“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?

What have you been doing lately for your own fitness? Try out any new programs or exercises? Have any questions for others about your training? Want to vent about poor behavior in the gym? Started a new diet or have a new recipe you want to share? Anything else health and wellness related?

UPDATE: the surgery went well amd she is recovering now

I talked in the past about my mother here.

She's been diagnosed with abdominal aortic aneurysm and keeping an eye on it.

Now it's time for surgery because it's big and in danger of rupture.

She's already in the hospital and will operate today or tomorrow.

She is still frail and eating less since my brother's death. Weight is only 44k/97lbs. She is 74 years old.

I keep reading that the endovascular surgery is not that dangerous. Just a minor cut in the groin, but I'm really afraid due to her weakness. Doctor assured is OK and he is the best in town. Last year he did 25 of these and this year 15.

Guess I'm just venting and afraid. Lost a brother a year and half ago and now it's my mother.

Feels like I'm just living between tragedies.

Hey Tildes,

Recently I picked up WoW again and I've felt a rush and focus I haven't felt for a while. I can play the game for an entire day. I feel nothing but guilt doing so. The one thing that gives me joy feels like something I'm not allowed to do at this stage of my life; I'm 35.

I'm in grouptherapy until march next year but I feel I'm not making any sensible progress. Others around me seem to open and loosen up, finding tangible changes that help their lives. Meanwhile I just keep resenting myself, dread doing anything that might even cost effort.

I feel I'm a fraud, a selfless good-for-nothing profiteer who blames anything but me. It fuels my self-hatred and my wish to self-isolate and act in self-destructive behavior. I also notice a growing bitterness as I get older.

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.

What have you been doing lately for your own fitness? Try out any new programs or exercises? Have any questions for others about your training? Want to vent about poor behavior in the gym? Started a new diet or have a new recipe you want to share? Anything else health and wellness related?

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?

What have you been doing lately for your own fitness? Try out any new programs or exercises? Have any questions for others about your training? Want to vent about poor behavior in the gym? Started a new diet or have a new recipe you want to share? Anything else health and wellness related?

What have you been doing lately for your own fitness? Try out any new programs or exercises? Have any questions for others about your training? Want to vent about poor behavior in the gym? Started a new diet or have a new recipe you want to share? Anything else health and wellness related?

Whenever I come up north to visit my parents my stomach liquefies, my skin breaks out, and my pain and inflammation flare up. Part of me wonders if it's the water? But I've been here for 3 weeks and there's no adjustment.

I leave tomorrow, thankfully, but damn is it a lot to contend with when trying to be present for my parents. There's a lot of baggage from growing up with them, but our adult relationship is solid. Also, my dad has some serious chronic health issues, so I want to be here when I can to help out and spend time with him and my mom, but damn does my body hate it.

What could cause this? Soon as I head back home (way south) things clear up and even out. This can't just be trauma related stress, can it? Could it be tied to the climate difference perhaps? The water? The city pollution?

I live in a very remote place in the desert, whereas here it is very humid and city. I know y'all probably can't give me an answer, but does anyone here have similar experiences, and if so what do you hypothetically link it to? I just want a normal shit, my skin to not have crazy rosatia and flaking and itching, and to not be in constant pain from my underlying health issues when I visit my parents.

I mentioned it to my dr today (rheumatologist) and he didn't really say much in response. So that's no help.

Preface #1: I know the first response with something like this will be "go see a therapist" - I have been in therapy for over a decade now. There are a lot of things it has helped with (specifically trauma-focused), but nihilism is not something I've been able to get help with. The help has ranged from things like "focus on the micro over the macro" (which I think is probably the best advice, but also can be boiled down to "don't think" and I can't not think), to "find religion" (for me at least: religion doesn't breed hope, hope breeds religion), to "I don't know how to help, I can't relate to that" (...not all therapist are good).

Preface #2: I know the quick response to "life is meaningless" is "so make your own!" but I absolutely despise that logic. If everything is meaningless, than that means making your own meaning is meaningless. It's self-defeating in and of itself. That said, I don't really care about "meaning" anyway. I personally view things as "irrelevant", as if you dig deep enough you get to a point where everything is relevant to nothing. And the conclusion to draw from that is: "it's irrelevant that everything is irrelevant" - similar meaning, but checks out logically significantly better to me. But this has it's own problems that I will go in below.

Preface #3: I know the quick response to the inability to enjoy things is "you don't enjoy things because you are depressed." What I'm positing is the inverse, "I no longer enjoy things, and it's causing me to be depressed." I'm very much not saying the former doesn't happen and I've gone through time periods like that. What I am saying is that the latter is also true, and I'm sure that other people who have dealt with depression for decades understands both "My depression is causing this to happen" and "This is causing my depression to flare" happen.

