#dr-cox

#dr-cox

Currently I'm working on a virtue ethics approach to the issue of whether examples of moral badness should be allowed in machine learning with artificial moral agents. Motivating the side that we should do so is of special interest to me, with a focus on actions that are not wrong yet worse than morally indifferent.

There is a unique kind of pain in losing your mind, not just once, but over and over. Losing your perception of reality, of your emotions, of your closest relationships-both across months and multiple times a day. Knowing deep down that something is wrong but being unable to stop it.

Psychotherapy and counselling psychology, however, did not emerge from institutional logic. The field was forged within relational, psychoanalytic, and depth-oriented traditions that prioritize lived experience, symbolic meaning, cultural complexity, and human nuance over procedural standardization. Bureaucracy seeks predictability, yet psychotherapy was built upon a disciplined engagement with uncertainty.

Evidence Based Medicine was formalized in the 1990s, largely by Canadian physician David Sackett. Sackett described the goal of EBM is to replace hunches and habits with data and clinical trials. Clinical guidelines were developed involving protocols that tell doctors which drug to prescribe first, what dose to use, when to escalate treatment, and when to refer a patient to a specialist.

Relationships can feel like both a blessing and the bane of your existence, a source of joy and a source of frustration or resentment. At some point, each of us is faced with a clingy child, a dramatic friend, a partner who recoils at the first hint of intimacy, a volatile parent, or a controlling boss - in short, a difficult relationship.

Many therapists know the experience of leaving work while still carrying pieces of other people's lives. Session after session, we sit with grief, trauma, uncertainty, anger, longing, confusion, messy family dynamics, sophisticated relational projections, and stories that can penetrate you to your core. In response, we listen deeply, track patterns across years of someone's life, unpack mind-boggling events, and implement advanced psycho-somatic interventions that may indefinitely alter a person's future.

A child was struggling to breathe after surgery. Monitors beeped erratically, staff spoke in rushed fragments, and fear hung in the air so thick it felt like fog. The mother stood frozen in shock. A nurse-one of those rare people who radiates groundedness-walked in. She didn't speak at first. She simply approached the mother, placed a gentle hand on her shoulder, and breathed slowly, visibly, intentionally.

If we treat ADHD as binary (you have it or you do not), we are missing the possibility that we all lie somewhere on a continuum with diagnosed ADHD towards one end (and perhaps an ability to focus and concentrate at the other). A diagnosis of ADHD then depends on where the line is drawn. I suggest that this line has been moved in recent years, so that a large group of people have been caught up in the positive ADHD group, who would not have been previously.

But these studies typically require large numbers of patients, huge amounts of data, and thorough follow-ups, none of which comes easy or free. The upshot is fewer investigations into scenarios that are clinically important but unlikely to yield a profit for the firms funding them. Accordingly, researchers have been developing an option that uses real-world data from insurers to save patients from falling through the cracks.

An AI-informed supervision is constantly reminded to treat speech as metaphorical and not literal, since humans, including therapy patients, are very good poets and very bad reporters. AI never forgets to inquire why at this moment this thought occurred to the patient. It never forgets to consider projective identification -the communication of an intolerable feeling by getting the therapist to feel it. It never forgets to consider a lose-lose comment during a frame deviation.

Yes, there has been a shocking lack of progress in developing transformative psychiatric medicine (We need new drugs for mental ill-health, 5 February), but this may be because in mental health, drugs are not always the answer (see, for example, Richard P Bentall's Doctoring the Mind). Huge progress has been made in the effectiveness of talking therapies for example, free effective treatment for post-traumatic stress disorder (PTSD) is available to all UK army veterans through the charity PTSD Resolution.

They arrive on time, think clearly, and care about their clients. Outwardly, everything seems fine. In private, though, things can feel very different. A clinician's depression may not show up as clear despair. More often, it feels like emotional numbness, quietly withdrawing, or slowly losing interest in things that once mattered. Pleasure fades, curiosity lessens, and the work goes on, but it feels heavier and less alive.

"If I had an intrusive thought, I'd restart the walk from the bus stop," she says. "I was genuinely terrified that if I didn't redo it and something happened, it would be my fault".

When we think about getting help for our mental health, therapy is often the first-and sometimes only-option that comes to mind. Therapy works, and for many people it is essential. But it is not the only effective path. Emerging evidence suggests that well‑designed coaching -especially when delivered inside an adaptive, stepped‑care model-can help people feel better faster, build emotional skills, and relieve pressure on an overburdened clinical system (Sagui Henson et al.).

Most people will forget a name, misplace their phone, or lose track of a conversation at some point. Usually, those moments pass without much thought. But for many adults, especially as they age, small lapses can trigger a much deeper fear: Is this the beginning of cognitive decline? As a neurologist, I hear this concern often. And as a researcher, I have learned something important: Worry about cognition and cognitive disease are not the same thing.