The Hacking of the American Mind: The Science Behind the Corporate Takeover of Our Bodies and Brains

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New York, New York 10014

Copyright © 2017 by Robert Lustig, MD, MSL

Illustrations copyright © 2017 by Glenn Randle and Jeannie Choi, Randle Design

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Library of Congress Cataloging-in-Publication Data

Names: Lustig, Robert H., author.

Title: The hacking of the American mind : the science behind the corporate takeover of our bodies and brains / Robert H. Lustig, M.D., M.S.L.

Description: New York : Avery, 2017. | Includes bibliographical references and index.

Identifiers: LCCN 2017031139| ISBN 9781101982587 (hardcover) | ISBN 9781101982594 (epub)

Subjects: LCSH: Happiness. | Pleasure. | Contentment. | Satisfaction.

Classification: LCC BF575.H27 L83 2017 | DDC 152.4/2—dc23

LC record available at https://lccn.loc.gov/2017031139

While the author has made every effort to provide accurate Internet addresses and other contact information at the time of publication, neither the publisher nor the author assumes any responsibility for errors, or for changes that occur after publication. Further, the publisher does not have any control over and does not assume any responsibility for author or third-party websites or their content.

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Dedicated to my late mother, Judith Lustig Jenner (1934–2016), the inspiration for this book. My mother wasn’t a particularly happy person. A Depression baby, she had to grow up quickly, and was an adult by the age of four. She missed out on a real childhood, and spent the rest of her life trying to make up for it. To her, money was the route to happiness, and she didn’t want for it, but it never really made her happy. She certainly knew pleasures—in food and drink, in jewelry, in casinos, in exotic spots around the world. But few of her exploits or possessions brought her contentment. The only true happiness she knew were her children and grandchildren, and her eight-year relationship with her second husband, Myron Jenner, who was taken all too soon. Along the way and at the end, she also knew a large dose of pain and suffering as her body broke down from a debilitating neurological illness while her mind stayed as sharp as a tack. Rest in peace, Mom. I have no doubt that the happiness that eluded you in this world will be yours in the next.

CONTENTS

Title Page

Copyright

Dedication

Introduction

PART I

A Few Fries Short of a Happy Meal

1. The Garden of Earthly Delights

2. Looking for Love in All the Wrong Places

PART II

Reward—The Agony of Ecstasy

3. Desire and Dopamine, Pleasure and Opioids

4. Killing Jiminy: Stress, Fear, and Cortisol

5. The Descent into Hades

6. The Purification of Addiction

PART III

Contentment—The Bluebird of Happiness

7. Contentment and Serotonin

8. Picking the Lock to Nirvana

9. What You Eat in Private You Wear in Public

10. Self-Inflicted Misery: The Dopamine-Cortisol-Serotonin Connection

PART IV

Slaves to the Machine: How Did We Get Hacked?

11. Life, Liberty, and the Pursuit of Happiness?

12. Gross National Unhappiness

13. Extreme Makeover—Washington Edition

14. Are You Lovin’ It? Or Liking It?

15. The Death Spiral

PART V

Out of Our Minds—In Search of the Four Cs

16. Connect (Religion, Social Support, Conversation)

17. Contribute (Self-Worth, Altruism, Volunteerism, Philanthropy)

18. Cope (Sleep, Mindfulness, Exercise)

19. Cook (for Yourself, Your Friends, Your Family)

Epilogue

Acknowledgments

Glossary

Notes

Index

About the Author

INTRODUCTION

Happiness is neither virtue nor pleasure nor this thing nor that, but simply growth. We are happy when we are growing.

—JOHN BUTLER YEATS TO HIS SON WILLIAM BUTLER YEATS, 1909

We were all children once. Like you, more chance than not, my greatest moments of happiness during childhood have stuck with me, and to this day continue to bring a smile, and sometimes even a tear. Childhood is a time of mind expansion—not just in knowledge but in experimentation, in inquisitiveness, in trying out new concepts and strategies. Childhood is supposed to be a time when the balloon of happiness soars high above the mundane. The tools of the trade for most kids were a peanut butter sandwich, a bicycle, and a bedtime story. I became a pediatrician, in part, to relive and help channel the wonder and delight involved in growth.

