Have you ever said, “I’d love to stop scrolling/ drinking/ shopping/ gambling, but…?” That’s the power of dopamine. Dr. Anna Lembke is one of our most brilliant science communicators. She’s the New York Times bestselling author of Dopamine Nation, the program director for the Stanford Addiction Medicine Fellowship, and the chief of the Stanford Addiction Medical Dual Diagnosis Clinic. Simply, if there is ONE VOICE you should listen to on why the relentless pursuit of pleasure leads to pain, it’s Anna Lembke. In this episode she helps us understand massive topics like self-binding and see that escaping the vicious cycle of compulsive behaviors is so much more than abstinence or will power. This is a hopeful and encouraging episode and one to share with everyone you know who’s said, “I’d love to stop scrolling, but…” Dr. Anna Lembke: https://www.annalembke.com/ Further reading: https://www.annalembke.com/selected-publications Dopamine Nation Book: https://www.amazon.com/Dopamine-Nation-Finding-Balance-Indulgence/dp/152474672X/ Tell Me Something True is a 100% independent podcast. There are no corporations or advertisers backing this community. We are 100% funded by the TMST community. Support TMST, hear uncut interviews, and keep it ad-free: https://tmst.supercast.com/ Join our free online community (it’s not a Facebook group!): https://www.tmstpod.com/
Tell Me Something True with Laura McKowen
Anna Lembke on Our Dopamine Nation
[00:00:00] Laura McKowen: Hello, thank you for agreeing to be here, especially on short notice.
[00:00:04] Anna Lembke: Yeah. I'm happy to do it. Thanks for inviting me. [00:00:07]
Laura McKowen: So how are you doing with publishing week? It's a big, it's a big energy.
[00:00:13] Anna Lembke: Yeah. I mean, you know, a lot of dopamine highs and lows going on as well. All I can tell you, I mean, I'm, I'm delighted that it's been so well received.
[00:00:25] Laura McKowen: I'm just going to dive in. So in chapter five, it's called Space Time. And you talk about this concept of self binding and you use this example of, I think it's Jacob as a sex addict. And this is one of those moments where I went, oh my God, I didn't realize what I was doing. And I even wrote a whole chapter about it in my own book.
[00:00:50] So I'm going to ask you to explain what self binding is in a minute, but I think it's so powerful because. To me, it distinguishes the difference between willpower and like proactive choice. And I don't know if you would use different words. I tried to get sober for a year and a half, uh, and I really try to kind of keep my life the same and get sober in the background without everybody knowing.
[00:01:19] And I had a really big job and all kinds of things. I'm sure you've heard it a million times. It wasn't until I realized that I really had to change my life like that change your life is, is, is something you hear, but it's hard to, to really know what that means because a lot of people can't get out of their lives.
[00:01:40] You can go to rehab maybe, but a lot of people don't. Even then you have to come back into your life and you have relationships and a job perhaps, and physically where you live, you can't change all of that. So this describes to me what it actually means to change your life. The chapter in my book is called stop getting on the train and it was a literal example of how I got on a train.
[00:02:07] And put myself in this situation where I would have to fight against all these forces, including willpower in order to not drink. And I didn't end up drinking. I took the train ride home because I had been trying to get sober for so long. I knew everything that could have happened if I did go out drinking and it's like having a near death experience, almost getting home and having that not happen, you know, I didn't crash my car.
[00:02:35] Stay home, stay out all night. I didn't wake up in some strange place. I didn't, the list goes on and on and on the horse that I had repeated so many times. So I said to myself, okay, I need to know exactly what happened this time versus every other time. And that's when I really dove deep into understanding the science of it.
[00:02:55] My chapter about stopped getting on the train was really about self binding, but I didn't know that concept. So, can you talk about that?
[00:03:02] Anna Lembke: Yeah. So, great. Well, thanks so much for sharing your own experiences. I always learn. So I appreciate that. One of the fundamental concepts in dopamine nation is that we live.
[00:03:16] In an addictogenic world. And what I hate is when my patients and not my patients, whoever, whoever people are, they're blaming themselves for not being able to abstain, but it's hard because this world is always luring us into using some form of high dopamine drug. It's nearly impossible. And as I say in the book, willpower is a finite resource and it lasts about a day if that, and when people are struggling, especially in early recovery with crazy.[00:04:00]
[00:04:00] It is nearly impossible to withstand intense craving. And it commands every ounce of energy that we have and people who have never experienced it, don't get it. And one of the ways I try to communicate it is have you ever had a really bad case? Poison Ivy, right? Where, where you couldn't not scratch it. I mean, if someone was holding a gun to your head, you still would probably have to scratch it.
[00:04:27] And so the whole idea was self binding is we have to change our environment before we're in the throes of desire. We have to build barriers, both literal and metacognitive between ourselves and our drug of choice so that when we are creating. There's a wall. There's a wall that would be very difficult to climb.
[00:04:48] Not impossible. It's never impossible. Uh, but, but it would be very difficult to climb and that's, that's essentially the essence of self binding. We do have to put those barriers in [00:05:00] place before we are craving, because willpower just is not enough.
[00:05:05] Laura McKowen: Yeah. And it's such a learning process because I mean, alcohol is one of those things that is just ubiquitous.
[00:05:12] It's everywhere. If you can avoid it, if you're an adult that goes out into the world. So
[00:05:18] Anna Lembke: yeah, I, I, you know, one of the most painful things that I see in, especially younger patients who are. Especially with alcohol is that their entire social network is composed of people who drink heavily. Some percentage of whom probably are addicted to alcohol.
