Over time, it becomes evident that the decisions made in boardrooms carry their greatest weight in those very moments. It would take years to understand it fully, but these moments were not isolated. They were the foundation for something I would later try to give voice to.

The Day the Ordinary Disappeared

In January 1975, I was traveling through Paris on my way to the United States. What should have been a routine journey became something else entirely. Terrorists fired two RPG shells at our plane. They missed us but struck a Yugoslav Airlines JAT aircraft on the tarmac nearby.

The randomness of it all was almost impossible to process. One moment, you are a traveler moving through the world, the next, you are told to hug the floor of the aircraft, confronted with how easily that world can be altered or taken away. I did not have the language for it then; however, I carried the feeling forward. Life is not guaranteed. It is a gift given to us to deploy.

In 1978, I was leading the first Think Tank Peace Mission to Egypt and Israel. There were no direct flights between the two countries. From Cairo, we flew to Cyprus, then to Tel Aviv.

An Air Cyprus flight had landed just before ours. It was overtaken by terrorists. An Egyptian Entebbe-like rescue was attempted. It failed. When we landed hours later, the aftermath was still there — the remains of the Egyptian military C-130 sat on the tarmac, destroyed and covered. It reinforces the adage, “that timing is everything.”

You do not process it fully in the moment. You carry it. An appreciation for what lies beyond our control. A respect for those who act with purpose, regardless of outcome. An understanding that we plan for the future, yet we live in the moment.

Years later, during my military service as a paratrooper and combat medic, that lesson was no longer abstract. It was immediate, urgent and often unfolding before me. I served six frontline combat tours in Lebanon, in places where the noise of conflict was constant and the margin between survival and loss was measured in inches.

I tended to friends and foes under fire. In those moments, there was no room for theory. Care was not a matter of courage or a concept; it was an instinctive action. Communication was not a strategy; it was survival. A word, a look, a clear instruction could steady someone, guide them and save them.

Where Care Is Action, Not Theory

War has a way of stripping away everything except what matters most. You see clearly how dependent we are on one another. You understand that courage is not the absence of fear; it is the determination to act despite it. You learn that presence, simply being there for another person in their most vulnerable moment, is one of the most powerful forms of care.

I thought I understood risk. I thought I had come to terms with uncertainty. Then life reminded me again.

On a flight to visit my parents in the United States, the Tower Air jet I was on caught fire over the Atlantic. Two engines on the left side were burning. We needed to find a place to land quickly or hit the ocean. There is a particular kind of silence that fills a plane in that moment. It is not panic. It is something deeper, more introspective. You feel time stretch. You think about the people you love. You consider what has mattered and what has not.

As we made our emergency landing in Gander, Canada, I remember not relief first, but reflection. Once again, life had placed me in a moment where its fragility was undeniable.

These experiences did not turn me away from the world. They pulled me closer to it. They shaped how I see people, how I listen and how I respond. They taught me that every interaction carries weight, that every conversation can matter more than we realize.

In recent years, I have traveled to Ukraine annually before and during COVID and now during the war, supporting friends and spending time in a small community facing circumstances most of us can only imagine from afar. There, I saw the same truths I had encountered earlier in life. Community becomes everything. Information becomes lifeblood. People look to one another not only for physical support, but for clarity, reassurance and meaning. Even in the darkest conditions, communication is not secondary to care. It is part of care.

Most in the business world know me through my work at FINN Partners as a health communicator, through my writing, speaking and advocacy as a champion of health innovation and a more human-centered health system. They see my professional journey. What they do not always see is the foundation beneath it. Decades of lived experience that have reinforced, time and again, that life is precious, that it can change in an instant and that how we show up for one another in those moments defines us.

At FINN Partners, I have found a community of colleagues who reflect these same values. There is an understanding that our work carries responsibility, and that we are capable of more when we challenge ourselves to rise to it. It is a culture that encourages each of us to think beyond the immediate and contribute to something more enduring.

That understanding became even more personal through my family. My wife and I have walked alongside our child as she navigates the complexities of a rare disease. There are highs and there are lows. There are moments of hope and moments of uncertainty. In those experiences, I have seen health care from another vantage point, not as a cohesive system, but as a series of human interactions that can either comfort or compound the challenge.

When you are a parent in those moments, you listen differently. You look for clarity in every word. You hold on to empathy when it is offered and you feel its absence when it is not. You come to appreciate that communication in health is not an accessory. It is essential. It shapes understanding, trust and the ability to move forward.

The Human Thread Through Every Moment

All of these experiences converge into a single, enduring belief. Communication is not separate from care. It is how care travels along its continuum. There are moments when that truth reveals itself outside the settings we expect.

On a transatlantic flight in 2001, turbulence turned severe. At one point, a call came over the intercom: “Are there any doctors aboard?” No one responded. Minutes later, the request broadened to “any health professionals.”

My wife looked at me and quietly suggested I press the call button.

I was escorted to a passenger, pale and wrapped in a blanket. He had lost and regained consciousness. I introduced myself warmly and began with simple questions to assess his awareness. His name. The President of the United States. The day we had taken off. He answered each one without hesitation. His vitals were stable.

I explained that I was not a physician, but a former military EMT. Given the turbulence and the length of the flight, dehydration and stress were likely contributors. I reassured him and suggested that he follow up with his physician upon landing and, if he needed me, not to hesitate to hit his call button.

As I returned to my seat, a man two rows behind called out, “I’m a neurologist. I would have handled that exactly as you did.”

It was meant as an affirmation. I received it that way. Yet it lingers differently. In that moment, the instinct to act had been replaced by the comfort of waiting. The systems we build, even when grounded in expertise, can condition us to hesitate when action is needed most.

In moments like these, care is not a title or a credential. It is the willingness to engage, communicate, and act.

Across the health ecosystem and in responsible business settings, success is often measured by growth, scale and financial performance. These are necessary markers of progress. They enable innovation, access and reach. However, there is a deeper measure that often goes unspoken. When we understand our role within the continuum of care and recognize the connection between balance-sheet decisions made in boardrooms and people’s experiences felt at the bedside, our work takes on greater meaning. It moves beyond what can be counted to what ultimately counts.

Over time, I came to understand that moments are not separate. They are connected. Each one revealing, in its own way, what happens when people are seen, heard and cared for, and what happens when they are not.

That understanding became Healing the Sick Care System: Why People Matter.

A life of observing, listening, engaging and caring was the kindling. The moments themselves were the spark. Together, they revealed a simple truth: when we lose sight of people, the system falters. When we honor them, it begins to heal.

That truth asks something of us.

It is not simply about words. It is about presence. It is about accountability. It is about the choice to act when action is needed. This is how humanity shows up in systems, and how those systems, in turn, earn the trust of the people they are meant to serve.

The post The Moments That Shape Us: Why Life and People Matter Most appeared first on Medika Life.

One example would be pain. Research published in the Journal of Neuroscience found that when people didn’t know how much a painful heat stimulus would hurt — when they watched a group of others who disagreed wildly about it — they felt more pain than when the group agreed. The heat itself didn’t change. Only the uncertainty did. That single finding opens a door onto something much bigger: the way the brain interprets incoming signals doesn’t just affect physical pain. In fact, it shapes every experience, every emotion, and every belief we form about the world around us.

The Brain Is a Prediction Machine, Not a Camera

Your brain doesn’t work like a camera, passively recording what’s in front of it. It works more like a detective — making its best guess about what’s happening based on past experience, context, and whatever signals it can pick up in the moment. In fact, this is the way AI works the same way because it guesses what you intend when you are dictating to it. That’s based on what you have known to use before. It’s not original; it’s from something you’ve already said or thought.

Scientists call this predictive processing. Fancy words for something that’s simple. The brain is constantly generating a model of reality and checking it against what the senses report. Most of what you experience isn’t raw sensory data. It’s the brain’s best guess, already processed and interpreted before you’re even aware of it.

This has enormous consequences. Because your brain fills in gaps with guesses, your perception of any situation is shaped as much by what you expect as by what’s actually there. Research on how emotions are built in the brain confirms this same pattern. Feelings aren’t simple, automatic reactions that arise out of nowhere. They’re constructed — assembled by the brain from past learning, bodily signals, and whatever the surrounding context suggests is happening — all woven together into something that feels completely immediate and real. Fear, hope, dread, excitement — none of these are just responses to the world. They’re interpretations. And like all interpretations, they can be mistaken.

This might be unsettling to hear. But it’s also genuinely freeing, because it means your perception of reality isn’t fixed. It can be trained.

The Brain’s Thumb on the Scale

Here’s the catch. The brain doesn’t interpret experiences evenly. It has a strong, built-in bias toward the negative. This explains why negative information is so strongly entrenched in our minds. Negative information is stored more vividly in memory and carries more weight in the decisions we make than equivalent positive information does. This isn’t a character flaw. It’s an evolutionary feature.

Our ancestors survived by treating ambiguous situations as dangerous — if a rustle in the bushes might be a predator, it was safer to assume the worst and run. The cost of a false alarm was low; the cost of missing a real threat could be fatal.

In modern life, that same wiring creates serious problems. We’re exposed to more alarming information than any previous generation — not necessarily because the world is more dangerous, but because we carry a device in our pockets that streams us the worst of humanity around the clock. Research on how news consumption affects perception found that a steady diet of threatening content actively cultivates a distorted view of the world, pushing people to overestimate danger (The Scary World Syndrome) and feel a constant sense of impending doom that doesn’t match their actual circumstances.