Fast-forward four decades. Children still grow, but sadly in my pediatric clinic I now watch many of them grow horizontally rather than vertically. Some take medicines previously reserved for adults, like metformin for type 2 diabetes or benazepril for hypertension. And that balloon of happiness, that sheer wonder of it all, is now so deflated, there isn’t enough buoyancy for it to soar. Rather, in its place has been dropped some weighty pleasures of the mundane, in this thing or that. Standard issue now are Capri Sun, Netflix, and Snapchat.

You might argue, well, that’s progress, that’s convenience, that’s technology, that’s our new instant gratification culture—buy a pleasure to increase happiness. But what if those pleasures, ostensibly developed and marketed in the name of increasing your happiness, actually did the opposite? What if they actually made you unhappy? What if they changed your brain so that happiness was sapped from you? What if today’s kids are actually canaries in the coal mine? What if these same brain changes extended to your coworkers, to your friends, to your family members, and to you? For better or worse? And better for whom?

Pleasure and happiness are similar, as they both feel good. But Yeats knew they weren’t the same. Since the recording of time, philosophers have tried to wrestle these two positive emotions to ground. These two uniquely human phenomena have together and separately occupied outsized parcels of our consciousness, our literature, and our national and international discourse. While our philosophers and social commentators have spent the last three thousand years defining and redefining these two terms for us, something quite unusual and likely even sinister has befallen these related yet decidedly different positive emotions.

These past forty years have witnessed the twin epidemics of the negative extremes of both of these emotions: addiction (from too much pleasure) and depression (from not enough happiness). Yet in these same forty years our knowledge of brain science has advanced to the point where these two emotions can now be dissected and parsed at a biochemical level. Did the uptick in prevalence of addiction and depression occur naturally? Separately? In a vacuum? Or under some form of outside pressure? What, or who, has ushered modern society into this new normal? What if all of Western society has been hacked, to profit a few at the expense of the many? And what if you didn’t even know you’d been hacked?

Hack is a word with a relatively short history in our modern lexicon, with a fluid meaning. The first reference to a hack was at a meeting of the MIT (my alma mater) Model Railroad Club in 1955. At that time hack meant a prank whose perpetrators demonstrated style, resourcefulness, and whimsy in its performance. Stealing a car is a felony offense. Stealing a Boston Police Department vehicle, disassembling it, carrying each piece up five floors, and then reassembling it at the top of the Great Dome at MIT, complete with a life-size policeman mannequin and a box of doughnuts in the front seat—now that is a hack. More recently Silicon Valley types stole the word to denote clever solutions to difficult problems, known as white hat hacking. Yet black hat hacking dates back to 1963, when an unauthorized hacker remotely commandeered the MIT mainframe computer. As computers became more interconnected and more technologically advanced, less whimsical people started to create viruses to infect other computers, and hacking took on a much more ominous and sinister tone. As we all learned from the 2016 election debacle, today’s computer hacking encompasses three steps. Step one is phishing, where a seemingly benign yet imperative e-mail message with a disguised zipfile or URL is sent to an unsuspecting victim; if the message is clicked, that computer is rendered vulnerable and the hacker can gain entry. Step two is the insertion of some form of malicious code into the victim’s computer. Depending on the goals of the hacker, step three is the hijacking of something—for instance, the material stored in a computer’s memory (like Democratic National Committee e-mails), which is transferred to the hacker, who can use it to humiliate or blackmail; or the computer’s executable files, in order to hold the computer for ransom; or even the victim’s hard drive, which can be crashed and erased, the ultimate in malevolence.

You say, well, that’s computers . . . What does this have to do with the human body or brain? How about everything? While human hacking does not occur via computer code, there are many ways to tinker with the human brain. Certainly drugs can do the tampering. How about cleverly disguised messages, disinformation, propaganda, and the newest method of tampering, fake news? Can these messages act like phishing? And what if one of these messages gains hold? Can these alter your brain? Or how about something as innocuous as food? All of the above.

