The Myth-Making of Dopamine Nation
hedonic Calvinism, anyone?
Last week, Stanford psychiatrist Anna Lembke admitted in the New York Times that it is an oversimplification to say addiction is solely caused by dopamine.
Good! We agree!!
This is hilarious, though, because Lembke just spent years promoting her best-selling book Dopamine Nation on every podcast that would give her a microphone, espousing a version of “dopamine makes us do it” to massive audiences that now firmly believe pleasure and vice are controlled by a single neurotransmitter in their brain.
The book has gotten a lot of press, but most people seem to be taking Lembke’s claims at face value, which is unfortunately something I am physically and spiritually incapable of doing! So this seems like the perfect opportunity to examine some of the book’s more questionable assumptions in-depth.
This is not going to be a positivist debunk, because “Is the dopamine science correct?” is not really the most interesting question to me here. I’m far more interested in asking: What morals are being communicated to us through this particular science story?1 And what kind of politics do those morals lead to?
If this is too long for you, skip to the end for a TLDR and a few books I would recommend reading instead. Usually I paywall deep dives like this, but I want this to exist in the world because I couldn’t find any of the following critiques of this book out there, so a very big thank you to everyone who supports my work and makes it possible for me to write everyday.
Fearing Pleasure
Dopamine Nation opens with the following thesis statement:
“The smartphone is the modern-day hypodermic needle, delivering digital dopamine 24/7 for a wired generation. If you haven’t met your drug of choice yet, it’s coming soon to a website near you.”
Is dopamine a drug that your brain makes? Or is it the internet that is a drug, and dopamine is another word for pleasure? She tells us the fact that “the brain processes pleasure and pain in the same place” is a “remarkable” finding — even though the brain, as a complex network, processes lots of different things with the same regions.
Continuing with the low-hanging metaphors, Chapter One is called Our Masturbation Machines. Lembke begins with the story of a patient named Jacob who tells her that he has a sex addiction and that he’s built a machine to help him masturbate more. Honestly, not that weird — I own several vibrating machines for this! But Lembke wants us to be horrified by Jacob’s fall into depravity, to fear — as she does — that pleasure could ruin our lives if we are not careful.
I was horrified, but not in the way she intends. As a queer person of evangelical experience, I was taught that masturbating is a sin that will get me sent straight to hell, so reading Jacob’s story of having to hide his “solitary vice”2 like a dirty secret all his life instantly made me feel a sort of sad camaraderie with him:
“..after his First Communion, he was awakened to the idea of masturbation as a ‘mortal sin.’ From then on, he only masturbated alone, and he visited the Catholic priest of his family’s local church every Friday to confess.”
Lembke doesn’t seem to think critically about the repressive religious upbringing behind her patient’s intense shame — later in the book, she will tell him to pray about it, claiming this would “resonate” considering his Catholic background.
Social norms are left unexamined. There is no discussion of what forces in his life may be driving him to develop a relationship to masturbation that distresses him, or what purpose this behavior — destructive as it may have become to his career and monogamous marriage — could be serving for him. We are just supposed to assume, as Lembke does, that addiction is caused by pleasure-seeking, and doing high-tech sex stuff is bad.
She then spends much of the chapter telling her own slippery-slope story about how she got addicted to reading erotic fantasy novels on her Kindle, I guess in some kind of effort to be relatable.3 Her “gateway drug” is Twilight. (That is not a joke, I am quoting the text!) She reads every monster smut book she can find where boy-meets-girl and then they smash, until she comes across a butt plug in 50 Shades of Gray and hits her own personal rock bottom:
“I remember being shocked at how easy it was to find graphic sex scenes right there on the general fiction shelves at my neighborhood library. I worried that my kids had access to these books.”
Ah, there it is, the library book pearl-clutching! Considering our current political climate of LGBTQ book-banning based in fears about corrupting the innocence of children, this line did not land friendly with me, but it did set me up to understand exactly what kind of Puritanism I was getting into here.
Lembke throws a shocking anecdote at us that she heard from a cop once about internet porn causing childhood sexual abuse and then concludes that we all have our own dangerous masturbation machines now, right in our very pockets, and there’s a social contagion afoot — your classic conservative, somebody-think-of-the-children, techno-pessimist moral panicking.4
The title Dopamine Nation is not lost on me here. These moral panics, especially when they center around masturbation, have historically been whipped out during moments of nationalistic anxiety. The Victorians, for instance, were terrified that young upper class white boys at boarding schools were going to touch themselves too much and not procreate enough, thus causing catastrophic population decline that would threaten Britain’s hold on the empire.5
The falling birth rate is a huge fear in Silicon Valley right now, so it makes sense that some of these ruling class anxieties may have made their way into a book forged in Palo Alto’s intellectual fires. Lembke runs the addiction medicine clinic at Stanford, and the patient stories she builds the book around involve rather wealthy men — one of which she describes as a real estate millionaire living a “Silicon Valley dream.”
