This book is about pleasure. It's also about pain. Most important, it's about how to find the delicate balance between the two, and why now more than ever finding balance is essential. We're living in a time of unprecedented access to high-reward, high-dopamine stimuli: drugs, food, news, gambling, shopping, gaming, texting, sexting, Facebooking, Instagramming, YouTubing, tweeting... The increased numbers, variety, and potency is staggering. The smartphone is the modern-day hypodermic needle, delivering digital dopamine 24/7 for a wired generation. As such we've all become vulnerable to compulsive overconsumption.
In Dopamine Nation, Dr. Anna Lembke, psychiatrist and author, explores the exciting new scientific discoveries that explain why the relentless pursuit of pleasure leads to pain...and what to do about it. Condensing complex neuroscience into easy-to-understand metaphors, Lembke illustrates how finding contentment and connectedness means keeping dopamine in check. The lived experiences of her patients are the gripping fabric of her narrative. Their riveting stories of suffering and redemption give us all hope for managing our consumption and transforming our lives. In essence, Dopamine Nation shows that the secret to finding balance is combining the science of desire with the wisdom of recovery.
"Brilliant... riveting, scary, cogent, and cleverly argued."--Beth Macy, author of Dopesick
INSTANT NEW YORK TIMES and LOS ANGELES TIMES BESTSELLER “Brilliant… riveting, scary, cogent, and cleverly argued.”—Beth Macy, author of Dopesick As heard on Fresh Air
Anna Lembke is an American psychiatrist who is Chief of the Stanford Addiction Medicine Dual Diagnosis Clinic at Stanford University. She is a specialist in the opioid epidemic in the United States, and the author of Drug Dealer, MD, How Doctors Were Duped, Patients Got Hooked, and Why It’s So Hard to Stop.
This book is moralistic hogwash parading as science. Lembke repeatedly uses inappropriate data (Page 38: She quotes a "famous seventeenth century physician" who thinks pain and inflammation are part of the healing process. Guess what?: 21st century research has found the exact opposite to be true: Pain impedes healing, and inflammation IS disease); over generalizes anecdotes from her work with severely addicted individuals to the general population; and uses bogus statistics (She lists lots of increases in drug use as percentage rates without giving a baseline. An increase from zero to one is a 100% increase, but that doesn't make it a significant trend). While Lembke has had her own brush with a behavioral addiction, she apparently has never suffered from chronic pain or she would not be so cavalier about the suffering and debilitation it causes nor would she make claims about it being good for anybody. I'm done at page 66 where she states, "Science teaches us that every pleasure exacts a price, and the pain that follows is longer lasting and more intense than the pleasure that gave rise to it." Science teaches no such thing and that statement is hogwash. Even according to Lembke, this is only true of the long list of pleasures that have addicted her clients (or maybe just those pleasures she disapproves of), but it's not true of those that meet her approval, like watching a sunset or taking a walk. Yes, sunsets and walks are nice, healthy, life affirming activities, but so is a glass of wine over dinner with a friend and other moderate indulgences with potentially addictive pleasures by non addicts. Yet, according to Lembke, pleasure is dopamine is pleasure and it's all bad; it all leads to pain ... except maybe sometimes?
Someone smarter than me in the field of addictions loved this book so take my armchair mental health expert (I did stay at a Holiday Inn Express last night) review for what it's worth.
Lembke makes a convincing anecdotal case, as have others, that dopamine dosing through easy access to porn, drugs, video game thrills, social media acclaim, etc. is the culprit for a new kind of negative behavior. So far so good, but if you’re looking for research backed conclusions this isn’t the book where you’ll find them.
From that premise about easy access dopamine that at this point is well-traversed, she brings up a few tougher cases she's reviewed: A couple drug users and a masturbation addict (his story is worth a listen...imagine the callouses?). I get it: These people are the extreme of her/our concerns about dopamine addiction. None of us want to be them and yet we are all them to some extent. She introduces them in exactly this way to generate a deserved sympathy.
But here's my gripe. From her shared clients' addictions stories to her personal romance novels addiction is quite a bridge. People can play video games and screw up their lives. That's a massive problem. People can smoke pot and burn out of society. That's a problem. But the vast majority of low dosing dopamine seekers play more video games than they would like, smoke more pot than they want to, and kind of get through life. Her romance novel "Addiction," erm, mmm, hmm.
