How to Find Balance in the Age of Indulgence - Dr. Anna Lembke

Summary

In this episode of 'After Skool', Dr. Anna Lembke explores the paradox of declining happiness despite increasing wealth and technological progress. She discusses the neuroscience behind the pleasure-pain balance, the impact of dopamine overload from modern indulgences, and offers strategies for finding balance. The video suggests 'dopamine fasting', self-binding techniques, and embracing pain as pathways to enduring pleasure, advocating for a mindful approach to life's challenges.

Takeaways

• 📉 The World Happiness Report indicates a decline in self-reported happiness in wealthy nations like the U.S., despite material wealth and technological advancements.
• 🌍 Similar decreases in happiness are observed in other high-income countries, suggesting a global trend rather than isolated incidents.
• 🧠 The brain processes pleasure and pain through a balance mechanism, which seeks to maintain homeostasis, or a neutral state.
• 🚀 Dopamine, a neurotransmitter associated with pleasure, can lead to addiction when over-stimulated, causing a 'hangover' effect and withdrawal symptoms.
• 📱 Modern technology, particularly smartphones, can be compared to a 'hypodermic syringe' delivering constant dopamine hits, contributing to overconsumption and unhappiness.
• 📉 The abundance of pleasurable substances and behaviors in our current world has not led to increased happiness but rather to higher rates of depression, anxiety, and other mental health issues.
• 🕊️ 'Dopamine fasting' is suggested as a method to reset the brain's dopamine levels by abstaining from pleasurable stimuli, leading to improved mental health.
• 🛡️ Self-binding techniques, such as setting limits on pleasurable activities, can help maintain a balance and prevent the negative effects of dopamine overload.
• 🏋️‍♂️ Engaging in activities that involve a degree of discomfort or pain, like exercise, can actually enhance pleasure by triggering the body's homeostatic mechanisms.
• 🧘‍♀️ The pursuit of pain, contrary to our natural instincts, can lead to more enduring pleasure and a stronger sense of well-being.
• 🌈 Finding balance in the dopamine-driven age of indulgence requires patience, maintenance, and a willingness to face life's challenges head-on.

Q & A

What is the main topic of discussion in this special episode of After Skool?

The main topic is dopamine and finding balance in the age of indulgence, and how an increase in access to pleasure affects mental health.

According to the World Happiness Report, how has self-reported happiness in the United States changed from 2008 to 2018?

People living in the United States reported being less happy in 2018 than they were in 2008.

What is generalized anxiety disorder as mentioned in the script?

Generalized anxiety disorder is defined as excessive and uncontrollable worry that adversely affects one's life.

Why do richer countries have higher rates of anxiety than poorer ones, according to the research findings?

The script suggests that the disorder is significantly more prevalent and impairing in high-income countries than in low to middle-income countries, although it does not provide a specific reason for this trend.

What has been the trend in the number of new cases of depression worldwide between 1990 and 2017?

The number of new cases of depression worldwide increased by 50 percent between 1990 and 2017.

What is the 'pleasure-pain balance' as discussed by Dr. Anna Lembke?

The 'pleasure-pain balance' refers to the brain's mechanism where the same parts of the brain process both pleasure and pain, working like a balance that the brain strives to maintain.

What is the concept of 'dopamine fasting' as suggested by Dr. Anna Lembke?

Dopamine fasting is the practice of abstaining from all sources of dopamine stimulation, such as screens and addictive behaviors, to allow the brain to restore baseline levels of dopamine firing.

How does the script describe the impact of modern technology on dopamine levels?

The script describes modern technology, particularly smartphones, as tools that deliver digital dopamine, contributing to potential dopamine overload and imbalance.

What are some of the self-binding strategies mentioned in the script to manage dopamine levels?

Self-binding strategies include restricting screen time, avoiding highly addictive games, physically separating gaming devices from work devices, and playing games only with friends to strengthen social connections.

What is the idea of using pain as a pathway to pleasure, as discussed in the script?

