Preface: Living in an Age of Indulgence

Part 1: Duet of Pleasure and Pain

Chapter 1: The Man Who Built a Masturbation Machine
Everyone lives a double life
Addiction, Dopamine, and Capitalism
Internet: Digital Drug Syringes

Chapter 2: People Addicted to Happiness
Is pain bad?
Will happiness come when the pain disappears?
The paradox of happiness and suffering

Chapter 3: How the Brain Understands Pleasure and Pain
Dopamine says…
Pleasure and pain are twins
The Pleasure-Pain Scale Revealed by Brain Science
Addiction fundamentally changes the brain
The scales are just a metaphor

Part 2: The Dilemma of Addiction and Restraint

Chapter 4: DOPAMINE: 7 Steps to Understanding Yourself and Addiction
D is for Data: Know Thyself
O is for Objectives: There is no grave without an excuse.
P is for Problems: Find the negative effects of addiction.
A is Abstinence: 30 Days of Patience
M is Mindfulness: Looking into Suffering
I Insight: Facing the Real Me
N is the next step: Establishing a new relationship with the addict.
E is Experiment: How to Befriend Addiction

Chapter 5 Self-Restraint: Three Approaches to Addiction Management
Physical self-restraint, throw it in the trash and throw that trash away too
Sequential self-restraint, time limit, and finish line
Categorical self-restraint, cast a wide net
“I worship beer.”

Chapter 6: The Two Faces of Prescription Drugs
A Stanford University Student's Chronicle of Addiction
Could medicine be the solution?
I am a psychiatrist with depression.
The Shadow of Drug Prescriptions

Part 3: Finding Balance in an Age of Indulgence

Chapter 7: Facing Pain
Why is a cold bath so thrilling?
The Science of Hormesis
Hero Therapy, Pain Management for Pain Management
The pleasure that pain gives

Chapter 8: Tell It Like It Is
Homo liar
Honesty heals the brain
Honesty improves relationships
How I Reconciled with My Mom
Honesty is contagious

Chapter 9: The Shame That Saves Me
The shame that destroys me
The shame that saves me
“Welcome shame”
Shame and Parenting

Conclusion: Lessons from the Scales

Americas
References
Acknowledgements

For modern people who survive with dopamine in a fatigued society
A Guide to Humans, the Brain, Addiction, and Recovery

This book is about pleasure.
At the same time, it deals with pain.
Above all, it explores the relationship between pleasure and pain and the impact that relationship has on our lives in the modern era.
Why is the relationship between pleasure and pain important?

Because we have changed the world from a place of scarcity to a place of abundance.
Addictive substances, food, news, gambling, shopping, games, chatting, pornographic texts, Facebook, Instagram, YouTube, Twitter… Today, the stimuli promising big rewards have increased in quantity, variety, and potency beyond anything in the past.
The advent of the digital world has given wings to these stimuli.
Smartphones have become modern-day hypodermic needles, constantly delivering digital dopamine to the computer generation.
If you're someone who believes they've never been addicted to anything, I guarantee you'll soon find it on one of your favorite websites.
(From the preface)

In the last century, neuroscience made two groundbreaking discoveries.


The first is the discovery of dopamine, the conductor of pleasure and pain.
Dopamine is a neurotransmitter in the human brain that was first discovered in 1957.
The protagonists are Arvid Karlsson from Sweden and Kathleen Montagu from the UK.
Carlsson later received the Nobel Prize in Physiology or Medicine.

Dopamine isn't the only neurotransmitter involved in reward processing, but most neuroscientists agree that it's the most important of them all.
Dopamine plays a greater role in the 'motivation process to obtain rewards' than in 'the process of feeling pleasure from the reward itself.'
So, mice that have been genetically engineered to be unable to produce dopamine cannot find food and starve to death even when food is right in front of them, but if you put food directly in their mouths, they chew the food and react as if they are enjoying it.


The second discovery is that the brain processes pleasure and pain in the same place.
Pleasure and pain are like weights at opposite ends of a scale.
You've probably experienced that moment when you eat a piece of chocolate and want another, or when you wish a good book, movie, or video game could go on forever.
If you are continuously exposed to such moments, the balance of your brain, contrary to common sense, tilts toward pain rather than pleasure, and eventually the scale itself becomes damaged.


Let's say there is a scale in the brain.
It is a scale with a lever support in the middle.
Normally, when there is nothing on the scale, it is level with the ground.
When we experience pleasure, dopamine is released in the brain and the scales tip toward pleasure.
The more and faster the scales tip, the more pleasure you feel.

But there is one important property about scales.
The scale tries to remain horizontal.
I don't want to be tilted to one side or the other for a long time.
So every time the scales tip toward pleasure, a powerful self-regulating mechanism kicks in to bring them back to level ground.


These self-regulating mechanisms are independent of human will.
It's just a reflex, trying to find balance.
The more you pursue pleasure, the greater the pain.
Then, at some point, when a critical point is reached, the brain can no longer feel pleasure even when given strong stimuli such as drugs, alcohol, or pornography.

