Dopamine Nation

This book was lent to me by my therapist after I had talked to her about some of the trouble I’m dealing with, mostly about the idea of doing certain tasks feeling so unpleasant that I don’t do them. Before she handed this to me, I actually had told her about DFW’s Infinite Jest, and I think the two pair well together.

The sense here is that so many of us (all of us?) live our lives chasing after a sense of “feeling good,” but that’s actually quite destructive. Lembke offers us the image of a scale: if we push down on the “pleasure” side of the balance, the amount of pressure falling on the “pain” side increases to balance it out. As a result, our homeostasis becomes one where one of high pleasure, to the extent that it engulfs us. As soon as the stimulation is gone, we feel horrible.

A lot of the book is dedicated to addiction, which I find fascinating. It should be so obvious that pleasure and addiction loop together, but there’s also something uncannily strange about it—as if the pleasure can’t be “true” pleasure for its addictiveness, but it is.

Lembke offers a handful of strategies to help the reader (aka me) balance my life better. The discussion of increasing pain (which causes a rebound in heightened pleasure) and engaging closely with accepting communities (to mitigate shame) really resonated with me.

This isn’t related to the book, but, as I wrote the above paragraph, I had this impression that there’s this really powerful, symbiotic relationship between pleasure and pain. I thought a bit about Freud who, until the last two decades of us practice, attempted to figure out why we do things that we find painful if the Pleasure Principle demands we act in such a way to increase pleasure and decrease pain. There something is to be said about the death drive (rather than Eros) here.

Now I have more questions about pain and pleasure than I did when I started reading Lembke’s book, and I don’t think I would have thought about them so closely had I not read it.

This book is fantastic, a model of combining personal stories, clinical narratives, science, and behavioral analysis. Just as I might be getting distracted during a bit of science or analysis, Lebke includes an anecdote from her personal life or one of her patient’s. (All stories are included with the explicit consent of the owner. Lembke even includes a bit of information about how she collected the consent at the end of the book.)

The book begins with some clinical definitions, one being that the measure of dopamine generated in neural pathways is how scientists measure the addictiveness of a substance or behavior. From there, she takes the reader into an unusual story of a patient addicted to sexual edging. The stories of this patient and others are revisited frequently throughout the book as their stories apply to the information in each chapter.

As the book moves into the balance of pleasure and pain, self-binding, and pressing on the lever, I found I learned a great deal. The story of the teenager who was being forced into therapy by her parents for her near constant use of marijuana to deal with her anxiety was particularly enlightening. Sometimes the cure becomes the problem.

The chapter on shame reveals a lot about our “post-shame politics,” despite this not being the intention of the chapter. She begins this chapter by explaining the difference between guilt and shame: guilt being connected to an action, shame being the same emotion but applied to our self-concept, of who we are.

Shame comes in two forms: destructive and pro-social. Pro-social shame is exemplified in the structure and tenets of Alcoholics Anonymous and is a positive force. It can also be used as a parenting tool. However, some groups use pro-social shame to encourage bad behavior, as in the disinformation business model.

The conclusion of the book reviews the ten most important take-aways from the book, and offers a nice summary of all of the previous information.

In the end, I wish the book contained a relevant story related to internet and social media addiction, addiction to electronics. It is mentioned a few times, but Lembke doesn’t delve into it much. That said, her own personal story of addiction makes it clear that any behavior can be addictive if abused to negative effect.