Pooja Lakshmin, REAL SELF CARE: A Transformative Program for Redefining Wellness (Crystals, Cleanses, and Bubble Baths Not Included)
Zibby speaks to perinatal psychiatrist and New York Times contributor Pooja Lakshmin, MD, about her compassionate and actionable new book Real Self Care: A Transformative Program for Redefining Wellness (Crystals, Cleanses, and Bubble Baths Not Included). Dr. Lakshmin discusses her New York Times article, “This is Betrayal, Not Burnout,” which argues women are burnt out because their social systems have failed them. Then, she dives into “real self-care” – an internal, self-reflective process that includes learning to set boundaries and letting go of mom guilt. Finally, she talks about her IVF journey, her mental health platform (Gemma), and what it was like to write this book!
Transcript:
Zibby Owens: Welcome, Dr. Lakshmin. Thank you so much for coming on “Moms Don’t Have Time to Read Books” to discuss Real Self-Care: A Transformative Program for Redefining Wellness.
Dr. Pooja Lakshmin: It’s such a pleasure to be here, Zibby. Thank you for having me.
Zibby: Oh, my gosh, your book was so interesting. You talk about your own journey through self-care and some of the winding paths of your own career. Then you really lay out this fabulous roadmap and explain the difference between faux self-care and real self-care and the martyr syndrome and all the things that we do that might convince us we’re not doing that good a job. By the way, I got a yellow on your score of the little quiz.
Pooja: That’s good.
Zibby: I’m not in dire straits. I felt good about that.
Pooja: Yes. Good, good.
Zibby: Why don’t you tell listeners a little bit about your Times article and how this book came about and what we should really know about Real Self-Care?
Pooja: Absolutely. First, I’ll just say, Zibby, that I’m glad that you got a yellow because I know how much is going on in your life right now. I was a little worried that you might have gotten red. I’m actually really happy with the yellow for you. I am a perinatal psychiatrist by training. In my clinical practice, I take care of only women, mostly moms who are going through things like postpartum depression, postpartum anxiety. I would say maybe around five years ago or so is when I really started to see that, actually, maternal mental health is a social justice issue. Even the smallest thing, like the fact that getting four consecutive hours of sleep postpartum is protective from postpartum depression or postpartum anxiety, the ability to get that sleep — do you have a partner? Do you have paid leave? What is your support like? Do you even have access to know that sleep is something that’s protective? All of that stuff is actually a systems issue. It’s part of just the external landscape of the world that we live in. That’s what got me fired up. I like to say that I’m kind of a reluctant activist. I didn’t really expect to be somebody who is in this position, but I found myself here.
In, I think it was maybe 2022 or 2021, I wrote a piece for The New York Times called “This is Betrayal, Not Burnout.” Especially during the pandemic, my patients were just burnt to a crisp. Everyone was using that word, burnout, but I felt like it was really missing the mark because, really, the problem is outside of us. When we use the word burnout, we’re exonerating the social systems, whether that is the lack of paid leave, whether that is the lack of affordable childcare, whether that’s the fact that it’s so hard to find a therapist and mental health support. Those are the real problems. American society in particular is really, really good at making women feel bad about ourselves and like we’re not doing enough. Real Self-Care is message to all the women out there who are just like, I’m burnt out. I’m stressed out. I’m not eating well. I’m not sleeping well. I feel like it’s my fault because I have this meditation app on my phone that I know I’m supposed to be using. I know I’m supposed to go to yoga, but how am I supposed to find the time? I have a nine-month-old. I say this as a mom myself. It’s just madness. It’s trying to figure out how to squeeze everything in. Again, it’s not for lack of trying on our parts. It’s actually the entire way the system has been set up.
Zibby: Then what do you do with the fact that we’re all operating in a systemic framework that might not set us up for success? We still have to live within those confines. You have a lot of suggestions and specific things we can do. What do we do even with that information? Yes, we can become activists. I think awareness, obviously, is really important, of it. Okay, this is not my fault. This is where we all are, but then what? Then you still don’t have the time for yoga. Then what do we do with all the information? You call out all these important things. Just because influencers look like — you ask people to think critically about what people are posting. Maybe these are paid posts. Maybe these people aren’t really getting their lives changed by this particular app or whatever it is they’re doing. How do we make sense of it all? What next? Help.
