A Stanford Psychiatrist on Escaping the Addiction Economy

Dr. Anna Lembke, Stanford psychiatrist and bestselling author of Dopamine Nation, joins Scott Galloway to discuss our dependence on validation – and why achievement doesn’t always make us feel better about ourselves. Drawing on her new book, Radical Surrender, she explains how to recognize addictive behavior, when parenting becomes enabling, and why letting go of control can help us build more meaningful lives. Plus, Scott opens up about the personal cost of trying to impress strangers. Order Dr. Lembke’s new book: Radical Surrender: Letting Go in a World Addicted to Control. Learn more about your ad choices. Visit podcastchoices.com/adchoices Learn more about your ad choices. Visit podcastchoices.com/adchoices

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• 1:37Speaker 00

  Welcome to a bonus episode of the Prop G Pod. We're now bringing you an Extra Conversations episode on Tuesdays. More time with the people who help us think differently about work, life, and what matters. Today, we're joined by Anna Lemke, a professor of psychiatry at Stanford, bestselling author, and psychiatrist specializing in addiction medicine. We discussed with Dr. Lemke her new book Radical Surrender and why a surrendered life is a more purposeful one, what recognizing and addressing addiction should actually look like, the modern teen rebels and how we can help them from falling behind, and how to avoid endemic narcissism and the urge to constantly measure our own success. That hits home. I absolutely adore Dr. Lemke.

• 2:19Speaker 00

  Her previous episode with us was one of the most downloaded. I am fascinated. Have people say this is an attention economy? No, it's not. It's an addiction economy. Anyways, with that, we hope you enjoy our conversation with Dr. Anna Lembke.

• 2:35Speaker 00

  Doctor, where does this podcast find you?

• 2:37Speaker 03

  I am in Stanford, California, in my office.

• 2:41Speaker 00

  Makes sense. And I imagine, as is the case 364 days a year, I imagine it's beautiful out there.

• 2:47Speaker 03

  It is gorgeous. We're having a great fall.

• 2:50Speaker 00

  By the way, I really enjoyed our last conversation. I was excited to see that we're having you on again.

• 2:54Speaker 03

  Thank you. I enjoyed it too. And I got a lot of credibility with my sons and their friends. So that was awesome.

• 3:01Speaker 00

  Yeah, there you go. You're with that crazy guy. So let's bust right into it. Your newest book Radical Surrender, which comes out November the 10th, offers readers the tools for letting go in a world engineered for certainty and control. You argue that we live in a time of unprecedented control over all aspects of our daily lives, which has made us unable to tolerate uncertainty. When we do face it, we often experience anxiety, loneliness, boredom, or self-loathing, shame in response.

• 3:32Speaker 00

  Set the table here. How has the world changed and created, if you will,

• 3:40Speaker 00

  this level of anxiety? What's changed about the world, if you will?

• 3:49Speaker 03

  First of all, we evolved over millions of years of evolution to exert our agency to reduce uncertainty. It's what's allowed us to survive in a chaotic, natural environment where famine, flood, fire was always imminently threatening our survival. We have evolved science and technology to really create an unprecedented amount of control over the natural environment, which you would think would make us all feel much safer. But the paradox here is that the more levers for micro-control that we have over our lives,

• 4:31Speaker 03

  the more anxious, fearful, and lonely, I would argue, as well as bored, we've become. And it is a paradox because, again, we are sort of teleologically or biologically evolved to exert agency. It feels good. It's adaptive in a chaotic environment. But now we are experiencing control at the micro level. And also, we've created this sort of virtual space where we have engineered a reality that we have an incredible amount of control over. But what I'm seeing is people, more and more people, especially young people gripped by paralyzing anxiety

• 5:14Speaker 03

  because they feel like, because they have so many choices and so much control, that if they make the wrong choice, they're going to miss out on their best lives. Also, a lot of shame that goes along with that when things don't work out perfectly. People feel like they only have themselves to blame. So there's an incredible amount of self-loathing. Also sadly, more and more people harming themselves, young people ending their own lives after really quite minor failures, like what a generation ago would have been considered tolerable, like social rejection or an academic reprimand. It becomes intolerable. And of course, the virtual space and the internet makes that worse

• 5:58Speaker 03

  as our mistakes ricochet around the world, as we see these constant curated images and narratives of these perfect lives. So again, the paradox of control is that we have so many more ways to quote unquote optimize that we all feel we should be engineering perfection.

• 6:16Speaker 00

  So I want to talk about social media. And that's sort of my go-to for the world's ills as I immediately look like, what's social media has done to cause this? But even before that, as a parent, I adopted, I forget, I saw this wonderful movie with Gene Hackman and Ben Stiller, where the protagonist, Ben Stiller's wife passes away and all he thinks about is protecting his kids. And it's a movie from about 20 years ago. And it really struck me because I remember my youngest broke his arm when he was like, I don't know, maybe four or five. And my partner was just so upset and said, we need to rearrange the living room. And I'm like, we're doing no such thing. And I remember when I was in elementary school, it was like the outpatient emergency room.

• 7:01Speaker 00

  There were kids with eye patches. We were, remember signing casts? That was a thing. Someone always had a cast and we'd sign it.

• 7:10Speaker 03

  Right.

• 7:10Speaker 00

  And you don't want them in danger, but you do want them in uncertainty and risk. And I used to leave my mom's house on a Saturday at 9:00 AM with a Schwinn bike and Abba Zaba bar and 35 cents. And she wouldn't see me for 12 hours. And in those 12 hours, I faced a lot of uncertainty and even mild amount of danger, whether it was roaming stray dogs or sixth graders who like to beat up second graders. And I think that was good for me. And I find that we inevitably, if my kids are 15 minutes late home from school, we call MI6. And so talk about, even before they have screens,

• 7:55Speaker 00

  what parenting, what role parenting or over-parenting, I'll say, plays in all this?

