Subscribe Now
It’s nearly impossible to go even a couple of days without coming across the term self-care, a word that encompasses any number of lifestyle choices and products – from juice cleanses to yoga workshops to bamboo sheets. Self-care has exploded in our collective consciousness as a panacea for practically all of women's problems.
But fixing your troubles isn't as simple as buying a new day planner or signing up for a meditation class. These faux self-care practices keep us looking outward, comparing ourselves with others or striving for a certain type of perfection. Worse, they exonerate an oppressive social system that has betrayed women and marginalized groups. So says my guest today, Pooja Lakshmin, a psychiatrist and author specializing in women's mental health. A clinical assistant professor of psychiatry at the George Washington University School of Medicine, the founder of Gemma, a digital community focused on women's mental health and equity, and a contributor to the New York Times. Pooja has spent thousands of hours taking care of women struggling with burnout, despair, depression, and anxiety in her clinical practice. Her work focuses on the intersection of mental health and gender, and her new book, Real Self-Care, helps women and marginalized groups heal from the tyranny of faux self-care, while exposing the systems that have gotten us here.
In this episode we discuss:
- The turning point that led Pooja to drop out her medical residency training program and explore alternative paths.
- Pooja’s surprising decision to join an orgasmic meditation commune in San Francisco, the eventual decision to leave, and the lessons she learned.
- Her personal mental health struggles, including depression and thoughts of suicide.
- The pivotal moment that motivated her to return to residency and pursue her calling.
- The nuances between genuine self-care and the commodified wellness industry, clarifying that the book does not dismiss common self-care practices but challenges their commodification.
- The three common reasons people turn to self-care and how these dynamics manifest in her life and the lives of her patients.
- The principles of real self-care and the importance of internal processes, emphasizing the role of boundaries and their significance in fostering genuine well-being.
- The intersection of privilege and self-care, especially for mothers juggling multiple responsibilities.
- The systemic issues causing stress, reframing the conversation from burnout to betrayal and the societal pressures for perfection
- The importance of embracing “good enough., balancing excellence with realistic expectations.
- How positive psychology methods contribute to individual change and reshape the wellness narrative
- The challenges of balancing motherhood, professional responsibilities, and real self care.
Thank you so much for taking the time to tune into this podcast! Enjoy the interview by listening above or wherever you listen to podcasts, and the transcript below to read along. I hope this conversation brings you more self-compassion and grace as we all mother in a culture that places so much pressure on motherhood.
Please share the love by sending this to someone in your life who could benefit from the kinds of things we talk about in this space. Make sure to follow me on Instagram @dr.avivaromm to join the conversation.
You can follow Pooja on Instagram @poojalakshmin and visit poojalakshmin.com.
The Interview: Dr. Aviva & Dr. Pooja Lakshmin
In this podcast, psychiatrist and author Puja Lakshmin discusses the concept of self-care and its importance in maintaining mental health. She emphasizes that self-care is not about indulging in materialistic practices like buying crystals or going for spa treatments, but about setting boundaries, being compassionate towards oneself, aligning actions with personal values, and understanding one's power. She also highlights the importance of staying engaged with societal issues and making time for community and relationships. Lakshmin shares her personal journey of dealing with burnout and the importance of taking a pause to reflect and make decisions. She also discusses the role of social determinants of health in mental health issues and the need for a holistic approach to treatment.
_______________________-
Aviva: It’s nearly impossible to go even a couple of days without coming across the term self-care, a word that encompasses any number of lifestyle choices and products – from juice cleanses to yoga workshops to bamboo sheets. Self-care has exploded in our collective consciousness as a panacea for practically all of women's problems.
But fixing your troubles isn't as simple as buying a new day planner or signing up for a meditation class. These faux self-care practices keep us looking outward, comparing ourselves with others or striving for a certain type of perfection. Worse, they exonerate an oppressive social system that has betrayed women and marginalized groups. So says my guest today, Pooja Lakshmin, a psychiatrist and author specializing in women's mental health. A clinical assistant professor of psychiatry at the George Washington University School of Medicine, the founder of Gemma, a digital community focused on women's mental health and equity, and a contributor to the New York Times. Pooja has spent thousands of hours taking care of women struggling with burnout, despair, depression, and anxiety in her clinical practice. Her work focuses on the intersection of mental health and gender, and her new book, Real Self-Care, helps women and marginalized groups heal from the tyranny of faux self-care, while exposing the systems that have gotten us here.
So nice to meet you, Puja. One of the things that I have been coming to recently is that something happened to me in the transition between being a midwife for decades and becoming a doctor. And that something is something I'm really unpacking lately, which is this insidious reinforcement of perfectionism and public appearance, and how I try to align what I say and do with what people's expectation of a good doctor is. And I'll tell you what, I'm an amazing doctor and what makes me a good doctor is actually keeping it real and dropping the occasional f-bomb with a patient when it's appropriate. I feel like I've been trying to do this podcast as a proper journalist, and I'm like, no, I just really want to have these kind of shoot the shit conversations with other women about what's really going on in their lives.
So, I'm really glad you're here to talk about your book Real Self-Care. I want to know who you are and what makes you tick and what made you write this book. I want to unpack things like the fact that most of us who write books are a little bit perfectionistic, and those of us who go to medical school are a little, so how does it all align?
So, let's take it from the top. You were in medical residency, and for those who are listening who don't know this, getting into a medical residency is a big freaking deal. We have an annual day called Match Day. You've done a dozen interviews, you've gone to med school, your whole life has put you in the position to do this, and it's a big thing. So you were in residency and you dropped out. What was going on?
