The Paradox of Pleasure

20:15And that self-forgetting was clearly something that I needed and wanted. You know, I read the whole saga. I think it's like four books. And then I wanted to recreate that feeling again. So I read the whole saga again. Wow. Pleasurable, but not as pleasurable as the first time around. But by then I was completely tapped into this whole genre of vampire romance novels. And so I started to invest larger and larger amounts of time, energy and creativity into obtaining and reading vampire romance novels. You know, seemingly innocent to start with, but it became a bit of an obsession. And when I ran out of vampire romance novels, I moved on to werewolf romance novels.

21:02And then there was necromancers and soothsayers and all kinds of paranormal romance novels. Where were you procuring these books? So I live right next to a little library, which has a limited collection. So when I went through the limited collection at my local library, I either biked over to the main library, or you can order through the interlibrary loan. And, you know, some of these romance novels have very revealing covers. Like it was some bodice ripper with some hunk on the cover, you know, at the prow of a ship or something. Like, I wouldn't want to be seen reading that anywhere.

21:42Anna Lembke:So Anna came up with a way to hide what she was reading from her family and friends. I haven't revealed this to anybody. This is terrible. But I would actually put the book inside another book so that if one of my kids came by or my husband came by, I could look like I was reading the other book. Wow, like a medical journal or something. Except that might not really trick them because they would know that I wouldn't spend that much time reading a medical journal. I mean, I used to do this in eighth grade, Anna. I felt like the trick of the book inside the book was something I had perfected in eighth grade.

22:20I know, I know. And I discovered it in my 40s. What can I tell you? I was a late bloomer.

22:27Anna Lembke:So at one point, Ana, your love of this literature received a turbo charge when you moved from the printed page to the electronic domain. Tell me how that happened. Well, my friend Susan said, Ana, you should get a Kindle because then you don't have to, you know, be carrying these books around. Kindles had just come out then. And of course, that was very, I liked that idea because it would be easy access. But pretty soon, I also started regularly going on Amazon and looking for, you know, things that were similar to the Twilight Saga. And guess what? Amazon will suggest those to you, as we all know now.

23:07And so Amazon did the work for me. All I had to do was look in my feed and say, oh, they're telling me I should read this one. They're telling me I should read that one. And like later on in the process, I also discovered that you can get free books on Amazon. So anything that was free that was in the romance category, I would download and read. And that was really the beginning of the end for me. Because once I had that electronic reader, I essentially became a chain reader. Like as soon as I finished one book, I would either borrow from the local library or buy on Amazon another book. These were all romance novels.

23:43and I got to a point where whenever I wasn't doing something that I absolutely had to do, like for my work or my family, I was reading romance novels.

23:53Anna Lembke:Wow. And then it got to where like, that's all I wanted to do. And I didn't enjoy anything else. I didn't even really want to like be with my kids or my husband, right? I just wanted those times to rush through them so that I could go back to reading romance novels. The other thing that I only realized in retrospect was that these sort of tamer versions of romance where, you know, the sex scenes aren't super graphic, well, those stopped working for me. And now I needed ever more graphic types of romance novels in order to get that zing that I was looking for.

24:36Anna Lembke:so this was no longer about the pleasure of reading at this point or your love of language it had become something else oh it had absolutely become something else and of course it was rooted in the pleasure of reading and the pleasure that I've always gotten from fiction but what happened was I got to a point where I really didn't care if it was badly written or badly plotted or the characters were uninteresting, I would just flip through to the climax, pun intended. So then I got to where I was like reading really graphic erotica. And the more graphic, the better. The more sex scenes, the better.

25:12But it was all about getting to that moment and getting a certain very specific feeling.

25:20Anna Lembke:Yeah. And I became the possessor of the knowledge that if you take any romance novel and you open it up to two-thirds or three-quarters of the way through, you know, you'll get right to the point. Which is to say these romance novels are engineered. They're written according to a recipe. So at this point, you know, you're a respected researcher and psychiatrist at Stanford University. You have a great family. But no longer. Soon to be no longer. But that's what I want to ask you about. You know, you have, you know, what you are doing in some ways must have felt at odds with your public persona, the sense that you had that you were a mom, that you had a great family.