• 8:01Speaker 03

  Yeah, so this is hugely relevant. I think many of us, maybe not you, but many of us are guilty of trying to raise our kids in these padded cells so that they are insulated from any kind of pain or uncertainty, so that we can also reduce our anxiety. And in many ways, it's a kind of a codependent phenomenon where we are protecting our kids so that we're not experiencing the anxiety about how they might get hurt or fail in some way. And as a result, we are raising a generation of young people that has no tolerance for uncertainty and also no kind of psychological touchstone for resilience,

• 8:46Speaker 03

  for knowing that they can encounter failure, that they can have a negative experience and it's going to be okay and they can lift themselves up. And the technology really exacerbates this problem. I mean, the ways in which we can now track our children from infancy with a device in the other room to make sure that their breathing is okay. And of course, these are natural worries that parents have. But we're now mediating this anxiety through these devices, which only make it worse because they play into our obsessive compulsive loops of wanting constant reassurance. And one thing we know about OCD is that the more we look for and get reassurance,

• 9:29Speaker 03

  the more OCD or anxious we become. It's kind of a self-fulfilling prophecy. So yeah, it's really, and we see that at the university level. I mean, here at Stanford, we see these wonderful young people who have enormous gifts and talents and promise for the future. But like any bit of uncertainty or even the hint of imperfection just sends them reeling. It's like there's no ballast to hold all that.

• 9:59Speaker 00

  One of the reasons I love speaking to you is I feel like I get free therapy from those qualified person in the world. So, back, back to me and my kids. I worry, what I, I see, I want to see if you see this path that I see. And that is, people think I would have had technology figured out in our home. I wrote a book warning the world about technology in 2017. And the cobbler's kids have no shoe here, no shoes. My kids are, especially my youngest, device addiction will, you know, fib, take TikTok into the bathroom, you know, just, we're literally, we've just screwed it all up. Anyway, what I see is, is constant action, reaction, DOPA, action, reaction stimulus,

• 10:43Speaker 00

  AI, million times a second with content to just keep them glued and the DOPA flowing. And what I worry about, and I used to come home and watch five hours of cartoons for, I guess, a milder shot of DOPA, or occasionally sneak into my dad's garage to get a peek at a Playboy for, you know, another DOPA hit, right? Something.

• 11:04Speaker 03

  Right.

• 11:05Speaker 00

  And what I see, though, is now that they have the IV connected to them six hours a day, and that constant cycle of DOPA, and then you take the device away, that is the first time I've ever seen addiction up close.

• 11:19Speaker 03

  Mm-hmm, mm-hmm.

• 11:20Speaker 00

  The lying, the negotiating, the, the outbursts, the inability to emotionally regulate, it's like, oh, I'm living with an addict. I mean, this, this is just what an addict acts like. Is all of this, is social media, are the largest companies in the world basically creating the mother of all on-ramps to addiction to other things later in life?

• 11:42Speaker 03

  Short answer, yes. That is exactly what is happening. These platforms are not just powerful tools, they're also very potent drugs. And the, one of the main reasons that they're so potent, and so much more potent, let's say than TV, you know, which people try to analogize to and say, oh, people said TV was the idea box. This is a totally different level, in large part because of our ability to micro-control what we're consuming. So, a huge part of addiction, people think that addiction is trying to like, escape control. Addiction is all about control, trying to assert control over our micro-experience to change the way they feel. And there's no more immediate way to do that than to swipe right, swipe left, scroll up,

• 12:27Speaker 03

  scroll down, tap. And it goes right to our visual cortex, which goes right to our brain's reward pathway, releasing dopamine in the nucleus accumbens, the same reward pathway that's activated by drugs and alcohol. And you're absolutely right, when kids, people in general, but especially we see this clinically with kids addicted to all forms of digital media, when we take the device away, they go into full-on withdrawal. The universal symptoms of withdrawal from any addictive substance or behavior are anxiety, irritability, insomnia, depression, and craving. But we also see physiologic, or physical symptoms of withdrawal, headache, you know, dizziness, stomach aches.

• 13:12Speaker 03

  And many of these kids have sort of these rageful temper tantrums, flinging themselves against the wall or on the floor. But the thing is, it's all time limited. For the most part, if you can create a safe container for these kids, within a couple of days, they'll begin to emerge. And what so many families and parents report is like, oh my gosh, I get my kid back. This person is sort of the person I recognize, they're socialized, they, they come and talk to us, they're helping with, with chores in the house. And I think this is a really important piece of it, like, part of addiction is creating personality disorders and sociopathy. I mean, that's sort of inherent, so you talk about the lying, you know, the lying habit is key to any addiction.

• 13:57Speaker 03

  So, you know, we, we really change our personalities when we are addicted. And when we get into recovery and emerge from that, we, we restore our sanity, we, we return to the people that we are, and we see this all the time in kids. The other thing I would say is there is a growing body of evidence showing that if you take emotionally distressed youth, and you reduce their time on social media to one hour a day, and you objectively measure that, so you're tracking what they're doing, and you compare that to a control group of youth where you don't change their social media consumption, what you see in the group that reduces social media use to no more than one hour a day, is decreases in depression, decreases in anxiety, improvements in sleep,

• 14:41Speaker 03

  because sleep is a huge part of this and mediates a lot of the emotional distress, improvements in loneliness and FOMO, fear of missing out. So, yeah, this is a, this is a huge and real issue. And again, the technology is not going away, we all know that, you can't put the genie back in the bottle. But we have got to establish a healthier relationship with the technology. And we can't really leave it to parents alone, it's just too hard. You know, schools have to come on board, the companies that make and profit from these digital devices and digital media have to come on board, which is why the meta-settlement recently was so landmark, because it didn't just involve billions of dollars, you know,

• 15:23Speaker 03

  in sort of retributed payment, but also it involved product design for teen Instagram, which, which I think is really momentous. We'll see if it happens and if it helps, but I think it's an important step forward.

