Sawbones: A Marital Tour of Misguided Medicine - Sawbones: Dopamine Detox

Episode Date: November 18, 2025

The algorithm strikes again, this time telling Justin about a popular wellness trend known as a Dopamine Detox. Dopamine is often associated with pleasure centers and addiction, and certain corners of the internet think we are overflooded with it. But Dr. Sydnee talks about what dopamine is, its connection to Parkinson's and other medical conditions, and how this culture around self-deprivation came about.Music: "Medicines" by The Taxpayers https://taxpayers.bandcamp.com/Native American Aid: https://nativepartnership.org/naa/

Sawbones is a show about medical history, and nothing the hosts say should be taken as medical advice or opinion. It's for fun. Can't you just have fun for an hour and not try to diagnose your mystery boil? We think you've earned it. Just sit back, relax, and enjoy a moment of distraction from that weird growth. You're worth it. All right. Sorry is about some books.

One, two, one, two, three, four. Two, three, four. We came across a pharmacy with its windows blasted out. Pushed on through the broken glass and had ourselves a look around. The medicines, the medicines that Escalent McCormack. For the mouth Hello everybody and welcome to Sawbones Samarital Tour of Misguided Medicine

I'm your co-host Justin McElroy And I'm Sydney McElroy Oh it's so good to be here with you So we didn't talk about our introduction Usually we brainstorm something No usually you just kind of launch in Oh I was using the Royal Wee Sorry I should have been more clear yes

I King Justin usually come up with a bit And actually this week's bit is that I've started using the royally apparently and calling myself king justin how's that grab you i love it i think it's a fair distribution of labor since i do all the research for the podcast and i do all the jokes occasionally do some of the jokes i think it's fair to say you do most of the jokes i hung up the lights in the room and i point the microphones and you decorated i decorated and point the microphone you do point the microphones i refuse to learn how to point the microphone so so i got that's my skill i keep myself relevant that don't fight you also keep changing the microphones so important that's how i keep myself

relevant you know without me you would leave me uh for someone more capable because but because you would have the microphone thing figured out so as long as i keep you sort of like dependent on my microphone pointing skills then you you will stay with me that's my theory i think we've entered into a lifetime packed with our podcast though not the kids no podcast yeah okay no no i mean yeah you know you Come and go. But podcasts? The podcast. I could, I mean, could I raise the kids on my own. Yeah. But we're talking. Yeah. Could you raise it on your own? But like, could you make talk toa on your own? I don't think so. No, I don't think so. Talk toa.

It's the Hawk toa Girls podcast. I wish I was lying. Welcome to Sawbones, Emerald Tour of Miss Guy and Mess. Sid, what are we talking about this week? Justin, you gave me the topic we're discussing this week. you know, the algorithm, my algorithm is not as bad as Sydney's, but she has sent me enough links that every once a while I start getting some wild stuff. And the marketing, I feel like in the TikTok era, the marketing is so specific that it starts to get pretty scary, right? Because they start talking about like, well, okay, we have your algorithm. And the AI has generated a song based on traits that we've noticed about you and maybe this is the problem all along. So it's a very, it's a very unnerving thing to pop up in your feed.

Justin, I think you need to do some soul searching because there was nothing, one, that I'd ever researched about this topic before. Right. So I would, two, never have sent you links about it before. And three, I have not. Now I have that I've researched this topic. But prior to this, I didn't know that this was a popular medicine, wellness. I mean, I had no awareness. I got no ads, no nothing. To be clear, I just meant that my algorithm

thinks I'm open-minded, health-wise. I have, I have, I'm open-minded from a health perspective. I think your algorithm may suspect that you would be interested in a dopamine detox. Uh, yes, said dopamine. The, uh, I feel like it's become such a buzzword in the last 20 years. This is so, this is so strange to me. I mean, I'm obviously familiar with dopamine. And I guess I understood that maybe there was some popular ideas about dopamine, but the ads you showed me related to dopamine were truly surprising. I had no idea that the discourse is what it is. That is, that's thrilling, Sydney. That's really exciting for me because this has bombarded my feed enough times that I'm glad to know that it is an outlier and that I am I am outsized.

Would you like to sort of give a general idea of what the ads, especially the ones you showed me? I will say this. We try to keep the show pretty language, family friendly. These ads are pretty buck wild. So we will be talking about some adult buck wild content in this episode. The ads that I started getting were about like not, it was like an addiction to dopamine, basically an addiction to stimulation. you're like overstimulated and that addiction is making you seek out like uh too much like over masturbation like too much masturbation or masturbation like addiction and like so like regular intimacy like isn't enough and you don't feel creative and it's all because of this like dopamine addiction that you have and it's also weird because it's like this claymation art style and that is clearly like all AI generated and there's this AI generated song And I can't click the like, please don't show me AI stuff ever again button fast enough.

