Book Review: Dopamine Nation

  

Dopamine Nation is a 2021 book written by Anna Lembke. Dr. Lembke is a psychiatrist and the medical director of Stanford Addiction Medicine.

The book, with its catchy subtitle "Finding Balance in the Age of Indulgence", focuses on modern trends of overconsumption, specifically in American society.

To understand the book, we need to put some contemporary social pathologies into context. Princeton economists reported shorter life expectancy among white Americans without a college degree. The morbid findings of midlife mortality among caucasians were mostly attributed to three major causes: substance abuse, alcohol-related liver disease, and suicide. (The term "Death of Despair" was coined by Anne Case and Angus Deaton, and the phenomenon is discussed in their book Deaths of Despair and the Future of Capitalism.)

The book oscillates between patients and personal memories, and scientific rationale backed by some evidence-based material. Most cases are clinical cases of high-end drug abuse or other types of addiction. To tackle the goliath of addiction, it is inevitable to (at least) touch on a few domains beyond the narrow scope of psychiatry. Education, pop culture, sociology, economy, internet, and information technology are the key players in this problem, and accordingly must be addressed as components of any proposed solution.

A part of the psychology of addiction is rooted in education and the current education system. As an example, in Chapter 2 (Running From Pain), the author questions some approaches to modern treatment of children:

"... I worry that we oversanitized or overpathologized childhood, raising our children in the equivalent of a padded cell, with no way to injure themselves but also no means to ready themselves for the world."

Later in the same chapter, the book quotes Neil Postman (American media theorist and cultural critic:

"... Americans no longer talk to each other, they entertain each other. They do not exchange ideas, they exchange images. They do not argue propositions; they argue with good looks, celebrities, and commercials."

These self-deceptive behaviors, norms, or traits divert attention and insulate us from pain. As mentioned earlier, this book is founded on American psychology. The book reports that pain perception is higher among Americans compared to other nations.

An interesting part of the book explains the physiology of pleasure, anticipation, action, reward, and ultimately pain. The brain's reward pathway involves the ventral tegmental area, the nucleus accumbens, and the prefrontal cortex. While dopamine plays the key role in the sensation of pleasure, its role is even more potent in the motivation to get a reward (Wanting over Liking!).

Chapter 3 (The Pleasure-Pain Balance) introduces the concept of dopamine-deficit state: a neurological process that occurs as a result of overconsumption of dopamine substances. This overexposure disturbs the dopamine release as well as the expression of dopamine receptor (D2), bringing about a full reversal from hedonism to anhedonia.

In Part II (Chapter 4 onwards), the book shifts gears towards solutions and management strategies. Chapter 4 introduces four weeks of Dopamine Fasting for starters. The point is that we need to embrace the pain and acknowledge the suffering instead of escaping from it. The critique should target escapism rather than the pain (This section of the book is in accordance with Susan David's Emotional Agility.)

In Chapter 5 (Space, Time, and Meaning), the Self-binding is defined as the method we intentionally and willingly create barriers between ourselves and our drug of choice to mitigate compulsive overconsumption. Later in this chapter, the book criticizes some aspects of current practice where pharmacotherapy alone is applied without understanding the patient and targeting the underlying behaviors. These lopsided approaches have usually proven futile.

As the study by Warren Bickel revealed, the addicted have a different perspective on the future. The compromised abstract thinking and planning lead to shrinking temporal horizons. One consequence of repeated overconsumptive behaviors, which are modulated through reward pathways, is the atrophy of the prefrontal cortex. For the addicted, the concept of "Future" is shrunken to next week, whereas a normal person looks at a more expansive horizon, years ahead. Fixing this perception should be stressed as a key task in any treatment regime.

Further, the applied medical treatment is not impeccable. Chapter 6 (Broken Balance?) underlines some wrong medical modalities in the prescription of psychotropic medications. The new role has been assigned to psychiatrists to replace the missing chemicals in patients' brains to enable them to work normally. This idea has been welcomed by the pharmaceutical companies, doctors, and patient consumers. The trend becomes more alarming when we notice the disparity in the administration of narcotics between lower and higher socioeconomic classes. Americans on federally funded Medicaid are prescribed opioid painkillers at twice the rate of non-Medicaid patients.

In Part III (Pressing on the Pain Side), the book enters a debate about pain-pleasure management, suggesting pressing on the pain side of the equilibrium can lead to a better and more enduring pleasure. The pain here is grossly used as any type of stress induced under control. The book claims repetitive exposure to pain stimuli leads to shorter initial responses and builds an afterresponse of pleasure, which grows over time. As a result of the fight-or-flight mechanism in our neuroendocrinology, pain morphs into hypervigilance and then morphs into a fit of joy. This part of the book is sensitive and subject to misunderstanding, and in my opinion, requires better structure. The idea as the author mentions, is counterintuitive and against dogma in the field. There are references to studies linking stress to increased dopamine release in the brain's reward pathway. Also, the administration of opioid receptor blocker (naloxone) is shown to block the ameliorative effect of repetitive pain stimuli (suggestive of increased endogenous opioid release in response to pain). These concepts may be labelled as hormetic healing. Overall, I agree with the concept of carefully dosed "pain" stimulus as a method to bring back balance to the flawed pleasure-pain equilibrium. Here, the term "pain" warrants careful definition and a precision medicine approach tailored to each individual's psychosomatic profile.

