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Rethinking Pain and Pleasure. “Dopamine Nation: Finding Balance in the Age of Indulgence
J Korean Acad Child Adolesc Psychiatry 2024; 35(3): 218-220
Published online July 1, 2024
© 2024 Korean Academy of Child and Adolescent Psychiatry.

Seungwon Chung

Department of Psychiatry, Chungbuk National University Hospital, Cheongju, Korea
Correspondence to: Seungwon Chung, Department of Psychiatry, Chungbuk National University Hospital, 776 1sunhwan-ro, Seowon-gu, Cheongju 28644, Korea
Tel: +82-43-269-6187, Fax: +82-43-267-7951, E-mail: Seungwon Chung
Received May 23, 2024; Accepted May 24, 2024.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
With the world becoming increasingly affluent in terms of material wealth, individuals’ mental health appears to be lagging. “Dopamine Nation: Finding Balance in the Age of Indulgence” offers a new perspective on the meaning of addiction and its solutions in modern society with disparities. This book discusses addiction from the perspective of the balance between pain and pleasure. However, it also offers insights into the mindsets of modern humans, going far beyond the boundaries of addiction.
Keywords : Dopamine; Addictive behavior; Pain; Pleasure
Body

A recent analysis by the Health Insurance Review and Assessment Service in South Korea [1] revealed a 35.1% and 32.3% increase in the number of patients with depressive and anxiety disorders, respectively, between 2017 and 2021, indicating a significant increase in the prevalence of these disorders. The detrimental effects of the COVID-19 pandemic on mental health have been documented extensively in several countries. The reduction in the stigma surrounding mental illness and prejudice against psychiatric care could be contributing factors in increasing the number of individuals seeking care at clinics. However, there is no indication that South Korea will relinquish its position as the OECD member country with the highest suicide rate. Many people emphasize factors unique to South Korea, such as the rapid influx of Western culture, generational differences due to economic development, excessive competition, and social pressure, as causes of the prevalence of mental illness in this economically affluent society. Nevertheless, a report [2] stating that the prevalence of depression has increased in affluent countries such as North America and decreased in South Asia over the past three decades raises an important question: Could it be that common factors shared by affluent countries, rather than factors unique to Korea, are influencing this trend? The subtitle of the book under review, “Dopamine Nation: Finding Balance in the Age of Indulgence” [3], may provide us with one possible answer to this question.

Anna Lembke, the author of this book, was born in 1967 and holds a Bachelor of Arts degree in Humanities from Yale University and a medical degree from Stanford University. She is currently a professor and Medical Director of Addiction Medicine at Stanford University School of Medicine and has published numerous outstanding papers on substance and behavioral addiction and the relationship between pain and addiction. Additionally, she provides counseling to the U.S. government, the Senate, and the House of Representatives on matters pertaining to addiction policies. In her acclaimed book on prescription drug abuse, “Drug Dealer, MD: How Doctors were Duped, Patients got Hooked, and Why it’s so Hard to Stop,” she argues that the rapid rise of opioid addiction as a serious social issue in the U.S. is the result of a combination of our modern culture’s desire for quick fixes through pills, the collusion of pharmaceutical companies and organized medicine, and a health care bureaucracy that values satisfaction over patient health. To address this issue, she claims that it is necessary to change the shape of our healthcare system. “Dopamine Nation” also addresses the topic of addiction, but is distinguished by Anna Lembke’s profound insights into more fundamental questions about the nature of human life and the answers to them. In this book, the author offers an intuitive and accessible explanation from various perspectives, including human history, neuroscience, and psychology, as to why addictive behaviors can trigger a rapid dopamine surge casting an ever-greater shadow on modern society, not limited to specific substances or behaviors. The book is structured to read as a series of fascinating autobiographies interspersed with the author’s first-hand accounts of the patients she has met and her own experiences. Furthermore, she elucidates the mindset necessary to survive the threat of addiction in a clear and eloquent manner.