But if sexuality and procrastination are interconnected, you might think you're procrastinating because you're lazy but the real culprit is dopamine. But yeah, that is the vibe. It's like so surreal. It felt very, very similar to like a low T commercial to me. It seemed very centered on, like, dopamine as having something to do with, like, there's a sad, animated figure in a bed with another sad animated figure, and one is sort of, like, peering under the covers forlornly, and the other one is looking very, like, disappointed. Yeah. And that's it.

Yeah. That is a weird, like, dopamine to their, that bridge to me is a wild, and I'm going to take us on this journey. But I still don't know that I fully understand how we've arrived. I mean, do you understand the fake connection that the ad is trying to make? No, I understand the fake connection. I guess I just, there are lots of fake connections you could make. This is a weird one. I understand why testosterone has, there's real, there's real information out there about testosterone.

And then there's a lot of misinformation and kind of pseudoscience about what would taking testosterone do for a person. Yeah. There's a lot of misunderstanding there. And I think people sometimes think it is a bit of a cure-all, especially for somebody who is a signed male at birth, any problems they're having. That is not, that's not all true. Dopamine is a weird plug-in to that sort of milieu, to my science mind. To my medical mind, I don't know how this happened, but I'm going to take you through the pseudoscience. Okay. Dopamine, Arvid Carlson. Discovered dopamine. He was a pharmacologist. He actually won a Nobel Prize for discovering, for his contributions to the neurotransmitter dopamine, to our understanding of it. He was, he went to medical school back in 1941. He was in the Swedish Armed Forces for a while, went back and studied. I mean, his main area of study were neurotransmitters and the brain and how do things work. At the time, we really didn't understand that, there were different neurotransmitters that were distinct. And a neurotransmitter is, think of it as a chemical in your brain that is sending a signal from like neuron to neuron, brain cell to brain cell, okay?

Okay. By sending these little chemical signals, we're communicating things, we're changing thoughts, feelings, behaviors, movements, you know, we're making the brain work. Okay. Right? There are lots of neurotransmitters, not just dopamine. Many, I will say, which have entered our popular understanding. For instance, another neurotransmitter is serotonin.

Elemental is bill. Oh, sorry. Yeah, serotonin. Serotonin. And what do we think about serotonin? It's like the happiness chemical, right? You get serotonin and you're happy. We have a cultural understanding of serotonin.

It is not complete. It's more complex. But that's, I mean, that's often true in medicine. We kind of have a popular understanding and then the scientific nuance. So dopamine is another neurotransmitter. At the time, we thought, that it was just a precursor of a different neurotransmitter, meaning that, like, it was a step in the production of norapinephrine,

which does other things in the brain. But that's not true. Dopamine is its own distinct thing that has its own distinct activity within the brain. Okay. And basically, in 1957, Dr. Carlson was the first guy to say, this is a different thing, okay? And he developed a way to measure dopamine in the brain. He found where the highest amount.

There's actually a pretty localized area in the brain where dopamine primarily comes from in the part of the brain, the substantia nigra. It doesn't really matter. The point is dopamine comes from this one particular part of the brain primarily, and he was able to understand that. And then from there, he was able to understand, it's kind of interesting. So you know that dopamine's there. You're trying to figure out what it does. So he blocked it. Oh, okay.

How do you feel without it? Yes. What happens? when you don't have it. And what he noticed was this loss of movement control primarily. I know this is going to sound weird because of our sort of cultural understanding of dopamine. But the first things we noticed is that if you didn't have dopamine, the symptoms that were produced looked like Parkinson's.

Oh. Hmm. Because Parkinson's primarily is a lack of dopamine. Oh. Huh. I didn't realize that. I know. That's why I think, and maybe this kind of explains why this.

was weird for me, this sort of connection that you were building around, not you personally, but you know, the ads you were getting about dopamine. Because to me, when I think medically, dopamine, a lack thereof, is responsible for the symptoms we see in Parkinson's, which is also why, and this is something that he figured out, one of the treatments for Parkinson's is dopamine, L-Dopa. You can give someone replacement dopamine to help manage the symptoms of Parkinson's. Hmm. That's fascinating. I never knew it was part of that. Dopamine is part of what initiates movements. So there's the gap between, I want to raise my hand. I am raising my hand.

Dopamine is part of that pathway. Okay. Okay. So without dopamine, and you can see this in some of the symptoms of Parkinson's disease, somebody wants to take a step forward and it takes them a while to initiate that movement. Hmm. Okay. Gotcha. So those were our first understandings of dopamine. Now, I think it's interesting, if there's not enough dopamine, this is what things look like. Dr. Carlson began to wonder, well, if there's too much dopamine, what would the, you know, or for instance, if you gave somebody L-dopa and they didn't need it, what kind of, what would happen, right? What happens to the brain with too much dopamine?