• 15:37Speaker 00

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• 18:37Speaker 00

  I do want to get to your work, but I think of you as one of the foremost authorities on a very, the very broad topic of addiction. And I've said that people say we're an attention economy. I don't think that's addiction economy. In my sense, and I want you to correct me here or edit me, that addiction stems from a healthy place of our instincts. There's a scarcity of salty, sugary, fatty food. So when we, when, when we have it in front of us because of industrial production, we gorge. An absence of free, safe play. So when we have free, safe play on our phone, we get addicted to gambling. An absence of mating opportunities. So if something resembling or a reasonable facsimile of a mating opportunity, we get,

• 19:19Speaker 00

  and there's industrial production of it, we get addicted to porn. Help us understand when an addiction is forming. And also, I, my other thesis is everyone has addictions. It's just what it is. It's an online shopping. Is it codependency? Is it addiction to food? Is it addiction to affirmation of others? Is it an addiction to money? What is it, right? Everybody has a certain amount of it. Take us back to, if you're a parent, where do you notice kids are beginning to develop? Or even in yourself as a young adult, some type of addiction? And I think part of the problem is we treat it like a monster and we put it in a closet and we all try and ignore it, not recognizing we're all guilty of some sort of addiction. At least I believe so.

• 20:04Speaker 00

  Take me to you're a parent. When can you recognize certain addictive tendencies? And how do you start to, if you will, educate a kid around modulation?

• 20:14Speaker 03

  Great. Yeah. I mean, I agree with everything that you just said. I think addiction is the modern plague. It's going to be the major problem that humans face in the foreseeable future because we have created this world of overwhelming abundance and also drugified almost everything that we do and consume by making it more potently reinforcing, more accessible, more novel, more bountiful. Parents need to understand, number one, that digital media are inherently reinforcing and therefore potentially addictive. Moving videos are drugs. Moving videos are drugs. Okay.

• 20:56Speaker 03

  It doesn't mean that they're, that we should never watch them ever, but they are so potently reinforcing, especially in their short form. But our brains evolved to fixate onto moving images, especially moving images of other humans and other living organisms. And that has become a drug. Quantity and frequency matter. So although we don't base our diagnosis of addiction on quantity and frequency for any substance, it's not that quantity and frequency is irrelevant. It's highly relevant. The more people use, the more they change their brains, the more likely they are to get addicted. Addiction is a brain disease characterized by the continued compulsive use of a substance

• 21:39Speaker 03

  or behavior despite harm to self and/or others. What do we look for? Out of control use, compulsive use, continued use despite consequences. We also look for tolerance, needing more of that drug over time to get the same effect. And also withdrawal, a physiologic negative response when we stop using. What does that look like in kids? Number one, that, that looks like a kid who is constantly compulsively seeking more time online. That looks like a kid who's, once they're engaged, is totally transported and entranced. That looks like a kid who, when they get off, plunges into an acute withdrawal phenomenon where they're highly emotionally dysregulated. Why?

• 22:24Speaker 03

  They're in withdrawal. That looks like a kid who has lost joy in other things that used to give them pleasure in reading and playing outside, playing with friends in real life, spending time with family, playing with a pet. That looks like a kid who's narrowed their focus where this one thing is the only thing they want to do. Other things become less salient. And that looks like a kid who lies. So, you know, kids to some extent are going to experiment with lying as they play around with language and try to figure out, you know, what are the boundaries of what language can communicate and not communicate and, you know. But, but really, one of the unspoken and sort of not in the diagnostic and statistical

• 23:09Speaker 03

  manual of mental disorders, but a key feature of addiction is lying about use, but also developing the lying habit more broadly, just lying about other stuff, because lying becomes the sort of modus operandi. I think you're right. This whole monster in the closet, not talking about it, terrified to name it, only makes it worse. One of the very first recommendations I make for families is not to immediately take the devices away, but to immediately sit down and talk openly about the problem. And I really encourage parents to be transparent about their own addictive patterns, you know, to say to their kids, hey, you're not the only one. I'm also struggling with, you know, consuming X, Y, or Z.

• 23:53Speaker 03

  And to really be open about, like, it's a, it's a, we're all struggling, right? It's difficult for all of us, but let's acknowledge the ways in which our individual lives and our family life has become impoverished because of the ways that we're all in our separate rooms, on our separate devices, consuming our separate digital media.

• 24:13Speaker 00

  In addition to addiction to actual social media itself, how has this constant DOPA economy, what addictions has that increased or quite frankly decreased? I see that alcohol consumption is down. I think it's because people are at home because they think a cheaper and easier and lower risk means of getting DOPA is, doesn't involve going out and drinking alcohol. So I would imagine alcohol addiction has gone down among teens because of social media. What, how has social media impacted other addictions distinct of social media itself?

• 24:50Speaker 03

  Well, you're absolutely right. Alcohol consumption is going down broadly across the United States. I like to think that's at least in some part due to increased awareness about the harms of alcohol, but I think you're absolutely right. Some of this is just trading addictions or compulsive sort of, you know, addictive tendencies to our devices, to digital media, to the internet. Some of the fastest rising addictions, and the numbers are very hard to get on this because the people who have them don't disclose them and they're otherwise also just hard to get, are addiction to pornography and compulsive masturbation, addiction to online

• 25:31Speaker 03

  gambling, especially sports betting, addiction, we've talked about social media, gaming in all its various forms, massive uptick in addictions to online shopping and sort of consumptive behaviors more broadly. So those are really leading the charge. There are gender differences here as well, where we have more women getting addicted to social media and online shopping, more men to pornography and sports betting. But, you know, we have plenty of men and women in those opposite categories. So yeah, the, the landscape of sort of teenage rebellion has really changed. You know, the teenage rebel used to be the kid that went out and like disappeared in

• 26:15Speaker 03

  the world and yeah, drank, maybe used drugs, experimented with drugs. Now you could almost say that the, the teenage rebel today doesn't leave their room, doesn't get off their devices, doesn't speak to their parents, you know, has gone virtually mute, is absolutely refusing to participate in any aspect of life. In Japan, they've, they have a name for this, hikikomori, which is kids who just literally disappear inside their rooms and behind their screens.

