AI-associated psychosis has been linked to folie à deux, in which delusions are shared between two people.

Although folie à deux is rare, "digital folie à deux" is becoming increasingly common.

AI-associated psychosis may be a "canary in a coalmine," portending false beliefs shared on a massive scale.

With increasing awareness of AI chatbot-associated psychosis and efforts to understand how it occurs, there has been renewed attention to the psychiatric phenomenon of folie à deux, meaning “madness of two.” Offering commentary for a news article back in September, I noted that the two syndromes do have some similarities.1 Since then, researchers speculating on mechanisms of AI-chatbot associated psychosis have likewise suggested that it amounts to “digital”2 or “technological” folie à deux.3

Delusional dyads, digital folie à deux, and spiralism

Folie à deux is a term that has been used in psychiatry to describe the phenomenon of delusions shared between two people. Since delusions, by definition, are typically unshared and therefore idiosyncratic to an individual, this rare syndrome usually occurs when a primary, dominant individual with delusions is able to convince a secondary, subordinate individual (e.g., within a family or an intimate relationship) that the delusions are true. Traditionally, the secondary individual isn’t thought to be mentally ill or even delusional per se, so much as impressionable. Accordingly, their treatment has historically involved separation from the influence of the primary individual.

In folie à deux, the transmission of a delusion typically occurs in one direction, from the primary delusion individual to the impressionable secondary individual. I first witnessed this dynamic when I was a psychiatric resident in training years ago—a woman and her 10-year-old son were both admitted to the hospital due to psychosis that included paranoid delusions. The mother, who was diagnosed with schizophrenia, justified her delusions based on her own subjective, inner experiences. But her son, who had few social contacts beyond his mother, had no real symptoms of mental illness. Instead, he just trusted, believed, and parroted what his mother had........

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