Dopamine Nation by Dr. Anna Lembke

    I just finished listening to Dopamine Nation by Dr. Anna Lembke and would recommend it for anyone trying to understand the mechanism of pleasure in the brain and its role in addictive behavior.

    Anna Lembke, MD - Dopamine Nation
    Dopamine Nation by Dr. Anna Lembke. In Dopamine Nation, Dr. Anna Lembke, psychiatrist and author, explores the exciting new scientific discoveries that explain…
    www.annalembke.com


    I had heard a podcast with the author and, at first, thought the focus on addiction was too narrow. But I was wrong. While some of the patients discussed in the book (with their informed consent!) are difficult to hear/read, Lembke does an excellent job in showing the wide range of addictive behaviors.

    I saw many echoes and/or applications to Epicurean philosophy in the book. To me, books like this are important because we can "philosophize" all day, but Epicurus advocates for evidence and knowing the science behind the brain and its reward pathways and how and why "not every pleasure is to be chosen" and "we sometimes choose pain for greater pleasures to come" is a reason to know the current science.

    I'll be interested if anyone reads it and has any comments.

    I don't know if I'll have time for this one, but I think you are absolutely right about its application.


    I'm curious whether Dr. Lembke goes into the other 4 major hormones/neurotransmitters of serotonin (mood, sleep, digestion), endorphins (mitigation of stress and pain), cortisol (increase of stress, and activation of "fight or flight" response) and oxytocin (associated with empathy, relationships and sex). Probably I do need to make time for this!

    The general topic of the relationship of philosophy to real life is something we need some hard-hitting material on that we feature on the website early in everyone's attention-span.


    I think our bottom line through Epicurus is that it is not logic or reasoning at all, but "feeling" that gives meaning to life. So in the end we DON'T look to some logical construct for all the answers, we look to a natural mechanism.


    But on the other hand, we can't conceptualize a feeling (other than words like pleasure and pain) and those general wordds leave the "mind" unsatisfied when we try to defend or state our positions using general words describing feelings and emotions.


    We have to therefore come to terms with exactly what Epicurean philosophy (or any philosophy) is and can do, and what it can't.


    I think I am going to work on a presentation to make on that topic but it keeps coming up over and over so is appropriate here.


    In Don's post it's a subtext -- how does "philosophy" work together with the observational science as to how the atoms and void are actually rolling around. We need to have a cofindent position on how these work together so that we're not implicitly apologizing for the lack of clarity every time we talk about it. BOTH have their roles but I don't think we've made it clear enough how they work together.

    Quote from JJElbert

    I don't know if I'll have time for this one, but I think you are absolutely right about its application.


    I'm curious whether Dr. Lembke goes into the other 4 major hormones/neurotransmitters of serotonin (mood, sleep, digestion), endorphins (mitigation of stress and pain), cortisol (increase of stress, and activation of "fight or flight" response) and oxytocin (associated with empathy, relationships and sex). Probably I do need to make time for this!

    The other neurotransmitters do come up repeatedly although her main focus is, of course, dopamine. She talks a lot about the reward pathways in the brain and how they get hijacked (my word, not hers) and lead to addictive behaviors.

    I see that in myself particularly with video games. {...New game -> binge -> tolerance -> increased need -> new variation -> binge...}, and so on. I think 'hijacked' is a fair term.


    The pecuniary cost for me is quite small because of the modding community and its infinite variation, but the timesink is considerable.

    Joshua you're right on point with the themes of the book! The author's addiction that she reveals was reading romance novels. Innocuous, one might assume, but it really took over her life in many ways. The patients she talks about are dealing with sex, drugs, alcohol, food addictions. Addiction can manifest itself in myriad ways it seems.

    This is the link to the podcast I listened to if anyone wants the short version before deciding to read the book:

    The Next Big Idea - DOPAMINE NATION: Why the Modern World Puts Us All at Risk for Addiction
    In “Dopamine Nation: Finding Balance in the Age of Indulgence,” Dr. Anna Lembke says today’s superabundance of pleasurable stimuli makes us all vulnerable to…
    podcasts.google.com

    Googel translate:

    Almost all people I know find satisfaction of a desire after a while.

    Except for my friends who fall heavily in love or who have a desire for even more money. That is also what Epicurus says, there is a limit to pleasure.

    In clinical situations, there will be people who become heavily addicted, but those are the exceptions who go to a doctor.


    As Elaine states in her overview:

    7. It is possible to enjoy life fully, and to be satisfied after attaining a desire. Desire is not fundamentally insatiable. There is no good reason to try and eliminate desires.

    8. If a desire appears to be insatiable, it is likely because a person is otherwise unhappy or because the desire is for something impossible.

    9. When a person is focused on an impossible desire, such as to live forever, the poor fit of substitute pleasures makes them feel their ordinary desires are insatiable.

    I have to disagree with some of your points.

    Quote from Marco

    In clinical situations, there will be people who become heavily addicted, but those are the exceptions who go to a doctor.

    Addictive behaviors are much more widespread than I have realized, and the exceptions are those people who seek treatment. I think many people with addictive behaviors don't seek professional help. That was one of the points underlying Dr. Lembke's book.

    Quote from Marco

    Desire is not fundamentally insatiable.