And what he began to see were symptoms related to what he perceived as schizophrenia. And so this became the dopamine theory of schizophrenia that primarily what we what we have dubbed schizophrenia, the symptoms related schizophrenia, hallucinations and delusional thinking, that it is connected to too much dopamine or overactivity, yeah, of dopamine in the brain. And I will say at this point in history, we have a more nuanced understanding of psychotic disorders in general and schizophrenia. it's not as clear cut as not enough dopamine equals Parkinson's, too much dopamine equals schizophrenia. There's more nuance. There are other neurotransmitters involved. Glutamate plays a big role we think now in schizophrenia. And I won't get into, this isn't an episode about schizophrenia.

But the point is, I don't want to leave you with the message that this is this simple. Yeah. Like a lot of things with the human brain, it's all really complicated. It's all very nuanced. And there's lots of stuff happening to produce a certain constellation of, symptoms and then it will look different in different individuals it's also it also I think lends itself to misunderstanding so much because we think so much about how our brains work I think that everybody wants to believe that there are just sliders if you just move them up

a little bit it's like oh that did it yep that's got it that's working better and I think I mean I think that's one of the problems we talk about this I think a lot on the show the one of the problems with modern medicine where there are some things we kind of figured out and are like we'll treat this with this. It starts to make you believe that perhaps everything in medicine could be that way once we figure it out. We'll just take this pill for that. And I think like antibiotics are the beginning of that for me usually. We figured out that if you have an infection with this bacteria that is killed by this substance, which also doesn't kill you, so that's groovy. We can put that substance in your body, kill the bacteria, and you get better. That's so clear cut. That's so,

that's such a, a simple idea. It's very attractive to think that everything in medicine could be that way. And the truth is, especially when it comes to, you know, psychiatry, behavioral medicine, neurology, the function of the human nervous system, it's just nothing is that clear cut, really. Right. So anyway, what we figured out is that there is, that there is dopamine definitely does play a role in psychotic disorders like schizophrenia. And you will see that a lot of the medications that were then developed to treat those conditions were aimed at reducing dopamine. Not just that. There are obviously other things that they do. But that was part of the process. So from a medical standpoint, and I'm not saying this is everything we ever know about dopamine,

this is all it does. But when you start talking about dopamine, these are the initial things I think about are neurological, psychiatric disorders. Obviously, we know that dopamine also has something to do with developing, I don't even want to use the word addiction yet, although that is where I'm kind of driving. The desire to repeat a behavior, right? Yeah. We know that if we do something that is pleasurable, dopamine is released. connecting that activity with the pleasure that we feel. Right.

Now, I will say a misunderstanding of this is, is dopamine causing us pleasure? I don't know. Dopamine alone is not responsible for this connection. Okay. When you do something pleasurable, you are also releasing hormones like, or neurotransmitters, like serotonin, oxytocin, endorphins. There are other pieces to this, right? It's not just the dopamine.

The dopamine helps make the connection. Okay, yes. And this is why when we start talking about addictive behaviors, things that we crave, things that we seek to do again to bring us pleasure, this is where dopamine starts to enter the picture. Because it is true, you know. What's something that brings you pleasure? Me?

You. Rated for this show. Rated for this show? Yeah. Whatever that is, PG? Yeah. Yeah, organizing the silverware drawer. Okay. That's a great example. That's a great example that everyone, I think, can sympathize with. Okay, cool. Sympathize was an interesting choice of words that you did unprompted.

Hmm. Hmm. Let me tumble that one around in the old noggin for a second. Okay. Got it. How do you feel when you organize the silverware drawer? I used to feel happy, but I have a sinking suspicion that I may not hit the same anymore. Do you crave organization of the silverware drawer? Do you think about it? You know the answer to that as well as you know my name. Of course I crave organization in the drawer. No, but do you think about it when you're not doing?

Do you have the impulse to go do it? Okay. Can I give you a better example? I feel like maybe organization of the silverware drawer, while it does bring you pleasure, is not quite. I'm going to give a better. Give us a better example. I'm going to give a better example, solving the crossword puzzle.

for a while I was doing it every single day okay when you haven't done it yet in the day you know it's early in the day or maybe it's even later this could be a better example

you're realizing the day is almost over and you haven't solved the crossword puzzle how do you feel bad do you feel like you need it you need it how do you feel when you sit down and solve the crossword puzzle good right so that that sensation is not purely

really dopamine related. Dopamine had something to do with that, right? Dopamine was released the first time that you solved that crossword puzzle and felt pleasure. Right. It's the same as your, one of my favorite analogies for cigarette addiction is that it's like you're wearing an uncomfortable pair of shoes and that what you're really looking forward to all day is not it's taking off the shoes that you are currently wearing. And that's the pleasure is, ah, I'm no longer wearing the shoes. You know what I mean? It's not putting on the slippers. It's, oh, thank God, those things are off. And this is definitely connected to our developing an addictive behavior, right?