• 26:43Speaker 00

  I literally think there's millions of young men that have, that we don't see.

• 26:49Speaker 03

  Yes.

• 26:50Speaker 00

  That are living with their parents in their basements, living, you know, quiet lives. You know that, that saying about millions of men live quiet lives of desperation? I think these, I think there's millions of young men living quiet lives of isolation.

• 27:03Speaker 03

  Yes.

• 27:04Speaker 00

  And we just don't see them. And it's not even that they're criminals or that they're joining the Taliban or that they're, they're not necessarily inherently bad people. They're just, they've just disappeared.

• 27:16Speaker 03

  Yeah.

• 27:17Speaker 00

  They're just invisible to the world, invisible to themselves. And they wake up in their late twenties and they don't have, maybe they're overweight, they're anxious, they're fearful, and they've never learned the skills to have friends, mentors, mates, get into an office, figure out how to get along with others. You know, they just kind of become almost unsavable. Do you think there's a role? And this comment is pregnant with a question, so, or this question is pregnant with a comment, so I'll just make the comment. I would like to see, and maybe they have this, in junior and senior years in high school, I think it's got to start pretty early, something resembling what I'll call an adulting curriculum.

• 27:59Speaker 00

  Just very open and honest conversations around. I remember taking Psych 10 in UCLA, and it changed my life because I'm like, oh wait, insecurity is a thing. I'm, I'm not the only person that feels imposter syndrome and doesn't, and, I mean, all of these neuroses I learned about, I'm like, wait, that's an actual thing other people had? I thought it was just me. And it was so helpful. And I wish that at an earlier stage.

• 28:26Speaker 00

  I mean, things like, what is interest rate on a credit card? I lived alone with my mom. Like, I wish someone had kind of dialed me as a young man into this thing called menopause and what your mom might be going through. Do you think if you, and I imagine you are, asked to consult to different lawmakers, the governor, Governor Newsom calls you and says, how do we better prevent bad behaviors in high school? Is it education? Is it coursework? Like, what? If you could, if you could have influence over the curriculum of all the public schools in California, what would that influence look like?

• 29:05Speaker 03

  Yeah, wow, great question. So first, just going back to some of your earlier commentary about how men have disappeared, the statistics bear this out. Men are not entering, men and young men of all ages are not, not entering the job market. So we have a ballooning number of young men who are not working. And the data suggests that it's because they're at home, you know, playing video games and on social media. So they're, they're literally not engaging, you know, with their milestones at their, at various ages. In terms of how to change the curriculum, I would recommend three things. Number one, I would teach young people about the neuroscience of pleasure and pain and

• 29:48Speaker 03

  about how, as we continue to bombard our reward pathway with highly reinforcing substances and behaviors, we don't get more pleasure, we get the opposite. We change our hedonic or joy set point and we actually tilt our mood and our baseline capacity for pleasure to the side of pain, such that we need more and more over time, more and more of our drug of choice to get any pleasure at all. And when we're not using, you know, we're in misery. We need to use just to feel normal. I think this is really key for young people to understand that what feels good or pleasurable or reduces anxiety or depression or insomnia in the moment, actually probably makes that

• 30:32Speaker 03

  worse in the long run because our brains will immediately adapt to that surge of dopamine. So I think that's really important. Number two, embodied anything. So way more curriculum that involves using our bodies, using our hands, doing real things in the real world. So this is for, and you know, a lot of people have talked about this, but I really think this is important. Lots of options for sports, for engagement in sports. They actually did this experiment in Iceland. It was called, you know, they had a growing youth drug and alcohol problem.

• 31:11Speaker 00

  I saw this.

• 31:11Speaker 03

  Yeah, so they did two things. They, number one, they made a curfew. So at a certain point at night, you know, kids couldn't, late at night, young, young kids couldn't go out. And number two, they built a whole bunch of gymnasiums and sports centers and organized sports teams. And they saw a really significant decrease in the number of kids both using and getting addicted to drugs and alcohol. Now, this was many years ago. But again, an embodied physical option where kids can get their dopamine, you know, and get that pleasure, but they pay for it upfront by, by moving their bodies and doing hard things, which is how we evolved, right? We evolved to do a whole lot of work, to get a little bit of reward, not to do no work at all, to get a lot of reward, which is the world that we live in now.

• 31:55Speaker 03

  And again, this whole embodied idea with, you know, also learning a craft, right? Or learning a profession. We have all of these industrial jobs that nobody fills. Like, it's not that the jobs are not out there. It's that young people do not have the basic skills to, to weld, to, to be an electrician, to be a plumber, to like, use their hands and do real things. And I think a lot of people would enjoy that work and find it highly satisfying and a wonderful antidote to this virtual world. The other thing that's happened in the world that I think we massively under, underappreciated

• 32:35Speaker 03

  is the extent to which the digital media has proliferated bureaucracy that rolls downhill. So now it's like the consumer that needs to do all of these things that the bank used to do, but now we have to do. Or for taxes, or for signing your kid up for anything at school. It's like this massive bureaucracy. And like, we don't learn anything, kids don't learn anything in school about how to like navigate, how to pay your taxes, how to make sure you have car insurance, how to make sure you have health insurance and navigate the insanity of the healthcare system. I mean, all of those, I mean, I frankly barely have those skills.

• 33:19Speaker 03

  But those are the types of skills that, that young people really need in order to navigate the modern environment. And, you know, especially kids who like tend toward ADHD, you know, or impulsivity. Like, these kids are going to need really a lot of extra help with all of these layers of bureaucracy.