The book would have been more relatable with advice for those situations because the truth is that not every person who plays video games needs to be a cold turkey quitter and not everyone who smokes a little more pot than they like is a disaster. And in her (somewhat amusing) case where she tried to make herself like her patients, not everyone who likes to read romance books needs to go through an aggressive stepped program towards abstinence. So for the low-dosing dopamine addict that is most of us inside our phones, it would be nice to discuss how to move the needle from a perceived bad habit to an acceptable escape, which is different from moving the needle from life-destroying addiction to abstinence/low-usage.
Good discussion though and thought provoking. "Quit for a month" if you think you are too into something is good takeaway advice.
Moral puritanism disguised as science. The author uses her credentials to make it seem like she is coming from a rational, scientific point of view, and then uses the kind of anecdotes you see in tabloids to cause scare/terrify you. For example, she tells the story of a four year old sodomizing his little brother as an example of the impact of widely available pornography on our society—as if such a bizarre, singular event had any statistical significance, and wasn't just meant to terrify you.
There is no other way for me to interpret her polemic on "availability" and touting the success of prohibition as tacit approval of the war on drugs.
This is what happens you spend your whole life wielding a hammer. Your love of romance novels and sexy vampires looks like a nail. Having a beer or surfing reddit every day looks like a nail. Everything that brings you any amount of joy that isn't "productive" is on the same spectrum as being an opiate addict or hooking yourself up to a masturbation machine for hours a day. Sorry, "the dark side of capitalism" is not the fact that you can now buy really good weed without fear of jail time—It's that if you do anything other than work your job and raise your kids, you should feel bad about it.
If you really enjoyed this book despite all that, I would highly encourage you to read Dr. Karl Hart's "Drug Use For Grownups" for a different perspective. I don't agree with everything in it either but I think it's a better bellwether for progress in the world of addiction medicine.
TL;DR skip it. There are better books about addiction and psychiatry.
A undercooked look at compulsive behavior and addiction, with lots of missing pieces. Seems like the author had a basic, mechanical understanding of homeostasis and tried to build out a global perspective on addiction that she wasn't prepared to give.
25% of this book was just lists of things people get addicted to. 25% was explaining homeostasis, which might be helpful to readers who have never heard of dopamine. The rest is anecdotes about patients and waxing poetic about the dangers of indulgence.
No mention of trauma or neurodiversity, not even a passing acknowledgement. Almost no mention of actual therapy(!?), and extremely stigmatizing discussion of antidepressants.
The author seems generally uninformed about the lives of people who don't come through her Stanford office. All mention of systemic and environmental factors that lend to risk of compulsive behavior, like race, poverty, disability, capitalism, etc are obligatory after-thoughts. It's no coincidence that basically all her patient anecdotes are about financially successful people addicted to food, sex, and prescription drugs.
Discussion of natural means to get dopamine and what healthy living can look like are shallow, and lack any real analysis of why people are so averse to feeling discomfort.
The author talks about some of her own mental health issues and doesn't seem to have a good grasp on herself either. She talks about how her childhood trauma (though she doesn't call it that) somehow made her better, and how she resolved her own compulsive behavior by leaning into...work.
Frankly, I'm shocked this person became chief of the addiction clinic at Stanford University. What the hell is going on at Stanford!?
The Body Keeps The Score isn't even about addiction, but offers much more for understanding why people resort to unhealthy behaviors to cope. Hell, Braiding Sweetgrass isn't even about psychology and has more to say about why people get lost in consumerism.
I only finished it because I was reading it in a book club. Wasn't worth the read.
Dopamine Nation is Dr. Anna Lembki’s plain spoken exposition on the neuropharmacological substrates of addiction, with case study examples from her psychiatry practice, featuring clients who struggled and eventually successfully overcame a variety of substance and behavioral addictions.
The book does a very nice job of normalizing addiction and tying drug addiction together with behavioral issues like sex and porn addiction by elaborating on the way they all operate on the mesolimbic dopamine system, and as such, share a common etiology.
The book also does a fair to middling job of explaining the opponent process theory of addiction whereby elevating so-called “happy chemicals” (like dopamine) in your brain (via drugs, gaming and porn etc) make you feel great in the short term, but elicit escalated production of the opposite “crappy chemistry” (for example stress hormones like cortisol) that trash your mood and mental heath in the longterm.
I think this book will be useful for people who are brand new to the issue of addiction and who need a brief, reliable, scientifically grounded introduction to the subject.
