Mic Drop: Take two chatbots and call me in the morning

Summary

Podcast Title: Click Here
Episode: Mic Drop: Take Two Chatbots and Call Me in the Morning
Release Date: July 25, 2025
Host: Dina Temple-Raston
Guest: Dr. Stephen Xenakis
Description: This episode delves into the innovative intersection of psychiatry and artificial intelligence, featuring Dr. Stephen Xenakis, a retired brigadier general and forward-thinking psychiatrist exploring how AI can revolutionize mental health care.

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1. Introduction to Dr. Stephen Xenakis

The episode opens with host Dina Temple-Raston reintroducing Dr. Stephen Xenakis, a multifaceted professional with a diverse background. Dr. Xenakis shares his extensive experience:

Dr. Xenakis [00:48]: "I'm a psychiatrist, spent 28 years in the Army. I came in 1970, retired in 1998 as a brigadier general, working with military families and veterans, and do a lot of public health activity as well."

His unique career path includes working with detainees at Guantanamo Bay, advising military officials on the impacts of blast wave concussions, and pioneering the use of psychedelic therapy for PTSD.

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2. Traditional Psychiatry vs. AI-Enhanced Psychiatry

Dr. Xenakis introduces his vision for integrating artificial intelligence into psychiatric practice. He contrasts traditional methods with AI-driven approaches:

Dr. Xenakis [05:29]: "We're getting away from questionnaires. That's what I'm trying not to do. I think questionnaires... are too crude."

He criticizes the limitations of standard questionnaires, arguing they fail to capture the nuanced complexities of patient experiences. Instead, he advocates for open-ended interviews supplemented by AI analysis to achieve deeper insights.

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3. Implementation of AI in Clinical Interviews

The conversation explores how AI can transform clinical interviews. Dr. Xenakis explains a hypothetical model where patient interviews are analyzed by large language models to identify patterns and correlations beyond human capacity:

Dr. Xenakis [05:55]: "It would just be a raw interview that could be uploaded and compared to what we think is our reference interview or our sentinel. And how close is the correspondence?"

By utilizing AI, clinicians can move beyond multiple-choice assessments, engaging in more naturalistic conversations that AI can interpret for deeper diagnostic accuracy.

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4. Potential Impact on Rural Mental Health Care

Dr. Xenakis emphasizes the critical need for AI in underserved areas. He envisions AI as a "force multiplier" that can extend the reach of limited mental health professionals in rural regions:

Dr. Xenakis [11:06]: "I mean, look, I think it'd be particularly helpful outside of our urban areas, places where we don't have a good number of mental health people, and yet we have a number of patients that are really seeking help."

This approach aims to bridge the gap in mental health services in states like Alaska and Wyoming, where the ratio of psychiatrists to population is alarmingly low.

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5. Data Integration and Personalization of Treatment

The discussion highlights how AI can leverage vast amounts of patient data to personalize treatment plans. Dr. Xenakis envisions AI systems that compare individual patient data against extensive datasets to predict treatment responses:

Dr. Xenakis [12:44]: "Yeah, exactly. And then it would learn over time, so we would be able to feed that back. The more we do that, the more we learn."

This iterative learning process allows for increasingly accurate predictions on which treatments, such as specific medications or cognitive therapies, would be most effective for each patient.

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6. Wearable Technology and Data Collection

Integrating data from wearable devices represents a significant advancement in psychiatric care. Dr. Xenakis discusses how devices like Apple Watches and Fitbits can provide objective data on sleep patterns, physical activity, and physiological metrics:

Dr. Xenakis [14:52]: "So let's look at that, and then let's look at what you did, or let's look at your diet. And the more we have that and we can look at it together, the better decisions we can make."

By incorporating real-time data, psychiatrists can gain a more comprehensive understanding of their patients' lifestyles and health metrics, leading to more informed and effective treatment strategies.

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7. Ethical and Humanistic Considerations

While the potential benefits of AI in psychiatry are vast, the episode also addresses the ethical and humanistic concerns. Dr. Xenakis acknowledges the importance of maintaining the human element in psychiatric care:

Dina Temple-Raston [16:12]: "Psychiatry isn't an equation. It isn't about solving for X. It's about people. And people can be messy."