To give quick context for myself: I had become a nihilistic atheist by the time I graduated elementary school; I had a rather traumatic childhood and my official diagnosis is (C-)PTSD and all the offshoots that come from it like depression and anxiety (Bringing up as I recognize myself these are thoughts that, according to the DSM/ICD, would be from someone with mental disorders). This led to things like dropping out of high school and becoming a mute hikikomori. To make a long story short, in my late teens I got to a point of either suicide or completely revamping my life with the belief that enjoyment could be found via actually being social (friends and dating) and proper self-sufficiency/money. I chose the latter for one simple reason: there was nothing to lose, so just trust the process. It took over a decade of constant self improvement, but I became a sociable person part of different clubs and hosting my own parties/gatherings with a very active dating life. I also got my degree in comp sci and have done quite well for myself with that. And a lot on top of that just in terms of trying to make the most out of life.

Unfortunately, none of that actually helped. Having to mask to be able to be social/date is exhausting and frankly people suck, and wasting life working 9-5 one of the most depressing things to me. The reason I bring this up is because I did really fucking try, I tried the stuff that everyone says brings happiness - but it don't. And it's all just so irrelevant.

Over the last half decade or so, I just can't bring myself to care about anything. And I mean anything, even super simple things. I'll talk to people or listening to a song and think "why do I care what you have to say?". I'll watch a movie or read a book and can't keep focus because seriously who cares about these imaginary things some person thought up? People I know die and I'll just think "yeah that happens." And the absolute worst for me was when it came for knowledge. Because knowledge was the thing I always cared above all else. But what does "knowing things" matter if "things" don't matter to me?

Which brings me back to preface #2. Everything is irrelevant, but it's irrelevant that it's irrelevant. Except that society demands relevancy to justify ones own existence within it. It's not possible to live an irrelevant life and be part of society. I personally really only see two options: reject society or embrace absurdism.

Speaking strictly personally, I do not see rejecting society as a means of living an enjoyable life. Mostly because I know it will lead to me living out of my car again, spending my time embracing hedonism via drugs and alcohol to fuel escapism until the end comes. And if in the end I'm just going to fuel escapism, why not just escape to begin with?

Absurdism is mostly what I fed into while "turning my life around". But I do have issues with it. One is how much it feels like the "this is fine" fire meme; it recognizes the problem but then rejects that it's a problem. This is fine if "life" itself is not a problem and you are able to enjoy your time regardless (after all, the problem itself is irrelevant so yeah just reject it as a problem), but then that gets to my second and main issue: if you don't enjoy life, what defense against suicide does absurdism have? Yes there is the whole thing of "suicide just adds to the absurdity by claiming meaning is needed" but that's only if you are committing suicide because life has no meaning. I don't care that life is irrelevant, I care that life fucking sucks. Suicide then is not rejecting the lack of meaning, it's rejecting time spent unenjoyably.

I've been able to get through things being both meaningless and unenjoyable with the belief that things would become enjoyable. Now I'm nearly 40 years old, things have played out, and I do not buy into it anymore. Either life needs to be enjoyable, or there needs to be some relevancy to it. Which, I reject the later as even being knowable as a human. Which leaves the former.

Which then comes to the silly question, how do you just enjoy things?

I am able to recognize one of my issues with enjoying things: In order to raise my emotional floor, I have embraced being stoic. Things happen that are out of our control. Things are lost, hardships are had, people die. They are simply facts of life. The problem is that it also prevents enjoying things - enjoyable things are also out of your control, so do not embrace them for they will be gone. Which, moments in time then neither "good" or "bad", they simple are just moments in time. Every moment is simply some indefinite, irrelevant moment in time.

Which, kind of tied to that as well, but another issue I recognize: as I have understood my own trauma and how it's affected me, I've really understood just how much is deterministic in life. Which is especially sad in the case of trauma responses, and how much society basically double downs on the trauma (just easy eg of how "hysterical women" have been treated throughout history, but look at the overlap of BPD and traumatic childhoods).

But now these are not just moments in time, but determined yet irrelevant moments in time.

But that still doesn't preclude enjoying things. And I guess that's mostly what I'm for the search for in life, to figure out what things I actually enjoy/how to actually enjoy things I want to enjoy. Because enjoying life is certainly enough, but that requires life to be enjoyable.

And it's actually part of why I'm even posting this. With all the different ways I've changed my life and such, I've tried to look back at what was actually enjoyable. And long-form text communication is definitely the way I prefer to communicate (oh do I miss when 'social media' was forums). I also recognize the importance of being part of more smaller, tighter-knit communities compared to being a blob in a mass. So it's part looking for help, and part just trying to get back into posting on smaller communities.

But I also feel like I'm all over the place and I do apologize for that. I think to try to summarize to bring the points clearer...like I said before, life either needs to be enjoyable or there needs to be some kind of relevancy to it. So either how do you find relevancy/where am I wrong on that, or how do you find enjoyment (and I don't mean "try new hobbies until you find what you enjoy!" kind of stuff - I've already ran that gauntlet. I'm not asking where to find enjoyment, I'm asking how to feel enjoyment; how are you able to care about things might be a better war to phrase it)?

What have you been doing lately for your own fitness? Try out any new programs or exercises? Have any questions for others about your training? Want to vent about poor behavior in the gym? Started a new diet or have a new recipe you want to share? Anything else health and wellness related?

What have you been doing lately for your own fitness? Try out any new programs or exercises? Have any questions for others about your training? Want to vent about poor behavior in the gym? Started a new diet or have a new recipe you want to share? Anything else health and wellness related?