“Dopamine” has entered cultural conversations as roughly equivalent to “the feel-good brain chemical.” People talk about “dopamine hits” and “dopamine fasts” and “low dopamine.” In a recent conversation a family member talked about starting the day on his phone and scrolling feeds “because I’ve gotta get my dopamine up before work.”

There’s a seemingly widespread understanding that dopamine makes us feel good and that it can be used against us to make us do things we don’t necessarily like (like endlessly scroll feeds).

Is any of this accurate to how dopamine actually works in our brains? It feels like an oversimplification to me, but I don’t actually know.

It also seems odd to me that there’s so much focus on dopamine but not, say, oxytocin or serotonin (unless you’re a Billie Eilish or Girl in Red fan, respectively).

Is our lay understanding of “dopamine” efficient shorthand or pseudoscientific sleight of hand?

I’m really frustrated by recent experiences interfacing with the mental health system for myself and for my teenager. For them, it’s really atrocious. There may be effective options for the upper classes, but they aren’t accessible to me.

This is inspired by @X08’s recent [post] (https://tildes.net/~health.mental/1iia/unable_to_feel_progress_lack_of_happiness_and_not_finding_motivation_to_keep_investing) . Obviously I don’t know about their particulars, but I’ve certainly had the experience of being a part of a group where it appears others are progressing while I am not. Partly this is a problem of how we perceive, measure, and judge “success.” “Don’t compare my insides to others’ outsides,” as the saying goes. But it is possible to a more faithful and reflective comparison, and it does happen that others similar to me* make progress where I don’t, and it’s really frustrating. I’m often wondering, what’s wrong with me that I can’t change and grow?

I don’t have a great answer, although my exceptionally shitty childhood certainly plays a great role.

What I really want to comment on, though, is how insensitive our current mental health system is to the impact disparate causes have on creating similar symptoms, and how that should inform treatment approaches. A gifted psychiatrist (of which there are shockingly few) once put it like this (paraphrasing): Before we look at treatment for depression, we have to make sure the patient isn’t just surrounded by assholes.

But it’s a real problem. CBT is touted by a lot of “weighty” authorities as a valid gold standard treatment for a wide range of MH symptoms, and is claimed to be effective regardless of causes. And it’s my opinion that there is a lot of reasonably scientifically rigorous research backing that claim up. But, it’s not all rainbows, and it’s not working for lots of people. For one, a lot of folks claiming to do CBT are really not. Actual CBT involves a lot of homework, and a lot of recipients don’t have home support and don’t do the homework. This is extra true for children and adolescents living in dysfunctional homes. But more than just patient effort, the research marking CBT as so favorable is mostly based on subjects who are only mild to moderately distressed.* The end result is everyone involved in the “evidence based” healthcare chain is signing sufferers up for CBT when that might not be the best approach. There are lots of other criticisms too. If a practitioner is not well-trained and dedicated, the practice can be very invalidating. It seeks to make the sufferer’s more cognitive process more ‘rational,’ but when that person’s experiences are really, objectively bad, it’s very rational to conclude the world is hostile and unsafe. The tool itself is prepared for this, but it takes a really effective therapist to pull off. Also, it’s not enough by itself, grieving and other healing is also required for success.

The same thing happens in 12 step groups. AA/NA is resoundingly helpful-for a certain set of alcoholics/addicts. Those who don’t make it are often exhorted to become more honest, more open-minded, or more willing.*** My observation, though, is that most of the ones that make it come from intact families with resources. This is not universally true, it’s important for me to point out that there are enough examples of success among folks with no such background to say that there is something valuable in that approach that transcends socio-economics. There are also plenty from well-resourced families who don’t make it, but many of those families are highly dysfunctional. Of this last group, folks from dysfunctional families, some of us find success in other groups. This is because AA/NA are designed for sociopaths, ACA**** is designed for the product of sociopathic parents (who are filled with shame).

I don’t know what the solution is. A lot of malaise, addiction, “maladaptive” behaviors are, I think, born in a dysfunctional society, and so long as that society remains dysfunctional, no individual focused therapy solution will create a permanent fix. I think right here and now, too, we are at one of humanity’s “high tides” of self-destruction, a result primarily of runaway capitalism (is there any other kind?). We also just came through a really nasty global trauma, everyone is feeling it some kinda way.

Thanks for attending my TEDz talk.

*Of course, when talking about something as complex as a human life, there may no way to determine how similar is enough to make valid comparisons

**Also, let’s not talk about the various biases and implementation problems with what those studies refer to as ‘validated’ assessments used for measuring level of distress

***I am, technically, an NA success story

****Adult Children Anonymous, aka Adult Children of Alcoholics and Dysfunctional Families, more info at adultchildren.org.