And I will say that the difference between solving a crossword puzzle and the amount of dopamine that is released in that scenario and, let's say, using methamphetamines, exponentially different. So I think that it's really important in these conversations that we not sort of paint the addictive behaviors. with a single brush. Yes. Because it, I think you're in danger of undermining the seriousness of certain addictive behaviors

and the difficulty in ceasing them as opposed to if you knew that doing the crossword puzzle was dangerous to your health. Just based on dopamine alone, my suspicion is it would be easier for you to stop doing the crossword puzzle. So,

yes and no. Obviously I wouldn't draw a parallel between like some of these substances you're drawing and but I have known people who in my life who have gone down the rabbit hole of some activities and of gaming specifically to where other parts of their life suffer and where their health suffers and where some some parts of their life suffer so I do think I've seen it take a hold on people in a dependent sense and and and I don't think that's dopamine but I've seen some people where that's the only control they have in the world and that is like it becomes monumentally important in that sense i think i think

what you're hitting on here though and this is what we're going to talk about as we transition into here's the science of dopamine what are these other ideas and i haven't even let me say this is not complete i wanted to give you some background on our understanding of dopamine historically obviously we know that dopamine plays a role in these different behaviors and that modulating our connection with them breaking that sort of like play that we feel when we experience that thing, whether it's a cigarette or playing a video game, whatever it is, could be useful in stopping that behavior, right? What I want to challenge primarily is this concept of dopamine addiction and a dopamine detox as useful

to your health and wellness and also just to sort of where did it come from. Okay? So we're going to talk about that. All right, let's do it. After the billing department. Ah, well, let's go. The medicines, the medicines that ask you let macabre for the mouth. All right, Sid, I'm ready. Okay, so I was trying to trace where did dopamine shift from a neurotransmitter that we understand as important in neurology, psychiatry, and then definitely an emerging understanding of addiction. substance use disorder, all kinds of addictive behaviors, right? Okay. We knew all that. That's under investigation. We are still perfecting the best ways to manage, you know, substance use for as an

example. But in 2019, there was an article that came out by Dr. Cameron SEPA who wanted to talk about, this was on LinkedIn. Sure. His article. So when I say an article, I mean like he, like a The gold standard. No, I don't mean like a peer-reviewed journal article. A blog. He went a blog. He wrote a blog. He wrote a blog.

Yeah. Okay. He's a psychologist who primarily works with like CEOs. He's like a executive psychologist, I believe. Sure. Luxury, concierge psychologist. Well, I think that's helpful to know that that's his focus. Sure.

This is not me. I'm not demeaning any of this work at all. I am simply saying that like the idea of peak performance is very much where we're driving here. Right. He wrote an article on LinkedIn called The Defendative Guide to Dopamine Fasting 2.0, the hot Silicon Valley trend. So. That I made. I don't. I'm guessing. I have no idea. I'm just going to that. I don't know that it. I think this was already sort of a trend among the kind of like tech genius millionaire Silicon Valley.

These are the same people who are trying to like live forever. You know what I mean? Like that whole idea that through technology, we can do a bunch of stuff to ourselves. Neurotropic, maybe some neotropic. Absolutely. And I mean, if it feels a little limitless pill, I mean, I assume that movie grew out of this sort of milieu. I have, yeah. So, yes, yeah, I think so.

I think that people saw a limitless pill and they're like, God, I wish there was a limitless pill, which we all do. Of course, we all want to. This pill. Sure. So what Dr. SEPA recommended was that dopamine is a problem for us because we are, we are so overstimulated. There's so much around us all the time. And a lot of this is tied to screens. Now, there are other things. He's going to talk about other things. It's not just tied to technology and screens. But I think for a lot of people, they focused in on time on their phone, time on their computer, primarily time. It's the new thing. It would be the thing. threat. Yeah, and primarily time spent with like social media and that kind of thing, right? Okay, so all of this stimulation is overwhelming us and we're just getting constant releases of massive amounts of dopamine. Right. To the point that we can't feel that rush when we actually experience pleasure. It's like we're up here all the time and so we don't feel those normal peaks and valleys. Does that make sense? Yeah, yeah, yeah, yeah. We're like, desensitized. Yes, our tolerance has gotten.

so high for dopamine. Be sensitized. And so what we need to do is detox or fast or whatever you want to call it, break your addiction to dopamine by reducing whatever these behaviors are. Okay. Right? And he ties it very much to like this is what all of these like tech CEOs, all these millionaires, all these, I don't want to say dudes because a lot of the, a lot of the way

its couch feels very... It's good culture... Yeah, for sure. It feels very mannosphere, you know? It feels very mannature because it is, I think. It does. But I mean, to be fair, he never says this is just for guys.

I mean, that is never explicit. It says boys only here on the screen with a big Z. But I think, like, it makes sense that you have gotten ads for this sort of stuff, and I never have... Yeah, of course. They're targeting you as a demographic, right? Okay.