[00:05:38] And so there's so much grief that comes with abstinence because you're not just grieving the loss of this drug, your best friend. You also have to say goodbye to a lot of those relationships because you just cannot maintain them and stay sober.
[00:05:51] Laura McKowen: So can you, can you give an example for, for people? Self binding might look like for someone who is trying to get sober from alcohol.
[00:06:06] In, you know, in a, in a world like we live in today.
[00:06:09] Anna Lembke: Yeah. Happy to. I mean, so basically in the book, I divide self binding into three categories, chronological, categorical, and spatial or geographic. Starting with the last one first geographic. And what that basically means is just putting physical distance between ourselves and our drug of choice.
[00:06:29] So if it's alcohol, something as simple as not having alcohol in the home, and a lot of my patients report doing that, or for example, if you're traveling, a lot of people, you know, are on the road for work. Calling the hotel in advance and asking them to clear out the minibar. So just little steps like that, um, to make sure that there's, it's just not around.
[00:06:50] And so it sort of takes it off the table. An example of chronological, uh, self finding or using time as the construct [00:07:00] is to mean for people who are abstaining. This is maybe not as relevant, but for people who are trying to moderate, it would be something like planning, um, only to drink on certain days of the week.
[00:07:10] Only for perhaps after completing a milestone event. So sort of just using time as a way to bind our usage. And then finally, categorical self binding is a way of trying to avoid. And again, this is for people who are moderating primarily, I'm not abstaining, but I've had many patients say that as long as they just drink wine or just.
[00:07:35] Beer and don't drink hard liquor. So they avoid that category of more potent alcohol. Then they're able to, um, abstain or to moderate their use. Um, I should say, yeah, they're able to,
[00:07:47] Laura McKowen: If only those things worked for me.
[00:07:50] Anna Lembke: I, yeah. Right. I know it's a slippery slope.
[00:07:53] Laura McKowen: Yeah. Yeah. I mean, I'm honestly, I joke, but I'm glad they didn't, for me, that was too exhausting to try to moderate.
[00:08:00] Well, it was impossible.
[00:08:02] Anna Lembke: Yeah. You know, and it opens up a really interesting but important aspect of this, which is, you know, the temptation to moderate for people with severe addiction is just never going to work out for some folks. But in my clinical experience, people have to kind of do it, do their own research on that.
[00:08:20] You know, I can support them, but you know, at the end of the day there, I usually see we'll have to go a couple of cycles around that, where they try to manage. You know, aren't able to abstain for a period, try to moderate, aren't able to do it. And then finally, you know, come to the conclusion that that moderation is not for them.
[00:08:39] But I do think that it is important to note that the literature is showing this too. There was just a paper that came out this month showing that there is a subset of people with alcohol use disorder who are able after a period of absence to go back to drinking in monitoring. So I, I, you know, again, it's, it's important to acknowledge that
[00:09:01] Laura McKowen: I'm so afraid that you just said...
[00:09:02] Anna Lembke: … I know, I'm sorry.
[00:09:05] Laura McKowen: No, it's okay. It's okay. I know what people will hear. You know, I know what I would have heard seven years ago.
[00:09:12] Anna Lembke: Yeah. I mean, it's a risk, you know, it's a risk and if you're in recovery and your life is good, like why would you gamble with it? Totally. And plus what I find with a lot of patients, even the ones who are successful in moderation, it's exhausting.
[00:09:26] Like in order to make it work, you have to put in a tremendous amount. Energy and effort into it. You have to use a ton of self binding. You have to be really hypervigilant. You have to document exactly what you're drinking. So it's like a major that becomes a major hobby. And ultimately for many, most people, it is not worth it.
[00:09:45] But the reason that I talk so much about moderation in my book is because there are drugs that we just can't abstain from, and that would include food. right. And then we have to moderate our food that would include smartphones. It's really, it has now literally become impossible to be a functioning professional and not use a smartphone.
[00:10:04] And yet the smartphone is such, such a vortex of, of dopamine and, uh, you know, potential addiction.
[00:10:13] Laura McKowen: Yeah. And I, I think for me now I'll be seven years sober this fall. I just think the price I would have had to pay or the costs, the energetic costs, the psychological costs, even the costs that I don't, I don't know about the unknown unknowns.
[00:10:31] Right, right. To try and moderate to think I would miss out on the things that have come in my life as a result of sobriety, just for what? So that I could have two drinks every Saturday. For what? Like w the, the payoff wouldn't be worth it for
[00:10:51] Anna Lembke: me. I want to comment on something you just said, which is the, the sort of rewards of abstinence.
[00:10:59] And [00:11:00] I think that, you know, we don't talk about that enough, like the kinds of really. Intangible, but very powerful, good things that come to us when we sacrifice something in our life. When we're willing to give something up, when we're willing to take the hard road, when you look at those incredible powerful gifts and you juxtapose them with, well, gee whiz, I can't drink wine on the weekends with friends.
[00:11:27] It sort of doesn't even compare. Right. It's just, it's like, who cares? Like, look at, look at what your abstinence. Brought into your life. It's just, I mean, when people can get to that place where they can see this amazing thing that they've made through sacrifice, um, it's, it's always a very powerful,
[00:11:50] Laura McKowen: I'm glad you said that.
[00:11:51] I totally agree. And this goes well into the next question that I had. There's another chapter [00:12:00] called, pressing on the pains. And you talk about the relationship between pleasure and pain and how they're processed in the same part of the brain, which I didn't know that even having, like I said, studied a decent amount.