Two weeks ago I decided to cut alcohol out of my life. I have a weird issue though where I don't feel I necessarily relate to other problem drinkers in support spaces online, and I assume would not in-person, because I feel like my habit was never particularly bad. I've never been addicted to the degree where I have to have a drink to function, I never used it as a crutch in social situations, or anything like that. I don't mean this to put anybody down, but I've grown up around alcoholics, and even count myself among that number, but feel I somehow never fell into the worst, and have a hard time walking away from where I was because of it.

To break down my cycles of drinking:

I started with a beer a day. I liked beer, then moved on to drink/include whiskeys and other hard liquors. I'd have 1-3 drinks a night most nights from when I was of legal drinking age and could afford my own alcohol, and have a pace usually of one an hour. I enjoyed the tastes, experimenting with different varieties, and just exploring what was out there from whiskeys, cordials, weird beers, meads, anything.

Then there came a point where I started drinking heavily infrequently but regularly about seven years ago, where half a handle was gone in a week and a half and I had no idea where it went. I didn't black out at all, but would later realize I was drinking it really fast. This continued, I would stop buying hard liquor, and then buy some, and drink it quicker than I should have, rinse repeat.

The thing where I feel conflicted is I feel like I was in control, in a sense. I really enjoyed the alcohol I was drinking and would sip on it over a few hours having glass after glass. For these heavier nights I would wake up with a mild hangover, but it wasn't an every day thing. I would occasionally mess up and drink half a 750ml bottle and regret it, but tone it back down.

As far as cravings, I would crave alcohol like I crave other foods/drinks, like "I really want some Johnnie Walker Black this week" similarly to how I would think "I want a coke." Then I would clear 375ml in three days, and realize I didn't have enough to enjoy until the next paycheck (I generally didn't buy liquor more than once a pay period because I was usually interested in being more intimate with one drink at a time). Similar to how if I eat candy bars regularly I crave them, alcohol is/was the same.

Part of this led me to take a long time to give myself permission to stop drinking. I decided two weeks ago that I just don't need alcohol and sort of just said I'd commit to it, do the "one day at a time" thing. No end time, just never doing it. I feel if there's a deadline, or any conditions to drink, I'll slip back into the patterns I had which weren't entirely self-destructive, but not something I wanted to live with. As far as work functions, I'll just get a soda, mocktail, or water.

As a result, I have also hit a sort of malaise about how different things aren't. I've had dry patches where I chose not to drink, and I don't have a huge recovery story since I wasn't drinking all the time anyway, but going through these sorts of cycles. I don't feel any different because I'm not healing, I'm not going through any withdrawals or detox, I don't have any behavior to feel guilty about, or anything. I feel like a bad alcoholic, in a sense, because I don't have much to run from beyond the problem of "one is too many, two is not enough." I also feel self-conscious about not drinking alcohol, because I'm worried about how to answer if asked why.

I guess, to a point, I'm reaching out because I feel a little alone on this. I'm not sure how to navigate my not-quite sobriety (I still use cannabis edibles on rare occasion, and kava quite frequently, but not regularly). Has anybody else been in a similar situation? How did you navigate it internally?

Hey all,

Recently I've had a really dark period from (ab)using drugs to hide from the pain and feel good about myself. Friends noticed me becoming distant and needlessly shouting into the (social media) void.
One friend wrote me a long message about all these things and his conclusion was that he thought I might be a narcissist. I broke down entirely, the following days were a roller coaster ride of trying to deal with it with high and lows, talking to friends if they also noticed these things but ultimately I couldn't shake the feeling that I had to give in to my friend's accusation to mend our now wounded relationship. People pleasing is in my nature and putting others in front of my own needs is what I deal with and I cope with low self-esteem.

My therapists all said that the accusations is not something they can see myself in but regardless of this I ended up having a suicide attempt. I saw myself as a bad person and that feeling became over-encumbering.

I'm better now, and I feel closer to friends and family after some much needed talks and quitting drugs altogether.

That said, what are your takes on the overlapping diagnoses. It made myself very paranoid and made me spiral at a low point.

I've been in therapy for ten years.

Recently, I hit a local minimum. I saw where the rest of the curve would take me, if I did not change somehow. It would end me early—maybe even in a few years or less.

And I saw what was holding me back.

I've had emotional scars accumulated from an early age. That kind of trauma seems to have a way of becoming a self-fulfilling prophecy; my life has been replete with repeated traumas. I've been reliving those root traumas over and over again, in my own mind, overlaid atop later events that only found correlation due to triggering those old wounded emotions.

I understand this to be called "CPTSD" in more civilized parts of the world than where I live: the United States. (As far as I know, the DSM-V does not acknowledge CPTSD.) I digress.

In therapy, I had identified two deeply wounded "parts" of myself: one represented by an ostracized seventeen year old Exile who attempted in all but direct intent to end himself and the other an emotionally abused and rage-filled ten year old Inner Child.

