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Viktoria Klett
Bio: Anna Lembke is professor of psychiatry at Stanford University School of Medicine and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. A clinician scholar, she has published more than a hundred peer-reviewed papers, book chapters, and commentaries. She sits on the board of several state and national addiction-focused organizations, has testified before various committees in the United States House of Representatives and Senate, keeps an active speaking calendar, and maintains a thriving clinical practice.
In today's fast-paced world, our brains are constantly bombarded with stimuli that can lead to dopamine overload and addiction. Dr. Anna Lembke's groundbreaking book, "Dopamine Nation," sheds light on the issue and offers practical solutions to regain control and find balance. In this article, we've compiled the top 10 takeaways from her book, aimed at helping you discover a more balanced and fulfilling life.
In "Dopamine Nation," Dr. Lembke explores the role of dopamine, a neurotransmitter linked to reward and pleasure, in our modern world. She argues that our current environment, with its constant stimuli and instant gratification, has led to an imbalance in our dopamine systems, resulting in addiction and other mental health issues.
For a book that marries neuroscience to lived experience and gives a more complex, humanistic explanation for addiction without reducing us to a single brain chemical, see The Biology of Desire by Marc Lewis
This is hilarious, though, because Lembke just spent years promoting her best-selling book Dopamine Nation on every podcast that would give her a microphone, espousing a version of \u201Cdopamine makes us do it\u201D to massive audiences that now firmly believe pleasure and vice are controlled by a single neurotransmitter in their brain.
This is not going to be a positivist debunk, because \u201CIs the dopamine science correct?\u201D is not really the most interesting question to me here. I\u2019m far more interested in asking: What morals are being communicated to us through this particular science story?1 And what kind of politics do those morals lead to?
\u201CThe smartphone is the modern-day hypodermic needle, delivering digital dopamine 24/7 for a wired generation. If you haven\u2019t met your drug of choice yet, it\u2019s coming soon to a website near you.\u201D
Is dopamine a drug that your brain makes? Or is it the internet that is a drug, and dopamine is another word for pleasure? She tells us the fact that \u201Cthe brain processes pleasure and pain in the same place\u201D is a \u201Cremarkable\u201D finding \u2014 even though the brain, as a complex network, processes lots of different things with the same regions.
The title Dopamine Nation is not lost on me here. These moral panics, especially when they center around masturbation, have historically been whipped out during moments of nationalistic anxiety. The Victorians, for instance, were terrified that young upper class white boys at boarding schools were going to touch themselves too much and not procreate enough, thus causing catastrophic population decline that would threaten Britain\u2019s hold on the empire.5
She also believes that addiction is a brain disease, in line with the stance of the National Institute on Drug Abuse, which funds 85% of all global research on recreational drugs.9 Because NIDA is a government organization particularly interested in biological explanations for addiction that can lead to individualized medical treatments, drug researchers who toe their line \u2014 and specifically, as Dr. Carl Hart notes, those who focus on playing up the dangers of drugs over any of their benefits \u2014 are the ones who get funded.
It\u2019s confusing how much Lembke conflates dopamine with pleasure, because scientists moved on from \u201Cthe pleasure molecule\u201D idea over ten years ago. She does briefly acknowledge in a few sentences that it probably has more to do with motivation and the uncertainty of reward, but considering that the entire book is a theory of pleasure and pain, this nuance gets pretty lost.
As justification for her dopamine reductionism, she cites brain scan research done by Nora Volkow, director of NIDA and champion of the brain disease model who was telling everyone that \u201Caddiction is all about the dopamine\u201D back in 2011. Four years prior, John D. Salamone wrote that dopamine had become a \u201Cdominant paradigm,\u201D referring to the work of historian Thomas Kuhn, who wrote a very famous book called The Structure of Scientific Revolutions.
There is definitely ignored data that doesn\u2019t fit the grand narrative about dopamine and addiction. A 2015 paper by David J. Nutt and colleagues cites studies that show alcohol, weed, and ketamine don\u2019t always trigger dopamine release, that blocking dopamine receptors doesn\u2019t necessarily block the feeling of reward or pleasure, and that heroin can cause a high without changing striatal dopamine levels.