In this book I am going to develop separate and parallel scientific, cultural, historical, economic, and social arguments that our minds have been hacked. I will also demonstrate that this hack—the systematic confusion and conflation of the concepts and definitions of pleasure and happiness—has been inserted into the limbic system (the emotional part) of our brains, thereby precipitating a slow-motion crash of a substantial percentage (somewhere between 25 and 50 percent) of individuals and exacting a severe detrimental impact on our whole society. I will also demonstrate that this hack wasn’t accidental but in fact has been a plot—that is, the hack was not to just create mischief; rather, it was specifically designed and engineered with a profit motive. And, similar to the Russian hack of the 2016 presidential election, this plot has been and continues to be executed by private interests with governmental support.

In order to convince the reader of each of these arguments, I will first lay out (in simple terms) the neuroscience of each of these two otherwise positive emotions, how they can sometimes appear similar, but more importantly how they differ, what underlies our experience of each one, and how they influence each other. I will then explain how the business community and government have taken advantage of this neuroscience to hack our decision-making capacity and alter our level of individual and collective well-being. But fear not: even though this plot is pervasive in all walks of life, there are ways to insulate yourself and fend off this hack. Because when we understand the neuroscience of pleasure and happiness, each one’s relationship to the other, and how they are manipulated by our current food, technology, and media environments, we can more accurately denote the causes—and in turn the treatments—for our own personal well-being, and for our twin societal scourges.

I am not a psychiatrist or an addiction specialist. I am not a motivational speaker or a pop culture icon. I am not a Buddhist or a self-help guru. I am definitely not Dr. Oz or Dr. Phil, nor do I want to be: those guys have got their own problems. I am not a purveyor or user of psychoactive substances (although I’ve consulted with some experts for this book). I am not even a strict practitioner of all the precepts elaborated in this volume. And I certainly don’t have a corner on either the pleasure or happiness markets. Hell, I’ve got my own issues and baggage.

I am a practicing pediatric endocrinologist (hormone problems in children) and obesity research scientist at UCSF, an academic medical center. Endocrinology is a profession that has morphed over the past three decades from one that previously generated great joy and satisfaction into one of the unhappiest occupations around. Burnout rates are at 54 percent of all doctors but 75 percent of endocrinologists. Our subspecialty takes care of patients with obesity who never get thinner and patients with diabetes who never get better, most of whom eschew the advice that we recommend and destroy their bodies and their minds in the process. The practice of endocrinology is particularly prone to mythology and quackery, because hormones are chemicals you can’t see. People can see the damage that smoking does to their lungs on X-rays, or to their hearts on catheterization. But you can’t see the hormones at work in obesity and diabetes. And so people don’t believe. For many people, not seeing is believing. And charlatans can make people not see anything they want.

I’m not a conspiracy theorist by nature. A conspiracy would suggest corporate malevolence with collusion between industry actors, with intended malice and with government approval. Woodward and Bernstein had to connect many dots before the pernicious nature and the smoking gun of Watergate was revealed. It took whistleblower Jeffrey Wigand and the publication of the tobacco documents before officials could demonstrate that tobacco industry executives were engaged in a conspiracy to defraud the public. In The Hacking of the American Mind, I have a lot of dots that I must connect for you in successive chapters (biochemistry, neuroscience, genetics, physiology, medicine, nutrition, psychology/psychiatry, public health, economics, philosophy, theology, history, law). Although there are indications that some of the perpetrators (like tobacco) have colluded, or at least shared data and practices, I’m going to declare right now there is no smoking gun (other than smoking), and so I’m not going to stick my neck so far out as to say that there has been a conspiracy between different industries and the government to purposefully inflict malice on the public. Nonetheless, I will argue that there has been a plot by some industries to obfuscate the link between their products and disease, and to willfully confuse the concepts of pleasure and happiness with the sole motive being profit. I will then tie these seemingly separate strands together to convince the reader of the new alt-reality that has been manufactured by these industries. The science, the history, and the politics are strong enough to provide circumstantial and empirical evidence. In successive parts of this book, I will elaborate on each of these.

