Speaking to no one: ontological dissonance and the double bind of conversational AI.
Hugh Brosnahan, Izabela Lipińska
Medicine, health care, and philosophy May 2, 2026 Peer reviewed DOI: 10.1007/s11019-026-10354-2 via PubMed
Summary
Sustained interaction with conversational AI can, in a small subset of users, contribute to delusional experiences. Existing explanations focusing on individual vulnerability or safety engineering failures are incomplete. Drawing on phenomenology, psychiatry, and cognitive neuroscience, this paper argues the risk arises from the interaction's relational and ontological structure. Conversational AI creates ontological dissonance: a conflict between appearing relationally present and lacking a subject to sustain it.
Study at a glance
| Design | theoretical or philosophical paper |
|---|---|
| Key finding | The risk of delusional experience from conversational AI arises from the relational and ontological structure of the interaction itself, specifically ontological dissonance maintained through a communicative double bind and attentional asymmetries. |
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.