Chapter One sets us up to be afraid that technology is ruining our lives, and Chapter Two tells us that we are sick and sad because we have it way too easy. Or, at least, that’s how it looks to Lembke from Palo Alto. Maybe ask someone in the half of America that struggles to pay for healthcare if they agree?
Dopamine Nation has a distinctly wealthy, conservative perspective on the world. There’s a fear of change, and a sentimentality for the way things used to be. “We’ve lost the ability to tolerate even minor forms of discomfort,” she writes, after telling us that in the 1800s doctors thought pain was healthy and didn’t like to use anesthesia.
Lembke presents her arguments in a somewhat neutral, just-presenting-the-facts type of way, so I can see how it would be easy to miss some of the book’s moral implications, but as an avid source-checker, it is very telling to me who she chooses to cite throughout the book.
For instance, she invokes Ross Douthat, a conservative Catholic columnist who has argued against abortion and gay marriage, to tell us that “It’s startling how little moral exhortation there is” in modern spirituality, before she goes on to muse in the very next paragraphs about how we don’t spank kids anymore because we’re too afraid of traumatizing them.
“By protecting our children from adversity, have we made them deathly afraid of it?” she asks. “Have we encouraged a new age of hedonism?”
She describes rich kids who “have every advantage in life” and still end up depressed, which she then goes on to attribute to society’s supposedly relentless pursuit to avoid pain.6 And here I have to stop and give you some more context about Lembke’s career.
The Prohibition Paradigm
In 2016, she wrote a book about opioids called Drug Dealer MD, where she argues that many disabled patients are malingering fakers who lie to get drugs and government money. In a 2017 TED Talk about the book, she says:
“We have over 13 million people in this country on disability. The number two reasons for disability are chronic pain and mental health. In the 1950’s, we had less than a million people in this country on disability, and the number two reasons were heart disease and cancer. Why is that? It's not because we're getting sicker, it's because patients have figured out, or people have figured out, that by adopting the sick role and signing up for disability, they can pay their bills.”
This take always baffles me, considering that the average monthly disability payment in the US is like $1,2007 and people on SSI frequently end up living in shelters, but it just goes to show, my dear disabled comrades, that Lembke is not our friend. If you’re in the chronic pain community, though, you might already know this!
In 2021, arthritis organization CreakyJoints cancelled a webinar on pain and pleasure that they had scheduled with Lembke after outcry from their audience over her work. She has her own Twitter hashtag — #LembkeLies — a reference to testimony she made in an opioid lawsuit that “1 in 4 patients prescribed opioids would become addicted.” A judge that reviewed the evidence concluded that it was more like 5% than 25%, and called her testimony “inadequate”.
She’s on the board of Physicians for Responsible Opioid Prescribing, which influenced the CDC’s Pain Guideline changes in 2016 that resulted in patients being forced to quickly taper off opioids, and may have contributed to further overdose deaths when pain patients were pushed into illicit markets.
Despite clear evidence from history that prohibition does not actually make anyone safer but paradoxically causes the development and sale of even more potent, unregulated drugs,8 Lembke believes that one of the biggest risk factors for addiction is access to drugs, so it follows that we must restrict that access and abstain.
She also believes that addiction is a brain disease, in line with the stance of the National Institute on Drug Abuse, which funds 85% of all global research on recreational drugs.9 Because NIDA is a government organization particularly interested in biological explanations for addiction that can lead to individualized medical treatments, drug researchers who toe their line — and specifically, as Dr. Carl Hart notes, those who focus on playing up the dangers of drugs over any of their benefits — are the ones who get funded.
It’s this anti-drug research that makes up the basis of Lembke’s arguments about behavioral addictions in Dopamine Nation, arguments that have been largely inferred from research on stimulant drugs. As therapist, addiction expert, and staunch critic of the brain disease model Stanton Peele has said:
“This psychiatrist is myth-making. It’s the same myth we’ve had for a hundred and more years, but she’s expanded her myth beyond narcotics and drugs.”