Pooja: Yeah, so we're diving right in. We're diving right in. Maybe I'll just start with sort of where I am now, and then I will take everybody back to that very tumultuous time in my life that was also very powerful too. So I am going to be 40 in December.
Aviva: Congratulations.
Pooja: Thank you. Thank you. And I am a psychiatrist. I specialize in women's mental health and I have a private practice. I live in Austin now. I moved here during the pandemic, but I was previously in Washington, DC for about seven years. So currently my practice is all telemedicine. My patients are still in DC but I'm here in Austin. And then I also am a writer and an author. I write regularly for the New York Times. I wrote my first book, Real Self-Care. The sub subtitle is Crystals, Cleanses and Bubble Baths Not Included. All that to say, I have a life where I'm a professional and have a toddler actually, so that's a fun experience. I went through IVF to become a mom, but a decade ago, a little more than a decade ago, I blew up my life. And like you said, Aviva, the path to becoming a physician is such a grueling path. Basically, you have to dedicate a decade of your life to the path before you even know if you'll get into a residency. You have to be pre-med, you to take all the science classes, you have to go to medical school.
I am South Asian American. My parents are immigrants from India. Prior to that time in my life, I had kind of done all the things that a good Indian girl was supposed to do. I got good grades, was valedictorian in my high school class, got into Penn for undergrad, got into medical school, got married, and I found myself in my second year of my psychiatry residency sort of being like, okay, I've checked off all the boxes. I've done everything that I'm supposed to. So now let me figure out how to be happy. I remember actually at the time I was reading Gretchen Rubin's great, great book, The Happiness Project. And I was kind of like, okay, what do I do? And I realized that I had built everything based on other people's values. I had never stopped to really think what I really wanted. And to be fair, I was totally, there's a lot of ego in this. I was chasing the prestige. I wanted those shiny things. I wanted those Ivy League schools and their degrees.
Aviva: If you come from, as I do, an immigrant background – I'm not first generation – but there's also something, at least for me that's so baked in of overcoming scarcity and adversity that I think, at least for me, and I suspect for you too, kind of feeds that drive a bit too. It gets all confused in this internal thing of security and ego and accomplishment and the things that we are actually naturally drawn to. And then we end up with this, wait, where am I in that?
Pooja: Totally, totally. And I think as a woman too, right, because proving myself, proving to myself and proving to others that I deserve to be in those rooms was a huge part of it. But yeah, I found myself there having everything that I said that I wanted, but feeling totally empty on the inside. I was really destructive. I kind of blew it all up. I blew up my marriage, and I found this group at the time that was really focused on spirituality and meditation and sexuality, female orgasm. I'd been a women's studies major at Penn, and immediately I was just kind of like, okay, this is my new life. And I left my residency. Again, I'll say it was a very destructive time for me, and there were a lot of people that I really cared about that were hurt in the wake of all of that.
But I thought that I had found sort of the magic bullet, not only for myself, but also because what I'd seen up until that point in psychiatry was… I was really disillusioned by it. The first two years of psychiatry residency, you're working mostly on inpatient units with folks who have diagnoses like schizophrenia or severe bipolar disorder. And the amount that you can help them is actually quite limited. You see a lot of suffering that you're actually powerless to change. And me being someone at that time who had gone straight from undergrad to medical school to residency, I was super naive about it. I thought that becoming a doctor meant that I would be able to fix everybody's problems, which clearly, as you know is not true.
It was really hard for me emotionally and psychologically to figure out how to resolve the fact that I went to school for so long and dedicated so much of my life to this career to end up there and feel like I actually, I can't get this person housing. I can't mend the relationship that they have with their family.
So I converted that to rage and was sort of like, okay, I'm just going to destroy it all. I left and I moved in with this group, and I was with them for two years. And in the beginning I thought that this was kind of this panacea, that there could be some guru, some practice that could solve all of your problems. But by the end of it, I realized that just like in allopathic medicine, just like in mainstream medicine, in alternative medicine and in the wellness space there's just as many hypocrisies and contradictions, and there is no magic panacea. There is actually no shortcut. And I realized that really in that two-year sojourn from my life, I was really just trying to run away from my problems. And so I came back to medicine, and that was the most difficult thing that I've ever done. Having to admit my failure and reapply to residencies, come back to the East coast, in real self-care. I turned 30 in my old childhood bedroom in my parents' house, which was just like, that was rough.
Aviva: And you say you were depressed and almost suicidal.
Pooja: Yeah, I was..
Aviva: I want to ask you, you say you had to admit failure, and I think that this is really important because it doesn't sound like it was a life failure. It sounds like it was a sort of SOS and you had to jump one ship that wasn't working for you. But then did you feel like a failure or was it that in order to get back into the system, you had to sort of say you were a failure to be re-accepted?
Pooja: I don't think I knew the answer to that at the time. I think all I knew was that these two things, first, psychiatry and medicine and then this alternative medicine path, neither of them worked for me as a person and also for who I thought I could potentially be helping as patients. And so I think I felt failed in that moment by both of them. And I turned that back on myself too.
And then I think for the first time I looked at myself from the outside – what my friends and family thought, and they were of course were all really worried about me when I left residency because this was not typical of my personality. And I was like, wow, this is a pretty pathetic story on the outside. But in that period of time for me facing what I was really terrified of, which is coming back full circle to what you said at the beginning of our conversation, talking about medicine and perfectionism, sort of facing the fact that I didn't have the answer.
