together for some people.”

    Should Mr. Kennedy be confirmed, his authority to establish healing farms would be uncertain. Building federal treatment farms in “depressed rural areas,” as he said in his documentary, presumably on public land, would hit political and legal roadblocks. Fully legalizing and taxing cannabis to pay for the farms would require congressional action.

    In the concluding moments of the documentary, Mr. Kennedy invoked Carl Jung, the Swiss psychiatrist whose views on spirituality influenced Alcoholics Anonymous. Dr. Jung, he said, felt that “people who believed in God got better faster and that their recovery was more durable and enduring than people who didn’t.”



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