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41 pages 1 hour read

Anna Lembke

Dopamine Nation: Finding Balance in the Age of Indulgence

Nonfiction | Book | Adult | Published in 2021

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Part 3, Chapter 9-ConclusionChapter Summaries & Analyses

Chapter 9 Summary: “Prosocial Shame”

Lembke introduces the concept of shame and how it differs from guilt. Shame tends to make people feel badly about who they are; guilt tends to make people feel bad about a particular action or misbehavior. Lembke notes that shame is maladaptive, whereas guilt is adaptive. In addition, she briefly mentions her objection to the clarity of the distinction between shame and guilt, admitting that she tends to see degrees of overlap. She then proceeds to discuss destructive shame and “prosocial” shame. Lembke offers an anecdote from her clinical practice as a representation of destructive shame—a woman named Lori, who at her first meeting with Lembke was abrasive. After Lembke eased Lori into a less confrontational state, she learned how Lori developed her compulsive behaviors. The first clue was that she was taking more than six times the prescribed dose of an antidepressant medication. She then revealed to Lembke that she had troubles in the past with binging on food, alcohol, and Ambien. Lembke provides some of Lori’s biographical details and traces her compulsive behavior to the shame she felt as a result of her religious upbringing. She was a devout worshiper but was brought up in a faith in which God was forgiving; instead, she believed, God was vengeful.

Lembke uses Lori’s story to demonstrate how destructive shame can create a feedback loop of compulsive behavior. She identifies four parts of the destructive shame cycle: overconsumption, shame, lying, and isolation. Nothing breaks the loop. She then discusses how this differs from “prosocial” shame and uses AA to dissect this contrast. At AA, “prosocial” shame is a critical component of the group’s core mission. Lembke identifies four components of the “prosocial” shame cycle: overconsumption, shame, radical honesty, and acceptance. Unlike the cycle for destructive shame, this one is broken when a person’s honesty is met with empathy instead of shaming.

Lembke further examines the “prosocial” shame used within AA. She weaves economics into her discussion and explains that the “club goods,” or rewards that one derives from being in a group, help reinforce a person’s sense of belonging. She mentions that for AA, honest reporting of experiencing a recurrence of symptoms is crucial for group members’ ability to help each other. In the final part of the chapter, Lembke discusses “prosocial” shaming as it pertains to parenting. Using an incident from her own experience, in which she ate her daughter’s chocolate and then lied about it, Lembke urges people to practice radical honesty because it provides children with a better example than her behavior toward her daughter in this anecdote.

Conclusion Summary: “Lessons of the Balance”

Lembke reiterates that modern society has created a world that can be overwhelming and that it’s natural to want to find ways to take a break from it. She mentions Muhammad, a patient of hers who sought treatment for an addiction to cannabis. She recalled a story he told her about a time he went hiking to distract himself from wanting to smoke cannabis but ended up in a place where he had smoked cannabis. His cravings became increasingly intense, and he was finally relieved of them after he had an epiphany while hiking. He was distracted by a beetle on a leaf and decided to take photographs of it. He then changed his perspective and took more pictures. All the rest of the hike, Muhammad looked for more beetles. What he learned was how changing his perspective could be useful in recovery—and that stillness is essential in a stimulus-saturated world. Lembke provides a list of 10 lessons of balance, which summarize the book’s main ideas.

Part 3, Chapter 9-Conclusion Analysis

Lembke’s primary focus in Chapter 9 is to examine the knife edge between what she terms “prosocial shame” and “destructive shame.” Shame by itself, as Lembke points out, can be useful in getting someone to drop their compulsive behavior, but it depends on what kind of shame is applied. One way to look at destructive shame is to view it as someone passing judgment on another’s behavior. Sometimes, this leads to scorn, ridicule, and contempt, which can damage a person’s recovery and have a lasting effect on the person’s self-image. Since many seeking help for an addiction carry a great deal of shame for their behavior, when they meet the negativity of destructive shame, it validates their self-disgust. Lembke introduces a patient named Lori and uses her story as an example. When Lori finally sought help for her compulsive behaviors in her church, she received a reaction that made her feel worse. She then retreated further into her negative behaviors. On the contrary, “prosocial” shame, according to Lembke, is a valuable tool in the process of recovery. Lembke mentions how this concept is built into the AA model. In fact, the fear of lying about resuming symptoms of addiction is one way that members of the group remain committed to sobriety. As Lembke often does throughout the book, she includes a graphic, which effectively illustrates the cyclical nature of destructive shame and the manner in which “prosocial” shame breaks the cycle that can be defined as isolation versus acceptance. Lembke winnows down her claims and notes, “We can leverage shame without shaming” (218). Shame is necessary and can be useful in recovery, but it must come with some level of acceptance.

The book’s conclusion begins with Lembke’s recognition that wanting a reprieve from the hustle of modern life is natural. This position tempers much of what she posits throughout the book and clarifies that she’s following the “prosocial” shame model she mentioned in Chapter 9. Effectively, Lembke offers an absolution here and demonstrates a level of empathy on par with the acceptance she mentioned earlier. In addition, she also lays a good deal of blame at the feet of modern industry and commerce, highlighting the book’s theme on The Danger of Digital Drugs as she notes, “We’re drawn to any of the pleasurable forms of escape that are now available to us: trendy cocktails, the echo chamber of social media, binge-watching reality shows, an evening of internet porn, potato chips and fast food” (231). The list could go on. Given that the world is so full of temptation and distraction, she suggests that it’s unsurprising that people increasingly engage in compulsive behavior and lose control of their lives. One could even say that Lembke sees it as inevitable.

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