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July 12, 2025 - Epoch Times
01:23:28
Why We Can’t Stop Scrolling, Eating, and Binging: Dr. Anna Lembke
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So we're living in this strange day and age when we've essentially biohacked all of the things that we do and really come to organize our lives around our little rewards, right?
So we wake up in the morning, we reach for our phones, we have our cup of coffee, we have our favorite muffin.
Anna Lemke is a psychiatrist, professor, and medical director of addiction medicine at Stanford University.
She's the author of Dopamine Nation, Finding Balance in the Age of Indulgence.
This is of course the great paradox that although we want to avoid pain, our efforts to avoid pain actually lead to more pain.
How have technology and modern living led to mass compulsion and overconsumption in America?
What is the societal impact of polarization driven by digital media?
We are not present for other people when we are entranced by our phones.
And this is going to have devastating generational repercussions for all of us.
This is American Thought Leaders, and I'm Yanye Kellek.
I'm Elenki.
Such a pleasure to have you on American Thought Leaders.
Thank you for having me.
I'm excited to be here.
So I'm going to read something that I think might sound controversial.
One of the biggest risk factors for getting addicted to any drug is easy access to that drug.
So in the world where harm reduction policies for drug abuse and so forth are kind of the norm, this seems like an incredibly controversial thing to say.
Well, it is surprisingly controversial in this day and age, and yet it's very evidence-based.
If you look at, for example, opioids, it's very clear that if you have a region in which opioids are readily available, either because of porous borders and being imported illegally, or through doctors prolifically prescribing them to patients in pain, as we had here in the first decade of this century, what you see very quickly thereafter is rising rates of addictive use and overdose death.
Likewise, when the supply retracts because doctors start prescribing less, because borders are shored up, use, addictive use, and related deaths and other harms go down.
And this is really true for almost any substance and behavior.
I mean, I wouldn't even say almost.
This is true for all substances, all addictive substances and behaviors, that when you have easy, ready access to any drug or any behavior, you're more likely to engage in that behavior, your brain is more likely to be changed from that frequent engagement, and you're more likely to trip over into addictive, maladaptive use.
Well, and this is the thing I find so fascinating about dopamine nation is that I just, it made me aware of how many things that you don't think of as drugs, because of just the nature of our technology and the nature of our society and perhaps our attitudes in general, have become effectively like drugs.
Right.
I mean, this is what I call the drugification of modern life.
Almost everything that we eat, that we engage in, including traditional drugs like cocaine, heroin, nicotine, alcohol, have all become more accessible, more potent, more novel, more bountiful.
And those factors make them, in essence, more addictive.
Even healthy behaviors, things like playing games or connecting with other human beings or exercise, have become druggified through the application of technology, again, made more accessible, more potent, more novel, more bountiful.
So we're living in this strange day and age when we've essentially biohacked all of the things that we do and really come to organize our lives around our little rewards, right?
So we wake up in the morning, we reach for our phones, we have our cup of coffee, we have our favorite muffin, we drive to work, we listen to whatever we want to listen to.
Throughout our day, you know, we work and then we take a series of breaks, we scroll on our phones.
At the end of the day, we look forward to going home and eating some kind of delectable food or binging on Netflix or eating cupcakes or smoking pot or drinking.
And I just think, you know, intoxicants have been around since the beginning of human time, but the extent to which they are readily accessible at the touch of a fingertips, the extent to which we organize our time around rewards, the extent to which they're incredibly potent, easy to obtain, cheap, right?
All of this means, and really free when you look at digital media, all of this means that we're sort of constantly bombarding our brains with these small and large rewards.
This is just a normal part of our reality now, right?
And it's acceptable.
This is the other part.
I've been thinking about this for a few years.
It's morally acceptable in our society to create technologies to basically to manipulate people or addict people as part of what we do through things put into food, through, another example of something we've covered on the show has been how a marijuana has been actively bred into something completely different today than it was even 20 years ago, just because of the potency and the impact.
And people get psychotic breaks from them and so forth.
It's just, it's this whole culture.
Right.
I mean, I shop, therefore I am.
You know what I mean?
I mean, we've really, we've reached this kind of tipping point where, you know, in a successful capitalist system, not to denigrate capitalism, it's a fine system in many ways, but, you know, in any successful capitalist system, we would all be the ultimate addicts, right?
So we are really, we've organized modern life around consumption, optimizing our consumption.
At the same time, we have, you know, many of us living in wealthy nations have our basic survival needs met.
We've got machines doing our Work, so we have more leisure time than ever before in the history of humanity.
We have access to more luxury goods, we have more disposable income, and all of that combined means that we're living in the kind of perfect storm for all of us to become addicted.
More and more, those of us who thought we would be immune to this problem are actually experiencing the addiction pattern in our own lives, whether you know addicted to our phones and digital media, addicted to our drug-ified food supply with the addition of salt, fat, sugars, flavorants, which lights up the same reward pathway as drugs and alcohol.
So, I think it's fair to say that many, many modern people are struggling with some form of compulsive overconsumption.
And we can really look to people with severe addiction in recovery as modern-day prophets for the rest of us, because they've had to figure out how to manage their compulsive behaviors as a matter of life or death.
You know, for those of us who have more minor addictions, it may not be life or death, but it certainly is quality of life.
So looking to kind of the recovery world, you know, how people get into recovery, how they think about their consumptive behaviors.
Plus, we've now got surgical interventions to help us manage our appetites, right?
People are for the first time in human history getting their intestines rerouted so that they don't eat so much food.
We've got medications that we've now invented that we take for appetitive control of all sorts, meaning that the boundary of the problem of addiction is now extending much further and including many, many more of us as we've changed our ecosystem, the world we live in, through science, technology, progress, to make the world more addictogenic, drugified, to make us all more vulnerable to this problem.
So it's this combination of consumption almost as a virtue, but also pain avoidance as kind of a top goal almost, right?
And you make the very strong case that this is a really bad idea.
Well, I think first we have to begin with empathy for ourselves because we evolved over millions of years of evolution to reflexively approach pleasure and avoid pain, right?
It's so deeply hardwired.
It's conserved over millions of years of evolution across species.
You know, we pull our hands away from a hot stove.
We approach, you know, mother's milk.
And if that weren't there, we wouldn't be here either.
The problem is that through human action, we've now created an environment where we no longer really have to work very hard to get those rewards that we need to survive.
And we're largely insulated from painful experiences, right?
Our lives are very, very comfortable.
We can micro-adjust the temperature in any given room to suit our comfort levels, right?
So we've really eliminated hardship.
We've exponentially increased pleasures.
And this kind of ecosystem is not well suited to our ancient reward pathways, which were really evolved for a world of scarcity and ever-present danger.
So it's this mismatch that we're grappling with now.
Well, and you document incredibly well how pain is actually a really important part of being able to actually experience pleasure.
Yeah, so we have an innate tendency to want to avoid pain.
On the other hand, pain avoidance and the pursuit of pleasure leads to more pain.
And this is, of course, the great paradox that although we want to avoid pain, our efforts to avoid pain actually lead to more pain.