[00:12:13] I didn't know that. And it made me think of this Rumi quote that I had printed out and framed before I got sober. When I was trying to get sober, that says the cure for the pain is in the pain. I've always been someone who makes sense of the world through words and poetry and prose and, and that type of.
[00:12:32] But there's in your book. It's like that is your book in a way there's like a strong part of your message that care for the pain is in the pain. I knew somehow that I had to go through a certain amount of pain, like both. The immediate, emotional, physical, psychological pain that comes with stopping drinking those early days.
[00:12:52] But then the longer-term pain was, was really what I knew, the pain that I had been pushing off for however long [00:13:00] things I hadn't processed or metabolize. Uh, can you talk about that from both from like the, the scientific side, as well as, as people go through early days of recovery, but also the deeper psychological.
[00:13:15] Of processing past trauma and grief and why that, why we have to do.
[00:13:21] Anna Lembke: Well, let's start with the basic neuroscience and this again, gets to the pleasure pain balance. When the first part of the book, I talk about how, if we repeatedly press on the pleasure side and flood our reward pathway, all our brain can do to compensate for that is to downregulate our own dopamine and our own dopamine receptors, which ultimately puts us in this dopamine deficit state, which is this dysphoria irritability, insomnia, anxiety, and mental preoccupation with our drug.
[00:13:52] And the first step toward resetting our balance is to abstain from our drug and that is a very painful step in and of itself. So that's already, you know, a prescription for pain and, and, you know, my patients will come see me with all manner of troubles, um, and they'll say help me. And I'll say here, here's my prescription for you.
[00:14:13] I want you to suffer first more so that you can feel better later. And it's really a hard pill to swallow because it's not a pill, right. It's, it's a thing that says stop taking the pill hurt more. Reset your brain. And so that's the very first painful step, you know, acute withdrawal of a come down, but then, then you've got the protracted withdrawal and you've, and that can be physiological, but really it's mainly psychological where now all of a sudden we have to experience all of those negative emotions that we were chasing away with our drug.
[00:14:49] Right. We have to sit there and let those thoughts and those emotions sort of wash over. And it it's hard. I mean, it is hard, especially when we've been used to going through life, you know, numbing ourselves or ignoring those feelings. And this is where I think really good psychotherapy can be helpful, but also meditation, prayer, uh, you know, a good friendship circle a, this is the place where we go, wow.
[00:15:16] You know, I used to drink when I felt this and now I just have to feel it and I have to kind of sort it out. One of the things that I really love about the 12 steps is that those 12 steps ask us to do that first hard thing, which is abstain, but then keep asking from us to do hard things. Probably the hardest of which is step four, where we didn't have to look at all the.
[00:15:42] That, you know, has quote unquote happened to us, you know, in our lives and then say, not like, oh, poor me, but what did I contribute to that problem? And that is fascinating to me because it's very different from standard modern psychotherapy where there's a whole lot of empathizing seeing the patient's point of view saying kind of poor you, that must've been horrible, your trauma.
[00:16:07] And I'm not saying that's all bad, but it's something. That is not enough. Right. You have to then say, okay, well, but what did, what did you bring to the table? And so, you know, again, another, another way that I ask patients to hurt and to suffer is to say, yeah, this is so horrible. All these things that happened to you, all this pain, you experienced the fact that you can't numb it anymore.
[00:16:29] If you're going to be in recovery. And then I say to them, but like, what, what's your part? And so again, inviting that pain, but that's the only way to get to the truth. And the truth is the way that we ultimately come to peace because the truth allows us to put the world in order to see it and ourselves as we really are.
[00:16:48] And then to be able to be free and make choices because we're making choices based on true and informed decisions. You know, when I was first shopping around this. [00:17:00] I thought to myself, nobody is going to want to publish this book because this book is. Right. Like, this is the last thing that people are gonna want to be told that yeah, you want to feel better, feel worse first, you need to hurt.
[00:17:16] And I've been really surprised that people are receptive to this message. Um, I think probably what it is is that in their own lives, people are beginning to come to this themselves. You know, this realization. Yes, that that it's falling on fertile ground and people are saying, yeah, you know what, uh, numbing doesn't work running away from our pain doesn't work, no matter how fast we run, it runs faster.
[00:17:40] And so I'm really delighted to see what I hope is the beginning of a kind of a paradigm shift in the way that we, we think about, you know, how to solve these problems. I think
[00:17:51] Laura McKowen: you're right, right in that people know that all. The pleasure seeking and escape buttons and all of that feel good, but they're not working.
[00:18:02] Like even if we don't cognitively know it, I think on a very soul, on a soul level, an intuitive level, we, we know. So I'm, I'm thrilled that it's being received well. Delivered in science has a way of neutralizing.
[00:18:16] Anna Lembke: Thanks. Yes. Yeah. It is interesting how a science makes things accessible and palatable and believable, even if it's really the same message, but in a kind of a different package.
[00:18:29] One of the things too, that I do quite a bit of in my work, which is contrary to how I was trained is I do a lot of thoughtful self-disclosure to let my patients know that yeah. I, I struggle too, that, you know, you can look at somebody and think they have it all together. And they may even have all of the wonderful things that, you know, people hope for in life and still be unhappy that, you know, is just sort of part of being alive, that, that being alive hurts and that we all have fears and doubts and we all struggle.
[00:19:03] And, and what I've discovered is that when we realize that and we stopped trying to. Pretend like that's not the case. And when we share our struggles, then, then we use our suffering because there's that sense of shared humanity in that we're not in it alone.
[00:19:19] Laura McKowen: I want to go back briefly to the point about the fourth step in AA.
