speaker stringclasses 2
values | text stringlengths 4 7.43k |
|---|---|
A | Welcome to the Huberman Lab podcast, where we discuss science and science based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. Today, I have the pleasure of introducing Doctor Anna Lemke. Doctor Lemke is a psychiatrist and the chief of... |
B | Thank you for having me. I'm excited to be here. |
A | Yeah, I have a lot of questions for you. I I and many listeners of this podcast are obsessed with dopamine. And what is dopamine? How does it work? We all hear that dopamine is this molecule associated with pleasure. I think the, uh, the term dopamine hits like, I'm getting a dopamine hit from this, from Instagram or f... |
B | So dopamine is a neurotransmitter, and neurotransmitters are those molecules that bridge the gap between two neurons. So they essentially allow one neuron, the presynaptic neuron, to communicate with the postsynaptic neuron. Dopamine is intimately associated with the experience of reward, but also with movement, which ... |
A | Interesting. So is it fair to say that one's baseline levels of dopamine, how frequently we are releasing dopamine in the absence of some, I don't know, drug or food or experience just sitting being. Is that associated with how happy somebody is, their kind of baseline of happiness or level of depression? |
B | There is evidence that shows that people who are depressed may indeed have lower tonic levels of dopamine. So that's a really reasonable thought, and there's some evidence to suggest that that may be true. The other thing that we know, and this is, you know, really kind of what. What the book is about, is that if we ex... |
A | Interesting. And is it the case that our baseline levels of dopamine are set by our genetics, by our heredity? |
B | Well, I think if you think about sort of the early stages of development in infancy, certainly that is true. You're kind of born with probably whatever is your baseline level. But obviously your experiences can have a huge impact on where youre a, your dopamine level ultimately settles out. |
A | So if somebody's disposition is one of constant excitement and anticipation or easily excited, I think about the kind of people where you say, do you want to check out this new place for tacos? They're like, yeah, that'd be great. And other people are a little more cynical, harder to budge, like my bulldog Costello, ve... |
B | I don't really think we know the answer to that, but I will say that people are definitely born with different temperaments. And those temperaments do affect their ability to experience joy. And we've known that for a long time. And we describe that in many different ways. One of the ways that we describe that in the m... |
A | Interesting in terms of impulsivity, is this something that relates literally to the startle reflex? Like I, for instance, as a lab director, I'm familiar with walking around my lab and when I decide, deciding I'm going to talk to my people, of course, when they knock on my door, it's always like, wait, why am I being ... |
B | Yeah. So I don't think that that startle reflex is necessarily related to impulsivity. That can be related to anxiety. So people who are high anxiety, people will tend to have more of a startle reflex. Impulsivity is a little bit different. And by the way, impulsivity is not always bad. Right. Impulsivity is that thing... |
A | Know, where hesitation can cost, right. |
B | Yes, that's right. That's right. But, you know, and I think this brings up a really something that I've come to believe after 25 years of practicing psychiatry, is that what we now conceptualize in our current ecosystem as mental illness are actually traits that in another ecosystem might be very advantageous. They're ... |
A | I see. Yeah. And I'm beginning to realize it's a fine line between spontaneity and impulsivity. What is pleasure, and how does it work at the biological level? And if it feels right at the psychological level, and if you don't mind painting a picture of sort of the range of things that you have observed in your clinic ... |
B | Well, I think it's actually really hard to define pleasure in any kind of succinct way, because certainly there is the seeking out of high or a euphoria, or, I think, the kind of experience that most anybody would associate with the word pleasure. Also, the seeking out of those same substances and behaviors is often a ... |
A | So someone could decide that they want to go out and dance or get up and dance because of the pleasure of dancing. I can imagine that. And maybe it's very difficult for them to stay seated when a particular song comes on, for instance. But seeking what we would call pleasure in order to eliminate pain, that evokes a di... |
B | Yeah, well, I mean, I think that life for humans has always been hard, but I think that now it's a harder in unprecedented ways. And I think that the way that life is really hard now is that it actually is really boring. And the reason that it's boring is because all of our survival needs are met. We don't even have to... |