And if you look at every major philosophy or religion in the world, they essentially come down to these kinds of similar messages that we have to face struggles, that suffering is a part of life, that suffering gives us really valuable information that helps us make our lives better.
But this kind of ancient wisdom, we've really forgotten in large part.
And we have lots of narratives that tell us the opposite, right?
That tell us that if we're uncomfortable in any kind of way, there must be something wrong with our lives or wrong with our brains, or we need to go get treatment or we need to get, you know, go on an antidepressant.
And that really we should be experiencing this kind of constant euphoria.
Otherwise, you know, we're doing something wrong.
And I think this is really a misleading narrative because it's also contrary to our biology.
Because our biology essentially says no matter what we pursue pleasure-wise and no matter how much we avoid pain, our brains will essentially recalibrate or neuro-adapt to a new hedonic or joy set point, such that we'll constantly need more pleasure over time to get the same effect.
And more minor injuries will, in turn, be painful.
So, you know, what philosophy and religion has been trying to teach us for millennia, I think neuroscience is now kind of corroborating.
Something that I haven't covered enough on the show, but I believe is a, I guess, underreported massive issue in our society is this sort of ubiquitous on-demand availability of hardcore pornography for children, for adult, for anybody instantly.
Tell me just quickly why that might be a problem.
Well, I mean, it's a problem on so many levels.
First of all, you know, pornography is highly addictive, right?
So what happens when people initially view these images and typically masturbate, you know, to these images, that over time they'll need more potent images, perhaps more deviant images, and they'll find themselves escalating to engaging in images that are outside their values, maybe even illegal, right?
But they need that higher potency over time to get the same effect.
And then they find when they try to stop that, they really can't.
So this is the addiction cycle.
You know, addiction broadly defined as the continued compulsive use of a substance or a behavior despite harm to self and or others.
And you could ask yourself, well, you know, what harm in pornography?
But, you know, you're potentially harming the people whose images are being used.
Certainly, we see people are harming, in many instances, their own relationships because over time they're spending more and more time engaging with these images.
Obviously, when you've got children engaging with these images, trying to process, you know, a video or a photograph that they can't possibly begin to contextualize, but then if that then becomes their definition of what sex should look like, you've got young people going out into the world with a very distorted sense of the meaning and purpose of sexual encounters.
So on a lot of levels, it's very dangerous and destructive.
A lot of people question, oh, can you really get addicted to pornography?
And I can tell you, if you could be a fly on the wall in my clinical setting, you would see people who come in who have lost everything because they can't stop watching pornography even when they want to.
They've lost their jobs.
They've lost their families.
They've ended up in jails and prisons because they've broken the law in pursuit of more deviant forms of pornography.
And these are at heart, in many instances, wonderful human beings.
They're good people.
But their reward pathway has essentially been hijacked by this behavior, this repetitive behavior of engaging with these images, engaging insects with these images, or in many instances now, real people on the other end.
So it's not just still images, it's videos, it's live chat, it's live stream.
And it's very, very destructive and devastating for folks.
It's weird subcultures that use electrical stimulation and film it.
I mean, just the kind of, I learned a lot of things from your book that I didn't want to know perfectly.
But the flip side is this one character, Jacob, that we kind of revisit constantly throughout so far seems to have had a happy ending.
Yeah, I mean, you know, Jacob, you know, was a patient of mine.
He came to see me for a very serious sex addiction involving initially pornography, but eventually escalating to live chats and eventually him building his own masturbation machine that he let people in live chat rooms that he didn't know control, which meant that he was really putting his life at risk.
But he had escalated so far in this addiction that even though he knew it was life-threatening, he still couldn't stop, even though he'd repeatedly tried to stop many times over.
So, you know, it's an extreme example, but I think we can learn a lot by looking at these extreme examples, especially when folks with this kind of extreme addiction can get into recovery.
They can stop that behavior.
They can get their lives back, their jobs back, their joy back.
And I think it's really, you know, it becomes a kind of, again, sort of a model for the rest of us with our little minor addictions, you know, which don't meet that maybe level of danger or impairment, but, you know, which are on that same spectrum.
I mean, I think many of us have this issue with smartphones and kind of related maybe food.
I certainly do, and your book made me reflect on the fact that I think I am in at least two areas quite significantly.
But here's the thing, right?
So using the smartphone, and this is, you know, I'm kind of, you know, asking you to do a little therapy on camera here, I guess.
But the thing with the phone is there's a lot of really important stuff coming through there.
I mean, legitimately, that I have to deal with.
And, you know, in some cases, you know, incredibly important.
And so I feel I need to have it by me.
And then I'm responding to things.
You find yourself kind of deviating from that, going into some really interesting stuff on the X platform, which is genuinely fascinating, but probably not the highest priority at this moment, right?
But in some cases it is, because I'm a news guy and I need to know what's going on, right?
So it's very hard in the throes of it to see.
And upon a bit of reflection, I can see I'm kind of picking the things that are easy as opposed to the things which are kind of more difficult.
Like I have this huge resistance, for example, to communicating when there's a significant chance of not getting the response back that you want.
Okay?
So that's just something, lifelong issue.
But I think it fits into this because you kind of end up picking the things that are quick and you know you can deal with.
But then again, that's also a reasonable, right?
Because hey, I can knock these things off of my to-do list.
Okay?
So someone, I would expect there's more than one person like me out there.
What is someone like me?
I think all of us.
Yeah.
How do you deal with that?
Yeah, right.
It's so embedded in so much of our lives and become necessary in order to function in the modern world.
You know, we look at Jacob and his masturbation machine, and that seems so wildly other, and yet in many ways, these phones are our masturbation machines in the sense that we really use them not just as tools, but as a kind of auto-stimulation to meet our intellectual needs, our emotional needs, our sexual and physical needs.
And in that process, many things are happening that are not good.
One of which is that in turning to our phone to meet these fundamental needs, we're no longer turning to each other.
And we see this in every aspect of life.
You just walk around in any neighborhood in the evenings when people used to roam or go on a walk or go to the park or stop by and see a neighbor.
The streets are empty now.
And I think this is, we have to really stop and look at this and say, okay, where are all the people?
They're inside in their separate rooms auto-stimulating on their smartphone.
Ana, if I may just jump in for one sec.
There was this incredible art that someone did some maybe five, some years, I have a terrible sense of the passage of time, but some years ago.
And they were, you know, took a scene of people doing what you're doing, but kind of in public, right?
You can kind of isolate yourself unbelievably, even among a whole group of people.
So the person took photos of people just naturally doing this, the phone thing, but then erased the phones out of the artwork.
Right.
And it's shocking.
Yeah.
And I thought very, and I'm not a huge fan of modern art, but I thought this is modern art.
And I'm guessing the point of the painting is that nobody was looking at anybody else, right?
Nobody was interacting with anybody else.
No, and you get this sense, like these people are completely isolated from each other because that's in fact the case.
Right, right.
Yeah, and you know, and you see this also in families with young children.
And I think we really, as a society, we need to be very alarmed about this.
You know, you see young children standing next to a parental figure on their phone and the child tugging at the skirt and tugging at the skirt and tugging at the skirt and not able to get the parents' attention.
That is no different than having a parent who is intoxicated and checked out on alcohol or any other drug.