The next chapter (Chapter 8: Radical Honesty) also explores the means to break the cycle of addiction and overconsumption by opting for a Radical Honesty attitude and utilizing Prosocial Shame.

Prosocial shame is the term used in contrast with a second (and morbid) type of shame called "Destructive Shame". The prosocial shame theory is predicated on the idea that shame can be harnessed as a constructive force through "acceptance" of the defect, flaw, or any transgressive behavior. This interaction and constructive behavior result in a sense of belonging and reduced consumption. 

These chapters stress the importance of prosocial shame in the management of addiction and beyond, for example, in parenting. The personal example from Dr. Lembke's family explains that the concept of perfection is a misleading goal to base a family upon. Instead, an open-hearted willingness to work in collaboration to rectify our mistakes is the way to create true intimacy. 

Truthfulness and honesty encourage a mindset called "Sense of Plenty" (opposed to "Sense of Scarcity"), which enhances the delayed gratification pathway.

Maybe a combination of these methods, applying measured pain stimuli, being radically honest, and being willing to work together (as an individual, a family, or a society/nation) can remedy the maladies of today's hypermedicated, overstimulated, pleasure-saturated world.

خطوط سفید، صفوف سیاه

،همین ها

،همین خودعلامه پندارها

،همین تحلیلگرها، کارشناس ها، درس خوانده  ها

 ،همین ها که بسیار هستند و همیشه در صحنه حاضر

:همین ها نماد مشکلات ایران امروز هستند.

.کسانی که خود را همیشه صاحب تئوری معرفی کرده اند و از دکترینی به دکترینی دیگر درحال مهاجرت و تولید تز هستند

،همین ها که نقد جن هست و وجود پاک ایشان بسم اله

،همین تفلون هایی که هیچ انتقادی به ساحت مطهرشان نمی چسبد

.در حباب نخبگانی(!) خویش چنان فرو رفته اند که با  درد و مصیبت  مردمان غریبه شده اند... 

.لبخند می زنند حال آن که در دل به آلام رنج دیدگان میخندند.

.به برکت وجود مستمرشان در طی بیش از چهار دهه، بی وقفه، وهن اخلاق را به تماشا نشسته ایم

Scratchband by John Adams

Scratchband was written expressly for the Ensemble Modern with that group’s unique mixture of virtuosity and stylistic adaptability always in mind. The instrumentation is that of a hybrid of a rock band. With the use of electric guitar, electric bass, drum set, and amplified winds and synthesizers, the timbres and style of orchestration make it a close sibling to the pit band of Ceiling/Sky, the 1995 song play I composed in collaboration with June Jordan and Peter Sellars.

During the preparation periods for the various productions of Ceiling/Sky, I noticed that the traditional "rock" instruments were capable of extraordinary power and virtuosity, but that these abilities were rarely, if ever, realized in commercial music. Technical "chops" displayed by even the greatest of rock musicians -- a Jimi Hendrix or an Eric Clapton, for example -- tended to rest comfortably within the accepted language of the tradition. Understanding and transcending this limitation may have been Frank Zappa’s most lasting contribution to the future development of the art. Zappa understood that the language of rock could be vastly expanded by an informed cross-fertilization from the world of classical music. He chose musicians for his bands who could move beyond the simple structures of popular music and respond to his experiments in rhythm and counterpoint with skill and audacity. For listeners familiar with my recent music, Scratchband will probably appear as a strange shotgun wedding, one that marries the busy, terrier-like activity of the chamber symphony to the pop timbres of the Ceiling/Sky score. As I write this note, the piece is barely more than half completed, so my comments are not unlike an attempt to fill in a full personality sketch on the basis of a single ultrasound scan. What strikes me about the piece, however, is the way in which minimalist gestures are beginning to reappear in my music after a significant absence (the overture to Ceiling/Sky being the only other significant exception).

After a frantic explosion of scales charging up and down the gamut in a garish panoply of constantly shifting modes, the music stabilizes in the key of B major, boogying back and forth across modal borders that suddenly and dramatically alter the color and mood of the action. Eventually, this hyperactive energy levels off into a series of panels that introduce motivic material in a more formal "minimalist" guise. But the emotional underpinning here is far more volatile than in pieces from the '70s or '80s. Nevertheless, this same volatility provides the stimulus for real virtuoso writing, a kind of writing that falls so naturally within the capacities of a group like the Ensemble Modern.