• 33:36Speaker 00

  I want to give you the profile, and this sort of bleeds into what you talk about in your book Surrender. So a young man, early twenties, and, I mean, this is the profile of the kid, or the young man that I deal with. Or when I, when I mentor a young man, I generally end up with a kid, and this is the profile. Good kid, did okay in high school, not great, did okay. Parents put a lot of pressure on him to go to college. He goes to college, doesn't work out. And there's this shame that comes over the household. And it's a shame that is so ridiculous because two thirds of our kids aren't going to end

• 34:19Speaker 00

  up with a traditional BA. But we've decided in America, something's wrong, you have failed as a family and as a kid. And, you know, the kid starts at a school and then everyone goes quiet and doesn't talk about it, but it's clear. And he moves home, he's in the basement or in, you know, the garage or spare bedroom, has sort of a job, has sort of a thing, you know, gets maybe, you know, decent, not, you know, he's not a bad kid. It gets up, maybe takes a couple of classes at community college, thinking he's going to go back to wherever next year. But it's clear college just probably isn't in the cards for him. And it's one, two years go by, and when I talk to these kids, what I see is not like

• 35:03Speaker 00

  full-blown addiction, but mild addiction to video games, to online gambling, to Reddit and Discord, and never go outside.

• 35:17Speaker 03

  Right.

• 35:18Speaker 00

  Start to believe their parents are their enemy, you know, not their allies. And I can just start to see this kid, if, if this happens, if this goes on for another three or five years, and I hate to say this, I feel like they're unsavable. That if they're, if they don't get to a point as young men where they develop that muscle around life and leaving the house and negotiating friendships and, and I, I, these kids, these young men, they are everywhere. And the parents, I don't know what to do. They don't know if they're enabling them, that, you know, their natural inclination

• 35:59Speaker 00

  is to be patient and give them support. But the, the line between support and enablement is just such a weird, it's not even a thin line, it's a giant line that's incredibly hazy, that's hard to discern, right?

• 36:13Speaker 03

  Yes.

• 36:14Speaker 00

  So how would you coach a coach or someone who wants to be a coach of young men? This is the profile I see everywhere. They're not meth addicts, they're not bad people. They're just, they're slowly but surely going invisible.

• 36:34Speaker 03

  Mm-hmm.

• 36:35Speaker 00

  Your thoughts?

• 36:36Speaker 03

  We see this all the time. This is our bread and butter in the clinic. You are absolutely right, this is a pandemic. And what I recommend or prescribe is, number one, living in reality. Getting off of the digital devices and the internet, leaving the house, going outside, interacting with the real world and the real people in it, and explicitly

• 37:11Speaker 03

  Trying to mess up. So not like trying to like do the wrong thing, having a good intention, but welcoming mess ups, welcoming it really a kind of a graded exposure therapy so that this young person can begin to say, number one, can live in reality. So, you know, like embrace uncertainty, go out there and engage with the world. Because what has happened is that more and more young people, because they're spending so much time in this virtual space, which is essentially our brains turned inside out. So they're spending time in the equivalent of their own heads is that they start to feel unreal in the world.

• 37:55Speaker 03

  They describe depersonalization, that I'm not real, derealization that the world isn't real. They will endorse things like, we're living in a simulation. And I know there are a lot of really smart scientists out there who speculate, we might really be living in a simulation. I don't care. That's not an effective model for a good life. It doesn't help, right? We need to feel tethered in the world. In order to feel tethered in the world, we need to get off of our devices, go out in the world, interact with other people, with nature, with things in the world to feel connected. And we need to do that, knowing that we will be terrified, that there's a lot of uncertainty there. Try to do something, you know, a hobby you've never done before,

• 38:39Speaker 03

  that you're probably not going to be good at. You know, don't be the constant optimizer. And then many of these folks have like opted out of optimizing, right? They're sort of, they're, they're not, they're, they're like not even career maxing or relationship maxing. They're like scroll maxing or what have you. So it's getting them out, re-engaging in the world. Very often getting them to go to some kind of school where they can have an embodied experience, use their hands, use tools, build real things in the real world. So that's, that's number one. Embrace uncertainty, get out into reality and reconceptualize the digital space as an addictive drug that is disconnecting them from themselves, other people in the world.

• 39:24Speaker 03

  Number two, when it comes to parenting, and this is really key. We of course, love our children and we want to help them. And when they're in distress, there's really nothing more distressing as a parent. And yet, if you are dealing with an adult child living at home, who is not launching, two things need to happen. Number one, you need to manage and get comfortable with your own anxiety and let your kid have their own experience. And this is, this is radical surrender, right? Like you need to let your kid have their own life and not constantly tie your wellbeing to them being okay. So this is letting go, right? Really radically surrendering said, you know, I've done what I can do.

• 40:09Speaker 03

  My child is an adult. My child needs to have their own life and make their own choices and deal with the consequences. And this, trust me, as a parent myself, I can tell you, especially if you have a vulnerable child, super hard. Now, this doesn't necessarily mean kicking your kid out of the house, but it does mean making a behavioral contract with your child that you have certain expectations, that it's not okay for them to sleep all day, stay up all night, be online, contribute not at all to the household, earn no money, not go to school, because that's what's happening. You sit down with your kid and say, well, we know we've been doing X and that has have, that has to change. And maybe that has to start with you going to a rehab

• 40:54Speaker 03

  where you're not on your device for a month and then coming back. But we need to reset things. And then when you come back, or maybe just starting now, like you cannot be on your device all night. We're going to shut down the wifi or whatever it takes. We're going to take the devices away. You need to go out and look for a job or you need to go to school. You need to participate in the household chores. Here's the list of things that you need to get done. So, I mean, and, and many of these kids are otherwise not mentally ill. Now, if you're dealing with a kid who's severely mentally ill, depressed, what I mean, maybe, maybe it's a whole different level. Obviously you're seeking out professional help. And by the way, again, a lot of time online makes kids depressed. Getting off makes them less depressed.

• 41:39Speaker 03

  So it's a contingency plan with a behavioral expectation that is appropriate for a young adult. And then it's just letting that kid have the negative consequences of their behavior in the world and letting go. And trust me, as a parent, I know how hard that is. But unless our kids go out there and have their own failures and their own experiences and see that they can get through it, they are never going to develop into real people. And then finally connecting, you know, with a greater meaning and purpose. And for this, I really recommend pursuing virtue. Like if you want a challenging, difficult life, try to do the next right thing.