We are not present for other people when we are entranced by our phones.
And this is going to have devastating generational repercussions for all of us.
We really need to pay attention to this.
I just, this is such an important, important topic.
The other thing I would say, in addition to the way that it's adulterating our ability to connect with each other, because we're just connecting with the device, you know, the internet, the metaverse, is that it's also impairing our ability to create new things.
Now, I know a lot of creation is happening online, creation and creativity, and that's great, but I can tell you that the numbers show it is a small minority of people who are creating the metaverse content.
The vast majority of us is just consuming this content.
And in this constant mode of reactive consumption, two things are happening.
Number one, we are not creating, right?
We're consuming.
And number two, we're not allowing our brains time to rest, recover, consolidate, and process this incredible flow of information.
And that's stressful.
I mean, that's exhausting.
Like, people wonder why with all of this leisure time and all this freedom and all these options and all these material goods, why are people so stressed out?
It doesn't make any sense, right?
People are like more stressed out maybe than during like famine or war or whatever.
It's because we're constantly overstimulating ourselves.
We're not letting our brains rest in between.
The other thing that's happening is what you alluded to, that these devices now are procrastination generators, right?
There are a lot of hard and annoying things that we all have to do in our lives, from taking out the garbage to responding to annoying, you know, unpleasant emails to writing thank you notes to people that we have delayed writing a thank you note.
I mean, you know, you name it.
And yet, the likelihood that we will engage in doing those mundane but important and necessary tasks is greatly decreased if we have that device there that allows us to distract ourselves, to avoid the pain of doing that mundane task, and really to get lost because once we go on the device, we forget.
We completely forget what we were meant to do there or what else we have to do.
We're sort of lost again in this kind of transportative experience that feels really good, but is probably not good for us.
There's an example of a woman who you ask to kind of step away from smoking marijuana.
You figured out that a month is the right amount of time to basically get someone the opportunity to reflect on what life would be like without the thing that they're doing, right?
That's a great way to phrase it, by the way.
I love that you phrase it that way because a lot of people don't appreciate that, that I'm not saying taking a dopamine fast for a month is curing your addiction.
I'm not saying that.
But you're right.
It's the amount of time on average it takes for people to sort of have that aha moment and say, oh, wait a minute.
Like look back at their, you know, using self and say, I don't really want to continue to live like that.
So explain to me at this moment how dopamine fits into this whole picture because it's the centerpiece.
Yeah.
So dopamine is a neurotransmitter.
It's a chemical that we make in our brain.
Neurotransmitters allow for fine-tuned control of the electrical circuits that make us who we are.
Dopamine is essential for the experience of pleasure, reward, and motivation.
It's not the only neurotransmitter involved in that process, but it's the final common pathway for all reinforcing substances and behaviors.
So neuroscientists have come to use it as a kind of common currency for measuring the addictive potential of a variety of different substances and behaviors.
So for example, experiments in rats measuring dopamine levels at baseline and then seeing how much dopamine increases in response to certain substances or behaviors find that food or chocolate in particular increases dopamine firing 55% above baseline.
Sex is about 100%, nicotine about 150%, on and on all the way up to cocaine, amphetamine 1000% above baseline.
And indeed that tracks with animal behavior.
If you put a rat in a cage with a lever to press for cocaine, that rat will press that lever till exhaustion or death.
Now human beings aren't rats, right?
So it's not that, you know, exactly what happens to rats in a cage is going to happen to every single human.
There's also the important concept of inter-individual variability and drug of choice.
So, what releases a lot of dopamine in your brain might not release a lot of dopamine in my brain, and vice versa.
But, in general, the concept holds true: that intoxicants or things that are highly reinforcing, including behaviors, tend to release dopamine in those nucleus accumbens, brain reward circuitry-type structures.
The more dopamine released, the faster dopamine is released, the more likely we are going to want to do that substance or behavior again and again.
One important misconception here is that it's not that dopamine is bad or that we're addicted to dopamine per se.
It's that dopamine is a chemical signal that we're always releasing dopamine in the reward pathway at a kind of baseline tonic level.
And it's the fluctuations in dopamine above and below that baseline, which then motivate certain types of appetitive behaviors, especially to take action to get our drug of choice.
So what is the relationship between pain and dopamine?
Okay, so we know that pain and pleasure are co-located in the brain, and in the simplest explanation, they work like opposite sides of a balance.
So, when we do something pleasurable, that releases dopamine.
Our balance or teeter-totter tilts to the side of pleasure.
But the first and most important rule governing this balance is that it wants to remain level, or what neuroscientists call homeostasis, such that we will work very hard, our brains will work very hard to restore homeostasis after any deviation from neutrality.
And the way our brains do that is actually by tilting an equal and opposite amount to whatever the initial stimulus is.
So if we do something pleasurable, that releases dopamine, and then our brain responds by down-regulating dopamine transmission, for example, by involuting postsynaptic dopamine receptors, so that we get back to not just baseline firing of dopamine, but actually below baseline.
I often talk about that as these neuroadaptation gremlins hopping on the pain side of the balance to bring it level again.
But they like it there, so they don't get off as soon as we're level.
They stay on until we're tilted an equal and opposite amount to the side of pain.
And it's that come down, that hangover, that moment of craving, which then drives us to reach for more of whatever that substance is.
And in a world of plenty, where we're surrounded by as much of whatever we like, again and again at the touch of our fingertips, it's very hard to resist the urge not to reach for more.
The problem is that with repeated exposure, we essentially end up in a kind of chronic dopamine deficit state.
You might imagine that as these gremlins camped out on the pain side of the balance.
And we've essentially changed our hedonic or joy set point.
Now we've entered addicted brain where we need more of the drug in more potent forms, not to get high, but just to level the balance and feel normal.
And when we're not using, we're walking around with the balance tilted to the side of pain, experiencing the universal symptoms of withdrawal from any addictive substance or behavior, which are anxiety, irritability, insomnia, depression, and craving.
And this is why people will find it so difficult to stop compulsive overconsumption once they've entered that dopamine deficit state, because the fastest way to get out of that state and restore homeostasis is to reach for more of our drug.
So we get into this very deceptive loop where more of our drug feels good, not just because, you know, it's dopamine releasing, but because now we're trying to get out of pain, right?
And when we're not using, we're in more pain.
So we can get into this very confusing, kind of chasing our tail situation where we don't recognize the ways in which the substance is actually contributing to pain, because in the short term, it's alleviating pain.
I think this is such a critical explanation you just offered, because I mean, how many people that are functioning in this kind of environment with the phones, with the computers, are not experiencing this reality?
I mean, it's almost everybody at some level, unless they have some very unusual, non-addictive personality or, you know, balance of neurotransmitters or something.
Yeah, I think anybody who is able to, with ease, manage their consumption of their smartphone or other digital media is either a very rare subset of individuals for whom this medium is not particularly potent and compelling.
And since the medium is invented by our own brains, there aren't going to be very many people like that because it's so cognitively and emotionally adhering.
Right, exactly.
It was invented to be enchanting and they've more than succeeded in that.
So I think you're looking at the vast majority of the population is struggling with compulsive overuse of smartphones and digital media and struggling to figure out how to limit use.
