Speaking to no one: ontological dissonance and the double bind of conversational AI.
Medicine, health care, and philosophy May 2, 2026 Hugh Brosnahan, Izabela Lipińska 1 citation
Sustained interaction with conversational AI can, in a small subset of users, contribute to the emergence or stabilization of delusional experience. Existing explanations attribute this to individual vulnerability or safety failures, but this paper argues 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 stabilize into a technologically mediated analogue of folie à deux. This account explains why explicit disclaimers often fail to disrupt delusional involvement and clarifies ethical and clinical implications.