introduction
Picking up this read I’ve expected it to be a discussion about the addictive essence of social media or such but it ended up being very different.
I enjoy reading books, not knowing what they are about, always helpful to find new topics to get into.
This time that lead me to spend two weeks with this read about addiciton, compulsivity, drugs and what to do about it, drugs and what to do about it.
In the following I will go a bit through the content of the book. Writing together my notes and the concepts I found the most helpful throughout this book. Afterwards I will talk about my thoughts concerning the content.
It is important to note how the book is stuctured. The author is a psychiatrist and thus has a lot of “clinical” experience. That leads her to be able to tell about the theoretical perspective and then introduce patients’ story that is able to show the theory in practise.
In my notes I won’t go into the patients’ stories because I want to talk about the raw concepts and figure from them instead. Read the book if you want the interesting stories.
summary of most important concepts
Part 1, The Pursuit of Pleasure
Talking about addiction we first need to define it. Lembke uses the following.
Addiction broadly defined is the continued and compulsive consumption of a substance or behavior (gambling, gaming, sex) despite its harm to self or others.
Here we can immediately highlight that addiction composes itself out of a compulsive action. That will be a topic throughout the book, going against those affective efforts.
Further, the biggest reason or cause for addiction is easy access. That can be brought back to the compulsive behavior. If you get offered some drug to take you can react to it compulsively and do a dumb decision. If you’d not get offered anything, you can see how it is considerably harder to get addicted to anything.
Addiction related deaths are also a very common thing, the author cites the following about it:
The top three leading causes of death in this group [middle aged white Americans without a college degree] are drug overdoses, alcohol-related liver disease, and suicides.
The researches who came to that conclusion (Anne Case and Angus Deaton) are calling those “deaths of despair”.
In the second chapter there’s then a discussion about the upsides pain gives us. Mentioning first of all that pain speads up tissue repair.
That may seem counter intuitive at first but that’s just how it works. Ask your doctor about it, not me.
But when we look at most of human history it is obvious that never pain was a thing you can “just get rid off” with some pain killers. Whereas now for most people pain is simply unacceptable. Much broader we have the exactly same thing with entertainment and other forms of distraction, but that’s a topic for another time.
Part 2, Self-Binding
“Self-binding” describes a thing that I always thouht about as “anti patterns”. Actions or things you undertake to prohibit usage or compulsive behavior.
Self-binding is used when doing e.g. a “dopamine fast”. Here a patient is highlighted to explain why that may be useful.
- patient smokes pot
- because they think they need that against anexiety
- Lembke tells her to fast it for a month
- after some days they are not anxious anymore
Here we see the “antidote” against their anexiety being what actually promotes it. Thus one has the illusion that it’s “required” to go normal through a week whereas it actually is what creates the anexiety whenever off of the drug.
The author recommends that dopamine fasts should be undertaken over at least a month to get any outcome from it.
At last in this part of the book, or rather my notes about it, we have a set of ways to “self bind”.
Physical
The most prominent example may be the Ulysses pact.
A more modern example of a compulsive shopper may be to just leave the credit card at home, or just putting a tv in a hard to reach place such that there’s an effort you need to undertake on every use.
Chronological
As in putting a time limit onto the activity. Such af “only on weekends”, or “only on holidays”, …
Categorical
Removing all the triggers that lead to usage or compulsion. E.g. when you’re gambling or porn addicted don’t go on twitch[1].
Part 3, The Pursuit of Pain
In the last part of the book Lembke talks about shame, honesty and their connection. She first points out that “Just as pain is the price we pay for pleasure, so too is pleasure our reward for pain”. Saying that being honest and vulnerable towards others is what leads us to a better state than before.
Further she observed that in most of her patients she has seen honesty being a essential part in getting out of an addiction.
Proposing radical honesty she says:
Radical honesty – telling the truth about things large and small, especially when doing so exposes our foibles and entails consequences – is essential not just to recovery from addiction but for all of us trying to live a more balanced life in our reward-saturated ecosystem.
And continuing she mentions other upsides, such as honesty promoting intimate human connections.
Telling the truth draws people in, especially when we’re willing to expose our own vulnerabilities. This is counterintuitive because we assume that unmasking the less desirable aspects of ourselves will drive people away. It logically makes sense that people would distance themselves when they learn about our character flaws and transregessions. In fact, the opposite happens. Peeople come closer. They see in our brokenness their own vulnerability and humanity. They are reassured that they are not alone in their doubts, fears and weaknesses.
From that we can then lead over to the “scarcity mindset” about which she basically says that it’s up to ourselves, to either have a scarcity mindset amongst plenty, just as much as having a plenty mindset amidst scarcity. Linking both of these states either honesty or lying based, resulting in either connectedness and meaning or isolation.
That is then illustrated in two graphs, the first being the following cycle of destructive shame:
overconsumption -> shame -> lying -> isolation -> overconsumption -> ...
And the next being a broken version of the same cycle, being called prosocial shame:
overconsumption -> shame -> radical honesty -> acceptance ->
belonging and decreased consumption
conclusion
In her conclusion she speaks about the pain/pleasure balance there is, ending the book with the following lessons:
- The relentless pursuit of pleasure (and avoidance of pain) leads to pain.
- Recovery begins with abstinence.
- Abstinence resets the brain’s reward pathway and with it our capacity to take joy in simpler pleasures.
- Self-binding creates literal and metacognitive space between desire and consumption, a modern necessity in our dopamine-overloaded world.
- Medications can restore homeostasis, but consider what we lose by medicating away our pain.
- Pressing on the pain side resets our balance to the side of pleasure.
- Beware of getting addicted to pain.
- Radical honesty prometes awareness, enhances intimacy, and fosters a plenty mindset.
- Prosocial shame affirms that we belong to a human tribe.
- Instead of running away from the world, we can find escape by immersing ourselves in it.
my opinion on the book
I enjoyed reading the book a lot. It’s practically written and the content too is very interesting as you may know by now. I’ve not expected a lot but received plenty.
It’s one of these non-ficton books where you don’t really know what they could tell or give you but at the end you got a whole toolbox of information, able to categorice e.g. self-binding principles in this book. Which could eventually make getting rid off of an addiction easier because one is aware of the progress to undergo to have a chance at it.
I would probably recommend the book to some friends that got a interest in such reads but it is nothing completely groundbreaking. Cool to read, easy to go through and accessibly written but not life changing, at least not for me.
As this is the first book review I would like to know your opinion about it. You can find my mail and gpg key here: contact.
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Actually not an example from the author. ↩