\u201cAI tools are already shaping decisions about who gets hired, who gets housing and even who gets flagged in the legal system. Most people don\u2019t realise how deep it goes right now in the United States,\u201d says Mollie Adler.<\/p>\n
Adler<\/a> is speaking to Novara Media from her home in Texas, US. The 35-year-old writer, researcher and thinker uses her podcast Back From the Borderline<\/a> to challenge dominant Western ideas about mental illness. It reframes stigmatised mental health symptoms as potentially important communications about our current circumstances, personal histories and deeper purposes. Adler promotes the human capacity to transform \u2013 a process of \u201cemotional alchemy\u201d \u2013 over labels and rigid diagnostic categories. But it\u2019s not your typical mental health podcast, covering ground from the media\u2019s treatment of Britney Spears and the history of psychiatry, to religious trauma and big existential questions.\u00a0<\/p>\n With Back From the Borderline ranking in the top 1% of downloaded podcasts globally and 60,000 downloads per month across all platforms, it\u2019s clear her ASMR-worthy deep-dives are resonating.\u00a0<\/p>\n In early March, Adler sounded the alarm on how, in her words, mental health labels are becoming \u201calgorithmic life sentences\u201d. In a Substack post<\/a> and subsequent podcast episode, she painted a dystopian picture of US citizens being rejected from jobs<\/a>, denied insurance coverage<\/a> and even losing access to their children<\/a> due to discriminatory algorithmic decision-making that is silent, unaccountable and nearly impossible to challenge.\u00a0<\/p>\n In the US, mental health-related data harvested from wellness apps, therapy platforms and journaling tools, alongside search histories and social media activity, is being scraped and analysed by AI screening tools and used to build \u2018risk profiles\u2019. Research from Duke University<\/a> found that US data brokers were selling information that identified people by their mental health diagnoses \u2013 data that had been freely handed over to health and wellbeing apps, including names, addresses, emails and ethnicities.\u00a0<\/p>\n In 2022, one in four<\/a> US companies were using automation or AI in recruitment and hiring processes, according to research from the Society for Human Resource Management. Due to president Donald Trump\u2019s second term AI deregulation efforts<\/a>, this figure is likely now much higher.\u00a0<\/p>\n The use of AI screening tools has already triggered multiple federal cases, including one currently pending in California. Plaintiff Derek Mobley alleges<\/a> that companies using AI screening tools made by the AI platform Workday rejected his applications for over 100 jobs because he is Black, over 40 and has experienced anxiety and depression.\u00a0\u00a0<\/p>\n \u201cDifferent hiring platforms are sorting and scanning the digital presences of people who apply for roles to assess for emotional stability,\u201d Adler says. \u201cLandlords in the housing sector can now use certain tools that harness AI to scan for behavioral volatility<\/a> as a factor in tenant scoring. Notice how vague these terms are \u2013 emotional stability, behavioural volatility, mental health signals, stress levels \u2013 what do they even mean? It\u2019s all very subjective.\u201d\u00a0<\/p>\n There is no single comprehensive federal law in the US that protects personal data. Instead, a scattered patchwork of different state-level protections mean regulation and individual rights differ across the country. Even California\u2019s Privacy Rights Act \u2013 which is more stringent than what many other states have \u2013 is compared unfavourably to the UK\u2019s GDPR legislation<\/a>. California\u2019s attorney general Rob Bonta issued two legal advisories <\/a>earlier this year \u2013 one explicitly warning healthcare entities who develop, sell and use AI and other automated decision-making tools. But this is only one state and companies are increasingly monetising psychological data without real oversight.\u00a0<\/p>\n \u201cWhen a user is treated as a product and their mental state becomes a risk score, the implications are chilling,\u201d Adler says. Before turning to podcasting full-time, she worked in tech \u2013 specifically in the software as a service (SaaS) space \u2013 for roughly ten years. \u201cBuried in all those terms and conditions is permission to scrape, sell or use that data for what they call research and product development. So once it\u2019s in the system, it\u2019s out of your hands.