A | And do you think they have that sense? My brain isn't suited to this world? Or they simply feel a restlessness and they're constantly seeking stimulation? |
B | I think that's right, yeah, I think it's not really knowing what's wrong with me? Why am I unhappy? How can I be happier? And of course, as you talk about, what's so pervasive in our narrative now is like, find your passion, find your, you know, whatever it is to save the world. And in a way, that's good because it has... |
A | Yeah. Well, there's a book by Cal Newport. I don't know if you know Cal Newport's work, but you guys are very symbiotic in your messages. Hes a professor of computer science at Georgetown. Yes, at Georgetown. And wrote a book some years ago, really ahead of its time called so good they cant ignore you, which is about n... |
B | Right. |
A | And he's been a big proponent of the evils of context switching too often throughout the day for sake of productivity, mostly. His new book is called a World without email. I'm beginning to realize, as I cite off these books and your book, Dopamine Nation, finding balance in the age of indulgence, that maybe the reason... |
B | That's it. |
A | Right. And yet you're two of the most productive people that I know, including productive authors. So that's a discussion unto itself. But I find this fascinating. So let's talk about the pleasure, pain, balance and addiction. And I've heard you use this seesaw, or balance scale, um, analogy before, and I think it's a ... |
B | Yeah. So to me, one of the most significant findings in neuroscience in the last 75 years is that pleasure and pain are co located, which means the same parts of the brain that process pleasure also process pain. And they work like a balance. So when we feel pleasure, our balance tips one way. When we feel pain, it tip... |
A | It'S like you have principal laws of physics. |
B | Yes. Right, right. So, like, I like to watch YouTube videos. When I watch YouTube videos of American Idol, you know, it tips to the side of pleasure, and then when I stop watching it, I have a comedown. Right. Which is a tip to the equal and opposite amount on the other side. And that's that moment of wanting to watch ... |
A | Yeah. And I just want to project there. So this moment of wanting to watch another that is associated with pain, I think is, are we always aware of that happening? Because you just described in a very conscious way. |
B | Right. |
A | But when I indulge in something I enjoy, I'm usually thinking about just wanting more of that thing. I don't think about the pain, I just think about more. |
B | Right. So really excellent point. Because we're mostly not aware of it, and it's also reflected. So it's not something that consciously happens or that we're aware of unless we really begin to pay attention. And when we begin to pay attention, we really can become very aware of it in the moment. Again, it's like a fall... |
A | So if I understand this correctly, when we find something or when something finds us that we enjoy that feels pleasureful, social media, food, sex, gambling, whatever happens to be, we will explore the full range of these. There's some dopamine release when we engage in that behavior. And then what you're telling me is... |
B | Yes. |
A | And beneath my conscious awareness, there's a tilting back of this scale where pleasure is reduced by way of increasing pain. |
B | Right. |
A | And I've heard you say before that the pain mechanism has some competitive advantages over the pleasure mechanism, such that it doesn't just bring the scale back to level, it actually brings pain higher than pleasure. Could you tell us a little bit more about that? |
B | Yeah. Yeah. So what happens again? So the hallmark of any addictive substance or behavior is that it releases a lot of dopamine in our brain's reward pathway. Like. Right. Like, broccoli just doesn't release a lot of dopamine. Just doesn't. Right. |
A | I'm trying to imagine. I was about to say maybe, and I stopped myself because, no, broccoli is good. It can be really good. But broccoli is never amazing, right? |
B | Broccoli's never amazing. |
A | Never like this. |
B | Honestly, we can probably find somebody on the planet for whom broccoli is amazing. And of course, if I'm starving, broccoli is amazing. |
A | Rich roll. Rich roll is big on plants, and he has a good relationship to plants. Rich, tell us how to make broccoli amazing. If anyone could do it, it'd be rich. |
B | But what happens right after I do something that is really pleasurable and releases a lot of dopamine is, again, my brain is going to immediately compensate by down regulating my own dopamine receptors, my own dopamine transmission, to compensate for that. And that's that come down or the hangover, that after effect, t... |
A | And that one drug could be a person, right? I mean, I. I know people in my life that are still talking about this one relationship, this one person that was just so great, despite all the challenges of that thing, that it's almost like they're addicted to the narrative. Yeah, they were, maybe still are addicted to the ... |