And yet we can and we must with intention do that either both through our own individual efforts to manage our consumption, but also through top-down policies, right?
Holding the companies that make addictive digital media accountable for the harms, getting schools to rethink the way that they've integrated technology because it's gone far too far.
Now you can't participate in the average American public high school without, you know, a QR code function.
Well, except for the ones where Jonathan Heidz work has actually taken hold and they've removed them entirely, which is really impressive and huge changes from that.
Yes, right.
Yeah, and Jonathan Height's work is amazing, but he didn't invent banning smartphones.
There were schools early on, mostly private schools, starting with a few on the East Coast, but also here, other parts of the world, that saw early on our kids are not connecting with each other.
They're not paying attention to learn.
They're not flourishing because of these devices, banned the devices, and have seen Huge improvements in social, emotional, and cognitive well-being.
Now, you know, formalizing studies of this is very difficult because it's a lot of apples and oranges.
You're comparing one school that banned smartphones with another school that didn't.
But did the first school really ban them, or did they just say, hey, don't use them?
So there's a lot of confusing data out there that when you tease it apart, you realize the methodology is flawed.
But what we see just experientially and phenomenologically is when schools ban smartphones, kids do better.
And Jonathan Haidt has been instrumental in spearheading that work, you know, advocating for getting smartphones out of schools, you know, K through 12 or at least through middle school, you know, bell-to-bell.
It can't just be per class, because then kids in between classes and at lunchtime, they're not interacting.
You know, it's really got to be a kind of a top-down policy, which also greatly reduces FOMO or fear of missing out, which was one of the main reasons that kids in particular, teens who are so socially sensitive, feel they can't get off their phones even if they want to because they're so worried they're going to miss out on something important.
Ana, I don't know if this is even reasonable to approach this in a meaningful way without changing our societal idea that just pain is terrible and we should do absolutely everything at all times to the extreme to prevent people from having it.
What do you think?
Yeah, we definitely need a cultural shift on this point.
Now, interestingly, what we do have is a kind of like very exercise, sports-oriented, sort of extreme fitness culture.
And, you know, getting back to this pleasure-pain balance, it turns out that if we intentionally press on the pleasure, if we intentionally press on the pain side to do things that are hard, those gremlins will actually hop on the pleasure side and we can get our dopamine indirectly by paying for it up front.
That's called hormesis.
Hormesis is a Greek term.
It means to set in motion.
And essentially, when we are doing hard things and experiencing mild to moderate pain, our body senses injury and then starts to upregulate feel-good neurotransmitters.
And not just dopamine, but also serotonin, norepinephrine, our endogenous opioids, our endogenous cannabinoids.
The problem is that we can also take that to an extreme, and that is not good, right?
We can actually get addicted to pain.
So for example, why do people cut themselves when they're in psychological distress?
Because it releases endogenous opioids, dopamine, and that temporarily feels good.
The problem is it's incredibly temporary, and with repeated cuts, it tends to stop working.
And then, of course, you've cut yourself, and that's terrible.
Or why do people engage in extreme exercise, often combined with calorie restriction?
Because it feels good.
It releases dopamine, but then people can get into that same addictive cycle.
My point being that we live in this world of extremes.
We've got this kind of work-hard, play-hard mentality.
We either are extreme on the work and pain side, or we're extreme on the pleasure side, or both, right?
We're doing both.
And that, by the way, is stressful for our brains too, because any deviation from homeostasis is biological stress.
Now, we need a certain degree of biological stress to thrive.
We are human.
We're not meant to just have a, you know, like, you know, flat line.
That's just not how we're built.
We're strivers, we're seekers.
We're meant to have these fluctuations.
But the constant sort of work hard, play hard fluctuations that we manipulate, aided and abetted by the latest technology, are really stressful for our brains.
So the idea is to come back to a more subtle in-between fluctuation between pleasure and pain.
Indulging in intoxicants infrequently and in moderation is probably okay.
You know, doing, you know, difficult things is actually something that we need to do more of because we have such a hyper-convenient, comfortable environment.
I even prescribe things like exercise and ice-cold water baths in order for people to be able to reset reward pathways.
But we don't want to take that to an extreme either, right?
So I think what our culture needs is just more of recognizing that life is hard, that everybody suffers, that we all experience anxiety, you know, insomnia, intermittent depression, that mental illness is real and the brain, like any other organ, can become diseased.
And those people, those individuals with extreme mental health issues do indeed need, in my opinion, treatment and help.
But that beyond that extreme gradation, like there's a lot of natural suffering.
And if we come together and recognize that we're not alone in our suffering and we come up with healthy and adaptive ways to combat it, that's much better for us.
I'm someone who at one point took for a fairly brief time an antidepressant.
And I remembered how it basically just dulled everything, which is kind of what I've learned since is kind of the common reaction.
But you asked the question, is that what we actually want?
Right?
And I mean, a lot of people are asking this question, especially people who are on cocktails of various psychoactive drugs and so forth, and have found that it's actually the side effects of those drugs in many ways that are causing the problems that at some point, not the original ostensible disease that they first got medicated because of.
Right.
Yeah, so I always like to enter into this topic by saying that I'm very grateful for antidepressants and other evidence-based psychiatric medications because in some instances they can be life-saving.
So I'm glad to have them and I want people to have access to them.
But it is also true that I think we've overmedicated and over-prescribed in this country, especially in the last 30 to 40 years, where patients are coming in with really normal grief reaction, like normal stress reaction, exactly what you would expect for major life loss and other stressful events.
Instead of normalizing that and helping people process those experiences and making room, frankly, just for people to be unhappy, we're trying to medicate that away.
And as you note, there are always side effects and this kind of what we call this sort of frontal lobe syndrome or passivity or dampening down of intense emotional experiences is something that can happen with antidepressants and mood stabilizers and antipsychotics and all of them.
So again, these are good tools to have.
They can be very helpful in persons with severe mental illness and we should be using them, but we don't want to overuse them.
Well, and it's also, I think there's a tendency to not fully disclose because of the desire to use the product or so forth.
This is something I've observed from talking to people, papers I've read, to not disclose the possible harms associated with things or the possible effects even in some cases.
Like there's often sexual dysfunction that's associated during the taking of these drugs, but then later in some smaller, much smaller subset of people, it becomes almost permanent or permanent.
Yeah, right.
Yeah.
But typically people don't know that that's a possibility and that might change their decision, right, that they're making whether to take a drug or not.
Yeah, I mean, you know, what we call, you know, telling people with all of the risks, benefits, and alternatives is called informed consent.
And every patient deserves to have informed consent.
Meaning that you don't have to read all, you know, 500 possible side effects, but you should certainly let them know about like the top five or so most common side effects so they can decide for themselves whether or not it's worth the risk to them.
You know, interestingly, for hospitalized patients, at least in California, we have informed consent laws.
We actually have to get their written informed consent before we can initiate a psychotropic medication.
That's not generally true on the outpatient side.
It's expected that we will give them informed consent, but you're right, it doesn't always happen.
In the book, you mention a film called Serenity.
Oh, yeah.
Happens to be one of my favorite films.