The idea is that exposing oneself to controlled amounts of pain, such as through exercise or other effortful activities, can trigger the body's homeostatic mechanisms, leading to a more enduring form of pleasure.

What is the final recommendation made by Dr. Anna Lembke in the script for achieving a balanced life?

The final recommendation is to immerse oneself fully in life, face challenges directly, and seek out pain in a healthy way to achieve a more enduring and profound pleasure.

Outlines

00:00

🧠 Dopamine and the Pleasure-Pain Balance

Dr. Anna Lembke introduces the concept of dopamine and its role in balancing pleasure and pain in the brain. She discusses the World Happiness Report, noting a decline in happiness scores in wealthy countries despite increased wealth and technological advancement. The paradox of increasing anxiety and depression in affluent nations is highlighted, setting the stage for exploring the impact of pleasure-seeking behaviors on mental health. The video aims to present ideas on how an overabundance of pleasurable stimuli can degrade mental health and suggests finding balance in an age of indulgence.

05:07

📈 The Consequences of Dopamine Overload

This paragraph delves into the evolutionary purpose of dopamine and how it has been disrupted by modern abundance. The easy access to highly reinforcing substances and behaviors, from social media to sugar, is contrasted with the increasing rates of depression, anxiety, and other health issues. The 'dopamine fast' is introduced as a potential solution, where a patient abstains from screens to reset his dopamine levels, resulting in improved mental health. The importance of self-binding techniques to manage dopamine intake and avoid the gremlins of addiction is emphasized.

10:08

🚫 Self-Binding and Dopamine Fasting

The concept of self-binding is further explored with strategies to prevent overindulgence in pleasurable activities. The patient's successful experience with a dopamine fast is detailed, illustrating the benefits of abstaining from video games to restore dopamine balance. Dr. Lembke shares her own practices for managing screen time and suggests that viewers consider their own pleasurable habits that may be detrimental in the long term. The challenge to take a break from one's 'drug of choice' is issued, with the promise of mental clarity and a restored ability to enjoy life's simple pleasures.

15:14

🏋️‍♂️ Pain as a Pathway to Pleasure

The final paragraph discusses the counterintuitive idea that embracing pain can lead to greater pleasure. It explains how the body's homeostatic mechanisms can shift the hedonic set point towards pleasure when exposed to pain intermittently. Historical experiments with dogs and the transformative effect of exercise on neurotransmitters are cited as examples of how pain can be a precursor to pleasure. The paragraph concludes with a call to action for viewers to immerse themselves in life's challenges rather than seeking escape, suggesting that this approach can lead to a more fulfilling and balanced existence.

Keywords

💡Dopamine

Dopamine is a neurotransmitter associated with the brain's reward system, which plays a key role in motivation, pleasure, and reward-seeking behavior. In the video, dopamine is central to the discussion of how an increase in pleasure-seeking through various activities and substances can lead to a degradation of mental health. The script uses the concept of dopamine to explain the hedonic treadmill, where constant stimulation can lead to a need for more intense experiences to achieve the same level of pleasure.

💡Balance

Balance, in the context of the video, refers to the equilibrium between pleasure and pain in the brain, which is essential for maintaining mental health. The script discusses how the brain strives to maintain a state of homeostasis, or balance, and how disruptions to this balance can lead to issues like addiction and mental health disorders. The concept of balance is integral to understanding the video's message about finding equilibrium in an age of indulgence.

💡Hedonic Set Point

The hedonic set point is the baseline level of happiness or pleasure that an individual experiences. The video explains how excessive indulgence in pleasurable activities can shift this set point, requiring more stimulation to achieve the same level of pleasure, leading to a state of dependency and potential addiction.

💡Anxiety Disorder

Anxiety Disorder, as mentioned in the script, is a condition characterized by excessive and uncontrollable worry that significantly impairs an individual's life. The video discusses how the prevalence of anxiety disorders is higher in wealthier countries, suggesting a link between material abundance and mental health issues.