\u201CThe apparent rush to publish findings showing that any given pleasure-inducing drug or behaviour can induce dopamine release reflects one of the more worrying and pervasive aspects of science today \u2014 the preeminence given to reporting \u2018positive\u2019 data in support of currently influential theories.\u201D
Lembke gestures at a feel-good kind of collectivism, but she ultimately isn\u2019t giving us that kind of myth. Readers will not come away from this book less individualistic, on the contrary. The dopamine mythos ultimately tells us that all the world\u2019s problems are just inside our own heads, and the solutions can only be found in individual self-management. It\u2019s not that the personal is political, but that the political is only ever personal.
Suggesting that climate change is a personal problem caused by dopamine-seeking hedonism is a view of society that overlooks material realities and completely flattens power and class. \u201CCompulsive overconsumption\u201D is the engine of capitalism, and only a few people control and profit from the production of these things we consume.
Palo Alto actually has an extremely high youth suicide rate, but a more charitable explanation is that children of wealthy high-achievers put a huge amount of pressure on their kids. The writer Malcolm Haris describes Palo Alto as \u201Chaunted\u201D by a dark eugenic history \u2014 see his book Palo Alto for more on that.
She thinks this all explains the fact that in a time of unprecedented abundance, we as a species are measurably less happy than ever, experiencing unprecedented levels of depression, anxiety disorder, chronic pain, and suicide. Studies disclose the steepest declines in happiness in the wealthiest nations.
Just like a drug addict, we go back to our sources of dopamine every time we need a new dose of pleasure. However, as we consume more of them, our brain starts to get used to the feeling and builds resistance.
Dopamine Nation explores how overflowing sources of dopamine can become a burden to carry. Although the constant availability of resources looks like a good thing from the outside, it can lead to serious problems and the avoidance of discomfort in our society.
All around us people are looking at their phones too much, eating too much, drinking too much. For many, the relentless pursuit of pleasure leads to pain. Join Careers, Life, and Yale for an important conversation with Stanford Professor of Psychiatry, Dr. Anna Lembke, about the neuroscience of addiction and how to find balance in a dopamine-overloaded world.
Anna Lembke is an American psychiatrist, Program Director of the Stanford Addiction Medicine Fellowship, and Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. In her recent bestselling book Dopamine Nation, Lembke compiles decades of research and expertise on addiction. She also tells personal anecdotes of patients from her clinical practice. As she sees it, their addiction experiences are not as distant from our lives as we might think. Instead, their stories are like those of a prophet, teaching us who we truly are. Living in a culture primarily motivated by high-dopamine rewards, it has become crucial that we all learn how to balance pleasure and pain.
A study shows that ice baths increase dopamine concentration in the body by 250 percent. After a cold bath, dopamine levels remain elevated above normal for up to two hours. Another (more controversial) study suggested that the Japanese citizens partially exposed to radiation from the 1964 nuclear attacks had longer lifespans and lower cancer rates than those without radiation exposure. In rodents and monkeys, intermittent fasting and caloric restriction has been shown to reduce blood pressure and improve heart rate variability. The pain of exercise also has excellent benefits. At the cellular level, exercise deprives the body of oxygen and glucose and puts it in a state of toxicity (a state usually thought to harm an organism). However, these pain exposures at the cellular level lead to improved physical and mental health overall.
The fantasy world of erotica had alienated her from her husband and kids, and it affected her sleep and performance in her clinical practice. To recover from her addiction, Lembke made a conscious effort to immerse herself in the world her addiction led her to neglect. She focused on the things she loved about her work. She focused her energy into building relationships with her patients. Eventually, Lembke re-established a dopamine balance and once again felt more satisfaction from her vocation than from badly-written pornographic fiction.
Anna Lembke is the medical director of Stanford Addiction Medicine, program director for the Stanford Addiction Medicine Fellowship, and chief of the Stanford Addiction Medicine Dual Diagnosis Clinic. She is the recipient of numerous awards for outstanding research in mental illness, for excellence in teaching, and for clinical innovation in treatment. A clinician scholar, she has published more than a hundred peer-reviewed papers, book chapters, and commentaries in prestigious outlets such as The New England Journal of Medicine and JAMA. She sits on the board of several state and national addiction-focused organizations, has testified before various committees in the United States House of Representatives and Senate, keeps an active speaking calendar, and maintains a thriving clinical practice.
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