I was really just trying to figure it out. And medicine did feel like, I don't want to use the word safe because medicine never feels safe. Medicine felt more known to me to kind of come back to the system, come back, finish my residency, but I came back a different person. And that's why I say that that experience, even though it was deeply painful and things I found out about the group later about how things that were going on there that were really quite disturbing -I didn't find that out till much later – but there was power there for me in choosing for myself and then sort of facing mistakes and facing problems. I think that did a lot for my own confidence and my ability to let go of that perfectionistic mindset. When you say perfectionism, I think a lot about control and how I think in medicine, oftentimes because of all the training we go through and the way that the structure is built, which is on a hierarchy model, a military model, there's this pressure to always know the answer.
Aviva: And there's right and wrong
Pooja: And there's right and wrong. It's black and white and know the answer. And it was the time for me where I just got a lot more comfortable with not knowing, and could come to psychiatry and come to practicing and doing it in a way that felt authentic to me.
Aviva: In so many ways. I feel like your story is allegorical to what led me to go from midwifery and herbal medicine to conventional medicine and bridge both. Western medicine is so incredibly limited. So many of the treatments are not based on do no harm, and it's this construct of there is a disease and there is an answer as opposed to this sort of ecosystem perspective of all the factors that make us well or make us ill. And then I feel like there's so many rules. But then when you go to wellness, well, and in conventional medicine, there's a lot of ‘blame the patient,’ right? It's your fault you're overweight, you're this, you're that. But I also feel like in the wellness movement as it is, there's a lot of the same, there's these very limited stories that are extreme in a different way. It's still kind of blaming the individual – if you just ate better or stressed less or slept more or prioritized your healthcare, if you just ate this diet, that diet or the other diet.
To be honest, when I first got your book and I saw the title, Real Self-care: Crystals, Cleanses and Bubble Baths Not Included…I'm not a crystals and cleanses person. I do have some beautiful stones that people have given me over the years, but I'm not a go to my crystals person. I also don't judge anyone who seeks whatever tools work. When I saw the book, I was like, oh my gosh, not another wellness model takedown not another GP takedown. Because I also feel like part of what happens in our culture is that there's this sort of knee jerk reaction against wellness. And there are quite a few people, including a couple of MDs who have kind of built their entire platform on a Gwyneth Paltrow takedown, which to me is sort of mean girl vibes. We don't need to do that. Let's talk about the problems in conventional medicine that are making women so desperate that they're turning to certain things or let's talk about where the real problems lie in our society that are making women feel so desperate that they're needing to turn to these things because if the only answer they're getting from their doctor is yet another medication, maybe that cleanse does seem more appealing.
So I feel like your story is almost allegorical. Like you were in the extremes of conventional medicine. You went to the extremes of a wellness model and now you're bringing your balance in the middle of which things to take from what. There's a security and a knowing and an evidence in the science, but there are really big gaps in what science has to offer.
I'm curious from your experience, you're a practicing psychiatrist. Women are struggling with mental health at unprecedented levels right now. What are some of the biggest challenges on a day-to-day that you're seeing women struggling with and how are you finding the intersection of all the things, the things that cause weathering, the cultural phenomena, the intersectionality, the wellness pieces that are worth pulling from and your training as a physician?
Pooja: I completely agree that there's a reason that women turn to wellness. And I think one of the things that was important to me in writing Real Self-Care is that I was writing it from yes, as a psychiatrist, as a clinical assistant professor at GW (George Washington), but also as a woman who has very much gone down the rabbit hole and felt deeply heartbroken too, by both sides. And so bringing compassion to, it's not that women are stupid, there's real reasons. And yes, my story I think was an extreme one, but there's micro versions of that I think that anybody can relate to. One of the asides is, I think something that's sort of analogous to the wellness space is also the productivity space.
Aviva: Yes.
Pooja: I noticed a lot of folks who maybe would not go to the crystals, feel like their bullet journal is going to be the answer to all the problems or
Aviva: Or biohacking. That term just drives me nuts, especially when it comes to our bodies as women. We're not computers,
Pooja: Right. Yes. So there will always be people that are trying to tell you and sell you a shortcut. The answer is always like, I'm so sorry, there's not a shortcut. The answers usually are simple and they're hard and they take a long time. I see the plight of “patients,” and I use quotation marks there because I'm a patient too. I struggle with depression and anxiety. I'm in therapy. I take medication. I think clinicians in conventional medicine feel equally as constrained and burnt-out and dissatisfied. And it's not an accident that both of those human sides are left without real sustainable solutions. I think the media likes to pit patients and clinicians against each other, but really we're all on the same team. And I think that the path forward is to really find ways to have a real relationship with your doctor or your mental health professional and take some of those power structures away too, so that it can be more of an equal playing field.
So, in Real Self-Care I describe a framework that has four principles, and I say that the things like the bubble baths or yoga, it's not that they're bad, it's a tool. It's something that you check off the list. But without the internal work, without the internal principles, the tools can end up being Just another thing on the to-do list that burden you because you never get to it and then you feel bad. So I like to say you can't meditate your way out of a 40-hour work week without childcare. We have to be talking about all of the systemic and structural issues that make it so that women feel the way that they do.