But may not be interesting to professionals working in the field or sufficient for individuals and loved ones suffering from more severe addictions.
The author seems like a nice person and an excellent psychiatrist.
Short Summary: From simple pleasure such as eating food to watching porn and using drugs, the desire we fill is fueled by a hormone called Dopamine.
Consider a scale in the brain. Whenever we indulge in a pleasure-seeking behavior such as scrolling through the Instagram feed to using drugs, it's like putting pleasure weights on this scale in the brain. The problem is that the brain always seeks to put this scale in equilibrium and balance. When you put pleasure on one side of the scale, the brain compensates by putting pain molecules on the other side of the scale.
The problem is that when the pleasure device is absent, you will have a lot of pain and craving. Why? Because the pleasure is absent on the scale, and the balance has tipped to the side of pain.
What's fascinating is that the other side of the story is also true. Namely, if you induce moderate pains onto yourself through activities such as a cold bath, or running in sprints, the brain tries to store the balance of the scale again. This time, by putting pleasure on the other side of the scale. What happens is that your biological set point for happiness is enhanced. In other words, you will generally have happier and more motivated in life.
Dopamine Fasting: The biggest takeaway for me is the concept of dopamine fasting. If we are addicted to destructive habits such as social media, alcohol, port, etc., since the balance is tipped to the side of pain, we will generally feel less motivated in life. We will have a hard time getting out of bed in the mornings. The way to restore this balance in the brain is by going on a Dopamine fasting. Namely, staying away from the addictive pleasure-seeking behavior that we have. It takes a maximum of one month for the brain to recover.
After that, we will feel much more lively and more importantly, we will derive more pleasure from more productive but maybe less pleasurable activities such as exercise or reading books.
This book did contain some valuable information (mostly for people who are pretty new to the topic) and I found it interesting most of the time, but I had some frustrations with it, namely:
- Complete vilification of cannabis. No mention of how people can use it medicinally or in a healthy way recreationally. - Praising Islamic and Mormon dress codes, which in my experience as an ex-Mormon, are a dangerous part of toxic purity culture as well as rape culture. The author could have used them to make her point while also mentioning their potential harmfulness. - Complete vilification of psychedelic drugs, with no mention of research showing that they’re an amazing tool for many with treatment-resistant depression, anxiety. etc.
Oh this book could have been a 5, I so desperately wanted it to be a 5... But I just had a few complaints that I can't get over:
1. The opening shock-and-awe story of the man with the masturbation machine makes this book un-recommendable for lots in my conservative socal circle - which is super unfortunate because I want to recommend this book but now I have to put a big caveat on it. I felt the story was included for shock value and that disappointed me.
2. It needed more focus on less obviously destructive addictions. AKA - Why was there not a whole chapter on phones?!? Stephan, a reviewer on here, hit it right on the nail: "So for the low-dosing dopamine addict that is most of us inside our phones, it would be nice to discuss how to move the needle from a perceived bad habit to an acceptable escape, which is different from moving the needle from life-destroying addiction to abstinence."
3. I could have done without her personal romance novel addiction narrative - it felt somewhat contrived and did not add to the book.
I really liked this book. I love the idea of this book. We are a dopamine nation and it is destroying us each in different individual ways.
I had trouble putting this book down as the learning I was doing each page was supplying its own flow of dopamine to me. A fascinating read by Dr. Lembke which bubbles through a multitude of journeys her patients took through their own addictions to reach a more optimal balance of pleasure and pain in their lives.
Lembke highlights her own personal experiences with addiction which offer a grounded perspective to the reader and establish her admirable honesty as a pillar of the book. To not become too attached to pleasure or pain appears to be the key to maintaining a healthy relationship with dopamine. As someone who previously had not read about addictions or found the topic interesting, I loved this book and could certainly recognize my own self-defeating addictions to dopamine through the text. In the end, this makes for a great questioning of our own personal habits and what feelings or actions we gravitate towards in our lives.
This entire book can be summed up with two words: Citation needed.
From beginning to end, the book drips with specious claims, not to mention moral puritanism. The author is repeatedly judgmental toward her clients (she is sickened by a client's masturbation machine, for example, and expresses overwhelming moral disdain for her temporary infatuation with romance novels). She alludes to ADHD patients abusing Adderall while ignoring the huge improvement these medicines have offered people with actual ADHD (and that these folks can take the prescribed stimulants and still end up taking a nap -- they aren't getting high). She seems to endorse at least one patient's disordered eating as a healthy lifestyle change! -- because hey, they lost weight, amirite? Another time, she -- a Stanford MD not in a religious therapy practice -- tells her patient to get down on his knees and pray. (Yet another reason why we should stop elevating professionals who attended/work at 'prestigious' schools, but I digress.)
