Understanding the neuroscience of pleasure

Nan Wise, Ph.D., is AASECT certified sex therapist, neuroscientist, certified relationship expert, and author. Follow her @AskDoctorNan. The following is adapted from her new book, Why Good Sex Matters: Understanding the Neuroscience of Pleasure for a Smarter, Happier, and More Purpose-Filled Life. — Mark

Our society has had a long, challenging relationship with pleasure. A recent study indicates that American adults are having sex less often than before, with an especially steep decline since the year 2000. This decline is significant even when you control for factors such as age, gender, and marital status. And to top it off, in spite of the media's portrayal of young people as freewheeling, casual sex-seeking, hookup artists, those born in the 1980s and 1990s are now the adults who are having less sex.

There is a clear paradox when it comes to our sexuality — a vexing approach/avoidance that I have come to characterize as a "lewd-prude" phenomenon. As much as we are reinforcing the need for mindful "sexual conduct," scores of people are coming forth to report sexual harassment and sexual abuse that has long been in the shadows. Sex has become for many a place of pain rather than pleasure. Unfortunately, as movements like #MeToo have uncovered, there is quite a long-standing disconnect between the code of behavior we preach and its effectiveness in our society, creating a kind of shadow culture where people act out negatively and harmfully around sex. And even those who have not had a traumatic sexual experience are impacted by this social component that reinforces a disconnect from pleasure.

Our culture has deep roots in a Calvinism that associates pleasure (especially sexual or sensual) with shame and places a higher value on stoicism. A number of recent studies have shown that modern-day Americans, even those who aren't particularly religious, continue to be influenced by traditional Puritan-Protestant morality. This infuses us with a disdain for and discomfort with worldly sexual pleasures and an excess of pleasure in general. It is my experience that people are literally afraid to "indulge" in the release of pleasure — as they have been conditioned by culture or bad experiences to associate having pleasure with the threat of danger or punishment. It is as if having "too much fun" evokes the sense that feeling good is bad or shameful. This connection may be even more potent for women. Just a few generations ago, women who engaged in such behavior might have gotten burned at the stake. Confusingly, this attitude seems to be directly at odds with the commodification of sex that is equally ubiquitous in American culture; sex sells everything from books to booze to boob jobs, from Viagra to online porn to plastic surgery to rejuvenate our lady parts, from haute couture to celebrity-endorsed Kmart collections. Indeed, looking in a shop window, we might actually believe that this celebration of sexuality is the American way. But a gap certainly persists between this advertised celebration and what we personally associate with pleasure.

In distinguishing between happiness and pleasure, psychologist Dr. Margaret Paul, the creator of the Inner Bonding Program, makes a common and often misleading point about pleasure. She says,:

There is a huge difference between happiness and pleasure. Pleasure is a momentary feeling that comes from something external — a good meal, our stocks going up, making love and so on. Pleasure has to do with the positive experiences of our senses, and with good things happening. Pleasurable experiences can give us momentary feelings of happiness, but this happiness does not last long because it is dependent upon external events and experiences. We have to keep on having the good experiences — more food, more drugs or alcohol, more money, more sex, more things — in order to feel pleasure. As a result, many people become addicted to these external experiences, needing more and more to feel a short-lived feeling of happiness.

This view of pleasure as being momentary and inconsequential is problematic and essentially inaccurate. It's deeply rooted in Western culture, stemming from religious thought extending back millennia, when pleasure was associated with sin, a life of intemperance, and the body being a source of evil or human weakness. Indeed, abstaining from sex was seen as a virtue. This binary view of body versus soul formed the underpinning of philosophical, religious, artistic, and even scientific thought for centuries. Alas, it lingers today.

But my bigger problem with this view of pleasure is that it implies that pleasure is optional and not as valuable, as say, happiness. From a neurobiological level, nothing could be farther from the truth. Pleasure is essential and critical to our emotional, physical, and mental well-being.

Our ambivalence about pleasure is most obvious in our conflict with sex. We are deeply into sex, but at the same time, deeply at odds with it, often misunderstanding our own urges, needs, and desires. We judge our sexual longings, we curtail our desires, and we cut ourselves off from all that it affords us. We convince ourselves that we just don't need it or want it. This is a problem that speaks to an unhappiness at our core and why redefining our relationship to sex and pleasure is so necessary.