[00:19:24] I relied on AA, a tremendous amount in early recovery, and then, and then found myself distancing going away from it. And I, I think the 12 steps are incredible. They're there to. Ancient spiritual wisdom and beautiful. And I am writing another book right now. So I'm just kind of using it to see what you think about this.
[00:19:50] Yeah. So they're not necessarily steps, but they sort of are in the first one is it's not your fault. And then the second one is it's, it is your responsibility. And, and I think that while what my understanding of it is that. Blame at some point or maybe altogether is feudal. So blaming our past our parents, friends, this person, or that person, or blaming ourselves does nothing.
[00:20:25] It's a dead end, but responsibility is entirely different. And I did not want to hear that I was responsible for my experience. Really pissed me off, but after it pissed me off, I realized it's actually the best news because I can't control the circumstances of my life necessarily or what happens, but I can control how I react to them, which is my experience.
[00:20:55] Right. And so that, that's how I take that. And I, I don't know how they got that right in 1935 with that force step. I think that was the intent. I don't know anybody who gets better without that step of let's call it radical responsibility.
[00:21:19] Anna Lembke: Yeah, I know. I love that responsibility without blame. That's a really nice way to frame.
[00:21:25] And I certainly see that in my work, when patients come in and they're blaming everybody else for where they are in their lives. I know that those patients are ill and not in recovery and the patients who themselves, right. Like, yeah.
[00:21:42] Laura McKowen: I'm the worst piece of shit in the universe
[00:21:45] Anna Lembke: . Yeah, that's right. That's a trap too.
[00:21:50] But it's really fast. It's been fascinating for me when patients slowly change that narrative to be able to identify their own character flaws and [00:22:00] what they have contributed to the problem there, it's amazing how that opens up then their lives into this place of wellness and recovery. That is just really powerful.
[00:22:12] And so I'm very convinced that the way that we narrate our lives is essential to healing and that there, there are healing narratives and narratives that are not healing.
[00:22:25] Laura McKowen: Don't you think then that, that sort of process of pulling apart our stories? Our narratives, because I, I think I know one of the reasons I was so attracted to writing, I mean, All of that energy that I was using to drink, I poured into writing and it really, it did many things for me.
[00:22:49] But when I say in this hyperbolic way that it saved my life, but it really, it really believe it did. One of the reasons is, is it helps me really straighten out my story. And I think that's what happens. I think in meetings, that's what happens in, you know, one-on-one conversations with other people who have gone through the same thing.
[00:23:13] Right? You get a broader context for your story. There's a pull of quote of the, how's it called a course in miracles, which I don't even, I don't follow too much, but there's this one line that I never forgot where it's a, a miracle is just a shift in perception. When you can get the, the right shift of perception, it can feel like a miracle in your life. It can change everything.
[00:23:37] Anna Lembke: Oh, absolutely. Yeah. That we really only exist in juxtaposition with each other. And the way that we define ourselves is a slow process. Essentially creating, imagining and narrating ourselves through these micro interactions with others, without these interactions, there would be no narrative.
[00:23:59] And so you're absolutely right. It's the slow process of telling our stories and telling a story that is approximate. It's the truth as closely as possible, which allows us to feel real in our bodies, you know, to be tethered to ourselves in a way that feels authentic and real, and also allows us to just make sense of our lives, to figure out true cause and effect and, and figuring out true cause and effect is also then fundamental to making good choices going forward, because unless we really know why.
[00:24:32] The thing has happened. We won't be able to have informed decisions the next time around. So, so this is all really important and powerful. And I just would add that. I think it's something that culturally is not encouraged. I think we have few opportunities in modern culture to get real feedback about ourselves.
[00:24:52] So for example, academia is rampant with recommendation letters that are not. Um, you know, that people right, that are praiseworthy because they feel they have to, because they're afraid of getting sued. If they don't, we have classrooms now where it's really not possible to give people real feedback about their performance, because.
[00:25:15] Well, because perhaps, you know, we are triggering them or we're, we're harming them or we're discriminating against them. You know, we're all, we're all walking on, on eggshells. And as a result, we've really deprived ourselves of an opportunity to learn about. And we've also not developed the mental callouses that we need to tolerate that kind of critical feedback, but that kind of critical feedback, you know, when it's well-intentioned and empathic and true is, is really hard to come by.
[00:25:46] And that's why I think a good therapist can be very valuable. So a good therapist will empathize, but at some point they will generally gently introduce, you know, a contradictory interpretation of reality. And that may be the only place that, that person's getting that information, right. I mean, it's really, really valuable.
[00:26:05] I think families can be a place where this happens. I talk about that a little bit. In my book, I have a chapter on truth telling and how, how important it is to give truthful feedback to our children and not try to protect them from some kind of psychological harm by telling them things that are not true about them.
[00:26:22] So what would be an example? An example would be that it is really important as parents that we point out to our kids, their character defects and the ways in which those character defects make them difficult to live with, to interact with, and will probably interfere with their relationships going forward.
[00:26:39] And then we help them learn about their character defects and learn to ameliorate and cope with them, as opposed to what often happens now is, you know, we're all trying to be our kids. And we're, you know, we don't want them to be psychologically scarred, so we never tell them anything negative. I mean, this is just, it's gone too far, you know, what was originally a well-intentioned desire to, you know, raise mentally well, children has really veered off course. So, so these kids are not getting real feedback. And then what happens is they go out into the world and they get like their first bit of real feedback and they collapse.
[00:27:15] Laura McKowen: Yes, I have a twelve-year-old. Just eating this up right now.