So basically... I got the low-t ads, too. You know. Well, there you go. I get ads for romanticcy books about werewolves. There you go. And underwear. Okay.

Those are probably tied together. That's your algorithm. Probably tied together. And now dopamine. So what he said is, okay, first of all, he says this is based on cognitive behavioral therapy or CBT, which is real therapy. Real. And in some ways this is absolutely true, right? Like there are elements of CBT in everything we're talking about.

The idea that you do something, there's a behavior in your life that is bringing you displeasure, that is infringing on your ability to live a quality life, that is harming yourself or others around you, and you would like to stop it. And you engage in CBT techniques in order to reduce this behavior in your life and then enjoy a happier, more quality life. It's better. Yeah. Like that's, and that's fine. Like, there's no, this is all real, and you should engage in CBT if it is needed, right?

And helpful. And helpful. Don't work for everybody. Right. Yes. Right. And every problem. Nothing works for everybody.

No, agreed. So he said, first of all, put the stimulus away, make it harder to access. Okay. Right? Engage in something alternative. Mm-hmm. And prevent yourself in ways from doing the thing, you know, put in safeguards. Oh.

Kind of like when you, um, I, I've seen the phones that people have now that are like the no, what are they called? It's like no distraction phones. Yeah, there are just like big screens with the you can make phone calls. And that's it. And like your apps are all hidden and you have to like search for them if you want to find them and stuff like that. Like put in safeguards for yourself.

Yeah. So like. I get that. Yeah. And so like some really basic things. And this kind of grew into a lifestyle from these like basic. And these are really, these are like CBT techniques, right, to try. to reduce the importance of something in your life in pursuit of happiness.

He went on to talk about like fasting schedules. And I think people really like the idea that they're doing something when they're not doing something. Oh, yeah. I think that's so attractive to us, right? So like if right now I am not using my phone, even though I'm not doing anything, I'm doing something. It's like part of why, aside from the convenience, washing.

machines and dishwashers are so powerful. Because as you hear that sound and you think, I through the power of technology, am washing dishes. In some sense, I am washing dishes right now. It's a huge boost. I can do the laundry for an entire day. Oh, yeah.

But only in like, what did you do today? The laundry. Right. Okay. So he put out like a schedule. And she was, and 500 pages of werewolves having sex with vampires,

but also the laundry. Don't shame me. You read it too. Didn't shame. I'm not shaming you. I'm just saying you're really, really productive. So he put out like a fasting schedule and a feasting schedule. Like this is you don't let yourself do whatever it is for these hours of the day.

Sure. You engage with it intensely for certain blocks of time. Oh. Which is, I mean, that's true. Like if you just say I'm putting down my phone and never picking it up again, that's not helpful. Right. We know that like trying to wean down a behavior typically is more effective than a cold turkey approach. Yeah, I guess that makes sense. I mean, within reason, if the thing you're trying to

quit is murder, I would say cold turkey would be better. But, see, this is where it breaks down for me a little bit, because I tend to think that, like, resetting your brain chemistry is more powerful here. Like, just trying to, like, change something very major and then letting your brain, like, settle back down. Because I think that this, to me, feels like, ah, finally, my brain is calm. Then you, like, jack back into the phone. And it's like, ah, it's all there. like it's all, I don't know, it feels like that up and down feels, feels a little bit chaotic to me, but I don't know. I'm not therapist.

Well, I think what you're presupposing, though, is that any exposure is bad. Hmm. No, I don't mean that. I just mean, like, I never, you never know what's going to be on there, I guess, is my fear. Yeah. He also, he, so he ties it, like, it very much starts with technology, but then he kind of, this is where I think all this other stuff came from. So he expands it to emotional eating, internet gaming, internet slash gaming, gambling, gambling,

slash shopping, porn slash masturbation, thrill slash novelty seeking, and recreational drugs. Okay. Which again, this is just, I just think that this is. That's just sin. He's just doing sin, right? Like, it's just like, here's the sins you can have. And then he goes through, like, here are all the things that are bad. And like, this is, and again, we're getting into pseudoscience here because he's like, emotional eating is bad. A lot of this is tied to intermittent and fasting. I should say that. The intermittent fasting community kind of morphed. Not everybody. It's not one of one but like there is a connection here between this and the dopamine detox that there are definitely ties people who are like well i don't eat for all these hours of the day and i feel so incredible because i'm so hungry and so if i don't do these things for these hours i'll also feel incredible

like there's definitely a tie there um and when he talks about food it's in not i mean he talks about the dangers of ultra ultra processed foods the dangers of sweet salty savory spicy and carbs and fat i it's almost all food yo it's almost all food and i mean he like as an example he talks about pretzels if pretzels are your vice then you're doing fine you're doing fine just eat pretzels for gods obviously he talks about internet and about um gaming talks about internet yeah like these are problems social media the clicking the the scrolling the the the this is i think our like perception of dopamine, you're just like, shoo, shoo, sure,

and that's what you're looking for. Gambling and shopping, he kind of breaks this down that like, boys gamble, girls shop, I don't know about that. I think anybody can do whatever they want. This, this is, this is not all right. I don't even want to describe this picture. He has images, like stock photos for all of these.

