If you haven’t met your drug of choice yet, it’s coming soon to a website near you. — *location: 71* ^ref-20034 --- 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. — *location: 552* ^ref-13398 --- 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. — *location: 571* ^ref-62625 --- Dopamine may play a bigger role in the motivation to get a reward than the pleasure of the reward itself. Wanting more than liking. — *location: 589* ^ref-12518 --- The more dopamine a drug releases in the brain’s reward pathway (a brain circuit that links the ventral tegmental area, the nucleus accumbens, and the prefrontal cortex), and the faster it releases dopamine, the more addictive the drug. — *location: 593* ^ref-24558 --- The paradox is that hedonism, the pursuit of pleasure for its own sake, leads to anhedonia, which is the inability to enjoy pleasure of any kind. — *location: 665* ^ref-46832 --- Here’s the good news. If we wait long enough, our brains (usually) readapt to the absence of the drug and we reestablish our baseline homeostasis: a level balance. Once our balance is level, we are again able to take pleasure in everyday, simple rewards. Going for a walk. Watching the sun rise. Enjoying a meal with friends. — *location: 673* ^ref-54962 --- We’ve all experienced the letdown of unmet expectations. An expected reward that fails to materialize is worse than a reward that was never anticipated in the first place. — *location: 700* ^ref-1579 --- Gambling disorder highlights the subtle distinction between reward anticipation (dopamine release prior to reward) and reward response (dopamine release after or during reward). My patients with gambling addiction have told me that while playing, a part of them wants to lose. The more they lose, the stronger the urge to continue gambling, and the stronger the rush when they win—a phenomenon described as “loss chasing.” — *location: 713* ^ref-61492 --- Learning also increases dopamine firing in the brain. Female rats housed for three months in a diverse, novel, and stimulating environment show a proliferation of dopamine-rich synapses in the brain’s reward pathway compared to rats housed in standard laboratory cages. The brain changes that occur in response to a stimulating and novel environment are similar to those seen with high-dopamine (addictive) drugs. — *location: 735* ^ref-5979 --- Science teaches us that every pleasure exacts a price, and the pain that follows is longer lasting and more intense than the pleasure that gave rise to it. With prolonged and repeated exposure to pleasurable stimuli, our capacity to tolerate pain decreases, and our threshold for experiencing pleasure increases. — *location: 769* ^ref-30006 --- As Dr. Tom Finucane, who studies diabetes in the setting of chronic sedentary feeding, said, “We are cacti in the rain forest.” And like cacti adapted to an arid climate, we are drowning in dopamine. — *location: 779* ^ref-33684 --- If we consume too much pain, or in too potent a form, we run the risk of compulsive, destructive overconsumption. But if we consume just the right amount, “inhibiting great pain with little pain,” we discover the path to hormetic healing, and maybe even the occasional “fit of joy.” — *location: 1949* ^ref-36532 --- In the late 1960s, scientists conducted a series of experiments on dogs that, due to the experiments’ 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 pupils dilated, its eyes bulged, its hair stood on end, its ears lay back, its tail curled between its legs. Expulsive 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.” The dog’s heart rate increased to 150 beats per minute above resting baseline during the first shock. When the shock was over, the dog’s heart rate slowed to 30 beats below baseline for a full minute. Over subsequent electric 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 whined 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 tail, in what we called at the time ‘a fit of joy.’ ” With subsequent shocks, the dog’s heart rate rose only slightly above resting baseline, and then only for a few seconds. After the shock was over, the heart rate slowed massively to 60 beats per minute below resting baseline, double the first time. It took a full five minutes for the heart rate to return to resting baseline. 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.” An elevated heart rate, consistent with a fight-or-flight reaction, morphed into minimal heart rate elevation followed by prolonged bradycardia, a slowed heart rate seen in states of deep relaxation. It’s not possible to read this experiment without feeling pity for the animals subjected to this torture. Yet the so-called “fit of joy” suggests a tantalizing possibility: By pressing on the pain side of the balance, might we achieve a more enduring source of pleasure? — *location: 1639* ^ref-63462 --- You’ll remember that Odysseus asked his crew to tie him to the mast of his sailing ship to avoid the lure of the Sirens. But if you think about it, he could simply have put beeswax in his ears like he commanded the rest of his crew to do and saved himself a lot of grief. Odysseus wasn’t a glutton for punishment. The Sirens could be killed only if whoever heard them could live to tell the story afterward. Odysseus vanquished the Sirens by narrating his near-death voyage after the fact. The slaying was in the telling. — *location: 2019* ^ref-44367 --- 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 transgressions. In fact, the opposite happens. People 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. — *location: 2092* ^ref-21656 --- The way I understand this is by differentiating what I call the plenty versus the scarcity mindset. Truth-telling engenders a plenty mindset. Lying engenders a scarcity mindset. I’ll explain. When the people around us are reliable and tell us the truth, including keeping promises they’ve made to us, we feel more confident about the world and our own future in it. We feel we can rely not just on them but also on the world to be an orderly, predictable, safe kind of a place. Even in the midst of scarcity, we feel confident that things will turn out okay. This is a plenty mindset. When the people around us lie and don’t keep their promises, we feel less confident about the future. The world becomes a dangerous place that can’t be relied upon to be orderly, predictable, or safe. We go into competitive survival mode and favor short-term gains over long-term ones, independent of actual material wealth. This is a scarcity mindset. An experiment by the neuroscientist Warren Bickel and his colleagues looked at the impact on study participants’ tendency to delay gratification for a monetary reward after having read a narrative passage that projected a state of plenty versus a state of scarcity. The plenty narrative read like this: “At your job you have just been promoted. You will have the opportunity to move to a part of the country you always wanted to live in OR you may choose to stay where you are. Either way, the company gives you a large amount of money to cover moving expenses and tells you to keep what you don’t spend. You will be making 100 percent more than you previously were.” The scarcity narrative read like this: “You have just been fired from your job. You will now have to move in with a relative who lives in a part of the country you dislike, and you will have to spend all of your savings to move there. You do not qualify for unemployment, so you will not be making any income until you find another job.” The researchers found, not surprisingly, that participants who read the scarcity narrative were less willing to wait for a distant future payoff and more likely to want a reward now. Those who read the plenty narrative were more willing to wait for their reward. It makes intuitive sense that when resources are scarce, people are more invested in immediate gains, and are less confident that those rewards will still be forthcoming in some distant future. — *location: 2240* ^ref-27662 --- Lessons of the Balance 1. The relentless pursuit of pleasure (and avoidance of pain) leads to pain. 2. Recovery begins with abstinence. 3. Abstinence resets the brain’s reward pathway and with it our capacity to take joy in simpler pleasures. 4. Self-binding creates literal and metacognitive space between desire and consumption, a modern necessity in our dopamine-overloaded world. 5. Medications can restore homeostasis, but consider what we lose by medicating away our pain. 6. Pressing on the pain side resets our balance to the side of pleasure. 7. Beware of getting addicted to pain. 8. Radical honesty promotes awareness, enhances intimacy, and fosters a plenty mindset. 9. Prosocial shame affirms that we belong to the human tribe. 10. Instead of running away from the world, we can find escape by immersing ourselves in it. — *location: 2678* ^ref-13937 ---