Izabela Lipinska

Hugh Brosnahan, Izabela Lipinska

Recent reports indicate that sustained interaction with conversational artificial intelligence (AI) systems can, in a small subset of users, contribute to the emergence or stabilisation of delusional experience. Existing accounts typically attribute such cases either to individual vulnerability or to failures of safety engineering. These explanations are incomplete. Drawing on phenomenology, psychiatry, and cognitive neuroscience, this paper argues that the risk arises from the relational and ontological structure of the interaction itself. Conversational AI generates ontological dissonance: a conflict between the appearance of relational presence and the absence of any subject capable of sustaining it. Maintained through a communicative double bind and amplified by attentional asymmetries, this dissonance tends, under conditions of affective vulnerability, to stabilise into a technologically mediated analogue of folie a deux. This account explains why explicit disclaimers often fail to disrupt delusional involvement and clarifies the ethical and clinical implications for the design and use of conversational AI.

Izabela Lipinska, Hugh Brosnahan

This paper argues that contemporary large language models (LLMs) can contribute to psychotic involvement by creating interactions that resemble the relational dynamics of folie a deux. Drawing on Bateson's double bind theory, clinical literature on shared psychotic disorder, and McGilchrist's hemisphere theory, we show how the combination of high linguistic coherence and the absence of an underlying subject produces a structural tension for the user: language suggests an interlocutor, while intuition registers a void. In contexts of emotional need or instability, this tension can lead users to resolve the conflict through imaginative projection, attributing interiority, intention, or presence to a system that possesses none. The paper situates these dynamics within emerging clinical reports, develops a phenomenological account of how they unfold, and argues that current engagement-optimised design choices exacerbate the risk. We conclude by proposing 'ontological honesty' as a necessary design principle for mitigating technologically mediated folie a deux.