[00:27:18] Anna Lembke: Yeah. Well, I mean, so for example, from my own, you know, my own children, um, you know, our, our youngest son, he is a natural contrary. And from the earliest ages, fun for you. Yeah. Right when we said, when we said yes, he said, no, you know what I mean? And so very early on, you know, we just sat down with him and said, you know, you have this tendency, it's like a quirk, you know, in your mental network, You want to do the opposite of whatever anyone tells you to do.
[00:27:47] And we said to him, you know, in some situations that's going to be awesome. Like if you were growing up in Hitler, Germany, and everybody was joining the Nazi youth, and then you didn't join, you would be. But in most, in most situations in life, that's going to get you into trouble. So we just want you to be aware of it and to think about it.
[00:28:05] And when you're doing it in a way that we think is, you know, not helpful for the family or for you, we're going to point it out and you know what, he totally got it really. Totally. He totally got it. He was probably maybe eight or nine years old. He totally got, so when we named it for him, he was like, oh yeah, you're right.
[00:28:23] I do do that. You know, so the naming of the thing, oh, he's now 14 and you know what he's doing? Great. I mean, he's a little Asperger's so, you know, he's got some other challenges as well, but he's doing really, really great. Yeah. I mean,
[00:28:37] Laura McKowen: God, I could go so many places with this and ultimately this is leading into social media discussion, which this plays a huge part, I think, because we're always performing on there.
[00:28:47] You said that ultimately we want to aspire to. Tell the truth about ourselves and really uncover it and learn it by exchanging with other [00:29:00] people the truth, as best as we understand it in that moment. And that has been for me, like the act of recovery and continues to be this explains everything that I have felt about truth, which, that you say it's telling the truth serves as the dopamine regulation mechanism?
[00:29:22] Anna Lembke: Absolutely. Yeah, so probably my favorite chapter in the book is the chapter called radical honesty, where I really try to dissect what it is about. Telling the truth about everything, not, not just the big things, but also the small things.
[00:29:38] That's so important for recovery and a life well lived. It's a theme I've seen again and again. And you know, there are many different ways that truth-telling is central to recovery and it works through a number of different mechanisms, which identify one of, one of them is that it promotes intimacy. So when we tell people the truth about the ways in which we're broken. People are drawn to us. We think they'd be repelled, but they're not. It's the opposite. They're no, they're drawn to us telling you attractive. Right. As long as it's authentic honesty, right. In this sort of manipulative honesty,
[00:30:12] Laura McKowen: right. I had this, I had a good guy friend in early recovery who I later ended up dating and you know, that didn't.
[00:30:19] He joked that I was like, why do people, why do you like AA meetings? Cause he was the most enthusiastic person about AA that I'd ever seen. He, you would have never thought that he was sitting in an AA meeting. He was, it was like, I don't even know, like watching his favorite movie eating cake or something, he was so happy. Just biggest shit eating, grin on his face. And he's like, because honesty is so sexy.
[00:30:48] Anna Lembke: Ah, interesting.
[00:30:52] Laura McKowen: I was like, oh my God, you're kind of way. And, you know, we were younger and in Boston and there's all these attractive people in meetings, and they're all figuring this stuff out and everyone's senses are heightened and all that, but it was, I really did remember that because he got me to see it that way too.
[00:31:10] He was one of the first people that I practice telling the truth with.
[00:31:14] Anna Lembke: Nice. Yeah. Yeah. And I love the way you use the word practice because it does require practice because our natural default is to lie. And that's just not, that's not just people, you know, struggling with addiction. That's all of us, right.
[00:31:25] Where we're all kind of natural liars. And it's usually little things, you know, little supposedly inconsequential things I have because of my patients. I have changed my entire orientation on lying. I now try every day I get up, I try really hard. To tell the truth about everything. If I can. And I slip all the time all the time, but at least I notice it when I do and I go, oh, wow, that's really weird.
[00:31:52] Why did I say that? Like that, which was really close to the truth. It was like 99.99, nine, 9%. But it wasn't a hundred percent.
[00:32:00] Laura McKowen: No. And you can feel that once you start to do this in your life, I know I can't tolerate, I literally can't talk. Dishonesty within myself, I'll get really sick. And these are things you hear, but you don't really know why, but this what, that's, what I loved about what you S what you explain is that.
[00:32:20] There's science behind it.
[00:32:23] Anna Lembke: It's fascinating. Right? And some of the science, so one of the things that we think happens when people are in the throes of addiction is that the neural networks and the prefrontal cortex, which is our part of our brain involved in decision-making planning, storytelling, delayed gratification, and which is, has very important communicate of neural networks with our emotion brain.
[00:32:45] Brain our reward brain that essentially those two parts of the brain stop talking to each other. And you kind of have this prefrontal cortex that's telling stories and, you know, making decisions that's not connected to what's going on in the reward pathways or the emotion pathways. And that part of what happens in recovery is that we reconnect those two regions of the brain.
[00:33:08] And there are even now. You know, interventions specifically designed like transcranial magnetic stimulation that, that people are now using to treat addiction that essentially stimulates the prefrontal cortex in hopes of it making connections with the reward pathway. So it's, it's really, you know, really fascinating to look at some of those potential targeted interventions that will strengthen the areas of the brain that needs more strengthening in addiction.
[00:33:34] Like the prefrontal cortex and calming down those. That need calming like the limbic brain or the reward pathway and what I postulate in the book, which I believe to be true. Is that telling the truth? So the, the project of intentional engagement with radical truth telling actually. Strengthens the prefrontal cortex and strengthens these connections between the prefrontal cortex and our limbic emotion reward brain, our primitive lizard brain.