• 42:24Speaker 03

  It's hard. We're given opportunities every day to choose between doing the right thing and just passing it by. And doing the right thing is hard to do. And it's simple things, you know? It's not like saving the world Allah effective altruism, you know, Sam Bankman Fried style. It's the opposite of that. It's like, what are the good things that I can do right now today? Because our ability to discern the good thing is much more accurate in the here and now. You know, so it's that doing the next right thing. And having that be kind of your mantra to pull you through. The Stoics said that in order to live in accordance with God,

• 43:08Speaker 03

  we need to live in accordance with nature. In order to live in accordance with nature, we need to pursue virtue. And I think that's absolutely right. And it also gives our lives a deeper meaning, a purpose. And it's hard. It's challenging, right? I mean, you want something that's hard and challenging? Like pursue virtue.

• 43:28Speaker 00

  We'll be right back.

• 43:36Speaker 00

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• 46:45Speaker 00

  We're back with more from Analemki. I want to talk a little bit about, I wrote a post on this that got a lot of feedback, polarized feedback, the cult of therapy. And that is, I see a lot of people thinking, oh, there's an issue here with one of our kids. And I'm being critical to parents, but I think sometimes, especially parents with money, outsource it and think, we'll just fix it with therapy. And I want to be clear, I think therapy is a wonderful thing and it benefits thousands of people, probably not millions, because there's not enough therapists. But if you have the resources and it's something that can help, what I worry, though, is that with TikTok, there's so many, what I call, ring light therapists, that we've created

• 47:30Speaker 00

  these cults of therapy where you just, you need to work on yourself first. And I'm fairly like bullshit. Get a job, get a friend, get a girlfriend, get out of the house, start exercising. That is the equivalent of a nuclear detonation of therapy for 60 to 90% of the young men I deal with. And there's this notion that they learn on TikTok, or that their parents want to put them in therapy, that, oh, they need to work on themselves. And my attitude oftentimes, and I realize there's a fine line here, and I will defer to what you say, as I have no training in adolescent psychiatry, but to be blunt, I work with a lot of young men.

• 48:11Speaker 00

  I find that a lot of this is, okay, the best therapy here is going to be life outside of the house. And occasionally I run across a kid and I'll say to the parents, I am in over my head, I'm over my skis, there's something going on here, you need a psychiatrist, this kid needs therapy, there's something going on here that I can't even begin to understand. But I think most of the time, it's like, if this kid can get a job, start working out, get some friends, and maybe start asking women out, that's going to be five years of therapy.

• 48:44Speaker 03

  Right.

• 48:45Speaker 00

  Right. So I'm putting forward a thesis that has, what I'll call this ring light TikTok cults of therapy, has it gone too far?

• 48:56Speaker 03

  Absolutely. And I've said very similar things. I mean, again, wanted to qualify all this by saying, I do psychotherapy, it can be tremendously helpful for many people. But the problem is that therapy is predominantly inward and backward, not outward and forward. And we are spending way too much of time inward and backward, thinking about ourselves, and importantly, thinking about past trauma. So a huge emphasis of modern therapy is to organize and structure our experience based

• 49:35Speaker 03

  on past trauma, and see everything that happens to us as causally related to some past trauma. That is a worldview that is not like fact, like we could choose to navigate the world in a very different way. And although I think it's important to process and understand what's happened to us in the past, including the bad things, what is effectively happening with a lot of people who develop this trauma-based worldview is that they never move past it. And every single felt experience or emotion they have, then they tie it back to this past trauma.

• 50:20Speaker 03

  And those folks end up with like, no friends, no relatives, they don't do well, and they're miserable. And so, we absolutely have to think about different ways of doing therapy, first of all, that it can't all be this Freudian concept, that, you know, everything that, any form of sort of mental suffering in adulthood is tied to some conscious or unconscious childhood experience. That's just not realistic. We are much more influenced by what is happening to us right now than we are influenced by what happened to us 25 years ago. I'm sorry, but that just, that is a fact. We cannot hold on to like, the, you know, what happened to me when I was eight as an

• 51:05Speaker 03

  explanatory model for everything that happens to me when I'm 25 or 35, for that matter, 55. So, and then also, I would just add, we just have to get out of our own heads. We spend so much time not in reality. We have to get out of our heads and we have to be very suspicious of the stories that we tell. I mean, one of my patients who got into recovery from long time addiction, finally kind of came to the realization that, like, he couldn't really trust his own narratives. Like, in some ways, they were all sort of not real. And what he needed to do was go kickboxing, look at a rose bush, go out and meet some people and talk to them.

• 51:50Speaker 03

  And I think that's exactly right. When we are feeling down, distressed, anxious, we're usually ruminating, we're caught up in our own heads. If we can pivot our psyche outward, surrender that desire to try to control things through our mental mentations and rumination, because that's what we're trying to do. It's this illusion that, oh, if I just keep thinking about this, I'm going to be able to, you know, fix this and solve this problem. It's like, no, no, stop. Stop thinking about that. Go out into the world, pay attention to reality and what's really happening, like, see what needs to be done, do that thing, move forward.

• 52:29Speaker 00

  I really do. I find your work so powerful. I want to talk a little bit about, I think, the most undiagnosed addiction, and this is because sample size of one in a modern age is, I like to think I'm fairly aware of my own addictions, is the addiction to the affirmation of strangers. And quite frankly, it's made me successful. I'm so concerned with what other people think and that they'll like me if I have a lot of money, and that if I'm on CNN, that I pursue those things at the cost of the health of my relationship with myself, my own health, my own self-esteem, and my relationship with my family.

• 53:08Speaker 03

  Right.

