Allen Curreri examines AI's presence in mental health care, and makes a case for greater clinical empathy in medical practice.

1. Can Robots Comfort? An Exploration of AI in Mental Health
Can human empathy exist without a human? In the medical field, innovators are determined to
find out. Within the last few months, a new mental health app has entered into the medical
self-help arena to support those suffering from common mental health conditions such as
depression and anxiety. Engineered with empathy in mind and programmed to apply principles
of cognitive behavior therapy without the input of a human psychologist, ​Woebot​ is meant to
serve as a trusted (virtual) companion through the Facebook Messenger app. While originally
designed for college students, the chatbot has since been expanded to support adults of all ages
through trying times as a readily-available conversational companion. Through the excitement,
however, medical professionals and patients alike are left to wonder - will empathy delivered
through an automated program have the same therapeutic effect as the care provided by a
human doctor?
It's certainly an interesting question to ask, given the current discourse in the medical field
about the role empathy should have in doctor-patient interactions. As I've written before,
dispassionate treatment is often seen as more appropriate than empathetic care. In fact,
according to a review published in ​Academic Medicine​ in 2011, ​empathy tends to decline​ in
medical school years as doctors strive towards a dispassionate professionalism, suggesting that
detachment is a trained, rather than intuitive, state for doctors. Despite the stigma of
unprofessionalism, however, numerous studies have found that ​empathy actually improves
patient satisfaction​ and even - in one ​2011 study concerning diabetics​ - patient outcomes.
So where does this need for empathy leave us in the mental health field, wherein trust and
connection between patient and caregiver is vital for treatment? Let's return to the basics for a
moment, and define the term within a medical context. ​Clinical empathy​, as described by an
article published in the ​British Journal of General Practice​ is: "an ability to: (a) understand the
patient's situation, perspective, and feelings (and their attached meanings); (b) to communicate
that understanding and check its accuracy; and (c) to act on that understanding with the patient
in a helpful (therapeutic) way. " With this in mind, the modified question left to us as patients
and medical professions remains: Can a program enact ​clinical​ empathy effectively without use
of a human practitioner?
With this question in mind, we should return to our examination of Woebot. As a conversational
partner, Woebot is meant to be charming and funny, but never intends to fool its human user
into thinking of it as a person. It weaves reminders of its AI nature into its ​jokes and
commentary​, and is intended to function more as a receptive sounding board than psychologist.
As ​Woebot Labs CEO Alison Darcy​ commented for ​MobiHealthNews​, “[Woebot] helps people
think, and they can start to learn more about how they function in the world with these emotions
and thoughts.” In other words, Woebot is a mental health aide, rather than a venue for
therapeutic care. Isolated as it is from any human professionals, the best Woebot can do when
faced with an at-risk user is to offer the number to a hotline: a direct link to human empathy.

2. Machines such as Woebot can mimic human empathy and ​offer conversational companionship​,
but I think that ​clinical​ empathy remains firmly under the purview of human doctors. At its
core, Woebot is a tool - a sounding board. It applies principles of cognitive behavior therapy to
encourage users to verbalize their thoughts and understand their feelings, and is effective in its
efforts to do so. However, it cannot take the place of a full-fledged therapist who has the
capability to pick up the nuances of subtext and body language and “act on their understanding
with the patient.” Given this, clinical empathy is beyond the reach of automation and in the
hands of doctors. Moreover, I believe that the entry of AI into empathy calls for us to reconsider
our conceptions of “professionally” dispassionate care in human medicine. This pivot towards
automated empathy displays patients’ human need for understanding and connection in their
care. Knowing this, I wonder if we aren’t in some way missing the mark by continuing to prize
“dispassionate” professionalism over emotional connection in medicine. Perhaps programs can
deliver human empathy without the human - but I would argue that in care, clinical empathy
always places human doctors as the most effective and connective sources of care.