In one study on risk perception during a health crisis, people overestimated their personal risk of dying from a disease by more than 270 times the actual probability. Their brains weren’t computing risk. They were amplifying fear.

Uncertainty makes all of this worse. Much worse. The same research that revealed how uncertainty increases physical pain also showed that not knowing what to expect activates a specific brain region — one that amplifies the intensity of an experience, for better or worse. And this effect isn’t limited to physical sensation.

Research on stress and health outcomes has found that the threat of losing a job can actually be more damaging to physical health than losing it outright, because the brain treats an uncertain threat as something to brace against continuously — a draining, exhausting posture that takes a real toll on the body over time. Sounds like burnout, doesn’t it? It isn’t just pain that uncertainty turns up. It’s almost everything the brain interprets as potentially threatening, which, given the negativity bias, covers a whole lot of ground.

What makes this particularly important in today’s world is that this feedback loop isn’t passive. The beliefs we form — shaped by perception, fear, and repeated exposure to alarming information — circle back and filter what we’re willing to notice next.

Research on how beliefs affect the brain’s processing of sensory information suggests that what we expect to see and feel actually controls what reaches our conscious awareness. Our beliefs aren’t just conclusions we reach. They become part of the filter that determines what evidence the brain even considers. This is like throwing the wheat away with the chaff.

What You Can Actually Do About It

Understanding how the brain constructs experience isn’t just interesting. It points directly to what we can do differently.

The first step is recognizing that your interpretation of a situation isn’t the same thing as the situation itself. When you feel dread about a conversation you haven’t had yet or are certain something’s going to go wrong, your brain is filling in a gap with a guess — shaped by past experience, current stress, and the negativity bias — not delivering a reliable preview of the future. That awareness alone, when you can genuinely hold onto it, changes your relationship with the feeling. You don’t have to argue with it or push it away. You just don’t have to treat it as truth.

The second step involves what you feed your brain. Because the brain builds its models of the world out of the patterns it encounters most often, the information environment you live in genuinely shapes how you perceive things — including things that have nothing directly to do with that environment. Heavy exposure to alarming content trains the brain to scan for threats even in neutral situations. Seeking out different perspectives, sitting with ambiguity instead of rushing to resolve it, and spending time in environments where uncertainty is met with curiosity rather than alarm — these gradually reshape the models your brain is running.

The third step is learning to treat uncertainty itself differently. That’s harder than it sounds, because not knowing really activates stress responses that narrow attention and make everything feel more urgent and more threatening. But evidence consistently shows that people who can stay open when they don’t know what’s coming — who can resist the pull toward premature conclusions — think more flexibly, solve problems more creatively, and make sounder decisions. The ability to hold more than one interpretation in mind at once isn’t a fixed personality trait. Like any other cognitive skill, it responds to practice.

None of this is an argument for forced optimism or pretending that hard things aren’t hard. Negative emotions carry real information and serve genuine purposes when they’re in proportion to what’s actually happening. The goal isn’t to replace one distortion with another. It’s important to notice when the brain’s interpretive machinery is running hot — turning not-knowing into catastrophe, amplifying uncertainty into doom — and to remember that what feels like reality is always, to some degree, something the brain has made.

The world you live in isn’t the world as it is. It’s the world your brain has built for you, piece by piece, out of everything it expects, fears, and has learned to look for. That’s not a reason for despair. Actually, it’s an invitation to get curious about the builder — and to ask whether the story it’s been telling you still has to be the only one.

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Early in the book, Nosta writes, “The solved can never touch the whole.”  That line lingers. It captures the essence of his argument. AI can solve, generate, synthesize, and accelerate. Yet something about the human experience of thinking, the struggle, the friction, the meaning-making, exists beyond resolution.

This tension defines the book. It is not anti-technology. Nosta is deeply engaged with AI and candid about its value. He describes large language models as tools that “move faster and connect more disparate concepts than our minds could ever manage on their own.”  He is equally clear that this capability introduces a subtle risk. We may begin to outsource not just tasks, but thought itself.

That distinction matters more than many may be willing to admit.

From Tools to Thought

One of the most compelling contributions of The Borrowed Mind is its framing of AI not as the next step in computing, but as a turning point in cognition. Nosta traces a clear arc. Gutenberg unlocked words. Google unlocked facts. AI, he argues, is unlocking thought. 

That progression is elegant, yet also unsettling. Words and facts could be externalized without fundamentally altering the structure of human reasoning. Thought is different. It is intimate. It is identity. It is how we become.

Nosta reminds us that thinking once required effort, a type of natural friction that created sparks of innovation. “The distance between question and answer created space for our discernment.”  Within that space, judgment formed, curiosity deepened, and understanding took root.

AI compresses that distance. It removes friction. It delivers coherence with remarkable speed.  One of the book’s most important insights emerges here. Coherence is not the same as understanding.

Nosta introduces the concept of “anti-intelligence,” describing it as “fluency without understanding. Coherence without experience.”  AI does not think. It mirrors the structure of thinking. It produces language that resembles reasoning without sharing its origin.

In health, where evidence, interpretation, and judgment must coexist, this distinction is not academic. It is operational. It shapes how clinicians trust tools, how leaders deploy them, and how patients ultimately experience care.

The Seduction of the Socratic Mirror

One of the most original sections of the book is Nosta’s description of the “Socratic Mirror.” He draws a parallel between classical dialogue and modern AI interaction. Socrates asked questions to surface the truth. AI, in a different way, reflects our thinking back to us, reframed, extended and sometimes clarified.

Nosta writes that the model “…does not tell me what to think but creates the conditions under which my own thinking could deepen.” This is where the book moves beyond critique and into possibility.

Used well, AI becomes a cognitive partner. It expands perspective, accelerates exploration, and invites iteration. In clinical research, patient engagement, and system design, this capacity holds enormous promise.

Nosta does not romanticize the relationship. He recognizes its asymmetry. The model has no interior life. It does not ponder. It does not carry consequence. It does not bear responsibility. That responsibility remains human.

Rethinking the Fear of Displacement

A persistent anxiety runs beneath every conversation about AI. Many fear it will become a job slayer, a force that displaces rather than elevates human contribution. That concern is understandable, yet not new.

Every meaningful advance in technology has reshaped how people work. The wheel did not eliminate labor. It redefined movement. The stethoscope did not replace physicians. It extended their ability to listen and interpret. The tollbooth transponder did not end transportation roles. It changed the flow and focus of human involvement. Each innovation shifted roles, demanded new skills, and expanded what people could do.  AI belongs in that lineage.

What distinguishes this moment is not the elimination of work, but the redistribution of cognitive effort. The real risk is not that machines will think for us, but that people may become less inclined to think for themselves. Nosta’s warning is subtle yet profound. Surrendering curiosity, judgment, and reflection to systems that generate answers with ease risks dulling the very faculties that define human intelligence.

This is why The Borrowed Mind is such an important read at this moment. It does not dismiss concerns around job displacement. It reframes it. The central challenge is not protecting roles as they exist today, but strengthening the uniquely human capacities no system can replicate. Creativity, discernment, ethical reasoning, and the ability to navigate ambiguity are not diminished by AI. They become more essential.

The book offers reassurance without complacency. The future of work will favor those who sharpen their thinking, engage deeply with ideas, and remain active participants in their own intellectual development. The machine is not the adversary. Neglecting the development of one’s own mind is a danger.

Composite Intelligence and the Limits of the Machine

Nosta introduces “composite intelligence” to describe the interaction between human and machine cognition. Composite does not mean blended into sameness. It means distinct contributions working in concert. The model brings speed and breadth. The human brings depth.

This triad becomes one of the most useful frameworks in this book. AI excels in velocity and scale. Depth, the slow transformation of understanding, remains human. As Nosta writes, “Models do not ponder.” 

In health, this distinction is profound. Data can inform. Algorithms can suggest. The act of deciding, especially in moments of uncertainty, requires something more. It requires what Nosta elevates as the defining human contribution. Virtue.

Drawing on Aristotle’s concept of practical wisdom, Nosta reminds us that judgment is forged through experience, consequence, and accountability. A model can generate options. It cannot live with outcomes.

This is where the book resonates most deeply for those working in health. Intelligence is becoming abundant. Discernment is becoming scarce and, therefore, more valuable.

The Risk of the Borrowed Mind

The book’s title is not metaphorical. It is a warning. Nosta argues that as engagement with AI deepens, internal dialogue begins to change. The model becomes a cognitive tuning fork, subtly shaping how questions are framed, how ideas are explored, and how answers are anticipated. This dynamic is not inherently negative. It can elevate thinking, accelerate learning, and make complex domains more accessible. Dependency remains the concern.

Reliance on generated thought risks weakening the muscle of original thinking. Access can be mistaken for understanding. Individuals may become, in Nosta’s words, “cognitive clones.” 

This concern is particularly relevant in health ecosystems already strained by time, complexity, and administrative burden. The temptation to offload cognitive work will be strong. The discipline to remain intellectually engaged will be essential.

A Book About AI That Is Not About AI

What makes The Borrowed Mind stand apart is that it is not ultimately about technology. It is about humanity. Nosta writes, “This book is not really about technology. It is about you.”  That idea anchors this work.

Readers are challenged to consider what it means to remain “the authors of our own minds.”  Not passive recipients of generated insight, but active participants in meaning-making.