26:00Anna Lembke:Were you embarrassed by your newfound love of steamy literature? First of all, I didn't really see what was happening as it was happening. I would occasionally joke to friends, oh, I'm so addicted to vampire romance novels or romance novels in general. But just by being able to joke about it, I felt that that must mean I'm really not addicted to it or it's not really a problem. The other thing was that because of the technology in large part, I could do the behavior secretly. Once I got the Kindle, you know, I could be reading something on that Kindle that nobody else knew what I was reading. Whereas before, I wouldn't want to be seen reading that anywhere.

26:43That would just be really embarrassing. But on a Kindle, like it was anonymous.

26:49Anna Lembke:How did this affect your patient care? because presumably through all of this, you were still treating other patients and helping people with their addictions. Right. As it was happening, I didn't really see it happening and I didn't relate it as being similar to what my patients were going through. That I really only saw in retrospect, but I started to be less interested in my work. Like again, the work that had given me meaning and purpose and joy started to be dull and gray and boring and I found myself less engaged and more just wanting to rush through the work so that I could go home and read romance novels.

27:26Anna Lembke:So you weren't reading this at work? You reserved the reading at home? Well, there was one day, and this was sort of near the sort of culmination of this behavior. Time is weird for me then, but I think it developed over the course of about a year or two. But I did bring a romance novel to work and was reading in the 10 minutes between patients. So I don't want to play armchair psychiatrist, but it seems that you were using your immersion in these books as a kind of escape. What do you think you were escaping from? Well, that's what's so fascinating. I really didn't have anything to escape from.

28:09I have a great husband. I have got these great kids. I have work that I adore. My patients are just so fantastic. there was nothing wrong. I was really just escaping to. And the thing that I was escaping to was just not having to be in my body, not having to think, being able to experience this kind of intense euphoria, you know, this other place, which was very, very pleasant for me. It just felt good.

28:45Anna Lembke:the other thing I just want to flag here is that the pattern we've seen over and over again which is that something starts out being pleasurable so your friend tells you about this romance novel you read the twilight saga you find it fun you find it enjoyable and so you go back for more but somewhere along this process sort of the balance shifts and now you're no longer actually reading these things because they're giving you pleasure, it's that, you know, you're reading them almost to avoid pain. Does that sound right? That's really the key, that we start out doing whatever the behavior is for, you know, rational reasons, and it succeeds in achieving what we're trying to achieve, either to give us pleasure or to, you know, accomplish some other goal.

29:29But if it then hijacks our brain's reward pathway, it gets a life of its own. And then even when it stops doing what we want it to do, we can't stop. And that's really the hallmark of addiction.

29:48Anna Lembke:When we come back, the brain science behind an increasingly global malady. You're listening to Hidden Brain. I'm Shankar Vedantam.

29:59Thank you.

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32:42Anna Lembke:This is Hidden Brain. I'm Shankar Vedantam. Ana Lemke is a psychiatrist and researcher in the behavioral sciences at Stanford University. She's the author of Dopamine Nation, Finding Balance in the Age of Indulgence. Ana, many of your patients suffered from problems related to compulsive overconsumption, and you experienced some of this yourself, but you had a big advantage over your patients. You were a researcher and a scientist who studies the brain, and you knew about a very important discovery in neuroscience that has to do with the relationship between pain and pleasure inside the brain.

33:19Anna Lembke:What was this discovery? This discovery was the fact that pain and pleasure are co-located in the brain. So the same parts of the brain that process pleasure also process pain, and they work like opposite sides of a balance. So almost like a seesaw? Exactly, like a seesaw or a teeter-totter in a kid's playground. And when that teeter-totter or that beam on a central fulcrum is level with the ground, it's at rest. or what neuroscientists call homeostasis. And when we experience pleasure, it tips one way. And when we experience pain, it tips in the opposite direction. And there are certain rules governing this balance.

34:02And the first and most important rule is that the balance wants to remain level. That is, at homeostasis. And our brains will work very hard to restore a level balance after any deviation from neutrality.

34:17Anna Lembke:So when we reach for things that are pleasurable, when I bite into a delicious dessert, for example, I'm imagining that I'm essentially pressing down on the pleasure side of that seesaw. That's right. So when we do something that's pleasurable and we release dopamine, the reward pathway, and the balance tilts to the side of pleasure, no sooner has that happened than our brains will work very hard to restore a level balance. And they do that first by tilting an equal and opposite amount to the side of pain. before going back to the level position. And I like to imagine that as these little neuroadaptation gremlins hopping on the pain side of the balance, and that's the come down, the hangover, the after effect.

