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" Researchers interviewed nearly 150 thousand people in 26 countries to determine the prevalence of generalized anxiety disorder to find, had excessive and uncontrollable worry adversely affected their life. They found that richer countries had higher rates of anxiety than poor ones. The authors wrote, "The disorder is significantly more prevalent and impairing in high income countries than in low or middle income countries." The number of new cases of depression world-wide increased 50% between 1990 and 2017. The highest increases in new cases were seen in countries with the highest sociodemographic index income, especially North America. Physical pain too is increasing. Over the course of my career, I have seen more patients, including otherwise healthy young people presenting with full-bodied pain despite the absence of any identifiable disease or tissue injury. The numbers and types of unexplained physical pain syndromes have grown. Complex regional pain syndrome, fibromyalgia... [], and so on. When researchers ask the following question to people in 30 countries around the world. "During the past four weeks, how often have you had bodily aches or pains"...[]. They found that Americans reported more pain than any other country. 34% of Americans said they experienced pain often or very often, compared to 19% of people living in China, 18% of people living in Japan, 13% of people living in Switzerland, and 11% of people living in South Africa. The question is, "Why in an unprecedented time of wealth, freedom, technological progress, and medical advancement, do we appear to be unhappier and in more pain than ever?'. The reason we're all so miserable may be because we're working so hard to avoid being miserable. "
― Anna Lembke , Dopamine Nation: Finding Balance in the Age of Indulgence
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" Because we’ve transformed the world from a place of scarcity to a place of overwhelming abundance: Drugs, food, news, gambling, shopping, gaming, texting, sexting, Facebooking, Instagramming, YouTubing, tweeting . . . the increased numbers, variety, and potency of highly rewarding stimuli today is staggering. The smartphone is the modern-day hypodermic needle, delivering digital dopamine 24/7 for a wired generation. "
― Anna Lembke , Dopamine Nation: Finding Balance in the Age of Indulgence
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" Once we get the anticipated reward, brain dopamine firing increases well above tonic baseline, but if the reward we anticipated doesn't materialise, dopamine levels fall well below baseline. Which is to say, if we get the expected reward, we get an even bigger spike, if we don't get the expected reward, we experience an even bigger plunge.
We've all experienced the letdown of unmet expectations. An expected reward that failed to materialise is worse than a reward that was never anticipated in the first place.
How does cue-induced craving translate to our pleasure-pain balance? The balance tips to the side of pleasure, a dopamine mini spike, in anticipation of future reward. Immediately followed by a tip to the side of pain, a dopamine mini defecit, in the aftermath of the cue. The dopamine defecit is craving and drives drug seeking behaviour. "
― Anna Lembke , Dopamine Nation: Finding Balance in the Age of Indulgence
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" Pleasure and pain are co-located. In addition to the discovery of dopamine, neuro-scientists have determined that pleasure and pain are processed in overlapping brain regions, and work via an opponent processing mechanism. Another way to say this is pleasure and pain work like a balance. Imagine our brains contains a balance, a scale with a fulcrum in the centre. When nothing is on the balance it's level with the ground. When we experience pleasure, dopamine is released in our reward pathway and the balance tips to the side of pleasure. The more our balance tips and the faster it tips, the more pleasure we feel. But here's the important thing about the balance. 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, everytime the balance tips towards pleasure, powerful self-regulating mechanisms kick into action 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. "
― Anna Lembke , Dopamine Nation: Finding Balance in the Age of Indulgence