Making Sex Important

Living without pleasure affects not only men and women in midlife and beyond, but also young men and women in their twenties, thirties, and forties, in the so-called prime of their lives. Consider Matt, a young, handsome, and very sweet professional, who is constantly perusing dating apps in search of the "right" woman. He goes on a dozen new dates per month, and yet, his deep thirst for connection goes unquenched. Matt has sex with a lot of women but does so for a variety of reasons, including in part because he believes his dates expect him to, and he thus sometimes has trouble becoming aroused. (Counterintuitively, young men are among the biggest consumers of Viagra-type drugs.) These first dates often involve more than a few cocktails to loosen up, sometimes causing Matt to experience alcohol-induced performance issues and further complicating his view of these experiences.

Previously, a young man like this would be diagnosed as having intimacy or commitment issues, and to some extent, that may be true. But what looms larger is Matt's context: he is stuck in a cycle of seeking pleasure — romantic and sexual — without the understanding of how and why he can't actually feel the pleasure. The ferocious pace of modern dating — the condition of plenty that dating apps create — results in a situation where it's difficult to learn how to get to know each other, to build desire, to savor connection. It's a catch-22: the pace of modern life makes it harder to slow down long enough to cultivate pleasure and savor its satisfaction.

Matt is in this exact position. His ability to be emotionally and physically intimate is being hijacked by an imbalance in his brain's basic emotional circuitry. What Matt doesn't know is that his frenetic seeking of connection is actually getting in the way of his finding it. On overdrive, all of his wanting has set off an alarm bell in the emotional basement of his brain, and when the alarm turns on, the sexual system shuts down, hence his erectile dysfunction.

The purpose of this seeking system that Matt is caught up in is to help us adapt, feel motivated, and be resilient. But if we don't know how to turn down the seeking and learn to like what we have, then we are forever looking and never enjoying what we have. Matt's anhedonic disruption shows up as a disconnection between too much seeking and very little satisfaction. Out of reach for him now are warm, fuzzy emotional connections that would help tamp down the seeking. Instead, he is stuck wanting and never gets the positive, fulfilling reward that would come from a real relationship, its intimacy, and the resulting calming and bonding experience that would in turn make him feel safe and secure enough to relax into spontaneous and juicy sexual functioning.

To resolve this situation, Matt has to uncover what is driving him to seek and never feel satisfied. The first step for him is to become aware of the emotional habits underlying the "speed dating" that keep him moving quickly from person to person, without time to get to know anyone in particular. As a hedge fund manager, everything in Matt's world moves quickly — an ongoing relentless influx of information about developments, national and global headlines to track, scores of emails to field, bets to make, probabilities to compute. Matt has become used to and then dependent on the fast-paced thrills and the buzz of taking risks and winning that go with his job.

But in his private life, the strategies that help him win in business bomb bigtime. He and his penis know on a deep level that no connections are being made; he also knows that he is stuck in a cycle. Fixated on the chase, he cannot shift and slow down long enough to think about choosing an appropriate partner who might actually make him happy. And his easy access to romantic or sexual connections is only reinforcing the hijacking of the brain networking that enables — and needs — a deeper or more drawn out path to pleasure.

Matt needs to break the cycle and get out of his anhedonic disruption by first becoming aware of how his bottom and midlevel minds are operating around these emotional and behavioral habits. Then he has to learn how to consciously enlist his top brain to change the frenetic pace of dating that's been preventing him from deepening his ability to be intimate with an appropriate partner. Once he becomes aware of the behavior patterns that have more or less been operating unconsciously, he is able to accept my coaching (more use of his top brain) and start to slow down and savor the opportunity to get to know each person without the pressure of rushing into sex. And once he eliminates the habit of racing into sexuality, he is able to let his heart and head discover who he feels not only attracted to, but comfortable with — and his sexuality will unfold seamlessly.

My patients represent the vast majority of women and men who complain of inadequate sexual experiences, from loss of drive or desire to penises that don't work, an inability to orgasm or an orgasm that comes way too soon, pain with intercourse, or pain with the intimacy that comes along with sexual interactions. Estimates of how many individuals suffer from sexual problems vary widely, depending on how these "problems" are defined and how the information is collected, as well as a host of other variables. Suffice it to say, it is believed that sexual problems are among the most common psychological disorders affecting the general population. We've been told by sex experts that the cause of an inability to enjoy sex is sexual dysfunction, brought on by age, hormonal disruptions, or other diseases such as high blood pressure, diabetes, heart disease, or depression. And yes, these conditions all play a role in sexual shutdown. However, the underlying causes for sexual dysfunctions that impede desire and responsiveness can be traced to the brain and how the brain processes emotions. That's why sex is such a powerful way to untangle our mysterious relationship to pleasure, our complicated neural networks that make pain and pleasure interdependent, and the dance of powerful emotions that underlie all aspects of our lives.

To truly reclaim pleasure in our lives, especially in our sex lives, we need to understand how we are driven by the powerful emotions that operate in the brain.