I have four principles, and these are kind of, again, simple, yet hard, simple to say, hard to enact – boundaries, compassion, values and power. You can kind of distill it down to do less things, be nicer to yourself, do the things that actually really matter to you, not to your mom, not to your best friend, but to you. And then lastly, figure out if you should be receiving or if you should be giving back. Because ultimately, self-care is about community and making time for community and relationships. And that's why boundaries is the first principle because everything rests on boundaries. I'm
Aviva: So excited. I have this whole section of questions for you on boundaries in my mind because it's something that I talk about a lot too. And it's been, I think for me, one of the most important pieces of valuing my self-worth and for me to set boundaries, it requires me to do the other things that you said, to step back and figure out what my values are, what I actually really have time for, literally have time for, not what I want to have time for. I think I have time for, and it means being kinder to myself when I have to let go of things that I don't have time for, or just literally can't do and still be well and not judge myself for somehow not accomplishing more. And then as you were saying, I think particularly as healers, there's a lot of give, but also knowing when I need to take back. I'm so excited to hear all your things on boundaries.
Pooja: I love how you frame that, Aviva, because you're pointing out that this is a process, it's an ongoing process. It's not just like boundaries, check, compassion, check. It's like, no, you're constantly sort of going back through each thing and coming back to boundaries, and then going to values, and then going to compassion, and then thinking about power.
When I was graduating residency, I just graduated at GW. This was 2016, and I'd just gotten my dream academic job as a supervisor at our women's mental health clinic, and I was going to be on the faculty, and my mentor took me out for lunch, and she gave me this piece of advice that was just so shocking to me. She said, ‘Puja, you don't need to answer your phone. You can let it go to voicemail, listen to what they want, and then decide how to respond.’ I was coming from a medical world where it's like, at that time we had pagers. I don't even know if residents still have pagers, or maybe now it's just all smartphones, but you had the pager buzzing, and then you immediately had the PTSD. Let me call them back. So I was like, whoa, okay, I don't have to answer my phone.
And then it clicked for me, oh, the boundary is the pause. And then you can say yes and say no, or you can negotiate. So a boundary isn't always no, it's the pause. And then you think. For me at that time when I was in full-time academics, it was like, okay, sometimes it's the front desk and they have some paperwork for me to sign and I can say, oh, I'll come around at the end of the day. Or maybe it's a patient that has ADHD, and I know if she misses even a day of her stimulant, she literally might get into a car accident. So I'll put in the refill, right? I decide. This I think is a much more realistic conceptualization for boundaries, because the reality is the No is not always accessible and the No always comes with a cost always, especially if you are, let's say a black woman in corporate America.
If you say no, there certainly will be a cost, or maybe you work three different jobs and you're taking care of your kids and also giving money to your elderly parents. And if you say no, you might not get that next promotion, and that's really going to impact your finances and your bottom line. So the No is not always accessible. There is a cost, but the pause, you can always do the pause and maybe at that moment in time you do the calculus and you're like, you know what, I really want to say no, but I can't say no right now because the risk is too high. So then you make a mental bookmark for yourself and you say, all right, you know what? A year from now I want to be closer to that No being accessible. And then that's something tangible that you can work towards.
Aviva: Let's talk about this pause. It's something that I'm really huge on. I talk to my patients about this when they're struggling with food compulsions, relationship decisions, job decisions. I'm so glad you touched on this. No, sometimes being privileged, it's not something that we can all do at any time. This pause to me is when I do it, for me, it's about dropping into my body. It's about getting out of the part of my brain that's automatic, that's operating on ‘I should do this or I shouldn't do this’ or overthinking it. It's about just kind of like 15 seconds of taking a deep breath. Tt’s how am I going to feel if I eat this right now, how am I going to feel if I say yes to this right now? And how am I going to feel in three months when it's time for me to do that thing? And so I talk to people about how I'd like to think about that for a few minutes. Can I get back to you? And just really taking that step back from what I have really come to identify as urgency, culture, and certainly as physicians, we're just trained on urgency culture, but how do we step out of that churn of urgency that we feel when something is offered or requested and just take three deep breaths or whatever works for you. What does that pause look like for you?
Pooja: I love the phrase urgency culture. Yeah, we're all living in it, and certainly some professions have more of it, but even parenting culture is urgency culture. I think of it as first what happens is you recognize the lack of pause. You put a name to it. That's why naming it as this urgency is really powerful. You see yourself doing it, oh, this email comes in, let me immediately, or my kid asks for something and it's immediately like you're like, okay, let me grab it for you. So I think the pause can look, it's really about the situation. So it's a conversation. Sure. It could be just taking a deep breath and just stopping, and you have to learn to be okay with that space, that time, because whether it's a couple seconds or whether it's something more dramatic where you get a difficult email and you're like, okay, well, I'm going to sleep on this.
Aviva: It's like you're not immediately reacting. You're taking a minute or however long you need to be proactive, not reactive or just active, not reactive.
Pooja: And I also want to say this is a skill to build. You will fall off the wagon and fall back into urgency culture all the time, probably multiple times a day. I think of all of this as using a mindfulness framework where success is coming back, right? Oh, I fell off. Oh, I'm back in it. Okay, let me come back. That's success. And I've been, since Real Self-Care came out, I've been very open about how I wrote a book called Real Self-Care, and then I went through burnout. I had never done this before. I had never had so many media requests and had to talk publicly about all this stuff. So I guess the reason I share that is because with every new role in your life, with every new season, you will have to relearn the pause, relearn boundaries, relearn compassion. It gets easier each time though because you recognize yourself falling into the old patterns and you have kind of the old landmarks that you've learned over time. So I caught myself more quickly, right?
Aviva: Yeah. I have one friend who said, you spin out less far and you come back faster.
And I think it's different for each woman too. So what might drive you to say yes, for example, when you really needed to hit pause? Or what drives you, Pooja, to answer that email urgently or me could be different for the next woman. I have really identified that some of us come from a good girl place where we feel like we have to say yes because we have to please someone. And if we don't, we're not going to be loved or liked. Or some of us feel like we have to say yes because we're caretakers, or some of us feel like we have to do it right then because we're caretakers and some of us feel like they're perfectionists, ‘I have to check everything off my list.’ So sometimes the practice of this can bring up some of these deeper patterns that then, at least in my experience, cause us to have to look at where is this coming from.