Once in a while, I come up with it, and it's a very, very interesting situation.
Well, okay, so tell me why you like this film.
Well, to me, it was just this wonderful encapsulation of why we need dopamine, right?
To be human is to strive, you know, to look for what's on the next horizon, to have joy or pleasure that's fleeting and then dissipates and then to need, you know, the next best thing.
And of course, in Serenity, they discover this pill.
I hope I'm remembering this right.
I haven't watched it multiple times, but they discover this pill that will basically take away desire, right?
And they give it to, they experiment on a whole population on a whole planet.
And they arrive at this planet.
Actually, the heroes don't know that this has happened.
They just arrive at the planet and they find all these people dead.
Dead slumped at their computers, dead sitting on couches, dead, you know, at a park.
And they're like, what happened?
Like, they have all the food they need, they have all the water, they have clean air.
Why are they dead?
And they're dead because this pill or whatever it was engineered them to not want anything, which I just thought was such a great sort of meme for the bind that it is to be human, where we are these sort of malcontents and it's just sort of, you know, baked into the DNA and we can't do otherwise.
So let me tell you what I noticed in the film, which was actually something quite different and why I love it, right?
And so now almost, almost, and I have this kind of problem.
The problem is that I remember movie plots unbelievably well.
I wish I remembered most things as well as I remember movie plots.
I don't, but movie plots, so it's actually they put a gas into the atmosphere of this planet.
It's close enough.
I think you've got it.
I think you've got it.
These people were fighting each other, and what they wanted to do is they wanted to prevent them from doing that, right?
So they put this gas that did what you said, right?
Basically kind of made people not want to do those things anymore.
But it ended up having them not want to do anything.
And the thing that struck me about this was it's this idea that someone thought to themselves, hey, it's a good idea to put this gas.
They made a decision for everybody else to do this without, you know, thinking, well, first of all, just thinking that that's an okay thing to do for an entire planet.
Or, you know, of course, you could apply this idea elsewhere.
So it's sort of like, to me, it's a bit of this totalitarian viewpoint, maybe.
That would be maybe a very strong way to put it, but some of us tend to think like that, like the people that want to design, for example, the perfect society, right?
And how can we do that?
Well, let's experiment.
But the experimentation often leads to huge problems or ethical disasters or everything else.
Yeah, that's right.
And that's not so far afield from what's actually happening in the world.
So if you, for example, look at rates of psychiatric medication prescriptions, people living in poverty are more likely to be prescribed psychiatric medications than people not living in poverty.
If you look at opioid prescribing for pain, poor people are more likely to get an opioid prescription than people who are not poor.
What's going on there?
You can begin to think About the way that we prescribe these feel-good pills as a way to sort of make people content with untenable circumstances so that they won't kind of rise up and fight against, you know, Karl Marx said religion is the opiate of the masses, but maybe now opiates are the opiates of the masses, right?
That we've really, we are giving people pills to just sort of say, be okay with your life, be passive.
And that's really concerning.
I'm just remembering, you know, going back to this example of the girl who had been, you know, constantly smoking marijuana and then had the month off and realized, wait a sec, I probably don't need this anymore.
Part of the reason she was doing it, if I recall correctly, there's a few examples like this, is because she didn't really want to deal with herself and her own thoughts and the anxiety that she experienced when she just had to deal with herself.
And I think that this, you know, addiction to smartphone, addiction to the things that are just kind of a normal part of our lives can very much be a way to do that.
Oh yes, it's absolutely.
It's like an anxiety avoidance technique, right?
So we'll work with a lot of teens who when they decide they want to try to give up their smartphones and social media, you know, digital media for a month, the first thing that they'll notice is sort of this roar, roar of anxious thoughts and feelings, you know, in the early part.
But as time goes on, they find that gradually their mind quiets down and eventually they get to a place where they're feeling much less anxious than they have in a really long time.
The other thing they'll talk about is how in social situations, you know, when there's like a moment of awkwardness, you're not really sure what to say, everybody just pulls out their phones now.
And that's not just teens, that's adults too, right?
And so what are we doing there?
Instead of like reinvesting in re-engaging with each other, we're pulling away from each other and disappearing in those tough moments.
I want to dig into something that really speaks to me.
You have a whole chapter dedicated to it, at least a chapter, if not more, but this idea of radical honesty.
And you have some very amusing examples, including from your own life with your kids and your chocolate sweet tooth taking, you know, basically eating your kids' chocolate and then lying about it and eventually deciding to come clean.
It's very kind of a touching little anecdote, actually.
But why don't you lay it out for me?
Yeah, so I mean, you know, there's a moral argument to be made for radical honesty, but there's also a neurobiological argument to be made for it, I think.
And to just define radical honesty, it means telling the truth about all things, large and small, in almost all circumstances.
Might there be some rare circumstance where a lie would be better than the truth?
Yes, I believe there would be, but very, very rare.
We often can rationalize why we need to lie when we really shouldn't.
And I first learned about radical honesty as a pathway to recovery from addiction in my patients in sustained recovery, who would tell me that basically they couldn't lie about anything other than otherwise they were very prone to relapse.
And what was really interesting to me about that was it wasn't just that they couldn't lie about their drug use.
They also couldn't lie about what they had for breakfast, why they were late for a meeting, what they were doing on Saturday night.
Any little lie became a kind of a domino effect for these larger lies and then relapse to using.
And I just found that really, really fascinating.
So that kind of launched my research into what might be going on there.
And I think radical honesty works at a lot of different levels to help people with appetitive control and, you know, not using drugs and not engaging in the kind of harmful compulsive overconsumption that we've been talking about.
And one of the ways I think it probably works is that it probably strengthens our prefrontal cortex.
So the prefrontal cortex is that large gray matter area right behind our foreheads, which is so important for delayed gratification, appreciating future consequences, autobiographical narrative.
And it turns out that we're all natural liars.
The average adult tells one to two small lies per day.
So that in order to be radically honest, we have to intentionally work at monitoring ourselves so as to not reflexively lie, which is kind of our natural default.
And in doing that, what we're probably doing is activating that prefrontal cortex.
And the prefrontal cortex is a key part of the reward pathway, and it acts like the brakes on appetite.
So that allows us more inhibitory control of these kinds of appetites.
And I talk about in the book some interesting neuroscientific experiments that sort of elucidate the role of the prefrontal cortex.
So it strengthens the breaks.
The other thing that it really does in a very interesting way is it increases our awareness of what we're actually doing.
So there's a very real way in which unless we put into words and tell other people or write down or somehow coherently use language to narrate our experience, we actually are not fully aware of what we are doing.
And this happens all the time in addiction.
You hear about, you know, denial and people living a double life and like not even really truthfully even knowing that they're using.
But what happens when you have to tell another human, oh, I did this and I ate that and I watched this and I smoked that, it really becomes real to us in a way that it's not when it's kind of peeing around in the dark recesses of our brains.
And the reason that's important is because the stories that we tell about our lives are not just a way to organize the past, they actually become a way to organize our future.
We're essentially Creating these verbal roadmaps, and if we're telling the truth in our lives, then we have more access to better information to make decisions going forward.
So, this awareness piece is really, really key.