34:58And it often happens even while we're still experiencing the dopamine hit, and it often happens outside of conscious awareness.

35:06Anna Lembke:So if I have this image here about pressing down on one side of the seesaw and these gremlins are jumping on the other side, why is it they wanna press down on the side of pain? Why not just try and get to equilibrium? Why press down so much that it tips over in the other direction? That's a great question. And I don't exactly know why the mechanism is built like that, why we pay a price for every pleasure. But I suspect it has to do with the fact that that kind of mechanism makes us the ultimate seekers, never satisfied with what we have, always looking for more. And if you think about it, we are evolved over millions of years of evolution to approach pleasure and avoid pain.

35:50And then on top of that, you have this pleasure-pain balance, whereby as soon as we get whatever reward we're looking for, we experience pleasure, we immediately remember where and how that happened, and we want to recreate it. And that recreation is accelerated by the fact that as soon as we get that hit of dopamine, we essentially go into dopamine freefall. That's those gremlins on the pain side of the balance. And now we're in a dopamine deficit state and we feel this overwhelming motivation to do the work it takes to get the next reward, which, you know, for most of human existence has meant walking tens of kilometers every day, you know, has involved doing enormous work in order to get just a little bit of reward.

36:37So it's not that dopamine is good or bad. It's that dopamine is essential for survival, and it keeps us moving and always looking for the next thing.

36:46Anna Lembke:So dopamine is not involved only in feeling pleasure. Perhaps more importantly, it's also involved in motivation, which is, of course, what you're talking about just now. Can you explain that connection between dopamine as a messenger of pleasure, but also dopamine as the architect for motivation? Yeah. So there's a very famous experiment in which rats were bioengineered to not have dopamine receptors in the reward pathway of the brain. And what the scientists discovered was that if they put food into the rat's mouth, the rat would eat the food and seem to get pleasure from the food. But if they put the food even, you know, a single body length away, the rat would starve to death.

37:27In other words, we need dopamine not just for the experience of pleasure, but also for the motivation to do the work to go get the reward. And probably the way that dopamine makes us motivated is to create this dopamine deficit state or those gremlins on the pain side of the balance.

37:48Anna Lembke:So what happens when we transport this brain that evolved, you know, over millions of years into the modern environment where everything is now available at the touch of button? This ancient wiring that has us experiencing pain in the immediate aftermath of pleasure is woefully mismatched for our modern ecosystem. Why? Because we are surrounded by pleasure. We have more access to more reinforcing drugs and behaviors than at any point in human history. Even things that previously you could have thought of as healthy, like reading or exercise or playing games has become drugified, has been turned into a drug in some way, making us all more vulnerable to the problem of addiction and also making us more vulnerable to the problem of this dopamine deficit state whereby our brains try to compensate for this excess of pleasure by down-regulating our own dopamine production and transmission, not just a baseline but below baseline, creating this constant physiologic craving for more pleasure, but also the things that go along with craving, which are anxiety, irritability, and depression.

39:06Anna Lembke:So the mechanisms in our brain that compel us to, you know, approach pleasure and avoid pain, you say were evolved over millions of years for a world of scarcity, whereas today, because we're surrounded by so much stuff, we're sort of drinking from a fire hose of dopamine, as you put it. Yeah, this is the plenty paradox, right? It's the literal physiologic stress of overabundance.

39:35Anna Lembke:so walk me through the same seesaw analogy that we talked about earlier you know again a hundred thousand years ago you know i found a date tree and the date tree had delicious dates and it made my my brain very happy to eat some of those dates but there were not very many dates on that one tree i had to find the next tree and the next tree might have been as you say three miles away and so So it required a huge amount of effort to get to that next date tree. What's happening with that seesaw now in the world in which we live, where things are in fact available at the touch of a button? Yeah, well, let's go back for a second and talk about what's happening with the seesaw when you're looking for the date tree.