Pooja: And I would say that that means you're doing it right. It's supposed to challenge your preconceived notions, and it's supposed to kind of bring up your old patterns. One of the things that I often see with patients in my practice and that I experience myself, is that they're usually specific people in your life where boundaries are more difficult or where the pause is more difficult. And so as you're kind of trying to incorporate this or thinking about experimenting with the pause, pay attention to if there's specific friends or specific family members or coworkers or your boss where you notice yourself being more vigilant and where it's harder to access the pause.
Aviva: I think it gets back to what you were saying earlier too. It may be that it is your boss, and it may be that your boss really is not going to give you that promotion if you don't say yes right now. But looking at what's triggering you, is it a fear of losing your job? Is it a financial trigger? Is there another option? And if not, how can you do what you need to do and still maintain what you said? One of the words you said was power. You're making the powerful choice to do this, and then set a goal for yourself down the road. I really love that.
Pooja: I think that's a great example of the real self-care process there. This is just one example of it. Then making time for yourself, actually blocking maybe 30 minutes or an hour in your calendar every week where you're going to brainstorm on, okay, I had to say yes to that thing, but here's my blocked time where I'm just going to think about what the other possibilities could be. Or maybe I'm going to use that time to talk to a friend who I know has maybe a little bit more of a less linear brain and a more creative mindset. I'm going to bounce some ideas off of her, but actually take some concrete steps to live in the new reality that you want to create as opposed to staying in the urgency culture where every meeting is blocked and you're completely stacked and there's no time to think about what could be different.
Aviva: And that comes to values. So can we talk about values? When I think of values, I think about what is it that's important to me and how am I moving toward alignment with that and staying in alignment? When you talk about values, what are you speaking to and how does this fit into this four point framework?
Pooja: So one of the things that I notice when I'm speaking and also when I'm with patients, is when you ask people about their values, either they kind of freeze up and get kind of angry at you because they're like, Pooja, look at my to-do list. I don't have time to think about my values. How dare you. So there's some of that, or it's kind of like the canned response, like, oh, well, I value my family, I value my church. And it's like, okay, great. Sure. That's not helpful. When I talk about values, when I teach about values, it's the how, it's usually a verb or an adverb or an adjective. What is the quality of how you're in your family, how you're showing up in your family, or what is the quality of how you engage in your kids' PTA group?
Aviva: How do you want to be in the world and in relation to others?
Pooja: Yeah. I have a patient who she was going through a really kind of difficult time in terms of caretaking burden. Had two little kids, a parent who was ill and was coming to live with them. She really felt like she didn't have time for herself at all. And so we were playing around with this values, and she said, one of the things I noticed is recently my daughter has these little clay figurines that she collects, and I noticed that after a whole day of working and doing everything, when I'm sitting on the couch with my Netflix, I'm playing around with them. I'm re-organizing them, I'm putting them in little scenes. And what came out was talking about silliness, playfulness, creativity, fun. That was a value for her. And that when she was feeling good, she was able to engage with that part of herself. But when she was sort of in this supermom, caretaking mode, urgency culture type of thing, that part of herself was very hard to access.
We kind of pulled out those words and then we thought about, oh, okay, what are other ways to infuse that type of feeling into your life? So we talked about when she was driving her kid to school, what if they listened to just silly music and dance together in the car? Just adding more of that type of quality. That's one example, and it takes a little bit more thought because you can bring that, if your value is fun or humor or silliness, you can bring that to your job and your professional life. You can bring that to your role as a parent. You can bring that to your friendships. It's not about anyone's specific goal, it's about how you show up in the things.
Aviva: One of the questions I do with my patients and also with my students is how do you want to feel? How do you really, really want to feel? And then for me, I like to identify – it's a kind of a thing I do once a year, usually on my birthday – what's one word that exemplifies how I want to feel, so then I can remember that word. So for me, the word, and actually this word has kind of stuck for a few years, is spaciousness. I don't like the feeling physically, emotionally, and psychologically when I feel like there's so much to do that everything feels like it's crashing down on me. And for me to feel a sense of autonomy and freedom in my life, I like a little breathing room. So for me, spaciousness is a word, and silliness can be a word, or play can be a word. And then when you remember, when you get into those moments in that pause, it's like, okay, how do I want to feel? Am I feeling that way right now? How can I get back to feeling that way? And that really helps me a lot.
Pooja: I love that. And I like that it's just one word too, because it's easy to remember and come back to. I lately have, in the wake of my book launch burnout, I've been thinking about luxury. When I say luxury, I mean time, luxury.. So the other day I went to this little fancy Austin hotel lobby and just hung out, got my coffee, paid $20 for a salad, and then came home and watched a cheesy Netflix show. So it was just kind of like letting myself just do whatever I wanted and not worry about the time I was wasting. I love that.
Aviva: And probably a lot of people who are listening are going, but I can't do that. I can't do that. And I get it. I have four kids. I was a medical student with four kids, and yet somehow we managed to do things. The amount of hours people spend doom scrolling without realizing it or shopping for things that don't feel good. How do we become cognizant of the ways that we actually could just find that 30 minutes or when my kids were little, sometimes I would just grab, it was before the days that there were lots of cool coffee shops, so it was kind of Starbucks and I wasn't even a coffee drinker, but I would go and just bring a book and read for an hour and a half with a cup of tea. It felt so luxurious to be able to do that. So how can independent moms, indie moms, in other words, single moms, I like indie moms much better as a term woman shared with me as an indie mom swapping with each other if you don't have a partner who can watch the kids on a Saturday morning.