<\/p>\n \u201cSometimes that phrase \u2018research and product development\u2019 is actually legit,\u201d Adler continues. \u201cThe problem is when it\u2019s used as a smokescreen, when it becomes this blanket permission for companies to do whatever they want without ever telling you how your data is actually being handled.\u00a0<\/p>\n \u201cIf you\u2019re going to ask people for access to their inner world, there should be total and pristine clarity about what that data is being used for, where it\u2019s going and who\u2019s benefiting from it. Anything less than that isn\u2019t innovation, it\u2019s just exploitation dressed up all pretty in tech bro, UX [user experience] language.\u201d<\/p>\n The speed of innovation and the quiet way tools are introduced \u2013 without fanfare or announcement \u2013 is part of the problem. Adler was living in the UK and working at e-commerce marketplace Groupon when our GDPR legislation was on the horizon. She witnessed internal corporate panic and describes a \u201cshitshow cacophony scramble behind the scenes\u201d where senior staff were \u201cfalling over themselves to get compliant\u201d.\u00a0<\/p>\n \u201cEverything we did was about GDPR, but even then, it was obvious that the rules weren\u2019t designed to protect people for what was coming next and honestly, how could they? Innovation is always outpacing things because even when companies play by the book, the book itself is outdated. AI is moving faster than any regulator can keep up with.<\/p>\n \u201cEntire industries are being built right now around collecting, sorting and monetising our inner worlds. With mental health data, the stakes are even higher because people are sharing what hurts them the most, what they\u2019re afraid of and what they\u2019re trying to heal from. But we continue to accept those terms and conditions because we\u2019re all just trying to get through the day \u2013 and tech companies are counting on that. People who don\u2019t have the resources to opt out or push back or research into this are the ones who will be harmed first. But I think it\u2019s going to impact all of us.\u201d<\/p>\n I ask Adler if the outlook for people in the UK is any brighter. She replies, \u201cI know your regulatory landscape offers a better starting point. That said, I also know how quickly technology tends to move past legislation. It\u2019s what we saw with social media. And it\u2019s starting to happen again here [in the US].\u201d<\/p>\n But the core issue for Adler is that AI tools like large language models are being trained on the biomedical model of mental health, when there\u2019s still no biological basis<\/a> for the vast majority of psychiatric diagnoses \u2013 with notable exceptions like Alzheimer\u2019s and Huntington\u2019s disease. The diagnoses listed in the Diagnostic Statistical Manual (DSM) \u2013 known as the North American \u2018bible of psychiatry\u2019 \u2013 and the International Classification of Diseases (ICD) are defined and formalised by committee voting<\/a> and, as such, are shaped by social factors like politics, culture, personalities and pharmaceutical lobbying, as opposed to hard science.\u00a0<\/p>\n \u201cPsychiatry is not like getting your blood drawn, for example and finding out you have low iron,\u201d Adler says. \u201cI could get my blood work done anywhere in the US, anywhere in the UK, and my levels would be the same. But for these DSM diagnoses, there\u2019s no test, no biomarker, no scan that would give you the same result across different providers. It\u2019s just symptoms on a checklist and even then, it\u2019s subjective.<\/p>\n \u201cEvery single time a new version of the DSM comes out, we get more diagnoses, more codes, more billable treatments<\/a>, more people walking around convinced that something is fundamentally wrong with their personalities or their brain chemistry<\/a>,\u201d she continues. \u201cAnd that\u2019s not care \u2013 it\u2019s commerce. It\u2019s really fucking good marketing. Look at how many of us believe it. And this is the foundation that\u2019s being fed into AI.<\/p>\n \u201cThese tools could have been designed to help people reflect, grow or engage with their inner world in new ways, but they\u2019re being trained on frameworks that actively flatten complexity, categorise our pain and sell solutions. It\u2019s not innovation \u2013 it\u2019s just automation of the same old stuff.