• 53:09Speaker 00

  And, you know, I wasn't at home as much as I should have been with my kids, and I really regret it now, because I couldn't resist going to the World Economic Forum, because I was going to get to be on stage with someone famous. And now I look back and I think, they're going to be dead and I'm going to be dead soon, who cares? And I think economic, economic security is really important, but I had that a long time ago. Why am I still sacrificing important things in the pursuit of it? And I think, well, it's because I think it makes me more impressive to other people. Talk about, one, is there a term for the addiction to the affirmation of others? And I won't say relevance, because that makes it sound more noble.

• 53:51Speaker 00

  It's, yeah, I'm going to read the comments in this video, and if someone says mean things about you and me, I'm going to get upset.

• 54:01Speaker 03

  Hmm, right.

• 54:02Speaker 00

  And if they say nice things, it's going to make me feel good. And that's sort of pathetic, because most likely, it's a bot, an Albanian troll farm sponsored by the GRU, just trying to create polarization. But is that, what is the term for that? And if you're an adult that has recognized some success because of that addiction, what are your thoughts around modulating it and turning it, you know, and hopefully, quite frankly, addressing it? Because I know enough to know that I suffer from it. It's like, I used to joke, I have German and Italian parents, so I'm smart enough to know I'm fucked up, but too lazy to do anything about it. So I'm smart enough to know this is some sort of addiction, but I'm not entirely sure what to do about it. Your thoughts?

• 54:46Speaker 03

  First of all, thank you for your humility and transparency. I think that really helps so many people when we admit our own vulnerabilities.

• 54:54Speaker 00

  I just like talking about myself.

• 54:55Speaker 03

  Well, okay, whatever. I still think it's helpful.

• 54:57Speaker 00

  Thank you.

• 54:58Speaker 03

  Yeah, I mean, at the end of the day, what we all want is human connection. It is our lifeblood. And social validation, reputation enhancement, affirmation, every other drug is really just an indirect vehicle to try to get that. That is what we all really desire at the end of the day. And of course, now we've created this medium with likes and shares and comments and followers, that makes that all so much more possible. Plus, AI agents are completely engineered to do that for us. So now we don't even need other humans. We can just get our affirmation from our AI chatbot that tells us how wonderful we are.

• 55:42Speaker 03

  So this is, and there's also science behind this, not just clinical observation, studies showing that social validation and reputation enhancement releases dopamine in the brain's reward pathway, feels really, really good. So you are not alone. We are living in the age of what I call endemic narcissism, where narcissism has become so common that we're all struggling with it. We have these, you know, all these technologies that literally force us to look at ourselves. We're constantly being encouraged from childhood on to achieve, to go to the best schools. Parents measure their success as parents by what their kids are doing, what school they went to, how much money they're making.

• 56:27Speaker 03

  I mean, this is absolutely baked into the, the sort of, I don't know what analogy I'm looking for, but it's baked into our experience now, this endemic narcissism. And what's very clear to me is that Narcissism is contrary to how we evolved, which is to live together in these tribes. And when we make these efforts to distinguish ourselves outside of and above the tribe, our, the natural homeostatic reckoning for that is shame and self-loathing. That shame and self-loathing is the natural ballast for narcissistic self-regard,

• 57:09Speaker 03

  which I think explains why we are seeing so many people in clinical care who hate themselves, who are experiencing imposter syndrome, who have overwhelming shame. If they really give themselves like a moment to let it in, so many people experience profound shame. I know myself, when I like give a talk, you know, to a big audience or whatever, afterwards, I have this incredible come down, which is primarily shame. And I just think we're not going to get away from that shame and self-loathing as long as we're so invested in our own individual narcissistic achievements. So the way to square all of that is actually to try to be more anonymous, right?

• 57:53Speaker 03

  To pursue excellence in the work that we want to do because we, you know, we want to do good things, but to not have it be self-focused. Very practical things are turn off the likes. Don't read the comments. If by virtue of your business model, you know, the comments need to be read, outsource it to somebody else.

• 58:13Speaker 00

  Mm-hmm.

• 58:13Speaker 03

  Turn off self-view. Don't look at yourself. Look at yourself enough to kind of get yourself together once a day, but don't constantly be looking at yourself or checking yourself. Don't over-invest in your physical appearance. Again, invest to the point where like you're being polite, you can show up and you're socially appropriate. But all of these things, we have to actually intentionally try to avoid that kind of self-recognition. Because trust me, the end result of that is self-loathing, shame. It's baked into the hardware to bring us down again.

• 58:45Speaker 00

  So I always like to pause on something I hadn't thought about that I think has real insight. Don't over-invest in your appearance. Everyone is work on yourself, optimization culture.

• 58:59Speaker 03

  Right.

• 58:59Speaker 00

  Get rid of the elevens with Botox, workout four times a day, sauna, red light, retinol. I mean, just optimize.

• 59:09Speaker 03

  Plastic surgery, right.

• 59:10Speaker 00

  Plastic surgery, optimize to the point where you're just a freakish specimen of what you shouldn't be, right? Just, just push back on biology.

• 59:21Speaker 03

  Boob implants, butt implants, cheek, I don't know, it's crazy.

• 59:25Speaker 00

  It's gone, it looks maxing. It has gone, it has gone overbore. And I'm, I'm subject absolutely or guilty of some of that. I probably work out more than I need to because I, anyways. But in your book, you talk about the fact that trying to control a life and create a frictionless life results in anxiety and depression. And then the second half of your book, you talk about solutions. And I just want to ping through some of them and let you pick one or two to expand on because I found them really illuminating for me. Pray, even if you're not sure you believe. I love that and I want you to expand on that. Do the next right thing and wait for meaning to declare itself. I like that, although I'm not sure my kids would be able to absorb that.

• 1:00:10Speaker 00

  Love, love by letting people have their own experience. You talked about that. Let your kids fail. Don't engage in concierge or bulldozer parenting. Cultivate awe through symbols and synchronicity. I want you to expand on that. And then stay connected and embrace uncertainty. So take any two or three of those and expand on them.

