Dopamine Nation

A Doctor Reads Erotica at 2 A.M.

Anna Lembke is a psychiatrist at Stanford, chief of the addiction medicine clinic, and the author of a previous book on the prescription opioid epidemic. She is not the person you would expect to be reading Fifty Shades of Grey on her Kindle at two o'clock on a weeknight morning. But that is where she found herself around the age of forty, hiding the screen from her husband, blowing through paranormal romance, then werewolf erotica, then frankly pornographic novels, then bringing the device to work and reading between patients. She started skipping to the climax three-quarters of the way through and abandoning the rest. She had a husband she loved, children she adored, work that mattered, no trauma to medicate. And she could not put the book down.

That confession opens Dopamine Nation, and it is doing more work than it appears to. Lembke is establishing that the thing she sees in her patients — the engineer who built an electrical machine to amplify orgasms, the teenager smoking cannabis from waking to sleep, the millionaire who took ice baths until his lips turned blue — is the same thing she sees in herself. Compulsive overconsumption is not a character flaw of weak people. It is what happens to a brain that evolved for scarcity when scarcity disappears.

The world used to be hard to get anything from. Food took effort. Sex required another human. Stories arrived once a week, on paper. Our reward system — the dopamine machinery deep in the brain — evolved for that world. Now there is a glowing rectangle in your pocket that can deliver food, sex, stories, gambling, validation, and outrage on a few seconds' notice. Lembke calls the smartphone the modern hypodermic needle, delivering digital dopamine twenty-four hours a day for a wired generation. The cocaine of our age is not cocaine. It is everything.