40:11Because what happens as you're scouring your environment to try to find one date tree with a couple of dates on it is that your pleasure-pain balance goes onto the pain side, right? Because you're hungry and you're walking. and you're tired. And then finally, you find this date tree, and you're ecstatic, and you eat this date, and your balance, your pleasure-pain balance goes back to the level position, which feels like euphoria, because part of the key here is the directionality of the pleasure-pain balance. So if I'm in pain because I'm hungry, and then I find something to eat, and it moves me in the direction of pleasure, that's as pleasurable as if I start out with a level balance, and I use an intoxicant and I get high.

40:59Anna Lembke:Interesting. And so now the same pain, pleasure, balance now, what happens now? Yeah. So now in the modern world, let's say, yeah, take Silicon Valley, because it's a prime example, but it's also true all over the world now. You go and you're hungry, right? And you're looking for a date tree. And all of a sudden, you know, you've got like a whole crate of dates shipped to you from Amazon right on your kitchen table. And by the way, they're giant, like they're like, like abnormally giant dates, right? So you eat a giant date from Amazon and you know, it releases dopamine in your reward pathway because they've also added sugar and salt and fat and flavorings.

41:40You know, it's like coffee dates or something, who knows? And you get the release of dopamine and wow, that feels great. Cause like, wow, who's ever had a date like that in the history of humans. And then, you know, as soon as it's over, your pleasure pain balance tips to the side of pain because those gremlins are trying to compensate for all that dopamine. And as soon as you're in that dopamine deficit state with the gremlins on the pain side of the balance, you want to restore a level balance. And what is the easiest way to do that? Well, you could wait until the gremlins hop off because if you wait long enough, they will hop off and homeostasis will be restored.

42:15Or you could eat another date. And if you eat another date, because there's a whole crate of dates right in front of you, that would work faster, right? And maybe you'll eat two this time because then that'll level your balance, but also get you over to the pleasure side. And pretty soon you've eaten the whole crate of dates. And now you're essentially at war with those neuroadaptation gremlins.

42:39Anna Lembke:And the more we then try and press down on the pleasure side of the seesaw, and the more the gremlins try and press down on the other side to achieve homeostasis, you make the case that over time, the gremlins start to push down on the opposite side of the seesaw, and then we end up depressed and anxious. Explain how this happens, Aina. Well, what happens as we continually bombard our reward pathway with highly reinforcing substances and behaviors is that we accumulate more and more gremlins on the pain side of the balance. They're just doing their job, you know, trying to restore homeostasis.

43:14And over time, you know, those gremlins essentially are camped out on the pain side of the balance, tents and barbecues in tow. And now we're in addicted brain. We've changed our hedonic or joy set point such that now we need more of our drug quantity-wise and more potent forms of our drug, not to get high, but just to level the balance and feel normal. And most importantly, when we're not using, we're walking around with a pleasure-pain balance tilted to the side of pain, which means we are experiencing the universal symptoms of withdrawal from any addictive substance, which are anxiety, irritability, insomnia, depression, and craving.

43:57Anna Lembke:I mean, you're an addiction psychiatrist, and you treat many patients who are dependent on drugs, so drugs in the conventional sense of a chemical that is swallowed or smoked or snorted or ingested. And obviously, that is a very big problem. But, you know, you're making a much more radical claim here. You're saying that our problem with addiction is not just limited to nicotine and cocaine and heroin. You're absolutely right. What I'm saying is that science, technology, and innovation has allowed us to drugify almost every human behavior. If you're not addicted yet, it's coming soon to a website near you.

44:33And my bigger claim is that the rising rates of depression, anxiety, and suicide, which by the way are rising fastest in the richest nations in the world, are due in part to the fact that we are overloading our brain's reward pathway with too much dopamine. And that in our brain's effort to compensate for too much pleasure, we are essentially individually and collectively down-regulating our own dopamine production and transmission, not just to baseline levels, but actually below baseline levels. So we are in a dopamine deficit state.

45:15which means that we're all unhappier, more anxious, more depressed, more irritable, less able to take joy in the things that used to give us joy or that have given people joy for generations, and also more susceptible to pain, right? Even the merest slight now can make us pain. And that we're not, this isn't happening because somehow we're spoiled or our values have changed is because we've literally physiologically changed our brains as a result of constantly bombarding them with these high reward substances and behaviors.