    Some desires are, some desires aren't. Epicurus specifically calls out the "empty" desires because they are insatiable. I've come to understand "empty" desires to mean that no matter how much you "fill" the box of an empty desire, it's still empty. Desires for money, fame, power for their own sake and not to achieve a certain goal are insatiable. That box is always going to be empty.


    Quote from Marco

    There is no good reason to try and eliminate desires.

    It's maybe not a matter of "elimination" but a matter of choosing which desires are worthwhile to pursue and which aren't. "Eliminating desires" sounds Buddhist. Making choices on which desires to choose and which to reject to lead to a pleasurable life puts it into an Epicurean context.

    Quote from Marco

    If a desire appears to be insatiable, it is likely because a person is otherwise unhappy or because the desire is for something impossible.

    It may be the case that someone is unhappy or has some underlying issue, but that still means they're pursuing a desire that's going to be insatiable (or "empty" as I described above)

    Quote from Marco

    When a person is focused on an impossible desire, such as to live forever, the poor fit of substitute pleasures makes them feel their ordinary desires are insatiable.

    I would include a desire for immortality as an empty desire, but there are many others, too. I don't think those people are necessarily feeling ordinary desires to be insatiable. I think they find them unsatisfying for any number of reasons, but we mighty be talking about two separate problems.


    If I've misunderstood any of your positions due to a translation problem, my apologies. But I felt I should clarify my understanding of those issues in light of reading Lembke's book as well as Epicurus's texts.

    Quote from Don

    calls out the "empty" desires

    Have you done a deep dive on the etymology of the "empty" word? i find that word very empty of meaning and i wonder if we have it right or could do a better job explaining it.


    "Vain" is a little better but still needs explanation as well, I would think.

    Empty (κενός) as a metaphor in the texts is derived from the actual, physical meaning of an empty vessel or box. You can place your hand in an empty box and move it around. It's the word Epicurus also used for void because it implies the atoms are able to move in the emptiness. Likewise, an empty desire is literally empty.


    Here's what I wrote in my Menoikeus commentary: "This is a word that carries a wide range of connotations, but all have that sense of emptiness, void, no ground to stand on (literally and figuratively). It carries the physical connotation of an empty box. If a box is κενός, it would be possible to move your hand around in it. There's nothing there to impede your movement."


    Here's the LSJ definition:

    Henry George Liddell, Robert Scott, A Greek-English Lexicon, κενός


    So, the common thread of κενός is void, empty, not able to be filled.

    Quote from Don

    So, the common thread of κενός is void, empty, not able to be filled.

    The main problem I have is that without some further explanation, the "void and empty" do not in my mind go together logically with "not able to be filled."


    The "not able to be filled" carries more meaning than "empty", but simply being void and empty does not (standing alone) because the nature of the atoms and void is that they move around, and considering any particular space at a particular time, there's no necessary reason why that space cannot be filled.


    Not sure I am being clear yet, and i am not faulting Epicurus, but i think our English usage of "empty" is probably missing the point, without more added to explain WHY it is not able to be filled. And since the allegation in the first place is apparently that the thing is "not able to be filled" then just saying that it is empty adds little or nothing to the statement.


    If something is not able to be filled then the question would be "WHY NOT?"

    Quote from Don

    So, the common thread of κενός is void, empty, not able to be filled.

    I found it to be clever that Epicurus links the idea of conceptual meaninglessness, vanity, superficiality, bankruptcy, uselessness, brokenness, and worthlessness with the physical void, emptiness, space. Thus, he reinforces the idea that those ideas which are not in accordance with the canon are much like space: literally non-existent.

    Quote from Don

    The void doesn't move and it extends infinitely. The atoms will never fill the void.

    I am not sure that I agree that the void doesn't move, at least in terms of a particular location. You CAN fill a vessel with atoms, can you not, and that displaces the void in that particular location.


    As to atoms in total never filling the void in total, absolutely we are in agreement.


    But these ambiguities in the use of void/empty are troublesome and would be better clarified.


    I feel sure that in the Greek the meaning WAS clear, and it is in our English formulations that the problem mainly exists.

    And even more so in regard to any analogy of a vessel. Vessels are MADE to be filled up, in human terms, so the first image that this analogy is making to a normal human is going to be incomplete unless there is something about the nature of this particular vessel that makes it impossible to fill (leaking, for example).

    Here is another aspect of this: The "leaking vessel" analogy is clearly an important part of Epicurean analogy, as illustrated at least once in the opening of Lucretius Book Vi.


    So the discussion of "filling vessels" is an important aspect of discussing how Epicurus taught to lead a life of pleasure.


    I would argue that the key question is what is it about these desires/vessels, other than that they start off empty or are empty at a moment in time, that prevents them from being filled?


    The issue cannot be solely that they are "empty" at a moment in time.

    Quote from Cassius

    I am not sure that I agree that the void doesn't move, at least in terms of a particular location. You CAN fill a vessel with atoms, can you not, and that displaces the void in that particular location.

    Void isn't a "thing". It's not composed of atoms. It's the "medium" in which the atoms move if you will, and even "medium" isn't the right word.


    I'll have more to write and respond soon. There's a teaser.

    These are great topics to discuss so keep it coming!


    I agree with your ultimate analysis of void, but it does have the one characteristic of giving a "place" for atoms to be, if I remember Herodotus and Lucretius correctly.


    And THESE / THIS is exactly on the list of things we are supposed to discuss, like infinity, right?