Pooja: Pooja, just fix the problem, please. Just fix it. I think that’s why this book is different. It’s funny, I didn’t set out to write a self-help book or a prescriptive book, but that’s what came out when I started writing because I think it felt like I was in the room with my patients. Really, I lay out these four principles. They’re all internal. Principle one is learning to set boundaries. Principle two is developing self-compassion. When I say self-compassion, I mean in the way that you talk to yourself, in the conversation you’re having in your own brain on a daily basis, bringing self-compassion there. Then principle three is really getting clear on, what matters to me? What do I really care about? Naming those things. It’s going to be lots of things. There’s no one right answer. Then four is bringing it back to power, understanding what Audre Lorde said. Self-care is self-preservation. By making self-care personal and not commercial, we are actually bringing agency back to ourselves. Only then is there a chance of the systems change happening. I can dive into some of those a little bit more. What I would say is that this framework is not — it was also really important for me in writing a self-help book to also just say the prescription is going to be different for everybody in terms of the form.
One person’s real self-care is going to be like, hey, I really do need to send a difficult email to my boss. I really do need to say I’m going to not be available on email over the weekends. That’s something that I really need to start setting a boundary with. Another person, it’s going to be like, me and my husband really need to sit down and have an honest, difficult conversation about the division of labor in our home. Another person, it’s going to be like, maybe I really do need a career change. Maybe I want to start dreaming about something different for myself. That sort of form that it takes is different for everybody. For some people, it will still mean, actually, yeah, yoga is great. When I go to yoga once a week, I feel really grounded and centered. I’m not trying to take away anyone’s yoga or bubble baths. It’s thinking deeply about it. Those four principles that I’ve identified, that comes from my clinical work and then also from my own personal journey. These are the internal steps that we can take. It’s a line of inquiry for yourself. It’s having a different conversation with yourself that are grounded in these principles as opposed to just that constant, monotonous, oh, god, Pooja, you’re not doing enough. Oh, god, you’re behind on your emails. Oh, god, you’re not a good mom. Whatever the normal narrative is, let’s replace that with this different conversation.
Zibby: Basically, it’s more positive self-talk. Someone once, a therapist — I don’t know when it was. What if your friend was going through the same thing? You’d be like, oh, my gosh, you’re doing such a good job. No, it’s fine. When it’s yourself, you’re like, oh, my gosh, I’m a total failure. How could I get so behind? or whatever. I feel like that is such a critical thing and so easy. I know you spell it out very clearly. We can all imagine what we would say to a friend in a given circumstance. We’d all give them the benefit of the doubt and praise the accomplishments. Yet it’s so hard to do for that for ourselves. I feel like that’s something so specific. Whatever you’re beating yourself up about, would you beat your friend up like this? That’s been really helpful for me.
Pooja: Another one that I love on that too, and this comes from acceptance and commitment therapy, is actually naming that critical voice and giving it sort of a character. For me, I always call that inner critic Angelica from Rugrats, the mean older sister who’s just terrible. I have a patient who named hers the Anna Wintour character from The Devil Wears Prada. That’s kind of a fun way. I know it sounds silly, but it actually creates distance from that voice and reminds you that that’s not you. That doesn’t have to be you. Of course, you can spend years in therapy figuring out that it’s your mom.
Zibby: Funny, I know that character. She’s so familiar. No, I’m kidding.
Pooja: Again, it’s about your relationship with yourself. With real self-care, the other piece of this, too, is that it doesn’t have to be something that is — it can be small steps, even just with the boundaries. A lot of folks talk about boundaries. I feel like it’s sort of a buzzword at this point. I think of boundaries as the pause. When I was just starting on the faculty at George Washington University, my mentor took me out for lunch. Her piece of advice to me was that, she was like, “Pooja, you don’t have to answer your phone. You can let it go to voicemail. Then just see what they want. Then respond.” That was an aha moment for me. We could say the same thing with text messages. You take a pause. You wait. You see. Then you can say yes. You can say no. You can negotiate. A boundary doesn’t always mean no. A boundary is just the pause. Then you get to decide how you respond. A healthy boundary shouldn’t be a brick wall. It actually should be one of those mesh nets like on a trampoline that is flexible, that things can move through. That’s a healthy boundary. Especially for moms, we are just so overburdened. Our brains are constantly on this cognitive overload. We’re the CEOs of the whole family’s life. We’re constantly in that react, fight-or-flight mode, and so to step out of that and just say, wait. I can take a breath. Then I can decide. I have a choice here, whether it’s my kid who wants something from me, whether it’s my work, whether it’s my partner.