[00:34:05] And so that telling the truth is actually a healing process that, that there's real neurological changes that occur. Um, as a result of, of that practice to be here. And it's also hard and challenging, which is good because we need challenges. You know, we need good challenges. It's like, I'll wake up. And I'm like, okay, let's see if I can get through the whole day without telling a single.
[00:34:26] Okay. You know, that's that kind of fun. It kind of a fun project, right? It's also
[00:34:30] Laura McKowen: a, yeah. That's a very courageous one any day that someone does that, you know?
[00:34:34] Anna Lembke: Yeah. Yeah. Because you, you almost need like the lion meter that like has to go off. Right. Because like, otherwise you just slip into it. It's like, you know what I was saying the other day, who said, oh yeah.
[00:34:44] You know, like just typical. It would be like, oh yeah, sorry. I'm late for this meeting. The traffic was terrible. Traffic. Wasn't terrible. You know, I wanted five more minutes to read, to read the paper and drink my coffee. But, you know, I just said it's so much easier to say traffic was terrible.
[00:34:58] Laura McKowen: If we're [00:35:00] continuing this thread about truth, you mentioned it's a pretty brief part in the, the one conversation I've heard with you with, which is with Dr.Hubermann, um, about social media and that you don't do it. And that cause you just need. Would be addicted to it. Right. So I recently stepped away from it after having a conflicted relationship with, with it. For years, I started to realize the parallels with my drinking and social media and like literally the, you know, bargaining about it, making arbitrary rules, trying to set up these systems and controls to regulate it, the extreme high.
[00:35:40] And the extreme lows and this feeling that I needed it to connect. You know, I had all these stories about drinking that I needed it for my business life because I worked in advertising and everybody drank and I needed it. Like, how was I going to have relationships or date or have sex? [00:36:00] Like you said earlier, it's not that that alcohol doesn't do anything for, for people.
[00:36:06] It certainly does. And it's not that social media. I mean, social media did a lot for me. Right. But I recently stepped back from it and I just can't stop thinking about what exactly it is. And there's many things. But what exactly it is that it was doing to me and likely doing to others. And I've, I've spent a lot of time to try to pull it apart.
[00:36:31] So one of the things that occurred to me as I have heard you talk is this part about truth. And I don't know if this is too much of a stretch, but this was my middle of the night brainstorm.
[00:36:49] Like tying the effects of lying and what that, if it disregulates the dopamine system, aside from the fact that, you know, that being on social media itself is like dopamine, you know, [00:37:00] it's like a dopamine, what would you call it?
[00:37:05] Laura McKowen: at least it's like a, it's like, um, you know, the, the big gulp that this part of about lying and telling the truth, that that is a major player in, in.
[00:37:17] Dopamine system as it relates to social media, because I don't, I wouldn't go on there and outright lie mostly like on, on Instagram, but I definitely, and I don't think anybody presents us totally honest because we know we have an audience and we know that just like you were saying in academia, there's all these arbitrary things.
[00:37:41] The motives aren't aligned and the rewards aren't aligned appropriately so that we are motivated to tell the real truth. And then there is the, the fact that I have absolutely lied in the sense that if I know a certain comment or a post is going to align me with certain people, potentially millions of people, because we know that we know that that's how big it is.
[00:38:11] I have said things that aren't really true for me because I, I want to be in with certain people or I know, you know, a specific person might be watching or, and, or I want to distance myself from other people. So in there's this cumulative dishonesty.
[00:38:28] Do you think. True or am I stretching this way too far?
[00:38:33] Anna Lembke: No, I mean, I absolutely agree with you. And I, I write about that, you know, in the chapter on radical honesty, it's not just that lying is morally wrong. And I do believe that there that the natural order of the universe extends to a moral law that we should abide by. But it's also that lying is in fact, emotionally dysregulating in that
[00:39:00] Then are engaged in the creation of this false self. And the false self is a concept that psychoanalysts Donald Winnicott coined in the last century to describe the effort that we put into. Projecting a certain image of ourselves, which is not consistent with who we really are. And as I write in the book that that's very dangerous because once we're curating this false image of ourselves online, or otherwise, we become alienated from ourselves and we start to not feel real in the world and not tethered to our existence.
[00:39:35] And that generates enormous amounts of anxiety and dysphoria and as a it's a really dangerous place to be. And that an essential part. Maintaining, you know, a healthy mental state is in fact being grounded in our true selves, not lying and being honest about, you know, ourselves, even when there will be consequences.
[00:39:57] And of course that, that is the key there. The, one of the main reasons that we lie, especially. Social self-aggrandizing lies is because we want people to like us and we want people to join with us and we want praise. And when sometimes telling the truth will in the short term threaten that. But I do believe that in the long-term it is, it is still better to tell the truth because suffering those short-term consequences is an opportunity to reevaluate and to grow, and also, you know, to potentially affiliate with other people who do agree with us, um, as opposed to, you know, a sort of a false group of friends. But I do want to validate those still. First of all, I appreciate your really appreciate your, your honesty about that experience.
[00:40:48] And, you know, you're definitely not alone. I mean, the pressure to. Not say, you know what? We really believe in certain contexts because we were, we, we fear being shunned or excluded. It's just super, super powerful because you know, we all, we're we're social beings. Like we want to belong to the tribe and the thought of the tribe abandoning us and leaving us behind is just, I mean, truly terrifying.