The substance that got me started on thinking about nutrition, health, disease, and how our emotions are manipulated—the substance that revealed its hidden iniquities to me back in 2006—is sugar. Sugar is the other white powder. It was the science of sugar that showed me that the behaviors associated with obesity (gluttony and sloth) were in fact due to a change in biochemistry, and that the biochemistry was due to a change in the environment. You may have read my book Fat Chance, which asked two questions: Why are we all so fat and sick? And in just thirty years? Fat Chance is a treatise on the science of obesity and metabolic syndrome, and the implications that the science portends for people and policy. But it was understanding the brain science that allowed me to put the data together to form a unifying hypothesis, and that sparked the impetus for my efforts to educate the public—to debunk the myths surrounding the obesity epidemic, which had prevented policy makers from addressing the deficiencies of our toxic food environment, rather than ineffectively trying to modulate the behaviors that are the result of that biochemistry. This meant I needed to know the law surrounding public health in order to understand and impact policy. So in my sixth decade I went to law school.

In the process of putting together the scientific argument in Fat Chance for nutrition and physical health, it became apparent to me that there is a wealth of information on the role of nutrition on outcomes related to behavioral health. Yet this information remains virtually unknown to most doctors and patients. Worse still, entire industries and governments have pushed hedonic (reward-generating) substances and behaviors on their unsuspecting populations for their profit, which has only caused further unhappiness. I also came to realize that some of the basic tenets of modern medicine were simply rubbish. They may sound right, but they do not stand up to scientific scrutiny.

This book, The Hacking of the American Mind, is similar to Fat Chance in that it uses biochemistry to educate the reader about the toxic environment in which we currently find ourselves—and perhaps even more importantly, how we remain there. (As was true in Fat Chance, the punch line is that it’s not about personal responsibility, but only you can help yourself, because no one else will.) Because pleasure and happiness, for all their apparent similarity, are separate phenomena, and in their extreme function as opposites. In fact, pleasure is the slippery slope to tolerance and addiction, while happiness is the key to long life. But if we don’t understand what’s actually happening to our brains, we become prey to industries that capitalize on our addictions in the name of selling happiness.

At this point it’s essential to define and clarify what I mean by these two words—pleasure and happiness—which can mean different things to different people.

Merriam-Webster’s Dictionary defines pleasure as enjoyment or satisfaction derived from what is to one’s liking; or gratification; or reward. While pleasure has a multitude of synonyms, it is this phenomenon of reward that we will explore, as scientists have elaborated a specific reward pathway in the brain, and we now understand the neuroscience of its regulation. Conversely, happiness is defined as the quality or state of being happy; or joy; or contentment. While there are many synonyms for happiness, it is the phenomenon that Aristotle originally referred to as eudemonia, or the internal experience of contentment, that we will parse in this book. Contentment is the lowest baseline level of happiness, the state in which it’s not necessary to seek more. In the movie Lovers and Other Strangers (1970), middle-aged married couple Beatrice Arthur and Richard Castellano were asked the question Are you happy?—to which they responded, "Happy? Who’s happy? We’re content. Scientists now understand that there is a specific contentment pathway" that is completely separate from the pleasure or reward pathway in the brain and under completely different regulation. Pleasure (reward) is the emotional state where your brain says, This feels good—I want more, while happiness (contentment) is the emotional state where your brain says, This feels good—I don’t want or need any more.

Reward and contentment are both positive emotions, highly valued by humans, and both reasons for initiative and personal betterment. It’s hard to be happy if you derive no pleasure for your efforts—but this is exactly what is seen in the various forms of addiction. Conversely, if you are perennially discontent, as is so often seen in patients with clinical depression, you may lose the impetus to better your social position in life, and it’s virtually impossible to derive reward for your efforts. Reward and contentment rely on the presence of the other. Nonetheless, they are decidedly different phenomena. Yet both have been slowly and mysteriously vanishing from our global ethos as the prevalence of addiction and depression continues to climb.

Drumroll . . . without further ado, behold the seven differences between reward and contentment:

Reward is short-lived (about an hour, like a good meal). Get it, experience it, and get over it. Why do you think you can’t remember what you ate for dinner yesterday? Conversely, contentment lasts much longer (weeks to months to years). It’s what happens when you have a working marriage or watch your teenager graduate from high school. And if you experience contentment from a sense of achievement or purpose, the chances are that you will feel it for a long time to come, perhaps even the rest of your life.

Reward is visceral in terms of excitement (e.g., a casino, a football game, or a strip club). It activates the body’s fight-or-flight system, which causes blood pressure and heart rate to go up. Conversely, contentment is ethereal and calming (e.g., listening to soothing music or watching the waves of the ocean). It makes your heart rate slow and your blood pressure decline.