He stresses that while AI can augment the capabilities of clinicians, it cannot replace the empathy and personal connection essential to effective mental health treatment. The balance between technological assistance and human judgment remains a critical consideration.

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Conclusion

In this insightful episode of Click Here, Dr. Stephen Xenakis presents a compelling case for the integration of artificial intelligence into psychiatric practice. By leveraging AI to enhance diagnostic precision, personalize treatment, and extend mental health services to underserved areas, psychiatry stands on the brink of a transformative evolution. However, the humanistic aspects of care must remain at the forefront to ensure that technology serves as a complement rather than a replacement for empathetic clinical relationships.

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Notable Quotes:

• Dr. Xenakis [05:29]: "We're getting away from questionnaires... are too crude."
• Dr. Xenakis [11:06]: "It'd be particularly helpful outside of our urban areas..."
• Dr. Xenakis [12:44]: "The more we do that, the more we learn."
• Dina Temple-Raston [16:12]: "Psychiatry isn't an equation... It's about people."

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This episode offers a thought-provoking exploration of how artificial intelligence can reshape the landscape of mental health care, highlighting both the promising advancements and the essential considerations needed to preserve the integrity of psychiatric practice.

Transcript

[Dena Temple]

From Recorded Future News and prx, this is Click Here. Hey, it's Dena. The Click Here team is taking a short summer breather today. We're returning to a conversation with Dr. Stephen Xenakis, a psychiatrist, a military man, and an early believer in using psychedelics to heal trauma and his latest frontier, artificial intelligence. He's asking whether an algorithm might do what some clinicians cannot. See the patient beyond the pattern. Take a listen.

[Stephen Xenakis]

I'm a psychiatrist, spent 28 years in the Army. I came in 1970, retired in 1998 as a brigadier general, working with military families and veterans, and do a lot of public health activity as well.

[Dena Temple]

You know what? You forgot your name.

[Stephen Xenakis]

Oh, Stephen. No, I'm Stephen Kanikis.

[Dena Temple]

From Recorded Future News, this is Click Here's Mic Drop, a longer cut of one of our favorite interviews of the week. I'm Dina Templewaston. So when you think of a psychiatrist, you probably have a picture in your head, calm demeanor, notebook, pen maybe. Sitting across from a patient who's stretched out on a chaise lounge, nodding, taking notes, classic Freudian stuff. But Dr. Stephen Xanakis is not exactly that kind of psychiatrist. For starters, he's a retired brigadier general in the army, so he deals with a different kind of patient. He's worked with detainees at Guantanamo Bay. He's advised top military officials on the impact of blast wave concussions. And he's the kind of psychiatrist who is not afraid to go against the grain and try new things. For example, he's a big proponent of psychedelic therapy for ptsd, something that for a long time was considered of kind of out there. And more recently, he's been thinking about this other thing he'd like to try to incorporate into his practice.

[Stephen Xenakis]

I've been for years thinking that we needed to use these AI tools in identifying patients who would best respond to particular treatments.

[Dena Temple]

Stay with us.

[Dina Templewaston]

Looking for more of the cybersecurity and intelligence coverage you get on Click Here, then check out our sister publication, the Record. From Recorded Future News, you'll get breaking cyber news from reporters in New York, Washington, London, and Kyiv, among others. And you'll see for yourself why it attracts hundreds of thousands of page views every month. Just go to the Record Media.

[Dena Temple]

I'm Dina Temple Roast, and this is Click Here's Mic Draw. Stephen Xenakis often spends the day navigating the fragile terrain of the human mind. His patients include veterans, men and women who have seen war up close and have lived through things most people never even have to imagine. Now these veterans are home but home isn't always a place you can simply return to. And they're struggling. Maybe they can't sleep, maybe their nerves are on edge, their thoughts racing. So they come to see him. And like most psychiatrists, Xanakis listens. He diagnoses, he prescribes medication when needed. He helps his patients develop coping strategies. Now, psychiatry has always been part science, part detective work, and part deep human connection. And these days, Xanakis is starting to explore how AI might be used as a way to sort of amplify his expertise, to help him diagnose and personalize treatment. Can you give me a hypothetical of how it would work?