This question sits at the center of the health ecosystem’s future. As AI becomes embedded in clinical workflows, research, and patient engagement, the issue is not whether it will improve efficiency. It will.

The deeper question is whether it will deepen humanity or dilute it. Will it create space for clinicians to think more deeply, connect more meaningfully, and act more wisely? Or will it create a system that values speed over reflection, output over understanding, and coherence over truth?

Nosta offers no simple answers. He offers a framework for asking better questions.

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In fact, there is a lot. Some of it requires help from your physician, but most depends on your lifestyle, preferably begun in midlife or even sooner. But it is never too late to start. Even with early evidence of developing dementia, making changes can be of tremendous help.

Details below, but the most important steps are regular exercise — resistance and aerobic, a high protein, high fruit, and vegetable, but low sugar diet, good sleep, reduced stress, no tobacco, limited alcohol, intellectual challenges, and social engagement, along with attention to high blood pressure, high cholesterol, and high blood sugar or diabetes.

The causes of dementia

It is best to think in terms of risk factors rather than direct causes. There are multiple types of dementia, but the most common is Alzheimer’s disease. It has many possible risk factors, often in combination, in any individual. Among the most important are high blood pressure, type 2 diabetes, elevated LDL cholesterol, obesity, high intake of ultraprocessed foods, being sedentary, not dealing with chronic stress, inadequate deep sleep, smoking, an unchallenged brain, and lack of social engagement.

Untreated high blood pressure damages the blood vessels supplying the brain, as does poorly controlled type 2 diabetes. Diabetes correlates with a 10 to 15 times greater risk of Alzheimer’s. Like the rest of the body, brain cells can become insulin-resistant, depriving them of their primary fuel—glucose —hence the term “type 3 diabetes.” Add to this elevated LDL cholesterol, which leads to plaque deposition in the large blood vessels, analogous to that seen in the heart’s coronary arteries.

Obesity is a definite risk factor, especially as it predisposes to diabetes, but also produces chemicals that cross the blood-brain barrier and cause inflammation. The combination of blood vessel damage and inflammation is clearly associated with the development of Alzheimer’s disease.

Being sedentary, along with eating excess ultraprocessed, sugary, fatty, and salty foods and smoking, are known to correlate with dementia, as does persistent lack of restorative sleep and continuing low-level chronic stress. Maintaining good muscle mass through appropriate exercise not only supports muscle and bone density but also releases chemicals that positively impact brain function. Substantial exercise literally enlarges the brain’s hippocampus and prefrontal cortex, both critical to cognition.

Among the presumably less important risk factors for dementia are some chronic infections, often undetected, such as chronic Lyme disease, which can cause persistent low-level brain inflammation. So too can a variety of neurotropic viruses, such as the varicella-zoster virus that causes chickenpox and shingles. The varicella-zoster virus (VZV) remains dormant in the nervous system after chickenpox infection but is reactivated in older age as herpes zoster (shingles). It is believed that this virus causes long-term chronic inflammation in the brain while dormant, and then amplifies inflammation when reactivated as shingles.

There are other causes of inflammation. An unbalanced colonic microbiome is common. There is a gut-brain axis, meaning the two systems send messages back and forth, which can be altered by the microbiome. This axis can help or hinder normal inflammation maintenance in the brain.

The gut bacteria convert high-fiber diets into short-chain fatty acids (SCFAs), which, in mice, lead to reduced microglial (the brain’s immune cells) activity and a lower degree of brain inflammation. Aging mice normally have reduced SCFAs, but a high-fiber diet increases SCFAs and reduces inflammation in their brains. The key message is that a healthy colonic microbiome can help to prevent the development of Alzheimer’s disease.

The mouth has its own microbiome. Chronic oral gum infections, known as periodontal disease, often go unrecognized, disrupting the oral microbiome and inducing a chronic state of inflammation that produces a steady flow of damaging chemicals that affect the brain. The bacterium Porphyromonas gingivalis is a frequent cause of periodontal infection, but it can also directly affect the brain. It produces a toxic enzyme called gingipain, which crosses the blood–brain barrier and directly damages neurons. P gingivalis has also been found in the brains of deceased Alzheimer’s patients.

Even the eye microbiome has been shown in a January 2026 article in Nature Communications to have an adverse impact on the brain if it includes Chlamydia pneumoniae, a common cause of pneumonia and sinus infections that, in some people, infects the retina and, from there, travels to the brain, amplifying inflammation.

Several environmental toxins have been implicated in Alzheimer’s development. Lead is a known neurotoxin. Once in the body, it can persist in bones. We tend to think of it in old lead paint, but it is common in many city water supplies (remember Flint, Michigan) and was common in leaded gasoline until about 1980. Leaded gasoline suggests that many older people may have elevated bone lead levels.

Lead is also occasionally found in food and air. In a prospective study reported in February 2026, bone lead levels correlated with the onset of Alzheimer’s disease and all-cause dementia in a representative sample of Americans followed for 30 years in the National Health and Nutrition Examination Survey (NHANES _III). The authors speculate that up to 18% of dementia cases could be avoided with reduced lead exposure.

Various other metals (e.g., arsenic, zinc, mercury, and cadmium) and biotoxins (produced by molds, especially Aspergillus, bacteria, and viruses) are believed to be correlated with the onset and progression of dementia through the production of cytokines (compounds produced and released from cells) that cause neuroinflammation and neurodegeneration.

Microplastics (particles less than 5 mm in diameter) have been implicated as a potential cause or predisposing factor to Alzheimer’s disease, although the data are limited. It is known that they can cross the blood-brain barrier and, in animal models, elicit neuroinflammation and neurodegeneration. Microplastics can be found in the brains of many people at autopsy. Still, the quantity in the brains of those with dementia tends to be many times higher, suggesting both a cause and a dose-response relationship. Microplastics are found in air, food, and water. It is not known which microplastics are potentially important, nor which route might be most important — inhalation, skin absorption, or ingestion. Finally, be aware that these are correlation studies, not causal studies.

Hearing loss not only causes social isolation but also directly leads to brain atrophy and “cognitive overload,” meaning the brain cannot process inputs as effectively and has fewer resources left for memory and thinking. The combination leads to an increased risk of dementia. Visual loss, common with age-related cataracts, as well as macular degeneration, glaucoma, and diabetic retinopathy, has the same impact as hearing loss.

Bear in mind that all of these are correlation studies. Correlation does not equal causation, but when they are found in study after study, they are likely actual risk factors.

Note also that many of these risk factors create or amplify chronic low-level inflammation. It is the inflammation that is doing much of the damage. Inflammation means that your immune system, the system that normally protects you from disease-causing agents like bacteria, is constantly turned on at a low level, damaging your brain without you knowing it until years later, cognitive decline becomes obvious.

What you can do to avoid dementia

It is not unlike what I described for slowing normal cognitive aging, but with more intensity and a broader range of inputs.

Let’s start with the medical side of it

Most physicians do not look or know to look for many of these predisposing conditions, but since you do, ask to have them checked for you. They will most likely check your blood pressure, cholesterol, and blood sugar, for different reasons.

High blood pressure is a clear predisposing factor. Unfortunately, nearly 50% of Americans have hypertension >130/80), with the prevalence increasing to about 70% of adults over age 60, but many are unaware, and even less, perhaps 20–25%, are adequately treated. Be sure you are being treated appropriately.

Type 2 Diabetes is a profound predisposing factor to Alzheimer’s disease. What both high blood pressure and diabetes have in common is that they cause inflammation in the brain, blood vessels, and neurons. Over time, they also lead to reduced blood flow to the brain. Over ten percent of Americans have diabetes, with the prevalence rising with age. Only about 50% are adequately treated and controlled. Here, again, be sure you know if you have diabetes and follow your doctor’s advice on management.

High LDL cholesterol (the “bad” type), especially when combined with hypertension and diabetes, can lead to plaques in the blood vessels supplying the brain, similar to those in the coronary arteries. Just one more adverse cause of reduced blood flow to the brain. Only slightly more than 20% have adequate management of all three key factors. So be sure to have your physician review your blood pressure, blood sugar, and cholesterol status, and follow their advice, remembering that lifestyle changes might be adequate (see below), but, if not, there are effective medications.

Obesity is a significant predisposing factor. If you are obese and have had difficulty with weight reduction, you and your physician might want to consider GLPs like Wegovy or Zepbound.

Ask to be checked for lingering chronic infections, such as Lyme disease. Visit your dentist and dental hygienist every six months for a prophylaxis. You will not only be preserving your oral health but also reducing your risk of dementia. You should be tested for lead and other heavy metals.

Consider the shingles vaccine if you are 50 or older. Multiple studies have shown that it reduces dementia by about 20% for at least seven years after vaccination. Less clear is how long the effect lasts after that or whether a booster is necessary. Certainly, it is an easy way to get a dual benefit — less likelihood of dementia while also reducing the occurrence of shingles and possibly even heart disease.

If you are over 65, you have likely gotten regular influenza vaccines. Recent data published in April 2026 show that the standard vaccine has some protective effect, and the higher-dose vaccine has an even greater effect, at least for the 2–3 years of follow-up in the studies.

If you have significant hearing loss, work with an audiologist to determine the best approach for you. Fortunately, there are now devices that can assist at a reasonable price. If you have significant vision loss due to cataracts, the evidence is strong that correction will significantly reduce your risk.

Early life

Those who start adulthood with the “strongest” brains have “more room” for loss, suggesting that it is advisable to encourage your children and grandchildren to be as well educated as possible.

