I wrote an AI policy for my private psychiatric practice.

In other domains, I evaluate AI use cases with a simple principle: does this tool expand or contract my humanity? This principle is personally useful, but it doesn’t communicate boundaries to my clients.

I started with two questions: (1) how will I use LLMs in decision-making, and (2) when will I use an ambient AI scribe?

The first question was easy to answer: I don’t discuss patient cases with an LLM, and I don’t directly use generative models in decision-making. This isn’t a change to my practice, and so it doesn’t impose a burden. Importantly, the hardest part of my work is the real-time application of “soft skills.” That’s not something I can outsource to AI.

(On the other hand, LLMs are invaluable for finding scientific literature. But I don’t outsource critical thinking; I personally review the relevant papers.)

The second question required more thought, but I ultimately decided not to use an AI scribe.

AI scribes make sense in most medical settings. When electronic health records were introduced, the tradition of minimalist note-taking slowly melted away. Bloated records became expected, and incentives pushed clinicians to spend more time with computers and less time with patients. AI scribes reduce late-night charting, which is a win for clinicians. This doesn’t necessarily mean that patients get more time with their doctor, but some of my colleagues are investing their time savings back into patient care.

My concerns are more subtle. An AI scribe is a third party to conversations. This changes the discussion, and that matters in psychotherapy—especially when someone is opening up about trauma, substance use, infidelity, religious doubts, non-disclosure agreements, or suicidality. Even a sandboxed, local LLM encourages self-censorship. That changes the therapeutic relationship in a way we haven’t adequately studied.

More importantly, AI scribes misrepresent therapy in a way that can’t be corrected with greater context. Therapy is not an information problem. (The bitrate of knowledge transfer is trivial.) Most of the automated summary is irrelevant, and the parts that matter most may be completely missed. How did the relationship progress? Which parts of the conversation had the most emotional resonance? What subtle hypotheses do the client and clinician refine? Machine distillation of therapy can short-circuit the most meaningful parts of the process. That’s not an idle concern. My school of therapy prioritizes clear explanations and rapid experimentation. But it works best when the client does most of the discovery. The journey is more important than the destination.

This approach won’t work for every psychiatrist. It’s my attempt to mindfully use technology in a way that matches my values and practice style.

Most opinions on AI are rage bait.

(This is the internet. It’s all rage bait.)

Don’t get me wrong: I use frontier AI models every day. They are useful tools.

But I hate the discourse we’ve created around AI. AI maximalists often understate the human involvement in their work. AI haters often conceal the ways they actually use AI tools.

And it’s rare to see the meta-dialogue around unit economics, power consumption, data-center externalities, and copyright concerns approached in good faith.

I’m most interested in the human question. Many of us are quietly finding AI workflows that expand our humanity. Collectively, we’re also deciding that there are places where AI just doesn’t fit.

For example: I want imperfect human writing. I want to hear what you actually believe. I don’t need content for the sake of content. Let Claude serve as a proofreader, a brainstorming companion, or a search engine. But let your voice and your thoughts shine.

Likewise: I want human art. Give me a glimpse of your heart. Show me human emotion and shortcomings. If AI is a tool you use to plan or even to paint your canvas, then use it with care. The final product is strongest when human vision comes through.

AI can’t yet (and maybe never will) replace the work of great mental health professionals. AI is an exceptional tool for finding, summarizing, and manipulating information. But mental health is rarely an information problem. If it were, we would have solved many mental illnesses decades ago through books. (While I personally love books, I’m afraid their impact is generally modest.)

Humans aren’t logical machines. We experience positive change in relationships, not isolation. If you’re struggling, reach out to someone who cares. And don’t be afraid to seek professional help. You’re worth it.

I worry about the way the world is going. But I’m still irrationally hopeful.

I grew up in a more optimistic time. Every problem seemed solvable. Eliminating poverty was a shared goal. Treating everyone with respect seemed to be a universal ideal. Truth was determined through open-mindedness and empiricism. The internet’s ability to connect people was positive.

I know that I was naive. Our ability to reduce poverty has been beautiful and imperfect. The respect I assumed was universal was sometimes a thin veneer over prejudice. Science has always been an imperfect, biased process. The good done by the internet is tempered by very real complexity.

Human history is marked by difficulty. Most problems are too big for any one of us to solve. But I still love the stories where dedicated people overcome impossible odds. I don’t think those times are over.

It’s easy to be cynical. I’m damn good at it. And I can’t tell you how much I value healthy skepticism.

The difference between medicine and poison is the dose, and I worry that our society is becoming intoxicated with pessimism.

I won’t advocate for a naive hope that ignores difficult realities. I certainly don’t have solutions to every problem. But I believe that most people are fundamentally good—even the ones I disagree with on core issues.