Aside from these issues, the author still does a poor job of educating on the science of addiction/compulsion, and she barely invests any effort in laying out specific strategies readers can use to identify and change problematic, addictive behaviors.
Still considering reading the book? I'll leave you with this - her take on why strict religious/social groups attract more adherents than liberal ones, her quick pivot to "churches," and her rating of churches with larger followings as "generally more successful" (term undefined, religious studies credentials lacking, and citations throughout much needed).
Under Iannaccone's Theory of Sacrifice and Stigma, "behaviors that seem excessive, gratuitous, or even irrational in existing religious institutions, such as wearing certain hairstyles or certain clothing, abstaining from certain foods or forms of modern technology, or refusing certain medical treatments, are rational when understood as a cost to the individual to reduce free riding within an organization. ***You might think that religious organizations and other social groups that are more relaxed, with fewer rules and strictures, would attract a larger group of followers. Not so. Stricter churches achieve a larger following and are generally more successful than free-wheeling ones because they ferret out free riders and offer more robust club goods.***"
«Самостримування – це необхідна складова сучасного життя у світі, надмірно обтяженому дофаміном.»
🍓Анна Лембке починає свою книгу, наче професійна маркетологиня: з випадку пацієнта, якому потім вона поставить діагноз компульсивна статева поведінка (по-моєму, так це звучало, але це не точно). Хто ж після такого відкладе читання?))) Наступні майже 200 сторінок заглиблять вас в природу залежності та історії людей, які або покажуть вам, що ви ще не так погано живете, або що живете дуже нудно😅 «Ми всі тікаємо від болю. Дехто з нас приймає пігулки. Дехто лежить на дивані й переглядає Netflix. Хтось читає любовні романи. Ми робимо все можливе, аби відволіктися від самих себе. Проте всі ці спроби захистити себе від болю лише посилюють його.»
🎰Залежність. Акцент на палінні, алкоголізмі, наркотиках, азартних іграх, відеоіграх тощо, хоча хотілося б більше інших прикладів. Авторка побіжно згадувала залежність від соцмереж, що для багатьох людей нині справжні проблема, але сильно на цьому, на жаль, вирішила не зупинятися. Так само побіжно, наприклад, згадується покупки в Інтернеті як залежність. Хотілося б глибше туди, бо здається про це пишуть менше, ніж про цигарки і наркотики. Історія про хлопця, що через наркоту чотири рази вилітав зі Стенфорда, я так розумію, мала викликати у читача співчуття? А те, що авторка постійно повторювала про період у своєму житті, коли вона запійно читала еротичн�� любовні романи, скидалося на те, що вона усіма силами хоче довести: «Я така ж як ви! Я теж була залежна! Ну, не наркота, але ж!»😅
🍷 Задоволення і біль працюють як терези, що підпорядковані системі регулювання та мають лишатися в балансі. «Тривалий і повторюваний вплив стимулів задоволення призводить до того, що наша здатність терпіти біль слабне, а пороговий рівень, на якому ми можемо відчувати задоволення, підвищується.» Саме тому люди збільшують дози, ставки, кількість книг😁
🎮«Нудьга – сприятлива атмосфера для відкриттів і винаходів. Вона створює простір, необхідний для того, щоб сформувалося нове мислення.» Пам’ятаєте, коли нам було нудно в дитинстві, ми вигадували цікаві, чудернацькі чи навіть трохи небезпечні розваги. Потім ми їх трансформовували, вигадували нові правила і залучали інших до наших ігор? В світі, де вас кожну хвилину розважає стрічка соцмереж і відосики в ютуб, про це можна забути.
☝️“Генетично модифіковані миші, не здатні виробляти дофамін, не шукають їжу й можуть померти з голоду навіть тоді, коли їжа лежить в кількох сантиметрах від них.”
📖 Книга класна, пізнавальна, не розмазана. Щоправда ближче до кінця можна вдосталь почитати про сором і чесність. А потім про чесність і сором. В той момент здалося, що авторці вже не було чого писати, бо пройшлася зовсім очевидною доріжкою. Але книгу перечитуватиму, це точно.