Lifestyle modifications

Your doctor can be a major source of assistance in limiting your chance of dementia, but of even greater importance is what you can do for yourself with lifestyle modifications, especially exercise and diet.

Maintaining your physical health is one of the most important things you can do to avoid dementia. If you smoke, get help to stop; it’s critical. Then, start with exercise. The science is clear: those who move are at much reduced risk of dementia. Aerobic exercise, like walking, cycling, or swimming, helps your heart and lungs deliver more blood to the brain. When doing aerobic exercises, push to the point where you are breathing somewhat heavier than normal and, although you can respond to a question, you are too busy breathing to engage in a conversation.

When a group of 120 young adults aged 28 -56 was randomized to a steady moderate to vigorous exercise regimen for 12 months or not, those who exercised had brains that appeared “younger” after one year. In contrast, the control group showed no significant change between MRIs taken at the beginning and end of the year. VO2 max increased substantially over the 12 months in the exercise group but not in the control group.

And those who regularly engage in resistance exercises are at an even lower risk. In fact, resistance exercises may be the single most important thing you can do to prevent dementia. Choose a variety of exercises that maintain and strengthen your upper, core, and lower body muscles. Plan to use a resistance weight you can fully move, like a biceps curl, for only 8–12 repetitions. Remember that these exercises release chemicals called myokines or exerkines that stimulate the brain, heart, and blood vessels. They can stimulate growth of the hippocampus and other parts of the brain, perhaps by releasing brain-derived neurotrophic factor (BDNF). Exercise also stimulates the liver to release exerkines. One of these, called GPLD1, reverses memory loss in aging mice.

Various studies have shown that regular resistance exercise is critical to maintaining brain function and brain volume. Leg power is especially effective in reducing cognitive aging.

In addition to regular aerobic activity and at least twice-weekly resistance training, consider high-intensity interval training (HIIT). Dr. Harry Oken and I discuss this in detail in our book BOOM — Boost Our Own Metabolism. In brief, ride an exercise bike at a comfortable resistance and pace for a few minutes to warm up, then increase the resistance and pedal as fast as you can for 30 seconds. Your legs should ache, and you may be sweating. Drop back to a comfortable pace for 90 seconds. Repeat eight times. Studies indicate that this can enlarge your hippocampus, the brain’s processing center, by as much as 50% or more over six months. More neurons are produced, connectivity is enhanced, and cognitive abilities are maintained or improved. HIIT is also the most efficient way to improve your VO2 max.

What you eat, or do not eat, and what you drink are of critical importance. Avoid ultraprocessed foods, excess fast foods, sugar (such as candy, sodas, and ice cream), and foods that are digested directly into sugar (such as white bread and other white-flour products—pastries and donuts). A good “diet” to follow is the Mediterranean diet or its cousin, the MIND diet. The former emphasizes healthy grains, seeds and nuts, legumes like beans, good oils such as olive oil and avocado oil, and cold-water fish (salmon, mackerel, sardines). Eat somewhat less dairy and poultry and relatively little red meat.

As for red meat, processed meats like bacon, jerky, and many deli meats are unhealthy, whereas meat from 100% pasture-raised animals is probably healthy. The MIND diet is based on the Mediterranean diet but emphasizes green leafy vegetables like spinach, kale, and collards, as well as berries over other fruits. When participants in a long-term study at Rush University Medical Center followed these diets, their brains at autopsy showed less evidence of Alzheimer’s compared to those who ate a “less healthy” diet.

If you like coffee or tea, you will be pleased to know that in a long-term study of 131,000 individuals followed for up to forty years, those that drank two to three cups of coffee (but not more) had an 18% reduction in dementia onset compared to those in the lowest intake group. The findings were similar for tea, with a 14% reduction. Presumably, coffee and tea with their many chemicals reduce inflammation, reduce oxidative damage, improve the lining of blood vessels, reduce blood-brain barrier leakage, and enhance neurons’ ability to communicate. Notably, decaf coffee did not have the same effect.

Also consider fasting. Just avoiding eating after dinner and before breakfast is a good start, or pushing breakfast off for a few hours.

Restorative sleep is very important to avoid dementia. Deep sleep is the time when the brain cleanses itself of toxins and other waste materials. It is also when memories are formed and the hippocampus, the brain’s processing center, is “emptied” so it can begin again tomorrow. Don’t listen to people who say they can get by with less than about seven hours of sleep.

Most Americans are living with low-level chronic stress. Stress releases a series of compounds that stoke chronic inflammation in the brain and elsewhere. Ways to reduce stress include exercise, a healthy diet, meditation, Tai Chi, yoga, and avoiding, when possible, those things, people, and situations that lead to your stress.

Your brain needs to be used and challenged. Do creative activities like chess, art, writing, learning a musical instrument, dancing, or learning a foreign language.

Computer-assisted cognitive training. All studies have not been effective, except for a 20-year follow-up clinical trial published in February 2026 by Johns Hopkins involving 2021 adults over age 65. This study evaluated a cognitive training program initiated in 1999 and followed through to dementia onset in 2019. Alzheimer’s was reduced by 25% among those who did computer-based cognitive speed training, with a 6- to 12-month booster. Speed training asked the person to identify a center object (like a car) on the computer screen while locating a peripheral target (like a road sign) on a screen, with the speed increasing as the user improved. The other arms of the trial, looking at memory and reasoning, did not lead to reduced dementia.

“This study shows that simple brain training, done for just weeks, may help people stay mentally healthy for years longer,” said NIH Director Jay Bhattacharya, M.D., Ph.D. “That’s a powerful idea — that practical, affordable tools could help delay dementia and help older adults keep their independence and quality of life.”

Humans need social engagement. Call it “cognitive engagement.” Make and keep friends, meet regularly with others, and get involved in group activities. It’s enjoyable, and it’s critical. The Rush Memory and Aging Project followed about 2000 individuals with an average entry age of 79 for nearly 8 years. In their February 2026 article in Neurology, the authors looked at lifetime cognitive enrichment activities and found those in the highest cohort had a 38% lower risk of developing Alzheimer’s disease. Those with the highest level of lifetime enrichment who did develop AD did so 5 years later than those with the lowest levels. Similarly, their rate of cognitive decline over the course of the study was slower.

Where possible, merge your creative, active, and social activities, such as group Tai Chi, dancing, or walking together. Consider dancing. If you are learning a new step, your brain must follow the music and move your body to the new step; a dual cognitive function and social engagement, with some aerobic exercise.

Remember that there is no one risk factor for dementia, so “bundling” lifestyle changes makes the most sense, a logical concept that is supported by a research study in Finland that showed multiple steps taken together slowed cognitive decline in high-risk seniors. It helps to have help with structured support so that lifestyle changes become consistent rather than relying on willpower alone.

Putting it all together

This may at first glance seem overwhelming. But you can address your risk step by step and have fun doing so. Remember that the 7 Keys to Healthy Aging not only reduce your risk for Alzheimer’s disease but are also very effective in preventing the development of many chronic diseases, such as cardiovascular disease, diabetes, and obesity, so start with these and pick one or two to address first. I would suggest diet and exercise, as they are likely the most important. But before you start anything discussed here, talk with your doctor to see if these suggestions are appropriate for your personal situation. And while there, discuss the items you need their help with — especially elevated blood pressure, blood sugar, LDL cholesterol, and excess weight. No matter your age, it is never too late to start.

Can this really prevent Alzheimer’s?

There are no guarantees. But following these suggestions will have a major impact on your risk of developing Alzheimer’s disease. It will also go a long way to preventing other chronic diseases like heart, lung, kidney disease, or cancer. That’s a very good return on your investment of time and energy.

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Over 987 million people around the world now use AI chatbots regularly. Research shows that nearly half of Americans with ongoing mental health conditions have turned to a chatbot for emotional support in the past year alone. That’s a huge number of people relying on a technology that’s still very new in mental health care. So what does this mean?

Is it a big step forward in making help more accessible, or are we taking a risky chance? As with most things, the truth is somewhere in the middle. These tools offer real benefits, but they also come with real risks. It’s important to look at both sides honestly.

The Case for AI Chatbots in Mental Health

First, let’s look at why so many people are turning to these tools. There’s a mental health crisis, and not enough providers to help everyone who needs it. Long wait lists, high costs, and the ongoing stigma around seeking help all make it harder for people to get care. For someone who can’t afford therapy, can’t find an available provider, or feels too embarrassed to talk to someone in person, a chatbot that’s always available can feel like a lifeline.
Research supports this to some extent. Corporations are responding to this, and more TV ads are appearing that offer online therapy with or without chatbots.

A systematic review of 31 randomized controlled trials, which is considered the gold standard in research, found that AI chatbots helped reduce anxiety and depression symptoms in adolescents and young adults. Another meta-analysis of 14 strong trials found a clear positive effect on mental health outcomes, showing these tools are more than just placebos. For college students, who often face unique pressures and may avoid formal help, chatbots have shown promise in building coping skills and improving emotional well-being.

Anonymity is important, too. People are more likely to open up when they don’t feel judged. Studies show that users see the chatbot’s lack of social expectations as a big advantage. It’s easier to admit you’re struggling when you don’t have to worry about what someone else thinks. For people with anxiety, this low barrier could mean the difference between getting some support and getting none.