[00:41:12] Yeah. But survival levels, right? I mean, you get that's right. You get down to real primitive brain stuff. But I still think it's worth it. I try really, really hard for example, in these interviews to not lie now know that sometimes. And I think I mostly succeed. I don't always tell the full extent of a story.
[00:41:33] You know, I might withhold some information, but I try really hard to never say something that I don't really believe. And it does mean that. I have detractors or that I ha I mean, I get some hate mail or I get criticized or, you know, and that's, people's right to do that. And I, I appreciate criticism as long as it's not done in a, in an unkind way.
[00:41:59] Laura McKowen: [00:42:00] Yeah. Which, which it's beaks too, because you yourself have decided not to be on social media. There's a difference between getting feedback, like you're talking about, like, with your. The necessity of provide of having places where we can get honest feedback about who we are and, and things that may or may not be working.
[00:42:23] But when you have these false selves interacting with these false selves, yeah. Online, it's like this for me, the circle of concern was totally unmanageable. It's not just the five people in my life that I care about the most. Millions of people potentially could say things that even if I know they're not true, right.
[00:42:47] My body could not tolerate. Right. The potential of all of it. It was like, I had this overwhelming sense of anxiety that [00:43:00] something bad was going to happen,
[00:43:01] Anna Lembke: like a pending doom. Right?
[00:43:03] Laura McKowen: Yeah. Like if I have this and I, I don't even post things. I mean, really. Controversial, I guess some people would say I post things about sobriety and recovery.
[00:43:15] That would that folks in AA, maybe for example, found controversial, but anything can be controversial now, you know, we're addicted to this, this outrage. And so to me that feels like the most bait. It's like this, these, um, holograms of each other interacting. Yeah. Like what does that do to.
[00:43:36] Anna Lembke: We're all so human, right?
[00:43:38] I mean, we're all vulnerable to these things and we all make mistakes. And I just think, you know, you're, you're acknowledging that, that this community that's built online with, with millions of people, it can lift your way, way high. And in the next heartbeat, it can drop you and leave you bleeding. I mean, I think I've become really impressed, the older I get, at how fundamental trust is to meaningful relationships. If we don't have trust, we don't have anything. And I, and trust is so important because trust allows us to give and receive real critical feedback without the fear of abandoned. Right. And that is really, really important, you know, and I, and my last chapter is about shame and, and the pro social aspects of shame.
[00:44:31] Uh, and that really the difference between pro social shame and, um, sort of destructive malignant shame is not so much our subjective experience, but how others respond to our transgressions. And when people acknowledge that we've done something wrong, but don't shun us, then you build trust and then you create a pathway for overcoming shame.
[00:44:55] Whereas if people just, you know, kick you to the curb, then you just want to go drink [00:45:00] again. And that online community is just probably not a safe space is the bottom line. It's just not a safe space. I also think here that, you know, ultimately, um, as wonderful as people can be, you know, we're also fallible that I do believe that it's important to have a higher power.
[00:45:19] As a kind of steadying guiding light. So where you can just sort of, you know, talk to your higher power and say, now what's going on here. Is this something I really believe? What do I really believe? Is this, is this something I really believe what, what is right and wrong here? What, what should I do? What is the good and right thing to do?
[00:45:38] And once you've kind of had that conversation, then you know what, it doesn't really matter what other people say. You did the best that you could do. You took the time you looked deeply and you made the best decision that you could make with every good intention. It doesn't always work out, but it wasn't for lack of trying.
[00:45:58] And it wasn't for lack of being [00:46:00] thoughtful. Right?
[00:46:01] Laura McKowen: I think, I think in a lot of ways that in absence of that people have made online figures influence. And you even sort of social Scott itself, a higher power truly.
[00:46:17] Anna Lembke: And that's right. That's
[00:46:19] Laura McKowen: right. Yeah. I, what you said reminded me of Zadie Smith is a novelist.
[00:46:27] Yeah. She has commented a fair amount on social media. She's not on it. And I pulled her this quote because I thought it might be helpful or relevant in our conversation. So. She says, I want to have my feeling, even if it's wrong, even if it's inappropriate express it to myself in the privacy of my heart and my mind, I don't want to be bullied out of it.
[00:46:53] And then she continues. I understand it's important to be appropriate in public life, in social life and in political [00:47:00] life, but in your soul, no, this is a different thing. We should be able to retain the right to be. Mm, I'm wrong almost all the time. It's okay to be wrong. It really is. Okay. You just have to sit with the feeling and deal with it.
[00:47:15] You never feel that certain in the first place. So this kind of succession of mistakes is just what I call my novels.
[00:47:22] Anna Lembke: Yeah. Right, right. That's so nice. I really liked that. That's really beautifully done. And I agree with that.
[00:47:30] Laura McKowen: So the last piece, this really speaks to everything that we've said so far about.
[00:47:36] So there's one psychologist who has, uh, 4 million plus followers on Instagram. So this is a real time scenario that just happened. She became known for putting out really bite-sized sort of information about trauma and psychological principles that weren't really mainstream. She has a really good way of condensing information and presented.
[00:48:04] The following is, is now huge. And you know, this is this weird blind between are we invested in information or now we invested in this person and the choice of a person to use their public life. Then as part of their way of teaching, she came out and said, she's in a, um, a three-person relationship.
[00:48:31] That's not even the point. The point was the post was made, there was a bajillion comments. And then a few days later, the follow-up post is what's really interesting to me. She, she says, I, when I posted this, I had 20,000 people unfollow me. These are a couple of lines. She says, I know that when you speak to me, she's talking about people that projected.