So I am embracing an irrational hope. I believe that we can improve systems. I believe that we can step outside our tribes. I believe that we can ask for honor and accountability from leaders in all domains, and that we can elevate the many great people who prioritize the welfare of humanity over their own ambitions.

I hope you’ll join me in being irrationally hopeful today.

The mission remains the same: specialized, discreet mental health and addiction care for executives, founders, and high-impact professionals.

Why California? Because I admire the ethos of the best Silicon Valley startups. Utah remains my home, and I love the startup scene we’ve developed here. Great leaders in both locations share an ambitious, humanistic purpose that transcends profit.

(I’m not planning to expand beyond Utah and California. My practice is still a boutique that only works with a handful of clients at a time.)

If you or someone you care about is quietly struggling, let’s talk. HighPerformanceMentalHealth.com.

I worked with great people. My tasks were usually interesting. (And I had an endless stream of great music to play during the frustrating, repetitive parts of the job.)

But I noticed that I was treating my downtime differently.

Content—genuinely good content—had become a trap.

I’m not saying I’ve solved this problem. I haven’t.

My book collection still grows faster than my understanding. I can’t keep up with the news. There’s a long list of great movies and shows I haven’t seen. My podcast queue doesn’t seem to get any shorter. (And there’s a long list of less useful things that I’m grateful to enjoy!)

But my life improves when I am deliberate with my content consumption.

FOMO—the fear of missing out—is real. But so is JOMO—the joy of missing out.

My work is better when my mind has time to wander. My relationships are better when my headphones are off and I’m present with the people I care about. I live my values more fully when I make space for self-reflection.

On the days when I consume less content, I’m not bored for long. My mind turns to curiosity, creation, and connection. And for me, that is a pathway to a much more fulfilling life.

1. Slow down. Minds that run at full capacity cannot be creative. You need persistence and original insights to overcome obstacles. Doing a little less helps you accomplish more.

2. Disconnect from feeds and reconnect with people. Every influencer, media outlet, and platform has an agenda; it’s probably not your health. An hour with someone you care about will feed you more than anything that happens on the internet today.

3. Be more human. Make mistakes. Say the wrong thing. Apologize. Create something beautiful for yourself. Pay attention to your body. The world needs all of your humanity, not just your economic output.

Feeding the algorithm this piece of content is a little ironic. But I also hope that it prompts a moment of reflection, a text to someone you care about, or a little more messiness in your life.

Addiction develops in three stages.

The first stage is sampling: trying a drug for the first time.

Sampling is usually driven by social factors. We try things that the people around us are doing. There will always be early adopters, but novelty-seeking isn’t the reason most people try drugs.

Sampling is best understood through social learning theory, a model that describes the ways we learn from imitation and observation.

It’s also why drug-refusal training is an important tool in adolescent drug-use prevention. A delay in sampling is associated with better lifelong outcomes.

The second stage is reward-driven use.

In this stage, we keep using a drug because it does something for us. Caffeine improves energy and focus. Alcohol is a social lubricant.

Reward-driven use is explained by operant conditioning. Operant conditioning describes the way we learn in terms of reward and punishment.

Most reward-driven substance use is not a significant issue. Problems only arise when we favor the immediate rewards of drug use (like the pleasure of six drinks) over the negative consequences we experience (like missed work or drunk driving). Diagnostically, problematic reward-driven use is typically associated with a mild substance use disorder.

The third stage is habitual use.

In this stage, drug use becomes much more automatic. This process is typically driven by classical conditioning, a learning process where simple cues become linked with substance craving.

For caffeine, these cues might be an alarm clock or the light coming through the curtains. Cues may also be internal signals: feeling tired prompts caffeine use; feeling bored leads to alcohol consumption.

Importantly, withdrawal is only one driver of habitual use. “Detox” may be the first step in recovery, but the risk of relapse persists long after withdrawal subsides.

Of course, habitual use alone does not constitute addiction. (You can keep joking about it, but very few of you are actually addicted to caffeine 🙂.)

Addiction is only present when habitual use continues despite significant ongoing consequences. From a diagnostic standpoint, this process usually fits a moderate or severe substance use disorder.

But the learning processes that govern addiction are not inherently pathological. The ability to chase rewards and develop habits is normal and often advantageous. That’s why we can mindlessly shower or type without looking at the keyboard. Drugs are just really good at hijacking the brain’s learning machinery.

People with substance use disorders often wonder “Why do I keep doing this?” I like to respond with the simplest, correct answer: “Because it’s something your brain knows how to do.” There’s always more to the story, but this is an accurate, shame-free place to start.

And although I have never found a reliable tool for unlearning addiction, I have witnessed hundreds of unique ways that people were able to learn recovery. That is the ultimate goal.

