Dopamine Nation: Finding Balance in the Age of Indulgence
Anna Lembke, 2021
Why does your hand reach for the phone on its own, for one more episode or a second slice of cake, while the joy you get from it keeps shrinking? A Stanford psychiatrist explains how the brain balances every pleasure with pain. And she shows the way out that she learned from patients who came back from addiction: a month of abstinence, barriers against temptation, useful pain and honesty.
Who it is for
For anyone who notices that their phone, sweets, TV shows or shopping take up more time than they'd like. And for everyone curious why it is so hard to feel joy in a world of plenty.
The reason we're all so miserable may be because we're working so hard to avoid being miserable.
The machine everyone has
Jacob is about sixty, a Silicon Valley scientist who looks like a man with no secrets. In psychiatrist Anna Lembke's office he tells a different story. At eighteen he was a lonely student. That was when he built a masturbation machine out of a record player and spent several hours a day with it. He swore he would quit, took it apart and threw the pieces away, and a day or two later fished them out of the trash and put it back together. Then the internet arrived, the machine grew more elaborate, and his life began to fall apart: he failed at an important presentation, and his wife left him.
It's easy to brush this off: what does it have to do with me? Lembke's answer is unexpected. By her account, to some degree each of us has a machine of our own. Hers was romance novels. It all started with the Twilight series. Soon she was reading instead of sleeping, instead of having dinner with her family, and once even at work, between patients.
The cause, as the author sees it, is that a world where everything was scarce has become a world of abundance. Food, shopping, news, TV shows, games and social media feeds are there at any minute, and they are stronger and more varied than ever. Lembke calls the smartphone the modern hypodermic needle, delivering digital dopamine around the clock.
Lembke has treated addiction for many years. Her book explains how the brain links pleasure and pain, and why chasing pleasure makes us less happy. Then she passes on what she learned from patients who made their way back to a normal life: a month of abstinence, barriers against temptation, useful pain, honesty, and a shame that heals. Let's begin with the balance everyone carries in their head.
Every pleasure is paid for with pain
Imagine that your brain holds a balance, a set of scales with a fulcrum in the middle. When nothing is on it, it is level. When we feel pleasure, the brain releases dopamine, a substance that carries a signal from one nerve cell to another. Then the balance tips toward pleasure. The main property of this balance, Lembke stresses, is that it can't stand being tipped. Scientists call this homeostasis: a living organism keeps working to restore its equilibrium.
The author pictures it with humour. Little gremlins hop onto the pain side and press down on it until the balance is level again. But they don't hop off the moment it evens out, and the balance tips toward pain just as far as it tipped toward pleasure before. That is where the familiar urge to eat a second piece of chocolate or put on one more episode comes from: it is a slight tilt toward pain after something pleasant.
If you repeat a pleasure again and again, the gremlins grow in number, size and speed. The rise gets shorter and weaker, and the drop longer. This is how tolerance develops: to feel the same thing, you need more. Lembke learned this firsthand. The second time around, Twilight gave her less pleasure; by the fourth reading the joy had almost vanished, and she went looking for ever more explicit books. About two years later there was no novel left that she liked.
This state has a name: anhedonia, the inability to enjoy anything at all. At the heart of the book lies a paradox: the pursuit of pleasure leads to its loss. The gremlins seem to pitch camp on the pain side, with air mattresses and barbecues, and without the usual dose a person feels not merely joyless but bad.
Neuroscientist Nora Volkow showed this in brain scans. In people who had used strong substances for a long time, dopamine transmission fell below normal and had not recovered even two weeks after they stopped. But there is good news too. According to Lembke, if you wait long enough, the brain usually regains its balance, and simple things start to bring joy again: a walk, a sunrise, dinner with friends.
About the author
Anna Lembke is an American psychiatrist and a professor at Stanford University. For many years she has treated people with addictions, and she writes about how abundance changes our brain.
All books by this author: Anna Lembke
Terms from the book
- Dopamine
- Volkow
- Attention deficit disorder
- Mindfulness
- Odysseus
- Hormesis
- Alcoholics Anonymous
- Twilight: Stephenie Meyer's series of novels about a schoolgirl who falls in love with a vampire. These books started the author's habit of reading romance novels.
- Homeostasis: A living organism's tendency to keep its inner balance and to return to it after any deviation.
- Gremlins: An image from the book, not a scientific term: the author's way of picturing the forces that bring the balance of pleasure and pain level again.
- Tolerance: Getting used to something: over time you need more of a substance or a pleasure to get the same effect, and the same dose brings less joy.
- Anhedonia: The inability to feel pleasure from things that used to bring joy.
- Adderall: An amphetamine-based stimulant prescribed in the US for attention deficit disorder.
- DOPAMINE framework: A framework the author devised for talking about a habit. Each letter of the word stands for a step: data, objectives, problems, abstinence, mindfulness, insight, next steps, experiment.
- Schuckit: Marc Schuckit, an American scientist who studies alcohol addiction. He showed that the sons of people with alcoholism carry a higher inherited risk of alcoholism.
- Self-binding: The book's term: barriers a person sets up in advance, of their own free will, between themselves and a temptation.
- Kindle: Amazon's e-reader, onto which you can download almost any book in an instant.
- Exposure therapy: A way of working with fear: a person gradually and repeatedly faces what they are afraid of, and the anxiety weakens.
- Radical honesty: The book's term: telling the truth about big things and small ones, even when it exposes our weaknesses and carries consequences.
- Destructive shame: The author's concept: shame after which a person is rejected, so they hide, stay alone and reach again for their usual drug.
- Prosocial shame: The author's concept: shame after which a person is accepted and shown how to make amends. It helps them stop.
- Dumbledore: Albus Dumbledore, the wise headmaster of the school of wizardry in the Harry Potter books.
All terms
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