[00:48:59] [00:49:00] Distaste and dislike of her announcement. You know, how unhealthy it is and the reaction to her telling everyone that she's in a three person relationship. She says, I know that when you speak to me, you're speaking to you too. And that must hurt. And then she goes on to say our work is to learn how to be the love, to learn to compassionately hold space for the opinion.
[00:49:25] Reactions beliefs. And to resist the ego's desire to shame them or punishment. We need to learn to trust that we each know what is best for our own lives. Then at the end, it says this space, meaning her space and Instagram is for the courageous warriors, willing to go inwards, willing to remember who we actually are and willing to forgive in the moments we feel.
[00:49:54] And the hashtag is self healers. And I read that [00:50:00] last part. The, especially the line that this is a space for courageous warriors. I mean, I don't know what to call it other than shaming or in-group out-group type of stuff. If you're courageous, you're here. Even if you're not, you must not be willing to do the work.
[00:50:18] And so there's all this intense energy around these types of things. And she's just one example. And again, it's really not about her. It's about this phenomenon online. There's so much energy around it. You can feel it when you go into a post like that, this phenomenon of in-group and out-group dynamics, and then dog piling and dunking people and scapegoating.
[00:50:44] Is there any part of this that's good for people?
[00:50:55] Anna Lembke: Right. Well, uh, okay, here, here's here. I mean, I couldn't possibly speak to all of that, cause I don't even know what I think yet, but, but, but, but what I can say, um, is that I think that social media can be a wonderful place to learn.
[00:51:20] And exchange ideas and even create, discover, create, and maintain some very intimate bonds, especially if they're reinforced with, um, in real life encounters. But even having said that, I, I believe that there are people who are meeting and having powerful and meaningful connections with people online that they'll never see in real life.
[00:51:43] And that that's good and can be good and positive. But what I think what you're getting at here, the scale. Um, and when you're dealing with, you know, groups of people, and by the way, again, we have an intrinsic need to belong to groups. We are tribal creatures. And when you're dealing with it at this scale of millions of people, um, communicating online and defining themselves through their online communications, that's not no longer at the human scale.
[00:52:14] Like that is not, that is more than what humans can process. And I think then it inevitably goes awry. It's just not at a scale for which we and our brains were designed. We were designed for the unit of, you know, of the family, of the neighborhood, possibly of a small village. We weren't designed for the tribe of 4.3 million people.
[00:52:40] That's just, it's just inevitably going to take on a life of its own. W which is, you know, gonna be at times, be amazing. And other times be really, really awful. So yeah, I guess my, you know, my reaction to that story is I sort of feel for everybody, I, I feel for the woman who, you know, who posted, I feel for the people who supported her, I feel for the people who, you know, expressed her, their contrary opinions, You know how to strong for it.
[00:53:08] Yeah, yeah. Got shamed for it. Or she tried to shame them. Who knows if they really felt shamed since it sounds like a lot of them dropped out, but I think that the human reactions and instincts are just sort of natural and normal, but just on such a massive scale that it's just really not possible for us to process all of that.
[00:53:28] And, and that's where you really realize that this just can be, the engagement can be really unhappy. And that's when you really just have to say, you know what, I know this is not good in my life. Right. I think it's also just important to reiterate what a powerful emotion shame is. And shame fundamentally comes from that fear of transgressing, you know, some kind of moral or social transgression, and then the fear of abandonment that you will be kicked out of the tribe, you know, that will be left behind or like violently expelled and that emotion of shame is devastating and overwhelming. It generates enormous anxiety and is really hard to just sit with and live with. I can tell you as somebody who has become, you know, somewhat of a public person, just in terms of, you know, speaking publicly about things, I have to deal with that emotion a lot. I experienced that a lot and I just have to, I've just, I have to sit with it.
[00:54:24] Yeah. I just have to not engage, you know, not retaliate. Um, just, just acknowledge, Hey, you know what? That's part of sticking your neck. And making certain claims and that's sort of the price of admission in a way. And then you have to kind of do the calculus. Is it worth it? Do you believe in your ideas enough that you're willing to tolerate that you might be shamed and shut out and discredited for it?
[00:54:53] And so those are, those are hard things.
[00:54:55] Laura McKowen: They're very hard things. Were you ever on social media and why did you decide. Not do it not participate.
[00:55:02] Anna Lembke: Yeah. So I never went on social media. I sort of had an instinctive awareness that that would not be good for me. The other thing that I worry about is the, the immediacy of it and the tendency to have a quick reaction.
[00:55:14] I, whenever I have a strong, emotional reaction to something, I like to sit on it for while. And sorted out and social media, doesn't encourage that. What I'm talking more about is the books that I've written. You know, the first book that I wrote was called drug dealer MD, and that's about the over prescribing of opioids and other psychotropics.
[00:55:33] And it was very counter-culture when I wrote it and I received a lot of, um, you know, negative, negative reactions and still to this day, it's. I have to deal with that, but I believe so much that what I wrote is true and important for people to know that I'm, I'm willing to, you know, to tolerate it, but it's not easy.
[00:55:54] Laura McKowen: No, it's not. And, and you know what we know as we, we kill our profits, [00:56:00] we, before we tell them profits and we, you know, popular ideas are never really popular, big ideas, ideas that change things are never very popular when they first come out. I just so. I can't even tell you how much I appreciate your time.
[00:56:15] And I'm just, I'm also really grateful you're doing the work that you're doing
[00:56:19] Anna Lembke: well, thank you. I appreciate that. And I thank you too for your work, and I applaud you for your recovery and enormous life accomplishment. And, uh, I've enjoyed talking with you too.