Garcia, Bosco and Chua, Eugene Y. S. and Brah, Harman (2025) The Problem of Atypicality in LLM-Powered Psychiatry. Journal of Medical Ethics.
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The Problem of Atypicality in LLM-Powered Psychiatry (Accepted).pdf - Published Version Download (303kB) |
Abstract
Large language models (LLMs) are increasingly proposed as scalable solutions to the global mental health crisis. But their deployment in psychiatric contexts raises a distinctive ethical concern: the problem of atypicality. Because LLMs generate outputs based on population-level statistical regularities, their responses—while typically appropriate for general users—may be dangerously inappropriate when interpreted by psychiatric patients, who often exhibit atypical cognitive or interpretive patterns. We argue that standard mitigation strategies, such as prompt engineering or fine-tuning, are insufficient to resolve this structural risk. Instead, we propose Dynamic Contextual Certification (DCC): a staged, reversible, and context-sensitive framework for deploying LLMs in psychiatry, inspired by clinical translation and dynamic safety models from AI governance. DCC reframes chatbot deployment as an ongoing epistemic and ethical process that prioritizes interpretive safety over static performance benchmarks. Atypicality, we argue, cannot be eliminated – but it can, and must, be proactively managed.
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| Item Type: | Published Article or Volume | ||||||||||||
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| Additional Information: | Preprint of 8/8/2025 -- please cite published version. This article has been published in the Journal of Medical Ethics following peer review and can also be viewed on the journal’s website at 10.1136/jme-2025-110972. | ||||||||||||
| Keywords: | large language models, psychiatry, medical ethics, atypicality, dynamic contextual certification | ||||||||||||
| Subjects: | Specific Sciences > Artificial Intelligence > AI and Ethics Specific Sciences > Medicine > Biomedical Ethics General Issues > Ethical Issues Specific Sciences > Medicine > Psychiatry General Issues > Science and Society General Issues > Science and Policy |
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| Depositing User: | Dr. Eugene Y. S. Chua | ||||||||||||
| Date Deposited: | 08 Aug 2025 12:47 | ||||||||||||
| Last Modified: | 08 Aug 2025 12:47 | ||||||||||||
| Item ID: | 25966 | ||||||||||||
| Journal or Publication Title: | Journal of Medical Ethics | ||||||||||||
| Publisher: | BMJ | ||||||||||||
| Official URL: | https://jme.bmj.com/content/early/2025/08/07/jme-2... | ||||||||||||
| DOI or Unique Handle: | 10.1136/jme-2025-110972 | ||||||||||||
| Subjects: | Specific Sciences > Artificial Intelligence > AI and Ethics Specific Sciences > Medicine > Biomedical Ethics General Issues > Ethical Issues Specific Sciences > Medicine > Psychiatry General Issues > Science and Society General Issues > Science and Policy |
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| Date: | 7 August 2025 | ||||||||||||
| URI: | https://philsci-archive.pitt.edu/id/eprint/25966 |
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