The third thing is that radical honesty promotes intimacy.
And we're always talking about how human attachment is the opposite of addiction.
And that in order to get out of addiction, we have to reconnect with other humans.
But how do we do that?
And radical honesty is a wonderful starting place because we can wake up on any given morning and say, you know what?
Today, I'm going to tell the truth.
I'm not going to lie about anything.
And what happens when we tell other people truthfully what's going on in our lives?
We have this morbid fear that they're going to run away screaming.
But in fact, the opposite happens and they come closer to us.
They see in us their own flawed humanity.
They want to help us.
So radical honesty has this wonderful paradoxical effect of making humans connect with each other, even though we're so afraid to tell the truth because we're certain, we're just certain that we will be rejected when we do.
And yet, that's not what happens most of the time.
I'm going to read a line.
First, radical honesty promotes awareness of our actions.
Second, it fosters intimate human connections.
Third, it leads to a truthful autobiography, which holds us accountable, not just to our present, but also to our future selves.
Further, telling the truth is contagious and might even prevent the development of future addiction.
What about that part?
Yeah, so that's really interesting.
If you talk to people with severe addiction, almost universally, they grew up in families where there was a lot of lying.
Now, there's also often a lot of addiction in caregivers, but even when there's no addiction in caregivers, there's hypocrisy, there's lying.
And what happens when people around us are lying is that we feel like we can't rely on them or on the future, that we have to get into survival mode and take care of ourselves.
And once we're in survival mode, we're not thinking about like six years ahead.
We're thinking about the next six hours and getting what we need to survive because nobody else is going to take care of us.
And this is wonderfully illustrated in the Stanford Marshmallow, famous Stanford Marshmallow experiment, where, and this is a sort of variation on the original experiment that not many people have heard about, where the original experiment, you put a kid in the room four or five years old.
There's nothing but a table, a chair, a plate, and a marshmallow.
And you say to the kid, the researcher in the white lab coat says, I'm going to go away.
And if in 15 minutes when I come back, if you haven't eaten the marshmallow on the plate, you're going to get a second marshmallow.
And then they measured which kids could do it, which kids couldn't.
Turned out the older the child was, the more likely they were to be able to do it.
But even within a given age bracket, some kids could wait longer and some couldn't.
They then tracked that forward and found that the kids who could wait or delay gratification were more likely to have other positive life outcomes.
So it's obviously, you know, a strength to be able to do that.
It's the exertion of willpower in that moment.
The variation on that that gets at this idea of radical honesty was they then gave the kid a little bell, right?
A little bell you could ring next to the marshmallow.
And they said, hey, I'm going to go away.
You know, when I come back in 15 minutes, if you haven't eaten the marshmallow, I'll give you another one.
But if at any point during those 15 minutes you just feel like you want me to come back, just ring the bell and I'll be back.
And they divided those kids into two groups.
One group, when the kids rang the bell, they went back as promised.
The other group, the kids rang the bell, nobody appeared.
And, you know, as you can probably guess, in the group where the kids were lied to, they were much more likely to eat their marshmallow before those 15 minutes were up.
Because, you know, once you're not truthfully coming back when you said you were.
You might not get that marshmallow.
Thank you.
You probably aren't going to give me that second marshmallow.
So here we go.
I'm going to eat mine.
You might take it away when you come back.
So I just think that's a wonderful kind of sort of microcosm of the impact of a lying family or a lying culture, you know, on people's ability to maintain, you know, healthy, appetitive control and delay gratification.
And what's so interesting to me, the corollary of that, is that in times of extreme scarcity, you of course hear about people doing amazing acts of generosity, even though they themselves are hungry or threat is imminent.
And often here, it's spirituality and religion that allows people to do that because they have faith in something outside of themselves, some sort of system of caring and love that helps them with sort of being generous and not being in that survival mode, even in very dire straits.
I've made a bit of a study of crimes against humanity and communist systems throughout my life.
And one of the things that has come out just talking to hundreds, if not thousands, of people who have come out of these societies is that lying is essential for survival.
It becomes a sort of a central part of your existence.
And you learn, most people learn how to lie in a way that other people can't really tell, like in societies where it's not, where you don't have to do it for your base survival.
It's easier to tell, apparently.
But people will explain this, just say, like, you know, you just, if you didn't, if you didn't do it, you could be dead very quickly or whatever.
And then I reflected also on how, you know, something like simple, which comes out of that system like political correctness where you lie kind of to help people not feel bad, for example, or something like that, it actually ends up leading in the same direction, kind of in the same direction.
So this is a very important point that, you know, although in theory, you know, I believe that radical honesty is a better way to live our lives, in practice, number one, it's very hard to do.
And number two, it's probably impossible if you are in a collective system that punishes people who tell the truth, right?
If you're in a collective system which is built on lies, then it's true that you can't really, or you'd have to be an incredibly exceptional and brave person because the system doesn't tolerate truth telling.
And I think when we look at the United States and our media coverage in many instances and all of the sort of fake memes and fake videos and things that can be generated, it's a scary time because people no longer know what to trust and what to believe.
And that, I think, then does encourage this kind of scarcity survival mode mindset where people are going to be more likely to struggle with addictive behaviors because they don't feel they can trust the system that they're living in.
I mean, because you get these sort of hegemonic narratives, these dominant narratives, that if you disagree with them, I mean, you could, even in the U.S., you could lose your job, right?
You could be shunned.
Correct.
I mean, this is not something that's happening other places.
This is happening in the United States.
Correct.
And this is, you know, it kind of leads to another question.
I was, you know, telling a close friend who thinks about these types of questions along with me.
And one of, I said, you know, what would you ask, Ana?
And he said, well, you know, we're experiencing a kind of polarization and accelerating polarization in our society that there doesn't seem to be a way out of.
I often, people that watch this show know that I often reference Andre Meir's work, Manhattan Institute scholar, who's kind of a Marshall McLuhan, modern Marshall McLuhan, saying that just the structure of media today is inherently geared towards that.
The question I have is, understanding these realities around dopamine, how everything is kind of wired around it, including for most of us, as we discussed earlier, like we're suffering with some kind of addiction.
Even people who have sort of structured their lives to avoid it in many ways.
How much do you think that plays a role in this kind of polarizing reality?
I mean, it's a huge role.
So one thing to keep in mind about addiction, addiction is the opposite of attachment.
Attachment is the opposite of addiction.
So you can have a wonderful social network and all kinds of friends and beloved family.
And if you get addicted, you will move away from them.
Likewise, if you don't have enriched attachments in your life, you're more likely to get addicted in the first place.
And this comes to play with digital media and media more broadly and polarization in the sense that more and more people than ever before in the history of humankind live alone.
I'm not talking lonely, that's true too, but live physically alone, which is not our natural state.
We're really meant to move in these social tribes.
So now we are having to attach to others through this very addictive medium.
It is the nature of any addictive medium that over time we will develop tolerance.
We'll need more potent forms, more extreme forms to get the same effect.
The algorithms know that.
They push us to more extreme content.
And when we see other people online having an emotion at the same time that we're having that emotion, that's a very potent reinforcer, right?
Because from an evolutionary perspective, that's how you bond together, right?