What a terrible book. This book demonstrates how a buzzworthy title and good cover design can elevate mediocrity to the NY Bestsellers List. It joins the Sixth Extinction, Confederates in the Attic, and Wild as "books that fooled me" with marketing.
So what was this book about? Not dopamine. Lembke waits 1/3 of her mercifully short book to even explain dopamine (in about two pages). This book was nothing but a loose collection of anecdotes of Lembke's patients struggling with their addictions to weed, porn, and prescription drugs. Plus Lembke's own 2-year addition to paranormal romance novels. Did you know it's easier to get high than ever before? Did you know porn and weed and opioids are readily available? Of course you did, because you can read. So I don't know who Lembke's book is for, because anyone who can read isn't going to learn anything from this book. Truly, you would learn more information from the Wikipedia article about dopamine. Throw in a little WebMD on breaking addictions and you're good to go, because this book offers nothing. Infinite Jest had better information on addiction, and that was a work of fiction.
I was looking for a refresher on "finding balance" (as promised on the book cover) in this pandemic time when binging Netflix or a glass of wine have become a bit too habitual. I was looking for a reminder about other ways to experience pleasure (laughter, yoga, joyful movement etc.) and tips on restoring that balance. However the book was focused on serious addictions but without serious help for the reader. The author is a doctor, has won lots of awards and runs an addiction program so I want to believe that her treatments consisted of more than "abstain for one month and then tell me how you feel" but that seemed to be what she was doing with clients. There were a couple of insightful aspects and I may have found this a tiny bit useful when I was a mental health practitioner but what moved my review from a possible 2 star to 1 star is that she lost all credibility when she talked about eating disorders. I'd be willing to bet she has no training in this field. She promotes fasting and doesn't really see any problem with weight loss surgeries/aka stomach amputations. Or rather she knows that it can lead to other significant problems such as alcohol addiction but still thinks that somehow these surgeries are a path to improved health. Overall, this book might have some helpful nuggets for folks with addictions but it could do damage as well especially for those with unaddressed trauma or with eating disorders.
The book is told through anecdotes and doesn't heavily emphasize the science or current research. Although some of the concept names were new to me, like self-binding, I didn't feel like I learned much from this book.
I had high hopes for this book and was disappointed. There were several positions Lembke took that I just don’t agree with: 1) abstinence is gold standard for addiction (my opinion is that this is true for some, but not a universal truth) 2) “pro-social shame” is great for recovery 🤔 (no) and 3) absolute honesty is essential for a well balanced life (she gave the example of telling her daughter she was like the tone-deaf penguin on Happy Feet)… idk, the book felt very moralistic and judgmental. Didn’t love it.
This book is written by a psychiatrist who works at Stanford. There were so many moments of near-lucidity where a point was on the cusp of being made, but a little niggle told me something very key was missing. Ultimately this book lacks nuance, and this lack of nuance is extremely damaging to the book's messaging and it's potential readers.
That said, here are weird things about this book:
- Talking about how parents "these days" are damaging their children by coddling them out of fear of traumatizing them - Writing a book about addiction but never addressing trauma other than the brief moment alluding to childhood trauma above - The author talking about her romance novel "addiction", not once, but multiple times as a contiguous reference point? - Referring to fibromyalgia as "a disorder that is largely due to an innately low pain threshold" - Saying that in treating physical and emotional pain with medication, we lose out on our humanity - Referencing her personal experience with Prozac as "reducing her irritability and improving her relationship with her mother" while also deciding to go off Prozac because she preferred her personality before and a "tolerate at a comfortable distance" kind of relationship with her mother - Saying that people spend too much time being the Victim and leading themselves to be revictimized, and how in order to avoid this it is key that we are honest with ourselves about our role in things (this included a self reference to taking an appropriate amount of responsibily for bad things that happened in her life, including in childhood/adolescence???) - Going on and on about how maybe if we learned to just Deal, we wouldn't need anti depressants, only to end that section with "anti depressants are life saving drugs and I'm glad I can prescribe them" - Repeatedly pushing the AA model of addiction treatment
Anyway, I had this on hold at the library for like 4 months and I'm super mad about it.
This should be required reading for everyone. It really helped me to understand how the brain maintains homeostasis. Many people in our society are searching for pain free lives, but our brain knows we need equal amounts of pleasure and pain in order to maintain equilibrium. Miss Lembke states that we might need to face pain in our lives in order to find that equilibrium rather than overmedicating ourselves.
