The Power of Radical Honesty - Dr. Anna Lembke

Hi, welcome to a special episode of After School. I'm Dr. Ana Lemke, Professor of Psychiatry and Addiction Medicine at Stanford University School of Medicine, and I'm really excited for you to watch this animation on radical honesty. Let's dive in. Every major religion and code of ethics has included honesty as essential to its moral All my patients who have achieved long-term recovery have relied on truth-telling as critical for sustained mental and physical health. I too have become convinced that radical honesty is not just helpful for limiting compulsive overconsumption, but also at the core of a life well-lived. The question is, how does telling the truth improve our lives? Let's first establish that telling the truth is painful. We are wired from the earliest ages to lie, and we all do it, whether or not we care to admit it. Children begin lying as early as age 2. The smarter the kid, the more likely they are to lie, and the better they are at it. Lying tends to decrease between ages 3 and 14, possibly because children become more aware of how lying harms other people. On the other hand, adults are capable of more sophisticated antisocial lies than children, as the ability to plan and remember becomes more advanced. The average adult tells between 0.59 and 1.56 lies daily. Liar, liar, pants on fire, we've all got a little smoke coming off our shorts. Humans are not the only animals with the capacity for deception. The animal kingdom is rife with examples of deception as a weapon and a shield. The Lomachusa pubiculus beetle, for example, is able to penetrate ant colonies by pretending to be one of them, something it accomplishes by emitting a chemical substance that makes it smell like an ant. Once inside, the beetle feeds on ant eggs and larvae, but no other animal rivals the human capacity for lying. Evolutionary biologists speculate that the development of human language explains our tendency and superior ability to lie. The story goes like this. The evolution of Homo sapiens culminated in the formation of large social groups. Large social groups were possible because of the development of sophisticated forms of communication, allowing for advanced mutual cooperation. Words used to cooperate can also be used to deceive and misdirect. The more advanced the language, the more sophisticated the lies. Lies arguably have some adaptive advantage when it comes to competing for scarce resources. But lying in a world of plenty risks isolation, craving, and pathological overconsumption. Let me explain. In today's world of overwhelming abundance, it is easy to slip into behaviors that feel good in the short term, but are ultimately destructive in the long term. We engage in lying and create a false persona or a mask to cover up our behaviors, which leads to shame and isolation and fuels ongoing consumption. We cannot get out of this cycle of destructive shame that fuels addiction until we stop lying and start being who we really are. Radical honesty, telling the truth about things large and small, is essential not just to recovery from addiction, but for all of us trying to live a more balanced life in our reward-saturated ecosystem. It works on many levels. First, radical honesty promotes awareness of our actions. Second, it fosters intimate human connections. Third, it leads to a truthful autobiography which holds us accountable not just to our present but also to our future selves. Further, telling the truth is contagious and might even prevent the development of future addiction. Awareness. Lying can become so routine that we are unaware that we are even doing it. I call this the lying habit. To restore a truthful narrative of our lives, we must become aware of the lies we tell ourselves and others. Recounting our experiences gives us mastery over them. Whether in the context of psychotherapy, talking to an AA sponsor, confessing to a priest, confiding in a friend, or writing in a journal, our honest disclosure brings our behavior into relief, allowing us, in some cases, to see it for the first time. This is especially true for behaviors that involve a level of automaticity outside of conscious awareness. When I was compulsively reading romance novels, I was only partially aware of doing so. That is to say, I was aware of the behavior at the same time I was not aware of it. This is a well-recognized phenomenon in addiction, a kind of half-conscious state akin to a waking dream often referred to as denial. Denial is likely mediated by a disconnect between the reward pathway part of our brain and the higher cortical brain regions that allow us to narrate the events of our lives, appreciate consequences, and plan for the future. Many forms of addiction treatment involve strengthening and renewing connections between these parts of the brain. Honesty promotes intimate human connections. Telling the truth draws people in, especially when we're willing to expose our own vulnerabilities. This is counterintuitive because we assume that unmasking the less desirable aspects of ourselves will drive people away. It logically makes sense that people would distance themselves when they learn about our character flaws and transgressions. In fact, the opposite happens. People come closer. They see in our brokenness their own vulnerability and humanity. They are reassured that they are not alone in their doubts, fears, and weaknesses. Intimacy is its own source of dopamine. Oxytocin, a hormone much involved with falling in love, mother-child bonding, and lifetime pair bonding of sexual mates, binds to receptors on the dopamine-secreting neurons in the brain's reward pathway and enhances the firing of the reward circuit tract. In other words, oxytocin leads to an increase in brain dopamine. While truth-telling promotes human attachment, compulsive overconsumption of high dopamine goods is the antithesis of human attachment. Consuming leads to isolation and indifference as the drug comes to replace the reward obtained from being in relationship with others. Experiments show that a free rat will instinctively work to free another rat trapped inside a plastic bottle. But once that free rat has been allowed to self-administer heroin, it is no longer interested in helping out the caged rat, presumably too caught up in an opioid haze to care about a fellow member of its species. Any behavior that leads to an increase in dopamine has the potential to be exploited. What I am referring to is a kind of disclosure porn that has become prevalent in modern culture, where revealing intimate aspects of our lives becomes a way to manipulate others for a certain type of selfish gratification rather than to foster intimacy through a moment of shared humanity. There is a well-known phenomenon in AA called drunkologues, referring to tales of intoxicated exploits that are shared to entertain and show off rather than teach and learn. Drunkologues tend to