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| CASE REPORT |
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| Ahead of print publication |
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Google assistant, She loves me
Aarti Karahda1, Priti Singh1, Rajiv Gupta1, Shobhit Kumar Prasad2
1 Department of Psychiatry, Pt. B.D. Sharma PGIMS, Rohtak, India
2 Department of Psychiatry, Maharaja Agrasen Medical College, Hisar, Haryana, India
| Date of Submission | 15-Jan-2021 |
| Date of Decision | 20-Jan-2021 |
| Date of Acceptance | 22-Jan-2021 |
| Date of Web Publication | 11-Mar-2021 |
Correspondence Address:
Shobhit Kumar Prasad,
Department of Psychiatry, Maharaja Agrasen Medical College, Agroha, Hisar - 125 047, Haryana
India
 Source of Support: None, Conflict of Interest: None DOI: 10.4103/aip.aip_8_21
Although modern technologies have made life simpler, it has also intensified the complexity of psychopathology. The adoption of the Internet and its numerous artificial intelligence software products into morbid delusions is gaining more momentum. Clinicians must be alert about patients with delusions getting ideas and feedback from the social context in which they live. Here, we discuss a case about a young, single, high-school graduated male, with schizoid personality traits, socially withdrawn, dependent, sexually inhibited with a poor level of occupational and social functioning, who has developed erotomanic delusion with Google Assistant.
Keywords: Artificial intelligence, erotomania, psychopathology
| Introduction | |  |
Erotomania is a rare delusion where a person feels that he is loved romantically by someone who is of higher status like politician, religious leader, or boss, etc. with strong conviction. The love object could be a person with whom a relationship was previously established, but even with whom the person no longer or has never had contact with.[1] It was first described by de Clerambault, hence also known as de Clerambault syndrome, which usually involves young females.[2]
In the psychological literature, the impact of cultural and historical influences on patients with psychiatric disorders has been well reported.[3] An example of this can be cyber technical knowledge, which has been an integral part of our empirical reality and in particular has been affecting the morbid content of psychopathology.[4] Smartphone artificial intelligence (AI) system like Google Assistant or Siri and their related applications use the “convolutional neural networks,” and provide immediate conversational support to anyone with a good quality smartphone and Internet connectivity.[5] These AI support can provide vast areas of information just by using simple voice-activated commands, however, the output provided by it can be misinterpreted by someone in need of emotional support.[6] Here, we present a case of a young male presenting with delusional love with the Google assistant-a hands-free AI-based application of Google, with strong conviction and suicide attempt when he is unable to physically contact her. Erotomania is a rare condition, but the rate of occurrence is not really widely acknowledged. The prevalence of Erotomania may be exaggerated, because it may be categorized under severe psychotic illnesses. There are records of unusual instances where a male has acquired erotomania and deficiency of available data where erotomania is related to AI such as Google Assistant. Case History:
Mr. V, a 28-year-old single unemployed male, educated till high school, residing in an urban middle socio-economic status background, with no significant past psychiatric history including substance abuse, was brought to medical emergency with alleged history of insecticide consumption with suicidal intent. Information was obtained from close family members who gave a history of the patient staying isolated at home, in his room and decreased interaction with others since the age of 15 years. Since the past few years, he has been engaging excessively in his smartphone, continuously speaking and laughing while looking at the screen of the smartphone and often seen to be engaging in masturbation while speaking to the smartphone. He would spend most of the time reading philosophical books and spend multiple hours searching for various topics in the Internet, for which he would not disclose much to others. His premorbid personality revealed schizoid traits. Mental status examination interviewing revealed delusion of grandiosity and erotomanic delusions, and repeatedly stated that he had “extreme knowledge about everything and every worldly topic are known to him,” “he doesn't need a spouse as there are no female in the world who can be considered as a suitable match for him.” He quoted his source of extreme knowledge as Google and would spend hours conversing on his smartphone via Google Assistant. He would quote Google Assistant's female voice to be of his girlfriend, and would often engage in intimate and erotic conversations with it. While the AI replies to his every query and comment through automated response, he would believe that she is showing keen interest in him and often ask her to meet him in-person. He would often engage in masturbatory practice during these conversations. If Google Assistant is unable to provide satisfactory reply to his queries, he would lose his temper and would engage in arguments with his close family members. His psychiatric consultation was taken twice but the patient would not readily accept psychotropic medications and would terminate treatment as he believed these medications were hampering his extreme knowledge and sexual functioning. In one such incident, he