Dopamine Nation
When feeling good is bad and feeling bad is good
This feels like an appropriate book to start 2023 off with, given many people make resolutions or look for clean starts around this time. A lot of resolutions center around reducing pleasure (e.g., dry January, weight loss) or increasing pain (e.g., exercising more) in the short term to make our lives better in the long term. Dopamine Nation is an interesting discussion of how pleasure and pain work, viewed largely through the lens of addiction, which is Dr. Lembke’s specialty. I’ll focus on the high-level takeaways and gloss over some of the specific science on what exactly dopamine is - but I highly recommend reading the whole book.
Dopamine Nation: Finding Balance in the Age of Indulgence by Dr. Anna Lembke
Summary
We are obsessed with pleasure and run from pain. 70% of worldwide deaths are due to behavioral reasons (obesity, smoking, drinking). How did we get here?
As a society, we’ve become far more pain averse and see pain as something that should always be treated. While better medical care is a good thing, we’ve arguably overshot in recent years: the opioid crisis was caused in part due to pharma companies persuading the healthcare establishment that pain was something that needed to be avoided at all costs as the “fifth vital sign.” And while parenting used to view kids as little adults who could help on the farm or family store, it now views kids as extremely fragile creatures who must be protected at all costs
One way to think about dopamine, pain and pleasure is a seesaw, where one side represents pleasure and the other side represents pain. Our body wants to do everything possible to keep the seesaw even
When we indulge in lots of high-pleasure activities (drugs, excessive alcohol, gambling), the seesaw tilts to the pleasure side. The body wants to keep balance, so it essentially creates additional “pain gremlins” to weigh down the pain side and balance the seesaw. But if the high-pleasure activities stop, the seesaw suddenly tilts all the way to the pain side as the “pain gremlins” stick around. And, at the same time, we become more used to whatever was pleasurable and require higher and higher doses for the same effect. This is why after using any kind of addictive substance for a while, it become less about feeling good and more about avoiding feeling bad. And because we become habituated to what feels good, hedonism (the pursuit of pleasure) actually leads to anhedonia (inability to experience pleasure).
On the flip side, if we do things that are somewhat unpleasant and painful (intense exercise, ice baths, cold showers), our seesaw tilts towards pain. Our body will create “pleasure units” to keep us in balance. When the unpleasant thing ends, we actually feel really good as the seesaw now tips towards pleasure. Of course, people can get addicted to ice baths the same way they can to gambling or smoking
So what should we do with all of this?
One key strategy is self-binding, or actively limiting sources of excess pleasure. Self binding works as 1) we only have to make the decision once as opposed to repeatedly and 2) it allows us to make the decision before we’re faced with the actual temptation, which can be pretty close to literally irresistible. Self binding can take several forms:
Physical: Limiting physical access to the substance. Examples of this would be not going to bars if you struggled with alcohol in the past or not keeping junk food in your house if you struggle with overeating
Chronological: Limiting access to only certain times. One example would be intermittent fasting, where one might only eat 8 hours a day or 5 days a week, for example
Categorical: Limiting entire categories. If you struggle with gambling, you can voluntarily put yourself on a “self exclusion list” that bans you from entering any casinos
(The right kind of) shame: Prosocial shame uses group norms as a way to encourage or discourage specific behaviors while not shunning or rejecting anybody who messes up. Prosocial communities accept people who stray, but hold them accountable to taking specific actions after straying. A good example is Alcoholics Anonymous, which is a safe space for people to discuss their issues with alcoholism. People aren’t shamed for being alcoholics; they’re shamed if they don’t try really hard to pursue sobriety
In contrast, destructive shame involves in people shunning or not engaging with the person dealing with addiction. That person then keeps their struggles a secret, which burdens them with more shame. Feeling even more isolated, they are likely to keeping abusing or overconsuming whatever it is they’re trying not to
Reactions
I really liked this book. The framework of the seesaw is a really clear / vivid mental model to understand the underlying concepts behind pleasure, pain, and addiction
I thought the concept of good vs. bad shame was interesting. Groups and group norms play a huge part in regulating our behaviors, but it’s something we’re kind of reluctant to explicitly discuss
The concept of good shame also ties into the idea of “psychological safety” that was very hot in work / pop psychology books a few years ago (because it’s a good idea). In short, the idea is that groups that have psychological safety tend to do better. You need to have an environment where people can discuss mistakes and issues while not being shamed. At the same time, a high performing team may shame people for not working hard enough, being a difficult team member, etc.
The book reminded me of the nutrition books I read last year: just like we’ve created foods that are too delicious to not overeat, we’ve done the same with things like video games or drugs
One thing that makes the book more effective is her disclosure of her struggles, the main one being an addiction to trashy romance novels to the point where she’d stay up to 2am consuming whatever she could (but other ones, including her complicated relationship with her mother). I thought it was a good example of how self-disclosure can be helpful as we often trust people more if they’ve gone through the same struggles that we are
The pushback might be: If all the fun stuff is bad for us, what should we do? If happiness isn’t what we should pursue, than what should we?
The author would probably argue that the issue isn’t fun stuff, but hyperaddictive substances and experiences we’ve created that our bodies and minds aren’t equipped to handle. And there are plenty of enjoyable things that are not addictive (e.g., good relationships, healthy food prepared well) that one can appreciate more if they’re not used to more addictive substances
She’d also probably argue that there is a difference between hedonic happiness (based on short term pleasure) and longer-term happiness (based on fulfilling relationships, a sense of accomplishment, etc.)