"The rewards of finding balance and maintaining balance are neither immediate nor permanent. They require patience and maintenance. We must be willing to move forward despite being uncertain of what lies ahead. We must have faith that actions today that seem to have no impact in the present moment are in fact accumulating in a positive direction, which will be revealed to us only at some unknown time in the future. Healthy practices happen day by day."
"Patients who tell stories in which they are frequently the victim, seldom bearing responsibility for bad outcomes are often unwell and remain unwell. They are too busy blaming others to get down to the business of their own recovery. By contrast, when my patients start telling stories that accurately portray their responsibility, I know they're getting better."
Neurodivergence and dopamine is a trending topic on TikTok right now and if you read the comments on popular videos, you will see a lot of people that struggle with ADHD, addiction, mood disorders, and other symptoms that leads to extreme and unproductive behavior in the pursuit of dopamine highs. I picked up this book to get a better understa nding of my own history with addiction and dopamine chasing and to find out more about the science behind it.
The blend of clinical and anecdotal storytelling makes this book an easy read. I also appreciated the humanization of shameful behaviors and looking at it from a neurological standpoint. Lembke keeps it simple by organizing the topic by extreme behaviors that lead to the pursuit of pleasure and pain. She does a really good job of identifying the problem without judging people's individual solutions. Interspersed between client stories, she also shares her own extreme behavior which I really appreciated and it gave me a better understanding overall of my own struggles.
Коли життя і так суцільний біль, але ти вирішуєш все одно написати про більші страждання задля позбуття будь-якої залежності. Або для того щоб переповісти історію своїх пацієнтів, похизуватись своє роботою у Кремнієвій долині та постійно нагадувати читачу про свою обсессію до любовних романів та Twilight. Практичні поради там звичайно є, але якщо ви хоч трохи прислухаєтесь до себе, то добре їх знаєте і можете з цим працювати.
Most helpful passage came at the very end on page 233 "I urge you to find a way to immerse yourself fully in the life that you've been given. To stop running from whatever you're trying to escape, and instead to stop, and turn, and face whatever it is."
While this book was intriguing and has a few good parts, there are numerous problems.
First: The author has some serious issues when it comes to her understanding of why people are fat. She claims that people are "obese" primarily due to food addiction, which is not supported by the science. But she just presents that as fact without supporting that claim with ANY scientific evidence, studies, etc. I feel like since she treats addictions for her job, she may just be seeing addiction as the root cause of this phenomenon. When your only tool is a hammer, everything looks like a nail and so-forth.
Secondly, she apparently has no awareness whatsoever regarding eating disorders. She praises one of her patients for losing a lot of weight, but then when she shares how this patient lost weight, we learn that this patient basically developed an eating disorder! She seems oblivious to this fact. Specifically, the patient has developed disordered eating strategies in order to ignore his hunger. We know that this level of weight loss is not sustainable in the long term (usually) and when eating disorders are sustained, they can be deadly! In general she thinks that being fat is an indication that a person has an addiction (false!) and that the best way to treat this addiction is with disordered eating! She is absolutely clueless.
Next, at one point she casually offers up the suggestion that people cover themselves up to prevent sex addiction! No evidence that this will work at all, no science. She pulls straight from purity-culture and rape-culture, which we know is so harmful, especially to women/girls who then view themselves as objects to be covered up rather than people with their own agency and inherent value. And again, I expected something scientific rather than the old purity-culture toxicity.
Finally: I listened to the audiobook, which the author herself reads, and it was SO CRINGEWORTHY when she tried to mispronounce words and mess up English grammar exactly the same way her patients do. She has a few patients who are from other countries, and when she tells their stories from their perspective, she mispronounces a lot of words, including the word penis, which is hugely distracting. I respect that people pronounce things differently and that's fine, but there was no value from her trying to recreate how they speak for her book. It was weird and distracting, and it added nothing of value to the stories she was telling.
Looking around here at the other review for Dopamine Nation on goodreads, it is clear that I'm not the only one who thinks this book is a mixed-bag! I've never encountered a book quite this strange.
Other than these MAJOR issues, the book was interesting to read, and it seems like this author is a good psychiatrist, but man, I was frankly shocked by the diet-culture/ disordered-eating / purity-culture / rape-culture BS contained in this book. I expected far better from a book that's supposed to be scientific. Hence my 2 star review.