We’ve turned the world into a slot machine.

You scroll through feed after feed. You’re looking for a new perspective, a connection, some entertainment, or a new client.

Sometimes, it works! You find something enjoyable. You keep scrolling.

But the companies who built these algorithms know that a valuable habit can eventually become mindless and compulsive.

The house always wins. And the new slot machines can tune their winnings with extraordinary effectiveness.

Engaging with purpose is valuable. And if you can stay within your budget, spending a little cash for a good time is fine.

But be clear about how you are betting.

And make a bigger bet today on the work that matters most.

My first rotation as a new medical resident taught me all the wrong things about psychiatry.

I was assigned to treat people with psychosis in a county hospital. My supervisor was great. The staff were excellent. And I really enjoyed the patients I served.

But the default assumption was wrong: the best way to learn about health is not through treating illness. It comes from working with people to improve health.

This is a tricky distinction. But I’ll do my best to explain.

Health and illness are separate but related ideas.

We would never say “he doesn’t have a broken hip, so he must have great health.” We know that you can be free from fracture and still have poor health. Likewise, it’s common to say “she has a broken hip, but her health is great.”

In the same way, good mental health is not the absence of psychosis, addiction, depression or any number of common symptoms.

In my view, good mental health is:

- Approaching problems with flexibility,

- Strengthening relationships,

- Applying intellectual expertise,

- Experiencing and managing the full range of emotions,

- Living in harmony with common human values,

- Empathizing with others, and

- Appreciating the connection between your mind and body.

In short: you can carry a diagnosis and be in great mental health.

It takes effort to build your mental health. It’s hard work, and it can be uncomfortable. But it’s worth the investment.

(This definition of mental health is adapted from a paper that came out during my first year of residency. S. Galderisi, A. Heinz, M. Kastrup, J. Beezhold, N. Sartorius, Toward a new definition of mental health. World Psychiatry 14, 231–233 (2015).)

Leaders with better mental health get better outcomes.

Kaluza and colleagues summarized data on 12,617 participants across 88 studies (Work Stress 34, 34–56, 2020). Leaders with poorer personal well-being were more likely to engage in destructive leadership behaviors.

In describing destructive leadership, the authors didn’t just include obviously destructive behaviors like abuse, coercion, and an autocratic approach. They also included more passive gaps in leadership: management-by-exception, laissez-faire supervision, and avoidant governance.

The opposite was also true: leaders with better well-being showed more signs of positive leadership.

None of this is meant to blame leaders for being human. Mental health is something we all have to work on.

But it is a reminder that supporting great mental health starts in the boardroom. If your leaders can’t get the support they need, you’re less likely to see the positive outcomes you hope for.

Let’s talk about unregulated peptides.

Two points for context:

First, I have no moral reservations about unregulated medication use. I’m an addiction specialist. Some of my patients have injected terrifying things into their bodies. My starting point is non-judgmental understanding. The same approach applies to peptides.

Second, peptides are not a new or magical class of medications. The first peptide drug was insulin, and it’s been used clinically for over 100 years. Moreover, drugs that mimic peptides have been used by humans for thousands of years. The biotechnology driving new peptide development is a wonderful achievement. But our understanding of pharmacology has not changed.

Here’s how I think about peptides (and every other medication) as a physician:

In medicine, we understand that there are no risk-free treatments. Medical decisions are a chance to exchange one form of risk for another. Sometimes, these decisions are easy. For example, untreated type 1 diabetes is fatal. The risks of insulin are small in comparison.

Many other decisions are not so simple. When should prostate cancer screening and treatment occur? Which types of back pain are best managed with surgery? These are hard questions with a mountain of nuance. We work with the data we have to make individualized, shared decisions with patients.

Regulated peptides have been thoroughly tested in humans. They have known risks and benefits. We continue to research them, and so we’ll continue to know more about their advantages and disadvantages.

In contrast, no one can accurately quantify the pros and cons of unregulated peptides. Almost every other drug candidate we’ve invented is ineffective or harmful in humans. (That’s why we require extensive clinical testing before marketing drugs.) There’s no reason to believe that peptides are different. Clinical research in humans is the foundation of good medicine. Animal studies and advertising claims are not good enough.

But the risks don’t stop there. You cannot readily verify that an unregulated medication is the molecule you think it is. You have no assurance that it was created using Good Manufacturing Practices. Contaminants in an oral medication are cause for concern. Injected contaminants carry even greater risk.

If the potential rewards were higher, I might be more open to unregulated peptide use. Reversal of aging might be the only claim I’ve seen that qualifies as truly high reward. But I’m skeptical. Say what you will about death during the regular season; I’m still not betting against mortality in the playoffs. A crack squad of molecules is trying to succeed when no other combination of medication, supplement, diet, or exercise has ever forced a game 5. We might beat death one day, but I suspect it’ll be a coalition of scientists (and not the peptide sellers) who pull it off.