From John Adams' Program Note

Carnegie Mellon Wind Ensemble (Stravinsky, Mingus, Adams, Mozart)

George Vosburgh, Director

Stephen Story, Associate Director

Bobbi Zimmmelman, clarinet

Camden Wentz, cello 

حنظله بادغیسی

 

مهتری، گر به کام شیر دراست
رو خطر كن ز كام شير بجوى
يا بزرگىّ و عزّ و نعمت و جاه
يا چو مردانت، مرگ روياروى

John Dewey and the Shortcomings of Industrial Education

 There is a trend that emphasizes success and revolves around a successful career before anything. The financial aspects, being defined as the ends (not the means) are ruining the foundation of education and the well-being of society. I have had a philosophical clash with this mentality from the get-go. I've seen this ideology spread throughout the educational system and respected in professional spheres.

The concept of being this money-generating machine and obtaining this social status is dorky, stale, and in many instances, a fantastic breeding ground for concealed fascism while acting politically correct. There is no two ways around this pseudoscience of evolutionary humanism or societal classes founded upon god-given privileges. The consequent hubris is one of the prime examples of post-industrial banalities. 

While this social superiority is attributed to inherent characteristics and essential differences, the root causes lie in a secure childhood in an affluent household and a protected track to a flourishing career. We witness a certain class arrogating to itself the right to be leaders as if being born in an affluent suburban neighborhood dismisses any need to hustle and bustle for a competitive position. The old stories of royal blood in someone's blood are as alive as ever.

 These trends are anti-meritocracy, anti-progressive, anti-humanistic, and basically at odds with all the values the Enlightenment era bestowed upon Western civilization. As long ago as 1670, mankind embarked on pursuing happiness and progress regardless of an individual's indulgence in fantastic social classification or genetic lineage.

This notion is in line with a part of John Dewey's ideas that I recently read. The following lines are excerpted from "Democracy and Education", published in 1916. While Dewey shows the importance of having an education that empowers individuals and ultimately provides financial independence, he warns about the grave dangers of the  "industrial education":

...social efficiency indicates the importance of industrial competency. Persons cannot live without means of subsistence; the ways in which these means are employed and consumed have a profound influence upon all relationships of persons to one another. If an individual is not able to earn his own living and that of the children dependent upon him, he is a drag or parasite upon the activities of others. He misses for himself one of the most educative experiences of life. if he is not trained in the right use of the products of industry, there is grave danger that he may deprave himself and injure others in his possession of wealth. No scheme of education can afford to neglect such basic considerations. Yet in the name of higher and more spiritual ideals, the arrangements for higher education have often not only neglected them, but looked at them with scorn as beneath the level of educative concern. With the change from an oligarchical to a democratic society, it is natural that the significance of an education which should have as a result ability to make one's way economically in the world, and to manage economic resources usefully instead of the mere display and luxury, should receive more emphasis. 

There is however, grave danger that in insisting upon this end, exisiting economic conditions and standards will be accepted as final. A democratic criterion requires us to develop capacity to the point of competency to choose and make its own career. This principle is violated when the attempt is made to fit individuals in advance for definite industrial callings, selected not on the basis of trained original capacities, but on that of the wealth or social status of parents. As a matter of fact, industry at the present time undergoes rapid and abrupt changes through the evolution of new inventions. New industries spring up, and old ones are revolutionized. Consequently an attempt to train for too specific a mode of efficiency defeats its own purpose. When the occupation changes its methods, such individuals are left behind with even less ability to readjust themselves than if they had a less definite training. But, most of all, the present industrial constitution of society is like every society which has ever existed, full of inequities. It is the aim of progressive education to take part in correcting unfair privilege and unfair deprivation, not to perpetuate them. Wherever social control means subordination of individual activities to class authority, there is danger that industrial education will be dominated by acceptance of the status quo. Differences of economic opportunity then dictate what the future callings of individuals are to be.  We have an unconscious revival of the defect of the Platonic scheme without its enlightened method of selection.

Dewey, John, Democracy and Education, p. 219

As mentioned above, this model has several limitations. First, it's constructed upon multitudes of inequities, unsolicited advantages, and unqualified privileges. Second, it is inherently protective of the status quo of the industrial society's constitution. Third, it is too specific to be adjustable to the dynamic social scene of modern life. Therefore, trainees will be kept high and dry amidst the shifting sands of modern life. The current consensus of many private education institutions and the sidelining of liberal arts and the opprobrium they hold against public engagement will jeopardize social integrity.