The concept of seeking pleasure and avoiding pain seems reasonable. However, the author posits that “The reason we’re all so miserable may be because we’re working so hard to avoid being miserable (Chapter 2. Running from Pain).” Therefore, those who answer “yes” to the question, “Can the human instinct to pursue pleasure continue to lead us to happiness?” may experience cognitive dissonance. A central theme of the book is the interrelationship between pleasure and pain and how this relationship affects our lives. The explanation of pain and pleasure, from a neuroscientific perspective likening them to balance, is intuitively logical even for nonexperts. Over the course of a few decades or centuries, a world that had long been characterized by scarcity was transformed into a world of abundance. Moreover, in the digital age, wherein intense pleasure (a dopamine rush) can be obtained at home with a few finger swipes, “The phylogenetically uber-ancient neurological machinery for processing pleasure and pain (Chapter 3. The Pleasure-Pain Balance),” according to the author, does not seem to fit well with our current abundance. The author argues that this discrepancy may be associated with a range of psychopathologies, including addiction. The book mentions that ancient philosophers such as Socrates discussed the mysterious connection between pain and pleasure, and that, as recently as the 19th century, doctors believed that a certain amount of pain was a sign of good health. This demonstrates the distinct differences between how we view pain and pleasure in the modern world. In the past, the experience of suffering may have been a more common and natural phenomenon. Instead of facing pain, we can now easily escape into pleasure (the easiest way is to lean into addiction); thus, pain has become a forgotten artifact, and individuals appear to have lost the capacity to experience it. In this book, the author posits that intentional “dopamine fasting” is a necessity in an age of pleasure excess. Similarly, as resources become more abundant, individuals must adopt dietary practices to avoid losing their health from overconsumption instead of worrying about nutritional deficiencies. The book also addresses the topic of food as an addiction. Additionally, the text dedicates a significant portion of its content to how pain should be accepted, managed, and “applied.” At the end of the book, the author demonstrates how honesty can facilitate recovery from addiction, how it interacts with dopamine in the reward circuitry, and how it serves as a core value in relationship recovery.

This book offers insights for pediatric psychiatrists engaged in clinical practice. First, it may offer a perspective on the emotional distress experienced by parents of children undergoing therapy. South Korea was once a society that did not prioritize emotional expression or emotional distress. However, this is no longer the case. Most parents visiting the clinic do their best to understand their children’s emotions, and some have studied psychology as much as their professional counterparts. However, despite these efforts, many parents still experience overwhelming feelings of guilt about their children. Can they find it abnormal to observe their child, whom they believe should always be happy, experience suffering? Clinicians may also feel the urge to align themselves with parents who are committed to completely eliminating their child’s suffering and act as service providers to make their clients 100% satisfied, rather than as therapists who deal with pain. Considering the “pleasure/pain balance,” it would be prudent to reconsider the matter. Second, the book may provide a perspective on adolescents who engage in self-harm. The prevalence of self-harm among adolescents has become a major concern in South Korea and worldwide. Non-suicidal self-injury (NSSI) is the act of intentionally causing harm to oneself to temporarily escape from intense negative emotions or even to obtain a sense of pleasure. This is comparable to the use of drugs. Those who repeatedly engage in NSSI experience a craving for self-harm comparable to addiction. Interestingly, one of the most effective interventions for young people struggling with NSSI is mindfulness, which involves the process of accepting pain as it is and allowing it to dissipate. Ultimately, it involves imparting knowledge to those who have lost their capacity to cope with suffering in an era of affluence. While previous scarcity required individuals to deal with the suffering caused by deprivation, the contemporary era of abundance requires them to strive (or suffer) for balance. The future is uncertain, but perhaps a new type of suffering will emerge. There is no paradise on earth, and pleasure and pain will always coexist. Although these words can be frustrating, they are also reassuring. The book is written in a straightforward style that is accessible to a general audience while also offering clinicians a wealth of insights and considerations regarding pain management.

Conflicts of Interest

The author has no potential conflicts of interest to disclose.

References
  1. Health Insurance Review and Assessment Service. Analysis of depression and anxiety disorder treatment trends over the past five years (2017-2021) [Internet]. Wonju: Health Insurance Review and Assessment Service 2022 [cited 2024 May 19]. Available from: https://www.hira.or.kr/bbsDummy.do?pgmid=HIRAA020041000100&brdScnBltNo=4&brdBltNo=10627&pageIndex=1.
  2. Liu Q, He H, Yang J, Feng X, Zhao F, Lyu J. Changes in the global burden of depression from 1990 to 2017: findings from the Global Burden of Disease study. J Psychiatr Res 2020;126:134-140.
    Pubmed CrossRef
  3. Lembke A. Dopamine nation: finding balance in the age of indulgence. New York: Dutton Books;2021.
    CrossRef


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