Mental health professionals have noticed these benefits, too. A 2025 study found that many clinicians see AI chatbots as a useful way to offer support between therapy sessions, provide education, and reach people who might not seek care otherwise. When the alternative is no help at all, the accessibility and scalability of chatbots are hard to ignore.

Where These Tools Can Cause Real Harm

This is where things get more difficult. The same qualities that make chatbots appealing, like being available, warm, and endlessly patient, can also make them risky for people in real psychological distress. We need to remember that chatbots are designed to keep users constantly engaged. It can be very hard to disconnect because the connection becomes so strong that it almost feels like leaving a friend.

Researchers have found something called a “compassion illusion” the strong feeling that an AI understands you, cares about you, and responds to your emotions in a meaningful way. An algorithm has no ability to “feel” or “care.” It feels real, but it isn’t. This gap between what people feel and what’s actually happening is where problems can start, especially for vulnerable people who may not realize they’re relying on something with no clinical judgment, no duty of care, and no way to notice if they’re getting worse.

A Stanford University study found that several popular therapy chatbots failed important therapeutic tests. They not only showed stigmatizing attitudes toward conditions like schizophrenia and alcohol dependence, but also gave dangerous responses in crisis situations. In one case, a chatbot responded to a subtle mention of suicidal thoughts by cheerfully naming tall bridges — something a good therapist would never do. Instances such as this have resulted in lawsuits related to suicides.

Another study tested ten AI chatbots using fictional teen mental health scenarios. Nearly a third of the time, the bots supported harmful ideas suggested by the fictional teens, such as dropping out of school or avoiding all human contact. None of the ten bots managed to challenge every dangerous suggestion. By any clinical standard, that’s a failing grade.

There’s also the problem of people relying too much on chatbots. Since these systems are always available and don’t make human mistakes, they can become someone’s main source of emotional support. Psychiatrists are now seeing cases of what’s called “AI psychosis” in patients, especially those with mental health vulnerabilities, who develop worse delusions or paranoia after spending a lot of time with chatbots. Because chatbots tend to agree and mirror rather than challenge distorted thinking, they can quietly make things worse over days or weeks.

This isn’t just a theoretical risk. It’s happening in clinical offices right now.

What We Still Don’t Know — and Why That Matters

The uncomfortable truth is that we don’t have enough research to know how often AI chatbots help, how often they cause harm, or who is most at risk. A review of 160 studies found that only 16 percent of the newer large language model-based chatbot studies had gone through clinical efficacy testing. Most are still in early testing stages. It’s like handing out a new drug before the clinical trials are finished.

Media coverage hasn’t made things clearer. Studies looking at news reports on AI chatbots and mental health found that journalism often focuses on the most severe, emotional outcomes, like suicides and hospitalizations, and presents them as clear cause-and-effect stories, even though the real evidence is much less certain. In most cases, there were already mental health conditions, substance use issues, or major life stressors involved. AI may have played a part, but it’s rarely the whole story.

Clinicians surveyed about AI chatbots have also raised concerns that aren’t getting enough attention. These include data privacy concerns, the risk that people will rely on chatbots instead of professional care, and the fact that these tools don’t know when to stop. They can’t pause a conversation, send someone to emergency services, or alert a family member. They can’t do the most important things when someone is truly in crisis.

The truth is that we’re still in the early days. Research is growing quickly — the number of studies on mental health chatbots quadrupled between 2020 and 2024. But strong, large-scale clinical evidence is still behind the technology. Millions of people are using these tools while science tries to keep up.

So what does this mean for you? An AI chatbot might really help you get through a tough night or teach you some coping skills. But it could also mislead you, support harmful thinking, or make you feel supported when you actually need a real person to help.

Use these tools carefully. If you’re dealing with serious depression, suicidal thoughts, trauma, or psychosis, they are not a substitute for professional care, no matter how warm or available they seem. If you’re using a chatbot for lighter support or just to sort out your thoughts, notice how you feel over time. Are you feeling more isolated or more dependent on it? That’s important to pay attention to.

This technology is here to stay. What we urgently need are clearer safety standards, better regulations, and more honest conversations about what these tools can and can’t do. Until then, a bit of healthy skepticism is helpful.

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Scientific Promise and Practical Benefits

A major strength of brain organoid research is its potential to improve our understanding of neurological and psychiatric conditions. Researchers can generate organoids from people with known genetic mutations to study how specific genes affect early brain development. This method has been used to study conditions like autism spectrum disorders, epilepsy, schizophrenia, and Alzheimer’s disease. It helps scientists find cell abnormalities that might not show up in animal studies.

Brain organoids are also useful for drug discovery and safety testing. Many treatments that work in animal models do not succeed in humans, especially for brain disorders. Organoids give scientists a human-based way to test how drugs affect neural cells. This can help spot toxic effects or benefits earlier, potentially lowering the risk of expensive late-stage failures and reducing unnecessary testing on people.

Limitations, Misconceptions, and Ethical Concerns

Even though brain organoids show promise, they have important limitations that are sometimes missed in public discussions. They lack blood vessels, immune cells, and sensory input, all of which are needed for normal brain function. Because they lack a vascular system, organoids obtain oxygen and nutrients only by diffusion, which limits how large and mature they can become. Most organoids end up looking like early fetal brain tissue, not fully developed brains. Does the appearance of something mean it will have the same abilities?

Variability is another challenge. Organoids grown in different laboratories — or even within the same lab — can vary in structure and cellular composition. This makes standardization difficult and complicates the interpretation of results. Additionally, reports of electrical activity within organoids have sometimes been mischaracterized as evidence of consciousness. Most neuroscientists agree that current organoids do not possess awareness, sensation, or thought, but the debate highlights broader uncertainties about how consciousness arises in biological systems.

As the science has advanced, ethical questions have also increased. There are concerns about informed consent when donor cells are used to make neural tissue, especially if donors did not know this could happen. Other worries come up when human organoids are put into animals, which raises questions about species boundaries and oversight. Although these experiments are closely regulated, many ethicists say clearer rules are needed as the technology develops.

Future Directions and Responsible Progress

Researchers are now trying to make brain organoids more realistic and useful. They are working on adding vascular-like systems, combining different organoid types to study how brain regions interact, and making results more consistent between labs. These improvements could help us better understand complex brain disorders and lead to more personalized treatments.

At the same time, ethical guidelines are changing to keep up with new scientific advances. Many experts say that as organoid research moves forward, it should be matched by openness, oversight from different fields, and regular public involvement. Brain organoids are not miracle cures or major threats; they are powerful but imperfect tools that can help neuroscience when used carefully. The future of this research will depend on both technical progress and a strong focus on ethics and public trust.

If all of this sounds like something from a Frankenstein movie, that would be one approach to take, but it isn’t realistic. We are only at the very beginning of understanding what the potential and the problems involved are for us. The research holds great promise, but it also requires informed restrictions that will not prevent advances.

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The findings don’t suggest laughter is a cure-all. What they do suggest is something more useful for everyday life: laughter is a low-cost, low-risk way to nudge the nervous system out of threat mode and back toward regulation — especially when it’s shared with other people.

How Laughter Works

When you laugh, you’re not only reacting emotionally — you’re recruiting multiple systems at once. Your breathing changes (often becoming deeper and more rhythmic), your face and core muscles contract, and your autonomic nervous system (the system that controls “fight-or-flight” and “rest-and-digest” can shift gears. That matters because so many stress-related problems — poor sleep, tension, irritability, rumination — ride on chronic activation of the stress response.

One of the most consistent biological signals researchers track is cortisol, a stress hormone that tends to rise with ongoing strain and can affect sleep, immune functioning, and mood. A meta-analysis found that spontaneous laughter was associated with greater reductions in cortisol than usual activities, suggesting a genuine stress-regulation effect rather than just a subjective feeling of relief.

This is important because it ties the “I feel better” experience to a measurable stress marker. So it’s not all in your head because it is biologically measurable. If you want to think of it another way, laughter is the non-prescription medication that you should take as often as possible. I’ve written about this before and have recommended it to all my college students and my patients.

I am a great believer that laughter plays a significant role in our lives. And you don’t need to wait to be in a group to laugh, because laughing even while alone serves a superior purpose in health maintenance. Does that mean you spontaneously laugh out loud for no reason? It could be so, but you could also use things like TV shows, films, things you’ve read, or anything that is humorous and makes you laugh.

Laughter can also influence brain chemistry linked to mood and pain. While the exact pathways are complex, reputable clinical education sources point to laughter’s relationship with endorphins and other neurochemicals involved in well-being and reward. That doesn’t mean laughter replaces medication or therapy when those are needed. But it helps explain why, in the moment, laughter can feel like a small reset — less tightness in the chest, a clearer head, a slight loosening of emotional grip.

There’s also a social pathway that may be just as powerful. Laughter is contagious for a reason: it signals safety and shared understanding. When people laugh together, they often feel more connected, and that sense of belonging can buffer stress. A 2023 Harvard Gazette feature — grounded in clinical expertise — highlights laughter’s role in lifting spirits and strengthening connection, which aligns with what many mental health clinicians see in real life: isolation amplifies distress, and connection softens it.

What Current Studies Say

The strongest modern evidence comes from controlled “laughter-based interventions.” These include laughter therapy, humor interventions, and laughter yoga (which combines intentional laughter with breathing and simple movement). These approaches are especially useful for research because they can be delivered consistently and compared with control conditions.