45:57Anna Lembke:So in some ways, this feels really mind-bending to me, Ana, because I can see how nicotine and alcohol and marijuana or heroin or cocaine, I can see how these could be addictive. But many of the things you're talking about, you know, food or social connection or sexual intimacy, these are not things that are inherently problems. In fact, many of them are part of what it means to be human. Talk about how our modern societies have taken these normal, healthy things and, in effect, as you would put it, drugify them. So the way that our modern society has drugified these things that used to be normal and healthy, like having sex or eating food or playing games, is essentially by increasing four factors, quantity, access, potency, and novelty.

46:47Because our incredible manufacturing system has allowed us to make these reinforcing substances in enormous quantities, and our amazing supply chain allows us to ship them all over the world. One of my favorite sort of anecdotes is that in the 1880s, the cigarette rolling machine was invented, allowing manufacturers of cigarettes to go from manufacturing four cigarettes a minute to 20 ,000 cigarettes a minute. And that's just one example of what we've done all around. And my own romance novel reading addiction that developed. And one of the things that I discovered when I went looking for other romance novels is that there's a whole universe of romance novels out there.

47:35There was no, it was really a never ending quantity and quantity really matters because the more we use our drug of choice, our substance or behavior that's reinforcing, the more of it we expose our brains to and the more often, the more likely we are to change our brains to this addicted kind of circuitry.

47:57Anna Lembke:So quantity is the first driver. What are the others? Yeah, so quantity is the first one. Availability or access is huge. So if you grow up in a neighborhood where drugs are sold on the street corner, we have lots of epidemiologic data showing that you're more likely to try drugs and more likely to get addicted to them. And now we live in a world where we all have more access to our substance or behavior of choice, whether it's vampire romance novels or potato chips or games or pornography or old-fashioned drugs like alcohol, cannabis, and nicotine. And of course, the smartphone is essentially the equivalent of the hypodermic syringe delivering digital dopamine 24-7 for our wired generation.

48:43And that's really what it is. The smartphone totally changed things. When people could carry in their pocket this device that gave them access to digital media and digital content 24-7, we all essentially became more addicted to these kinds of digital drugs.

49:07Anna Lembke:All right, so we've talked about quantity and we've talked about accessibility. What's next? Yeah, availability, accessibility. And the other one is potency. So one of the ways to overcome these gremlins on the pain side of the balance, or what's often referred to as tolerance, is to either use more of the drug or use more potent forms or have a more potent drug delivery mechanism. So for example, with opioids, someone might start out using opium, but eventually go to heroin, which is about 10 times more potent, and then eventually progress to fentanyl, which is 50 to 100 times more potent. And this would allow them to temporarily win that battle with their gremlins and get the feeling that they're looking for.

49:54But another way to achieve potency is to combine two drugs to make yet a third more novel drug. And this is done all the time. For example, people combining opioids with things like benzodiazepines or now this new veterinary sedative, TRANQ, which people are sadly using. By combining two distinct drugs together, we get a new novel drug, which then changes it up for our brain receptors and allows us to overcome tolerance.

50:23Anna Lembke:And in the realm of non-illegal substances, you can also have combinations like French toast ice cream. Exactly. Or, you know, I very easily get hooked on YouTube videos, especially outtakes of American Idol. And when I think about why on earth is American Idol so entrancing for me, well, they've figured it out, right? They've taken music, which is already reinforcing for most people's brains, releases dopamine, feels good. And then they've combined that with gaming and they've turned it into a competition and thereby really made a very potent drug. Can you talk a moment about the factor that's known as novelty?

51:03Anna Lembke:This is true in drugs of abuse, but it's also true for many of the other things that, you know, previously we might not have thought as being problematic. Yeah. So dopamine is extremely sensitive to novelty, which is why, for example, people can get addicted to things like the news. That's the definition of news. It's new stuff coming your way. But what's become so toxic about the modern world is that, you know, in order to maintain customers and keep them coming back, you've got to take the thing that they liked before and then package it as slightly new or different or better. And the internet has absolutely mastered that, right?

51:38These AI algorithms learn us, figure out where we've spent time before, what we've liked before, and then proffer or suggest to us things that are similar but a little bit different. And that absolutely engages this treasure-seeking function where we keep going because we're hoping that the next hit will be something that's just a little bit better, but similar to what we had before.