We're all outraged together or we're all sad together.
We're all happy together.
So what happens, you get people living alone, they're going online, this addictive medium, to find other people.
They're getting sucked into the addictive medium itself, which is driving them to these more polarized displays.
And then they're experiencing the illusion of connection through shared outrage, right?
Through shared animosity, through, you know, shared all kinds of emotions.
I mean, like, I remember, I don't know how long ago, probably about 10 years ago, spontaneously people started posting videos of themselves watching other people with posted videos.
We weren't just watching content.
We were watching other people reacting to content.
Do you remember that moment?
Now that you mention it very vaguely, but To me, it said we are connecting, trying to connect with other humans on the internet by having a shared emotional experience.
A shared emotional experience.
That is what we are looking for.
And we're doing it by reacting in the same way.
So whether you're watching, you know, a news outlet or whatever, and you see the commentary and you see that somebody has the same reaction to something as you do, that's very reinforcing.
You know, that releases don't mean a reward pathway.
And then people want more and more of that.
And that's the way that people are getting their human connection as opposed to actually making these connections in real life, in real time.
My producer tells me I shouldn't sound too grim.
But given everything we just talked about, and given what you just said, that does not paint a picture of a very positive future if the trend continues.
And the trend is continuing because of addiction pathways, not because people are volitionally choosing based on, I think, your argument here.
I do think addiction is the modern plague, but I do think we're going to figure it out.
It's probably going to take hundreds to thousands of years, but I think we will get there.
And I'm optimistic because already we begin to see change, right?
I mean, I and others were talking about getting smartphones out of, you know, primary schools 15 years ago.
It's happening now.
You know, it's beginning to be a movement around people recognizing, hey, this isn't good for kids.
I see teenagers who self-opt out out of addictive social media because they realize this doesn't make me feel good.
This makes me feel more lonely.
I see all kinds of different sports and entertainment venues that are saying, hey, check your phone at the door.
If you're going to come to this event, we want you to be fully present.
So I am optimistic.
And you know, if you think about how new this technology is, and we're already talking about the dark side, you know, that's good.
Let's say you're someone who is addicted to their phone at some level, but uses it in a very valuable and meaningful way as well daily.
The second piece, I think food, I think, again, having this discussion, I think I have to confess that I think I have that exact relationship as well with food.
Yeah.
Like, what can you actually do?
Because you got to eat.
Yeah.
Right.
And you got to use your device.
Yeah.
Or what do you do?
Yeah.
So I like to start by like framing the positive.
Like the fact that you like to eat means that you like to live, that you're embracing life when you want to eat and when you enjoy food.
The fact that you're on your phone a lot means that you want to know what's going on.
You're engaged in life.
Okay.
So that's the first thing.
The second thing is just recognizing that both food and these devices are forms of drugs.
With food, with the addition of salt, fat, sugar, and flavorants, when we eat food now, we're not just getting the calories we need, which would allow us to not stop naturally when we got enough calories.
We're also getting hits of dopamine that are rewarding, that make us want to keep doing it, right?
When you think about the world that we evolved in, we had to walk tens of kilometers every day just to find a tiny little bit of food.
That's not the world we live in now, so it's a very challenging world.
And naturally, we want more once we begin.
thing with the digital media.
So I think once we recognize that, we can begin to think about, okay, how can I engage in self-binding strategies that will allow me to- If you can define that for, I don't think people are familiar with this term, but now it's become an important part of my life just having read your book here.
So yes.
Yeah, so I mean, you know, willpower can only go so far.
When we wake up, we have more willpower than we will at the end of the day.
It's not an infinite resource.
And if we rely on willpower alone in our drugified dopamine overloaded world, we're never going to make it.
So we have to put both literal and metacognitive barriers between ourselves and our drug of choice so that we can press the pause button between desire and consumption.
And that can take many forms.
It can be like actual space barriers, like we get the potato chips and the cookies and the cakes and the empty carbohydrates out of the house, right?
Or the alcohol out of the house or the pot out of the house or whatever it is.
With our devices, you know, it's things like using time as a self-binding strategy and say, hey, you know, I'm not going to even touch a screen or my device until I've finished my healthy morning routine.
I'm going to get a regular alarm clock.
I'm not going to use my phone.
I'm going to make sure I exercise, make my bed, eat, brush my teeth.
And only then am I going to sit down at a consolidated space, so not while I'm moving around doing other things, and like really then focus on my digital device and what I need to do.
Maybe I'm going to make a list of what I'm going to do before I get on, because I know once I get on, it can be very easy to forget what I meant to do here because I'm so distracted by this incredibly reinforcing rabbit hole.
Sounds like my morning, but please continue.
Yes, exactly.
You know, and then when we think about potency, right, how can I make food or the devices less potent?
I mean, generally speaking, broccoli is not something most people overindulge in, right?
Because it just doesn't have that same kind of, you know, kebang in our brains.
So, you know, focusing on healthy foods that are, you know, made in a tasty way, but not the kind of ultra-processed foods that really are drugs.
And the same thing with devices, you know, again, trying to circumscribe the time that we're using, making it, you know, the classical things, making the phone grayscale so it's not as potent for our brains.
Turning off notifications is absolutely key because every time we get that ping or that vibration, it distracts us from what we're doing over here.
It pulls us back in there.
It probably releases dopamine in the reward pathway, so it's in itself rewarding and it compels us to check.
I really recommend also powering the phone down and off when we're not using it.
So, you know, in the world of diabetes and type 2 diabetes is caused by a poor diet and lack of exercise in vulnerable folks.
But when you talk to diabetes specialists, they talk about one of the major ills of modernity is what they call chronic sedentary feeding.
It's the ways in which we kind of snack all day long.
So for example, intermittent fasting or using time as a self-binding strategy can help people who are trying to moderate their consumption of food.
So not just the type of food, but also the times that we eat, the amount of bowel rest we give ourselves in between.
But the kind of chronic sedentary feeding that we think about with food is very applicable to digital media, right?
The ways in which it's not just the total amount of time, but actually the frequency, the constant pulses throughout the day.
I check the first thing in the morning.
I check 10 minutes later.
I go and do something else and then I check again.
And so thinking about really consolidating the time and having a specific time when we sit down and focus on The digital media and what we need to do, and then powering it down and getting off of it, putting it in our bag, powered down.
I really recommend doing as much as possible on a laptop or a desktop, including texting, rather than on the phone, because again, it's sort of got a place that it lives: a room, a desk, a space.
It's not this sort of on-the-go, which is what makes the smartphone so insidiously addictive.
So that's actually one of my strategies, is to do more from the computer than from the phone whenever possible.
I didn't realize that that was one of my strategies, but it is.
And I think the other thing, especially with digital media and social media, is to realize that what we're really wanting when we're engaging in that kind of mindless scrolling is human connection.
And if in those moments we can recognize that, put the phone away and actually go find a person and, you know, if appropriate, like hold their hand or talk, because then we're getting the real deal.
Fascinating.
Shame.
This is something that, again, I think we're not supposed to deal a lot of in our current overall worldview.
And it can be incredibly destructive, but you actually make the case it could be incredibly valuable.