Reward can be achieved with different substances (e.g., heroin, nicotine, cocaine, caffeine, alcohol, and of course sugar). Each stimulates the reward center of the brain. Some are legal, some are not. Conversely, contentment is not achievable with substance use. Rather, contentment is usually achieved with deeds (like graduating from college or having a child who can navigate his or her own path in life).

Reward occurs with the process of taking (like from a casino). Gambling is definitely a high: when you win, it is fundamentally rewarding, both viscerally and economically. But go back to the same table the next day. Maybe you’ll feel a jolt of excitement to try again. But there’s no glow, no lasting feeling from the night before. Or go buy a nice dress at Macy’s. Then try it on again a month later. Does it generate the same enthusiasm? Conversely, contentment is often generated through giving (like giving money to a charity, or giving your time to your child, or devoting time and energy to a worthwhile project).

Reward is yours and yours alone. Your sense of reward does not immediately impact anyone else. Conversely, your contentment, or lack of it, often impacts other people directly and can impact society at large. Those who are extremely unhappy (the Columbine shooters) can take their unhappiness out on others. It should be said at this point that pleasure and happiness are by no means mutually exclusive. A dinner at the Bay Area Michelin three-star restaurant the French Laundry can likely generate simultaneous pleasure for you from the stellar food and wine but can also generate contentment from the shared experience with spouse, family, or friends, and then possibly a bit of unhappiness when the bill arrives.

Reward when unchecked can lead us into misery, like addiction. Too much substance use (food, drugs, nicotine, alcohol) or compulsive behaviors (gambling, shopping, surfing the internet, sex) will overload the reward pathway and lead not just to dejection, destitution, and disease but not uncommonly death as well. Conversely, walking in the woods or playing with your grandchildren or pets (as long as you don’t have to clean up after them) could bring contentment and keep you from being miserable in the first place.

Last and most important, reward is driven by dopamine, and contentment by serotonin. Each is a neurotransmitter—a biochemical manufactured in the brain that drives feelings and emotions—but the two couldn’t be more different. Although dopamine and serotonin drive separate brain processes, it is where they overlap and how they influence each other that generates the action in this story. Two separate chemicals, two separate brain pathways, two separate regulatory schemes, and two separate physiological and psychological outcomes. How and where these two chemicals work, and how they work either in concert or in opposition to each other, is the holy grail in the ultimate quest for both pleasure and happiness.

The Hacking of the American Mind will not just elaborate how reward and contentment work on a biochemical level, it will show what the differences between them mean for your personal and mental health and for the health of our society. However, right at the start, I must acknowledge three caveats.

First, the science of these two phenomena relies primarily on animal models. Who says depression in a rat is the same as depression in a human? Or even addiction, for that matter? Can rats become sex addicts?

Second, most human studies that are available are correlative, not causative. Correlation is a snapshot in time. You can only say that two things are related to each other. And even that can be a stretch. Might they have nothing to do with each other? For instance, ice cream consumption correlates with frequency of drownings. Does that mean eating ice cream causes you to drown? Or do survivors of the drowned victim bury their sorrows in a banana split? More likely, we eat ice cream when it’s hot, we swim when it’s hot, and some unfortunate people drown when they swim. Just because there is a correlation, does that really mean there is a cause-and-effect relationship?

There are other complications in interpreting human studies:

It’s very hard to do causative studies on emotions and psychiatric illness. Determining causation means assessing the disease process over time. Few people have had magnetic resonance imaging (MRI) or positron emission tomography (PET) scans of their brains performed before their mental illness occurred.

Many of the studies measure blood levels of these neurotransmitters. However, what is going on in the brain may be different than what is going on in the blood.

Brain neuroimaging studies require special equipment; some involve radioisotopes and are therefore terribly expensive to perform and often not immediately available.

It’s not just all dopamine and serotonin. Other neurochemicals do play major roles in how we think and feel, are part of these pleasure and happiness pathways as well, and thus complicate the picture.

All of these pathways and neurochemicals are influenced by genetic, epigenetic (changes to the expression of DNA, not changes to the sequence), and experiential forces. Thus, what might be true for one individual may not be true for another.