52:01Anna Lembke:You know, I remember when I was in eighth grade, or maybe seventh grade, and teachers would tell me, you know, to avoid a local park, me and all of my classmates, because the rumor was that drugs were being bought and sold and used at this park. But, you know, if everything can be drugified, if addictions can be beamed and streamed and, you know, Wi-Fi'd into our living rooms and bedrooms, it becomes really now very hard to put a fence around it and say, avoid going to this park because the problem is no longer just with one park. That's the problem we're all facing as individuals, as parents, as schools.

52:37I mean, I don't know about you, but when I walk around and see the way that people are just glued to their phones, it just makes me really sad. And yet I totally get it. I mean, these things are, They're literally mesmerizing. We are put in a trance by these devices. They're highly reinforcing for our very fragile little human brains.

53:05Anna Lembke:When we combine the ancient pleasure-pain seesaw in the brain with a modern world that is ready to push hard and often on the pleasure side of the balance, we get trouble. We end up with compulsive overconsumption and all the associated problems it causes for people's health, well-being, and relationships. We also end up with a plague of depression and anxiety. In the second part of the story, coming up in the next episode, how to reset our relationship with a world of plenty and turn unhappiness into thriving. Anna Lemke, thank you so much for joining me today on Hidden Ray. Oh, you're very welcome.

53:49Anna Lembke:Hidden Brain is produced by Hidden Brain Media. Our audio production team includes Annie Murphy-Paul, Kristen Wong, Laura Querell, Ryan Katz, Autumn Barnes, Andrew Chadwick, and Nick Woodbury. Tara Boyle is our executive producer. I'm Hidden Brain's executive editor.

54:16Anna Lembke:Before we go today, we want to say thank you to Loom by Atlassian for sponsoring the Hidden Brain 2025 Perceptions Tour. With Loom, teams move work forward faster, replacing endless meetings and slow approvals with quick, clear video messages. Today, we'll hear from Dr. Molly Sands, head of the Teamwork Lab at Atlassian, about how Loom is transforming the way teams work. I'm Dr. Molly Sands, and I lead the Teamwork Lab at Atlassian, which is our future of work research and innovation group. If I could wave the magic wand and change something about teamwork, I would stop teams from using meetings for every single thing.

54:56I wish teams would embrace asynchronous communication, so sharing updates or feedback in ways that don't require everyone to drop what they're doing at the same time. Loom is a video messaging platform that lets you quickly record and share updates, walkthroughs, or feedback without scheduling another meeting. The magic of Loom is that it feels really personal, like someone tapping you on the shoulder, but it's actually asynchronous. Loom makes it very easy for teams to share and get the information they need in less time. And the more that teams use Loom to communicate and to capture conversations, the smarter their AI-enabled knowledge bases get.

55:40It lets people design their day around their energy and around their priorities instead of being trapped by their meeting schedule.

55:52Anna Lembke:Loom is AI-powered video communication that moves teams forward. Whether you're sharing feedback, obtaining approvals, or setting context, Loom makes it easy for teams to share and collaborate on work. Save time and stay focused on what matters without another meaning. Try Loom today at loom.com. That's L-O-O-M dot com. I'm Shankar Vedantam. See you soon.

56:29Anna Lembke:Support for Hidden Brain comes from Claritin D. Our daily rhythms are delicate. When allergies interrupt them, everything from mood to momentum can shift. Suddenly, you're rescheduling plans, your whole day derailed. Claritin D can help you take back control. Claritin D provides fast, powerful relief of your worst symptoms, including nasal congestion, and starts working in as little as 30 minutes. When allergies get in your way, try Claritin D. Claritin clears. Use as directed. Hey guys, it's David And I'm Jason This is the Views Podcast Yeah, and this is our podcast And we talk about What do we talk about on here?

57:09We talk about scientific things Yes We talk about friendship We talk about sex We talk about rock and roll We talk about living in LA Being an influencer Not being an influencer Jason trying to be an actor Yeah Trying to figure out how to live life And everything we say is mostly wrong Pretty much Yeah, so don't take anything Don't take anything seriously and just enjoy the ride. Sorry there's noise in the background. Our friend is f***ing filming a video. Listen to views wherever you get your podcasts. Your phone is your lifeline. Calling your kid to say goodnight, waiting on a job callback, or just sending a meme to your best friend when it's been that kind of day.

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