It was an enjoyable simple read. It’s based not just on pure theory, but also on the hands-on experience the author has as a psychotherapist. The problem the book exposes is the increase in dopaminergic consumption in our modern societies. We became obsessed with the pursuit of pleasure for its own sake. That leads to neuroadaptation and tolerance to pleasure, ending in all sorts of nasty and harmful addictions. The solution is to find and maintain a pleasure-pain balance that allows us to experience the pleasure of simple things, without needing to resort to overconsumption of high dopamine substances or behaviours.
The first part of the book explains the terminology: the substances involved in the brain's reward pathway, how the addiction is formed, and the ways in which today’s society presses on the side of pleasure to sustain this vicious cycle.
The second part explores personal solutions to the problem of addiction, like dopamine fasting, self binding (physical, chronological, and categorial strategies), embracing mild intermittent exposure to pain, practising radical honesty, and finding compassionate persons or groups that can keep you accountable. While the analysis of the problem is done both at individual and society level, the solutions are explored only from the individual point of view.
I especially liked the realism of the book, it doesn’t offer cookie-cutter solutions, like many books on this subject are tempted to do. Moreover, it somehow adds value to an already over-saturated subject. I think that’s because the author knows how to go sideways and to digress in relevant ways. On the other hand, there are no citations to the studies, for those who want to fact check. All references are added at the end. And beware, some discreet readers might find one particular counselling example disgraceful.
I came into this book really wanting it to be good, to be an insightful analysis of the dynamics of pleasure and addiction in America, studying the causes and offering solutions. One of my friends had given it a glowing rating, and thus... I found myself disappointed with the uninformed, surface-level moralizing glazed over the text.
This book isn't for people who want to analyze, curb, or prevent addictions, this is a book that starts with the assumption that you're addicted to something and spends pages moralizing on your and other people's 'addictions', even if it has to define a short-term obsession or a minor bad habit as an addiction.
I honestly feel like this author doesn't have a working grasp on the full topic of addiction. She understands what it looks like on the surface or at its peak, when a person is so compelled to perform an action they come to her for help, but does not seem to understand any of the underlying causes of addiction, preferring to treat the surface-level actions without investigating the root causes and looking for ways to solve and/or cope with those, as well.
Additionally, she has no understanding of systemic or societal causes of misery or addiction outside of what a Buzzfeed article has been able to tell her.
I don't think she's ever met someone who lives in poverty, and if she has, I don't think she's ever seen any aspect of their life or listened to them without filtering it through a moralizing, puritan lens. Multiple times, she's able to cite studies of rats that state they'll rarely become addicted if given enriched, accessible environments fulled with large social groups, and rats isolated in bland environments will almost always become addicted, but fails to make the connection between this study and human environments.
She also doesn't seem aware of the existence of poverty in her own country, as multiple times she wonders why people are addicted to anything in the 'richest country in the world', making her seem deeply ignorant of the material conditions of the non-wealthy. Again, she can plainly state 'cheap entertainment is now more widely available than stable housing, meaningful work, affordable healthcare, meaningful community spaces or consistent community events', then turn around and, consciously or not, assume that the marginalized have all of the same resources her rich community and clientele do and merely choose to ignore them to become addicted to various substances.
When faced with solutions to concerning addiction, rather than proposing systematic changes to provide citizens with the missing resources she's cited before, she trots out the individual solutions her fellow silicone valley residents have used, leading to a large chunk of pages being used to praise how a man uses cold showers to cut down on his own drinking. Combined with a long tirade on how 'high-wage earners' are less likely to be addicted that puts the cart far before the horse (assuming that their high wages come as a result of avoiding addictions), it leads to the uncomfortable implication that the impoverished just haven't applied the right individual solution to conquer their own chemical dependencies.
The book operates under the assumption that everyone in America is drowning in artificial happiness all of the time, and pushes people to eschew pleasure and embrace pain as if most Americans outside her Stanford enclave aren't awash in low-grade malaise caused by structural isolation and increasingly unbearable economic inequality.
Speaking of her Stanford enclave, throughout the book, every single character is EXTREMELY privileged, and the author only acknowledges this in throwaway statements that feel like her editor or or brunch friends had to remind her to use. One character, a young doctor who got a DUI while earning his Ph.D offhandedly says 'if I was POC or poor, I would have lost everything' but thanks to his white wealth, he is given the privilege of showing off his flaws at every application without suffering any loss of status. I wish she'd actually spoken to someone who *had* lost everything to something like that.