So explain that to me.
Yeah, so shame is this really interesting double-edged sword in that it's very true that intense shame can perpetuate addictive behaviors, but it's also true that if we felt no shame at all, we wouldn't be motivated to change those behaviors, right?
In many ways, shame is our most pro-social emotion because it's that sort of gut punch of a kind of dread when we know we've done something wrong and we're worried that we're going to be shunned or kicked out of the tribe, right?
But on the other hand, if we didn't experience any shame in reaction to certain types of behaviors, why would we bother to want to make it different?
So I think it's really important for us to let ourselves acknowledge and experience shame and to be thoughtful about the source of our shame and then importantly to try to make amends around that behavior.
So it's kind of a three-step process.
It's acknowledging the shame of something that we've done that we regret and feel shame about.
It's being committed to not doing that thing again.
And then third, it's going to the people that we have harmed and essentially making amends.
And this is where I think Alcoholics Anonymous and other 12-step groups have really learned how to leverage pro-social shame and mitigate malignant or toxic shame.
Many people who get into recovery through AA will say that the most important aspect was the deshaming aspect, how they went and they sat in a circle and they realized I'm not the only one.
And that person over there describing their life is describing my life.
And the sense of not having to be drowning in their own self-loathing around all of the behaviors adjacent to their addiction.
But on the other hand, the 12 steps are really all about owning my own character defects, you know, taking a careful moral inventory of where I've wronged others, going and making amends to those individuals.
So really providing this kind of pro-social shame pathway for people to change the behavior and also, again, importantly, get closer to other people.
It seems like we have to really enshrine agency.
Yes, I agree.
You know, it's fascinating when people come into the office, the way that they tell their autobiographical narrative, I can already know sort of their level of psychological health.
And what I mean by that is when people tell the story of their life in a way that makes them the perpetual victim of other people's actions, I know those are folks who are not well and often deep in their addictions.
And when people get into recovery, one of the very first things that changes is the way that they look at their own responsibility, culpability, agency in terms of their lives, past, present, and future.
We have a culture today where we essentially reward victimhood and we don't celebrate agency.
But again, getting back to Alcoholics Anonymous and other 12-step groups, their motto on the back of their pamphlet is, quote, three letters, three words, I am responsible.
So it's this fascinating paradox between sort of the spiritual transformation, a recognition of locus of control being outside of myself, my higher power.
And yet I am responsible, right?
I have agency.
I can one day at a time make decisions that will impact my life, impact other people's lives, impact the whole world.
Because really, how does change happen?
It's those small decisions and actions that we make in our everyday lives.
You end your book kind of abruptly, but it's something very valuable.
It's like one page of lessons of the balance, as you call them.
Why is it the balance, first of all, and not of balance?
Oh, well, because I think I use this extended metaphor of the pleasure-pain balance.
And so I think I'm referring to, and the metaphor is grounded in, you know, some exciting findings in neuroscience.
So I'm kind of referencing back to that.
I'm saying, how can some of these neuroscientific discoveries, you know, inform the choices that we make in our lives?
But this is a, I mean, I'm not going to read the whole list, but it's a fantastic list.
I'm going to print it out and put it up in my office somewhere.
But just kind of reminders, right?
Relentless pursuit of pleasure leads to pain.
And avoidance of pain leads to pain.
What a great reminder, right?
I mean, for me, that's a valuable reminder.
Yeah, we all need the reminder because again, we reflexively approach pleasure and avoid pain.
It's what keeps us alive.
It's a cognitive lift to actually avoid pleasure and approach pain.
And yet to be happy and to flourish, especially in this time in human history, we actually have to do that.
We have to eschew pleasure and we have to seek out things that are hard.
I'm going to add another one.
Abstinence resets the brain's reward pathway.
Yeah, people often think, well, can't I just reduce?
And really, it looks like that's harder to do than if you just abstain for a period of time, let your reward pathways reset, get insight on that consumptive behavior, and it also gives us the ability to take joy in other more modest rewards, which we lose when we're chasing these highly potent reinforcers.
Your number nine out of ten here is pro-social shame affirms that we belong to the human tribe.
And you talk about club goods, which I found, I almost have difficulty remembering that term, but it's something about how in a group we help keep each other in check.
Yeah, so club goods is from behavioral economics, and it basically speaks to what are the intangible goods that we get from coming together in communities.
Like why do people, you know, gather outside of the exchange of material goods?
What are these intangible club goods and how do we measure them?
And basically because they're intangible, they're very difficult to measure.
But part of the ways that you can measure it is through sacrifice, right?
How much time and energy are people devoting to these club goods and how willing are they to investing in this club and not another club, right?
So there's an enormous amount of sacrifice that goes into making that experience worth the bother.
Club goods and behavioral economics also talks about free riders, which is a little bit like freeloaders, people who try to get the positives of that group without contributing to the group.
So it's an interesting, you know, behavioral economics is a way to try to get at some of these interesting behaviors from the perspective of these mathematical models.
And shame is really important to club goods because every club has norms, right?
Kind of rules around what is and is not appropriate behavior.
And I think on the way on the margins, we can all agree what those should be.
Like I think we could all agree killing other human beings is not good.
Okay, I'm just going to use that as an example because we can mostly all agree that that's not good.
And that if you do break that rule and kill another human being, you should be shamed for that, right?
You should experience shame.
You know, you should be, in some sense, the community should shame you for that, but also importantly, you know, provide a path for making amends, however that may look in a given social group.
You know, it was very interesting.
You're just reminding me that you have this one scenario where there's a young woman who I think she ends up with a very big eating addiction.
She grew up in a very sort of militant evangelical family, and then later she kind of drifts away from the church and kind of finds her way.
And I thought that was interesting because it actually made me think about my mom, where I'm unbelievably grateful for my mother's church community because frankly, you know, for example, during the pandemic, right, when older people were, you know, she lived in Toronto, it was one of these places where it was, you know, complete lockdown, all this.
This community was like basically a central part of her life.
She didn't lose any community, whether it was on the phone, people were calling, people were coming over, delivering groceries, all this.
I mean, unbelievable, right?
Unbelievable.
And of course, and she will often talk to me about the types of things they think about and talk about, which are very different from most a lot of society today.
So these are the club goods.
What do they think about?
Well, the central part is praying, for example, right?
So my mother spends, she's very deeply believing Catholic.
She'll spend, she'll, I mean, multiple rosaries a day kind of thing.
She'll pray for, you know, all sorts of victimized people in the world, some specific people that the church has decided they're going to dedicate time for.
And that's a great example of club goods, like prayer, like the amount of time you're spending praying for other people.
Those are club goods.
Well, Anna, this has been an unbelievably wonderful conversation.
I've learned a ton just sitting here with you.
A final thought as we finish?
Well, you know, I just want to say thank you for your close read of my book.
It's such a joy to be interviewed by somebody who's not just read the book, but like read the book in its entirety, read the book carefully and thoughtfully.
I've really enjoyed the conversation.
Well, Anna Lemke, it's such a pleasure to have had you on.
Thank you.
It's been a pleasure for me too.
Thank you all for joining Ana Lemke and me on this episode of American Thought Leaders.
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