Pooja: And in that example too, it's also about community and interdependence and sharing resources, which also we know is good for your mental health, that pro-social behavior being more deeply connected with your neighbors and your family and your friends, right?
Aviva: Absolutely. And the whole tendon befriend Shelley Taylor model really showed that the giver and the supporter gets as much oxytocin benefit as the person in need. So we're actually both lifting each other up. If I call you when you're in need and you answer, and you're there not to the point where obviously we're not setting boundaries when we need to, but that mutual sharing can really lift each other up on a biochemical level too.
Okay. So we've talked about – inadvertently – just we just talked about the giving and the taking, and we've talked about boundaries and we've talked about values. What about power?
Pooja: Yeah, so the roots of self-care as a term actually have two sort of lineages. One is actually in psychiatry. Originally psychiatrists in the 1950s started using the term self-care for the food and clothing and exercise decisions that patients could talk about on a locked psych unit. Actually, so much of their life on that unit was controlled, but they could decide what they wanted to eat, what they wanted to wear. And the psychiatrist referred to that as self-care, which I thought was interesting. But the other lineage is from the work of black queer thinkers, Audrey Lorde, self-care is self-preservation, bell hooks, and their work brought self-care into the zeitgeist, and it was very much a political movement and about how people on the outside, black people, queer people, anybody who was lower caste could protect themselves from a social structure and a system that was working against them and attacking them, really.
And so the last principle is really going back to those roots and sort of like you can't yourself out of the 40-hour workweek with no childcare. You need to constantly be thinking about the systems of oppression and the social determinants of health, and really think about by you making different choices about how you spend your time and your energy, that can actually be quite subversive. When self-care is something that's personal as opposed to commercial, then at least we have a chance of enough people being able to change their mindset so that we get to collective action. In the book, I give some examples of patients who went through this process of boundaries, compassion, values, and that led to things like getting paid parental leave in their workplace or getting a promotion after taking a mental health leave. I'm not saying that that's… certainly that those are exceptional circumstances. It's not every time that it's going to lead to something like this, but what I see is women in their own families taking up more space and then modeling for the next generation or modeling for their sister or their other friends that it's actually possible and it's worth it.
Aviva: Sometimes I have to ask my mom-patients who are struggling with overwhelm or depression or anxiety or just burnout, when they'll say, well, I can't take self-care time. I can't do that yoga class even online. And I'll just, when I approach it from a You Deserve It place, you have a Right To Place, they're still like, but, and then I'll reframe it as saying, okay, as moms, what do we want our daughters and sons, our children to grow up thinking, being a parent? And when they get that, they're like, oh yeah, I don't want my children to grow up thinking once you become a mom, you can't ever do yoga again or take care of yourself anymore. And then the other thing I've learned too, well, there's so many things that what you're saying gets me thinking of just sometimes we are so afraid to ask that we don't ask.
And for me, there have been things where somebody's like, this is due on XYZ date, and I'll get all worked up because I want to do the thing, but there's no way I can get it done in that time. And maybe it's somebody who has a lot of influence. And I've learned that really, I can actually say, I would really love to do that. There's no way I can do it in a month, but if there's room for me to do it in three months, that would be great. And most of the time people are like, okay. Often we just don't ask.
Pooja: Right? Right. And that in the asking that is you exerting agency and power when it's coming from you as an individual. I think it's so easy to feel powerless. It's so easy to feel cynical because there's so much that's wrong in the world. Climate change, gun violence, it's every day. It's something deeply disturbing and terrible. And so many of my patients and even myself, you're just kind of like, I'm just one person. How am I going to fix any of this? And it's not any one individual's burden to fix all of it, but it is up to us to stay engaged. And coming back to what we were saying earlier about kind of mindfulness. I see this, I see power and hopefulness as also something like we all fall off. We all have our nights where we doom scroll, and it's just sort of a lost night. But then you come back and you say, you know what? I'm going to look up and see what's happening at that next school board meeting. I'm going to donate to that woman candidate who is running for office. It's not going to be every time, but there are ways to keep yourself coming back, and we're not able to do that unless we're also taking care of ourselves, really taking care of ourselves.
Aviva: One of the things I want to ask you about is kind of funny. Recently I was talking with a woman who's a friend of mine who’s actually a student of mine and a friend, and she's an avid maternal health activist with a formidable organization. And she said about something that she was kind of overwhelmed by and trying to do and trying to get perfect and just right. And she said, Lord, give me the confidence of the average white male. It just made me laugh so hard. And then in my interview recently, which hasn't aired at the time that you and I are talking, but I interviewed Kris Carr who has a book that's just come out about grief, and she shared that when she was losing her dad cancer, just to cope with the emotional weight of her life, she just couldn't function as well.
And she realized that she just had to lower her standards and expectations for herself for a while. And then as we were talking, she laughed and she said, really, actually, I need to do that all the time. And one of the things that you talk about in your book is coming from a place of good enough, and it's definitely something I have to work on. So I wonder from your experience, because you talk about this in the book, why do you feel we drive ourselves so hard and how you're an author, clearly you want to cross your T's and dot your I's, you're a doctor, you have standards of excellence. How do you balance that quest for excellence, the pressure that the world puts on us to perform? And especially as women, so many women feel like they have to do 180% to the average male, white males, a hundred percent to succeed and to get promotions and all the things. How do you balance that with good enoughness in your life?