💡Depression

Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. The script notes a 50 percent increase in new cases of depression worldwide between 1990 and 2017, particularly in regions with higher sociodemographic indices, indicating a potential correlation between societal progress and mental health challenges.

💡Dopamine Fasting

Dopamine fasting is a concept introduced in the video as a method to reset the brain's dopamine levels by abstaining from activities that trigger dopamine release, such as using screens and engaging in certain behaviors. The video presents a case study where a patient benefited from dopamine fasting, experiencing reduced anxiety and depression after a month of abstinence.

💡Self-Binding

Self-binding is a strategy discussed in the video for managing addictive behaviors by setting limits and creating barriers to prevent overindulgence. The script provides examples of how a patient used self-binding techniques to control his video game usage, which helped him maintain a healthier dopamine balance.

💡Pleasure-Pain Balance

The pleasure-pain balance is a core concept in the video that describes how the brain processes pleasure and pain as a seesaw, constantly adjusting to maintain equilibrium. Disruptions to this balance, such as through excessive pleasure-seeking, can lead to mental health issues and addiction.

💡Homeostasis

Homeostasis is the body's natural tendency to maintain a stable internal environment. In the context of the video, it refers to the brain's efforts to maintain a balance between pleasure and pain. The script uses the term to explain how the brain adapts to changes in dopamine levels and how this process can be disrupted by modern indulgences.

💡Pain as a Pathway to Pleasure

This concept from the video suggests that engaging with pain or challenging activities can lead to a more profound and enduring sense of pleasure. The script discusses how pain can trigger the body's homeostatic mechanisms, leading to an increased natural hedonic set point and making individuals less susceptible to pain and more capable of experiencing pleasure.

💡Behavioral Risk Factors

Behavioral risk factors are actions or habits that increase the likelihood of disease or other health problems. The video cites examples such as smoking, physical inactivity, and poor diet, which contribute to a significant proportion of global deaths. The script connects these factors to the broader theme of overconsumption and its impact on mental and physical health.

Highlights

The World Happiness Report indicates a decline in happiness in the United States and similar wealthy countries.

Researchers found higher rates of generalized anxiety disorder in wealthier countries.

Depression cases have increased globally, with the highest increases in regions with higher sociodemographic index.

The paradox of unhappiness despite unprecedented wealth, freedom, and technological progress is discussed.

Pleasure and pain are co-located in the brain, and they work like a balance.

The brain strives to maintain a level of balance or homeostasis after experiencing pleasure or pain.

Dopamine release in response to pleasure can lead to a downregulation of dopamine receptors, causing a need for more stimulation.

Continuous exposure to pleasurable stimuli can result in a shift in the hedonic set point, leading to addiction.

The modern world provides abundant access to highly reinforcing drugs and behaviors, contributing to mental health issues.

Depression, anxiety, and physical pain rates are increasing, especially in rich nations.

Dopamine fasting is introduced as a method to reset the brain's dopamine levels and restore balance.

Self-binding techniques are suggested to manage dopamine release and prevent overconsumption.

Pain can be a pathway to pleasure by triggering the body's homeostatic mechanisms.

Exercise is highlighted as a healthy way to increase neurotransmitters involved in positive mood regulation.

The importance of finding the middle way between pain and pleasure is emphasized.

The speaker encourages embracing life's challenges and seeking balance rather than escape.

Maintaining balance requires patience and ongoing effort, with benefits revealed over time.

Transcripts

hi i'm Dr. Anna Lembke welcome to a special  episode of After Skool today we're going to be  

talking about dopamine and how to find balance  in the age of indulgence so without further  

ado let's dive in according to the world  happiness report which ranks 156 countries  

by how happy their citizens perceive themselves  to be people living in the united states reported  

being less happy in 2018 than they were in 2008.  other countries with similar measures of wealth  

social support and life expectancy  saw similar decreases in self-reported  

happiness scores including belgium canada  denmark france japan new zealand and italy  

researchers interviewed nearly 150 000 people  in 26 countries to determine the prevalence of  