The one for porn and masturbation is. It's a sliced ham. Let's not, yes. And he talks about, this is where this kind of comes into it that like porn is okay but how are you using porn can you read this first this sentence actually can you read that sentence there's nothing intrinsically wrong with occasional porn viewing or masturbation for the person doing it leaving aside the social implications for now okay so stop there if you have to clarify that as a physician running a blog post you have already messed up so

fundamentally if you need to clarify that like masturbation isn't bad bad like yeah Yeah, dude, you're a doctor. I didn't think for a second. First of all, what does bad mean or wrong? There's something wrong. Like, what are you talking about? There's something wrong with it. Well, and he goes into...

I assume because you're an adult. You don't think anything's wrong with masturbation, whatever that means. It's really interesting because there's obviously so much, like, societal taboo. And then there's, like, religious underpinnings to our different, like, belief structures around masturbation, specifically. And then pornography. That you're getting into a whole other human men. us with that, things that we feel and think. But then he throws sex in there, and he says sex is trickier to include in a dopamine

fast, given there's another person involved, and thus may be hard to schedule. Yeah, by the way. So you needed to, like, when can we dopamine fast together? By the way, Doc, you think there aren't other people involved? If I stop gaming, what if we need a raid, man? What if the team needs their warlock, right? And I'm like, sorry, guys, dopamine fast. I can't be there to help you get all the great crystals that we need for the adventure.

That's the same. That affects other people. It affects other people. But he kind of suggests that maybe sex can, I mean, like just inherently could be bad. And the reason that he says is if you're doing it impulsively, started without clear intention, compulsively, repeated without clear intention, or high risk, which high risk, Health hazard is, okay, set that aside. But what do you mean started without clear intention? I don't even know how to parse that.

He tripped? And then he gets into like thrill-seeking behavior. I mean, basically anything that makes you have like an adrenaline rush is bad. Basically all good stuff. And then recreational drugs, alcohol, cigarettes, caffeine. He says you've got to get rid of caffeine. too. He talks about, like, things you could do instead anytime, man, listen, I know I'm a family

doctor and I understand that like nutrition and exercise are part of the things that I was trained to talk about all the time, but I am not so naive as to think. I could look at somebody who is, I don't know, I guess, like cliff diving and masturbating every day and be like. Hopefully not at the same time. That is a hazard. Instead of cliff diving and masturbating Have you tried taking a walk?

Why do we say that to people? That's always the thing. Take a long walk. Have you tried taking... That's not as fun as cliff diving and masturbating, I bet. Probably not. Not at the same time, certainly. And so he offers other things.

It says like writing and art, like creating stuff. If creating stuff doesn't give you a sense of pleasure, I think you got bigger problems, man. Like, if you're like, that's not fun, just making stuff? How is it like a TV show at all? And he gets it down to there's this chart at the bottom, where he's talking about in toxicology, we have like the benefit of something at the beneficial dose. And then as the dose gets higher, you get into the toxic dose and the harm increases.

This is wild to me because dopamine is not a toxin. But if you just look at this in the context of dopamine, you would assume that there is a toxic dose of dopamine. And unless we're talking about, quite literally, ingesting dopamine, which is not what we're saying, right? Right. There is not, I mean, you can't do something so much, so fun. So when you get poisoned from it? Yes, that you experience a toxic dose of dopamine.

So, okay, I have a theory. I think this is where this came from, because since then, it's grown into exactly what you talked about. There are supplements that you can buy that will help you. I don't even know what they mean. Like, support your dopamine detox, break your dopamine addiction. There's a lot of stuff out there that's kind of been drawn from the stop masturbating, stop using pornography, where if you stop those things, not only is it sort of insinuated, I have to reference this article.

Can I reference this article? Sure. My dear friend John, who's a psychologist, sent me this article, The Ultimate Test of Self-Discipline, lockdown, and the No-FAP community, which Justin had to explain to me what No-FAP meant. Nice talks. Just a quick doxing for the day. Thanks, Sid. I appreciate that. So there's a drive-by doxing and your sweet husband. Just narque your husband.

I thought it was funny because I read the whole article and I couldn't find what it meant. And I do wonder if the author is- She said, I don't know. She said, hey, y'all, here's what she said. It was actually very precious. She said, I've read this whole thing. I still don't know what FAP stands for. I tell, can I get, this is, can I educationally, should we, should I say that it is a, it is a, it is a puerile reference to Master masturbation. It's an automatopoeia. It's anomatopoetic. I'll move on. Okay. So I'm just a, I'm just a supportive, supportive guest. But in this, they talk about, and I have to imagine that this sort of like idea, and I'm not blaming this one psychologist, there were lots of these,

especially like the executive psychologist kind of community, not just the individuals, but like people who buy into the psychology of success, I think, like, that there's a certain right mindset that makes you a successful human, and we got to get you into it, which I will argue all day long, and that has nothing to do with these individuals. I will argue that to the cows come home. But I think that from that sort of thought, like, I am going to withhold pleasure from myself in a variety of ways in order to gain better. cognitive function, more focus, more intelligence, to experience pleasure more when I actually do a thing.