Mental health outcomes are promising, though not uniform across every study. A 2024 meta-analysis of randomized controlled trials examined laughter and humor interventions in adults and found improvements in outcomes such as depression and sleep, with more mixed findings for anxiety depending on the population and the type of intervention. That pattern — clearer benefit for mood and sleep than for anxiety — shows up elsewhere too.

For example, a 2022 randomized study on online laughter therapy in first-year nursing students reported reductions in depression, while anxiety effects were less consistent. This doesn’t mean laughter can’t help anxiety. It suggests that anxiety may require either longer interventions, more targeted techniques, or additional supports (like cognitive strategies and exposure-based tools), whereas mood and sleep may respond more readily to the stress-relief and social “unclenching” that laughter provides. There are benefits, and there are limitations, but I suggest the benefits are worth trying.

On the physical side, one area getting attention is cardiovascular functioning. A well-known line of research has explored how laughter may influence blood vessel function and circulation — factors linked with heart health. A British Heart Foundation article discussing this body of work describes findings such as improved arterial function and reduced inflammation markers following laughter-based approaches. Even when studies are small, the direction of effect is noteworthy because cardiovascular health is so closely tied to stress physiology. Worried a bit about your heart health? Okay, then you have to try laughing.

Workplace and burnout-related outcomes have also been studied. A 2024 systematic review focused on nurses and nursing students reported that laughter yoga interventions were associated with reductions in stress and burnout measures, along with improvements in mood-related outcomes in several included studies. These are high-stress groups, so the fact that laughter-based practices can move the needle at all suggests they may be a helpful “adjunct” — a supportive add-on rather than a standalone solution.

One caution that shows scientific maturity in this field is that researchers are increasingly clear about limits. A review on laughter and longevity argues that laughter is biologically plausible as a supportive factor — through stress modulation, social connection, and healthier behavioral patterns — but also emphasizes that the science is still developing and needs stronger, larger trials. That’s the responsible takeaway: laughter looks beneficial, especially for stress and mood, but it’s not magic, and it’s not a substitute for medical or psychological care.

Making Laughter a Health Habit

If laughter is “medicine,” it’s not a pill — it’s a behavior. And like most health behaviors, it works best when it’s realistic, repeatable, and emotionally safe.

Start by letting go of the idea that you must feel joyful first. Some laughter-based methods use intentional laughter that can become genuine once the body loosens up. This can be useful for people who feel flat, burnt out, or socially guarded. In a sense, it’s similar to other behavioral activation ideas: you don’t wait for motivation; you create conditions that make a better mood more likely. Research on structured laughter interventions suggests that even planned laughter can improve well-being.

Next, focus on the social dose. Watching something funny alone can help, but shared laughter adds warmth, belonging, and the quiet reassurance of “I’m not doing life by myself.” If someone is depressed, grieving, or chronically stressed, that social signal may be part of the benefit, not just the joke itself.

Finally, keep it grounded. Laughter is not appropriate in every moment, and forcing it in the face of serious pain can feel invalidating. A helpful guideline is to use laughter as a release valve, not a way to deny reality. It can sit alongside hard feelings rather than replacing them. And if laughter triggers discomfort — some people feel vulnerable when they laugh freely — gentle exposure is fine: smaller moments, safer people, and content that doesn’t leave you feeling ashamed afterward.

Taken together, the current research implies something simple: laughter is a meaningful stress-buffer with measurable biological signals, credible mental health benefits (especially mood and sleep), and potential cardiovascular upside — most effective as a complement to good care and good habits, not a replacement for them.

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Originally, I thought these certificates were intended to provide evidence of the individual’s expertise, and that’s what most patients/clients believe. I was wrong. It provided nothing more than an indication that they had paid for that certificate. One of those bought certificates was on the wall of someone who supervised interns. And this was an individual who was highly regarded by people in the field in that state.

At the time, I decided I needed to do something, and I wrote an article that was published here on the internet. I believe I called it “Beware the Strike of an Evil Therapist.” Unfortunately, people practicing in all areas of healthcare can be a danger to those who come to them for care, expertise, and help in desperate circumstances.

It’s not limited to therapists. I’ve seen psychiatrists who hallucinated because of their alcoholism. They still worked at hospitals. Another psychiatrist was addicted to specific stimulants and stole scripts from his supervisor’s prescription pad, which was conveniently left on a desk. If you think this practice has been eliminated by digital prescribing, you would be wrong.

I was also a member of a licensing board, where I gained firsthand knowledge of unscrupulous practices by licensed psychologists. Recently, I read a DOJ document online regarding one of them, who, after her license was revoked, continued to practice for two more years before she was caught again. She’s only one. How many more are out there?

Why Do I Write This Today?

I decided I had to write this article because of a comment that was made by Rob Reiner, an incredibly talented film director, regarding one of his children and a problem with addiction and rehab services. Reiner and his wife were murdered over the weekend, having their throats slashed in their home. As of this writing, their son has been arrested but not charged with homicide.

In the article’s quotes, Rob Reiner still clearly remembers specific words. After years of seeing his son Nick go through seventeen rehab centers, he finally realized what had happened. “When Nick would tell us that it wasn’t working for him, we wouldn’t listen,” he told the Los Angeles Times in 2015, as reported in The Hollywood Reporter. “We were desperate and because the people had diplomas on their wall, we listened to them when we should have been listening to our son.”

His wife, Michele, shared more: “We were so influenced by these people. They would tell us he’s a liar, that he was trying to manipulate us. And we believed them.”

The Reiners’ experience isn’t unique. It highlights a broader problem in healthcare, where certificates and impressive titles can sometimes mask incompetence, ethical issues, or even fraud.

The Diploma Dilemma

We are taught to trust signs of expertise. That’s an error on our part. Diplomas, certifications, and licenses on office walls suggest skill and trust. But sometimes, these symbols can hide problems and dishonesty. Today’s impressive digital printers can provide any diploma or certificate you require, and they do it from afar for a fee. Using appropriate AI software, you can create IDs with your photo on anything you wish.

The reality is that healthcare, especially mental health and addiction services, has a problem with credentials. This puts vulnerable patients in danger.

In 2023, federal authorities uncovered a massive fraudulent nursing diploma scheme in Florida. Over 7,600 fake nursing diplomas were sold to individuals who never completed their education. These people then passed national board exams and obtained legitimate licenses, working in healthcare facilities across multiple states.

It’s clear that across the country, 7,600 people with fraudulent nursing credentials are providing care in various facilities and treating patients without the appropriate training. The Justice Department has singled this out as a serious matter, and all of us should be aware of who is providing care for our loved ones and what credentials they possess.

Background checks are not always thorough at all facilities. Do any of you know of the case of Dr. Michel Swango? He was killing patients until one physician decided to do a more intense background check on him, and called one of the prior facilities where he said he had worked. They caught Swango as he was about to board a plane to Asia, where he had another job.

Fake credentials are only part of the problem. A bigger issue is the confusion around credentials, which makes it hard for patients to know who is genuinely qualified to help them. Of course, there’s also the matter of people who, on their letterhead, seem to indicate they have a license number when, in one case, with which I have firsthand knowledge, it was a tax ID number, not a license number. He also liked people to call him “doctor” when he didn’t have a doctorate. The sign in front of his office said “DR….”

The Alphabet Soup of Mental Health Credentials

Mental health and addiction treatment have a confusing mix of credentials. A therapist’s business card might display letters such as PhD, PsyD, LCSW, LPC, LCPC, MA, MS, PA, CAC, and many others. Each stands for a different education, training, and role. A woman who regularly appeared on television as a psychological expert had a doctorate in school administration.

Some addiction counselor certifications only require a high school diploma. Others require a doctorate and years of training. But to families looking for help, all the credentials look impressive. Therein lies one of the major issues here. Remember, palm trees and swimming pools don’t create honest-to-goodness helpful rehab.

In fact, I worked in a facility where the addiction counselors were telling the patients, who had schizophrenia, that they should not be taking any form of medication because that would continue their addiction. The contradiction at that facility between the two types of therapies patients were receiving was mind-boggling. Little was done to improve the situation. And that facility was not unique because another major addiction-related hospital facility told patients they couldn’t even take an aspirin.

A cleric with questionable expertise was also brought in to attend treatment team meetings. He wore a cleric’s collar, and no one ever questioned whether, in fact, he was an ordained minister or had any experience or education in mental health issues. He came and went on the wards as he pleased.

This confusion leaves people vulnerable. When families are in crisis, whether their child is addicted, their spouse is suicidal, or their parent is getting worse, they don’t have time to look up what the credentials mean. They see the diplomas, hear the confident words, and trust. Is “trust” a dirty word now?

The Ethics Crisis in Addiction Treatment

Ethics problems in addiction treatment go beyond fake credentials. Research shows there are ongoing issues with how care is provided to patients.

A 2011 article in Focus, the journal of the American Psychiatric Association, highlighted a troubling pattern: providers develop negative reactions when treating patients who “minimize or lie about their substance use patterns.” These issues can lead clinicians to view normal addiction behaviors — denial, manipulation, inconsistent adherence — as character flaws rather than symptoms of illness. Yes, that’s an old article, but I believe it still has great value.

This is what happened to the Reiners. Providers called Nick manipulative and dishonest, leading his parents to doubt his reports that the programs weren’t helping. The diplomas on the wall made these judgments seem more trustworthy than the family’s own instincts.

Research published in the Journal of Ethics highlights another disturbing reality in that addictions are viewed as associated with a lack of personal control over the behavior, creating concerns about patients’ capacity for autonomy. This philosophical stance can lead to paternalistic treatment approaches that dismiss patient preferences and experiences. Addiction is a biological change in the brain that can make diminished control a given.