generalized anxiety disorder defined as excessive  and uncontrollable worry that adversely affected  

their lives they found that the richer countries  had higher rates of anxiety than the poorer ones  

the authors wrote the disorder is  significantly more prevalent and impairing  

in high income countries than low to middle  income countries the number of new cases of  

depression worldwide increased 50 percent  between 1990 and 2017. the highest increases  

in new cases were seen in regions with higher  sociodemographic index especially in north america  

the question is why in a time of unprecedented  wealth freedom technological progress and medical  

advancement do we appear to be unhappier than  ever in this video i present five big ideas  

that outline how an increase in access to pleasure  causes the degradation of mental health and how to  

find balance in an age of indulgence to understand  the roots of this issue we must start in the brain  

big idea number one the pleasure pain balance one  of the most important discoveries in the field  

of neuroscience in the past 100 years is that  pleasure and pain are co-located by that i mean  

the same parts of the brain that process pleasure  also process pain and pleasure and pain work  

like a balance when we feel pleasure the balance  tips one way when we feel pain it tips the other  

one of the overarching rules governing  this balance is that it wants to stay  

level after any deviation from neutrality our  brains will work very hard to restore a level  

balance or what neuroscientists call homeostasis  for example i like to watch videos of american  

idol when i watch my brain releases a little bit  of the neurotransmitter dopamine in my brain's  

reward pathway and my balance tips slightly to the  side of pleasure but no sooner has that happened  

then my brain adapts to the increased dopamine  by down regulating my own dopamine receptors  

and dopamine transmission i like to imagine  this as little gremlins hopping on the pain  

side of my balance to bring it level again not  very scientific i know but here's the thing about  

those gremlins they like it on the balance so  they don't hop off once it's level they stay on  

until it is tipped an equal and opposite amount  to the side of pain this is the after effect the  

hangover the come down or in my case that moment  of wanting to watch just one more video if i wait  

long enough the gremlins hop off the balance  neutrality is restored and that feeling passes  

but what if i don't wait what if instead i  watch another video and another and another  

pretty soon i'm no longer watching american idol  videos i'm watching videos of people watching  

videos alternating with memes of dr pimple popper  if i keep doing this for hours a day days to weeks  

weeks to month i end up with enough gremlins on  the pain side of my balance to fill a whole room  

they are camped out for the long  haul tents and barbecues in tow  

once that happens i've changed my hedonic set  point now i need to keep watching videos not to  

feel pleasure but just to feel normal as soon as i  stop watching i experience the universal symptoms  

of withdrawal from any addictive substance  anxiety irritability insomnia dysphoria and  

mental preoccupation with using otherwise known as  craving this is the hallmark of the addicted brain  

big idea number two dopamine overload this  fine-tuned balance of ours has evolved over  

millions of years to help us approach pleasure and  avoid pain it's what's kept us alive in a world of  

scarcity and ever-present danger but here's the  problem we no longer live in that world we now  

live in a world of overwhelming abundance  the access quantity variety and potency of  

highly reinforcing drugs and behaviors has never  been greater including drugs that didn't exist  

before texting tweeting gaming gambling sugar  shopping vaping voyeuring the list is endless  

online products with their flashing lights  celebratory sounds laudatory likes bottomless  

bowls and the promise of ever greater rewards  just a finger click away are engineered to be  

addictive the smartphone is the equivalent of the  hypodermic syringe delivering digital dopamine for  

a wired generation if you haven't met your drug of  choice yet it's coming soon to a website near you  

yet despite increased access to all these  feel-good drugs or as i hypothesize because  

of it we're more miserable than ever rates of  depression anxiety physical pain and suicide  

are increasing all over the world especially in  rich nations our compulsive over consumption has  

led not just to increase psychological suffering  we are literally consuming ourselves to death  

seventy percent of world global deaths are  attributable to diseases caused by modifiable  

behavioral risk factors like smoking physical  inactivity and diet the leading global risks  

for mortality are high blood pressure tobacco use  high blood sugar physical inactivity and obesity  

in 2013 an estimated 2.1 billion adults were  overweight compared with 857 million in 1980.  