Pooja: Maybe I'll answer the second question first in the process of going through another iteration of it. So I noticed that for me, because I'm somebody who is creative and is sort of always wanting to color outside the box a little bit, that maybe every six months or so I have to go through another iteration of looking at what's on my plate and taking stuff off. I think good enough is also very linked to boundaries. Because when I'm doing too much, that is when I also get into the place of beating myself up for my perfectionistic standards. Whereas when I feel like I can be fully present and engaged and embodied with whatever I'm doing, then there's less of that sort of self-critical perfectionistic talk.
Aviva: So with you, I got interviewed some years ago by a dear friend of mine, Jonathan Fields, who runs the Good Life podcast, and Jonathan asked me what a good life means to me. And my single answer was the ability to be present because it meant that I didn't have so much going on, that I wasn't constantly pulled from one thing to another, but I could actually be with whoever I was with at that moment without feeling stressed.
Pooja: Or the next thing.
Aviva: Exactly. Again, that kind of urgency, right?
Pooja: The urgency and the way that I talk about it in the book, I think I talk about this in relation to self-compassion, is that especially for women, it's so easy to get into worrying that you're selfish and then sort of exalting the selfless. And I say that good enough is that middle road where you're sort of allowing yourself to be good enough. And so I think so many of my patients, they worried that if they were to let that stuff go, if they were to fully be present and not be mentally checking off the to-do list of what the next thing is and making sure everything's okay and blah, blah, blah, that somehow that's selfish. When in fact, it's actually quite generous, especially with moms. What I see is folks who say, I spend so much time managing my family. I don't actually feel like I'm part of my family. I'm not saying that none of this is easy. We struggle with it too. It's not like a one-time fix all. But I think sort of noticing these patterns and asking yourself why it's so hard to give yourself the generosity that you would give to a friend.
Aviva: I have a big question for you. There are a lot of really complex mental health challenges that people face, schizophrenia, bipolar disorder, things that are hardwired and baked in or the result of often a severe trauma or some situational genetic intersection. We know that rates of anxiety and depression for women have really been escalating. The pandemic made it worse. Conventional medicine really attributes so much to biochemical disruption, and certainly there are biochemical disruptions that happen with depression and anxiety, and this is not to in any way, shape or form say that any individual is responsible. This is a cultural, as you talk about in your book, betrayal of women. How much of what you're seeing with anxiety and depression do you feel is some kind of inherent biochemical challenge that needs medication to solve it – I'm not saying medication can't help no matter what the situation – versus how much of it is this cultural betrayal, right? Juggling, caregiving responsibilities, a family that depends on you for a paycheck with lack of mandated and affordable childcare. Living in a world where women are subjected to sexual assault or racism or all the things, to me that feels to be such a cause of depression and anxiety for so many people. So I'm just curious where you land with that and what you see in your practice.
Pooja: Yeah, I'm going to give you a very psychiatrist answer, which is both and. Right? It's all multifactorial. And so much of my writing in the past few years has really been on social determinants of health because I think that's a place where psychiatry has really struggled. So I think that's what needs a lot of lifting up. And we know that depression and anxiety is biological and that there's a neurobiological component. We're learning more and more about this. And even with trauma too, it impacts our genetic code. So it really is both, and I think that as a culture, we don't have a great language yet and framework for threading all of those things together. It's really easy to become this sort of nature versus nurture debate. I also will say what I focus on with my patients, the conversations that I think are most productive and useful is sort of like, why does it matter if it's coming from the outside that doesn't make it any less powerful and it doesn't make the suffering any less.
I remember when the pandemic first started, and so many of my patients were kind of like, well, I feel this way because of the pandemic, because I'm worried I have to make all these decisions about whether to focus on my work or to focus on the fact that I have two toddlers running around in my house when they're clinically exhibiting all the science of depression. And it's like, well, that actually still deserves treatment. Why is it only worth caring about if we're talking about neurotransmitters and wiring in your brain? It's something that will probably forever be a conversation that we're having in mental health and psychiatry. And I hope that as it evolves that we can really get to a place where more folks are embracing that both and.
Aviva: I’s also just love to see us moving toward a culture as people and as women where the social factors are so mitigated that we can actually really unpack that. Yes, it doesn't matter chicken and egg, but if people are having to medicate, and I recommend and prescribe medications for mental health in my practice, I'm very supportive of people using them and encourage when they're needed, and also get so concerned that we're living in a culture that is creating so much anxiety and depression. But then the answer becomes the individual having to sort of alter or repair their biochemistry chemically when what we really need to do is be changing society. And that's the piece that I struggle with, not in a sense of should we do it? Because sometimes it's just needed. And I agree with you. I mean, get the relief from the suffering how you can. And also, as you talk about in the book, these cultural betrayals are very real.
Pooja: One of the ways that I think about it too is that in order to get to a place where we have enough women in power to be making these changes that are so needed is that we need to use everything available to us. So there's never just one answer. It's never just medication. It's never just exercise, it's never just nutrition. It's all of it combined. And so sometimes, depending on what's going on in your brain, and depending on your social determinants of health, how much support you have and how much money you have, you might need medication to get your brain to a place where you can actually problem solve from a place of calm and strategic thinking to then be able to make the choices in your life so you have more social support, so you have, right, ask for what you need to then get to that next place
Aviva: Or to have even the energy to get up out of bed and exercise and cook food for yourself if that's what you're trying to do.