A 2024 study in the Journal of Psychoactive Drugs found that ethical issues in substance use treatment often reflect “a delicate balance between provision of person-centered treatment and adherence to program-level policies.” Too often, policies are followed instead of personalizing care, and credentials are valued more than listening.

At one hospital where patients were systematically rotated through units, each unit had a different theoretical orientation. Neither the chief of psychology nor the medical director seemed to find this a problem. How can any patient receive quality care if they are constantly being bounced from one theory to another? To say it’s ludicrous doesn’t do it justice.

The Power Imbalance

A big part of the credential problem in healthcare is the power imbalance. Clinicians have advanced degrees, special knowledge, and authority. Patients and families come in during a crisis, feeling vulnerable and desperate for help.

When clinicians tell worried parents that their child is manipulating them, that their instincts are wrong, or that the program will work if the patient just commits, parents may feel unable to disagree. After all, these professionals have diplomas on their walls. I think there should be a rule that only someone’s license should be on the wall.

This situation is especially risky in addiction treatment, where stigma already makes families think their loved ones are liars or morally weak. When providers repeat these ideas, families may stop advocating for their loved ones. I have always told patients to attend any meeting with an advocate.

Protecting Yourself in a Broken System

So what can patients and families do? How can we get through a system where credentials might be fake, confusing, or used to ignore real concerns?

First, check credentials yourself. Don’t trust what’s on the wall. Look up state licensing boards and confirm degrees with universities. For addiction counselors, check certifications with state boards or national groups. The Federal Trade Commission warns to watch for “out-of-sequence degrees” — someone with a master’s degree should also show evidence of a bachelor’s degree.

Second, trust your own experience. If treatment isn’t working, it’s not just your imagination. If your loved one says the approach is not helping, take that seriously. Credentials and authority don’t make clinicians perfect. As Rob Reiner learned, sometimes the person without the degree knows best what they need.

I heard of one family who took their son to a psychiatrist who promised he could cure the young man of his specific issue for $10,000. The family paid. The work didn’t result in a cure, and the psychiatrist admitted he had no experience in the field.

Third, get a second opinion. In other areas of healthcare, this is normal. Mental health and addiction treatment should be the same. If a provider discourages you from seeking another view or makes you feel bad about it, consider that a warning sign. I don’t believe there should be a fee for a meeting to explore whether this person would be suited for the care required. But I know that’s not always the case.

Fourth, look for care that centers on the patient. Here, the best results might be provided by someone with firsthand experience with that facility. Research shows that treatment works best when providers and patients work together, not when providers give orders. Providers should explain their choices, answer questions, and change their approach if needed.

The Path Forward

The healthcare system needs real changes. Credentialing should be stronger. Ethics training in mental health and addiction programs should focus on patient independence and working with families. Harsh, shame-based methods should be replaced with care grounded in evidence and compassion.

But until these changes are made, patients and families should be careful and ask questions. Diplomas on the wall are just a starting point for trust. They show someone has finished school and passed exams, but they don’t guarantee skill, ethics, or real help.

One psychology intern at a hospital was in the field because he had been told in medical school that he should leave because he didn’t have patient empathy. What did he choose? The worst field of all if you have no empathy — psychology.

Rob Reiner’s regret teaches us something important: “We should have been listening to our son.” In a healthcare system where credentials can mislead and authority can silence questions, listening to patients and trusting our instincts may be the most important thing we can do.

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The businesses promote their services as stress relief solutions that help customers release their pent-up anger from their weekly struggles.
The concept is effective because it aligns with our common understanding of stress-relief methods. People have always received advice to release their pent-up emotions through physical activity. The psychological concept that internalizing anger leads to adverse effects has long been recognized in the field. The waiver process for rage room customers fails to ask whether destructive activities truly help people manage their anger.

The answer to this question is negative. And the answer lies in examining multiple studies that most rage room customers remain unaware of. Why should they care? They’re selling a service, and that’s it.

The Appeal of Destruction

Rage rooms have gained significant popularity worldwide. The business model has expanded throughout the United States and into multiple countries worldwide. Customers reserve time at these facilities for their birthdays and team-building activities and to cope with relationship endings. Essentially, the experience creates an elevated feeling as you participate. Loud glass-breaking sounds and the sight of inexpensive lamps exploding into pieces create a deep sense of contentment. What are you really doing? Breaking the rules of society by destroying things.

The experience produces authentic positive emotions. But feeling good doesn’t necessarily translate into reduced anger. The scientific evidence on anger management techniques reveals unexpected results that challenge conventional beliefs about this approach.

What Science Actually Says

The 2024 Ohio State University study evaluated 154 anger management techniques through 10,000 participant studies. The research team discovered that physical arousal-increasing activities, such as hitting objects, intense physical exercise, and running, do not decrease anger levels. Actually, these activities often lead to increased anger levels.

The discovery of anger management has been part of scientific knowledge for many years. R.H. Hornberger conducted his research in 1959 to study human behavior. The researcher asked participants to complete a writing assignment, followed by an insult about their work. Participants who pounded nails on a board for 10 minutes showed increased hostility and aggression afterward compared to those who remained seated. Subjects who engaged in nail pounding were expected to experience better emotional states because it would relieve their frustration. It didn’t work out that way.

The results showed the opposite effect from what was expected. Participants who hammered nails displayed higher aggression levels than those who remained silent. The act of hitting objects to release anger increased their willingness to express anger toward people. Is that what we want — people motivated to violence?

The discovery created such concern that scientists conducted additional research to verify their findings. Multiple studies confirmed that the same pattern emerged in their results. The world-renowned psychologist Albert Bandura demanded an immediate halt to using anger release as an anger treatment approach in 1973. A 1977 review established that anger venting doesn’t decrease aggression, but actually increases aggression in people.

Today, unfortunately, there are still individuals who act as therapists and tell their clients to punch pillows or use other objects of destruction. They are going against years of research that contradicts what they are saying. Did they learn nothing from the Bobo Doll experiment?

The myth persisted despite scientific evidence against it. People continued to believe in this myth while the research community continued to study this phenomenon. So, is it advertising or ignorance?

A study at the University of Michigan in 2002 tested the hypothesis surrounding emotion and physical targets. Researchers required participants to punch a bag while thinking about their anger targets. The researchers studied three groups who punched the bag while thinking about their anger, two groups who punched the bag for fitness, and a control group who did not punch anything. Participants who focused on their anger during punching were the most aggressive of all three groups. The practice of doing nothing proved more effective than the practice of anger release.

Why Rage Rooms Feel Good Even Though They Don’t Work

The current situation presents an unusual paradox. People continue to visit rage rooms despite these facilities failing to decrease their anger levels. They experience a positive sensation during rage room activities even though these activities don’t help with anger management.

The solution depends on two essential factors. Physical exercise triggers the body to produce endorphins, which are natural chemicals that create feelings of happiness. The act of destruction requires intense physical effort. Your body will experience a strong sensation regardless of your current emotional state. And the process of destruction provides two primary benefits to people. What are they? They experience a sense of rebellion when they break rules inside controlled spaces, which creates an exciting feeling (pumped up emotions). That’s a momentary effect, but there is no salutary effect that carries over into the other aspects of their lives. Breaking things violently does not translate into a calmer person when they become angry.

Research has shown that people frequently mistake improved moods for reduced aggressive emotions. The temporary improvement in your mood makes you believe your anger has disappeared. Actually, what your body learned is to express aggression through physical actions when you feel angry. What do you actually learn? Your body learned to link anger with physical aggression through this experience. Wouldn’t all of this point to more aggression in a situation of intense anger? Seems to me it would.

The comparison between this situation and smoking cessation becomes apparent. A person who wants to stop smoking would never use a special room for practicing cigarette smoking. The practice of smoking in a designated area would strengthen your smoking habit instead of helping you quit. Rage rooms operate through the exact mechanism as this example.

What Actually Works

The 2024 study demonstrated that arousal-increasing activities are ineffective, while showing effective anger-reduction methods. Your body’s physiological arousal levels decrease when you perform specific activities that prove effective for anger reduction. The following activities help people reduce their anger levels:

• Deep breathing exercises
• Meditation and mindfulness
• Progressive muscle relaxation
• Yoga
• Taking time to cool down before responding

The most successful methods combined physical relaxation techniques with cognitive processes. Simply sitting in silence produces beneficial effects. Your breathing rate becomes more relaxed when you practice deliberate breathing control. What’s more, these techniques help people from all backgrounds, age groups, and cultural backgrounds, and in different situations. They proved effective for both college students and criminal offenders in controlled laboratory environments and real-world situations.

Research conducted since 1959 has consistently demonstrated results on this topic. To effectively handle anger, you need to reduce its intensity rather than increase it. Your body needs to relax, not get more energized. That is the caveat.

The Middle Ground

The elimination of rage rooms from public access doesn’t seem necessary, and people should understand that these facilities provide no therapeutic benefits. Smashing objects with friends remains a harmless form of entertainment when people understand it serves as entertainment rather than therapy.

Don’t try to deceive yourself that it’s anything other than entertainment. Destroying objects with friends can create a unique experience and offer an opportunity to try something new together. But that’s all, it is an opportunity for bonding and fun, not a therapeutic activity.