Recently, I healed the seventeen year old part. I saw how it was hurting me. Its expectation, its fear, of exile fueled nearly half of my life. My therapist and I pushed on it. What was preventing me from changing?

It was the fear of what I would become without it. Would I lose my wife? Would I lose my identity? Would I lose everything?

But it was this or my life. So, in that moment, I made a choice.

Instead what happened was something unexpected. The Exile flourished. It was as though my teen and 20 something years had been rewritten: a Back to the Future moment. It was no longer The Exile. It was transformed into something else entirely. It became strong and confident. Tapping into that part, by choice, I now seem to be able face most situations that would once cause near panic with, instead, determination. I persevere. I even seem, at times, to flourish.

However, the rage-filled Child remains. He is more activistic. He still has the sense that he will be punished for some perceived wrong. When provoked, he doesn't feel anxiety from these imagined tortures, he feels rage.

In my meditations, now, I attempt to integrate with this newfound strength to then reach out to and show more compassion to the Child—to salve his fear and show him that we, together, as a being, are now strong. I am hopeful.

In these ways, I am remade.

I still recognize old pieces. And, yet, there is so much new, so much yet undiscovered, that I confound myself with what is now easy and what remains difficult (but difficult in new ways). I am increasingly kinder to myself, allowing more connection with others, particularly those I would once consider incompatible, and perhaps even beginning to become physically healthier.

I can see a light at the end of the tunnel. Or, perhaps, I am only now stepping into that light, after decades.

How have you become more than your past traumas? How have you transformed for the better? How did you accomplish it?

EDIT: I shared this in the hope that it inspires. There can be healing, though it can take years and much effort. I would love to hear your stories of hope!

EDIT2: Feeling self-conscious, this all was decidedly not a humble brag. I never imagined that this sort of abrupt transformation was possible. However, it was a culmination of literally a decade of therapeutic intervention and hard work.

I have tried and failed to journal many times in the past. I always find myself self-editing, avoiding writing certain thoughts or feelings and just overall not being as authentic or honest or genuine as I should be to actually get some value out of journaling. I wish I could get over this “self-censoring” habit because I love reading and writing and really think journaling could be a great outlet for me.

So, I ask, what tips do you have to help write? To help actually get your thoughts and feelings out on the page, without judging yourself or feeling self conscious or critical? What do you write? What do you find helps you write more honestly and genuinely?

Could really use some help and guidance.

Hey everyone!

Do you have any experience with time blocking? Do you use any apps to help or do you do it all manually in your calendar? I recently watched a video I found on Tildes by Answer in Progress (https://youtu.be/vYaNiC4kchg?si=zh02N4bStqAhBBAe) about attention span. I have heard a lot about time blocking in the past, but always thought I never really needed it.

However, recently I've been starting to realize maybe I'm not doing well mentally..days can slip by on YouTube, or a video game, and the things I wanted to get done get pushed back to the next day..and the next day, and so on..or things I was passionate about, things I want to succeed in that I am good at..just sort of slip away, and I stop doing them and lose my drive. So maybe I need to block time to get it done... I'm not sure. So I guess I can try Meditation and time blocking..

Anyway, anyone have some suggestions if they do this? Have you found that it helped?

I've been doing a lot of work with my therapist and it has been suggested that I might have a mix of both Autism and ADHD.

I have always related to Autism to a certain extent but I would never say it because I felt like I didn't really fit because some things I do don't make sense it that context. I was also obsessed with learning to be human since young and have a lot of systems to deal with it and apparently that means I've been masking for a very long time.

But my therapist also brought up ADHD and that has explained a lot about some the things I'm still currently struggling with. But again, when I look it up, I don't feel like I fully fit. But also, I have developed a lot of systems over the years to deal with my issues and function like a normal human being. So a lot of the things I struggle with is hidden because I've "fixed" them.

I'm still reluctant to say I have either of those two things because I feel like an imposter. So I've just settled on Neurodivergent and think that I can always learn the tools that help people with ADHD even if I don't have it. Because if the tools work for you, then why not?

But my therapist has suggested getting diagnosed because it does change what kind of medication you might get. I'm currently on medication for anxiety and depression.

So now I'm wondering how common it is to have a mix of both ADHD and Autism. For those who have both, what is it like for you? What is your daily life like? What are your struggles and how do you deal with them? When did you realise you might have a mix of both? How do you feel about yourself and your brain?

I apologize if this isn't the right place to ask this. I don't post very often and am getting used to it.

The last time I cried was probably like 3 years ago. I have no idea why. I know that not being able to cry can be a result of depression, or some sort of trauma, or having to suppress your emotions for a long time - but I never experienced any of that. I just suddenly stopped being able to cry and it sucks because crying is a great emotional outlet and sometimes I really feel like I want to cry but just can't for some reason.

Has anyone else dealt with the same thing?