I think that's where this came from. This sort of, if I can not, I mean, and really in the, as far as I can tell, in the NOFAP community, it's very clearly like, I'm not going to orgasm. Yes. I'm going to withhold that from myself. Yes. In every way possible. Yes.

For as long as possible. Yes. And some of it, I think for some people, is tied to a desire to eventually have sex with a partner and experience. I've seen that in the article, quote unquote, real sex. Yes. Idea being that your drive to do so would maybe be stronger. And that it will be better. Better.

That it will be more pleasurable because you withheld. But then there's also this sort of like mainly in the involuntarily celibate community. where it is a power within itself that you are preserving some essential masculine energy it does start to sound a little testosterone because it's like you will be stronger your biceps will be bigger you'll be a more

dominant presence in a room so I think I don't even know what the word you know what I mean you will become alpha I think you will become the alpha of the territory. Right. I have a theory about this.

And let me know when you know when you want to hear my theory because I have a theory about it. I want to hear you. That's really all I wanted to talk about with it. There's lots of books and apps and programs you can buy and like I said, pills.

And now I'm getting ads on Facebook for pills that I could take to fix my dopamine. I think, okay, so this is a very quick version. The only missing piece here that I think I as a former game journalist can help with here. The dopamine thing was

Very, very huge in gaming. This idea that dopamine was a stand-in for the sorts of addictive behaviors that are very cheap to come by in video games that are easy to replicate and manipulative, almost in a sense, right? That idea of the rat hitting the feeder bar, once the dopamine became part of the popular imagination, that idea of a rat hitting a feeder bar became very big in gaming, right? because it's like people latched onto that idea of dopamine being a chemical that was released when you're playing video games in a specific way and that this idea that people who were too spent too much time on video games or were addicted if you want to use that word had this like it was a dopamine issue because they were getting such quick hits from it and nothing else could like replicate that because it is this it is an electronic tool right almost

like vaping is for cigarettes, right? It is an electronic facsimile of that sense of progression or satisfaction, right? You're getting the dopamine without actually doing anything. And of course, in dopamine here is being utterly misconstrued, like, because of what you've talked about, dopamine is really standing in for the idea of addiction, or mental addiction, you know, addiction to gaming specifically here, right?

But I think that that idea of dopamine, amongst people who game which I think there's a huge overlap with the people that you are talking about right now especially you know 10 15 20 years ago when they were maybe learning some of these basic fundamentals of science might have really taken purchase

this idea that there I think it is very logical if you look at how much discussion there was in the world of video games about dopamine and it being like a a way that games would like basically addict you like would get you hooked

and that was the problem the idea that people would have internalized that and hooked all that to that chemical for a lot of people that that would take place in the zeit guys I think that that might have been a really big contributor because that was a very big part of the discussion and I could see that over the years

morphing into a sort of self-hatred where it's like all that time I spent playing video games I was just depleting my stores and desensitizing myself. And that's my problem is I spent too much time there. I could see them wanting to build that argument. That's such a, I mean, it's unfortunate that if that's what grew from that,

because what has to be tied to that is why is receiving a dopamine surge and not just dopamine? It's all the other chemicals we talked about from doing well in a video game. Why is that inherently inferior to other things you could do in your life? And the reason that we would want to think that is productivity, productivity based on what society wants from you. This is all capitalism again, trying to force upon people what makes your time worthwhile and what doesn't count as worthwhile time. Yeah, but I think that you can also, I agree with that, but I think that you can also have personal, like, things that you would like to achieve with your life, where that does make it difficult if you are getting a sense of satisfaction. from something that is not actually nourishing you or people around you. And I think that that is exactly where CBT could be helpful.