[Stephen Xenakis]

Well, the hypothetical would be, and we have tested this out, is that a patient comes in, let's say a veteran. And we know that these veterans have multiple problems. They've got ptsd, many have been exposed to trauma, and they have traumatic brain injury. They have had other injuries, so they've got chronic pain. They may have sleep problems. They may have been exposed to medications that have also made them feel more anxious or caused thinking problems. And they come in for an interview and they say, look, I need some help here.

[Dena Temple]

So how do you figure out what this person needs? The traditional response was use a questionnaire, fill in some bubbles, rate your mood on a scale of 1 to 10, things like that. But Dr. Izanakis says, no, that's just not enough.

[Stephen Xenakis]

We're getting away from questionnaires. That's what I'm trying not to do. I think questionnaires, excuse me, I think are too crude. That's standard in the field. But I don't think they get the kind of nuanced subtleties that we get just from an interview.

[Dena Temple]

What Dr. Xanakis would do, instead of multiple choice questions is a more open ended kind of interview with the patient.

[Stephen Xenakis]

It would just be a raw interview that could be uploaded and compared to what we think is our reference interview or our sentinel. And how close is the correspondence? And because of the way these large language models work, they're able to find key words and nests of words that show what the correlation is. So this goes way beyond its quantum leaps, beyond a questionnaire.

[Dena Temple]

So this is the idea, not just forms, not just checklists, but something closer to the way real conversations work. And then AI would help doctors scan those conversations and pick up on things that might otherwise get missed. Maybe just some nuance that got lost in the shuffle of a long conversation. Or it could be something that a psychiatrist just doesn't have expertise in. But the AI has been programmed to understand. Dr. Zenakis says his interviews with patients would be structured in a way to actually help the AI. So would there be set questions so that you could compare apples and apples?

[Stephen Xenakis]

Just a good clinical interview? I mean, I think good clinical interviews have set questions. I mean, what is the problem? How serious is it? How long have you had it? You know, what other problems do you have like this? I mean, what's the history have you had? I mean, it's just a good clinical interview, right?

[Dena Temple]

Are you sleeping? Which is usually a pretty good one.

[Stephen Xenakis]

Yeah, exactly.

[Dena Temple]

To tell if something's off.

[Stephen Xenakis]

I see.

[Dena Temple]

Pairing these kinds of structured interviews with AI, he says, could take the doctor patient relationship out of multiple choice and into something he thinks would be, well, deeper. Which raises the question, could technology, something that feels cold and impersonal, actually help make mental health care more human? And do we even want it to stay with us? Support for Click Here comes from Quince with summer in full swing, I feel that familiar urge to refresh my closet. But I'm not trying to waste money on pieces I'd only wear once, or maybe just for a season. That's where Quince comes in. Their clothes are timeless and the quality is way beyond what you'd expect for the price. Think 100% European linen tops starting at $30, washable silk dresses and skirts and soft cotton sweaters. I have a pair of their suede mules. They're water repellent, look really expensive, but aren't. And the insole is incredibly comfortable. So from the moment you put them on, they're the perfect slip ons for the summer. Give your summer closet an upgrade with quince. Go to quince.com clickhere for free shipping on your order and 365 day returns. That's Q U I-n c-e.com clickhere to get free shipping and 365 day returns. Quince.com clickhere.

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[Dena Temple]

So imagine you're a psychiatrist in a small town, maybe in Wyoming, maybe Alaska. You've got veterans coming into your office, and some are struggling with ptsd, others with pain that just won't go away. And they need your help. But you don't have a huge team. Instead, you have a backlog of patients and not a lot of resources to go around. What Dr. Xenakis hopes AI can do is give doctors access to something that could both extend their expertise and make the treatment process more efficient by connecting doctors to a system that could take every interview, every conversation they've had, and compare it to thousands, maybe hundreds of thousands of other conversations. Are there particular places where you think this would be particularly helpful?

[Stephen Xenakis]

I mean, look, I think it'd be particularly helpful outside of our urban areas, places where we don't have a good number of mental health people, and yet we have a number of patients that are really seeking help.

[Dena Temple]

In the military. There's a term for this kind of thing. It's called a force multiplier. A force multiplier is anything, a weapon or a tool that lets soldiers do more than they could do on their own. It essentially amplifies their abilities. And Dr. Xenakis, he says AI could be a force multiplier for doctors.

[Stephen Xenakis]

I know that there are many therapists out there that are in communities and may not have had a lot of.

