A good education on addiction, fascinating case histories, and a sensible formula for treatment.
An addiction specialist discusses her patients’ problems and how she deals with them, and it’s an unsettling picture.
Lembke, medical director of the Stanford Addiction Medicine clinic, begins with a lesson in neuroscience. Nerves along brain pathways that process rewards (i.e., pleasure) use dopamine as a “neurotransmitter”—to deliver signals. The more dopamine an experience releases, the more we enjoy it. However, dopamine processes pain as well as pleasure, and a healthy brain maintains a balance. Most of us stop eating when we feel full. Coffee often provides all the stimulation we need. Gambling, drinking, shopping, or watching pornography are intermittent activities. Addiction, the mark of an unhealthy brain, is a compulsive behavior that continues despite the harm it causes, and it’s a worldwide epidemic. The biggest risk factor is easy access. History books proclaim Prohibition a failure, but it produced a big drop in alcoholism, public drunkenness, and alcohol-caused liver disease, which rose again after repeal. Today, it seems, all indulgences are accessible. Since around 2000, the rampant overprescription of narcotics has produced skyrocketing addiction and death. The internet allows us to engage in social as well as unseemly activities in private. Popular medical books rely on vivid case histories, and Lembke offers plenty. Her first is a lifelong masturbation addict who was ultimately able to achieve control. There follow accounts of other types of addicts, and she describes her treatment strategy based on the acronym DOPAMINE: data, objectives, problems, abstinence, mindfulness, insight, next steps, and experiment. Most readers will find it reasonable, and the author does not trumpet its success rate. Some of the most insightful passages involve lying, a malignant process in a cooperative society but essential to maintaining addictive behavior. Many people believe that honesty—unmasking our flaws—will drive people away, but it does the opposite.
A good education on addiction, fascinating case histories, and a sensible formula for treatment.Pub Date: Aug. 24, 2021
ISBN: 978-1-5247-4672-8
Page Count: 304
Publisher: Dutton
Review Posted Online: June 15, 2021
Kirkus Reviews Issue: July 1, 2021
A short, smart analysis of perhaps the most famous passage in American history reveals its potency and unfulfilled promise.
Words that made a nation.
Isaacson is known for expansive biographies of great thinkers (and Elon Musk), but here he pens a succinct, stimulating commentary on the Founding Fathers’ ode to “life, liberty, and the pursuit of happiness.” His close reading of the Declaration of Independence’s second sentence, published to mark the 250th anniversary of the document’s adoption, doesn’t downplay its “moral contradiction.” Thomas Jefferson enslaved hundreds of people yet called slavery “a cruel war against human nature” in his first draft of the Declaration. All but 15 of the document’s 56 signers owned enslaved people. While the sentence in question asserted “all men are created equal” and possess “unalienable rights,” the Founders “consciously and intentionally” excluded women, Native Americans, and enslaved people. And yet the sentence is powerful, Isaacson writes, because it names a young nation’s “aspirations.” He mounts a solid defense of what ought to be shared goals, among them economic fairness, “moral compassion,” and a willingness to compromise. “Democracy depends on this,” he writes. Isaacson is excellent when explaining how Enlightenment intellectuals abroad influenced the founders. Benjamin Franklin, one of the Declaration’s “five-person drafting committee,” stayed in David Hume’s home for a month in the early 1770s, “discussing ideas of natural rights” with the Scottish philosopher. Also strong is Isaacson’s discussion of the “edits and tweaks” made to Jefferson’s draft. As recommended by Franklin and others, the changes were substantial, leaving Jefferson “distraught.” Franklin, who emerges as the book’s hero, helped establish municipal services, founded a library, and encouraged religious diversity—the kind of civic-mindedness that we could use more of today, Isaacson reminds us.
A short, smart analysis of perhaps the most famous passage in American history reveals its potency and unfulfilled promise.Pub Date: Nov. 18, 2025
ISBN: 9781982181314
Page Count: 80
Publisher: Simon & Schuster
Review Posted Online: Aug. 29, 2025
Kirkus Reviews Issue: Oct. 1, 2025
BOOK REVIEW
BOOK REVIEW
BOOK REVIEW
SEEN & HEARD
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular...
A neurosurgeon with a passion for literature tragically finds his perfect subject after his diagnosis of terminal lung cancer.
Writing isn’t brain surgery, but it’s rare when someone adept at the latter is also so accomplished at the former. Searching for meaning and purpose in his life, Kalanithi pursued a doctorate in literature and had felt certain that he wouldn’t enter the field of medicine, in which his father and other members of his family excelled. “But I couldn’t let go of the question,” he writes, after realizing that his goals “didn’t quite fit in an English department.” “Where did biology, morality, literature and philosophy intersect?” So he decided to set aside his doctoral dissertation and belatedly prepare for medical school, which “would allow me a chance to find answers that are not in books, to find a different sort of sublime, to forge relationships with the suffering, and to keep following the question of what makes human life meaningful, even in the face of death and decay.” The author’s empathy undoubtedly made him an exceptional doctor, and the precision of his prose—as well as the moral purpose underscoring it—suggests that he could have written a good book on any subject he chose. Part of what makes this book so essential is the fact that it was written under a death sentence following the diagnosis that upended his life, just as he was preparing to end his residency and attract offers at the top of his profession. Kalanithi learned he might have 10 years to live or perhaps five. Should he return to neurosurgery (he could and did), or should he write (he also did)? Should he and his wife have a baby? They did, eight months before he died, which was less than two years after the original diagnosis. “The fact of death is unsettling,” he understates. “Yet there is no other way to live.”
A moving meditation on mortality by a gifted writer whose dual perspectives of physician and patient provide a singular clarity.Pub Date: Jan. 19, 2016
ISBN: 978-0-8129-8840-6
Page Count: 248
Publisher: Random House
Review Posted Online: Sept. 29, 2015
Kirkus Reviews Issue: Oct. 15, 2015
PERSPECTIVES
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