Sure. This is what I'm saying, right? And it's not dopamine either. It's what's going on with you that, you know, that you're so dependent on this sensation and are there like healthier ways of getting this feeling that are maybe longer lasting or a little bit more like soul sustaining. I think that that's a really helpful conversation. And I definitely think that. that you know I mean there are plenty of studies if we start looking especially at like younger people that can correlate social media use with depression sure with negative mental health outcomes and so the idea that there is a connection between less happiness or more you know chronic illness related to some of these things as opposed to other activities absolutely I agree with all that especially when we're talking about youth that being said I think that that this idea that depriving yourself of all pleasurable activities will give you superpowers

but I mean essentially yeah right yeah is a is a really I mean it's false it is a way to make you feel like you've achieved something when I just I would push back against the idea that simply withholding pleasure from yourself not doing things that you enjoy would give you superpowers you know or that you the goal of like the way to accomplish something is to not do something no i i agree i 100% yeah i don't think that that will be it's not certainly a long term fix i think that it's you know what is tough though i do think that our brain i think we are so overtaxed a lot of the times with our i over stimulated is not quite the right word here but i feel like our senses are and our synapses are so taxed constantly by being connected digitally

a lot that I think that when you stop when you take a break like this it can feel transformative you know it can feel like you've discovered the secret because your brain maybe is like quiet for the first time in a long time and it's like yeah there's there's also something to like putting the screen down for a little bit and letting your and like trying meditation or running or whatever there's something positive there too and that's kind of I feel like what they're piggybacking off of it's like hey you know if you stopped everything that could possibly be unhealthy that you're doing. And then you replace that with running and doing art. That would probably fix stuff for you. It's like, oh, no kidding.

Yeah, no way. No more salty, sweet, fatty foods. And I'll run all the time and I'll be like, like I'll be feeling good. Like, oh, thank you, Doc. But that's also, I mean, the problem is everything you just said, yes, I guess if we all went for a run. Sure. More or less. I mean, you know, exercise generally speaking is a healthy activity um not looking at your phone right before bed we think improve sleep quality like there i mean yes there's some really basic things here that are absolutely true i think what's dangerous is one painting it as you need to make this gigantic lifestyle overhaul that will be incredibly difficult and it's been a systemic problem for you for years that is holding you back from your real potential because one when you make gigantic like

if you decide I drink too many diet Dr. Pepper's in it a day, so what I'm going to do is never drink Diet Dr. Pepper again, that change for me would be incredibly difficult, and statistically I would be likely to fail. But if I said, I am going to drink one less every day to start with and start from there, I could probably achieve that, right? That will motivate me to continue down that road. And maybe eventually I do get to a point where I never drink a diet Dr. Pepper again. I don't know why. I don't know why I did that. I mean, they're fine. I get fine. It's not a problem. But like you get my point. I mean, that generally, those sorts of changes, if you're trying to like some sort of lifestyle factor, something that you

want to change, those are more sustainable and more successful and can leave to higher quality of life and make you feel good. Trying to punish yourself or create a sense of shame when you do something generally is not as useful because we aren't rats at a feeder bar. That's the other part of all this. And that's why it gets lumped into these. The fact that you would put all of these behaviors on the same list as like addictive substances. I mean, you cannot in the same conversation talk about, you know, playing video games too much or looking at TikTok too much or masturbating too much and also being addicted to methamphetamine. being addicted to heroin, being addicted to, I mean, even nicotine.

You know, I mean, these are not the same. These are complex, you know, illnesses that require multifactorial solutions. It's everything, I mean, medications and therapy and supportive services. Yeah, yeah, yeah, there's behavioral and chemical and societal factors. You know, we have to think about socioeconomics and like housing status and food security. And, I mean, there's so many things that go into these more complex issues. You can't just toss them on a list and say it's dopamine. Right.

That's been the, yeah. Yes, that's my problem. And certainly I'd have, there's no evidence that taking these supplements for, I don't even know what they would do to your dopamine. Because I think dopamine's the problem. You certainly shouldn't try to deplete all your dopamine. You couldn't. And if you did, there could be major problems. You shouldn't add extra dopamine because there could be major problems.

Just don't mess with it. Unless your doctor tells you to do this. Just don't mess with your dopamine. Okay. Yeah. Dopamine is not the problem. And if you need help reducing a behavior, I would seek professional help to reduce the behavior. It's me.

Hi. I'm a problem. It's me. Thanks for listening to Sawbones. Do you want to come to Cannon Nights? You can on December 6th. You should. You should.

There's tickets for it. Let me tell you the link, okay, because I don't want to mess it up. It's bit. Dot L-Y, Cannon Nights, 2025. Now, is that true or not? There's no way of knowing. Bit.L.Y forward slash

Candle Nights 2025 is yes that is the website bit dot LY for it slash candle nights 2025 go there you can get tickets to watch the show but you can also get a virtual

stream ticket to watch the show later that's included with your live ticket but you can also get that independently there and all proceeds from that show are going to go to Harmony House which what is that? that, Cindy? Harmony House is a day shelter here in Huntington for people experiencing homelessness. We provide a variety of services, both, you know, basic, like food and showers and clothes and

hygiene, and also get people connected with housing resources to get them in apartments and help them with whatever supportive services they need after that. And I'm the doctor there. Me too. That's going to do it for us. So please come to that. Bit.org.org.com. Thanks to the taxpayers for the use of their own medicines as the intro and outro of our program. And thank you. Thanks to you. Listen, it's going to do it for us for this week. Until next time, my name is Justin McRoy. I'm Sidney McRoy.

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