Hidden Brain - The Paradox of Pleasure

All of us think we know what addiction looks like. It’s the compulsive consumption of drugs, alcohol, or nicotine. But psychiatrist Anna Lembke argues that our conception of addiction is far too narrow — and that a broader view might help us to understand why so many people are anxious and depressed. This week, we revisit a 2023 episode that remains of the most popular in the history of our show. We'll explore how and why humans are wired to pursue pleasure, and all the ways the modern world tempts us with addictive substances and behaviors.

Duration: 57m
Broadcast on: 08 Dec 2025
Audio Format: other

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This is Hidden Brain. I'm Shankar Vedanta. In the hit television show Ozark, a bright financial advisor finds himself suddenly working on the wrong side of the law. What's our story for the kids? Well, we could tell them the truth, Wendy. How would that be? Following a series of bad decisions by his business partner, Marty Bird, played by Jason Bateman, begins working for a drug cartel. I want you to be ready to set up shop within a week. Marty, when I drive by you house, there better be a for sale sign under law. Almost from the start, the bodies start to fall. People get thrown off balconies. People get shocked. People are electrocuted. When government officials get involved, more violence unfolds. People betray one another. They cheat each other. They act in selfish and short-sighted ways. Let me just jog your memory for a minute. There was an innocent man who was murdered. Gary, he was a good man. You might say this is the genre of the drug movie or television show. You see it in critically acclaimed TV shows like The Wire and Breaking Bad, and in movies such as Traffic and Scarface. Running through these dramas, we sense the irresistible power of drug addiction, the implacable draw of heroin or cocaine or methamphetamine, the chaos and crime that follow everywhere the drug trade is polite. I've watched many of these TV shows in movies as entertainment. For many years, I also reported on the work of researchers who studied the science of drug addiction. But some time ago, I came by a mind-bending idea that transformed my understanding of addiction. It challenged how I think about drugs and what it means to be addicted. And it told me that as gripping as TV shows in movies about the drug trade might be, they don't begin to capture the profound story of addiction in all of our lives. Today, we begin with a story we are telling across two episodes. It will change the way you think about your brain and offer some profound insights into what it means to live a life of happiness and contentment. Pleasure, pain and balance, this week on Hidden Brain.

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All of us think we know what addictions look like. We've seen the movies and TV shows about gang violence and drug-dense. At Stanford University, Anna Lemke studies the science of addiction. She argues our conception of addiction is far too narrow. Anna Lemke, welcome to Hidden Brain. Thank you for having me. I'm excited to be here. Anna, you're a practicing psychiatrist in the heart of Silicon Valley, and I think of California's Bay Area as perhaps the richest part of the richest country in the history of humankind. So a time traveler from the 17th century might assume that even if the streets were not paved with gold, at a minimum, people would be very happy with so much material success. Is your psychiatric practice empty? Ha! I still marvel at the gap between how people present outwardly and the truth of their inner experience. We see people every day who seem to have everything you could ever want, wealth, beauty, you know, meaningful work, and yet when you look under the hood, they're miserably unhappy. So over time, Anna, you've seen more and more patients suffering from depression, anxiety, and chronic pain, ailments for which they are hard-pressed sometimes to find a source or a cause. And as you say, often these are healthy, affluent, educated people with seemingly everything they could want in life. One patient of yours was a young physician with a very promising career. Can you describe what he was like when you first met him? Delightful young man, handsome, kind, thoughtful, considerate. He came to me, in fact, because he got a DUI. He was driving under the influence. But as it turned out, alcohol was not his primary problem. Once he was in my office, he revealed to me that he did, in fact, have an addiction problem, but it wasn't addiction to alcohol. It was an addiction to online gambling sports betting. And his story went like this. He was a very successful high school and collegiate athlete, Division I, all kinds of accolades, really a remarkable athlete. And that cycle of engagement in high-level athletics, the adrenaline that goes along with high-level competition, the wins, the losses, that absolutely was his jam, right? It kept him busy and engaged and really, really happy. But when that career came to its natural end, like so many high-level athletes, there was sort of a free-falling disappointment.

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