there are now more people worldwide who are  obese and who are underweight except in parts  

of sub-saharan africa and asia the poor and  under-educated especially those living in  

rich nations are most susceptible to the  problem of compulsive over consumption  

they have easy access to high reward high  potency high novelty drugs at the same time  

that they lack access to meaningful work safe  housing quality education affordable health care  

and race and class equity before the law this  creates a dangerous nexus of addiction risk  

over the course of my 20-year career i have seen  more and more patients including otherwise healthy  

young people with loving families elite education  and relative wealth presenting with depression  

anxiety and or full body pain in the absence  of any identifiable disease or tissue injury  

big idea number three dopamine fasting a  patient of mine a bright and thoughtful  

young man in his early twenties came to see  me for debilitating anxiety and depression  

dropped out of college he was living with  his parents and vaguely contemplating suicide  

he was also playing video games most of every day  and late into every night twenty years ago the  

first thing i would have done for a patient  like this was prescribe an antidepressant  

today i recommended something altogether different  a dopamine fast i suggested he abstain from all  

screens including video games for one month what  he said why would i do that playing video games  

is the only thing that gives me any relief well i  said let me explain my patient came back a month  

after having abstained from all screens reporting  feeling better than he had in years less anxiety  

less depression why because when he stopped  bombarding his reward pathway with dopamine  

he gave his brain the opportunity to restore  baseline levels of dopamine firing in other  

words a level balance he was more surprised than  anyone that he felt better it's hard to see cause  

and effect when we're chasing dopamine it's only  after we've taken a break from our drug of choice  

that we're able to see the true impact of our  consumption on our lives and the people around  

us big idea number four self binding my patient  was able to return to playing video games without  

getting depressed or anxious by keeping the  gremlins in mind first he restricted his video  

game playing time to no more than two days per  week no more than two hours a day that way he left  

enough time in between for the gremlins to hop off  and for balance to be restored he avoided video  

games that were too potent the ones that once he  started he couldn't stop and that way he avoided  

accumulating more gremlins on his balance at once  than he could handle he designated one laptop for  

gaming and a different one for schoolwork to  keep gaming and classwork physically separated  

finally he committed to playing only with friends  never with strangers so that gaming strengthened  

his social connections human connection itself  is a potent and adaptive source of dopamine  

for myself i took my patients lead i still watch  american idol videos but i try to keep it to no  

more than two days a week no more than two hours  a day and preferably with friends and family  

i avoid dr pimple popper all together how about  you what's your drug of choice the thing that  

once you start you have trouble stopping or the  thing that makes you feel good in the moment  

but worse afterward consider the smartphone  itself as a possible culprit whatever your  

drug of choice i challenge you to give it up  for a month or a week or even a single day  

when you do notice how at first your pleasure  pain balance tilts to the side of pain and you  

feel restless cranky and most of all preoccupied  with using your drug your brain screaming out all  

the reasons why you should use even though  you committed to a period of abstinence  

but if you wait long enough and the gremlins hop  off and balance is restored you'll find you're  

free your mind is less preoccupied with using  you're more able to be present in the moment  

and life's little unexpected joys are rewarding  again if and when you decide to go back to using  

remember to create literal and metacognitive  barriers between yourself and your drug of choice  

so you don't go to war with your gremlins bottom  line to reset your dopamine brain first abstain  

big idea number five pain as a pathway to  pleasure pressing on the pain side of the  

balance can lead to its opposite pleasure  unlike pressing on the pleasure side  

the dopamine that comes from pain is indirect  and potentially more enduring so how does it work  

pain leads to pleasure by triggering the  body's own regulating homeostatic mechanisms  

the pleasure we feel is our body's natural  and reflexive psychological response to pain  

with intermittent exposure to pain our  natural hedonic set point gets weighted  

to the side of pleasure such that we become less  vulnerable to pain and more able to feel pleasure  

