November 7

Dopamine Nation


Resetting the pleasure/pain balance

By Dr. Anna Lembke

Book Review by Meredith Connie

In the written works of F.M. Alexander I have always been fascinated by the idea that Alexander Technique is some kind of panacea for the problems of the world – and there is a thread that runs through the AT community that believes – from my observations – that AT can solve a great spread of problems from physical discomfort and injury all the way through to the psychological pitfalls of being a member of the human race.  My own personal skepticism has been tempered by my experiences – including the patience to really see the change in action over time.  However, in AT as in all things, change is more effective and clarifying after an identification of the problem you want to change has been made.  In other words, AT does have the potential to create changes across the psycho-physical-spiritual spectrum of consciousness, but only if we personally want it to.  So how do we identify all the things that warrant change?  The way the best of us do – through curiosity.

Curiosity led me to Dopamine Nation:  Finding Balance in the Age of Indulgence.  There are many interesting ideas that contribute to our understanding of pain and wellness in the book but what led me to it in the first place was noting the work of Dr Anna Lembke on the substantial accrued evidence that smart phones act on the brain like any other drug.  Smart phones and social media are actively changing the way our brains function through their stimulation of the pleasure response – increasing dopamine production and receptors in the typical spiral seen in addiction – the more you get something the larger the quantity needed to get the high.  There is a larger cultural conversation going on at the moment surrounding the shift towards mental health awareness in the aftermath of isolation during the pandemic, and this book will contribute to understanding both why the discussion is important and why it is also lacking.  If you interact with teenagers and young adults and see how stressed out, sensitive and overwhelmed by challenges many of them seem, then this book will also offer perspective – and how Alexander Technique can offer some a pathway towards balance.

There are contributions in Dopamine Nation that fill in some gaps in my understanding of the pain/pleasure systems within the body.  Lembke evokes the image of a see-saw to demonstrate the way in which any pleasurable activity (an activity which fires up dopamine in the brain) must have balance by some form of pain to restore an over-stimulated system to homeostasis.  In other words, our system wants to retain a balance between pleasure and pain:

It wants to remain level, that is, in equilibrium.  It does not want to be tipped for very long to one side or another.  Hence, every time the balance tips toward pleasure, powerful self-regulating mechanisms kick in to bring it level again.  These self-regulating mechanisms do not require conscious thought or an act of will.  They just happen, like a reflex. [p. 51]

If you have ever done some form of performing, as I do as a musician, then this is a very comforting thought – after the high of a performance there is always a psychological low.  This is an experience common to all performers – a name for it might be post-performance blues.  Of course, as performing becomes a more everyday experience, then the high is not as great, and so the inevitable low is also not as great.  Many performers say, for instance, that after having children performing becomes very easy because it isn’t so important anymore.  Where there is much invested, there will be a large emotional reaction to it’s enactment, and performers invest a great deal of themselves within the act of performing.  For many years I detested this low, but recognizing it as a form of resetting the equilibrium brings a compassion to it. 

The compassion that can be found in understanding the biological imperative to balance out a high with a low is akin to the relief I felt when I understood the potential of brain plasticity – we can change the habits of a life-time, yes, but there are heavy metabolic costs to making such changes; it can be plain exhausting.  Having compassion for the lows of life as a balancing mechanism in the body is both reassuring and refreshing.

Many of us experience physical pain when opening up a new pathway through the mind-body; it can really hurt to change a habit as an underused or damaged part of your system begins to ‘take the load’ of postural support.  Understanding that pain is not just a warning system (bad! bad! don’t do it!)  but is also a mechanism to restore homeostasis can help us.  When a student feels pain and when we ourselves feel pain we should question what we are doing, but conceptualizing and communicating the inevitability of feeling pain is also very important.  I myself, six years in, am finally starting to feel less pain when I play my instrument.  I’m sure that if I had an independent source of income and nothing else to do the process would be faster, but given that most of our students are like me – overworked and time-poor – it is no wonder that it takes a particular kind of person to really commit to the long-term process of transformation through Alexander Technique.

More and more I am understanding how many factors it takes to move towards and maintain homeostasis within our body-mind systems (our psycho-physical-spiritual whole).  This book has a lot of insight into how we can moderate excessive behaviour in a way that is different to other books that deal with addiction in both small and large form.  The linkages between addictive behaviours and trauma have been effectively explored by Bessel Van der Kolk (The Body Keeps the Score) and Gabor Mate (When the Body says No), who make a very strong case that societal and parenting misdeeds create tendencies towards addiction and maladaptive relationship management (anxious and avoidant attachment styles).

In a related argument that builds on this work, Lembke writes convincingly that the modern age of hyper indulgence or avoidance of pain is creating a different kind of imbalance. One that makes everyone vulnerable to addictive tendencies, particularly because of social media and avatars, and instant gratification through online everything (she now does not own a smart phone because of her research, see her interview on smart phone addiction with John Favreau  She asks the question “Why, in a time of unprecedented wealth, freedom, technological progress, and medical advance, do we appear to be unhappier and in more pain than ever?” To Lembke the answer is that “we’re working so hard to avoid being miserable”. [p. 46]

The net effect is that we now need more reward to feel pleasure, and less injury to feel pain.  This recalibration is occurring not just at the level of the individual but also at the level of nations.  Which invites the question:  How do we survive and thrive in this new ecosystem?  [p. 67]

Lembke examines how, as a therapist, she has successfully treated her patients and herself through modifications of behaviour (what she calls ‘Self-binding’ or the setting of limits around people, places and things to avoid transgressions).  What I find the most interesting is her exploration of actively pursuing pain as a way to regulate our systems.  For example, there is some research that suggests that acupuncture may be successful because the administering of a small amount of pain can reduce larger amounts of pain [p. 154] (a discussion that completely avoids the interconnectedness of body tissue and systems, but that is not where her expertise lies).  The pursuit of psychological pain is explored through a chapter titled ‘radical honesty’ – an interesting read and something that I see missing from our society on every level, including within Alexander Technique.

The most well-intentioned analyses often miss how important awareness of our bodily systems can be; this book is not one of them, but it is also not informed by the kind of self-awareness that Alexander Technique demands of us on minute-by-minute basis.  To me, asking, listening, moderating the bodies systems as we do within Alexander Technique by noting tensions and misalignments and then running the sequenced order of AT directions – this is a form of radical honesty.  The body cannot hide when there is a lack of equilibrium – if you are fully engaged with listening to it. 

It’s an interesting and engaging read – it is not heavy or difficult – and an enlightening contribution to the understanding of our current hyper-sensitive times and pain management.

All page references from the Headline Press Edition:  Dopamine Nation:  Finding Balance in the Age of Indulgence by Dr.  Anna Lembke, London, 2021.

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