B | Yes, exactly. And that's where this whole idea of cross addiction comes in. So once you've been addicted to a substance, severely addicted, that makes you more vulnerable to addiction, to any substance. |
A | And when you say substance does the same, is what you just said also true for behaviors? |
B | Yes. So when I do, when I use the word drug, I'm talking about substances and behaviors, really? And I'm talking about behaviors like gambling, sex, porn. Gaming, porn. Absolutely shocking work you've accused me, just. |
A | For the record, Anna, doctor Levge has accused me, not accused me, has diagnosed me outside the clinic in a playful way of being work addicted. You're probably right. The first thoughts I have when I wake up are typically about work, certainly within 50 milliseconds or so of waking. And probably the last thoughts I hav... |
B | Yes, that's exactly right. And you're certainly not alone in that. And of course, at Stanford. |
A | No, no, no. |
B | I mean here in Silicon Valley. Right. It's highly rewarded. Right. So that kind of. |
A | That kind of embedded in the culture. Absolutely, yeah. Yeah. And there's this other city, I think it's called New York, where they also work a lot out here, and it's heavily rewarded. I once said, and I'm sure that I'm not the first person to say it, but I was thinking about addiction, and I was thinking about the und... |
B | Yeah, so it's a great question. I mean, and I understand the question as, so where. What should we be striving for? Right. Where. Where should we settle out? And, you know, in my book, I really hold out people in recovery from severe addiction as sort of modern day prophets for the rest of us, because I do think that p... |
A | So does that mean never allowing myself to be absolutely in complete bliss or does it mean not allowing myself to stay in that state too long? |
B | The latter, I think the latter. And then that gets to temperament. So I'm going to get that to a second. So in general, what we want is some kind of flexibility in that balance and the ability to easily reassert homeostasis. We don't want to break our balance, which is possible if we overindulge for enough period of ti... |
A | Right. |
B | That would be a disaster. We wouldn't be human and we wouldn't want that. It would be really, really boring. On the other hand, what people in recovery from addiction talk about is to some extent, having to learn to live with things being a little boring a lot of the time, right? So trying to avoid some of this intensi... |
A | Sorry to interrupt, but when you say boring, can we add stressful and boring? |
B | Yes. |
A | Because there are days where I'm not. I have to, I'm one of these people, have to remind myself to have fun because I sort of forgot what the term means because I've. I like to think that I experience a lot of pleasure in little things, but I'm pretty hard driving guy. I like goals and big milestones, all that stuff. A... |
B | Oh, for sure. I mean, actually, boredom is highly anxiety provoking. |
A | Okay, that's good to know because I think people hear boredom and they think like, oh, there's nothing to do here, right? There's nothing. I feel like we have a ton to do. We just don't really want to do it. |
B | Right. |
A | As opposed to something that we're excited to do. |
B | Right. Okay, so this gets to sort of some of the core things. Also, we were talking about earlier about finding your passion. So I'm going to try to link it all together. But basically boredom. First of all, boredom is a rare experience for modern humans because we're constantly distracting ourselves from the present m... |
A | It could happen. |
B | Lightning could spike, and you walked your dog and you cleaned your house and you went shopping. Imagine that for a moment you would be sitting in your house and my guess is you would be terrified because, wow, what am I supposed to do now, right? There's nothing I really have to do. And that is really, really scary. T... |
A | Them to do, and then everything will feel like a natural progression, right. |
B | Will be wonderful. |
A | I can attest to the fact that is not how it works in any endeavor, right. |
B | And that you'll have all this great success or, you know, but. And here, here's where I really think the answer lies. And I really, really believe this. Stop looking for your passion. And instead, look around right where you are. Stop distracting yourself, look around right where you are and see what needs to be done. ... |
A | It's a really important point. And if you're willing, I'd like to actually stay on this issue of passion because I think the dopamine systems, if I understand them correctly, the dopamine systems merge with this work that you're referring to, this immediacy of things calling to us, like taking out the trash, which soun... |
B | Yeah, that was beautifully said. And I would just add to that, I see a lot of young people who, for example, spend most of their waking hours playing video games. And they come to me and they say, I am anxious and depressed. I'm majoring in computer science. I hate it. I thought I would like it, you know, if I could on... |