[Dena Temple]

Experience, and the numbers are kind of shocking. In states like Alaska and Wyoming, veterans make up at least 10% of the population. But the number of psychiatrists in these states, well, for the roughly 1.3 million people, there are less than 200 registered psychiatrists in both Alaska and Wyoming combined. Psychiatrists in rural areas are strapped not just for resources, but for patient data to refer to. But a large language model could essentially expand the amount of patient data they can draw from to help guide their patient care. And then what they would be able to do is, with a large language model, it would be compared with thousands, maybe hundreds of thousands of other patients. So that you'd be using all that knowledge to come up with a solution.

[Stephen Xenakis]

Yeah, exactly. And then it would learn over time, so we would be able to feed that back. The more we do that, the more we learn. And we say that, for example, a patient's prescribed a particular medication that we think would help with sleep. Well, as we look at that and look at those patients who were prescribed and look at their interviews, we can get a better idea of who would be a responder. And that's really important.

[Dena Temple]

Right. So that they don't take a pill that doesn't end up helping their problem.

[Stephen Xenakis]

Yes, Right.

[Dena Temple]

Because even with a great interview, even with the best doctors, no one gets everything right. But maybe with enough data, they could get closer. So let's be honest. Anyone who's ever gone to a doctor has probably fudged a thing or two. You say you exercise a few times a week, but really, was it twice? Once, not at all. You tell your doctor you sleep okay, but if they asked you how many hours, how much was deep sleep versus light sleep, you wouldn't really know. Xanakis knows this. He knows that some of the information he gets from his patients isn't exactly, well, precise.

[Stephen Xenakis]

It's really hard to get good information from your patients about how well they slept or really did they exercise. Not that any of this intentionally being misrepresented or, you know, that they're not intentionally not disclosing to us. I mean, how well did you sleep? I don't know.

[Dena Temple]

But now we don't have to guess about some of those things because we have wearables. So think about something like an Apple Watch or a Fitbit. It tracks your heart rate. It knows how many steps you take. It even knows down to the minute how much deep sleep you got last night. And when doctors have access to that kind of data, it changes the game.

[Stephen Xenakis]

So let's look at that, and then let's look at what you did, or let's look at your diet. And the more we have that and we can look at it together, the better decisions we can make. And then we can decide what treatments might work best with you as we think about either medicines or activities or cognitive behavior therapy.

[Dena Temple]

Because mental health isn't one size fits all. What works for one person might not work for another. But AI, these wearable devices and the technology being developed now, Dr. Sinakis says this is a real turning point, a way to customize treatment better and get past the guesswork. So I just got a new Apple Watch. And so I have it tracking my sleep because I was interested. I'm not really interested in all the exercise stuff and heart rate and all that other stuff, but I'm finding myself being quite obsessed with how much deep sleep versus core sleep versus REM sleep, how much I'm awake. And it is, as you say, something I would never be able to tell a doctor. I could just say, okay, I feel pretty rested, I guess, but this is showing me just how much it is.

[Stephen Xenakis]

Yeah. And I think it's very. I mean, I know that people get obsessed with it, but I think it's really helpful. I use it a lot with my.

[Dena Temple]

Patients using technology in psychiatry. It sounds futuristic, maybe even revolutionary. The rub is that psychiatry isn't an equation. It isn't about solving for X. It's about people. And people can be messy. And then there's this bigger question. Is this what we really want? Sure, AI has its place. It can help with paperwork, maybe spot early warning signs. But psychiatry isn't just science. It's an art. And AI isn't an artist. At least not yet. From Recorded Future News, this has been Click Here's Mic Drop. It was written and produced by Megan Dietre, Sean Powers, Erica Gaeda, Zach Hirsch, Lucas Riley and me, Dina Temple. Rest it was edited by Karen Duffin. We'll be back on Tuesday. Have a great weekend.

[Dina Templewaston]

If you're looking for a daily guide to cybersecurity news and policy, sign up for the Cyber Daily From Recorded Future News. It serves up the day's most interesting and important cyber stories from our sister publication the Record, and then aggregates all of the big cyber stories you might have missed from news outlets around the world. Just go to the Record Media and click on Cyber Daily to get all you need to know about the world of cybersecurity right in your inbox.