• 1:00:33Speaker 03

  Yeah. What I mean by pray is whether you're a person of faith or not, pray is a stance of humility. It's rightsizing our ego and our place in the universe. It's acknowledging that we have limited control and that there are many things that we don't control. And it's just showing up for life in a, in a humble way, asking for guidance. And also, you know, kind of like being in awe of the cosmic order and how mysterious and beautiful and amazing it really is. So I think that's really a humble and important stance. It's also kind of the opposite of psychotherapy, which again is inward and backward.

• 1:01:14Speaker 03

  To me, prayer is this outward and forward pivoting in a way that I think is an important antidote to the times that we live in now. Do the next right thing is again, I think a really powerful way to give our lives meaning, but it's not an arrogant sort of like engineering perfection. It's like, hey, what can I do in my life right now, right, you know, today? And I think it's, it's really the, again, this antidote to sort of this optimized life. We're not projecting ourselves to some engineered, perfect future version. It's like, hey, who knows what tomorrow will bring, but what can I do right now to be of service? What is the right thing that I can do, that I can walk through the world and feel, you know, good about that?

• 1:01:59Speaker 03

  Because as you said, it's so ironic, you know, you went to the World Economic Forum and you gave a talk, and yet you look back now and you kind of regret that, right? But I bet like the things that you've done for other people that got no attention and nobody knew about them and nobody else cared or acknowledged except for yourself, those are the things we really remember and that have sort of a powerful undergirding like, oh, you know, I'm, I'm a lovable person. Like I, you know, I made a good choice in that moment. That feels really good. You know, something for me as simple as swimming the other morning and my lane was, didn't have a cover on it. So I could have just kept swimming, but somebody else came and was like struggling to get the, the cover off of their lane.

• 1:02:41Speaker 03

  And I interrupted my workout and got out on the cold pool deck to help them do their cover. Now, it's a small thing, but I felt really, I felt really good about that, you know?

• 1:02:51Speaker 00

  Powerful.

• 1:02:52Speaker 03

  Yeah. It's the same with me. I was like, yeah, I like got out of my like little workout mode and like I helped this person be able to, you know, do what they needed to do. So it's so many little things like that and they come up all the time, but we don't see them. To love other people by letting them have their own experience. One of the things about radical surrender, when we really acknowledge the limits of our control, we also acknowledge the limits of like how we can manipulate other people's experience or reactions to us. And that is so incredibly freeing. Just be like, I can't control this person's experience. I don't know what they think or what they're going to do. All I can do is just show up and be real and, and you know, and be in the moment as much as possible. So to me, that's been really powerful, especially as a parent, where I think we're constantly

• 1:03:35Speaker 03

  worrying about how to help our kids. And at some point we just have to like, you know what? They're going to have their life. If they ask me for help, that's one thing, but otherwise I just got to let them have their own experience. Cultivating awe, symbols and synchronicity, these are all these sort of meaningful coincidences, you know, where like you show up at the same place that somebody else shows up. It's like, oh wow, that's so cool. And the felt experience of that can be very, very powerful, especially in times of distress, right? When we've lost a loved one or somebody's sick, we're very, we're open and receptive to that. But I think it's also a way to sort of tie us to the world, to remind us that there is this greater order that we don't control. Again, all this kind of rightsizing.

• 1:04:20Speaker 03

  And then ultimately we talked about the importance of human connection and embracing uncertainty, living in reality. You know, it's, it's when we stop trying to control other people in the world that we're actually free to experience it.

• 1:04:34Speaker 00

  Doctor, you have two boys?

• 1:04:37Speaker 03

  I have four children, two boys and two girls.

• 1:04:40Speaker 00

  Two boys and two girls. I think people probably listening, who've listened to you on this podcast thought, oh my gosh, wouldn't it have been great to have Anna as a mom?

• 1:04:49Speaker 03

  Oh my, no, no.

• 1:04:50Speaker 00

  Well, that's my question.

• 1:04:52Speaker 03

  Plenty of mistakes.

• 1:04:53Speaker 00

  What did you get wrong?

• 1:04:54Speaker 03

  A lot of codependency traits. I grew up in a house with an alcoholic parent, a lot of codependency patterns. So my biggest, also, as I talk about in the book, our first child died of leukemia. And so my trigger is always the health of my kids, that they have some physical problem or disease or something. And then a kind of intrusive wanting to manage their experience and tying my relief from anxiety to them saying, my life is great, mom. So again, this is a kind of a narcissistic investment in my children that I've worked very hard on, but I still really struggle with.

• 1:05:39Speaker 03

  Like I need them to be always okay for me to be okay. And we talk about it openly and they give me lots of feedback and pushback when I'm doing that. And so I think overall, like it's worked out. I'm really close to my kids and they are doing well in the deep ways that I care about, you know, being good citizens, but it's an ongoing struggle.

• 1:06:02Speaker 00

  In addition to being a mom, Dr. Anna Lembke is a professor of psychiatry at Stanford University School of Medicine and author of the bestselling book, Dopamine Nation: Finding Balance in the Age of Indulgence. Her latest book is Radical Surrender: Letting Go in a World Addicted to Control. Dr. Lemke, I think that historians and psychiatrists, we're going to look back on this age and think they were, they were important, but we should have listened to them more. I can't tell you how much I enjoy these conversations. I don't think, as I said, we're not in an attention economy, we're in an addiction economy. And I think it's so important that people such as yourself with the credentials and,

• 1:06:44Speaker 00

  and the demeanor you present, I think your voice has never been needed more on a lot of levels and very much appreciate your time and your good work.

• 1:06:53Speaker 03

  Oh, well, thank you. That inspires me to keep going.

• 1:06:57Speaker 00

  There you go. Thanks, Doctor. This episode was produced by Jennifer Sanchez, Laura Janier and Asher Schwartz. Our video editor is Bianca Rosario Ramirez. Kami Reek is our social producer. Drew Burrows is our technical director and Catherine Dillon is our executive producer. Thanks for listening to the Prof G Pod from Prof G Media.

• 1:07:24Speaker 04

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