Being able to incorporate that into your thinking then leads to these downstream effects where you’re then able to look more strategically at, what do I want from my life? What really fills me up? What are my goals? I think of real self-care as not only the balm in the moment — we all need that help just to survive, really. Again, especially as moms, so many of us are just drowning. Then it’s also, step two or maybe self-care 2.0 is allowing us to dream about, what do we want for ourselves? Just thinking about the folks in your community, “Moms Don’t Have Time to Read Books,” none of my patients have time to read books. That’s why I recorded an audiobook. I was like, it needs to be an audiobook. I have patients who, I almost want to say lost a decade. You’re in that decade of, you have two or three kids. You’re breastfeeding or whatever, all the stuff that comes with that. Then you come out the other end of that. Then you’re just like, okay, wait, but who am I? What do I want? Especially as your kids start to become more independent and you finally have a little bit more space to breathe, I think that’s actually a really powerful season of life to start to ask yourself some of these different questions. Again, the answers that come back might be a little bit surprising. That’s okay. You don’t need to act right away. It’s more about just having the conversation and inquiring.
Zibby: I had dinner last night with two girlfriends who are in their forties. We were all saying now friends are going off on all these different tangents, some productive, some crazy. At this point with people’s kids growing up, there’s not that much guidance. That’s why I like, in your book, this whole
Pooja:
Zibby: How important is it? How do you find meaning in what you’re doing? If you’re just going through the motions with your job or your career or whatever, how do you take all that and make it worthwhile? If you don’t find meaning in what you’re doing, it’s much harder to be dedicating yourself to it. I feel like it’s this combination of finding meaning, getting yourself through what you called that decade, and being able to come out the other side and be like, wait, now I have this whole life ahead. Now what? Maybe self-care is reading books. Maybe I did put that aside for a long time because I had no time. I was with my kids on spring break last week. Literally, I could barely get through three pages. I was like, if this was my life all the time, I would never be able to do my job, ever, with them climbing on top of me. I think finding meaning is just so important.
Pooja: With that, also giving yourself permission. For moms in particular, anytime that you take that space for yourself, no matter how old your kids are, there’s that requisite guilt that comes. For me, I’ve been living it myself right now with this book launch. We’ve had childcare on the weekends because, as you know, there’s so much to do when you’re launching a book. Acknowledging the fact that I had to — there’s no perfect solution. There’s no perfect answer. My son right now is almost ten months, which is such a fun, cute age. He’s crawling. He’s pulling up. It’s really cute. Then part of me is sort of like, gosh, is it terrible for me to have a babysitter on the weekends? It’s that mom guilt that comes up that I talk about in the book that’s always with us. You have to learn that it’s going to be there. It’s going to be there. The guilt does not have to be a moral compass. It can just be a feeling that’s there. You can turn the volume down. You don’t have to listen to it. You don’t need to let it guide all of your decisions.
Zibby: You wrote about, in the book, how you were going through IVF when you were writing the book and how even that was getting in the way of your writing schedule. How are you even going to get it done? Tell me a little bit about what it was like writing the book and all that and how you did manage to pull it off.
Pooja: Honestly, I still don’t even know. We were going through IVF. I’d had a miscarriage maybe six months before we started IVF. I’m thirty-nine now. I was an older person starting my family. It was really rough. Also, while I was doing IVF, I was limiting how much caffeine I drank. I wasn’t drinking alcohol. There was no external substances involved with writing this book.
That’s hard. If you’re somebody who enjoys what you do and is passionate about all of the things that you do — I imagine maybe this resonates for you, Zibby. When your work is something that really brings you a lot of energy, finding that line of, when have I pushed too far? How do I know that this is actually costing me emotionally, energetically too much? I think because of the IVF process and the fact that that was not only so logistically taxing because of all the doctors’ appointments and things like that, but also emotionally, it was a nice counterbalance for me. Now even having my son is also a nice counterbalance of just knowing, okay, these are hard stops to my time. The calculus becomes a little bit more clear. I remember before I had him, I had friends say once they became mothers that, actually, they sort of became more productive workwise because it was easier to know what their no was. That definitely has been true for me as well.