over time just as pain is the price to pay for  pleasure so too is pleasure the reward for pain  

in the late 1960s scientists conducted a series of  experiments on dogs that due to the experiment's  

obvious cruelty would not be allowed today but  nonetheless provide important information on  

brain homeostasis or leveling the balance after  connecting the dog's hind paws to an electrical  

current the researchers observed the dog appeared  to be terrified during the first few shocks  

it screeched and thrashed about its pupil was  dilated and its eyes bulged its hair stood on  

end its ears lay back its tail curled between  its legs explosive defecation and urination  

along with many other symptoms of intense  autonomic nervous system activity were seen  

after the first shock when the dog was freed  from the harness it moved slowly about the room  

appeared to be stealthy hesitant and unfriendly  over subsequent electrical shocks its behavior  

gradually changed during shocks the signs of  terror disappeared instead the dog appeared  

pained annoyed or anxious but not terrified  for example it wind rather than shrieked  

and showed no further urination defecation or  struggling then when released suddenly at the  

end of the session the dog rushed about jumped  up on people wagged its tails in what scientists  

at the time called a fit of joy with repeated  exposure to a painful stimulus the dog's mood and  

heart rate adapted in kind the initial response  pain got shorter and weaker the after response  

pleasure got longer and stronger pain morphed  into hypervigilance morphed into a fit of joy  

now i'm not recommending you shock  yourself to get high the dog experiment  

is merely an example to illustrate the  indirect outcome of painful stimulation  

there are however many healthy examples to  pursue pain a 10-minute ice cold water bath  

fasting exercise breathing techniques yoga martial  arts sensory deprivation or any effortful activity  

let's for example look at exercise exercise  increases many of the neurotransmitters involved  

in positive mood regulation dopamine serotonin  norepinephrine epinephrine endocannabinoids and  

endogenous opioid peptides or endorphins exercise  contributes to the birth of new neurons and  

supporting glial cells exercise even reduces the  likelihood of using and getting addicted to drugs  

exercise has more profound and sustained positive  effects on mood anxiety cognition energy and sleep  

than any pill i can prescribe but pursuing  pain is harder than pursuing pleasure it goes  

against our innate reflex to avoid pain and pursue  pleasure it adds to our cognitive load we have to  

remember that we feel pleasure after pain pursuing  pain instead of pleasure is also counter-cultural  

going against all the feel-good messages  that pervade so many aspects of modern life  

buddha taught finding the middle way between pain  and pleasure but even the middle way has become  

adulterated by the tyranny of convenience hence  we must seek pain out and invite it into our lives  

we all desire a respite from the world a  break from the impossible standards we set  

for ourselves and others it's natural that  we would seek a reprieve from our relentless  

ruminations why did i do that why can't i do this  look what they did to me how can i do that to them  

so we're drawn to any of the pleasurable  forms of escape that are now available to us  

trendy cocktails the echo chamber of social media  potato chips fast food porn immersive video games  

the list really is endless addictive drugs and  behaviors provide that respite but add to our  

problems in the long run what if instead of  seeking oblivion by escaping from the world  

we turn toward it what if instead of leaving  the world behind we immerse ourselves in it  

i urge you to find a way to immerse yourself  fully in the life you've been given to stop  

running from whatever you're trying to escape  and instead stop and turn and face whatever it is  

then i dare you to walk toward it  in this way the world may reveal  

itself to you as something magical and  awe-inspiring that does not require escape  

instead the world may become  something worth paying attention to  

the rewards of finding and maintaining balance  are neither immediate nor permanent they require  

patience and maintenance we must be willing to  move forward despite being uncertain of what  

lies ahead we must have faith that actions today  that seem to have no impact in the present moment  

are in fact accumulating in a positive direction  which will be revealed to us only at some  

unknown time in the future healthy practices  happen day by day may you find the balance  

thanks for watching this episode of after  skool i really hope that these animations  

help you in your daily life balancing dopamine  and living a flourishing life thanks for watching

you