Dopamine notes

I am still contemplating Dr. Anna Lembke's 'Dopamine Nation: Finding Balance in the Age of Indulgence'. It seemed such a quick read and I don't want to just 'move on from it.' Here are some notes I highlighted that I'd like to look back on from time to time. Enjoy...

P. 2 -

"In addition to the discovery of dopamine, one of the most remarkable neuroscientific findings in the past century is that the brain processes pleasure and pain in the same place. Further, pleasure and pain work like opposite sides of a balance."

"This book aims to unpack the neuroscience of reward and, in so doing, enable us to find a better, healthier balance between pleasure and pain."

"As philosopher and theologian Kent Dunnington wrote, 'Persons with severe addictions are among those contemporary prophets that we ignore to our own demise, for they show us who we truly are.'"

P. 75 - 

"The world is sensory rich and casual poor." (neuroscientist Daniel Friedman). That is to say, we know the doughnut tastes good in the moment, but we are less aware that eating a doughnut every day for a month adds five pounds to our waistline. 

 

PP. 81-83 - 

"Yeah, I know. Hard. But it's also an opportunity. A chance for you to observe yourself as separate from your thoughts, emotions, and sensations, including pain. This practice is sometimes called mindfulness."

"Mindfulness is simply the ability to observe what our brain is doing while it's doing it, without judgment."

"Mindfulness practices are especially important in the early days of abstinence. Many of us use high-dopamine substances and behaviors to distract ourselves from our own thoughts. When we first stop using dopamine to escape, those painful thoughts, emotions, and sensations come crashing down on us. ... "The trick is to stop running away from painful emotions, and instead allow ourselves to tolerate them."

 

P. 97 -

"The medication naltrexone is used to treat alcohol and opioid addiction, and is being used for a variety of other addictions as well, from gambling to overeating to shopping. Naltrexone blocks the opioid receptor, which in turn diminishes the reinforcing effects of different types of rewarding behavior." ... "Another medication that is used to treat alcohol addiction is disulfiram. Disulfiram interrupts alcohol metabolism, leading to the accumulation of acetaldehyde, which in turn causes a severe flushing reaction, nausea, vomiting, elevated blood pressure, and an overall feeling of malaise... is an effective deterrent for those trying to abstain from alcohol, especially for people who wake up in the morning determined not to drink but by the evening have lost their resolve..."

 

P. 129 -

"Despite substantial increases in funding in four high-resources countries (Australia, Canada, England, and the US) for psychiatric medications like antidepressants (Prozac), anxiolytics (Xanax), and hypnotics (Ambien), the prevalence of mood and anxiety symptoms in these countries has not decreased (1990-2015). These findings persist even when controlling for increases in risk factos for mental illness, such as poverty and trauma, and even when studying severe mental illness, such as schizophrenia."

 

P. 132-133 -

"In medicating ourselves to adapt to the world, what kind of world are we settling for? Under the guise of treating pain and mental illness, are we rendering large segments of the population biochemically indifferent to intolerable circumstance? Worse yet, have psychotropic medications become a means of social control, especially of the poor, unemployed, and disenfranchised?"

 

P. 135 -

"Please don't misunderstand me. These medications can be lifesaving tools and I'm grateful to have them in clinical practice. But there is a cost to medicating away every type of human suffering, and as we shall see, there is an alternative path that might work better: embracing pain."

 

P. 152 -

"A key to well-being is for us to get off the couch and move our real bodies, not our virtual ones. As I tell my patients, just walking in your neighborhood for thirty minutes a day can make a difference. That's because the evidence is indisputable: Exercise has a more profound and sustained positive effect on mood, anxiety, cognition, energy, and sleep than any pill I can prescribe."

 

P. 171 -

"Every major religion and code of ethics has included honesty as essential to its moral teachings. All my patients who have achieved long-term recovery have relied on truth-telling as critical for sustained mental and physical health. I too have become convinced that radical honesty is not just helpful for limiting compulsive overconsumption but also at the core of a life well lived."

 

P. 187 -

"As I have alluded to before, the modern practice of psychotherapy sometimes falls short of that lofty goal. We are mental-health care provides have become so caught up in the practice of empathy that we've lost sight of the fact that empathy without accountability is a shortsighted attempt to relieve suffering. If the therapist and patient re-create a story in which the patient is a perpetual victim of forces beyond their control, chances are good that the patient will continue to be victimized. ... But if the therapist can help the patient take responsibility if not for the event itself, then for how they react to it in the here and now, that patient is empowered to move forward with their life."

 

P. 207 -

"When it comes to compulsive overconsumption, shame is an inherently tricky concept. It can be the vehicle for perpetuating the behavior as well as the impetus for stopping it. So how do we reconcile this paradox? ... The psychological literature today identifies shame as an emotion distinct from guilt. The thinking goes like this: Shame makes us feel bad about ourselves as people, whereas guilt makes us feel bad about our actions while preserving a positive sense of self. Shame is a maladaptive emotion. Guilt is an adaptive emotion. ... My problem with the shame-guilt dichotomy is that experientially, shame and guilt are identical."

 

P. 208 -

"Yet the shame-guilt dichotomy is tapping into something real. I believe the difference is not how we experience the emotion, but how others respond to our transgression. ... If others respond by rejecting, condemning, or shunning us, we enter the cycle of what I call destructive shame. Destructive shame deepens the emotional experience of shame and sets us up to perpetuate the behavior that led to feeling shame in the first place. If others respond by holding us closer and providing clear guidance for redemption/recovery, we enter the cycle of prosocial shame. Prosocial shame mitigates the emotional experience of shame and helps us stop or reduce the shameful behavior." ...