The Secret Power of Pain: Here’s How to Make Friends With It, Says Psychiatrist Anna Lembke
As a psychiatrist, chief of Stanford University’s Addiction Medicine Clinic, and a specialist in the opioid epidemic, Anna Lembke has seen it all when it comes to addiction. The Yale-trained physician has been in practice for more than 25 years, so it’s not all that surprising that she’s helped countless patients manage addictions to everything from video games and social media to alcohol, opioids, and more.
Yet it wasn’t until a student in a class she was teaching asked her a personal question—“What’s a behavior in your life you’d like to change?”—that Dr. Lembke realized her own seemingly harmless habit of reading romance novels at night was impacting her in more profound ways than she realized.
“As I talked about how I was staying up too late reading, how it was making me tired the next day and interfering with the kind of parent and doctor I wanted to be, it was an ah-ha moment,” says Dr. Lembke. “Saying it out loud to another human made it real in a way that it wouldn’t have been if I hadn’t said it.”
We all have our go-to habits—things that make us feel good when life feels tough. Maybe it’s scrolling through your endless social media feeds when you’re feeling a little anxious or having a glass of wine or chocolate chip cookie at the end of a tough day. While these little treats may seem like no big deal, they’re actually keeping us in pain, argues Dr. Lembke in her new book Dopamine Nation: Finding Balance in the Age of Indulgence.
We sat down with Dr. Lembke to talk to her about why the things we turn to to feel better may actually be doing more harm than good, and what we can do instead.
A Conversation with Dr. Anna Lembke
You write about how we’re living in a time of unprecedented progress, yet we’re unhappier than ever—and the reason we’re all so miserable may be because we’re working so hard to avoid being miserable. Can you explain?
I see so many people who have everything you could want and hope for in life and yet they are really unhappy. On top of feeling miserable, they also feel guilty because they recognize they have so much wealth and privilege and should feel good, but don’t.
The reason, based on my experience and research, is this: Our primitive brains aren’t wired for this world. We’re wired for friction and difficulty; we’re not wired for abundance and luxury and time and leisure and frankly, boredom. So, we’re caught in this funny place where we should be feeling good—yet we don’t.
What’s really ailing us is that our lives are too easy in the wrong kinds of ways and not hard enough in the ways we need our lives to be. What we need to do is consciously make our lives less convenient—to reduce our consumption of these highly-rewarding, pleasing, feel-good activities and intentionally invite difficult things into our lives.
That sounds counterintuitive. How does it work?
Pleasure and pain are processed in the same part of brain, and they always want to be in balance. Think of it like a seesaw, with pleasure on one side and pain on the other. If you are constantly doing things that make you feel good in the moment—things that boost your dopamine—your brain will overcorrect for that by tilting balance on the side of pain. It is counterintuitive: With enough pleasure stimuli, you’ll ultimately end up in this dopamine deficit state because your homeostasis-seeking body is trying to bring that dopamine surge back into balance.
A better way to boost your dopamine is to actually do things intentionally painful or physically or emotionally hard. By doing that, you’re pressing on the pain side to set in motion our body’s compensatory balance toward the pleasure side. That way we get dopamine not as an initial response, but as a corrective response—and research shows that dopamine is more enduring.
Can you share a little more about your realization that you were tilting too much toward the pleasure side of the balance in your own life, by reading romance novels?
After that first ah-ha moment when I shared out loud that I was staying up too late reading, I decided to try a month of abstinence to re-set my dopamine reward pathway in my brain—and it was so hard to do. Then when I decided to go back to reading, I binged! I found myself reading about butt plugs at 3 a.m. and thought, “Good Lord, I’m not even interested in that! How did I get here?”
What can we do to recognize when our own patterns aren’t serving us?
I share an acronym (DOPAMINE) in the book that’s helpful. It’s something you can follow with a therapist, a friend, or even do yourself:
D is for data: Be radically honest about what you’re doing. Write down what you’re using, how much, and how often.
O is for objectives: Figure out why you turn to this habit or addiction. What’s the upside for you? This behavior must be doing something positive.
P is for problems: What kinds of problems is this behavior causing in your life? If you’re fixated on this one activity, are other things becoming less pleasurable?
A is for abstinence: Can you ditch this habit for a month? This is an important step to help you reset your brain’s reward pathways and get a true picture of the impact of this behavior on your life.
M is for mindfulness: This is especially key in the first few weeks of abstinence, when you’ll likely feel worse before you feel better. Can you tolerate those painful emotions without reacting to them or trying to change them?
I is for insight: After abstaining from your dopamine-boosting habit, you’ll undoubtedly get additional insight into how it was impacting your life.
N is for next steps: Once you’ve made it through a month, think about whether or not you’d like to re-introduce your habit. If the answer is yes, what barriers are in place to make sure you use whatever it is in moderation?
E is for experiment: This is where you go back to your habit and see if you’re better equipped to bring more intention and moderation to what you’re doing.
It seems the ultimate goal is to stop running away from painful emotions, and instead learn how to tolerate them. How can we start to do this?
The first thing is to recognize that emotions really do crest over us like waves. When we’re experiencing painful emotions, they feel interminable. But they will pass. If we can just sit there with the discomfort, it will get better. You have to have faith that that’s going to happen, even if in the moment it’s difficult to believe.
If you’re a person of faith and have a spiritual practice, that can be very helpful. The way that works for me is just sort of giving whatever it is over to my higher power and asking for help: “Please help me. Help me endure this. Help ease my mind and my thoughts.”
Finally, doing something that is painful or hard can really help. So much of the time we’re told that if we’re feeling bad, we should reach for something to make us feel better. But that presses more on the pleasure side of the balance and contributes to addiction. When we do something painful, we upregulate our body’s own ability to produce more endogenous dopamine. (One caveat: Don’t do anything extremely or suddenly painful, like cutting yourself. What I’m talking about is mild to moderate stimuli.) Some examples are exercise, iced water baths, reading a challenging book, or doing something that makes you anxious. These activities distract our brain from the pain of what we’re feeling in that moment.
So, it turns out we should see pain as our friend—and as something that’ll ultimately make us feel better?
I am convinced that pain is vital for our sense of wellbeing and ironically, our sense of happiness. Our lives are devoid of meaningful pain. We need a frame shift in terms of what to do when we’re unhappy. The standard narrative—see a doctor, take a pill, watch a movie, treat yourself to some kind of reward—ultimately isn’t the answer.
I like to recommend a little experiment to my patients: Can you spend an entire day not doing anything that feels rewarding? No special meal, no favorite TV show, no scrolling through your phone. It changes the shape of your day! If you have nothing to look forward to, you only have right now. And if you only have right now, you’re truly present.
Order Dopamine Nation here.
