Dopamine Nation: Finding Balance in the Age of Indulgence

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