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

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

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Publication Details

Journal
Medicine Health Care and Philosophy
Published
2026-05-02
DOI
https://doi.org/10.1007/s11019-026-10354-2
Primary Topic
Digital Mental Health Interventions
Type
article
Field-Weighted Citation Impact
0.00

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article

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

Hugh Brosnahan, Izabela Lipińska
Medicine Health Care and Philosophy
Digital Mental Health Interventions
article

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

Hugh Brosnahan, Izabela Lipińska
article en

Abstract

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

Medicine Health Care and Philosophy
University of Otago (NZ)
University of Otago
Peace, Justice and strong institutions
Openalex Percentile: Top 9%
Digital Mental Health Interventions
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