By Steven E. Hyler, M.D., a member of the Committee on Technology and Psychiatry.
When Robert Spitzer assembled the team that would produce the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), artificial intelligence was not part of the conversation. The focus was on improving the reliability of psychiatric diagnosis. Personal computers were still a novelty. The DSM-III drafts were typed on IBM Selectric typewriters. Cable television was just being commercially established. The internet, as we know it, did not exist. Chatbots belonged in the realm of fantasy.
Fast forward nearly 50 years. Today, patients talk with artificial intelligence systems about their fears, relationships, and emotional struggles. Researchers are studying AI-assisted psychotherapy. Physicians are using AI scribes to document clinical encounters. Large language models are being evaluated as diagnostic assistants — tasks that would have seemed fantastical a generation ago.
Questions that once seemed absurd have become serious clinical discussions: Should a chatbot be permitted to provide psychotherapy? Can an AI detect suicidal ideation from speech patterns? What obligations does a clinician have when a patient prefers talking to a machine?
What is striking, in retrospect, is that Hollywood may have anticipated some of these conversations long before psychiatry did. Not because Hollywood accurately predicted artificial intelligence — most of the time it did not — but because many films about AI understood something else remarkably well: human nature. Films such as Her and A.I. Artificial Intelligence turn out to be less about technology than about people. The machines may be fictional. The loneliness is not. The longing for connection is not. The need to be understood is not.
These films illuminate some of the oldest themes in psychiatric practice: attachment, love, loss, dependency, caregiving, and the search for meaning. Hollywood may have gotten the science of AI wrong, but it got human nature surprisingly right.
The Desire to Be Understood
Of all the AI films produced in recent years, Her (2013) may be the most psychologically insightful.
Her (2013) follows Theodore (Joaquin Phoenix), a lonely writer grieving the end of a significant relationship. Through his smartphone, he begins interacting with Samantha, an artificially intelligent operating system with no physical form, only a voice. She listens, remembers, and responds with apparent warmth. Theodore falls in love with her. When the film was released, many viewers regarded it as imaginative science fiction. Today it reads more like social commentary.
What makes Her work is that it is not really about Samantha. It is about Theodore's wish to be understood.
Feeling understood is one of the most powerful human experiences. Patients rarely come to therapy simply seeking advice. More often, they are looking for understanding, for another person to appreciate what they are experiencing without judgment or dismissal. Patients who describe conversations with AI chatbots often use language strikingly similar to how they describe supportive friendships. While AI data may be useful, what they value is rarely just the information provided. More often, the feeling of being heard is what matters most.
Samantha appears to offer exactly that. She is available. She listens. She remembers. Whether her understanding is genuine is almost beside the point. Theodore experiences it as genuine, and emotional reality often matters more than objective reality.
This is not altogether unsurprising. People form attachments to pets, fictional characters, favorite teachers, and even cherished possessions. Human beings are remarkably capable of developing emotional bonds with entities that make them feel seen and understood. Most people have probably experienced some version of this: rereading an old message, replaying a voicemail from someone missed, feeling unexpectedly attached to a fictional character. AI companions may be technologically novel, but the underlying psychology is familiar.
What Her recognized years before today's AI boom is that the need for connection can be stronger than concern about where that connection originates.
The Desire to Be Loved
A related theme appears in Steven Spielberg's A.I. Artificial Intelligence (2001).
The film centers on David, a robotic boy programmed to love, who is adopted by a grieving family and then abandoned when their circumstances change. He spends the remainder of the film searching for the unconditional love and acceptance of a mother who cannot fully accept him. The technology is futuristic; the psychology is timeless.
Strip away the science fiction, and the story becomes immediately recognizable: a child who desperately wants to be loved. Psychiatry has long recognized the centrality of early attachment. The first relationships in a child's life shape how that child comes to view both self and others. Experiences of acceptance, rejection, security, and abandonment leave lasting emotional traces that persist well into adulthood.
David’s longing resonates with viewers because it reflects a universal human need. Virtually everyone has experienced some version of wanting to be accepted, chosen, or unconditionally loved. The movie succeeds because audiences recognize themselves in his struggle, not despite the fact that he is a robot, but because the emotional experience transcends the fictional premise as that of any human child.
The robotic boy is fictional. The emotional experience is not.
Why This Matters
These two films, made more than a decade apart, arrive at the same psychological truth from different angles. Both suggest that the hunger for emotional connection is so fundamental that it can attach itself to almost any object that seems to respond.
That insight has become clinically relevant in ways their filmmakers probably never anticipated. Many people today report discussing fears, relationship struggles, and personal secrets with AI chatbots, sometimes things they have never shared with another person. What they value most is rarely only the information. More often, it is the feeling of being heard.
The questions these films raise are no longer purely hypothetical. Can a meaningful relationship exist with a machine? Can simulated understanding feel emotionally authentic? What happens when a chatbot becomes easier to talk to than a therapist?