Zibby: Also, the reminder that it doesn’t all have to get done immediately. I always feel the pressure. When I take the pressure off and say, it would be nice if I could reply to this right away, or I could make a whole bucket of emails and tackle this one topic all at once when it works for me, there’s no fallout. I think it’s easy in any job to magnify things, that everything has to be done. I don’t know. Are you still seeing patients also? How to stay totally — although, I guess I stay totally present because I’m interviewing you right now. This is what I do. When you’re giving advice — psychiatry is obviously completely different. How do you stay in that moment and offer the advice medically, psychologically, all of it, and bringing your own experience into it? Or do you not bring your own experience into it?
Pooja: Actually, I don’t bring my own experience into it. As a psychiatrist, I actually do therapy with a good number of my patients. I prescribe medication and do therapy. I don’t talk about my own stuff. Some of my patients don’t even know that I’ve written a book or that I’m on social media, actually.
Zibby: This is a missed marketing opportunity.
Pooja: For me, it’s really important that I’m there for them. That’s the boundaries of psychotherapy and psychiatry. I’m there for them. I see patients right now about one and a half days a week. Then the rest of my time is writing or Gemma, which is my women’s mental health platform. That’s a salve for me. It fills me up, actually, to have that intense one-on-one interaction where I’m not thinking about all that other noise that’s out there. I can just focus on my patient. To be completely frank, I haven’t taken new patients for several years. These are people that I have long-term relationships with who I really feel a strong connection to. Those are the grounding moments in my week where I get to just do what I’m trained to do and what I really enjoy doing. Part of my real self-care journey was learning for myself that if I
Zibby: You, in the beginning of the book, talk about your own journey sort of in this cult for two years. That was a wild, unexpected introduction. One thing that I kind of love the image of is you almost licking your wounds and going back to your childhood home and being in your old bedroom with your parents and the support you got. I was just wondering about your relationship with your parents now and what that all looks like.
Pooja: That’s a great question. I will say after that experience in my life, I went through seven years of psychoanalysis. Psychoanalysis is that intense type of therapy where you’re on the couch, and the analyst is behind you. I think that my parents and I, we’ve come a really long way. Especially with the immigrant experience, I like to say because my parents sacrificed so much for me — my dad’s a physician. There was certainly a lot of privilege in my life. Because they sacrificed so much for me, I had the privilege of this existential crisis in my late twenties when I blew up my life. I didn’t have student loans, so I could just up and leave Madison and focus on female sexuality for two years and do all that stuff. I was able to land back and still be a doctor. I was in my childhood bedroom. It wasn’t a pretty picture. I was just binge-watching reruns of SVU and texting with my friends from college who had stayed with me. Love them to death. We’ve come a long way. Now myself as a parent, every generation is just going to therapy for the wounds from the previous generation. That’s just what it is. It’s this cycle. Since we worked through that process together, I was able to also come to motherhood on my own terms and not feel like I needed to do it because they wanted me to or to fulfill some sort of expectation. I also recognize that I had the luxury of being able to pay for IVF and all the resources to make that happen at this age. Like all relationships, it’s a lot of work. It’s a process.
Zibby: Wow. Would you write another book? Are you going to write another book? How do you feel about the whole thing? Are you just so excited that the book is done, and you never want to do it again?
Pooja: I do feel a little bit like I’m hobbling out with a cane. Maybe ask me in a month. I don’t know. You tell me. You have more experience with this than I do.
Zibby: It’s a lot to launch a book. It is. I found it very emotional. It’s emotional launching it, especially when you include your own story, which you do here. You’re putting it out there. It’s a lot.
Pooja: Totally. It is. There’s been definite exciting and joyous moments. There’s been low moments too. Just the roller coaster of it emotionally, the ups and downs, it’s a lot. I might need a little space.
Zibby: Thank you so much. I found your book really fascinating. I learned a lot. I really appreciated how open you were about it and the new lens, shifting the framework of how we even evaluate all the self-care talk being shoved down our throats all the time and being able to look analytically at some of the suggestions and pulling back a little bit to see where we are in the whole ecosystem. I think that helps each individual journey. Thank you for your book. I hope you survive the tour.
Pooja: Thank you so much for having me, Zibby. It was such a pleasure.
Zibby: Thanks a lot. Buh-bye.
Pooja: Thanks, Zibby. Take care.
Zibby: You too. Buh-bye.
REAL SELF CARE: A Transformative Program for Redefining Wellness (Crystals, Cleanses, and Bubble Baths Not Included) by Pooja Lakshmin
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