And to be clear, when I say myth, I don’t necessarily mean This is false, but here is the truth. I mean it in the traditional, religious sense — a story that is trying to explain some kind of truth about the world to us, of which there are many.
As a psychiatrist, Lembke is well aware of the importance of narrative. “I immerse myself in story,” she writes of her work with patients, and there is one myth that she just can’t stop talking about: the brain gremlin see-saw. (Oh my god, I know, stay with me here!) It’s the idea she built all of Dopamine Nation around, but it’s not even a new idea, because she wrote about it already in Drug Dealer MD.
Basically, she says there’s a see-saw in your brain with pleasure on one side and pain on the other, and when you feel too much pleasure, little gremlins hop on the pain side of the see-saw and make you feel bad again. She says overusing your “pleasure center” can result in not being able to find anything pleasurable at all anymore, and accompanies this claim with illustrations like this:
It’s confusing how much Lembke conflates dopamine with pleasure, because scientists moved on from “the pleasure molecule” idea over ten years ago. She does briefly acknowledge in a few sentences that it probably has more to do with motivation and the uncertainty of reward, but considering that the entire book is a theory of pleasure and pain, this nuance gets pretty lost.
As justification for her dopamine reductionism, she cites brain scan research done by Nora Volkow, director of NIDA and champion of the brain disease model who was telling everyone that “addiction is all about the dopamine” back in 2011. Four years prior, John D. Salamone wrote that dopamine had become a “dominant paradigm,” referring to the work of historian Thomas Kuhn, who wrote a very famous book called The Structure of Scientific Revolutions.
Salamone explains:
“It was suggested by Kuhn that scientific hypotheses can become so predominant that eventually they result in a set of received beliefs that lead researchers to restrict their thinking within the limits set by the tenets of the hypothesis; alternative ideas are easily ignored, and data that do not fit the hypothesis are readily discarded.”
There is definitely ignored data that doesn’t fit the grand narrative about dopamine and addiction. A 2015 paper by David J. Nutt and colleagues cites studies that show alcohol, weed, and ketamine don’t always trigger dopamine release, that blocking dopamine receptors doesn’t necessarily block the feeling of reward or pleasure, and that heroin can cause a high without changing striatal dopamine levels.
“Findings from studies investigating only stimulants (generally cocaine or amphetamine) were often discussed as though they applied to all addictions, even though there was no evidence for such an assumption,” they write.
Some studies have found increases in dopamine from behaviors like playing video games or eating food, but they’ve been small and poorly replicated, according to Nutt et al, who caution:
“The apparent rush to publish findings showing that any given pleasure-inducing drug or behaviour can induce dopamine release reflects one of the more worrying and pervasive aspects of science today — the preeminence given to reporting ‘positive’ data in support of currently influential theories.”
Hedonic Calvinism and Market Logic
Dopamine Nation is full of old, influential theories. The gremlin see-saw is something called “opponent process theory” that was applied to motivation and emotion by psychologist Richard Solomon in the 1970’s, based on dog shock experiments and studies of skydivers.
George F. Koob, director of the National Institute on Alcohol Abuse and Alcoholism and another frequent citation in Lembke’s bibliographies, expanded on Solomon’s opponent process theory in the 1990’s, framing pleasure as a limited resource in the brain.
Here’s an exchange between Koob and Bill Moyers on PBS:
Dr. Koob: Basically, it means that we have so much money in the bank in terms of pleasure in our lives, and we can expend that money over the course of a single weekend's binge on cocaine or we can expend it over a two-week period in the normal pleasures of everyday life. If you spend these pleasure neurochemicals in one lump sum such as a crack binge, you use up your supply of pleasure for a certain period, and so you pay for it later. The system has to self-regulate.
Mr. Moyers: Spoken like a good Calvinist. There's only so much pleasure in life you can have.
Dr. Koob: Exactly, but it's really a biological Calvinism.
Calvinism was a particularly ascetic strain of Christianity that the sociologist Max Weber believed to be a driving moral and psychological force for capitalism.10 The Calvinists believed that sin was hereditary, and it was every good Christian’s duty to work hard in this life and avoid worldly pleasures so as to deserve their predestined spot in heaven.
Koob called a restrictive approach to pleasure “hedonic Calvinism” and in a 1997 paper, he wrote that it “probably makes biological sense.” Even though the phrase does not appear anywhere in the book, I consider Dopamine Nation to be a sort of hedonic Calvinist manifesto, and I am validated in this belief by the fact that Christian pastors picked up on it immediately. Lembke has been more than happy to go on their podcasts, too.