Pedram

11/10/2025

Nazism and Evolutionary Humanism

 These lines from Harari's book stood out:

Even though liberal humanism sanctifies humans, it does not deny the existence of God, and is, in fact, founded on montheist beliefs. The liberal belief in the free and sacred nature of each individual is a direct legacy of the traditional Christian belief in free and eternal individual souls. Without recourse to eternal souls and a Creator God, it becomes embarrassingly difficult for liberals to explain what is so special about individual Sapiens.

Another important sect is socialist humanism. Socialists believe that "humanity" is collective rather than individualistic. They hold as sacred not the inner voice of each individual, but the species  Homo sapiens as a whole. Whereas liberal humanism seeks as much freedom as possible for individual humans, socialist humanism seeks equality between all humans. According to socialists, inequality is the worst blasphemy against the sanctity of humanity, because it privileges peripheral qualities of humans over their universal essence. For example, when the rich are privileged over the poor, it means that we value money more than the universal essence of all humans, which is the same for rich and poor alike.

Like Liberal humanism, socialist humanism is built on monotheist foundation. The idea that all humans are equal is a revamped version monotheist conviction that all souls are equal before God. The only humanist sect that has actually broken loose from traditional monotheism is the evolutionary humanism, whose most famous representatives were [are] the  Nazis. What distinguishes the Nazis from other humanist sects was the different definition of "humanity", one deeply influenced by the theory of evolution. In contrast to other humanists, the Nazis believed that humankind is not something universal and eternal, but rather a mutable species that can evolve or degenerate. Man can evolve into superman, or degenerate into subhuman.

Yuval Noah Harari, Sapiens, A Brief History of Humankind, (pp. 230, 231)

This is curious, since we anecdotally observed human efforts to sideline monotheistic ideologies throughout years/decades/centuries and under various projects. But the most modern attempt is nothing less than prime debauchery and barbarity. More than anything, this dark period indicates the perils of the hegemony of anti-enlightenment sects. Any type of forced distillation of a racial/ethnic, ideological, religious, or cultural milieu is an anti-enlightenment aspiration, and its outcomes have hitherto proven to be tragic human milestones.

Adam Smith's Sympathy (Part II)

 Sympathy, as Smith defines it, is a cognitive capacity rather than an emotional one. It is not to be identified with sympathetic feeling. Smith points out how difficult it is to feel concern for people who are remote from us. If we did not have conscience to give us some sense of proportion, then, says Smith, we would care more about a trifling injury to ourselves than about the entire destruction of China in an earthquake: 

If [a man] was to lose his little finger to-morrow, he would not sleep tonight; but, provided he never saw them, he will snore with the most profound security over the ruin of a hundred millions of his brethren, and the destruction of that immense multitude seems plainly an object less interesting to him, than this paltry misfortune of his own. 

He dismisses those ‘whining and melancholy moralists’ who claim that we ought to make ourselves unhappy by imagining the unhappiness of people unknown to us. There is no virtue in merely caring (or professing to care) about unknown persons. Passive emotion is feeble and ineffectual, but active virtue is motivated by a far stronger force – that of conscience, originating in a desire for others’ approval and hence for self-approval. 

We have, moreover, a ‘general fellow-feeling . . . with every man merely because he is our fellow-creature’. Our strong emotions, however, are directed towards individuals, beginning with our friends and relatives. General fellow-feeling underlies our attachment to the principle of justice, without which, Smith insists, society would collapse into anarchy. The importance of justice for the good of society is confirmed by reflection. Humane people may well feel sorry for a condemned criminal, especially as, having been captured, he can do no more harm, and may wish him to be spared the death penalty. On further reflection, however, ‘[t]hey counterbalance the impulse of this weak and partial humanity by the dictates of a humanity that is more generous and comprehensive’, and acquiesce in the criminal’s execution. What underlies our love of justice, however, is not an abstract regard for the good of society, but an ingrained feeling, which makes us detest the idea of a murderer escaping punishment. 

Misguided emotions need to be corrected by ‘reason, principle, conscience... the man within, the great judge and arbiter of our conduct’, which has itself a foundation in the deep emotions implanted in us by nature. Smith thinks well of the emotional self-control advocated by the Stoics. He even praises the astonishing ‘magnanimity and self-command’ of native North Americans, who endure torture with ‘heroic and unconquerable firmness’. But the Stoic virtues are one-sided. Stoics are wrong to recommend insensibility. Affectionate feeling is itself a source of pleasure: ‘The poets and romance writers, who best paint the refinements and delicacies of love and friendship, and of all other private and domestic affections, Racine and Voltaire; Richardson, Maurivaux [sic] and Riccoboni; are, in such cases, much better instructors than Zeno, Chrysippus, or Epictetus.’ They teach ‘that moderated sensibility to the misfortunes of others, which does not disqualify us for the performance of any duty’.

Robertson, Ritchie. The Enlightenment: The Pursuit of Happiness, 1680-1790 (pp. 271-272). (Function). Kindle Edition.