Pooja: It's very real. I think the fear of, oh my gosh, if I take medication, then I'm going to be stuck on it forever. And what does it mean versus thinking about it as there's all of these different things that are important and they all can go together in a program. I
Aviva: Agree. You are going through burnout. I want to honor that. Launching a book is, it's a lot. It's a lot, a lot, a lot. Emotionally, psychologically, time. The day after my last book came out, I had 18 radio interviews.
Pooja: Oh my gosh.
Aviva: And it sounds so glamorous and sexy. I was like, one of them got canceled at three in the afternoon, so it went down to 17. And I was like,
Pooja: So glad.
Aviva: How are you healing and addressing and being with your own burnout right now? And thank you for being here in the midst of it.
Pooja: Yes. And it's so funny that you say that because I feel like that too. It's like, gosh, world's smallest violin, kind of like, what was me, right? People want to talk to me about my book, geez. But I think most people that write are not, I guess I'm an extroverted introvert.
Aviva: Same here.
Pooja: So I need a lot of alone time. And it's funny, when I first realized I was burnt out, it was maybe three months after the book came out, and in my very own puja type a fashion was like, okay, I'll just take a week or two and go slow and it'll be okay. No. So I actually, I was in the hospital last month because I had gallstones and then I had a kidney stone. So it got to a place where it was like, I was literally in the hospital for four nights where I was like, that was my wake up. And I said to my therapist, I was like, I feel like such a hypocrite because I'm a psychiatrist, and it took something physical for me to stop working. I'm also human.
Aviva: I actually said to my husband, same for me. It was about three months after the book came out, and I just felt really tired. And I remember saying to my husband, if I don't hit pause, I am going to be one of my patients.
I do this timeline for my patients. So let's say somebody comes to me with an autoimmune condition and they're like, Dr. Aviva, I have no idea where this came from. And we're looking at all the pieces, right? There's no blame that you did anything. We're looking at genetics, we're looking at family history, we're looking at, but often I'll see a pattern like mother got breast cancer, had to move for a job, kid going through something, and it's all in three months leading up to…. And they'll say, look, I was feeling fine, and now I am struggling with thyroiditis or rheumatoid arthritis.
I didn't have this before and maybe it was brewing and maybe they had predispositions. And I remember saying to my husband, if I don't hit pause and really full stop on interviews and all the things, and yes, world's tinies, violin, but who feels it, feels it, right? You can drown in a pool or you can drown in a puddle. I really felt that. So I was fortunate. I'm 57. I'm at a place in my life where career wise, I have the luxury to some extent say, okay, I can take Fridays off. And I did that for months. I took Fridays off, and then I took a longer vacation where I just wasn't producing any new content where I could go in, be quiet and not have to create, but more take in. I was reading novels, I was watching Netflix, I was taking walks, and I really needed it. I know, again, not everyone has the luxury to do it in a big way, but sometimes we need to find the ways too. So what are you going to do next? You had the wake-up call.
Pooja: So I've been just going a lot slower. I made a rule for myself only one interview per week. I recently joined my local YMCA. They have an indoor track. I'm in Austin, so it's super hot still here. There's a nice indoor track. They have childcare there. That's lovely. And I'm just blocking unscheduled time. For me, writing is also cathartic journaling. One thing I realized is that I like seeing people in person, and I want to figure out a way to bring more of that back to my clinical work and to my speaking. And so right now I'm kind of taking stock. I'm in one of those places where I'm going more slowly. I'm giving myself lots of time to be more slow and not produce.
Aviva: Have a quote in your book that I just want to acknowledge because it's one of my favorite quotes and it's probably one of the quotes I say most often and usually in relationship to women struggling with male partners in a heterosexual relationship, which is you can't go to the hardware store expecting milk and then get mad at the hardware store for not having it.
Pooja: Yes.
Aviva: How do you find that showing up for women and why did you include that in the book?
Pooja: It's one of the ways in which I think we get stuck in these patterns of training other people in our lives to sort of be, I almost want to use the word helpless. I see so many patients who are confident to make up for everyone else around them, but not recognizing that the whole system has been set up that way. I think that that quote in particular, that saying, it's not my saying, it's kind of like a therapy saying that, right? But when it comes to boundaries, the best predictor of future behavior is past behavior. If you have somebody in your life who is always going to be the person that's sort of poo-pooing your dreams, don't go to that person to ask for advice when you're thinking about quitting your job
Aviva: And then get disappointed when they do the same thing they always do. Pooja, I have a question I love to ask each of my guests, and I know we've been chatting for a while, so be as brief as you need to be. If you could tell your younger self anything, how old would she be and what would you tell her? Oh gosh,
Pooja: This is such a hard question. Aviva was, there's so many younger versions of me that I wish the person that I am now could sort of be on their shoulder, but I guess I said I was turning 40 in December, so if I think about that 30-year-old woman who was turning 30 in her childhood bedroom and kind of feeling like she had ruined her life, I would say you're going to keep going. You're going to figure it out and that you're brave and that you're lucky to have the family, you have the friends that you have, and you're going to find even more good things in the next decade. My son is, he is now almost 17 months and my partner Justin, we're here in Austin, and so there's so much good in my life that I would never have imagined at that time.
Aviva: Thank you for being here with me today. Time in your busy patient day and for being your one interview this week, and I hope we get to talk lots more and everyone wants to read Real Self-Care, so we'll make sure everyone knows how to find it. Thank you so much for joining me.
Pooja: Thank you so much for having me, Aviva. It was a pleasure.
Aviva: Bye everybody. Thank you for joining us and I'll see you next time.
The post Beyond Crystals and Bubble Baths: Talking About Real Self-Care appeared first on Aviva Romm, MD.