How too much pleasure can cause you pain

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Dopamine isn’t the only neurotransmitter involved in reward processing, but most neuroscientists agree it’s among the most important. (Photo: Getty Images/Gallo Images)
Dopamine isn’t the only neurotransmitter involved in reward processing, but most neuroscientists agree it’s among the most important. (Photo: Getty Images/Gallo Images)

It's instinctive for human beings to want pleasure and avoid pain. We are programmed to do so – it dates back to a time when people needed to find food and shelter every day or risk death.

But we don’t live in that world anymore. In today’s world, these basic needs are often readily available. In fact, we’ve transformed our world from a place of scarcity to a place of overwhelming abundance: not only of food, but of all sorts of other things that stimulate our pleasure centre – shopping, news, gaming, gambling, texting, Facebooking, Instagramming, YouTubing, tweeting, alcohol . . .

This overabundance changes things, says psychiatrist and addiction specialist Dr Anna Lembke, and understanding the relationship between pleasure and pain has become essential for a life well lived.

This extract from her book Dopamine Nation: Finding Balance in the Age of Indulgence, shows how and why we’re vulnerable to compulsive overconsumption of all kinds, and why it’s critical to do something about it.  

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“My patient Sophie, a Stanford undergraduate from South Korea, came in seeking help for depression and anxiety. Among the many things we talked about, she told me she spends most of her waking hours plugged into some kind of device: Instagramming, YouTubing, listening to podcasts and playlists.

In a session with her I suggested she try walking to class without listening to anything and just letting her own thoughts bubble to the surface. She looked at me both incredulous and afraid. “Why would I do that?” she asked, open-mouthed.

“Well,” I ventured, “it’s a way of becoming familiar with yourself. Of letting your experience unfold without trying to control it or run away from it. All that distracting yourself with devices may be contributing to your depression and anxiety.

“It’s pretty exhausting avoiding yourself all the time. I wonder if experiencing yourself in a different way might give you access to new thoughts and feelings, and help you feel more connected to yourself, to others, and to the world.”

She thought about that for a moment. “But it’s so boring,” she said. “Yes, that’s true,” I said. “Boredom is not just boring. It can also be terrifying. It forces us to come face-to-face with bigger questions of meaning and purpose.

 (Photo: Getty Images/Gallo Images)
The more dopamine in the brain’s reward pathway, the more addictive the experience. (Photo: Getty Images/Gallo Images)

“But boredom is also an opportunity for discovery and invention. It creates the space necessary for a new thought to form, without which we’re endlessly reacting to stimuli around us, rather than allowing ourselves to be within our lived experience.

The next week, Sophie experimented with walking to class without being plugged in. “It was hard at first,” she said. “But then I got used to it and even kind of liked it. I started noticing the trees.”

We’re all running from pain. Some of us take pills. Some of us couch surf while binge-watching Netflix. Some of us read romance novels. We’ll do almost anything to distract ourselves from ourselves.

Yet all this trying to insulate ourselves from pain seems only to have made our pain worse. 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 generalised anxiety disorder, defined as excessive and uncontrollable worry that adversely affected their life. They found that richer countries had higher rates of anxiety than poor ones.

The authors wrote, “The disorder is significantly more prevalent and impairing in high-income countries than in low- or 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 the highest sociodemographic index (income), especially North America.

Physical pain too is increasing. Over the course of my career, I have seen more patients, including otherwise healthy young people, presenting with full body pain despite the absence of any identifiable disease or tissue injury. The numbers and types of unexplained physical pain syndromes have grown: fibromyalgia, myofascial pain syndrome, pelvic pain syndrome and so on.

The question is: why, in a time of unprecedented wealth, freedom, technological progress, and medical advancement, do we appear to be unhappier and in more pain than ever? The reason we’re all so miserable may be because we’re working so hard to avoid being miserable.

By better understanding the mechanisms that govern pain and pleasure, we can gain new insight into why and how too much pleasure leads to pain. The main functional cells of the brain are called neurons. They communicate with each other via electrical signals and neurotransmitters.

‘The rewards of finding and maintaining balance are neither immediate nor permanent’
Dr Anna Lembke

Dopamine isn’t the only neurotransmitter involved in reward processing, but most neuroscientists agree it’s among the most important.

Scientists rely on dopamine as a kind of universal currency for measuring the addictive potential of any experience. The more dopamine in the brain’s reward pathway, the more addictive the experience. In addition to the discovery of dopamine, one of the most remarkable neuroscientific findings in the past century is that the brain processes pleasure and pain in the same place. Further, pleasure and pain work like opposite sides of a balance.

When we experience pleasure, dopamine is released in our reward pathway and the balance tips to the side of pleasure. The more our balance tips, and the faster it tips, the more pleasure we feel.But here’s the important thing about the balance: it wants to remain level, in equilibrium. It does not want to be tipped for very long to one side or another.

So every time the balance tips toward pleasure, powerful self-regulating mechanisms kick into action to bring it level again. These self-regulating mechanisms do not require conscious thought or an act of will. They just happen, like a reflex.

Once the balance is level, it keeps going, tipping an equal and opposite amount to the side of pain.We’ve all experienced craving in the aftermath of pleasure. Whether it’s reaching for a second potato chip or clicking the link for another round of video games, it’s natural to want to recreate those good feelings or try not to let them fade away.

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The simple solution is to keep eating, or playing, or watching. But there’s a problem with that. With repeated exposure to the same pleasure stimulus, the initial deviation to the side of pleasure gets weaker and shorter and the after-response to the side of pain gets stronger and longer – and we need more of our drug of choice to get the same effect.

Here’s the good news. If we wait long enough, our brains (usually) readapt to the absence of the “drug” and we re-establish our baseline level balance. Once our balance is level, we are again able to take pleasure in everyday simple rewards.

We all desire a respite from the world – a break from the impossible standards we often set for ourselves and others. And there are many pleasurable forms of escape now available to us: trendy cocktails, the echo chamber of social media, binge-watching reality shows, internet porn, fast food, immersive video games . . . The list really is endless. But addictive behaviours add to our problems in the long run.

The rewards of finding and maintaining balance are neither immediate nor permanent. They require patience and maintenance. 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.

Maria, a patient of mine who battled alcohol addiction, said to me, “Recovery is like that scene in Harry Potter when Dumbledore walks down a darkened alley lighting lampposts along the way. Only when he gets to the end of the alley and stops to look back does he see the whole alley illuminated, the light of his progress.”


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