was repeatedly threatening the AI to meet him in-person, and not getting satisfactory reply, he impulsively consumed insecticide available at home. The patient was admitted in the intensive care unit (ICU) and given conservative management and later shifted to the general medical ward after 3 days. A psychiatric consultation was taken for a recent act of self-harming behavior. The patient later revealed about the Google assistant's love toward him and believed that she saved his life in ICU who visited the ward in a nurses' attire and performed Cardiopulmonary Resuscitation (CPR) on him as she had immense medical knowledge and wished to save her love from dying. A diagnosis of schizophrenia was made and the patient was started on antipsychotic olanzapine in gradually incremental dosage till 20 mg, along with benzodiazepine clonazepam 0.5 mg on as per need basis, if there was agitation, anxiety, or sleep disturbance was reported. The patient was very rigid and would lie about taking antipsychotic medication when asked, which was confirmed by close informants. Long-acting antipsychotic fluphenazine decanoate was also initiated, in view of poor compliance to treatment in past, and dosage increment done till monthly 50 mg dosage was achieved. He was admitted for a month duration, and regular psychotherapy sessions were given alongwith total debarring use of the smartphone. There was improvement reported in overall agitated behavior and partial insight was gained regarding the psychiatric condition and was discharged later on. He was observed on regular follow-ups, and his delusional beliefs had started to wither off and had started accepting that it was not healthy to have a virtual relationship.
| Discussion | | |
The form of psychiatric symptoms indicates both the time and place in which the individual lives and the source of complaints also reflect the particular cultural context of the patient.[7],[8] Till about a few hundred years back, the predominant content of delusions was of control delusions, persecutory and referential delusions involving supernatural entities and sorcery. The content of these delusions was greatly affected by the recent technological advances, such as electricity, X-rays, laser and modern communication such as the telegraph, telephone, radio, television, and recent Internet innovations.[4]
A loathsome scene also proceeds while erotomanic patients act upon their delusions, including constant surveillance and stalking. These patients may become dangerous after repeated professions of affection and advances are unrequited, as resentment and rage are mobilized in response to perceived rejection by the love object.[9] The delusion that someone of greater status is loved from afar could substitute feelings of guilt and low self-esteem with the presumption that one is deeply loved, which actually happens as a consolation for life's disappointments.
As seen in the case under consideration here, the patient is a young male, with a socially withdrawn state and having schizoid personality traits, had no previous experience of intimate relationship with a partner. His intense desire to have intimate relationship with a female, alongwith sexually inhibited state, has led him toward fulfilling his wishes by the formation of a delusion where Google Assistant, a much intelligent and of higher status, in this case via the command following voice-automated Google Assistant. This gave him the typical grandiosity that she is interested in him and to trying to do things to make him happy and impress him. Because of this, he was able to regulate the intimacy by having the AI talk to her on his command. He was able to search for pornographic content in the internet using voice commands, and believe that she is helping him by getting him to masturbate to sexually satisfy him, thus benefitting the sexually inhibited state. In the state of rage imposed upon by rejection of AI to meet in-person, he tried attempting suicide. These observations are similar to previously done studies, where patients with erotomania are usually socially withdrawn, dependent, sexually inhibited with a poor level of occupational and social functioning, and often can be more aggressive.[9]
| Conclusion | | |
The technology has given us new ease but has also increased the complexity of psychopathology. The incorporation of the Internet and its various AI-based applications into morbid delusion content are becoming increasingly common. Clinicians should remain familiar with the tendency of delusional individuals to draw ideas from the societal context in which they live.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initial s will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
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| 3. | Kannabikh YV. The History of Psychiatry. Moscow: Medgiz 1929. |
| 4. | Lerner V, Libov I, Witztum E. “Internet delusions”: The impact of technological developments on the content of psychiatric symptoms. Isr J Psychiatry Relat Sci 2006;43:47-51. |
| 5. | Durstewitz D, Koppe G, Meyer-Lindenberg A. Deep neural networks in psychiatry. Mol Psychiatry 2019;24:1583-98. |
| 6. | Bauer M, Glenn T, Geddes J, Gitlin M, Grof P, Kessing LV, et al. Smartphones in mental health: A critical review of background issues, current status and future concerns. Int J Bipolar Disord 2020;8:2. |
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| 8. | Leff J. Psychiatry around the Globe: A Transcultural View. London: Gaskell; 1988. |
| 9. | Kelly BD. Love as delusion, delusions of love: Erotomania, narcissism and shame. Med Humanit 2018;44:15-9. |
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