Moreover, there is ZERO investigation into the root causes of either societal or individual addiction throughout the book, and, combining this with her well-off clientele, it begins to feel like addictions are oddly-shaped warts stuck onto otherwise perfect lives instead of flawed coping mechanisms for whatever actual struggles they may have, none of which she ever even seems to mention.
Further expounding upon her shallow analysis, throughout the book she keeps making the insulting equation of her short erotic literature obsession with full-blown chemical dependency. She continually causes her brief obsession 'an addiction', as if it could ever rival the drug or alcohol addictions of her clients. She presents many stories about her clients, but none of them ever seem to have the substance or critical analysis the topic deserves. Only ONE of her many anecdotes features someone with a life-long addiction, and his story feels like it's presented for shock value more than anything else.
The low-grade moralistic dog-whistling throughout the book ramps up in the final few pages, as she praises all forms of social restriction (pro-social shame and restrictive rulesets within groups) in the effort of weeding out 'freeloaders', a phrase loaded with connotations I *hope* she misunderstood, because the other implication is yet another instance of her looking down on 'lazy' people with 'no will power'.
Even before the book pulls the canine controlling device out of its' pocket, there's a distinct black-and-white mindset, where anything that isn't tightly and consciously controlled is an 'addiction'. To the point that the author states that people with mental issues or chronic pain shouldn't be using medications to improve their lives, claiming they're 'upsetting their dopamine balances' and further implying that because the drugs they're using could be abused in theory, the patients themselves are on the verge of abusing said drug at any time it becomes too pleasureful.
Referring back to the assumption of America as a nation drowning in artificial dopamine, the author assumes that everyone, at all times, is too joyful and the only way to 'reset their balance' is to pursue long-term asceticism. This dovetails nicely with her prescription of abstinence as the only cure for 'addictions', even to the point of uncritically promotes eating disorders in the form of extreme food restriction.
All of this, from the assumption of too much joy to the praise of restriction, all stems from a puritan mindset of 'pain will make you stronger' no matter what, and pleasure is just a loss of mental muscle mass that can only be regained by forcing yourself to abstain from what pleases you and lean into what hurts.
In summary, I feel like an alien wrote this book. Someone trapped in a misinformed, centuries-old mindset and a wealthy enclave who sincerely believes they have been given the answers when they still can't even comprehend the question.
This book is yet another, very important piece of the puzzle in the big picture about dopamine and why we crave it. However, rare case of what seems like author's own personal issues and prejudice that spills over when talking about some of her clients, especially related to sex, ruins it a little for me. Also, this pain-pleasure balance is perfect tool in explaining how BDSM works, and she didn't even touch that. Which is strange, considering she herself was addicted to "certain" kind of novels for quite some time. This is still a good book, although I like my therapists more open and less judgmental.
Lembke's thesis: Mental illness and/or neurodivergence can be "cured" with good ol' will power. Kids today; too many participation trophies made them soft and squishy. Now they can't handle an iota of mental or physical pain, turning to pills and weed for relief. SSRIs are bad. Stimulants for ADHD patients are bad. Just stop it, folks. You can do it.
The takeaway: Yes, over prescription of medication exists, as does abuse of stimulants and alternative drugs. But only once does the author champion medication as necessary treatment for millions and millions of patients. Her attitude towards young people is condescending, and some of her comments on sexuality and expression lean towards puritanical.
"Допаминов свят" е интересно приключение в света на болката и удоволствието. Д-р Анна Лембке, през призмата на опита си като психиатър, разкрива на достъпен език каква е взаимовръзката между две от най-важните неща, които можем да изпитваме. И въпреки че са неразривна част от живота ни, почти никой не си дава колко е важно да се информираме какво точно представляват, какви заплахи крие свръхконсумацията им и как да ги управляваме, за да балансираме живота си. Полезно четиво, препоръчвам!
I really enjoyed this very reasonable book. It argues in favor of boring, hard things that we don't do very well as a society, such as moderation, patience, temperance, honesty.
It made me reflect on the time I gave up alcohol but then started eating too much candy, then gave up candy and started eating too much starch, gave that up and bought too much yarn and too many books. Giving up a substance is one thing, but how does one give up the habit of overconsumption?
But the best part about it is it was recommended by my little brother! The last time he recommended a book to me that I read and loved was probably The Golden Compass in 2001 or so.