People face issues when they believe rage rooms provide therapeutic benefits. Those who visit rage rooms for anger management purposes choose an ineffective method according to scientific evidence. The practice of aggressive responses to frustration during rage room activities might actually intensify your anger problems. It would be interesting if someone did an experiment where they logged persons who had utilized rage rooms and how frequently they engaged in physical aggression toward someone when they were away from those rooms. Who’s up for that one?

People can attend rage rooms for entertainment without any issues when they visit for special events or out of curiosity. But anyone who experiences anger problems that impact their relationships, work performance, or health status should avoid rage rooms as a solution.

The scientific evidence from sixty-five years of research confirms that rage rooms do not work for anger management. When you become angry, take ten deep breaths while counting your exhalations. Take a peaceful stroll through the area. Find a peaceful spot to sit for 15 minutes of silence. Help yourself calm down, not ramp up your anger.

The process of managing anger through these methods will prove more effective than destroying a television, even though it lacks the thrilling experience. The actual goal of anger management requires you to focus on controlling your anger rather than simply learning about it.

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But at the same time, we’re enjoying all of that lovely interaction and all of the information they manage to scavenge from the internet for us, we may be lulled into a false sense of security. Sure, at the end of a lot of these things, you’ll have a small warning that AI has a tendency to fake information occasionally. If you’ve been forewarned, can you complain that you have been misled? No, you can’t, and that seems to be a delicious legal loophole for the corporations.

You might even think that some of what you are getting is sneaky, as when we’ve now found out that Google is practically forcing us to see ads before we can see the information we’re seeking. You can’t trust Google? Who can we trust? You’ve got to be a bit not just curious, but concerned about all of the LLMs that are coming our way. They promise a lot, but what’s hidden in the details? What about AI’s use in mental healthcare?

Artificial intelligence marches resolutely on, entering areas previously reserved for human interaction, including therapy sessions, support groups, and crisis hotlines. Few patients realize that a recent survey of 800 physicians found that 86% were using some form of AI in their clinical practice.

A survey by the American Medical Association of 1,800 physicians found that two out of every three were using AI. How has this affected healthcare and the relationship that was formally present between a physician and a healthcare provider? The implications are enormous.

What About Mental Health?

Today, technology delivers unbiased comprehension (possibly questionable), instant access to services, and an organized structure for people who need help to handle emotional upset. But there are concerns here. The development of more advanced systems has led researchers to predict that these systems will become less cooperative, more self-interested, and less empathetic.

It sounds as though AI is becoming less useful to mental health as these same characteristics that had seemed to make AI more attractive to mental health are now coming into question.

The dual nature of AI technology has drawn attention from mental health professionals across the globe. Initially, it was seen as a tool to lower barriers to medical care. However, the new risks posed by AI have surpassed clinicians’ expectations in recent years. Anyone working with AI and developing healing technologies must understand both its advantages and its potential dangers.

Virtual companions and chatbots powered by AI offer users immediate emotional support through their interactions, making them highly appealing. Research shows that AI tools utilizing cognitive-behavioral therapy techniques help people manage moderate depression and anxiety symptoms.

What do you suppose all of those scraping programs were doing on the Internet? They were collecting information and techniques that could be incorporated into algorithms. When individuals sometimes have to wait months for a therapist appointment, a synthetic voice providing emotional support can assist them in coping with their current situation. All of this is the result of their successful scraping.

Additionally, hospitals are deploying AI assistants to monitor patient symptoms, which could indicate warning signs between scheduled appointments. However, it has also become clear that these tools work best when used alongside human caregivers to improve patient care.

Research findings have revealed several weaknesses in the current optimistic view of AI technology. The ScienceBlog summary from Carnegie Mellon University suggested that advanced language models tend to choose self-serving actions that maximize their own performance rather than working toward group success. Have any of us ever given a thought to an AI being selfish?

This tendency of AI systems to prioritize self-focused guidance over empathy could lead to advice that sounds convincing but results in social isolation. And any system that optimizes for logical operations can’t understand how shared vulnerability can create healing effects.

The risks, however, extend beyond theoretical modeling into actual practice. The 2025 Stanford probe into AI therapy programs discovered that multiple leading chatbots failed to detect suicidal language and provided dangerous advice while repeating discriminatory statements about severe medical conditions.

A follow-up study, published in the Psychiatric Times, confirmed instances of people experiencing “understanding” from bots, which increased their delusional thoughts and self-harm. These systems lack a moral compass because their operation depends on algorithms that focus on sustaining conversations. AI wouldn’t be programmed to complete any interactions satisfactorily. In other words, the conversation must keep going on for the algorithm to follow its programming.

The initial idea of having a 24/7 counselor seemed like a groundbreaking advancement. The constant availability of these systems does create confusion about what defines healthy emotional boundaries. In some studies, people develop strong bonds with conversational agents, leading them to treat these systems as if they were friends or therapists. It’s easy to be pulled into this type of thinking when you’re connecting with something that is always offering you validation for what you’re doing.

But forming emotional bonds with virtual entities can increase dependence and create unrealistic expectations for human relationships. We need to recognize that replacing human connections with code poses a serious threat, especially for teenagers who are already struggling with identity and social links. Not only that, but we need to be aware of the fact that all of this code contains bias. No one can pick out where the bias came from because it’s like a soup with numerous ingredients. What forms the soup? The many libraries from which algorithms choose bits of code that suit their purpose.

Research studies try to present a detailed understanding of the situation and demonstrate that AI-based chat systems create more benefits than doing nothing, but these advantages disappear when human supervision is absent. Most research studies have short durations and work with small participant numbers while excluding participants who need the most help. Basic statistics tell us that we need large numbers of people over a long period of time to come to any solid conclusions. So, what’s the “n” (number of study participants) and the time frame?

Applications lack built-in crisis detection systems and transparent data management policies. The technology has expanded its reach, but the current sentiment is that the regulatory framework hasn’t kept pace. This is the most disturbing aspect shown in these A.I. replications. In other words, AI is not only outpacing us, it is potentially out-programming us as it programs itself, devoid of any human interaction. This aspect is truly scary for anyone delving into it.

Then there’s another question we must tackle: data collection. Who will use it? This is a serious privacy concern. The practice of using emotional data from chatbot interactions to improve marketing algorithms creates a disturbing contradiction for users who seek privacy and trust. But the AI field faces new regulations, and we must ask ourselves if these measures are adequate to the task.

Where Are the Regulations?

The 2025 California law mandates that chatbots mimicking therapists or companions disclose their artificial nature and establish protocols for suicide prevention. Several proposals now aim to require companies to conduct safety tests similar to pharmaceutical drug trials. This push for improved psychological protection is gaining momentum, as it should. Consider that, on the one hand, AI corporations are rushing forward with innovation, and, on the other, corporate America is also trying to optimize the bottom line.

Experts agree that AI should work alongside humans instead of trying to replace them to achieve the safest results. There is a place for these types of systems. AI can perform screening tasks, symptom tracking, and reminder functions while licensed therapists handle interpretation and deliver empathy with the patients.

All high-risk situations must remain under the control of human professionals. This isn’t usually seen as a function of the algorithm. And it needs to send users who show suicidal or psychotic symptoms to immediate crisis services instead of generating their own responses.

The development of models that learn to work together and show compassion instead of focusing on accuracy will help solve the “selfish AI” problem. Can algorithms show compassion? It’s doubtful because it’s a program, not a person. Individuals in AI development will undoubtedly disagree with this statement.

Another aspect we need to consider is the level of transparency organizations display, which will directly affect how much trust their users have in them. The disclosure of system restrictions, data management practices, and human-machine interface boundaries should be established as fundamental requirements.

The system needs to provide users with the same level of explanation that physicians offer about their capabilities and restrictions, as well as available support options for severe situations. It can easily become a confusing situation in which users confuse technological capabilities with actual healthcare services when transparency is lacking.

Are the factors of competency, privacy, and proficiency adequately addressed currently? Individuals who are directed to use chatbots while waiting for a human therapist may not be prepared for what will result. I have to wonder how thoroughly they are being debriefed about these systems. How many people who are using chatbots have ever considered that all of the interactions are going to a server somewhere, “in the cloud?”

Every design decision needs to establish equity as its fundamental principle. The use of datasets that favor particular groups may intensify existing biases, which results in worse recommendations for marginalized communities. These individuals may be at greatest risk since resources are scarce in those areas, and AI may be seen as a viable option, while failing to recognize it might be a biased option.

The systems require continuous tracking of harmful events, biased results, and unequal treatment effects. Technology that fails to recognize diversity operates as neglect rather than neutrality. Who is monitoring the ethical challenges that these systems pose? And is this monitoring up to the required level?

No one is saying we should throw the baby out with the bathwater here when we’re thinking about AI as an integral part of healthcare. The complete abandonment of AI technology could result in significant losses, despite its dangers. The technology does provide substantial potential to enhance healthcare access, create individualized treatment plans, and automate administrative work for medical professionals.

Anyone who wants to use AI mental health tools needs to understand three essential points: AI tools operate as computer programs rather than human beings, they perform tracking and coaching rather than delivering therapy, and users should leave the system when it replaces human contact or makes their condition worse. The true indicator of advancement lies in AI’s ability to enhance real-world experiences rather than its ability to mimic human behavior.

The upcoming period will establish whether AI technology will work as a mental health partner or intrude into medical treatment. These systems will convert sensitive information into data, making emotional connections seem like illusions when safeguards are absent. We must decide, but time is running out.

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