trigger craving rather than promote recovery. The line between honest self-disclosure and a manipulative drunkologue is a fine one, including subtle differences in content, tone, cadence, and affect, but you know it when you see it. Truthful autobiographies create accountability. Single simple truths about our day-to-day lives are like links in a chain that translate into truthful autobiographical narratives. Autobiographical narratives are an essential measure of lived time. The stories we narrate about our lives not only serve as a measure of our past but can also shape future behavior. In the more than 20 years as a psychiatrist listening to tens of thousands of patient stories, I have become convinced that the way we tell our personal stories is a marker and predictor of mental health. Patients who tell stories in which they are frequently the victim, seldom bearing responsibility for bad outcomes, are often unwell and remain unwell. They are too busy blaming others to get down to the business of their own recovery. By contrast, when my patients start telling stories that accurately portray their responsibility, I know they're getting better. The victim narrative reflects a wider societal trend in which we're all prone to see ourselves as the victims of circumstance and deserving of compensation or reward for our suffering. Even when people have been victimized, if the narrative never moves beyond victimhood, it's difficult for healing to occur. One of the jobs of good psychotherapy is to help people tell healing stories. If autobiographical narrative is a river, psychotherapy is the means by which that river is mapped and, in some cases, rerouted. Healing stories adhere closely to real-life events. Seeking and finding the truth, or the closest approximation possible with the data at hand, affords us the opportunity for real insight and understanding, which in turn allows us to make informed choices. As I have alluded to before, the modern practice of psychotherapy sometimes falls short of that lofty goal. We as mental health care providers have become so caught up in the practice of empathy that we've lost sight of the fact that empathy without accountability is a short-sighted attempt to relieve suffering. If the therapist and patient recreate a story in which the patient is a perpetual victim of forces beyond their control, chances are good that the patient will continue to be victimized. But if the therapist can help the patient take responsibility, if not for the event itself, then for how they react to it in the here and now, that patient is empowered to move forward with their life. I have been deeply impressed with AA philosophy and teachings on this point. One of the preeminent AA mottos, often printed in bold type on its brochure, is, quote, I am responsible. In addition to responsibility, Alcoholics Anonymous emphasizes rigorous honesty as a central precept of its philosophy, and these ideas go together. The fourth of AA's 12 steps requires members to take a searching and fearless moral inventory in which the individual considers his or her character defects and how they have contributed to a problem. The fifth step is the confession step. This is where AA members admit to God, to ourselves, and to another human being the exact nature of our wrong. This straightforward, practical, and systematic approach can have a powerful and transformative impact. A truthful autobiographical narrative further allows us to be more authentic, spontaneous, and free in the moment. The psychoanalyst Donald Winnicott introduced the concept of the false self in the 1960s. According to Winnicott, the false self is a self-constructed persona in defense against intolerable external demands and stressors. Winnicott postulated that the creation of the false self can lead to feelings of profound emptiness. No, there, there. Social media has contributed to the problem of the false self by making it far easier for us, and even encouraging us, to curate narratives of our lives that are far from reality. In his online life, my patient Tony, a young man in his 20s, ran every morning to take in the sunrise, spent the day engaged in constructive and ambitious artistic endeavors, and was the recipient of numerous awards. In his real life, he could barely get out of bed, compulsively looked at pornography online, struggled to find gainful employment, and was isolated, depressed, and suicidal. Little of his real day-to-day life was evident on his Facebook page. When our lived experience diverges from our projected image, we are prone to feel detached and unreal, as fake as the false images we've created. Psychiatrists call this feeling derealization and depersonalization. It's a terrifying feeling which commonly contributes to thoughts of suicide. After all, if we don't feel real, ending our lives feels inconsequential. The antidote to the false self is the authentic self. Radical honesty is a way to get there. It tethers us to our existence and makes us feel real in the world. It also lessens the cognitive load required to maintain all those lies, freeing up mental energy to live more spontaneously in the moment. When we're no longer working to present a false self, we're more open to ourselves and others. As the psychiatrist Mark Epstein wrote in his book, Going on Being, about his own journey No longer endeavoring to manage my environment, I began to feel invigorated, to find a balance, to permit a feeling of connection with the spontaneity of the natural world and with my own inner nature. Truth-telling is contagious, and so is lying. Lao Tzu wrote, Trust is something that takes time and effort to build, and can be destroyed in an instant. Friedrich Nietzsche wrote, Telling the truth is a two-way street. By being open and honest with others, we inspire them to be open and honest with us. If you don't trust yourself, you will live in fear that others will betray you. So honesty starts with not lying to yourself, and this honesty has a contagious effect. Conclusion My patients have taught me that honesty enhances awareness, creates more satisfying relationships, holds us accountable to a more authentic narrative, and strengthens our ability to delay gratification. It may even prevent the future development of addiction. For me, honesty is a daily struggle. There's always a part of me that wants to embellish the story just the slightest bit, to make myself look better or to make an excuse for bad behavior. Now I try hard to fight that urge. Although difficult in practice, this handy little tool, telling the truth, is amazingly within our reach. Anyone can wake up on any given day and decide, today, I won't lie about anything. And in doing so, not just change their individual lives for the better, but maybe even change the world. Thanks for watching this episode of After School. If you want to learn more, you might try my book, Dopamine Nation, Finding Balance in the Age of Indulgence.