\u201d<\/p>\n Adler also wants to challenge those who see themselves as on the left but haven\u2019t really examined the neoliberal and capitalist engine driving dominant understandings of mental health. \u201cI see people actively embracing these labels who are deeply progressive,\u201d she says. \u201cThey question capitalism, they fight state control, they\u2019re trying to build a more liberated world, yet they\u2019re putting DSM and ICD codes into their social media bios. I say that with so much compassion, because I\u2019ve been there too. I\u2019ve identified with labels that helped me make sense of my pain. They gave me a map \u2013 and I think that\u2019s their utility \u2013 but we have to eventually ask: who wrote the map and where does it lead?\u00a0<\/p>\n \u201cThese frameworks were giving me a narrative that said my distress was chemical and the best I could hope for was stability, compliance and basically just like, \u2018get back to work\u2019. And if you look critically, you can see this logic baked into the popular treatments most often covered by health insurance like CBT [cognitive behavioural therapy] or DBT [dialectical behavioural therapy].\u201d<\/p>\n Adler qualified that she\u2019s not saying these treatment types can\u2019t be helpful \u2013 but that they\u2019re only just enough to get someone out of crisis and back into the workplace, \u201cnot enough to heal, get to the root cause of suffering or transform your life\u201d. She describes CBT and DBT as \u201cmanagement for the sake of productivity\u201d \u2013 a view shared by British psychotherapist James Davies, who has explored<\/a> how short-term modes of therapy that promise the greatest return on worker productivity such as CBT are marketed to Westminster politicians and adopted by the NHS.<\/p>\n Many of Adler\u2019s critiques of psychiatry and the medicalisation of human experience are recognisable to those familiar with the work of psychologists like Lucy Johnstone<\/a> and Mary Boyle, or psychiatrists Sami Timimi and Joanna Moncrieff. If the accepted Western biomedical model of mental health is unhelpful \u2013 or harmful \u2013 then it really matters that AI tools are being trained to predict early signs of a \u201cmental health crisis\u201d \u2013 with one study finding this is possible with 89.3% accuracy<\/a> based entirely on online behavior.\u00a0<\/p>\n \u201cYou\u2019re not being asked to wake up \u2013 you\u2019re actually being asked to fall more deeply asleep and just behave and not be a problem, which is why it\u2019s so disorienting to see people who would have been actively protesting psychiatry in the 70s now embracing it like it\u2019s some kind of gospel truth,\u201d Adler says. \u201cQueerness used to be pathologised. Being gay was literally categorised as a mental disorder in the DSM until the 1970s and now we\u2019re actively taking part in pathologising our own grief, our rage, our trauma and we\u2019re calling it identity. And to me, it feels like we\u2019re just drinking the same poison in a new bottle, and then like psy-opping ourselves into believing it\u2019s the cure.<\/p>\n \u201cIt replaces self-inquiry with symptom checklists. It tells you what you are and who you are, instead of helping you figure that out for yourself and to me, that\u2019s horrifying because this whole dystopian framework is being embedded into machine logic. Tech founders and psychiatrists are falling over themselves to build therapy bots and mental health tools, using this model as the blueprint. It\u2019s not progress, it\u2019s regression.\u201d<\/p>\n So what does Adler see as the way forward? She views AI as a neutral tool \u2013 \u201clike a scythe\u201d \u2013 with its impact entirely depending upon how it is wielded. Adler is hopeful about what AI could potentially offer \u2013 once it\u2019s been \u201cjailbroken\u201d from the biomedical model of mental health.<\/p>\n \u201cAll of us deserve better tools, not DSM-trained chat bots, not these sleep wellness apps that basically sell your breakdown to the highest bidder. I know this emergent intelligence can be used for inner work that\u2019s actually liberating \u2013 but only if we build it from the ground up with new framework, better values and a really uncompromising approach to data protection and psychological safety. That\u2019s how we make sure we don\u2019t repeat the past, and how we actually build stuff that\u2019s worthy of all of the people who are going to be using it.\u201d<\/p>\n