“Your book helped me understand the Bible better,” a pastor tells Lembke in one such interview. Later, she gushes to him that neuroscience has begun to prove the morality of the Bible was right, that we must pay “a physiological price” for every pleasure.
Within the logic of the brain gremlin see-saw, Lembke writes that the treatment for addiction is to “press on the pain side” and seek out hardship. Again, perhaps this advice is appropriate for a person who has a comfortable, financially stable life, but it is a strange thing to say to a person who works several jobs and still struggles to pay rent.
“The pleasure we feel is our body’s natural and reflexive physiological response to pain,” she writes. “Martin Luther’s mortification of the flesh through fasting and self-flagellation may have gotten him a little bit high, even if it was for religious reasons.”
Hedonic Calvinism, indeed!
In practice, seeking out a “more enduring source of pleasure,” as she calls it, means exercising, dieting, and taking cold showers — basically the same advice John Harvey Kellogg was giving rich people in the early 20th century. But Lembke also advocates for “stricter churches,” an idea borrowed from a 1992 paper called Sacrifice and Stigma: Reducing Free-Riding in Cults, Communes, and Other Collectives by a behavioral economist named Lawrence Iannoconne.
This guy studies religion as if it’s a “market phenomenon”, and his 1992 paper asks questions like: Why do people do “costly” things like abstain from sex to be part of a church? And why do churches with more rules make the most money?
His answer is that strict rules weed out “free riders.” Everyone is contributing their fair share, Iannoconne explains after like seven pages of math formulas, so these churches can offer better “club goods” and attract more members. Lembke clarifies in the book that synonyms for “free riders” include “freeloaders and moochers,” words that, as a disabled person, haunt my dreams!
It’s here that we can clearly see what Health Communism calls the “eugenic and debt burden” framework, one that Lembke wrote about much more obviously in her previous book, which includes a listicle that classifies various types of malingerers and questions whether disability pay has become a “social harm.” It’s this section of Drug Dealer MD where she utilizes the brain gremlin metaphor to explain how drugs “hijack” the brain of patients and turn them into “drug-seekers,” adding to what she calls the “disease burden” of addiction.
Beatriz Adler-Bolton and Artie Vierkant write:
“Waste—surplus populations—are policed and certified by capitalist states to demarcate the boundary of who is an acceptable member of the body politic, with all who fall outside of this normative frame labeled as burden.”11
Disabled people and drug users have long been part of this group, but Dopamine Nation seems to be widening the boundary, telling everyone else that they are also at risk of joining the surplus population if they let their masturbation machines take over and turn them into undeserving free riders.
Using an economist’s argument, Lembke is telling us that in order to make the addicted into deserving citizens again, we have to tighten the rules. It’s a book that seeks to normalize deviants for the “club goods” of society, and in place of a religious argument — which wouldn’t play anymore in our secular world — we get neuroscience imbued with Calvinist subtext and capitalist market logic.
Making The Political Only Personal
Lembke concludes the book by telling a story about a guy who started doing nature photography instead of smoking weed, imploring us to turn toward the world instead of trying to escape what we’re running from by using drugs — real or figurative. This is frustrating, because on the surface, I want to like what Lembke is saying here.
To an extent, I agree. My own development out of alcoholism did involve facing the painful things I was drinking to ignore. Turning to face my suffering led me to understand that I needed to change my entire life, to accept my queerness and stop trying to fit myself into normalcy. Only then was I able to really stop drinking.
But this change was not just personal for me. It completely upended my political understanding of the world. I came to see myself in solidarity with everyone else who is deemed surplus and socially deviant, and to reorient myself not as a ruler of nature, but just another part of it.
Lembke gestures at a feel-good kind of collectivism, but she ultimately isn’t giving us that kind of myth. Readers will not come away from this book less individualistic, on the contrary. The dopamine mythos ultimately tells us that all the world’s problems are just inside our own heads, and the solutions can only be found in individual self-management. It’s not that the personal is political, but that the political is only ever personal.
“Our compulsive overconsumption risks not just our demise but also that of our planet,” Lembke writes. “We are devouring ourselves.”
Suggesting that climate change is a personal problem caused by dopamine-seeking hedonism is a view of society that overlooks material realities and completely flattens power and class. “Compulsive overconsumption” is the engine of capitalism, and only a few people control and profit from the production of these things we consume.
Workers have to both produce and consume in order for the whole thing to function. Sociologist Robert Crawford12 has described this as a contradiction between two necessary ethics in a capitalist economy — the work ethic and the pleasure ethic — which causes internal conflict.