A | Very interesting. And just to underscore this notion that tending to the immediate things can lead to super performance, I may have mentioned it earlier this episode, but if I didn't, I'll mention now, which is I have the great privilege of having some close friends that were in the SEAL teams and doing some work with ... |
B | Yes, I just want to add so even beyond that, because that totally resonates for me and is very consistent with people in recovery from addiction who learn to take it one day at a time, which is one of the standard lingo from Alcoholics Anonymous and other twelve step groups. But I think also, as you say, our brain is r... |
A | Well, I think the unit of the day is something that comes up again and again in my discussions with colleagues who are extremely successful and who also have balanced lives. This actually came up in the discussion with Carl Dyseroth, who is also a successful scientist and clinician and manages a family, et cetera. So t... |
B | Yeah. And 30 days is, in my clinical experience, the average amount of time it takes for the brain to reset reward pathways for dopamine transmission to regenerate itself. There's also a little bit of science that suggests that that's true. Some imaging studies showing that our brains are still in a dopamine deficit st... |
A | So that progressive narrowing of what brings one pleasure eventually expands. So I'd like to dissect out that 30 days a little more. Finally, and I also want to address, how does one stop doing something for 30 days if the thing is a thought. So we'll kind of put that on the shelf for a moment. So days one through ten,... |
B | Should. |
A | Should one expect all of that? Should the family members of people expect all of that? |
B | Yeah. So what I say to patients, and it's a really important piece of this intervention, is that you will feel worse before you feel better. For how long? |
A | Yeah, this is probably the first question they ask. Right. |
B | And I say, usually in my clinical experience, you'll feel worse for two weeks. But if you can make it through those first two weeks, the sun will start to come out in week three. And by week four, most people are feeling a whole lot better than they were before they stopped using their stubborn substance. So, um, yeah,... |
A | So the way you describe it, it seems like it's hard, but it's doable for most people, not everybody. And we'll return to that category of people who can't do that on their own. Well, then days 21 through 30, people are feeling better. The sun is starting to come out, as you mentioned, which translates in the narrative ... |
B | Exactly. |
A | Whereas before, it was only to insert, you know, addictive behavior. |
B | Right. |
A | Whichever it is. |
B | Of course, coffee can be addictive, too, but. But we'll leave that aside. Yeah. |
A | I feel like coffee has a kind of consumption limiting mechanism built in where at some point, you just can't ingest anymore. Yeah, but maybe that's wrong. Sorry to give lift to the caffeine addicts out there as I. As I clutch my mug. So days 21 through 30, I've seen a lot of people go through addiction and addiction an... |
B | Yeah. Yeah. So there. There are people who will die of their disease, of addiction, you know, and I think conceptualizing it as a disease is a helpful frame. There are other frames that we could use, but I do think, given the brain physiologic changes that occur with sustained, heavy drug use and what we know happens t... |
A | It's almost like the hinge on that. |
B | Balance is messed up. Exactly. And so, I mean, for someone who's never experienced addiction like yourself, maybe one way to conceptualize it is why I didn't say that. Okay. |
A | To be clear, I was not referring to myself, but in this example I was given, if I were, I would come clean. I would reveal that. But I think that especially after hearing some of your lectures and descriptions of the range of things that are addictive, I think I've been fortunate. I don't have a propensity for drugs or... |
B | Right. |
A | I'm lucky in that way that, frankly, if they remove all the alcohol from the planet, I'll just be relieved because no one will offer it to me anymore. So don't send me any alcohol. It won't go to me. But I don't have that. I like to think I have the compassion, but I don't have that empathy for, you know, taking a real... |
B | Yeah. So, okay, so this is really, I think, important because I also had to come to an understanding of this, and I feel that I have, in my 20 years of seeing these patients. And, of course, addiction is a spectrum disease. Right. And so you've got the severe end of things. Imagine that you had an itch somewhere on you... |
A | That's a great description. And actually, in that description, I can feel a bit of empathy because the way you describe scratching an itch in your sleep. |
B | Yeah. |
Subsets and Splits
No community queries yet
The top public SQL queries from the community will appear here once available.