Unfortunately, the advertised benefits of unregulated peptides are rarely worth the risk. There is almost always a safer, more effective way to reach the promised goal. When there isn’t, what proof do you have that the outcome you’re being sold is real?

But hey, you do you. I’ll wait for rock-solid data and rigorous quality control before adding these medications to my toolkit.

Unless you work in mental health, navigating therapy can feel like swimming in alphabet soup.

Seriously, WTF? There’s CBT, DBT, ACT, ERP, EMDR, IFS, TFP, and every other form of SNAFU.

Now there are situations where the type of therapy really matters. I refer people with severe obsessive-compulsive disorder and anorexia nervosa to specialists at the top of their game. And for people with opioid problems, recommending therapy without offering a referral for medication assessment should be a slam-dunk malpractice case.

But most of the time, the skill of the clinician matters much more than the type of therapy they practice.

Think of therapy like a language. There is no best mother tongue. However, the ability to communicate clearly is not universal.

Likewise, there is no best management style. But you can tell when a leader has a principled, disciplined approach.

There is no simple way to know if a therapist is good. So approach the relationship as if it were a trial. Can they explain in plain English what you’ll do together? Are they a generalist, or do they specialize in the problems you experience? Can they tell you what they don’t treat? Do they respect your goals? Is it clear what you’re working towards, or are you spinning in circles?

Ask for excellence in the professionals you work with. And when things aren’t working, find someone who’s a better fit for you.

I believed that the knife would make cooking much more enjoyable. And it did.

But I didn’t initially appreciate the value of a great sharpener. I had tried a simpler product where you pull a knife through v-shaped grooves. (It didn’t work well.) I had scraped my knives against a honing rod. (It doesn’t do anything to a dull blade). I had watched countless Youtube videos describing “the right way” to sharpen a knife with a whetstone. But I know myself. And I’m the kind of person that would buy a whetstone and then let it gather dust.

A belt-driven electric sharpener just works for me. Once or twice a year, I run every plain-edge knife in the house through it. Even my cheap, 20-year old knives have a new lease on life after just 15 minutes of effort.

A newly sharpened kitchen knife is one of life’s great joys. Every time I use one, I wonder why I waited so long to pull out the sharpener.

This is really a post about mental health. Every brain needs proper care and maintenance. Some generally effective strategies won’t work for us, and some of our habits don’t work for anyone (who else is on social media right now 😜). But when we do find something that works, it’s worth doing again and again.

So find some small way to sharpen your mental health today. And if you’re struggling to make progress on your own, it might be time to ask a professional for help. You just might find yourself asking why you waited so long.

But there’s one aspect of authenticity that is always valuable: authentic integrity.

Leaders we trust get better outcomes. Their teams have lower turnover. They get more done with less. Their employees are more engaged. And the whole team tends to be happier and healthier.

Hiring for authentic integrity is difficult. Because the opposite of integrity is rarely frank dishonesty. It’s performative integrity: the practice of acting with integrity only when it places us in a positive light.

Performative integrity infects our media, our entertainment, and our politics. This is a tragedy. We cannot let it become normal in the domains we control.

The most pressing concern is performative integrity in our teams. Do your reports take responsibility for everything their team does, or do they push blame downward? Are they trusted by their employees? Do they make the right long-term decisions, even when it makes them look bad today? Is integrity rewarded, or do you allow people to get ahead despite their dishonesty?

And could the same be said of you and me? If not, it’s time to change.

The pursuit of authentic integrity is one of the highest-return investments an organization can make. The moment-to-moment cost may feel high. But the long-term benefits are sublime.

Don’t let anything get in the way of your team’s integrity.

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Leaders and individual contributors face different mental health challenges.

Loneliness, anger, sadness, and stress are more common among leaders. And although engagement and life-satisfaction may also be higher, leaders are less likely to experience a large amount of enjoyment or laughter on any given day.

Gallup summarized this finding in their 2026 State of the Global Workplace report with this phrase: “leaders have higher life evaluations but worse days than those they lead.”

That’s not to say that leaders are crushing it. 57% of leaders are not thriving. And a 26% engagement rate is a major cause for concern.

The question we’ve often asked is “what actions should leaders take to improve employee mental well-being?”

And while we desperately need to solve that problem, we also need to ask the sister question: “What can we do to improve mental health in leaders?”

In this twice-weekly series, I’ll be exploring mental health in leaders. I’ll examine the data that’s been collected, the gaps in our collective knowledge, and the insights I’ve gained from treating leaders as a psychiatrist.