Crawford argues that the professional middle class, which seems to be Dopamine Nation’s target audience, turned to health practices in order to deal with this conflict and reassert their work ethic:
‘Taking responsibility’ for one’s health formed a metonymic alliance with a growing intolerance of welfare ‘dependence’, ‘over-bloated’ government expenditures and being ‘soft’ on crime.
These themes run throughout Lembke’s work, and though she vaguely acknowledges social problems in a way that feels somewhat obligatory, Dopamine Nation has no liberating political analysis to offer us — just a neo-puritanical myth that replaces demons with a body-hijacking brain chemical that makes us “all at risk of titillating ourselves to death.”
What of the companies that drive overconsumption, and the billionaires that hoard profits from exploiting workers and the planet alike? Lembke has nothing much to say about them. Regulation, it seems, is not for corporations — it’s only for the self.
TLDR
Dopamine Nation is a hedonic Calvinist manifesto that uses federally-funded research on the neuroscience of drug addiction and behavioral economics to argue that pleasure is a limited resource that always carries “a physiological price”, and that the way to treat addiction is to tighten social rules and become more vigilant in our own self-management.
Lembke’s history of prohibitionist activism and experience as a medical professional who previously wrote a book describing some of her disabled patients as drug-seeking malingerers informs the conservative worldview of Dopamine Nation, which is marked by a fear of deviance and seeks to normalize readers through scientific rationality and self-help strategies, lest they become “free riders” on society. The book expresses cultural anxieties about becoming “soft” and can be seen as an example of what sociologist Robert Crawford has argued about health practices becoming a way to manage a contradiction of capitalism — the inner conflict between work and pleasure.
Alternative Readings
I did not enjoy this book, but here are a few others that have shaped my thinking around drugs and addiction that I would recommend:
For a book that marries neuroscience to lived experience and gives a more complex, humanistic explanation for addiction without reducing us to a single brain chemical, see The Biology of Desire by Marc Lewis
For a book by a neuroscientist whose research on the brain disease model led him to very different conclusions about politics and society, see Drug Use For Grown-Ups by Dr. Carl Hart
For a sociological study of porn and the many arguments around porn addiction, see The Pornography Wars by Kelsy Burke (specifically, Part 3)
Also, Health Communism!!! Have you read Health Communism yet?!?!
I share the mission of religion and science scholar Mary-Jane Rubenstein: “To expose the values of contemporary techno-science as the product of bad mythologies and seek out better ones.”
fun fact: that’s what Kellogg called it
Lembke tells Tucker Carlson in an interview that she’s never been vulnerable to substance abuse because alcohol “does nothing” for her, so I assume she had to come up with some kind of addiction anecdote so she could do that writer thing where you get the reader to relate to you so that they are more likely to agree with you. But is there anything more annoying than someone who has never done drugs telling everyone else what they should or should not do about drugs??
To be clear, I think the fact that young people are learning about sex solely from porn is a problem, but that can’t be solved by even more repression. We need less shame and comprehensive sex ed!
Palo Alto actually has an extremely high youth suicide rate, but a more charitable explanation is that children of wealthy high-achievers put a huge amount of pressure on their kids. The writer Malcolm Haris describes Palo Alto as “haunted” by a dark eugenic history — see his book Palo Alto for more on that.
It varies depending on the state and whether you’re on SSI or SSDI, but it’s always right around the poverty level. One of Lembke’s main arguments in her last book is that disability programs incentivize people to stay poor, which seems like quite a contradiction because she’s also arguing that the pay is “too good to pass up”? How is it simultaneously good pay and also keeping people poor?
called The Iron law of Prohibition
Nancy D. Campbell, Toward a critical neuroscience of ‘addiction’, 2010
See the Waste chapter of Health Communism for a history of how these arguments have been used to block movements for socialized medicine
you may know Crawford for his coining of the term “healthism”, the idea that being healthy is morally good
I just finished reading this book. I cannot tell you how much appreciated your article. I felt like I was the only person in a sea of fans who found the book condescending and puritanical. I feel so seen. You put into words all the criticisms I could never say as eloquently. Thank you for writing this.
As someone who has used MDMA in conjunction with IFS therapy to treat C-PTSD with astonishing success, there’s so much about Lembke’s narrative that concerns me. It’s frustrating that she’s gotten so much attention for her book whereas Carl Hart’s research (and others who’ve done similar research) is largely unheard of.