People addicted to happiness vs. people who face pain

How can we overcome addiction and find balance in our lives? The author argues that we must first change from conventional, drug-based treatments.
The United States already suffers greatly from over-prescribing drugs.

Today's doctors try to eliminate all suffering for fear of failing in their role as compassionate healers.
Pain in any form is considered dangerous.
This is because it is believed to stimulate the brain to feel pain even after recovery, leaving irreversible nerve damage, not just because it hurts.

The paradigm shift surrounding pain has shifted to mass prescribing feel-good pills.
Today, more than 25 percent of American adults and more than 5 percent of American children take antipsychotic medications daily.
The use of antidepressants such as Paxil, Prozac, and Celexa is increasing around the world, with the United States leading the way.
More than 10 percent of Americans (110 out of 1,000) take antidepressants, followed by Iceland (10.6 percent), Australia (8.9 percent), Canada (8.6 percent), Denmark (8.5 percent), Sweden (7.9 percent), and Portugal (7.8 percent).
(From the text)

Would aggressive drug prescribing solve the problem? Drug overdoses, masked by legal prescriptions, kill more Americans than gun and car accidents.
Despite the numerous deaths, the number of new cases of depression worldwide actually increased by 50 percent between 1990 and 2017.
This is even more severe in wealthy countries, including the United States.
The use of antidepressants in China, which has recently emerged as a G2 country, is also rapidly increasing.

As a psychiatrist, the author acknowledges the need for drug treatment, but points out that current methods have clear limitations.
Especially in a world where addictions can be found with a single click, drug treatment could lead to the proliferation of illegal drugs or create new addiction epidemics that replace existing ones, they say.
In fact, the book introduces the stories of people who changed their stimuli from drugs to alcohol and from drugs to food, but were unable to escape addiction.
Is there no alternative?

Dopamine Nation focuses on the experiences of addicts.
Who better to teach someone how to break free from addiction? It's the addicts themselves.
This book introduces ways to find balance in the brain and the center of life through real-life stories of patients who fell victim to addiction and then escaped.


From a Silicon Valley scientist obsessed with voyeurism who creates a masturbation machine, to a college student who dabbled in dozens of drugs for 13 years, to a woman who started out with food addiction and then became immersed in Trump-style conspiracy theories, to a Korean student who lost touch with reality because of Instagram, the stories of these diverse addicts and their journeys of overcoming them are fascinating and contain real-world solutions.
This includes the author's own story of depression and his addiction to erotic fiction.

Everyone wants to get away from the world for a while and relax.
I hope we can break free from the impossible standards we often apply to ourselves and others.
'Why did I do that? Why can't I do this? Look what they did to me.
'What am I going to do to them?' So we're drawn to anything that offers a pleasant escape we can lean on right now.
Trendy cocktails, the echo chamber effect of social media, binge-watching reality shows, watching porn online at night, potato chips and fast food, immersive video games, second-rate vampire novels… the list is endless.
Addictive objects and behaviors may give us a temporary respite, but in the long run they compound our problems.
But what if, instead of escaping from the world and seeking oblivion, we turned toward it? What if, instead of running away from it, we immersed ourselves in it? (From the closing remarks)

The author says the first step to breaking free from addiction is facing the pain.
As a concrete method, Chapters 4 and 5 present the 'DOPAMINE 7 Steps' to objectively evaluate one's current situation and seek alternatives, and three self-restraint strategies to escape addiction by limiting space, time, and meaning.
Finally, Chapters 7 and 8 introduce how to overcome addiction and find vitality in life by facing suffering, and how to tell it like it is to improve relationships.


“If you want to be happy, face your pain.”

This book provides a sobering understanding of what is happening in our brains right now for modern people who are surviving on dopamine in a fatigued society but are unaware of the seriousness of their addiction, and offers medical advice on how to achieve happiness without relying on drugs.
I recommend this book to all modern people who are hastily searching for pleasure as if it were happiness.
(From a recommendation by Jeong Jae-seung)

We all want to escape from the routines and parts of life that lead us astray.
But what if, instead of trying to escape, we learned to face it and create peaceful harmony with ourselves and those around us? Lemke's book fundamentally changes our understanding of mental illness, pleasure, pain, reward, and stress.
Face it and you will be happy.
(From Daniel Levertin's recommendation)

The author says that paradoxically, the reason we cling to our addictions is because we want to be happy.
Everyone is suffering because they are addicted to happiness, like the pleasure-pain scale that rules the brain.
Messages urging us to pursue happiness are not limited to the secular realm.
Modern religions also say that the theology of self-awareness, self-expression, and self-realization is the highest good.
In parenting, it is also said to reduce negative experiences and give achievements and positive experiences.


But can a child raised in a solitary confinement filled with cushioning material truly survive the harsh realities of life? As Daniel Levertin says, facing reality is the only way to find happiness.
This book will be an excellent guide for modern people who, in a fatigued society, are surviving on dopamine but are not yet aware of the seriousness of their addiction.

"Dopamine Nation" immediately rose to the top of the New York Times and LA Times bestseller lists (published in the US in August 2021) and continues to be a top Amazon.com bestseller.