The science on serotonin was stymied for forty years by Congress and the FDA. I’ll expand on this later in the book. But it means we have way less information on the role of serotonin on behavior than we should.

Third and finally, the connecting of our moods and emotions to rational public policy is complex, nuanced, and indirect. People can’t be told what to do. As a New Yorker, I admit that if someone tells me to jump, my first response is not How high? But to have even a remote chance to unhack our brains, first we have to recognize what the hack is and how it works.

Part I will discuss the differences between reward and contentment, how their meanings have been confused and obscured, and how they indeed can be opposites. We will also start to explore what parts of the brain are involved in each experience. Part II will elaborate on the biology of reward and the science of dopamine. I will explain why the motivation for pleasurable experiences starts with dopamine but how too much of it can lead to aggression and irritability. There really can be too much of a good thing. It can even kill you. Throw on top of that some emotional stress, which aggravates the need for pleasure seeking, and you’ve got a great recipe for addiction. Part III will discuss the biology of contentment and the science of serotonin and how the reward and contentment systems overlap (or don’t). For instance, certain serotonin agonists (like psychedelics) can improve mood, while other serotonin-boosting medications (known as selective serotonin reuptake inhibitors, or SSRIs) treat depression. In Part IV, I will show how the perpetration of this plot has brought us to this place, from a personal, historical, cultural, and economic standpoint. In the last half century, America and most of the Western world have become more and more unhappy, sicker, and broke as well. Marketing, media, and technology have capitalized on subverting our brain physiology to their advantage in order to veer us away from the pursuit of happiness to the pursuit of pleasure, which for them of course equals the pursuit of profit. Fueling our quest for reward has only contributed to the epidemics of non-communicable diseases such as diabetes, heart disease, cancer, and dementia, which are eating away at our health, our health care system, and the fabric of our society. Lastly in Part V, I will offer simple solutions that all of us can employ to defend against the pernicious peddling of pleasure, and ways to mitigate the stress that drives both addiction and depression, so that we may be able to pursue our individual happiness to the fullest. I will explore how and why different modalities for taming dopamine and increasing serotonin work and how we can rethink our lives and our goals so we can enjoy health (more than we have now) as well as pleasure (sometimes) and happiness (all the time). But you can’t solve the problem until you know what the problem is. That’s what this book is about.

Humans speak many languages, have varying standards of beauty, and worship at the altars of different deities, but their underlying biochemistry and what makes them tick is nonetheless the same. All our behaviors are manifestations of the biochemistry that drives them. To pull ourselves and our children back from the edge of this man-made abyss at which we now stand, we first have to understand the science.

PART I

A Few Fries Short of a Happy Meal

1.

The Garden of Earthly Delights

Once upon a time we were happy. Then the snake showed up. And we’ve been miserable ever since. Hieronymus Bosch’s painting Garden of Earthly Delights (circa 1500) is a triptych housed in the Prado in Madrid. It is an allegorical warning of what happens when we squander our birthright of happiness divined from God in one garden and move on to the pleasures of the flesh in the next garden, with the inevitable result of eternal damnation. Figures. Our most lauded goal in life—to be happy—is seemingly an illusion, out of reach for us common folk. Except the rich aren’t any happier. Happiness seems to be a mirage, something to chase after, to keep us turning over rocks, kissing frogs, and trying to fit keys into the magic lock.

But along the way, wandering through our own individual gardens of earthly delights in search of our seemingly unobtainable nirvanas, we’ve sure had a whole lot of fun. Or we’ve at least tried to. We buy shiny things, play Powerball, imbibe with friends or sometimes alone. So why are so many of us miserable? Are we destined just to sink further into the abyss of pleasure with no hope of extricating ourselves to find real happiness? Is it all futile? Lots of people have died trying to get to that magic place of contentment and inner peace, that thing called happiness. But if we can’t get there, what’s the point?

What if I told you that happiness is right there in front of you, just behind the curtain of your own brain?

To some, an argument over the difference between pleasure and happiness might seem like a straw man, a false argument not really worth having. Hey, they both feel good; why should you care? And pleasure is here, now. Happiness . . . maybe not so much, and not so soon.

But it